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Jan
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Pia schreef:
several snips made.......... > Hi, > > I'll look for a third optometrist tomorrow and want complete > checklists so she won't miss anything. My first optometrist > didn't use florescien pattern for tear inside contacts > evalution nor the 2nd who didn't even use trial lens. > > So I need to equipt myself with full knowledge of how to fit > lens so I won't be fooled again by lazy and inefficient > optometrists. I live in a country where RG lens is rare and > many optometrists haven't touched one (literally). First of all if you'r still wearing your RGP lenses at this very moment it's impossible to perform a perfect refit. BTW, wich country do you live in? > > Checklist review: > > 1. Florescein pattern to test for tear performance between lens/cornea > > Is this still done at the states or outdated already by superior > Topography data which some doctors may take total > confidence in? Still done despite the topography wich is very very helpfull for trained professionals. > > 2. Lid Fitting and Design > > The lens should be in between my eyelids so that if I have small > eyes, the lens should be small and not go beyond the eyelid, right? Not always. > > 3. Optical Zone Diameter > > I heard that optical zone diameter encompass anything from 65% > to 80% of the lens diameter. But most commercial RGP only > make you choose base curve, diameter, power. How could you > know its optical zone diameter? Nowadays RGP lensdesigns are very often off an asperical backcurve type. Meaning no OZ. > > Right now. I should have preferred soft contacts but according > to the opthalmologist, from 1 to 10. My eyes dryness is at 7. > Can Silicone Hydrogels help? or is Gas Perm lens the only > solution? Your professional have the knowledge to decide. > > Also is the Corneal Topography accurate enough that > fluorescein screening can be bypassed just like what > the second optometrist did? In RGP fittings absolutly not!!!! Or I heard there is a > software that can make a virtual fluorescein simulation > based on the Corneal Topograpy data. Nothing more nothing less a theoreticaly image. Gives you an idea but not neceseraly the real image seen by the fluorescein test. > 6. Tear Layer Power > > So it's better to always get lens at flatter than K by > 0.25 D to prevent edge closure? There is more to know. > Some doctors here not want to tell me what is in > the Corneal Topography but don't worry, i'd still > look for an optometrist who would be the one > to actually fit my lens.But I just want to know > how to read the Topography like knowing how > many point samples it used, etc. So please tell > me asap. It looks like you want to fit your RGP lenses yourselfes, this is simply not possible. Jan (normally Dutch spoken) |
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Pia
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On Mar 2, 5:44*am, Jan <nospam@nospam> wrote:
> Pia schreef: > > several snips made.......... > > > Hi, > > > I'll look for a third optometrist tomorrow and want complete > > checklists so she won't miss anything. My first optometrist > > didn't use florescien pattern for tear inside contacts > > evalution nor the 2nd who didn't even use trial lens. > > > So I need to equipt myself with full knowledge of how to fit > > lens so I won't be fooled again by lazy and inefficient > > optometrists. I live in a country where RG lens is rare and > > many optometrists haven't touched one (literally). > > First of all if you'r still wearing your RGP lenses at this very moment > it's impossible to perform a perfect refit. I stopped for one week already because one of them got lost. I keep thinking about going to soft contacts but it seems to have significantly higher risk. For example. How do they manage tear exchange in the big diameter lens like 14.2mm in the Focus O2Opiks Silicone Hydrogels? If there is already problem using a 10mm RG lens. What more if the diameter is 14.2mm. How do you think tear exchange work in the 14.2mm soft contacts? > > BTW, wich country do you live in? Somewhere in Asia. > > > > > Checklist review: > > > 1. Florescein pattern to test for tear performance between lens/cornea > > > Is this still done at the states or outdated already by superior > > Topography data which some doctors may take total > > confidence in? > > Still done despite the topography wich is very very helpfull for trained > professionals. > > > > > 2. Lid Fitting and Design > > > The lens should be in between my eyelids so that if I have small > > eyes, the lens should be small and not go beyond the eyelid, right? > > Not always. Know how I can check lid tension myself so i'd know whether my lid is flexible or stiff. > > > > > 3. Optical Zone Diameter > > > I heard that optical zone diameter encompass anything from 65% > > to 80% of the lens diameter. But most commercial RGP only > > make you choose base curve, diameter, power. How could you > > know its optical zone diameter? > > Nowadays RGP lensdesigns are very often off an asperical backcurve type. > Meaning no OZ. You