Credible opinions requested.
Roger2
lenses properly? I would say fewer than 10%.
The problem is, that's an expensive ordeal to go through to find out
if your OD is able to fit them right. You don't know until after they
tried if they knew what they were doing.
Eric 10Dpt
find a good fitter.
Jan
"Eric 10Dpt" <eric...@aol.com> schreef in bericht
news:20030901150952...@mb-m15.aol.com...
> Thats true Ragnar. rgps are the best alternative to RS. But it is
difficult to
> find a good fitter.
In what kind of "third world" country you live boys?
A successful percentage of about 90% to 98% must be possible!
At least it is in my country (The Netherlands)
--
Jan (normally Dutch spoken)
nor anti nor pro LASIK,LASEK,PRK etc.....
Ragnar Suomi
have some doctors in Holland.
Far less that 98% of eye doctors even attempt to fit RGP lenses. Most
do simple glasses and soft contacts.
Dr. Leukoma
I have no idea if what Ragnar says is true, but I think not. A person who
has had difficulties with RGP lenses may not be a good candidate. On the
other hand, that same person might be tempted to think that their doctor
didn't know what s/he was doing.
Also, in the U.S., the optometrist' training is now more medically-oriented,
and there is only so much that can be fit into the four-year curriculum.
Perhaps something has got to give, and learning how to be proficient in RGP
fitting "might" be one of them, but I am not familiar with the current
curriculum and so cannot comment. Is your scope of practice in Holland
similar to that in the U.S., i.e. diagnosing and treating eye disease,
including glaucoma?
DrG
"Jan" <ou...@haalditwegkabelfoon.nl> wrote in message
news:10624561...@halkan.kabelfoon.nl...
Jan
"Dr. Leukoma" <gre...@ix.netcom.com> schreef in bericht
news:Qz15b.5738$tw6....@newsread4.news.pas.earthlink.net...
> Jan,
>
> I have no idea if what Ragnar says is true, but I think not. A person who
> has had difficulties with RGP lenses may not be a good candidate.
I have the same opinion and what I meant to say is the 90% to 98% succes
appears after talking over and screening the candidate first before fitting
with RGP lenses.
On the
> other hand, that same person might be tempted to think that their doctor
> didn't know what s/he was doing.
When you use the name "doctor" in Holland whe assume you meant an
opthalmologist.
Opthalmologists in Holland seldome are fitting contactlenses by themselves,
the leave it to optometrists or contactlensspecialists.
>
> Also, in the U.S., the optometrist' training is now more
medically-oriented,
> and there is only so much that can be fit into the four-year curriculum.
The "new style" optometrist education in Holland several years ago started
in the same way but nower days they choose to have more time reserved for
education in fitting contactlenses (hard and soft one's) and a bit knowledge
in glasses.
Long time ago we had three stages in education, first "optician" after that
"optometrist (old style)" and the last part was to be trained as a
"contactlensspecialist".(you had to follow all three)
More or less a technical education in those days with lesser training in
diagnosing diseases and knowledge about pharmacy then optometrists have
today but more skilled in fitting procedures as today.
The "former" optometrist may not use this title anymore in Holland unless
he/she had an additional education to compensate for the missing medical
part and having the examening at the same level as the "new" optometrist.
BTW, the optometrists have to learn the same "stuff" as learned in the USA.
Most optometrists have a "bachelor" status (the same in the USA?) in Holland
and are not allowed to use the "doctor or Dr" title.
> Perhaps something has got to give, and learning how to be proficient in
RGP
> fitting "might" be one of them, but I am not familiar with the current
> curriculum and so cannot comment. Is your scope of practice in Holland
> similar to that in the U.S., i.e. diagnosing and treating eye disease,
> including glaucoma?
Optometrists in Holland are allowed to diagnose, but not to tread, eye
diseases.
They are allowed to use pharmaca for diagnosing but not for treating.
In Holland a standalone practice in optometry is rarely seen, due to the
fact that prescribing glasses or contactlenses is allowed to everebody who
wants to.
A part off them are working in eye-hospitals in a team together with
ophtalmologists and a larger part are practicing in eyecare-care shops (a
combination of optometry practice with an optician)
To make a living they have to be good in diagnosing diseases to point out
there different skill and expertise as opticians have and they have to be
good in fitting lenses wich they are allowed to sell.
Also others (without any knowledge grrrrrr....) are allowed today, to sell
and fit contactlenses so you have to be good to earn your money.
Originally the optometrists have to let go the consumer who is free to buy
where they want to but in practice this does't work that way.
No worries, only prescribing when needed in the same manner as you are
doing!
