| 1. |
I have a patient who has been wearing Night and Day lenses for 3 months (+4.00). At her last aftercare I discovered that she had suffered an intracorneal haemorrhage on removal of her lens. She has some slight vessel infiltration and suffers from HBP. I sent her to an Ophthalmologist who said she should not wear any CL's for 2/52 but did not want to see her back again! I have now reviewed the situation 2 weeks later and the haemorrhage is slowly resolving but looks like it will leave an opacity. Should I continue with CW and how long is it likely to take for it to resolve completely? I understand it will leave a scar but fortunately is not close to the visual axis so isn't likely to cause a problem with VA.answer |
| 2. |
Since the silicone hydrogels have thicker edges, does this increase the rate of GPC, and more importantly, can the patients arrive sooner at the "exhaustion syndrome", where they no longer tolerate contact lens wear?answer |
| 3. |
What is the youngest age that you feel you could ethically fit a patient with cosmetic 30 day wear silicone Hydrogels? I had a request today from a 12 year old (accompanied by her mother). She presently wears one day disposables successfully but finds insertion a bit of a problem first thing in the morning.
Apparently a school mate of hers already has them!answer |
| 4. |
I would like to know if there is any study between hydrogel CL and silicone hydrogel for patients with dry eye.answer |
| 5. |
I would like to know where I go to find a 'handy' chart that shows different stages of GPC to have in th exam room in order to educate patients about GPC? I am looking for a color photo series with the different stages illustrated. Something 8" X 11" or smaller.
".....a picture is worth 1,000 words...."answer |
| 6. |
With the flatter base curve N&D I noticed that the lenses seemed to have a tendency to loosen or become flatter after a few days of wear. I though this might have been because the front surface of the lenses became dryer. Because the posterior surface of the lenses remained in contact with the eye, it would stay wetter and the lenses would tend to be pulled away from the front surface only causing it to flatten. I have also noticed that the steeper lens does not have that tendency. I believe that because the material is more rigid than conventional soft lenses, the steeper anterior surface has a harder time to be pulled away from the cornea. Could you comment on this.answer |
| 7.
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Just wanting to know what the experience has been using Ciba N/D's in a piggy-back system for the more sensitive keratoconics that don't tolerate RGP's very well. Which lens is best used on the eye first, the soft or the hard?answer |
| 8. |
I have a patient who is now some 8 months pregnant and has been wearing Night and day lenses for some 18 months now. She is -7.00 and is keen to wear her lenses during childbirth to enable her to see the new baby when it arrives. Should I advise her to wear the lenses or to remove them during child birth?answer |
| 9.
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Silicone hydrogel extended lenses can cause keratitis etc, which can be caused by non-EW as well. Are there any effects that are UNIQUE to silicone hydrogel?answer |
| 10. |
What is your opinion on fitting a patient with silicone hydrogels for continuous wear if the patient is diabetic due to obesity and is not on any medication but is assessed regularly by his/her doctor?answer |
| 11.
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Which cleaning regimen(s) do you recommend for silicone hydrogels, and which regimens, if any, are contra-indicated?answer |
| 12. |
A patient is very pleased with N&D. White eyes, 8.40 better than 8.60 in contralateral trial and Rx -8.00 -6.50 R&L. Previous history low grade hypoxia with Focus and better with Dailies 7/7. Some Focus sols toxicity. N&D most comfortable etc etc no stain brilliant... Except they gum up between lens and eye with deposits nocte. Clear by morning and only way to see clearly in evening is to remove and clean (Opti-free express seems OK with no apparent allergic response). She loves the lenses, so do I, from her hypoxic history and D/W is obviously on at some cost but do you have any ideas. The deposits are greasy/oily, brownish under SL and stringy not mucin balls and no epithelial indentation, they disappear when lens is removed. Doesn't seem to need a rub just drop into sol, muck floats off and re-insert. Bit of a loss mate!answer |
| 13.
