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Thread: Contact Lens Education

  1. #126
    ATO Member HarryChiling's Avatar
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    Contribution of regimen steps to disinfection of hydrophilic contact lenses, Contact Lens & Anterior Eye (27) 2004 149–156

    dbracer,

    The above paper discusses fusarium solani, the problem is not the solutions any of which would be highly effective if given the proper rub time and soak, but with more wearers wanting to skip steps and time the increase in cases infections will continue to rise, unless the regimen is changed or the solutions are made stronger and if they are made stronger I would assume their would be concerns about the toxicity of the active ingredients. I could e-mail you the paper above if you PM me your address.
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  2. #127
    OptiBoard Professional dbracer's Avatar
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    Compliance

    Quote Originally Posted by HarryChiling View Post
    Contribution of regimen steps to disinfection of hydrophilic contact lenses, Contact Lens & Anterior Eye (27) 2004 149–156

    dbracer,

    The above paper discusses fusarium solani, the problem is not the solutions any of which would be highly effective if given the proper rub time and soak, but with more wearers wanting to skip steps and time the increase in cases infections will continue to rise, unless the regimen is changed or the solutions are made stronger and if they are made stronger I would assume their would be concerns about the toxicity of the active ingredients. I could e-mail you the paper above if you PM me your address.
    HarryC,

    Yes, I agree that the solutions really aren't the problem. Compliance is.

    But I also get the distinct impression that an agency that was created post WWII for the control of malaria (the CDC) has very little to do, and CL companies are on their hit list.

    B&L was hung out to dry on flimsy evidence at best with no regard for the consequences except for a feather in some bureaucrats cap, especially considering that the same outbreak in Europe had no relationship to Moisterloc.

    Sorry I got off on that tangent, but the CDC needs to be cut from the federal budget. They probably read forums like this; and I'm probably the next SOB on their radar.

    I'll send you my email, PM.

    Respectfully,
    dbracer
    "Do not waste time bothering whether you 'love' your neighbor; act as if you do." C.S. Lewis

  3. #128
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by dbracer View Post
    HarryC,

    Yes, I agree that the solutions really aren't the problem. Compliance is.

    But I also get the distinct impression that an agency that was created post WWII for the control of malaria (the CDC) has very little to do, and CL companies are on their hit list.

    B&L was hung out to dry on flimsy evidence at best with no regard for the consequences except for a feather in some bureaucrats cap, especially considering that the same outbreak in Europe had no relationship to Moisterloc.

    Sorry I got off on that tangent, but the CDC needs to be cut from the federal budget. They probably read forums like this; and I'm probably the next SOB on their radar.

    I'll send you my email, PM.

    Respectfully,
    dbracer
    I agree not much evidence, actually a case could be made that global warming has lead to the increase in temperature thus leading to a more optimal enviornment for these fungus to grow. I kind of brought up the article and posted those graphs because it supports your point and mine. If the case against moistureloc was weak at best and it performs the best out of the solutions, then we have a slight problem.
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  4. #129
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    If the lens and the solutions contained therein can't stand 98.6 degrees they ain't woth nuthin. Global warming hasn't effected this.
    And yes it is the solutions not so much compliance as we have attempted to make "compliance" so simple thinking the patients were such dunderheads or "our precious time" was too valuable to give proper instructions that we dumbed down the system. We made it as simple as possible and then the patients cut down on what was an already precariously minimal appliation.
    The best system we ever had was when We had the Ciba (or was it allergan) peroxide system, the slightly gritty cleaner, and Unpreserved Aerosol saline, and an eyzyme cleaner that worked in peroxide. The manufacturer didn't like putting other peoples products in the kit, so it got "simplified" for compliance.

    Chip

  5. #130
    OptiBoard Professional dbracer's Avatar
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    CL Slns

    I think HarryC may be on to something here.

    The problem in all CL solutions is GLOBAL WARMING! Not just any global warming, but GREENHOUSE GAS GLOBAL WARMING.

    That's the worse kind. We've past bill after bill and reduced emissions logarithmically. But it has done absolutely no good. So now it's worked its way into our industry. Damnit!!

    Actually the best solution system on the market was Quickcare, as long as they use the cleaner. Ain't much that can get around isopropyl alcohol. I see that they've put Miraflow (I believe sp??) back on the market.

    dbracer
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  6. #131
    threadkiller? eromitlab's Avatar
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    I'm still trying to figure out the best cleaning system for my RGP patients. Most stick with Boston Original, because it's what they know. We get Simplus from our lab with every pair of lenses made, which I'm not too fond of (I only asked about it a few pages back to get a more 'educated' opinion of the solution). My doc thinks that the LoBob Optimum system is a good one, but I have has several patients complain about the re-wetting drops and that it's pretty much not available in the area. I would consider Clear Care, but after seeing some of the comments, I guess that's not a good idea either.