mean modern lens has no optical zone? Or do you mean the entire lens is the optical zone? > > > > > Right now. I should have preferred soft contacts but according > > to the opthalmologist, from 1 to 10. My eyes dryness is at 7. > > Can Silicone Hydrogels help? or is Gas Perm lens the only > > solution? > > Your professional have the knowledge to decide. But my professionals don't own any fluorescein screener and some don't even have trial lens because only rare number of people get RGP lens in my country so we can say some have practically no experience in RGP lens. No exaggerations. > > > > > Also is the Corneal Topography accurate enough that > > fluorescein screening can be bypassed just like what > > the second optometrist did? > > In RGP fittings absolutly not!!!! > > * Or I heard there is a > > > software that can make a virtual fluorescein simulation > > based on the Corneal Topograpy data. > > Nothing more nothing less a theoreticaly image. > Gives you an idea but not neceseraly the real image seen by the > fluorescein test. > > > 6. Tear Layer Power > > > So it's better to always get lens at flatter than K by > > 0.25 D to prevent edge closure? > > There is more to know. In two threads below. I shared my Corneal Topogaphy. Can one get the base curve from the Mean Power there (in the case of the OD 43.7D and OS 43.8D)? > > > Some doctors here not want to tell me what is in > > the Corneal Topography but don't worry, i'd still > > look for an optometrist who would be the one > > to actually fit my lens.But I just want to know > > how to read the Topography like knowing how > > many point samples it used, etc. So please tell > > me asap. > > It looks like you want to fit your RGP lenses *yourselfes, this is > simply not possible. > > Jan (normally Dutch spoken) No. But since many optometrists in my country only focus on eyeglasses and have minimal experience in contact lens especially gas permeable. I have to be informed and aware of things so as not to be duped. Pia |
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Pia
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On Mar 2, 7:06*am, Pia <pia_...@yahoo.com> wrote:
> On Mar 2, 5:44*am, Jan <nospam@nospam> wrote: > > > > > > > Pia schreef: > > > several snips made.......... > > > > Hi, > > > > I'll look for a third optometrist tomorrow and want complete > > > checklists so she won't miss anything. My first optometrist > > > didn't use florescien pattern for tear inside contacts > > > evalution nor the 2nd who didn't even use trial lens. > > > > So I need to equipt myself with full knowledge of how to fit > > > lens so I won't be fooled again by lazy and inefficient > > > optometrists. I live in a country where RG lens is rare and > > > many optometrists haven't touched one (literally). > > > First of all if you'r still wearing your RGP lenses at this very moment > > it's impossible to perform a perfect refit. > > I stopped for one week already because one of them got lost. > I keep thinking about going to soft contacts but it seems to > have significantly higher risk. For example. How do they manage > tear exchange in the big diameter lens like 14.2mm in the Focus > O2Opiks Silicone Hydrogels? If there is already problem using > a 10mm RG lens. What more if the diameter is 14.2mm. How > do you think tear exchange work in the 14.2mm soft contacts? > > > > > BTW, wich country do you live in? > > Somewhere in Asia. > > > > > > > > > > Checklist review: > > > > 1. Florescein pattern to test for tear performance between lens/cornea > > > > Is this still done at the states or outdated already by superior > > > Topography data which some doctors may take total > > > confidence in? > > > Still done despite the topography wich is very very helpfull for trained > > professionals. > > > > 2. Lid Fitting and Design > > > > The lens should be in between my eyelids so that if I have small > > > eyes, the lens should be small and not go beyond the eyelid, right? > > > Not always. > > Know how I can check lid tension myself so i'd know whether my > lid is flexible or stiff. > > > > > > 3. Optical Zone Diameter > > > > I heard that optical zone diameter encompass anything from 65% > > > to 80% of the lens diameter. But most commercial RGP only > > > make you choose base curve, diameter, power. How could you > > > know its optical zone diameter? > > > Nowadays RGP lensdesigns are very often off an asperical backcurve type.. > > Meaning no OZ. > > You mean modern lens has no optical zone? Or do you mean the entire > lens is the optical zone? > > > > > > Right now. I should have preferred soft contacts but according > > > to the opthalmologist, from 1 to 10. My eyes dryness is at 7. > > > Can Silicone Hydrogels help? or is Gas Perm lens the only > > > solution? > > > Your professional have the knowledge to decide. > > But my professionals don't own any fluorescein screener > and some don't even have trial lens because only rare > number of people get RGP lens in my country so we can > say some have practically no experience in RGP lens. > No exaggerations. > > > > > > > > > > Also is the Corneal Topography accurate enough