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Medical Forum / General / Vision / May 2005Silicone hydrogel lenses five times safer
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 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. > i agree. however safety has never been the driving issue as to why > patients seek refractive surgery. But it IS becoming so for an increasing number of surgical candidates. > 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. 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. > 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. 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. > 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. 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. 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 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 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 > 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. 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. > 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. 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. 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 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. > 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 [quoted text clipped - 9 lines] > > DrG 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 The thing > is that the LASIK problems are a cumulative number. Those people don't > just get better overnight and go away 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 > 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? 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. 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 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 Speaking as a lifelong wearer of spectacles and intermittent dabbler with contact lenses I have to say I'm tired of relying on an appliance of any sort for good vision. I remember the horrid results many of my friends experienced after having RK back in the early 1990s. I can learn from other people's experiences I'm convinced that any inconvenience attached to wearing corrective lenses is just that - inconvenience. It sure as hell beats the alternatives. Wooly "just call me four-eyes" Grrl >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. +++++++++++++ Reply to the list as I do not publish an email address to USENET. This practice has cut my spam by more than 95%. Of course, I did have to abandon a perfectly good email account... 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 |
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