Questions about contact lenses

[oxmoon]

I would very much like to know what you all think about contact lense usage in general. The doc here tells all CL patients not to wear their lenses more than 6 days a week, and preferable just 5. He also doesn't want them to sleep in their CLs, even if they have been approved for that purpose. Yet most of the patients seem to just ignore this advice and wear their lenses continuously with out any problems. There is a 72 year old myope who says she wears dailys for 16 hours a day or more, 7 days a week with no issues. (This is hard for me to comprehend, having worn CLs in the past for high astigmatism and feeling like it was pure torture to leave them in for a couple of hours). Is the doc being overly cautious? Are these patients flirting with danger? Who is right on this issue, and does it vary depending on which CLs you are using? What are the hazards of overuse? Thanks.

[fjpod]

It's hard to generalize, but the more you put some foreign object in your eye, the greater the chance there is for something to go wrong. Limiting wearing time to 12-14 hours per day, and taking one day off during the week is, a sensible recommendation.

Many patients disregard sensible recommendations...and sometimes we may over compensate and suggest even stricter guidelines. One thing I have learned over the years, is that even when you have a good patient, use nothing but the best lenses, teach-instruct-and verify with the patient, and all the stars are in alignment, stuff still goes wrong. If you are going to prescribe or fit contacts, you must do your due diligence.

[kaypaula]

Working for an Ophthalmologist; we see our share of problems associated with noncompliance of CL wearing schedules. It catches up to some. And it is SO not worth it.


Paula

[TLG]

Working for an Ophthalmologist; we see our share of problems associated with noncompliance of CL wearing schedules. It catches up to some. And it is SO not worth it.
Paula

Me too. Sometimes I wish we could steal some of the nasty GPC pics I see in patient charts and give a copy to every contact lens patient just to give them an idea what abuse looks like.

[fjpod]

Me too. Sometimes I wish we could steal some of the nasty GPC pics I see in patient charts and give a copy to every contact lens patient just to give them an idea what abuse looks like.

Many of the lens/drug companies do make pictures and charts. Ask your rep. Also professional journals publish them.

[chip anderson]

The fact that a drug or product is approved by the FDA or other authority doesn't mean it's good for a particular individual, or that the maximum approved dose is good for an individual. Sometimes it just means enough money has passed or the regulatory body felt it had to do something just to break the inactivity.
Now either your doctor is a wimp or a poor fitter of contact lenses. While I don't think extended wear is a good idea as a general regimine. I have seen thousands of CL patients wear plain old PMMA lenses 18 hours a day for four or five decades with no more problems than the general population without contact lenses. Are there problems specific to CL wear, shure.
But if you couldn't tolerate your contact for more than a few hours a day either you have a recurrent eye condition and shouldn't be wearing them at all or you have a very poor fit. See someone who actually knows contact lens fitting inside and out and isn't just fitting them as a sideline when his surgical practice is slow. Contact the CLSA for someone in your area.
And All Contact lenses are not the same. The skills of all contact lens fitters and merchants are not the same.
If you have a healthy eye, and cannot wear you contact lenses all your waking hours seven days a week, you have a lousy fitter.

Chip

[RIMLESS]

If you have a healthy eye, and cannot wear you contact lenses all your waking hours seven days a week, you have a lousy fitter.Chip

On this particular I call B_LLS___T. I've seem numerous patients with perfectly healthy eyes who flatout cannot wears CL's. They mostly all boil down to very vague comfort compalints no matter what lens is tried. You guys have some special lenses up yonder??

[AustinEyewear]

On this particular I call B_LLS___T. I've seem numerous patients with perfectly healthy eyes who flatout cannot wears CL's. They mostly all boil down to very vague comfort compalints no matter what lens is tried. You guys have some special lenses up yonder??

I think most docs would agree. Dry eyes immediately come to mind..... I guess that could be considered an "un-healthy" eye, but I think the statement is too broad. To be more accurate one would need to say an eye that has developed perfectly to accept contact lens wear. I'm sure there is a percentage of the population that has unhealthy eyes that could wear contacts 18/7..... None the less, it is probably excellent advice to give your eyes a rest now and then, even if you have the ability to wear them 24/7

[oxmoon]

Actually I think our doc is excellent at fitting lenses and that is why so many of our patients are able to wear them comfortably for such extended periods of time. What I was wondering is whether he is being too conservative in his instructions to them, or whether the patients were being too casual in their attitudes toward their lenses.

[tmorse]

If you have a healthy eye, and cannot wear you contact lenses all your waking hours seven days a week, you have a lousy fitter.

Seems like too general a statement.

Patient could be on undisclosed medication that causes dry-eye symptoms or, if a RGP lens, the CL may have been imperfectly finished at the lab.

This doctor may be old school and just overly cautious. Or wants to limit liabilty in case of lawsuit. But 10,000 rabbits can't be wrong. However, your Dr. gets to set CL policy in his own office.

Chip's advice about joining the Contact Lens Society of America (CLSA) is very sound. Ask your Dr. to pay some of the expenses, and then attend CLSA's annual educational meeting for the best and most current advice available. And your membership and attendance at CLSA meetings will look very good in court if potential liability is your Dr's concern. CLSA also offers many resources with graphic pictures of CL complications.
Start learning your craft.

[RIMLESS]

Believe it or not there are people that simply can't tolerate CLs. I've had 6 Pt's this year that have stumbled around with CL for several years that I've sent for LASIK and are very pleased with the results. Granted LASIK has it's own set of risks but it's sometimes a viable alternative for unhappy or non compliant patients. Yes there are many excellent CL options that are available but don't forget refractive surgery. Personally, I'd rather have a non compliant -8.0 myope deal with LASIK risks vs a pentetrating
keratoplasty procedure.

[OHPNTZ]

To the original poster:

The risk of corneal infection increases with overnight wear. Studies talk about the increase in incidence of microbial keratitis. At minimum, check out a manufacturer's insert on some of the lenses.

Making those recommendations AND documenting are good practices from a liability standpoint...especially with the chronic CL wearers.

As for Chip and his BS, I would love to see his decade PMMA wearers and measure the amount of corneal edema and watch their topography change over time as his thousands discontinue their wear.

For current contact lens fitters, I would be more concerned with having a topgrapher, and being up to date with current specialty lens designs and methods. I would be interested if Chip still does 3 point touch on keratoconic patients while only using K's...

[chip anderson]

If by 3 point touch, you mean one of these to be a apical touch, Chip never fit any rigid with an apical touch. This was a method favored by OD's. Opticians, especially CLSA members fit apical clearance or apical brush. For those of you who don't know what apical brush is, flouricene at apex after blink, darkening slightly before blink. And while I am familiar with K's changing after removal. I have seen many patients wearing PMMA that had signifcant (.25 dio.) change during wear and maintaining same for decades. It can be done, it's just a lot more work than current materials.. You give up something for everything you get in this business. New is often not better in every respect while it may be in many respects.
As for lasik you can have real nightmares fitting contacts on those that had "less than optimum results with this." Especially if they were convinced by the surgeon that they were "intolerant to rigid lenses" before surgery, but now rigid lenses are thier only hope of having good vision post lasik.

Chip

[chip anderson]

Lastly I'll give you a quote from Jim Tannehill (who finally taught us to properly make and fit toric rigid lenses) from a CLSA meeting decades ago. "There aren't any real fitters here or they would all be buying uncuts."

Translation: If you can't edge and modify the lens yourself you can't fit.

Chip