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si hy lens experiences
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Sat Jul 15, 2006 1:56 am    Post subject: Re: si hy lens experiences Reply with quote

William Stacy wrote:
Quote:
I've refit quite a few people into silicone lenses this year, and am
thinking I should have paid more attention to some of the complaints
about these lenses I've heard off an on. Specifically, I've done quite
a few Oasys lenses. Lately I've seen more than my share of keratites,
and I'm starting to think it might be the lens material. For example, I
refit a gal who was happy with focus monthlies with Oasys a couple of
months ago. Last month she came in with 3+ generalized spk o.u. 3+
conj. redness o.u., and lots of discomfort. 10 days later after
Tobradex q.i.d. she was fine, so we threw out the case, started over
with a fresh pair. She's back. Same problem. Using optifree. So now
I'm blaming the materials. I've also seen a lot of limbal staining,
loss of adaptation and what not . Oh yeah, and I did have one case of
fusarium; an Oasys patient using renu with moistureloc (on her own).
But then lots off success, too. Any thoughts from the professionals or
any patients who might have recently switched?

thanks

w.stacy, o.d.


contacts are much safer than lasik but not risk free. Were any of your
patients sleeping in their contacts? Thats a big NO NO. My own
optometrist warns his patients to never sleep in contacts and not to
wear them more than 12 hours without removing them to give your eyes a
break.
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Dr. Leukoma
medicine forum Guru


Joined: 30 Apr 2005
Posts: 1283

PostPosted: Sat Jul 15, 2006 2:47 am    Post subject: Re: si hy lens experiences Reply with quote

William Stacy wrote:
Quote:
I've refit quite a few people into silicone lenses this year, and am
thinking I should have paid more attention to some of the complaints
about these lenses I've heard off an on. Specifically, I've done quite
a few Oasys lenses. Lately I've seen more than my share of keratites,
and I'm starting to think it might be the lens material. For example, I
refit a gal who was happy with focus monthlies with Oasys a couple of
months ago. Last month she came in with 3+ generalized spk o.u. 3+
conj. redness o.u., and lots of discomfort. 10 days later after
Tobradex q.i.d. she was fine, so we threw out the case, started over
with a fresh pair. She's back. Same problem. Using optifree. So now
I'm blaming the materials. I've also seen a lot of limbal staining,
loss of adaptation and what not . Oh yeah, and I did have one case of
fusarium; an Oasys patient using renu with moistureloc (on her own).
But then lots off success, too. Any thoughts from the professionals or
any patients who might have recently switched?

thanks

w.stacy, o.d.

Are you serious? Our experiences couldn't be more dissimilar.
Silicone hydrogel lenses have resolved many of those very problems in
my practice.

DrG
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Anon E. Muss
medicine forum Guru Wannabe


Joined: 22 May 2006
Posts: 136

PostPosted: Sat Jul 15, 2006 6:20 am    Post subject: Re: si hy lens experiences Reply with quote

On Sat, 15 Jul 2006 00:40:37 GMT, William Stacy <wstacy@obase.net>
wrote:

Quote:
I've refit quite a few people into silicone lenses this year, and am
thinking I should have paid more attention to some of the complaints
about these lenses I've heard off an on. Specifically, I've done quite
a few Oasys lenses. Lately I've seen more than my share of keratites,
and I'm starting to think it might be the lens material. For example, I
refit a gal who was happy with focus monthlies with Oasys a couple of
months ago. Last month she came in with 3+ generalized spk o.u. 3+
conj. redness o.u., and lots of discomfort. 10 days later after
Tobradex q.i.d. she was fine, so we threw out the case, started over
with a fresh pair. She's back. Same problem. Using optifree. So now
I'm blaming the materials.

Extended wear or daily wear?

Quote:
I've also seen a lot of limbal staining, loss of adaptation and what
not . Oh yeah, and I did have one case of fusarium; an Oasys patient
using renu with moistureloc (on her own). But then lots off success,
too. Any thoughts from the professionals or any patients who might
have recently switched?

The only problem with silicone hydrogel lenses I have had are these:

1. They deposit easier, and in some cases, much easier. I have had a
couple patients that couldn't even get a week's wear out of them. For
most people, this isn't a problem.

2. Some people who have been successful EW patients (as far as not
getting CLARE and bacterial keratitis) for years with, say, Acuvue
have had problems when I switched them to silicone hydrogel lenses, in
particular, Ciba Focus Night & Day. These people may have had bad
limbal neovascularization, conjunctival injection and microcystic
edema, but not acute problems with Acuvue. Sure enough, switching to
a silicone hydrogel got rid of the microcystic edema, made the eyes
whiter and the limbal injection start to regress, but they'd come in
the aforementioned problems.