Leukoma, it is not easy to describe in a nutshell how it works here in my
beautiful country and therefore if you want to know more just email me. (if
you buy my English)
(remove the first ten letters after the "at" sign)
Roger2
population of Holland are generally all highly intelligent people.
Their standards are very high. There are no Minariks in Holland.
I find it obscene that the people of Holland speak English as a second
language better than people in England and the U.S. do as a primary
language.
I think to bring this thread back to it's original question, we need
to consider just the United States as a benchmark. Countries better
or worse just confuse the question.
Has anybody come up with an opinion of what percentage of U.S. ODs
they think successfully fit RGP lenses? Most of them don't even
attempt to fool with RGPs. Surgeons aren't the people to go to for
RGPs either, because they spend their time doing surgery, not fitting
contacts. Conversely, you don't go to an OD to have surgery done,
except in the case of followups in co-management. And in that case,
contacts are a good alternative to having enhancements done. And the
surgeon isn't going to be proficient at that.
CatmanX
cunsumer oriented society that demands perfection NOW and is not
prepared to wait. Optometrists just respond to that desire by avoiding
putting patients through the "pain" of GP lenses. There is the
patients fear of pain and the optometrists fear of the patients fear
of pain.
I am sure Dr L would agree that it is all in the presentation to the
patient. If you sit and discuss the options, pro's and con's, many
patients do opt for the GP option (certainly in my practice), but too
often we see OD's scared to go down that track due to lack of
expertise and fear of patient response.
In Japan and the UK, there is a much higher GP usage rate. In UK
because they have just tended to do more GP fitting over the years,
and in Japan as the market is practitioner driven and the patient gets
what the doctor tells them is best for them.
Eric 10Dpt
lenses after wearing them for more than 10 years or so. On the other hand rgp
lenses can be tolerated for decades. That's the reason why I think that soft
contact lenses eventually lead to refractive surgery. You start to wear them at
the age of 15 and you get lasik at 25. Given that most people cannot handle
rgps refractive surgery has a promising future. I am sure there are many people
who cannot tolerate any contact lens but do well with lasik or asa. In fact I
know some people who used to get red eyes after wearing a contact for only 2
hours but did very well with lasik.
Dr. Leukoma
news:20030903052256...@mb-m16.aol.com:
My practice is oriented about 60/40 in favor of soft lenses. This is a
consumer-driven market over here, and nowhere is that more true than in
North Texas. People seek instant gratification in part because they are
too busy working and shuttling the kids back and forth to activities. The
kids are busier than the parents. Then there is the peer pressure,
athletics, etc., etc.
In my practice, I see intolerance develop to both types of contact lenses.
I believe that the success of RGP wearers later in life is primarily due to
the fact that RGPs cause some anesthetization of the cornea. They are
mostly male, and are more likely to have a better tear film than the
androgen deficient female on HRT. I do know that I see more conversions to
soft lenses in this age group than vice-versa.
I think that the practitioner who fits nothing but soft lenses will say
that his/her patients are as happy as they can be, and therefore there is
no need to change philosophy. The RGP practitioner will probably say the
same. The refractive surgeon, who knows nothing about RGP lenses,
obviously thinks that LASIK is the answer. The reason is that the unhappy
patient either doesn't know that things could be better, or will quietly
leave the practice.
DrG
Ragnar Suomi
myopes.
The problem is that it seems like most ODs are almost exclusively soft
lenses and they are inadequate for high myopes with astigmatism. Soft
torics are worthless.
Eric 10Dpt
>I believe that the success of RGP wearers later in life is primarily due to
>the fact that RGPs cause some anesthetization of the cornea. They are
>mostly male, and are more likely to have a better tear film than the
>androgen deficient female on HRT. I do know that I see more conversions to
>soft lenses in this age group than vice-versa.
I think that intolerance to both types of lenses is mainly due to poor tear
film quality. I have read that rgps perform better in these conditions (because
they allow for tear exchange and don't adhere to the eye). However, in bad tear
film conditions my eyes get more irritated when wearing rgps. I have to
lubricate my eyes in order to tolerate rgps. But then I can wear them longer
than soft lenses and my eyes remain healthier.
Roger2
plenty of side-threads are emanating from it.
Here's another one. I'm not sure of it's validity because it's
something I remember from months ago. As I recall, lenses with a low
water content are better for eyes that are on the dry side. I think
this is due to the high water content lenses being like sponges, and
if they don't have a good fluid source, they don't perform as
intended.
Another issue is how often lenses are replaced. Ideally people would
put in brand new lenses every 8 hours. Due to expense, that is
impractical. Parents don't like pouring their entire savings into
their kids healthcare, so they are stuck with their glasses or
contacts for much longer their intended use.
