I really, truly enjoyed your commentary. Especially the "mass market
vision condoms". Can I use that?

And you're right on most accounts. I will admit that I personally use
RGP lenses and do so because, for my prescription, for my needs, they
are optically vastly superior to any soft lens currently available. I
also fit probably more RGP lenses than anyone around these parts. So
there it is. I'm out of the closet and I'm OK with it.

But you know what? It is technically possible for what I need to be made
in a soft, well, at least in a silicone hydrogel lens, not the good old
55% water bags. And it will happen as soon as the manufacturers' CPAs
and advertising execs develop an understanding that they can make good
bucks with it.

Of course there's a catch: I totally, sadly agree that Americans are
sold on the quick and comfortable, and many add cheap to the equation.
And our colleagues are too often locked into old technology either
because of laziness of financial "commitments" or "considerations",
neither a good excuse. The manufacturers only care about one thing, and
the mass market quick-and-easy chain stores and mail order resellers are
ruining it for everyone. Oh----except the manufacturers.

The reality is that for some people, prescription, cornea curvature,
cornea diameter, pupil size and lid tension issues come together in a
way that allows soft lenses to do a damn good job of providing an
excellent vision experience. And as I said, sometimes equal to or
superior to RGPs. Certainly not routinely. Certainly not never.
Sometimes what works is a surprise to me. I guess the eye is indeed more
than just a box camera ;-)

And you are also correct about the very cool new(er) high DK RGP
plastics and the unique things we can do with them. But for some people,
no matter how wonderful the material or design it will not be a
comfortable experience. Of course the same holds true for soft lenses.
How many people out there are just tolerating the end of day discomfort
and variable vision in a soft lens that could be improved upon by simply
switching to a different plastic or design? I've even switched people to
RGP lenses for better comfort, not to mention vision. Yup, it happens
that way, too.

There's no doubt that looking through a stable optical surface provides
better vision than seeing through a sponge of a lens.  I think aspheric
and high DK silicone hydrogel lenses change that, a bit, just as high DK
controllable flexibility RGP lenses and custom topography assisted lens
designs do the same. Very nice. There's a place for both. It would be
nice if more contact lens practitioners believed that. It would be nice
if we could meet more people's real-life needs with contact lenses so
there would be less cutting-and-melting LASIK.

The really important new contact lens technology in RGP, soft and
hopefully now hybrid lenses is pretty darn recent stuff coming after
decades of little innovation.  I think we might finally be getting
somewhere.

I'm glad we've had this discussion and I hope it has a message for our
colleagues and readers interested in contact lenses.

LB, OD
(still waiting for my perfect lens and a little bummed that some of my
patients have it better than I. ;-(   For now.)