    What are the favored systems for use with RGPs??

  7. #132
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    Don't use one-step stuff, makes lenses and case coat with deposits in a very short time. Don't use any no-rub. Boston Origional is better than other Boston's especially when combined with enzymatic clearer. LoBob is good.

  8. #133
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by chip anderson View Post
    Don't use one-step stuff, makes lenses and case coat with deposits in a very short time. Don't use any no-rub. Boston Origional is better than other Boston's especially when combined with enzymatic clearer. LoBob is good.
    I don't know, I would say use a one step, but instruct them to use them with enzyme cleaners. I say use the no rub and tell them to rub. I wish the manufacturers of these new solutions would just stop trying to eliminate the things that are needed to get th lenses clean.

    No rub, thats like taking a shower with no soap.
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  9. #134
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    Don't want to disagree with Harry here but:
    Back in the day when we had only PMMA lenses the only patient (or in some cases fitter advise) caused problems I saw were due to:
    Dry storage, combination solutions, and handling lenses over the sink.
    I almost never saw deposits on lenses except when combination solutions or dry storage were used. I always saw scratches when the patient rinsed lenses over the sink.
    Now bear in mind this takes in 49 years of all stages of CL, mfg and retail fitting. I always examine every lens on the patient with slit-lamp and remove the lens and examine it under 7x magnification under various forms of lighting. I polish off scratches and deposits when indicated. I see deposits on almost all HGP's and soft lenses over 6 months old, some times a lot less, sometimes a lot more. In some cases you will see almost none but once polishing has begun one will see "invisible" deposits being removed in layers like layers of cellophane being ground off as one polishes.
    Now this isn't scientific and I have no electron microscope, but it's what experience has shown me. But patient's (with a few exceptions of non-rotating fits, and some with a lot of goo always in the eye) with good cleaning/storage habits, lenses stay cleaner.
    I often feel that some of the deposits are storage solution components, I have seen many long stored "new" contacts with deposits. Most of the spair pairs in both PMMA and HGP will have deposits if stored wet. I try to always advise patients to keep lenses that are going to be stored and not worn for long periods of time to: "Clean lenses thoughly, blot off all moisture and store lenses in a dry flat pack." You will see practially no warpage or deposits even with decades of storage in this manner. However, I hope obviously, lenses that are going to be worn at least weekly should be stored wet.

    This combined with the difficulty in pre-inspection makes me wonder why some mfg.'s ship lenses wet.

    Chip
    Last edited by chip anderson; 09-16-2007 at 08:52 PM. Reason: dry to wet

  10. #135
    Master OptiBoarder OptiBoard Silver Supporter rdcoach5's Avatar
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    No rub instructions are to blame

    Even the sales reps are advising us to ignore the instructions on their own No-Rub solutions. We hear that the product recalls for patients getting infections from their solutions is really the fault of the patients improper use of the product. Most of the patients with infection were not only not rubbing their contacts, which does 80% of the disinfecting, but were also re-using their solution.In other words, the patients were taking their lenses off dirty and soaking dirty in the same solution for days or weeks at a time. I tell my patients, if you didn't rub it you didn't clean it and you always clean your case between uses with very hot tap water and dry with a clean towel by rubbing.Frequent replacement of cases is also recommended or disinfecting with peroxide.
    Bob Taylor
    Last edited by rdcoach5; 08-25-2007 at 03:51 PM. Reason: spelling

  11. #136
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by chip anderson
    This combined with the difficulty in pre-inspection makes me wonder why some mfg.'s ship lenses wet.
    Chip,

    Your supposed too, but how many offices check RGP's for correct parameters? I would be suprised if my doctor knew how to work a radiuscope.
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    Harry: None of them do, this can also be done with a keratometer and a con-ta-check. The fact that none of them do is one good reason why they should not be "fitting" contact lenses. I find that rejects for base curve alone (and sadly I have learned to accept .25 dio tolerance instead of .12 dio.) run 20%. I sometimes find base curves as much as two diopters off, appearently where someone pulled the wrong button off the shelf or miss-converted diopters to millimeters. This could easlily result in a corneal ulcer in a short time, especially if no one bothered to view the lens on the eye and just handed or had direct mailed the lens to the patient.
    I also see lenses where no peripherial curves or vastly insufficent curves were on the lens. Edges that are squared instead of properly tapered and rolled. Honestly I don't see how practioners and manufacturers stay out of lawsuits with the lenses sent out.
    I can't tell you how high the percent of lenses with unpolished lathe marks, especially of lenticular or other semi special design. The optics now that most manufacturers are willing to polish center out as opposed to edge to center are horrible on 90% of rigid lenses, stronger the power, the worse the optics. There is a reason these aren't "good as glass" in the lensometer.
    I origionally came to Mississippi from Texas knowing that the contact lenses available where horrible, too thick, distorted, poorly finished, etc. thinking I would make a fortune here. I found that when I made calls he practioners where interested in price, who the stockholders of the compay where (O.D's wanted O.D. stockholders, M.D.' wanted MD's, etc.) None of them had even such rudimentary instruments for checking lenses as a thickness gauge. Even less knew how to use inspection equipment if they had any in the shop.

