RGP/Ortho-K Dry Eyes/Sticking Contacts

Anyone have any ideas on sticky rgp contacts? I started with OK back
in january and am still working to make it right. Today I am pretty
happy with the results, though I do have some nighttime starbursting.

My biggest issue is dryness induced decentration. If I wear my lenses
while I am awake and blinking, it will take about 15 or so minutes for
my lenses to "stick" on my eyes, generally slightly off center. If I
put some drops in it will take a few minutes to "unstick" them but 15
minutes later they will stick again. Putting drops in every 5-10
minutes is not a viable option as the more drops I put in, the drier my
eyes seem to get. I would be happy to put the lenses in when it gets
dark as my starbursts are drastically reduced, but as t it sticks off
center I get a nice double vision problem the next day which is not
acceptable.

My normal use is actually while sleeping where I also have the issue
but to a much lesser extent. If I put them in and IMMEDIATELY go to
bed after putting a few drops of the boston re-wetting solution in, I
am generally fine by the next morning though every once in a while one
eye will stick a bit.

I did have my eyes checked with a corneal topographer and it looks
good, after a night where the contacts did not stick.

I'll be checking in with the doc next week, but figured I would ask to
see if anyone had any hints.

Using boston advance solution, the boston cleaner and boston drops.
Lenses are jade, based on boston materials (can't remember the exact
material name but there is only one or two AFAIK from boston)

Scot

If you have dry eyes, you need that addressed. Treatments include
punctal plugs and drugs such as Restasis. First, you need a dry eye
workup.

DrG

Scot wrote:
> Anyone have any ideas on sticky rgp contacts? I started with OK back
> in january and am still working to make it right. Today I am pretty
> happy with the results, though I do have some nighttime starbursting.
>
> My biggest issue is dryness induced decentration. If I wear my lenses
> while I am awake and blinking, it will take about 15 or so minutes for
> my lenses to "stick" on my eyes, generally slightly off center. If I
> put some drops in it will take a few minutes to "unstick" them but 15
> minutes later they will stick again. Putting drops in every 5-10
> minutes is not a viable option as the more drops I put in, the drier my
> eyes seem to get. I would be happy to put the lenses in when it gets
> dark as my starbursts are drastically reduced, but as t it sticks off
> center I get a nice double vision problem the next day which is not
> acceptable.
>
> My normal use is actually while sleeping where I also have the issue
> but to a much lesser extent. If I put them in and IMMEDIATELY go to
> bed after putting a few drops of the boston re-wetting solution in, I
> am generally fine by the next morning though every once in a while one
> eye will stick a bit.
>
> I did have my eyes checked with a corneal topographer and it looks
> good, after a night where the contacts did not stick.
>
> I'll be checking in with the doc next week, but figured I would ask to
> see if anyone had any hints.
>
> Using boston advance solution, the boston cleaner and boston drops.
> Lenses are jade, based on boston materials (can't remember the exact
> material name but there is only one or two AFAIK from boston)
>
> Scot

Anon E. Muss wrote:
> On 9 Jun 2006 05:47:42 -0700, "Dr. Leukoma" <(E-Mail Removed)> wrote:
>
> >If you have dry eyes, you need that addressed. Treatments include
> >punctal plugs and drugs such as Restasis. First, you need a dry eye
> >workup.
>
> Which brings up an important point for laypersons: a good eyedoctor
> does not just prescribe artificial tears dor dry eyes based on
> symptomology only. A good doctor will perform a dry eye workup.
>
> Dry eyes have various etiologies such as insufficient tear production,
> excessive tear drainage, meibomian gland dysfunction. And different
> causes have different treatments. Prescribing a wrong treatment
> regimen for the particular cause of dry eyes can actually make things
> worse (e.g., prescribing artifical tears when the cause is entirely
> excessive evaporative loss due to meibomian gland disease.)
>
> Some patients are put on topical steroids, some on hot compresses/lid
> massage, some on a tetracycline, others on artificial tears, others on
> RESTASIS, others on flaxseed oil, others still on punctal plugs and
> other treatment modailities.
>
> A careful workup -- usually beyond what is part of a routine
> comprehensive eye examinaiton -- is normally required including things
> such as a tear break-up time, fluorescein staining, and Schirmer's
> testing, etc. Follow-ups are also required to gauge response to
> treatment and to adjust the treatment regimen as needed. The various
> treatment methods for dry eyes (topical steroids, oral tetracycline)
> while normally quite safe can have serious potential side effects.

