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Thread: Contact lens help required

  1. #1
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    Contact lens help required

    I have an 18 y.o female client that i have fit with contacts for the first time. K's are average, rx is only -1.25 ou, patient otherwise healthy. The optometrist said that she is okay to wear contacts.

    Problem; in the right eye only,
    when she puts on the contact lens, her eye waters excessively. After several minutes the watering stops and there is a white purulent secretion from the lateral part of the upper and lower eyelids. This purulent ejection floats around the eye. Some times it appears ( had her come into my store repititively throughout the day) constantly or sometimes it will disappear.

    I have swithched the type of solution once and have observed her putting the lenses in and she does absolutely nothing wrong in handling the lens.

    I am wondering what this may be caused by and if it poses any harm.

    referred her back to her o.d with the contacts in and the o.d. said that it should eventually go away. (althugh he did not explain to the pt. what is causing this ejection)

    I appreciate any help!

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    Have you tried switching lenses to see if it's peculiar to the lens or the eye? If it moves with the lens, something is wrong with the lens. Have you everted the lids and looked for GPC?
    Looked at the lens under magnification? Looked at the eye and the lid with the slit-lamp?
    Stained the cornea?

    Chip

  3. #3
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    I have put in disposable trial lenses into her right eye from three different companies. (ac oasys, biofinity, and b&l soflens 38) and have had the same problem with each lens. Have checked with slit lamp but nothing under the upper lid shows signs of gpc (no bumps, redness, etc.) and happens pretty soon after putting in contacts. I have even switched her over to a hydrogen peroxide solution just in case if it was the lens building deposits rapidly.

  4. #4
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    Tried axeing the doctor: "What the hell is wrong with this patient?"

  5. #5
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    I think that is a wonderful idea. I don't know why i was trying to be a superhero, she will probably end up buying her contacts on line in the future anyway.

    I should just send her to her doctor and have her tell the doctor to write down what the problem is and how to fix it. If the doc can than the patient will thank me for referring her, if he can't, than i'll tell the patient how the hell did she think i could fix her problem. I might even suggest that she switch her doctor and probably even ask for a refund of her money if she isn't satisfied.

    Besides, I think she looks better in glasses anyway.
    I hate these young people with their unreasonable f*#*ing expectations. She can see with one eye, she is just being greedy. for real.

  6. #6
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    Yeah go ahead... :p Tell her its fine if she is using only one eye....:p
    Jokes apart check out some doctor and suggest her the best possible thing.. Don't spoil your own reputation... Its fine if the lens are not suiting her.. NO big deal...

  7. #7
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    Some whitish matter can be expressed from the meibomian glands with eye rubbing, which can follow some minor irritation. Is there evidence of blepharitis?

  8. #8
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    no there is no bleph, scaling or anything else that would suggest otherwise. I have already told her to go see her optometrist with the contact lenses.

  9. #9
    Master OptiBoarder Shwing's Avatar
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    'No' to Co- Managing

    For what it is worth (and not much) but we (my MD) does not (emphatically) co-manage, period.

    We have a very busy ophthalmic office and contact lens clinic, as well as doing peds, glaucoma, etc. c/ one MD.

    Our policy, expained to all, is that we DO NOT co-manage. If you want to buy your Cx elsewhere, no problem, but WE will NOT be able to serve you in the future; not for exams, emerg, Cx etc.

    Same goes for Lx (PRK, LASIK, etc,) we do NOT recommend it (I'm -11.00-ish and have never seriously considered any of the various zaps), and if you are a Px of ours who opts for Lx correction, don't come to us with prblms of dry eye, haloes, etc. Go back and see the laser surgeon. If you had your Cx fitted elsewhere, go Back to where you were fitted.

    We are too busy with our own Px to deal with everyone else's problems.

    So,if your Honda is having problems, why would you go to GM for the fix?

    Simplistic view, but germane.
    Shwing

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    Your MD refuses to see or treat people that purchased eyewear or other opthalmic services elsewhere?
    GOD I hope we never actually get socialised medcine like you folkes.

    Chip

  11. #11
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    Quote Originally Posted by Shwing View Post
    For what it is worth (and not much) but we (my MD) does not (emphatically) co-manage, period.

    We have a very busy ophthalmic office and contact lens clinic, as well as doing peds, glaucoma, etc. c/ one MD.

    Our policy, expained to all, is that we DO NOT co-manage. If you want to buy your Cx elsewhere, no problem, but WE will NOT be able to serve you in the future; not for exams, emerg, Cx etc.

    Same goes for Lx (PRK, LASIK, etc,) we do NOT recommend it (I'm -11.00-ish and have never seriously considered any of the various zaps), and if you are a Px of ours who opts for Lx correction, don't come to us with prblms of dry eye, haloes, etc. Go back and see the laser surgeon. If you had your Cx fitted elsewhere, go Back to where you were fitted.

    We are too busy with our own Px to deal with everyone else's problems.

    So,if your Honda is having problems, why would you go to GM for the fix?

    Simplistic view, but germane.
    Wow, that's craziness...is that even allowed? For a doctor to refuse care, because a patient chooses to buy elsewhere? if all MD's or OD's acted this way how can I, as a stand alone shop with one Optician
    a) get scripts
    b) send a pt back for a re-check if refraction was wrong? Which, by the way, my patients pay on average $130 for...
    c) refer back to pt's doctor if pathology is present?

    I don't see how this can be....you must be flying under the radar for now...but continue this trend and you could get yourself in a load of trouble!

  12. #12
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    It's not crazy. It's greedy. I was also unethical, back when O.M.D.'s had ethics.
    In the U.S. it would also be illegal..