    Chip;)

  13. #138
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    Hi Steph!
    Just another way to answer your first question- I think B is the right answer and the reason is because 42.5D (7.9mm) is flatter by 0.4mm than the base curve [this corresponds with the cornea's shape which is steeper in the centre and getting flatter toward the periphery (assuming it's not a postK cornea and it's not RGL lens)
    (a) and (c) are steeper which is not likely in normal geometry lenses and (d) 30 is way too flat.
    Hope I helped.

  14. #139
    ATO Member HarryChiling's Avatar
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    Here is some awesome research done into the biocompatibilty of solutions to materials. This was truly a find and shows that all solutions aren't built equal as well as some solutions will work well for some materials and some solutions fail for certain materials. If your office uses the hand them whatever's on the shelf system you may want to rethink it.

    http://www.staininggrid.com/

    Also check out a similar spin off:

    http://www/staininggrid-japan.com

    I would love to hear comments.
    Last edited by HarryChiling; 09-01-2007 at 11:32 AM.
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  15. #140
    Master OptiBoarder OptiBoard Silver Supporter rdcoach5's Avatar
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    Real results seem different

    We don't see the irritation from our patients that this study would predict. Anyone else?

  16. #141
    Master OptiBoarder OptiBoard Silver Supporter rdcoach5's Avatar
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    The Book is correct

    Quote Originally Posted by stephanie View Post
    Ah Chip!! I believe me book has some wrong answers. I have for the answers both as being B. Hmmmm... interesting. Well at least now I know when I question things it is usually with good reason. I don't have a chart as I have never had a reason to get the contact lens books. Thanks for all your help this has cleared some things up. At least til I get stuck again. Lord knows it is likely to happen any minute.
    Thanks Again!
    Steph"I am gonna end up in a rubber room before I am finished with cls."D
    As a general rule I use an intermediate curve 1.5 Diop flatter than Base curve =9.00 or 43.50 Diop and a Peripheral Curve 1.5 Diop flatter than the intermediate =10.50 or 42.00 Diop. It's easy to flatten from here if needed.
    Bob Taylor

  17. #142
    threadkiller? eromitlab's Avatar
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    Quote Originally Posted by HarryChiling View Post
    Chip,

    Your supposed too, but how many offices check RGP's for correct parameters? I would be suprised if my doctor knew how to work a radiuscope.
    we have one... but doc never uses it... he couldn't even get it calibrated.:drop:

  18. #143
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    If they don't impress the importance of and teach them how to check lenses what the hell do they teach them in optometric school or the "exensive 18 hours of contact lens training" in residency?
    These people are those with power over us in contact lens fitting?

    Chip

  19. #144
    OptiBoard Professional dbracer's Avatar
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    Quote Originally Posted by chip anderson View Post
    If they don't impress the importance of and teach them how to check lenses what the hell do they teach them in optometric school or the "exensive 18 hours of contact lens training" in residency?
    These people are those with power over us in contact lens fitting?

    Chip
    Chip,
    Just because we have "power over you" has nothing with whether, in a given area, we are smarter or better. To the contrary. The Opticians that I know do great work. Some better than mine.

    I'll be the first to admit that I don't check my RGP's as well as I should.

    It's all a matter of priorities. With the advent of HIPPA and baffling change in optometric practice, those things that are of lesser liability and cash flow importance take the back burner.

    Of the two liability takes priority. The south end of litigation ain't funny, I've been there.

    Don't get me wrong. I love my profession even more, but 20 years ago I could prescribe ophthalmics. That's about it.

    Now it's ophthalmics, intra-clinic diagnostic meds, topical lub therapeutics to oral narcotics, limited injections, superficial surgeries, CL's by topography, pre & post-op work,meds & directions, GP's asking me for advice, consults with neurologists, pediatrics, internists, and endocrinologist.

    Not to mention, as ya'all know the rise in ophthalmic technology is boundless. Individualized laser wavefront guide glasses are being done but currently it's impractical. Corneal topographies for the average optometric office was also a decade ago.

    I'm sure their are some tasks even in your businesses that have been pushed to lower priority.

    In short: keeping up with the evolution is no small task!

    I know. I know. It's no excuse, but it's the answer. It's exciting, but it's also exhausting.