I have attributed this to inadequate tear exchange between the contact
lens and the cornea. I have eliminated this in the vast majority of
cases by switching patients to the 8.6 BC. The ones that still have
problems (flat corneas) I instruct to remove the lenses periodically
(as often as daily), rinse them off with saline and insert back into
the eye. Even using artifical tears a couple times a day might help.

It just goes to show us all that oxygen transmission isn't everything.

BTW, I haven't had problems with Oasys because I don't fit them as
much as other silicone hydrogels. I have been "gun shy" using them
because they only come in an 8.4 BC and tend to not move much on
corneas with average Ks (~ 43.50). For the same reasons, I don't fit
8.3 Acuvue Advance much even though the Vistakon rep told us it is the
BC the vast majority of eye doctors are fitting (something like 80%).

Even with these problems, silicone hydrogels are still, far and away,
my soft contact lens material of choice in 7/2006. I'm also a
satisfied wearer -- I get a full day's of comfortable wear out of them
(18 hours) consistently where my eyes would feel dry with HEMA lenses
after a couple hours.
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Astrid via MedKB.com
medicine forum beginner


Joined: 01 May 2006
Posts: 12

PostPosted: Sat Jul 15, 2006 11:22 am    Post subject: Re: si hy lens experiences Reply with quote

I switched from dailies to O2 Optix in December last because I was finding
the dailies too dry - by 5 pm I was desperate to get them out and finding
them very uncomfortable. My optician was initially a bit cautious as I'd
never had anything but dailies and he thought I might find the cleaning
routine bothersome. But nearly 7 months later I've had no problem with them
and the cleaning really isn't much of an issue. Given my previous experience
with dailies I can only sing the praises of silicon hydrogel lenses.

--
Message posted via MedKB.com
http://www.medkb.com/Uwe/Forums.aspx/vision/200607/1
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Dr. Leukoma
medicine forum Guru


Joined: 30 Apr 2005
Posts: 1283

PostPosted: Sat Jul 15, 2006 12:25 pm    Post subject: Re: si hy lens experiences Reply with quote

Anon E. Muss wrote:

Quote:
1. They deposit easier, and in some cases, much easier. I have had a
couple patients that couldn't even get a week's wear out of them. For
most people, this isn't a problem.

????? Again, not my experience. But, then again, I don't use Acuvue
Advance.
Quote:

I have attributed this to inadequate tear exchange between the contact
lens and the cornea. I have eliminated this in the vast majority of
cases by switching patients to the 8.6 BC. The ones that still have
problems (flat corneas) I instruct to remove the lenses periodically
(as often as daily), rinse them off with saline and insert back into
the eye. Even using artifical tears a couple times a day might help.

It depends on the modulus. Si-hy lenses are quite "rubbery," and tend
to show greater movement on the eye than HEMA lenses in my experience.
Tight lens syndrome is virtually unheard in my practice with Sy-hy
lenses. I am in the Southwest, BTW, where dry eyes are pandemic. In
fact, Texas has the dubious distinction of being near the top of the
list for dry eye symptoms in a recent survey.

Quote:
It just goes to show us all that oxygen transmission isn't everything.

No, it isn't. But, ultra high oxygen transmission coupled with low
water and a wettable surface is a pretty darn good thing.
Quote:

BTW, I haven't had problems with Oasys because I don't fit them as
much as other silicone hydrogels. I have been "gun shy" using them
because they only come in an 8.4 BC and tend to not move much on
corneas with average Ks (~ 43.50). For the same reasons, I don't fit
8.3 Acuvue Advance much even though the Vistakon rep told us it is the
BC the vast majority of eye doctors are fitting (something like 80%).

My experience with Oasys is that I cannot keep enough of them in stock.
I have been fitting Sy-hy lenses since 1999.
Quote:

Even with these problems, silicone hydrogels are still, far and away,
my soft contact lens material of choice in 7/2006. I'm also a
satisfied wearer -- I get a full day's of comfortable wear out of them
(18 hours) consistently where my eyes would feel dry with HEMA lenses
after a couple hours.

AMEN to that, brother. Having said that, there is still room for
improvement in terms of surface chemistry.