Dr. Leukoma
news:15dclvogro7dk3hla...@4ax.com:
> Nobody is coming up with answers to the original estimation, but
> plenty of side-threads are emanating from it.
>
> Here's another one. I'm not sure of it's validity because it's
> something I remember from months ago. As I recall, lenses with a low
> water content are better for eyes that are on the dry side. I think
> this is due to the high water content lenses being like sponges, and
> if they don't have a good fluid source, they don't perform as
> intended.
You are absolutely correct in thinking that low water lenses are best for
dry eye. These are also known as Type I, low water, low ionic lenses per
the FDA classification. The silicone hydrogels behave more like those,
according to my research.
DrG
Dr. Leukoma
news:sj2clvognks9ogrt6...@4ax.com:
OK, how about 70/30?
DrG
Dr. Leukoma
That's essentially what I said. Tear quality tends to change over time.
When that happens, most of my patients are elated to be out of their RGP
lenses. Sorry.
DrG
Eric 10Dpt
>When that happens, most of my patients are elated to be out of their RGP
>lenses. Sorry.
>
Hopefully silicon hydrogels are a good solution to this kind of problems. I
still don't know wether the lack of tear exchange with low water content soft
lenses will cause intolerance after some years. In theory rgps should perform
better than soft lenses. My feeling is that hyaluronic acid does a lot in
increasing rgp comfort.
Dr. G, do you have any idea why rgp lenses would exacerbate dry eye more than
soft lenses? Is it poor wettability of the rgp surface or something else? How
do macrolenses perform in these cases?
Dr. Leukoma
For lack of a good technical explanation, I would just say "increased
friction" with the smaller diameter RGP. With a larger lens - a Macrolens,
for example - the lids glide smoothly over the edges, with only the surface
friction which is reduced with increased mucus production of the dry eye.
In a tear deficient situation, Macrolenses tend to suffer from lack of tear
exchange, or at least it would appear so from the fluorescein pattern under
the slit-lamp. After awhile, the patient reports foggy or hazy vision, but
rarely discomfort until the lens is removed. If the epithelium has been
compromised, then the eye can be uncomfortable.
I don't equate a low water soft lens with low tear exchange. I equate a
low water hydrogel lens with poor oxygen permeability. This is not true
for a silicone hydrogel lens, whose oxygen permeability is actually
inversely related to the amount of water. Their low water content also
gives them better dimensional stability in the dry eye, as they tend to
shrink less and remain mobile with the blink.
Very recently - within the past year or so - research is showing that the
rate of mitosis in the epithelium markedly slows under the influence of the
contact lens, more so in the case of low Dk lenses, and it takes awhile to
recover. Perhaps this is somehow related to long-term intolerance in some
way, but that is only pure speculation at this point. Nobody really knows
at this point. This work is being done right here in the Big D at our own
UT Southwestern Medical Center.
DrG
Ragnar Suomi
well enough. 70/30 is still a LOT more RGPs than most ODs do.
On Thu, 04 Sep 2003 02:16:09 GMT, "Dr. Leukoma"
Jeff Strickland
"Dr. Leukoma" <gre...@ix.netcom.com> wrote in message
news:Qz15b.5738$tw6....@newsread4.news.pas.earthlink.net...
> Jan,
>
> I have no idea if what Ragnar says is true, but I think not. A person who
> has had difficulties with RGP lenses may not be a good candidate. On the
> other hand, that same person might be tempted to think that their doctor
> didn't know what s/he was doing.
>
> Also, in the U.S., the optometrist' training is now more
medically-oriented,
> and there is only so much that can be fit into the four-year curriculum.
> Perhaps something has got to give, and learning how to be proficient in
RGP
> fitting "might" be one of them, but I am not familiar with the current
> curriculum and so cannot comment. Is your scope of practice in Holland
> similar to that in the U.S., i.e. diagnosing and treating eye disease,
> including glaucoma?
>
> DrG
>
I'm confused. You guys are talking about optometrists fitting these special
lenses, and diagnosing and treating eye diseases, but don't opthamologists
and not optometrists diagnose and treat eye diseases?
I know it probably doens't matter a whole lot, but I was under the
impression that opthamologists performed eye checks for disease and
glaucoma, and that it took an opthamology license to perform Lasik or Lasek,
or any other eye surgery.
Roger2
lenses and tests for various problems such as macular degeneration
whilst an ophthalmologist does things such as treating glaucoma,
cataracts, and doing refractive surgery.
Other than in Oklahoma, optometrists are forbidden from performing any
refractive surgeries. In OK, they can do PRK and IntraLASIK if they
meet a load of conditions and are highly supervised.
Dr. Leukoma
news:vm1ighq...@corp.supernews.com:
> I'm confused. You guys are talking about optometrists fitting these
> special lenses, and diagnosing and treating eye diseases, but don't
> opthamologists and not optometrists diagnose and treat eye diseases?
