I'm sure that most have heard. FDA approved Focus Night and Day, by Cibavision, for therapuetic use. No longer an off label use.( in The US). FYI
I'm sure that most have heard. FDA approved Focus Night and Day, by Cibavision, for therapuetic use. No longer an off label use.( in The US). FYI
And .... I heard a Sears Optical advertisment for Focus Night and Day.... Such a DEAL!
Homer,
Probably not advertising the therapuetic use. I don't know if you've used it much but it is an excellent lens. Not perfect, but it has worked well
Except for teraputic use I think that exteended wear is ten to 16 times more likely to be complicated with serious ulcers and infections. The problem is not the lack of wonderous materials but the fact that whatever is under the lens is there until the lens is removed. If this is dirt, bacteria, sloughed off epithelium fungus or acanthomeba, it's there until the lens is removed. Unfortunately, soft lenses do not have the courtesy to hurt when things go wrong until they are very wrong, i.e. very sick eye.
Even with theraputic use, I found that things can go sour and get worse in a big hurry, the patient should be watched, daily if possible. Remember this stuff is not new, it's been aroung since the '60's and we had problems then. They were "FDA approved" then because the FDA wanted to curtail implants which they were not confident about. Now the rumor is the FDA has approved these lenses to curtail refractive surgery, which it also has doubts about.
Be careful, and remember that lots of things that are FDA approved can prove disasterous in some individuals. FDA approval does not mean that the product is safe for all individuals in all cases.
Chip:finger:
Ciba lists some complications on their website:
Chip, you are correct; these are not new complications and we cannot count on patients reading the package inserts. If you visit many of the major solution manufacturer's websites they also recommend against rinsing only and recommend rubbing. Success with these lenses is going to depend heavily on compliance to wearing procedures.http://www.nightanddaycontacts.com/c...ormation.shtml
What are the risks of wearing contact lenses for extended wear?
While there are many benefits of wearing contacts, sometimes problems can occur and the risk of serious problems is greater when lenses are worn for extended wear. You should carefully discuss the benefits and risks of extended wear lenses with your eye care professional.
There is an increased risk of developing a serious ocular infection, such as a corneal ulcer. A corneal ulcer may develop rapidly and cause eye pain, redness or blurry vision as it progresses. If left untreated, a scar, and in rare cases loss of vision, may result.
In addition, studies have shown that smoking increases the risk of corneal ulcers for those who wear lenses overnight.
What are other possible side effects of extended wear contact lenses?
An inflammation of the cornea called infiltrative keratitis is another potential side effect. During the one-year U.S. study about 5% of the 1,300 eyes experienced this type of side effect. Other less serious side effects were conjunctivitis and lid irritation or discomfort while wearing the lenses, including dryness of the eye and mild burning or stinging.
Are there times when you should not wear contact lenses?
Your eye care professional can tell you about situations or environmental conditions that may be inappropriate for contact lens wear. Some examples are:
Exposing contact lenses to water during swimming or while in a hot tub may increase the risk of eye infection from microorganisms.
Fumes, smoke or vapors should be avoided to reduce the chance of lens contamination.
How often do I replace the lenses and how do I care for them?
Lenses should be replaced every month, as recommended by the eye care professional. When removed from your eyes in between replacement times, they should be cleaned and disinfected with a chemical disinfection system (not heat), if not replaced with a new lens. The lenses are sold in multi-packs so replacements are at hand.
You can't "rely on your eyecare professional" as long as he is economicly benefiting from the filling of his Rx's either. Most "eye care professionals" will sell people what they want as long as the "professional" can make money off the sale. (Boy am I gonna get a lot of resposes from O.D.'s "defending thier honor" on this one. I know of quite a few "precribers" in our area along that if the patient is foolish enough to say: "What about contact lenses Doc?" The patient will find he has a pair on his eyes, a brochure in his hand, intructions to: "Take them out when your eyes start bothering you." "And pay the receptionist on your way out."
This is where our "profession" is today.
Chip
chip anderson said:
You can't "rely on your eyecare professional" as long as he is economicly benefiting from the filling of his Rx's either. Most "eye care professionals" will sell people what they want as long as the "professional" can make money off the sale. .................................This is where our "profession" is today.
Chip
You are so right. I think we should start a new thread just on this subject, leading to some hot revelations.
You've got good and bad eggs on both sides of the isle.
I, for one, am in a 55 year old family practice. Our patients have been coming in for generations and trust our decisions. That's not to say that some patients want lenses that I don't think are appropriate. Extended wear, for instance. After I expalin the risks, and I don't fluff over the risks, we make a serious decision. I explain, to make the concept vividly clear, that "extended wear contact lenses are like extended wear underwear". That usually drives home the message.
The silicon hydrogels have been a major improvement for the extended wear (or marginal wear) patient. For these "corneas at risk", I switched from conventional materials into PureVision and Nite and Day. The majority of subjects liked the PureVision better, and I thought that the B&L product was better for the eye. When PureVision was pulled from the American market, I tried to switch many wearers into Nite and Day. Over half really didn't like the lens, so much so that they went back to their old non-silicon lens. I never had that much negative feedback from a particular lens type wearer. As a result, I rarely fit anyone in silicon extended today. When PureVision is back on the market or a new similar product, we'll consider not discouraging EW as much as we now do.