AMEN!

Anon E. Muss wrote:
> On 9 Jun 2006 05:47:42 -0700, "Dr. Leukoma"
> <(E-Mail Removed)> wrote:
>
>> If you have dry eyes, you need that addressed.
>> Treatments include punctal plugs and drugs such as
>> Restasis. First, you need a dry eye workup.
>
> Which brings up an important point for laypersons: a
> good eyedoctor does not just prescribe artificial tears
> dor dry eyes based on symptomology only. A good doctor
> will perform a dry eye workup.
>
> Dry eyes have various etiologies such as insufficient
> tear production, excessive tear drainage, meibomian gland
> dysfunction. And different causes have different
> treatments. Prescribing a wrong treatment regimen for
> the particular cause of dry eyes can actually make things
> worse (e.g., prescribing artifical tears when the cause
> is entirely excessive evaporative loss due to meibomian
> gland disease.)
>
> Some patients are put on topical steroids, some on hot
> compresses/lid massage, some on a tetracycline, others on
> artificial tears, others on RESTASIS, others on flaxseed
> oil, others still on punctal plugs and other treatment
> modailities.
>
> A careful workup -- usually beyond what is part of a
> routine comprehensive eye examinaiton -- is normally
> required including things such as a tear break-up time,
> fluorescein staining, and Schirmer's testing, etc.
> Follow-ups are also required to gauge response to
> treatment and to adjust the treatment regimen as needed.
> The various treatment methods for dry eyes (topical
> steroids, oral tetracycline) while normally quite safe
> can have serious potential side effects.
>
> <rant>
>
> I get some people -- mostly people who have well-vision
> insurance through which we are participating providers,
> but their medical insurance elsewhere (e.g., HMOs) -- who
> want me to treat their dry eyes without peforming such a
> workup without getting properly reimbursed because of
> cost or convenience, or simply not performing a
> workup/followups.
>
> o "Can't you just tell me which drops I should try?"
> (implied: without me having to do [read: PAY for] the
> workup and follow-ups).
> o "Can't I just try RESTASIS?" (implied: without me
> having to pay for the workup and follow-ups)
> o "What do you mean you don't know what is causing my
> dry eye? You just performed an eye exam."
> o "I don't want (have to) to go through my HMO. It will
> take at least a couple weeks to see a specialist -- I
> will have to go to my primary care doctor and then he
> will have to schedule an appointment with a specialist --
> that will be at least two days off work and the hassle of
> dealing with my HMO (but I don't want to pay for a dry
> eye workup and associated followups). Can't you just
> tell me what I should try?" (implied: without me having
> to do [read: PAY for] the workup and follow-ups).
>
> Laymen should realize when you do things like that, you
> put the doctor in an uncomfortable position. No matter
> nicely how you state it, some patients will feel that the
> "rich" doctor is being "greedy" (rather than the patient
> is being frugal) -- "You're already getting paid for an
> exam by the insurance" (note: at an already reduced
> reimbursement rate over usual & customary fee!) or the
> patient will feel like the doctor is accusing them of
> being "cheap"
>
> And some other patients still will say "That much! Just
> for dry eyes??!!" These typically aren't cash patients
> who are used to paying the normal U&C fees for an eye
> exam, but those with well-vision insurance who come in
> only when the insurance covers an eye exam, want "only
> what the insurance will cover" as far as frames/lenses,
> and pay a $5.00 deductible. Perhaps when one gets used
> to paying a $5.00 deductible when their employers pay for
> their health/vision insurance, how much school and what
> an OD does becomes undervalued?
>
> (BTW, it's not the doctor's job to explain to you how
> your insurance works, the intracies of it, why it covers
> vision and not medical eye problems, etc. It's the
> patient's job to know what it covers. I mean -- didn't
> you at least briefly read the coverage when you signed up
> for it?)
>
> Please don't tell me no other ODs ever experience this
> and I alone occasionally get patients from the Twilight
> Zone.