that > > > fluorescein screening can be bypassed just like what > > > the second optometrist did? > > > In RGP fittings absolutly not!!!! > > > * Or I heard there is a > > > > software that can make a virtual fluorescein simulation > > > based on the Corneal Topograpy data. > > > Nothing more nothing less a theoreticaly image. > > Gives you an idea but not neceseraly the real image seen by the > > fluorescein test. > > > > 6. Tear Layer Power > > > > So it's better to always get lens at flatter than K by > > > 0.25 D to prevent edge closure? > > > There is more to know. > > In two threads below. I shared my Corneal Topogaphy. > Can one get the base curve from the Mean Power there > (in the case of the OD 43.7D and OS 43.8D)? > > > > > > Some doctors here not want to tell me what is in > > > the Corneal Topography but don't worry, i'd still > > > look for an optometrist who would be the one > > > to actually fit my lens.But I just want to know > > > how to read the Topography like knowing how > > > many point samples it used, etc. So please tell > > > me asap. > > > It looks like you want to fit your RGP lenses *yourselfes, this is > > simply not possible. > > > Jan (normally Dutch spoken) > > No. But since many optometrists in my country only focus on > eyeglasses and have minimal experience in contact lens > especially gas permeable. I have to be informed and aware > of things so as not to be duped. > > Pia- Hide quoted text - > > - Show quoted text -- Hide quoted text - > > - Show quoted text -- Hide quoted text - > > - Show quoted text - For those who are lost in seeking a correct contact lens fit. I spent a day prioritizing the search for the right optometrist to get a correct prescription. I saw 6 optometrists. but didn't continue with most of them because they didn't have any slit lamp nor fluorescein dye. They said its expensive to own. Since the free chapter in a contact lens book at amazon says the fluorescein dye would be the deciding factor in getting a right fit (for uniform tear binding). I look all over the city for a doctor with a fluorescein dye. At last I found one (and only). After a second Corneal Topography and trial lens/ fluorescein dye exam. I finally got a final base curve of 7.8 for both eyes and 9mm and ordered a pair. I asked her about the calculations. What the previous doctor who gave me a prescription without even giving me trial lens did was simply add the min and max in the simple K, divide by 2 and get the base curve in mm which is 7.75. So I guess that most of the time, Corneal Topography results is close to the values in actual fit. I wonder if United States optometrists would agree to this. Corneal Topography took thousands of sample points compared to just 2 in the manual keratometer. So the thousands sample points would be pretty accurate and can mean equal fluorescein dye pattern in an actual exam especially if 9mm diameter is chosen and if the choice or parameters patients can order is only base curve, power, and diameter in a gas permeable contact lens which is true in my country. I found the information I seek about the fluorescein dye, etc. from a contact lens book at amazon where you can read the entire free chapter 5 called "Lens Design, Fitting and Evalution" at http://www.amazon.com/Clinical-Manua...f=pd_rhf_p_t_1 Pia The search is over |
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Jan
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Pia schreef:
Major snip.................... > For those who are lost in seeking a correct contact lens fit. > I spent a day prioritizing the search for the right optometrist > to get a correct prescription. I saw 6 optometrists. but didn't > continue with most of them because they didn't have any > slit lamp nor fluorescein dye. They said its expensive to own. Yes and that's why they could afford the much cheaper instruments like the Orb and the Zyoptic, you make me laugh. I suppose you have a great thumb Pia another major snip. > Pia > > The search is over I can imaging that........... Jan (normally Dutch spoken) |
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Pia
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On Mar 3, 4:25*am, Jan <nospam@nospam> wrote:
> Pia schreef: > Major snip.................... > > > For those who are lost in seeking a correct contact lens fit. > > I spent a day prioritizing the search for the right optometrist > > to get a correct prescription. I saw 6 optometrists. but didn't > > continue with most of them because they didn't have any > > slit lamp nor fluorescein dye. *They said its expensive to own. > > Yes and that's why they could afford the much cheaper instruments like > the Orb and the Zyoptic, you make me laugh. > The Orb and Zywave is owned by a corporation with dozens of opthalmologist and one main optometrist. It was he who prescribed me 7.75 base curve without even putting trial lens. When I asked him why. He said he is sure that's why no trial lens and fluorescein pattern and just made me order a pair. The other independent optometrists in the mall and city don't have any slit lamp or fluorescein dye because they didn't invest in