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I have been wearing both the PureVision lens and the Night and Day lens to test them for myself. The Purevision is comfortable after cleaning, but the Night and Day lens is less comfortable. The Night and Day lens wears beautifully as a continuous wear lens, but, once it is cleaned apparently loses some comfort. Is there a reason behind this?answer |
| 14. |
I have a 29 y.o. breast-feeding female trying the PureVision lenses. She had an episode of solution sensitivity induced keratitis about 18/12 ago but that has resolved and she has returned to normal daily lens wear (extreme h20)for the past year or so. After the first overnight wear, everthing seemed fine at the 'morning - after' review. However, during the second DAY of wear, she noticed the lenses were dirty and she needed to remove them, clean and reinsert. My examination revealed some type of deposits on the lenses. A rub and rinse removes them but she will notice the 'blur' from the deposits within six hours of wear again. This does not happen with her extreme h20 lenses. What is the cause of this? Her Rx is R & L -2.50 DS.answer |
| 15.
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I have found the Ciba Nite and Day cl to be useful in managing patients with dry eye (used on a daily basis). Is cleaning i.e. Rub and rinse, with a one step solution recommended on these particular lenses?answer |
| 16. |
In Dumbleton's editorial as well as the Optician article by Guillon and Maissa a distinction is made between rigidity and elasticity. My dictionary defines elasticity as flexibility and rigidity is lack of flexibility. Please explain the differences as applied to the properties of silicone hydrogels.answer |
| 17.
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I fitted a patient with silicone hydogels recently. No problem at 24 hour visit. At 1 week visit patient was happy but I noted distinct SEALs in both eyes. Still noticable 24 hours later after removing lenses. I have discontinued her wear with this mode of lenses and returned to daily disposables for occasional wear. Patient was disappointed. Did I have any option?answer |
| 18. |
What is the percentage of discontinuation due to SEAL and CLPC respectively?answer |
| 19. |
Could switching brands of Silicone Hydrogel lenses avoid or reduce the recurrence of the above reactions?answer |
| 20. |
Do you recommend refitting DW patients who have had inflammatory events such as IK, AIK or AI into CW? Would they be at greater risk for developing CLARE or CLPU?answer |
| 21. |
Are there any topographical changes in the cornea with a well fitting silicone hydrogel lens?answer |
| 22. |
Since the silicone hydrogel lenses are stiffer than a normal hydrogel how much astigmatism can be "masked" clinically with the focus day/night lens?answer |
| 23. |
How often would you expect to see microcysts in the cornea of silicone hydrogel extended wear patients?answer |
| 24. |
How do silicone hydrogels overcome the potential to be hydrophobic?answer |
| 25. |
Do you recommend a daily flush of the eyes when using CW lenses? If necessary, what would you recommend flushing with?answer |
| 26. |
I am a solo practice optometrist of 30 years with a moderate size contact lens practice. I have found success in reducing complication incidence with disposable soft lenses by emphasising the necessity for clean lenses and providing information on supplemental cleaning for those patients who will not be compliant with recommended disposable schedules. Due to the cost of silicone hydrogels I am having a problem compliance with monthly disposable schedule resulting in corneal complications assoiciated with soiled lenses. Is it possible to extend the lifespan of silicone hydrogels with supplemental cleaning?answer |
| 27. |
What are mucin balls and are they of clinical significance?answer |
| 28. |
Why should you not use low Dk/t soft contact lenses for extended wear.answer |
| 29. |
Does continuous wear of silicone hydrogel lenses result in physiological changes?answer |
| 30. |
Is continuous wear with silicone hydrogel lenses a viable alternative to refractive surgery?answer |
| 31. |
Is there a difference between continuous wear and extended wear?answer |
| 32. |
How much overnight corneal swelling do silicone hydrogel lenses produce?answer |
| 33. |
What sort of adverse events occur with silicone hydogel lenses?answer |
| 34. |
Because of greater price for CW lenses compared to DW to the patient, what would you suggest to a regular practice on how to approach patient with these type of lenses without having the usual "It's way too expensive" type of reaction from patient?answer |
| 35. |
Is high molecular weight fluorescein necessary for testing with the lens on the eye, or do silicone hydrogel lenses not take up stain in the same way as HEMA lenses do?answer |
| 36. |
Could you elaborate on the push up test, or give me an online reference?answer |
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