Silicone hydrogel lenses five times safer

Discussion in 'Optometry Archives' started by Dr. Leukoma, May 18, 2005.

  1. Dr. Leukoma

    Dr. Leukoma Guest

    A recent study from the University of Manchester of patients who were
    admitted with eye problems associated with contact lens wear found that
    those who were wearing silicone-hydrogel lenses had five times less
    risk.

    If we extrapolate that finding to the large population studies of
    conventional lenses, we ought to be able to conclude that the rate is
    1/2500 annual incidence with silicone-hydrogel overnight wear, compared
    to 1/500 annual incidence with conventional hydrogel overnight wear.

    The inescapable conclusion is that overnight wear of silicone-hydrogel
    lenses is safe, and far safer than having eye surgery.

    DrG
     
    Dr. Leukoma, May 18, 2005
    #1
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  2. Dr. Leukoma

    retinula Guest

    i agree. however safety has never been the driving issue as to why
    patients seek refractive surgery. most often it's simply a convenience
    issue-- they are tired of relying on contact lenses and glasses to see
    well. they want to see well without any prosthetic device.
     
    retinula, May 18, 2005
    #2
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  3. Dr. Leukoma

    LarryDoc Guest

    But it IS becoming so for an increasing number of surgical candidates.
    And hence, when the contact lens industry gets it together and has
    si-hydros in the full range of fitting and optical parameters.
    refractive surgery is dead.

    14 to 30 days of 24-7 perfect vision with essentially no risk, well
    that's a no-brainer for me and the patients that walk through my (open)
    door.

    That being said, my CIBA rep informed me yesterday that they WILL NOT be
    expanding parameters until at least the end of the year. The B&L rep
    said "maybe September". Vested interest in the LASIK business? J&J is
    test marketing a new si-hydro, very quietly, on the other side of the
    pond. So is Cooper.

    The writing on the wall is clear. Money talks and when they see dollar
    signs, well.........

    Meanwhile, I have a list of 40+ patients waiting for si-hydros to be
    available in their Rx. And I'm a pretty small practice.

    --LB, O.D.
     
    LarryDoc, May 18, 2005
    #3
  4. Dr. Leukoma

    Dr. Leukoma Guest

    Are you speaking as an eye doctor or as a consumer? As an eye doctor I
    have a fiduciary responsibility to my patients, and I have an
    obligation to weigh the relative risks of various options before I
    recommend one over the other.

    As a group, we used to be a pretty conservative bunch. Safety was
    paramount. If a patient was blind in one eye, you automatically
    prescribed spectacles with polycarbonate lenses to protect the
    remaining good eye. I cannot believe that I am actually living in a
    time when patients with amblyopia are being offered LASIK. But it's
    being done all the time, sometimes with disastrous results.

    I agree that convenience has become the driving force behind LASIK.
    Sometimes what is convenient isn't the best thing for us, as with fast
    food. Not only are we becoming a nation of overweight people, but a
    nation of overweight and contrast-sensitivity impaired people with dry
    eyes.

    DrG
     
    Dr. Leukoma, May 18, 2005
    #4
  5. Dr. Leukoma

    Dr. Leukoma Guest

    Speaking as a lifetime wearer of spectacles and a not always but now
    highly successful contact lens wearer, and also a frequent fixer of
    post-refractive surgery problems for the past two decades, I am quite
    satisfied with my status quo.

    DrG
     
    Dr. Leukoma, May 19, 2005
    #5
  6. Dr. Leukoma

    retinula Guest

    i am speaking as a patient. not as a doctor. to understand the
    reality of the market you must think about what motivates the patient
    (=consumer) as to what they do or want, not what YOU think is best for
    them.

    i am in total agreement with your views. technically speaking LASIK
    causes a permanently weakened cornea, decreased contrast sensitivity,
    etc. Unfortunately, patients frequently make decisions based upon
    emotions rather than logic. its the reality of the market
     
    retinula, May 20, 2005
    #6
  7. Dr. Leukoma

    retinula Guest

    you are the consumate technician. i do not disagree with your
    arguments, but you miss the reality about what emotionally motivates
    refractive surgery patients. many do not want prosthetic devices
    (glasses and contacts) on their eyes for whatever reason regardless of
    your technical argument regarding safety, acuity, etc. its a matter of
    vanity, self-image, etc. refractive surgery is not dead, and it is
    foolish to think so.
    the numerous majority of others that do not even bother to walk through
    your door nor even to ask you what your opinion is think differently
    than you!

    do not misunderstand me. i agree with the logic of not risking
    refractive surgery for myself. i am not contact lens intolerant so i
    am perfectly happy with silicone hydrogels and occasional glasses. i
    have seen enough button-holes, over-corrections, irregular
    astigmatisms, etc. The general public however wants perfect vision just
    like they want liposuction, face lifts, botox injections, and hair
    plugs. we can educate them about the risks but their numbers are large
    and their inertia is great.
     
    retinula, May 20, 2005
    #7
  8. Dr. Leukoma

    Dr. Leukoma Guest

    Nice discussion. I agree that refractive surgery isn't going away.
    However, I find the use of the term prosthetic device to be rather
    quaint, and a purposeful perjorative misuse of the term. Both
    Webster's and Taber's dictionaries define a prothesis as an artificial
    body part replacement. Taber's third, or least common use of the term
    includes "a device to augment performance of a natural function such as
    a hearing aid." Funny how they didn't mention eyeglasses. On the
    other hand, prosthesis would be the proper term for an artificial eye
    or scleral shell.