    Respectfully,
    dbracer
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  20. #145
    OptiBoard Professional dbracer's Avatar
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    Quote Originally Posted by HarryChiling View Post
    Here is some awesome research done into the biocompatibilty of solutions to materials. This was truly a find and shows that all solutions aren't built equal as well as some solutions will work well for some materials and some solutions fail for certain materials. If your office uses the hand them whatever's on the shelf system you may want to rethink it.

    http://www.staininggrid.com/

    Also check out a similar spin off:

    http://www/staininggrid-japan.com

    I would love to hear comments.
    I don't know Harry. I used to fall for the staingrid thing a lot.
    Alcon is the shrouded sponsor, and I find it interesting that their products come out looking better.

    Of course they're no fools this is an "on the average" thing. Looking too good would be overly suspicious.

    Why not just state in big letters: "Brought to you by Alcon."

    Respectfully,
    dbracer
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  21. #146
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by dbracer View Post
    I don't know Harry. I used to fall for the staingrid thing a lot.
    Alcon is the shrouded sponsor, and I find it interesting that their products come out looking better.

    Of course they're no fools this is an "on the average" thing. Looking too good would be overly suspicious.

    Why not just state in big letters: "Brought to you by Alcon."

    Respectfully,
    dbracer
    Yes, Alcon is funding the doc who did this study, but none the less it is interesting to see. Has anyone applied his methodolgy in office and found the results differ?
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  22. #147
    OptiBoard Professional dbracer's Avatar
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    Alcon's doctor

    Quote Originally Posted by HarryChiling View Post
    Yes, Alcon is funding the doc who did this study, but none the less it is interesting to see. Has anyone applied his methodolgy in office and found the results differ?

    Good point, Harry.

    I sure haven't. I'd rather be on the archery range when I've got a spare moment.

    dbracer
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  23. #148
    threadkiller? eromitlab's Avatar
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    Quote Originally Posted by chip anderson View Post
    If they don't impress the importance of and teach them how to check lenses what the hell do they teach them in optometric school or the "exensive 18 hours of contact lens training" in residency?
    These people are those with power over us in contact lens fitting?

    Chip
    this is why I'm trying to educate myself further... I know he's too busy to probably do everything by the book or absolutely correct, but, he pays me to be his assistant... so, why can't I take over the load? It's not like we have a huge contact lens fitting business going on here anyhow (we're mostly medically focused), but with my help doing it right and in fewer redos would certainly be a shot in the arm for the practice.

    excuse me for asking, though... what would your folks recommend as far as textbooks and educational materials for the emerging contact lens technician? I have already purchased two, Current Contact Lens Practice by Efron and Manual of Contact Lens Fitting and Prescribing by Hom and Bruce.

    Any other resources would you suggest??

    Thanks Loads!!

    ~eromitlab

  24. #149
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by eromitlab View Post
    this is why I'm trying to educate myself further... I know he's too busy to probably do everything by the book or absolutely correct, but, he pays me to be his assistant... so, why can't I take over the load? It's not like we have a huge contact lens fitting business going on here anyhow (we're mostly medically focused), but with my help doing it right and in fewer redos would certainly be a shot in the arm for the practice.

    excuse me for asking, though... what would your folks recommend as far as textbooks and educational materials for the emerging contact lens technician? I have already purchased two, Current Contact Lens Practice by Efron and Manual of Contact Lens Fitting and Prescribing by Hom and Bruce.

    Any other resources would you suggest??

    Thanks Loads!!

    ~eromitlab
    Contact Lens Manual from CLSA both volume I and II are great office resources. Also if you join the CLSA they provide you with a publication called the Eyewitness, great articles and very little fluff so it acts as a great resource. I would also suggest:

    Contact Lenses (5th) - author Phillips/ Speedwell
    Contact Lens Manual - author Gasson/ Morris
    Contact Lenses A-Z - Efron
    Essential Contact Lens Practice - Veys, Meyler and Davies
    Eye Essentials - Rigid Gas-Permeable Lens Fitting - Andrew Franklin & Ngaire Franklin
    Eye Essentials - Soft Lens Fitting' - Andrew Franklin & Ngaire Franklin
    Manual of Gas Permeable Contact Lenses' - E. Bennett & M. Hom

    JCAHPO and CLOA have a Contact Lens Learnign Systems CD-Rom also I've heard the learnign systems CD-Roms are pretty good, but expensive.

    JCAHPO also offers a Contact Lens Course - it's basic to intermediate.
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    threadkiller? eromitlab's Avatar
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    awesome! thanks for the info, Harry!!

    n.b: I just realised that I mis quoted the title of the Efron's book, it's Contact Lens Practice, I just got my copy in the mail and noticed the mistake. I bought it on the glowing reviews it got on the book review forum. Just quickly flipped though it, and I can already tell it's a great text to have.

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