Contact lenses of specific indications

**karimretina** · 05-17-2011, 12:32 PM

Dear guys,

Who can help me in order to get a simplified list of contact lenses of specific use in Canada. e.g Air Optix Night and day for patients who want to sleep with the contact lenss.

Thanks in advance

karim

**chip anderson** · 05-17-2011, 12:38 PM

Smartest thing you can do is tell them: "Anything you sleep with is more likely to get you in trouble."

Otherwise there are lots of EW and FW lenses on the market, check with manufacturers, or Eyedoc.com, or any of the several catalogues available (frame fax for one).

Chip

**LandLord** · 05-17-2011, 10:16 PM

With proper management, the right patient can sleep with any silicone hydrogel lens. IMO

**chip anderson** · 05-17-2011, 10:38 PM

Not as safely as they can not sleep in one. Incidence of infection, ulcers and the like 10 to 16 times as high as daily wear. But I know you are superior practioner have more complient patients who are all rich and healthy, want this and are willing to pay for it.

Chip

**Oedema** · 05-17-2011, 10:53 PM

Originally Posted by chip anderson

Not as safely as they can not sleep in one. Incidence of infection, ulcers and the like 10 to 16 times as high as daily wear. But I know you are superior practioner have more complient patients who are all rich and healthy, want this and are willing to pay for it.

Chip

Exactly.

**karimretina** · 05-18-2011, 02:37 AM

Dear Chip,
I'm not a superior practioner!!. simply I'm preparing for CAOS exam. So, I'd like to know from Canadian colleagues the common lenses in the Canadian market that can be used in special purposes. e.g. what is the daily lens that can be used with mild infection?

**fjpod** · 05-18-2011, 03:40 AM

Originally Posted by LandLord

With proper management, the right patient can sleep with any silicone hydrogel lens. IMO

-1

**optilady1** · 05-18-2011, 02:25 PM

Originally Posted by chip anderson

"Anything you sleep with is more likely to get you in trouble."

Snort. Sounds like something my mom would say. Ok, you can continue with you serious thread :)

**Oedema** · 05-18-2011, 06:46 PM

Originally Posted by karimretina

Dear Chip,
I'm not a superior practioner!!. simply I'm preparing for CAOS exam. So, I'd like to know from Canadian colleagues the common lenses in the Canadian market that can be used in special purposes. e.g. what is the daily lens that can be used with mild infection?

CSAO will not test you on this kind of thing. Infection? Absolutely no lens!

**cleyes** · 05-21-2011, 10:51 PM

Originally Posted by karimretina

Dear Chip,
I'm not a superior practioner!!. simply I'm preparing for CAOS exam. So, I'd like to know from Canadian colleagues the common lenses in the Canadian market that can be used in special purposes. e.g. what is the daily lens that can be used with mild infection?

If you are interested in ensuring many more follow-up visits use any lens "for a mild infection"
If you are interested in the patient's eye health...NO cl!

**fjpod** · 05-22-2011, 05:45 AM

what's goin' on in Canadian ophthalmology programs?

**NorthStar** · 05-26-2011, 09:19 PM

This is an ophthalmologist from Egypt who has just gone through the controversial International Optometric Bridging Program (IOBP) at University of Waterloo - likely bridging 2, an 8wk program. Why UW accepted foreign opthalmologists in the first place is a mystery...other than for the $.

**LandLord** · 06-02-2011, 10:26 PM

Originally Posted by fjpod

-1

Can you please clarify? -1 means you disagree? How

**fjpod** · 06-03-2011, 03:08 AM

Originally Posted by LandLord

Can you please clarify? -1 means you disagree? How

I have seen corneal ulcers with silicone hydrogels just as frequently as I did with hema. In fact, I have seen more corneal ulcers with lenses like Pure Eyes, Oasys, Night and Day, and Air Optix than I did with original Acuvue. Silicone hygrogels may give more oxygen, but they still cause corneal ulcers. It;s a proven fact. So if you recommend or prescribe things to a consumer that are know to have a higher rate of complications, you put the patient and yourself at risk

**LandLord** · 06-03-2011, 02:06 PM

Originally Posted by fjpod

I have seen corneal ulcers with silicone hydrogels just as frequently as I did with hema. In fact, I have seen more corneal ulcers with lenses like Pure Eyes, Oasys, Night and Day, and Air Optix than I did with original Acuvue. Silicone hygrogels may give more oxygen, but they still cause corneal ulcers. It;s a proven fact. So if you recommend or prescribe things to a consumer that are know to have a higher rate of complications, you put the patient and yourself at risk

Can't imagine how you can suggest that Oasys causes more ulcers than first generation Acuvue. Once again, its about managing the risk. Risk vs benefit. Guess what has the lowest rate of corneal ulcers? Spectacles. So are you putting yourself at risk by prescribing contact lenses to anyone? It's all relative.