    Neither contact lenses nor LASIK addresses the true cause of myopia,
    except that contact lenses do not permanently alter the structure or
    function of the eye to such a degree as surgery. The general public
    does indeed desire perfect vision 24/7, but most do not believe that
    the radical alteration and invasive nature of refractive surgery is the
    way to go about it...at least for now. I don't think my job is to
    widen the misperception gap between contact lenses and LASIK. My job
    is to be a reality check. With refractive surgery, only a few microns
    stand between a good result and a permanently disabling result.

    If someone has hypertension, it's not usually because they have too
    much healthy heart tissue.

    DrG
     
    Dr. Leukoma, May 20, 2005
    #8
  9. Dr. Leukoma

    LarryDoc Guest

    Except that the hype marketing of RS obscures their understanding of the
    risks vs. benefits and then it does indeed become our responsibility to
    advise what's best for them. There is, at least around here, extreme
    misrepresentation of refractive surgery in the media, all geared to
    generating (or maintaining) patient flow, not what's best for the
    patient in the long term.
    And that is precisely the problem. If we can get beyond the emotion and
    focus on practical aspects and future possibilities, the market for
    LASIK dries up, as it has in places where the early adopters and risk
    takers have been used up. (The marketers' term, BTW.) If it was not so,
    then they wouldn't have to advertise with come-ons, enticements and
    misleading information to get patients in the door.

    Dr. G said it nicely:

    "I don't think my job is to
    widen the misperception gap between contact lenses and LASIK. My job
    is to be a reality check. With refractive surgery, only a few microns
    stand between a good result and a permanently disabling result."

    How many of our colleagues and their families go for RS compared to the
    uninformed mass public?

    --LB, O.D.
     
    LarryDoc, May 20, 2005
    #9
  10. Dr. Leukoma

    Dr. Leukoma Guest

    The point of consumer demand is well-taken. I have heard more than one
    comment coming from an eye professional to that effect, i.e. this is
    what the public wants so give it to them. This is called market-driven
    medicine. I'm coming from a similar place, which says that people want
    to see well 24/7, but they also don't want an intolerable amount of
    risk. Patients have had years of admonitions about sleeping in contact
    lenses drummed into their heads, whereas there has never been a similar
    drumbeat of bad press about the negative aspects of refractive surgery.
    I'll bet the average consumer thinks that sleeping in contact lenses
    will lead to a potentially blinding eye infection, whereas the risks of
    refractive surgery are insignificant. Am I way off the mark here?

    DrG
     
    Dr. Leukoma, May 20, 2005
    #10
  11. lasik is almost a rite of passage for some folks, and that is market
    driven for sure. With near record low "surgical" risk (as surgeries
    go), the surgeons love to do it, and are glad to accommodate the demand,
    even when it's questionable medicine. I can remember an early lasik
    seminar I attended where a doc said he thought that some day everyone
    would have lasik, even the low hyperopes. So maybe it's not as bad as
    it could be.

    w.stacy,o.d.
     
    William Stacy, May 20, 2005
    #11
  12. Dr. Leukoma

    Dr. Leukoma Guest

    So, whom are we kidding, then, William? When the venture capitalists
    were out trying to sell me limited partnerships in the Bachman Eye
    Institute in Toronto, they were estimating the market share to be
    waaaaay less than it actually is. I believe that the "right of
    passage" analogy is spot on. First glasses, then contacts, and when
    you reach 16, surgery. Kids are already asking me about it. The thing
    is that the LASIK problems are a cumulative number. Those people don't
    just get better overnight and go away, whereas the contact lens
    problems do always get better and go away.

    DrG
     
    Dr. Leukoma, May 20, 2005
    #12
  13. Dr. Leukoma wrote:

    The thing
    I had an OMD tell me something that is kind of spooky. He said he was
    thinking seriously about getting some additional training in corneal
    transplant surgery, because he is thinking there will be a significant
    demand there for post lasik people, one which could be a lucrative
    niche, especially for all those lasik surgeons...

    I wonder what the final numbers might be... Even if only 1% of all post
    lasik people eventually needed one transplant... hmm..., could we have
    a run on the bank?

    bill
     
    William Stacy, May 20, 2005
    #13
  14. Dr. Leukoma

    LarryDoc Guest

    No, right on. The question is how did it get this way or why did we let
    it.

