The College of Optometrists

now that its been a few years since sillicon hydrogels have been around, do many of you actively promote extended wear and do you feel more comfortable about it now then a few years ago? if a px wishes to wear c/l all day, everyday, do you recommend the daily disposable route as the best one or a daily wear sillicon hydrogel or extended wear sillicon hydrogel?

daily wear Si, with some overnight wear, couple/three days. some wearing extended - full 30days but seems to be not essential for most patients

I encourage CW where suitable.recent research shows that those who are able to wear for more than 20 days are less likely to encounter a serious problem.Of course the ultimate contact lens would be a daily replacement silicone hydrogel-how far away is that?

it is silly to equate silicon lenses with extended wear. The real use of silicon lenses is to decrease chronic hypoxia and also to some extent reduce immune reactions from lens soiling (as the lenses stay cleaner).

Some people can wear the lenses for up to a week at a time - but we always say 2 days no lenses then.

The way we look at it is that

1)its a problem solving lens for px with neov &/or chronic limbitis

2) It can give some extended capability if needed.

But we explain that extended wear is not a human right and is associated with corneal infections. I remember the researchers said you only get one infection per 100 years wear ( or what ever they claimed) - rubbish! Infections are th never ending risk with these lenses = we are in a very open plan public opticians in a supermarket - and we get (on average) 20 infections a year from these lenses (fitted elsewhere might I add). I had so many when I first joined I was able to write a report on them!

Are you sure that the patients you have seen have infections palfi?yes there is an increased amount of infiltrates but remember that is inflammation not infection and we also see infiltrates in non contact lens wearers.

I believe these lenses are excellent for continuous wear if given to the correct patients and if monitored correctly.

They have been an excellent practice builder for my practice and also have given us something interesting to research.

Did you write a report on the "infections"?Did you report them to the regulatory bodies?If you saw any Mk you should have if only just to help us get accurate figures for infection rates.

yes they were MK and happen suddenly - presenting mainly on awaking.

You cannot monitor people - behind yr back they do what they like - so you can only explain what to do in cases of problem. And that hardly ever works - I give my mobile number and email address to EVERY CL user I see. I do 2 - 3 fits a day and countless after cares. Number of people using this STANDS AT NILL. (I had one email me to bitch about slow service - thats all).

I sent my report to City and Islington College - it missed the BCLA deadline for posters. But II have come to various conclusions on the risk of Si and MK - but thats my business.

don't seek anything over it.

If you are not getting problems back - then yourt grief cases are going elsewhere. Thats all. Blimey - I even had one px (just after I started) who lost most of her vision in such an incident (I use her case to educate the other wearers). Sorry -- its true - palfi

20 cases of MK in one practice in one year?Now that is a lot.How are you so sure they were MK?.Did you see them after they had been to the hospital?was it confirmed by cultures at the hospital?

It is very easy to suspect an MK but very few actually turn out to be MK.It is easier after the event to decide what the nature of the problem was.This can be done by observing the size,shape,location and depth of scar.

I have referred some patients with nasty looking lesions which I have suspected to be MK.In the vast majority of occassions they have returned to the practice with NO scarring at all telling me it was not an MK.I have seen one MK and it was so very different to all the other adverse events I have seen.

If you look at the figures on the silicone hydrogels website you will see that not many cases of MK have been reported worldwide.In fact you can also report any cases of MK on the site and help contribute to the worldwide knowledge on the lenses.

-it does sound a lot ! I will check with my colleague on tuesday to get accurate numbers. I think it was total cases of MK from all kinds of lenses that I was quoting. We do get them though - I can think of a recent one. One common link is that I think they all smoked. I will have to check with my colleague....

C'mon do you really think that an MK sufferer will be walking around a brightly light supermarket?Its the ophthalmological equivalent of a heart attack .You may have seen one or two but 20?

Palf

I am not trying to be critical of you but i do think it is easy to jump to the wrong conclusion when we see a patient with a sore red eye.And as you say MK or any adverse event can be caused by many different types of CL's.I have referred many thinking I have a definite MK only to see them return with a perfectly clear cornea 3 or 4 days later!Of course the correct thing to do is to refer for ophthalmological treatment.The problem being we dont always get the feedback as to what the problem has been.This is due to a combination of poor communication and in many cases the ophthalmologist wont be sure what the problem has been.It will in most cases have cleared up so they aint to concerned as to the nature of the problem.Of course the ophthalmologist will blame the contact lenses.

yea - perhaps Graeme - I can remember the last one had a definite corneal break - it was not marginal, and it hurt like hell, with a clowd underneath. I will check with my colleague tomorrow - I can't believe the number I quoted myself. It may have been all the inefctions together. I will check tomorrow. Most we sent up there had corneal type antibiotics - I know that.

Right, had a word with my mate - we have had about 8 infections this yr and one possible. Two CLARES of some degree and an odd Marginal ulcer.

All were wearing Night and Days, nearly all smoked, all were ladies and abt 30 year old, professional and most had kids. Most ulcers started on awaking within the third week of wear. THey started with a gritty feel which increased. All had slightly swollen lids and limbal engorgement. None had reached the stage of getting very painful (which seems rare in my humble opinion).I had forgotton most of this as we are busy and seeing an infection is nothing remarkable to me.

All were refered to eye casualty and reported back that they were treated for ulcers of the cornea. One resumed wear as before, the rest went to daily lenses. We also had one lady (last year) who had a corneal ulcer from daily disposables.

Which goes to say that its not the lens - but the handling and care.

We get good feedback - 'cos we keep in phone contact! palf

The smoking is an interesting one.There are definetely links there of some sort.My problems seem to have been young males more than females and I alwasy linked it to personal hygiene.

We still have a lot to learn regarding ulcers and inflammation and the causes.Certainly wearing contact lenses of any sort increases the chances of an infection.

for blokes - well - we definately don't reccommend extended 'cos - when I started we were having so many problems with them. So iphoned up the wives and mums etc behind the px back. (Not very ethical - but interesting!).

Blokes who like to sleep in their cls - also enjoy staying out late and having a drink. So they skip hygiene and fall into bed. Then they dig their lenses out and hey presto - a problem or infection. Needs more research doesn't it Graeme - would be interesting too!

The other way to look at it with many cl abusers is that they will sleep in their lenses no matter what type they have.So surely its better to have them wear a SiH than a daily disp?

Any thoughts on the smoking issue?Is it a lower immune system or is it a link to the physical touching of the cigarette.It may even be due to the smoke being exhaled-who knows?Not sure the best way to tackle any research.there may be two projects required.One to estasblish how many ulcers occur in smokers,non-smokers etc.the other to find out what it is amongst smokers or the act of smoking that makes them more likely to get a cl related infection.