    Chip

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    Quote Originally Posted by renee1111 View Post
    Wow, that's craziness...is that even allowed? For a doctor to refuse care, because a patient chooses to buy elsewhere? if all MD's or OD's acted this way how can I, as a stand alone shop with one Optician
    a) get scripts
    b) send a pt back for a re-check if refraction was wrong? Which, by the way, my patients pay on average $130 for...
    c) refer back to pt's doctor if pathology is present?

    I don't see how this can be....you must be flying under the radar for now...but continue this trend and you could get yourself in a load of trouble!
    Its likely a gray area ,but if the Dr wants to cut people loose who buy elsewhere,all the power to him.

    Ive considered doing the same thing with people that Ive seen who get cls elsewhere.Im getting tired of cleaning up the mess created by outside dispensers who fit inappropriately.
    Last edited by kws6000; 12-12-2008 at 10:48 PM.

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    Quote Originally Posted by chip anderson View Post
    It's not crazy. It's greedy. I was also unethical, back when O.M.D.'s had ethics.
    In the U.S. it would also be illegal..

    Chip

    That was then and this is now.Get over it Chip.The 1960s are gone and wont be coming back.
    Last edited by kws6000; 12-12-2008 at 10:52 PM.

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    Quote Originally Posted by renee1111 View Post
    Wow, that's craziness...is that even allowed? For a doctor to refuse care, because a patient chooses to buy elsewhere? if all MD's or OD's acted this way how can I, as a stand alone shop with one Optician
    a) get scripts
    b) send a pt back for a re-check if refraction was wrong? Which, by the way, my patients pay on average $130 for...
    c) refer back to pt's doctor if pathology is present?

    I don't see how this can be....you must be flying under the radar for now...but continue this trend and you could get yourself in a load of trouble!
    Lucky for you this isnt wide spread.I think that if it were,you would need to look for another line of work or a government bail out.

  16. #16
    Master OptiBoarder Shwing's Avatar
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    Quote Originally Posted by kws6000 View Post
    Its likely a gray area ,but if the Dr wants to cut people loose who buy elsewhere,all the power to him.

    Ive considered doing the same thing with people that Ive seen who get cls elsewhere.Im getting tired of cleaning up the mess created by outside dispensers who fit inappropriately.

    Bingo.

    And all is fine by the College (regulatory body), the Standards of Practice, etc.

    You 'choose' to have LASIK and need follow-on care (new rx, night VA probs) then go see the LASIK surgeon. We told ya so...
    Last edited by Shwing; 12-13-2008 at 12:54 AM.
    Shwing

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    Quote Originally Posted by kws6000 View Post
    Lucky for you this isnt wide spread.I think that if it were,you would need to look for another line of work or a government bail out.
    Although if it does become more widespead, it would prove that it's time for Opticians to increase their scope of practice...which is a good thing anyway. In Canada, we're taking the right steps by learning about refraction. So all in all, I'm so proud to be Canadian!

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    KWS:
    Very sad to say that ethics disappeared in the 1960's and we do not wish to see them return.
    Chip

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    I don't know about that in the US, I have to call a spade a spade that's just plain greedy. Through threat of withholding care the doctor tries to hold onto sales. :hammer: I could see if there were additional fees involved if the diagnosis of a problem was attributed to another practitioner, but to refuse to see them. So then opticians should have been charging all along for doctors remakes? It just seems like a turd thing to do.

    And Shwing, don't you teach opticians? And work in a practice that has practices that would discriminate against the profession? Isn't that a moral conundrum?

    It does go to show the value of a GOOD optician, often time our business skills are such that we are willing to sacrifice our own, cannibalize.
    Last edited by HarryChiling; 12-13-2008 at 03:27 PM.

  20. #20
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    The M.D. that stop's seeing his Pat's when they buy somewhere else could have a deeper problem. "It is possible for psychopaths to be charming, popular and successful in many lines of work." Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse". "What is missing, in other words, are the very qualities that allow a human being to live in social harmony."

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    Do Canadian Doctor's take the Hippocratic Oath?

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    Quote Originally Posted by haliopt View Post
    The M.D. that stop's seeing his Pat's when they buy somewhere else could have a deeper problem. "It is possible for psychopaths to be charming, popular and successful in many lines of work." Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse". "What is missing, in other words, are the very qualities that allow a human being to live in social harmony."
    Or it could simply be that this Dr is busy enough that he doesnt want to deal with time consuming problems caused by outside sources.

    People chose all the time which practitioner they would like to see...Its interesting to see the shoe on the other foot where practitioners decide who they want to see....I know of colleagues and MD's who periodically cut people loose if they arent a good fit or if they are too much trouble...I dont see anything wrong with that..It is interesting to hear how some of these patients have a hard time comprehending that they are being fired.... They seem to think the customer/patient is always right.


    Shwing is located in a large enough urban area that there are other practitioners people can see when they are fired.
    Last edited by kws6000; 12-15-2008 at 11:15 PM.

  23. #23
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    Odd that if this MD is that busy he bothers to be in the optical business at all.
    And the thought of cutting patients because thier problems are difficult and keeping only the easy profitable is atrocious.
    Now there is something to be said for cutting them loose if they are a pain in the behind or don't pay thier bills.

    Chip

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    Quote Originally Posted by haliopt View Post
    The M.D. that stop's seeing his Pat's when they buy somewhere else could have a deeper problem. "It is possible for psychopaths to be charming, popular and successful in many lines of work." Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse". "What is missing, in other words, are the very qualities that allow a human being to live in social harmony."
    That about sums it up! Specially being proud of the fact, that they DO NOT co-manage their OWN patients, is laughable!

    Seriously though, this represents the main reason that the three O’s will NEVER get along, well enough to work together. We are direct competition after all, and there are more egocentric and self-serving professionals than ones that are looking out for patients’ best interest.

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