them due to small amount of gas permeable users in the country. Yesteday. I went to a second corporation who dozens of doctors. There I found one using slit lamp and fluorescent dye with corneal topography. I spent 2 hours or more with her as she said it is common to spend 2 hours with one patient for many trial fit and dye scan. Therefore it explains why the previous optometrist just gave me prescription without any tests.. because with 30 patients a day. He has just no time. I wonder if optometrists in the US like Mike Tyler also spent 2 hours with each patient for complete test (remember one has to wait 20 mins for trial lens to settle down and if there are many trials.. waiting in the middle would take a hour). > I suppose you have a great thumb Pia > > another major snip. > > > Pia > > > The search is over > > I can imaging that........... > > Jan (normally Dutch spoken) |
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Jan
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Pia schreef:
Major snip............... > The other independent optometrists in the mall and city don't have > any slit lamp or fluorescein dye because they didn't invest in them > due to small amount of gas permeable users in the country. An optometrist without a slitlamp? Jan (normally Dutch spoken) |
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Charles
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In article <49ac6923$0$12241$(E-Mail Removed)>, Jan
<nospam@nospam> wrote: > An optometrist without a slitlamp? Maybe they don't have them in a third world country like the Philippines. -- Charles |
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Pia
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On Mar 3, 7:53*am, Charles <fort...@mac.com> wrote:
> In article <49ac6923$0$12241$58c7a...@news.kabelfoon.nl>, Jan > > <nospam@nospam> wrote: > > An optometrist without a slitlamp? > > Maybe they don't have them in a third world country like the > Philippines. > > -- > Charles Yes, I live in the Philippines. I only found 2 optical centers to have slit lamp and fluorescein dye, Asian Eye Institute and American Eye Center. The rest only have refraction or autorefraction machines especially in optical shops in the mall or private practionioners who can't afford millions to buy them and having only 1 RG lens customer a month. Also since soft contacts with adaptive base curve and disposable lens are the norm. Who needs slit lamp or fluorescein dye. Asian Eye Institute has 10 opthalmologists with different specialies like glaucoma, retina, catract and only one who specilize in low vision. That is why he didn't put me in any trial lens or fluorescien evaluation because he has over 30 customers a day and don't have time to spend 2 hours for each. While at American Eye Centers they have 10 optometrists who go through procedures hence I was able to spend 2 hours with one of them to have the confidence of a precision fluorescien pattern evaluation for uniform tear distribution. Also I think manual keramatomer is not accurate or they need skilled practioners. The first optometrist I saw who prescribed me 10mm diameter RG lens and told me I had GPC (which I don't) only used manual keratometer and got a reading of 7.95 base curve when 2 Corneal Topography shows reading of 7.75-7.8 base curve which is what I got. Anyway. The last optometrist told me that it would usually take 3 months after taking off gas permeable lens used for 15 years for the cornea shape to get back to original. Is this true?? Could it be because I've used 7.8 base curve for the past 20 years that they also measure 7.8 in the Corneal Topography because somehow the rigid gas permeable is able to reshape the cornea which takes 3 months to get back to normal? In their Lasik requirement. One must not wear any rigid gas permeable for at least 3 months before one can have accurate shape of the cornea. Is this concept also practiced in US optometry and lasik clinical setting or is this a myth belief only by local opticians? Pia |
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Pia
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On Mar 3, 1:45*pm, "Mike Tyner" <mty...@mindspring.com> wrote:
> Fluorescein dye strips cost about a dime. > > Slit lamp microscopes cost considerably more (not millions) but optometrists > don't buy them so they can fit RGP contacts. They buy microscopes to provide > basic, competent eye care. Of course opthalmologists use slit lamp but optometrists as I know only measure diopters in myopia, hyperopia and presyopia (that is why it is called optometrist.. opto.. metrist.. metric.. measurement of opto or optical). Anything about the organic eye is refered to opthalmologists... at least as locally practised. > > It's reckless to fit any contact lenses without a slit lamp examination. > It's reckless to remove foreign bodies or lance styes or monitor surgical > recovery without a microscope. You'd miss cataracts and corneal ulcers and > uveitis and a hundred other things that have nothing to do with RGPs. Since almost all soft contact lens are disposable and the base curve is adaptive. Why do they have