    I'll propose some answers: 1. Our colleagues jumped on the LASIK
    bandwagon to reap the profits from so-called co-management, perhaps
    because we were afraid of competition from RS. We did a piss poor job of
    educating our patients. 2. Our profession is slow to adopt new contact
    lens technologies. There is simply no excuse for dispensing low DK
    lenses for extended wear and there is plenty of data to suggest that
    si-hydros are far, far safer than anything else out there for EW and
    likely safer even for daily wear. We did a piss poor job of educating
    our patients. But: 3. The contact lens industry has been slow to provide
    a full range of parameters in si-hydros. And as I have written
    previously, perhaps there is a "conspiracy" to forsake contact lenses in
    the hope there will be a larger pool of patients for RS.

    Now for the test: How many LASIK procedures to date? At 3% (a
    conservative) bad outcome rate, how many people will be seeking
    additional medical and optical threatment(s) in the coming years? There
    is the next be industry, friends.

    Thank goodness this is not cross-posted to alt.lasik-eyes!

    --LB, O.D.
     
    LarryDoc, May 20, 2005
    #14
  15. Dr. Leukoma

    Dr. Leukoma Guest

    Oh, Larry, I don't believe in that conspiracy. There was a confluence
    of events, beginning with the over-marketing of 30 day continuous wear
    lenses in the 1970's. Those lenses were originally developed for
    aphakic cataract patients who couldn't remove and insert their lenses.
    Unfortunately, the science lagged the hype, and infections resulted.
    Of course, we didn't fully understand the role of DK back then. Then
    everybody recoiled from extended wear.

    Instead, the idea of disposability took hold, and came to fruition with
    the Acuvue lens. That sparked a revolution in manufacturing technology
    from expensive lathe cut lenses to cheap molded lenses. The result was
    massive capitol diversion from material science R&D to manufacturing
    upgrades. Unfortunately, that didn't resolve anything, except to
    convince everybody that the contact lens market was maturing into a
    price-driven commodity business with little or no product
    differentiation.

    The promise of problem-free continuous wear lenses was all but
    eliminated in the minds of the consumers as well as in the minds of the
    practitioners because of the steady drumbeat of articles and lectures
    on the dangers of continuous wear. It was at that time that I had an
    interesting conversation with my Menicon representative on the Japanese
    view of the American market, which essentially was that the market
    wasn't ready for technical innovation because technical innovation
    couldn't exist in a cut-throat market dominated by price.

    Now, the irony is that just as the contact lens industry has once again
    come up with true innovation, many practitioners cannot make enough
    profit to want to promote it to consumers who are still afraid to sleep
    in their lenses and who justifiably question the justifcation of the
    higher prices that new technology demands. LASIK marketers have very
    effectively exploited this situation, and justifiably so. But, I think
    that tables are about to turn. I have turned so many problem patients
    into contact lens successes with the new technologies, and there are
    more in the pipeline. If I were to have a third career, it would be as
    a polymer scientist in this new and exciting field.

    DrG
     
    Dr. Leukoma, May 21, 2005
    #15
  16. Dr. Leukoma

    Dr. Leukoma Guest

    Oh, Larry, I don't believe in that conspiracy. There was a confluence
    of events, beginning with the over-marketing of 30 day continuous wear
    lenses in the 1970's. Those lenses were originally developed for
    aphakic cataract patients who couldn't remove and insert their lenses.
    Unfortunately, the science lagged the hype, and infections resulted.
    Of course, we didn't fully understand the role of DK back then. Then
    everybody recoiled from extended wear.


    Instead, the idea of disposability took hold, and came to fruition with

    the Acuvue lens. That sparked a revolution in manufacturing technology

    from expensive lathe cut lenses to cheap molded lenses. The result was

    massive capitol diversion from material science R&D to manufacturing
    upgrades. Unfortunately, that didn't resolve anything, except to
    convince everybody that the contact lens market was maturing into a
    price-driven commodity business with little or no product
    differentiation.


    The promise of problem-free continuous wear lenses was all but
    eliminated in the minds of the consumers as well as in the minds of the

    practitioners because of the steady drumbeat of articles and lectures
    on the dangers of continuous wear. It was at that time that I had an
    interesting conversation with my Menicon representative on the Japanese

    view of the American market, which essentially was that the market
    wasn't ready for technical innovation because technical innovation
    couldn't exist in a cut-throat market dominated by price.


    Now, the irony is that just as the contact lens industry has once again

    come up with true innovation, many practitioners cannot make enough
    profit to want to promote it to consumers who are still afraid to sleep

    in their lenses and who are naturally sceptical of the
    higher prices that new technology demands. LASIK marketers have very
    effectively exploited this situation, and justifiably so. But, I think

    that tables are about to turn. I have turned so many problem patients
    into contact lens successes with the new technologies, and there are
    more in the pipeline. If I were to have a third career, it would be as

    a polymer scientist in this new and exciting field.


    DrG
     
    Dr. Leukoma, May 21, 2005
    #16
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