I agree with what you say except for your assumption that
it's entirely motivated by cost. A very good number of
us patients are just plain lazy. We got other stuff to do
without the inconvenience of taking care of our bodies.
That's why we came to you. There are some of us who
take great interest in ourselves and make a point to put
forth the effort to become as educated a participant in
our health care as possible, but that's not everybody.

It is a hassle/inconvenience to go to the doctor's. And
even more so to go through the HMO process, etc. There
is always the hope of taking the "quick shot". "Heh doc,
just try something, maybe we'll get lucky. If not, well,
then we'll have to go the prescribed route."

Yes I can well imagine the price thing. Especially with
something like eye care. There is a perception factor.
You go to the eye doc and there are glasses, frames,
and stuff up front for sale. The docs and assistants
usually aren't wearing white lab coats and full hospital
gear. It has a sort of commercial atmosphere. Like you're
at the mall. You go to your GP and the atmosphere is
different (granted, less pleasant). For some reason you
expect the charges at your GP to be mysterious, numerous,
and huge. I won't get into that. Back to the post.

Absolutely true. It's not your responsibility to know how
my insurance works and what I'm supposed to do to
submit a claim. BUT... that's going to be a huge factor
in my decision to use your services. You have no idea
the impression it makes when the person at the front
says "Yes, we take that. I see you have this option so
your co-pay will be this". "uhhh, do I have to call my
PCP, submit this form here and that one there?". "No,
I'll take care of all that for you". Inside I'm going "YES!".

I would guess it to be cost effective for your office
management to have someone up front to keep up
on all this and handle it.

-Quick

Quick wrote:

> I agree with what you say except for your assumption that
> it's entirely motivated by cost. A very good number of
> us patients are just plain lazy. We got other stuff to do
> without the inconvenience of taking care of our bodies.
> That's why we came to you. There are some of us who
> take great interest in ourselves and make a point to put
> forth the effort to become as educated a participant in
> our health care as possible, but that's not everybody.

By the same token, "we" have better things to do than shuffle papers.

(snip)

> I would guess it to be cost effective for your office
> management to have someone up front to keep up
> on all this and handle it.

I'm not sure it is ever cost effective. The person who files insurance
claims cannot also be doing patient care things. Yet, that person adds
to the overhead of running a practice. Patient X, who used to pay $Y
for a service, now has insurance that reimburses $0.7Y for the same
service. When every provider is on the same panel, all that has been
accomplished is that additional layers of cost have been added to
service the same patient.

Yes, we're doing more for the same amount of money, or less money
usually, but it isn't related to patient care or services.

DrG

I think the issue is less about lazy patients and more about the lack
of valuable information out there. Nowhere have I found this more
apparent than in dentistry, with eye procedures and practices being a
close second Much of the information you do find is biased and
there are a great number of doctors out there who are basically sales
people for different brands. I know this isn't always the case, but
from the consumers standpoint it is a bit disconcerting.

At this point patients don't know what to ask for. Just the fact I am
asking this here says something, and I would rate myself as a
persistant searcher for information.

As for my condition, I will be seeing the doc next week so its all
good, just looking for more information. To the question of "dry eye" I
never really seem to have an issue except with contacts. The longer I
wear them, the dryer my eyes get. I take em out, and viola I am fine
again. Must be nice to be one of those people who can just pop them in
early and take em out at midnight.

Scot

Scot wrote:

>
> As for my condition, I will be seeing the doc next week so its all
> good, just looking for more information. To the question of "dry eye" I
> never really seem to have an issue except with contacts. The longer I
> wear them, the dryer my eyes get. I take em out, and viola I am fine
> again. Must be nice to be one of those people who can just pop them in
> early and take em out at midnight.
>

Scott, trust me. I routinely fit RGP lenses on very challenging cases.
If you don't have enough tears to float them, they will stick. Of
course, that isn't the only variable, but it should not be overlooked.

DrG