**fjpod** · 06-03-2011, 02:49 PM

Originally Posted by LandLord

Can't imagine how you can suggest that Oasys causes more ulcers than first generation Acuvue. Once again, its about managing the risk. Risk vs benefit. Guess what has the lowest rate of corneal ulcers? Spectacles. So are you putting yourself at risk by prescribing contact lenses to anyone? It's all relative.

Trouble is...published reports "prove" wearing CLs overnight carries a 10x greater risk of microbial keratitis than DW lenses.

And yes, I will stand behind my statement that original Acuvue caused fewer corneal ulcers than Oasys does today, and that is why I will no longer fit a silicone hydrogel for overnight wear. One advantage to original Acuvue was that it was very, very, very thin...AND...I only allowed my overnight wearers to wear it ONCE. Six nights in, one night out. Absolutely no re-use of the same lens. Today manufacturers are pushing lenses that you re-use and sleep with...just a disaster waiting to happen, IMHO.

Don't be lulled by oxygen permeability alone.

**uncut** · 06-03-2011, 04:01 PM

Originally Posted by fjpod

Trouble is...published reports "prove" wearing CLs overnight carries a 10x greater risk of microbial keratitis than DW lenses.

And yes, I will stand behind my statement that original Acuvue caused fewer corneal ulcers than Oasys does today, and that is why I will no longer fit a silicone hydrogel for overnight wear. One advantage to original Acuvue was that it was very, very, very thin...AND...I only allowed my overnight wearers to wear it ONCE. Six nights in, one night out. Absolutely no re-use of the same lens. Today manufacturers are pushing lenses that you re-use and sleep with...just a disaster waiting to happen, IMHO.

Don't be lulled by oxygen permeability alone.

Well stated, fjpod...... I will only add that fitting an extended wear contact lens requires a better fitting contact, than for daily wear, with exceptional tear exchange. If the industry provided more diameter/base curve choices, success would follow.

**chip anderson** · 06-03-2011, 05:57 PM

Please note: Most patient's that want EW are thinking that they won't have to learn how to take them in and out. Many sit at your instruction table (those that are lucky enough to have a practioner that actually takes the time to personally instruct them) and then go home thinking they will remember and be competent a week later. A week later they find they don't remember a thing. All patients should be instructed to the point where you think they can do it without you and in given stern instructions to go home and practice that same day doing the proceedure over and over. Even those sleep on it over night find they are brain dead on the subject the next day. Those that practice enough to get over the fear of putting something on the eye have no trouble.

Chip

**cleyes** · 06-03-2011, 06:20 PM

All patients need to use cl daily as DW for at least 1 mo, that makes them proficient in handling. Especially "social" intermittent wearers, and the EW if you fit for that mode. Instructing them to the point of competency goes without saying! Unfortunately it seems to be lacking in many offices :(

**Oedema** · 06-03-2011, 10:10 PM

Originally Posted by LandLord

Can't imagine how you can suggest that Oasys causes more ulcers than first generation Acuvue.

There's a lot more to consider than just Dk/t, thats why I'm not at all surprised to hear that his experience mirrors my own. Silicon hydrogel is not the panacea everyone thought it would be.

**cleyes** · 06-03-2011, 10:30 PM

High Dk RGP make better EW cls......Haven't seen ulcer or CLARE in these pts EVER!!

**LandLord** · 06-04-2011, 11:48 PM

Originally Posted by Oedema

There's a lot more to consider than just Dk/t, thats why I'm not at all surprised to hear that his experience mirrors my own. Silicon hydrogel is not the panacea everyone thought it would be.

I agree there's much more to cl wear than dk/t, namely proper management if i had to pick one thing. Otherwise, go with RGP if you want the safest lens. But the other side of the coin is you can't be all safety and no benefit. People do want the convenience of extended wear. Inform them fully but don't deny the overnight benefit out of hand. The chances of injury in a a motorcycle crash are much greater than in a Volvo station wagon but I'm not giving up my Harley.