>
> I know it probably doens't matter a whole lot, but I was under the
> impression that opthamologists performed eye checks for disease and
> glaucoma, and that it took an opthamology license to perform Lasik or
> Lasek, or any other eye surgery.
Jeff,
I understand your misinformation. However, the fact is that optometrists
in nearly every state can and do diagnose and treat eye diseases within
their legal scope of practice. In my state of Texas, I can treat virtually
anything that can be treated with prescription eyedrops - and this includes
infections, inflammations, and glaucoma - and also prescribe oral
antibiotics and analgesics up to schedule III narcotics for the treatment
of eye conditions. This is quite similar in scope to your family dentist.
Of course, I am still continually referring patients out to
ophthalmologists for the treatment of things beyond my legal scope.
It is legal for optometrists in Oklahoma to use lasers. Oklahoma is just
across the Red River from Texas. I believe that Texas has more
ophthalmologists than Oklahoma.
DrG
Jeff Strickland
"Dr. Leukoma" <drgN...@leukoma.com> wrote in message
news:Xns93F3CF97D76...@204.127.204.17...
I am in California. I went to the optometrist recently to get my Rx checked,
and the doctor was not allowed to discuss laser surgery to me at all, except
that she did say that her examination showed no indications that I was a
poor candidate. Obviously, her statement fell short of endorsing the idea,
but she said that my eyes appeared to be healthy enough to support the
procedure. I tried to pry from her what the latest studies indicated as a
success/failure rates and if they had any idea of what the implications were
5 years later.
I considered Radial Keratotimy back in in '83, it turns out that 5 or 10
years after the procedure, many patients complain of stars caused by the
scarring on the eyes, andn I am glad that I did not get RK done on my eyes.
What, if any, late term implications have been discovered with laser eye
surgery? We understand the immediate implications of failures with the
procedures, but what are the long term implications of successful
procedures? I know people that had a procedure done 8 years ago, that is I
knew them then but have lost touch since then, and they were thrilled beyond
words with the procedure. The question is, are they still thrilled today?
Roger2
That is not good. I wonder if she is allowed to discuss things such
as toric lenses or RGPs. Just because your doctor doesn't prescribe
something or works at a place that doesn't deal in RGPs, why should
the patient suffer as a result?
Jeff Strickland
"Roger2" <roge...@aol.com> wrote in message
news:sru3mvgfkt9mp5t3u...@4ax.com...
> Your OD was not allowed to discuss laser surgery?
> That is not good. I wonder if she is allowed to discuss things such
> as toric lenses or RGPs. Just because your doctor doesn't prescribe
> something or works at a place that doesn't deal in RGPs, why should
> the patient suffer as a result?
>
>
optometrists do not get into areas that are covered by opthamologists, then
it makes perfect sense to me that my optometrist would not provide specific
guidance relative to laser surgery.
Dr. Leukoma
> I am in California. I went to the optometrist recently to get my Rx
> checked, and the doctor was not allowed to discuss laser surgery to me
> at all, except that she did say that her examination showed no
> indications that I was a poor candidate. Obviously, her statement fell
> short of endorsing the idea, but she said that my eyes appeared to be
> healthy enough to support the procedure. I tried to pry from her what
> the latest studies indicated as a success/failure rates and if they
> had any idea of what the implications were 5 years later.
>
> I considered Radial Keratotimy back in in '83, it turns out that 5 or
> 10 years after the procedure, many patients complain of stars caused
> by the scarring on the eyes, andn I am glad that I did not get RK done
> on my eyes. What, if any, late term implications have been discovered
> with laser eye surgery? We understand the immediate implications of
> failures with the procedures, but what are the long term implications
> of successful procedures? I know people that had a procedure done 8
> years ago, that is I knew them then but have lost touch since then,
> and they were thrilled beyond words with the procedure. The question
> is, are they still thrilled today?
>
>
With radial keratotomy, the chief long term problem is hyperopic shift
affecting 20-40% of RK eyes. This was known within the first five years of
the PERK study. With LASIK or PRK, I think that most of the complications
will occur within the first 6 months, if they are going to occur. A
notable exception would be in the case of ectasia, which is like the
hyperopic shift of RK except that it results in rapidly increasing myopia.
There again, I would expect signs of this to develop within the first five
years. But, we are not talking about 20% of post-LASIK patients here, and
probably not even 1% chance of this happening by today's standards.
DrG
lasik advocate with flap melt
requires referral to an Ophthalmologist then?
"Dr. Leukoma" <drgN...@leukoma.com> wrote in message news:<Xns93F3CF97D76...@204.127.204.17>...