ReNu problem...what do you think it is?

**William Stacy O.D.** · 06-14-2006, 12:41 PM

Originally Posted by shellrob

What the heck kind of doctor fits a patient in a contact lens that he only sees 20/60 out of? Who cares at that point what the patient wants or doesn't want. That's ridiculous. That's not even legal to drive? If he didn't want the correct lenses for his rx, he shouldn't have been given contact lenses at all.

We will refuse a patient contact lenses after while if they continue to be non-compliant. It's not worth it. We've had patients come in wearing a 2 week lens for months and months at a time. It's ridiculous.

Hey, that's a pretty strong statement. The post says the BEST CORRECTED VISUAL ACUITY is 20/60, not even if that's with contacts or glasses. His best VA with glasses could be worse than that. If it were, contacts would be better than glasses (at least visually) and either one is good enough for driving in most states with the consent of an o.d. (in Calif). I think you were assuming he's better with glasses, but you can't make that assumption from the post.

**fjpod** · 06-14-2006, 02:19 PM

Originally Posted by William Stacy O.D.

Hey, that's a pretty strong statement. The post says the BEST CORRECTED VISUAL ACUITY is 20/60, not even if that's with contacts or glasses. His best VA with glasses could be worse than that. If it were, contacts would be better than glasses (at least visually) and either one is good enough for driving in most states with the consent of an o.d. (in Calif). I think you were assuming he's better with glasses, but you can't make that assumption from the post.

Just for the record...the patient's BVA with glasses is 20/25+ in each eye. He prefers to wear the CLs even though he sees 20/60 with them. Why does he choose to wear spheres, when he has had torics? "They're cheaper". :hammer:

**shellrob** · 06-14-2006, 03:14 PM

I don't get it......so he gets them on-line without your rx right?

**fjpod** · 06-14-2006, 06:01 PM

Originally Posted by shellrob

I don't get it......so he gets them on-line without your rx right?

Correct. I never fit the patient in the first place, and I refused to write an Rx for any type of lenses unless he agreed to proper refit and compliance.

You've never had the experience of patients coming in who had been ordering CLs online for years on end without a current Rx?

**shellrob** · 06-15-2006, 08:07 AM

I misunderstood that patient and what was going on with him. Although I understand that you didn't write the rx, I still think there was someone along the way(whether it be Dr or Optician) that gave him the info so he could order those particular lenses online. Better that he's not your patient anymore anyhow.

**fjpod** · 06-30-2006, 06:59 AM

B and L seems to have resumed shipment of sample kits of ReNu MultiPlus. Who's gonna be the first to use them? Do we trust it?

**striker22** · 06-30-2006, 07:24 AM

I'd say why not. I'm sure they don't want to scr*w it up a second time and would have done more in-house testings.

**VERNON R. LAMB** · 06-30-2006, 09:50 AM

Originally Posted by fjpod

B and L seems to have resumed shipment of sample kits of ReNu MultiPlus. Who's gonna be the first to use them? Do we trust it?

I still do not believe that B&L is the only solution with the problem. Ectended
wear and Disposable lenses is the problem. I use 38% lenses and still boil them
at least once per week in distilled water and then back in saline. Never have to
change due to fit etc. Clean them yearly and they last and last. When lost or
mold grows thru the lenss they are replaced. VR

**chip anderson** · 06-30-2006, 11:53 AM

VR:

Why boil them in distilled water instead of saline? If done in a boilable case then you would have sterile saline, a sterile case and sterile contact lenses. Otherwise one is putting them back in a contaminated environment.

Your protoge,

Chip

**William Stacy O.D.** · 06-30-2006, 12:28 PM

Originally Posted by VERNON R. LAMB

When lost or
mold grows thru the lenss they are replaced. VR

That's the silliest thing I ever heard.

**chip anderson** · 06-30-2006, 01:49 PM

Ole Vern was an accomplished fitter of contact lenses when I started in 1958. I have also seen fungus inside of lenses including some RGP's. Ole Vern don't say nothing rediculous until after his last drink at closing time.

Chip

**fjpod** · 06-30-2006, 02:05 PM

Guys,
Boiling a lens repeatedly is about the worst thing you can do to it. (except maybe placing it into old multipurpose solution, in a dirty old case.)

Boiling cooks soil onto the lens and denatures proteins (similar to boiling eggwhites). In short, it ruins the lens. It sets the patient up for all kinds of problems including microbial keratitis and GPC.

Give it up. Replace the damn things.

**Dave Nelson** · 06-30-2006, 03:44 PM

With respect to guys who have been fitting contacts since before I was born, IMHO boiling is a throwback to a "gentler" time. It does denature lysozyme and other proteins, and they tend to build up in little layers on the lens. I confess I don't know the direct effects of denatured protein on the tarsal plate, since I always have considered loose protein deposits to evoke the auto-immune response that triggers GPC, but denatured protein deposits affect the fit and permeability of the lens. Not very desirable. I am in awe of the statement regarding replacing them when visible mold deposits are present, and can only assume ol' Vern wasn't serious? There are better methods of disinfection available, even without the compromise of "multi-purpose" methods. There is still the "best" method, and one we need to push more...single-use lenses. (I just ask if they would be comfortable re-using a peice of dental floss if it soaked overnight in a multi solution.)

**chip anderson** · 06-30-2006, 04:11 PM

Didn't say boiling was a good thing (although VR did) but I did say I have seen fungus growing inside of soft and RGP lenses. You will see more as the silicon materials become more prominent. If your really want to make a point go to a dental lab and watch while they try to clean , buff and relign a pair of dentures that have a soft silicone liner. Usually only one person can stand to be in the shop (the one stuck with the job) from the smell alone.

Chip

**Dave Nelson** · 06-30-2006, 04:32 PM

Memo to self:

must run, not walk, to the nearest dental lab

for a really good whiff...

**VERNON R. LAMB** · 07-01-2006, 04:12 PM

Originally Posted by chip anderson

VR:

Why boil them in distilled water instead of saline? If done in a boilable case then you would have sterile saline, a sterile case and sterile contact lenses. Otherwise one is putting them back in a contaminated environment.

Your protoge,

Chip

Dear Chip and All,
All soft lenses grow salt from morning to night and they use lens lubricants which add more and more salt. The boiling in demineralized water allows all the salt to be perged from the lens. This makes the lens free of salt. The lens has to be boiled in saline again to be compatible with the tears in the eye. As long as the lenses stay wet they do not grow protein in the molecules of the lens. No one asked about the cleaning proceedure which extends the life of the material. If you want to know how to clean a lens,just
come see me and I will be more than happy to teach you( FOR A SMALL FEE).
vr