DrG
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JohnDoe
medicine forum Guru


Joined: 14 Jun 2005
Posts: 364

PostPosted: Sat Jul 15, 2006 12:37 pm    Post subject: Re: si hy lens experiences Reply with quote

William Stacy wrote:
Quote:
I've refit quite a few people into silicone lenses this year, and am
thinking I should have paid more attention to some of the complaints
about these lenses I've heard off an on. Specifically, I've done quite
a few Oasys lenses. Lately I've seen more than my share of keratites,
and I'm starting to think it might be the lens material. For example, I
refit a gal who was happy with focus monthlies with Oasys a couple of
months ago. Last month she came in with 3+ generalized spk o.u. 3+
conj. redness o.u., and lots of discomfort. 10 days later after
Tobradex q.i.d. she was fine, so we threw out the case, started over
with a fresh pair. She's back. Same problem. Using optifree. So now
I'm blaming the materials. I've also seen a lot of limbal staining,
loss of adaptation and what not . Oh yeah, and I did have one case of
fusarium; an Oasys patient using renu with moistureloc (on her own).
But then lots off success, too. Any thoughts from the professionals or
any patients who might have recently switched?

thanks

w.stacy, o.d.


I've only been fitting Oasys for about a month since I've had them
available to me, but O2Optix for over a year and Foc N&D 30N CW for
several years, and have had no problems at all with SPK (more than a few
problems with CLPC with the Foc N&D though).

As I was reading your post I was starting to think 'ReNu keratitis'...
until I came to the part where you said 'Using Optifree'. But could it
be some other external irritant e.g. preservatives in artificial tears,
or some other non-eye product she is exposed to??

With the exception of the CLPCs, all the patients I have upgraded have
been very happy and none have wanted to switch back.

Tell us the story of your Fusarium Px?

Dom
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William Stacy
medicine forum Guru


Joined: 01 May 2005
Posts: 1177

PostPosted: Sat Jul 15, 2006 3:16 pm    Post subject: Re: si hy lens experiences Reply with quote

Dom wrote:

Quote:

Tell us the story of your Fusarium Px?

Dom

I refit her from standard soft to oasys about 6 mos ago. On her own,
she bought renu withe moisture lock and was sleeping in them. She
walked in with what looked like a bacterial ulcer, but on referral, it
was cultured positive for fusarium. She ended up with a large scar
centered just outside the pupil margin superiorly, and lost a little
best va. She's still wearing oasys daily now on the other eye (nothing
on the scarred eye) and is going to sue B&L. Hopefully I won't be
named... She was case 119 in the US.

w.stacy, o.d.
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William Stacy
medicine forum Guru


Joined: 01 May 2005
Posts: 1177

PostPosted: Sat Jul 15, 2006 3:17 pm    Post subject: Re: si hy lens experiences Reply with quote

Most of the replies I've gotten are from docs who don't use much oasys,
so I'm for now gonna blame oasys and shift more towards Ciba si hys
since everyone seems to love them.

w.stacy, o.d.
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William Stacy
medicine forum Guru


Joined: 01 May 2005
Posts: 1177

PostPosted: Sat Jul 15, 2006 3:21 pm    Post subject: Re: si hy lens experiences Reply with quote

acemanvx@yahoo.com wrote:


Quote:
contacts are much safer than lasik but not risk free. Were any of your
patients sleeping in their contacts? Thats a big NO NO. My own
optometrist warns his patients to never sleep in contacts and not to
wear them more than 12 hours without removing them to give your eyes a
break.


As in most cases, such blanket statements are patently wrong. There are
plenty of people who are better off sleeping in their lenses than not,
due to constant innoculation of microbes from their hands when they
reinsert the lenses over and over agin...

w.stacy, o.d.
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Anon E. Muss
medicine forum Guru Wannabe


Joined: 22 May 2006
Posts: 136

PostPosted: Sat Jul 15, 2006 4:32 pm    Post subject: Re: si hy lens experiences Reply with quote

On Sat, 15 Jul 2006 15:16:18 GMT, William Stacy <wstacy@obase.net>
wrote:

Quote:
I refit her from standard soft to oasys about 6 mos ago. On her own,
she bought renu withe moisture lock and was sleeping in them.

Was she compliant with her lens care?

Quote:
She walked in with what looked like a bacterial ulcer, but on
referral, it was cultured positive for fusarium. She ended up with a
large scar centered just outside the pupil margin superiorly, and lost
a little best va. She's still wearing oasys daily now on the other
eye (nothing on the scarred eye) and is going to sue B&L. Hopefully I
won't be named... She was case 119 in the US.

That really sucks -- for the patient and for you.