Chip, I don't think that there is enough profit in competitively selling boxes of contact lenses to make the risk worthwhile of pushing potentially site threatening modes of wear, especially to potential wearers who might not seem to be particularly compliant. But, as in all professions, there are some bad eggs.
As an aside, since CIBA bought up WJ, dropped some lines of lenses, made other impossible to get in a timely manner, changed pricing making smaller accounts pay a lot more, made returns almost impossible (read "get stuck with unreturnable lenses"), pushes wearer distribution through commercial outlets, doesn't return calls...need I go on? I don't support companies who don't support me. I used to fit some of the now discontinued FreshLook OptiFit Toric 4-packs, based on the old Optifit toric design. They had major production delays causing fittings to run over the 90 day return limit. They flatly refused to credit the returns (probably on only 3 or 4 patients) which included 12 or so unopened, unexpired toric vials becuase it was "their policy" not to do so. In short: tough luck, drop dead. My policy is not do deal with companies that have inflexible, predatory policies. So there are no new Freshlook or Focus fits. No new sources of recurring orders for mailorder houses or discount chains. With new fits going elsewhere, eventually CIBA will realize that this big gorilla will have to advertise like heck to regain the lost momentum it has lost by alienating the accounts that made it a leader in contact lenses. (Let's face it- Freshlook and Focus lenses are very old designs in the realm of today's lens materials and designs.) It takes a long time to build goodwill and trust with accounts, just like it takes a long time for us to do it with patients and clients. I know of other large practices that have switched. Whether the loss will be made up with gains from the chaoins, I don't know. I do know that I feel better dealing with companies that support me and not the other way around. Maybe it's an American thing, but if you tell me what to do -the only way to do it- or else, I take my ball and play the game with someone else.
Not "defending our honor", but I disagree with the statement the most eyecare professionals will sell patients what they want for the money--do you have any statements to back this up?? Any journal reviews or papers written?? Or is it just Optometrist? Or is it just the eyecare professionals in MS?? I have never heard one of my colleagues use the "take them out if they start hurting" statment as their only means for scl care. You can't really believe this--if you do, you have serious issues--you need more time around contact lenses and ODs--you just might learn something. At the very least, most ODs are afraid of legal action and wouldn't do that, but I tend to believe that most ODs care for their patients and wouldn't put them into a situation like this. Money is definitely an issue, but you are accusing most ODs of malpractice, do you really believe this?? Some things just amaze me...................chip anderson said:
You can't "rely on your eyecare professional" as long as he is economicly benefiting from the filling of his Rx's either. Most "eye care professionals" will sell people what they want as long as the "professional" can make money off the sale. (Boy am I gonna get a lot of resposes from O.D.'s "defending thier honor" on this one. I know of quite a few "precribers" in our area along that if the patient is foolish enough to say: "What about contact lenses Doc?" The patient will find he has a pair on his eyes, a brochure in his hand, intructions to: "Take them out when your eyes start bothering you." "And pay the receptionist on your way out."
This is where our "profession" is today.
Chip
Vitalogy:
Actually the one I had in mind about "Take them out when they begin to bother you." was an M.D. practice. Who believe it or not seems to be one of the best opthalmic surgeons around. Not the nicest guy but good with a knife. Did I mention that the patient recieves no intruction on care or even how to get them out, if they do start bothering him?
Foveator:
As long as we are on the subject. I have always found B&L to be the absolute best on returns and trial lenses. They do have a shortage of reps. but they never fuss about "you don't have that many in your "lens bank" and they do realize that you could use a half dozen lenses per eye and still not make a sale on some types of lenses, especially bifocals. None of this c---- about you only get one trial lens for every two boxes you sell, etc. In the negative, a lot of thier lenses tear and stick together,, but outside of this I have never had a complaint with B&L.
Chip,
Your point about what is under the lens is valid. It is important. But the fact is that patients are sleeping in the lenses for long peroids of time and they will continue to do it, so the should probably be wearing a lens that allows 4-5 times more O2 to the cornea so the cornea is not under hypoxic stress and more suseptable to the insult of what is under the lens. No one is saying that this is safer than daily wear. All my patients are educated on the risks of wearing Cls especially EW. As far as a therapuetic lens it is a great lens and so was Purevision and of course you watch these patients closely.
Sorry,
Forgot to defend honor. As others have said, most docs do what is best for the patient. some don't but this is the exception. Not the rule. I really hope you don't think most ODs treat their patients the way you described.
Chip,
You are so wrong. We were at a party where we bumped into a staff member of the other OD in town. She said she really respected our doctor because he will refuse to fit or sell CL if he feels it isn't best for the patient. And our patient ends up in their office.
Your comment " Most 'eye care professionals' will sell people what they want as long as the 'professional' can make money off the sale. " is simply not true.
You are so jaded and apparently hurt by your negative experiences with some people that you can't see the forest for the trees.
Why do you blame ODs for the faults of OMDs? Everyone knows OMDs are experts at surgery, not optometry. So why would you expect the surgeon to focus his staff on CL patient education when they are running an exam mill to get patients referred (ahem, make that self-referred) to surgery?
BTW, don't you think it's unethical for a surgeon to do an eye exam and then recommend surgery that he himself will perform?????
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