to examine the patient eye using slit lamp since all curves can fit the eye. If uncomfortable, then getting a flatter base curve would be the order of the day.. this is as locally practiced. > > In several large countries, insurance companies refuse to pay optometrists > who lack basic equipment. Licensing boards disapprove of practicing without > a slit lamp. Failure to diagnose is the most common malpractice complaint, > and about half of the overlooked conditions are found with the slit lamp > microscope. Slit lamp is quite expensive... and only veterans optometrists use slit lamp. How can the beginner optometrists afford to buy a slit lamp. > > You're pretty impressed with the importance of topography and fluorescein > patterns, but all they do is tell you where the contacts touch and where > they vault over the cornea. That can predict what's comfortable, but it's If topography and fluorescein is ok, the mechanical part of contact lens fitting is solved, the rest is nervous system related and it can be adjusted mentally or if immune related.. then the patient simply has to go back to eyeglasses. I'm only concerned about the mechanical fitting since I know I can wear gas perm having worn them for 2 decades. > all hypothetical until you actually wear the lens for a while. That's why > all wholesale RGP labs offer warranty exchange options. > > Three months is a reasonable time to rehab before surgery. Waiting three > months to fit new contacts would be silly, because RGPs make corneal > irregularities irrelevant. What I mean to say is. For LASIK patients. All local doctors only do final corneal topography if the patient at least stopped wearing gas perm for 3 months because the cornea is still not in original shape. They say it takes 3 months for cornea to get back to original shape. Is this not the concept in the US too? Do they let patients wait for 3 months to mentally prepare and not to wait for curves to get back to original? The last optometrist also told me that if I don't wear gas permeable as soon as possible or change to soft contacts, the astigmatism may slowly get back in a few months (If I had one 20 years ago) when the eyes slowly gets back to original shape. What you said before was that the cornea gets back to original shape in as little as one day?? Can you confirm it again? There is no case where the cornea slowly gets back to original shape after 1 month or 2?? Any study that refute this? Pia > > I took two hours for my first GP fit, many years ago. In later years I've > gotten it down to 90 minutes or less. ![]() > > -MT > > "Pia" <pia_...@yahoo.com> wrote in message > > news:1a5564a2-3a60-401a-ad6d-(E-Mail Removed)... > On Mar 3, 7:53 am, Charles <fort...@mac.com> wrote: > > > In article <49ac6923$0$12241$58c7a...@news.kabelfoon.nl>, Jan > > > <nospam@nospam> wrote: > > > An optometrist without a slitlamp? > > > Maybe they don't have them in a third world country like the > > Philippines. > > > -- > > Charles > > Yes, I live in the Philippines. I only found 2 optical centers to > have slit lamp and fluorescein dye, Asian Eye Institute and > American Eye Center. The rest only have refraction or > autorefraction machines especially in optical shops in the > mall or private practionioners who can't afford millions to > buy them and having only 1 RG lens customer a month. > Also since soft contacts with adaptive base curve and > disposable lens are the norm. Who needs slit lamp or > fluorescein dye. > > Asian Eye Institute has 10 opthalmologists with different > specialies like glaucoma, retina, catract and only one > who specilize in low vision. That is why he didn't put me > in any trial lens or fluorescien evaluation because he has > over 30 customers a day and don't have time to spend > 2 hours for each. While at American Eye Centers they > have 10 optometrists who go through procedures hence > I was able to spend 2 hours with one of them to have > the confidence of a precision fluorescien pattern > evaluation for uniform tear distribution. > > Also I think manual keramatomer is not accurate or they need > skilled practioners. The first optometrist I saw who prescribed > me 10mm diameter RG lens and told me I had GPC (which > I don't) only used manual keratometer and got a reading > of 7.95 base curve when 2 Corneal Topography shows reading > of 7.75-7.8 base curve which is what I got. > > Anyway. The last optometrist told me that it would usually take > 3 months after taking off gas permeable lens used for 15 years > for the cornea shape to get back to original. Is this true?? > Could it be because I've used 7.8 base curve for the past > 20 years that they also measure 7.8 in the Corneal Topography > because somehow the rigid gas permeable is able to reshape > the cornea which takes 3 months to get back to normal? In > their Lasik requirement. One must not wear any rigid gas > permeable for at least 3 months before one can have accurate > shape of the cornea. Is this concept also practiced in US > optometry and lasik clinical setting or is this a myth belief only > by local opticians? > > Pia |
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