It's still my personal opinion that there is no culpability on the
part of B&L, however, I think anyone who gets/had gotten a fusarium
related complication related to their MoisturLOC will probably get
some money from whomever has got (deep) pockets.

Scumbag, bottom-feeding lawyers are all over this.
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Dr. Leukoma
medicine forum Guru


Joined: 30 Apr 2005
Posts: 1283

PostPosted: Sat Jul 15, 2006 10:09 pm    Post subject: Re: si hy lens experiences Reply with quote

William Stacy wrote:
Quote:
Most of the replies I've gotten are from docs who don't use much oasys,
so I'm for now gonna blame oasys and shift more towards Ciba si hys
since everyone seems to love them.

Based upon your sci.med.vision poll? Unbelievable.

DrG
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Sun Jul 16, 2006 12:04 am    Post subject: Re: si hy lens experiences Reply with quote

William Stacy wrote:
Quote:
acemanvx@yahoo.com wrote:


contacts are much safer than lasik but not risk free. Were any of your
patients sleeping in their contacts? Thats a big NO NO. My own
optometrist warns his patients to never sleep in contacts and not to
wear them more than 12 hours without removing them to give your eyes a
break.


As in most cases, such blanket statements are patently wrong. There are
plenty of people who are better off sleeping in their lenses than not,
due to constant innoculation of microbes from their hands when they
reinsert the lenses over and over agin...

w.stacy, o.d.



There is something called washing your hands. I am amazed you dont know
that its much riskier to sleep in contacts and wear them for a week or
more without taking them out to be cleaned and to let your eyes rest.
You have strange beliefs that go against other optometrists who always
say to never sleep in contacts or if you must, take them out the next
morning and clean them well for dispotists. Leaving extend wear lens
for weeks on end lets dirt, gunk and bacteria build up and this is why
your patients develop infections and uclears. Thats what my own
optometrist warned would happen and thats what youve been seeing in
your patients :(


Yes I am against extend wear contacts and so is my optometrist, he will
only pescribe it if you promise to take them out every night.
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Sun Jul 16, 2006 12:07 am    Post subject: Re: si hy lens experiences Reply with quote

William Stacy wrote:
Quote:
Dom wrote:


Tell us the story of your Fusarium Px?

Dom

I refit her from standard soft to oasys about 6 mos ago. On her own,
she bought renu withe moisture lock and was sleeping in them. She
walked in with what looked like a bacterial ulcer, but on referral, it
was cultured positive for fusarium. She ended up with a large scar
centered just outside the pupil margin superiorly, and lost a little
best va. She's still wearing oasys daily now on the other eye (nothing
on the scarred eye) and is going to sue B&L. Hopefully I won't be
named... She was case 119 in the US.

w.stacy, o.d.


B&L may be able to prove her standard of lens care wasnt proper, ie
sleeping in contacts which is a big NO NO. I read an article on that
and B&L says its not the fault of their products but how people dont
take care of their contacts and eyes. If someone cant be responsable
for contacts, he or she needs to stick to glasses.
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serebel
medicine forum addict


Joined: 12 Aug 2005
Posts: 81

PostPosted: Sun Jul 16, 2006 12:46 am    Post subject: Re: si hy lens experiences Reply with quote

acemanvx@yahoo.com wrote:
Quote:


B&L may be able to prove her standard of lens care wasnt proper, ie
sleeping in contacts which is a big NO NO. I read an article on that
and B&L says its not the fault of their products but how people dont
take care of their contacts and eyes. If someone cant be responsable
for contacts, he or she needs to stick to glasses.


If sleeping in contacts are a big no-no, why do you extoll ortho-k ?
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acemanvx@yahoo.com
medicine forum Guru


Joined: 15 Nov 2005
Posts: 732

PostPosted: Sun Jul 16, 2006 2:04 am    Post subject: Re: si hy lens experiences Reply with quote

serebel wrote:
Quote:
acemanvx@yahoo.com wrote:


B&L may be able to prove her standard of lens care wasnt proper, ie
sleeping in contacts which is a big NO NO. I read an article on that
and B&L says its not the fault of their products but how people dont
take care of their contacts and eyes. If someone cant be responsable
for contacts, he or she needs to stick to glasses.


If sleeping in contacts are a big no-no, why do you extoll ortho-k ?


its as safe as regular wear lens because orthoK is based on RGP and
they are removed every morning so your eyes get all the oxygen. If
orthoK was worn a week or more without removing them then yes, problems
will occur too.
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