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RGP/Ortho-K Dry Eyes/Sticking Contacts
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Scot
medicine forum beginner


Joined: 18 Jan 2006
Posts: 18

PostPosted: Thu Jun 08, 2006 4:22 pm    Post subject: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

Anyone have any ideas on sticky rgp contacts? I started with OK back
in january and am still working to make it right. Today I am pretty
happy with the results, though I do have some nighttime starbursting.

My biggest issue is dryness induced decentration. If I wear my lenses
while I am awake and blinking, it will take about 15 or so minutes for
my lenses to "stick" on my eyes, generally slightly off center. If I
put some drops in it will take a few minutes to "unstick" them but 15
minutes later they will stick again. Putting drops in every 5-10
minutes is not a viable option as the more drops I put in, the drier my
eyes seem to get. I would be happy to put the lenses in when it gets
dark as my starbursts are drastically reduced, but as t it sticks off
center I get a nice double vision problem the next day which is not
acceptable.

My normal use is actually while sleeping where I also have the issue
but to a much lesser extent. If I put them in and IMMEDIATELY go to
bed after putting a few drops of the boston re-wetting solution in, I
am generally fine by the next morning though every once in a while one
eye will stick a bit.

I did have my eyes checked with a corneal topographer and it looks
good, after a night where the contacts did not stick.

I'll be checking in with the doc next week, but figured I would ask to
see if anyone had any hints.

Using boston advance solution, the boston cleaner and boston drops.
Lenses are jade, based on boston materials (can't remember the exact
material name but there is only one or two AFAIK from boston)

Scot
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Dr. Leukoma
medicine forum Guru


Joined: 30 Apr 2005
Posts: 1283

PostPosted: Fri Jun 09, 2006 12:47 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

If you have dry eyes, you need that addressed. Treatments include
punctal plugs and drugs such as Restasis. First, you need a dry eye
workup.

DrG

Scot wrote:
Quote:
Anyone have any ideas on sticky rgp contacts? I started with OK back
in january and am still working to make it right. Today I am pretty
happy with the results, though I do have some nighttime starbursting.

My biggest issue is dryness induced decentration. If I wear my lenses
while I am awake and blinking, it will take about 15 or so minutes for
my lenses to "stick" on my eyes, generally slightly off center. If I
put some drops in it will take a few minutes to "unstick" them but 15
minutes later they will stick again. Putting drops in every 5-10
minutes is not a viable option as the more drops I put in, the drier my
eyes seem to get. I would be happy to put the lenses in when it gets
dark as my starbursts are drastically reduced, but as t it sticks off
center I get a nice double vision problem the next day which is not
acceptable.

My normal use is actually while sleeping where I also have the issue
but to a much lesser extent. If I put them in and IMMEDIATELY go to
bed after putting a few drops of the boston re-wetting solution in, I
am generally fine by the next morning though every once in a while one
eye will stick a bit.

I did have my eyes checked with a corneal topographer and it looks
good, after a night where the contacts did not stick.

I'll be checking in with the doc next week, but figured I would ask to
see if anyone had any hints.

Using boston advance solution, the boston cleaner and boston drops.
Lenses are jade, based on boston materials (can't remember the exact
material name but there is only one or two AFAIK from boston)

Scot
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Anon E. Muss
medicine forum Guru Wannabe


Joined: 22 May 2006
Posts: 136

PostPosted: Fri Jun 09, 2006 2:35 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

On 9 Jun 2006 05:47:42 -0700, "Dr. Leukoma" <drg@leukoma.com> wrote:

Quote:
If you have dry eyes, you need that addressed. Treatments include
punctal plugs and drugs such as Restasis. First, you need a dry eye
workup.

Which brings up an important point for laypersons: a good eyedoctor
does not just prescribe artificial tears dor dry eyes based on
symptomology only. A good doctor will perform a dry eye workup.

Dry eyes have various etiologies such as insufficient tear production,
excessive tear drainage, meibomian gland dysfunction. And different
causes have different treatments. Prescribing a wrong treatment
regimen for the particular cause of dry eyes can actually make things
worse (e.g., prescribing artifical tears when the cause is entirely
excessive evaporative loss due to meibomian gland disease.)

Some patients are put on topical steroids, some on hot compresses/lid
massage, some on a tetracycline, others on artificial tears, others on
RESTASIS, others on flaxseed oil, others still on punctal plugs and
other treatment modailities.

A careful workup -- usually beyond what is part of a routine
comprehensive eye examinaiton -- is normally required including things
such as a tear break-up time, fluorescein staining, and Schirmer's
testing, etc. Follow-ups are also required to gauge response to
treatment and to adjust the treatment regimen as needed. The various
treatment methods for dry eyes (topical steroids, oral tetracycline)
while normally quite safe can have serious potential side effects.

<rant>

I get some people -- mostly people who have well-vision insurance
through which we are participating providers, but their medical
insurance elsewhere (e.g., HMOs) -- who want me to treat their dry
eyes without peforming such a workup without getting properly
reimbursed because of cost or convenience, or simply not performing a
workup/followups.

o "Can't you just tell me which drops I should try?" (implied:
without me having to do [read: PAY for] the workup and follow-ups).
o "Can't I just try RESTASIS?" (implied: without me having to pay
for the workup and follow-ups)
o "What do you mean you don't know what is causing my dry eye? You
just performed an eye exam."
o "I don't want (have to) to go through my HMO. It will take at
least a couple weeks to see a specialist -- I will have to go to my
primary care doctor and then he will have to schedule an appointment
with a specialist -- that will be at least two days off work and the
hassle of dealing with my HMO (but I don't want to pay for a dry eye
workup and associated followups). Can't you just tell me what I
should try?" (implied: without me having to do [read: PAY for] the
workup and follow-ups).

Laymen should realize when you do things like that, you put the doctor
in an uncomfortable position. No matter nicely how you state it, some
patients will feel that the "rich" doctor is being "greedy" (rather
than the patient is being frugal) -- "You're already getting paid for
an exam by the insurance" (note: at an already reduced reimbursement
rate over usual & customary fee!) or the patient will feel like the
doctor is accusing them of being "cheap"

And some other patients still will say "That much! Just for dry
eyes??!!" These typically aren't cash patients who are used to paying
the normal U&C fees for an eye exam, but those with well-vision
insurance who come in only when the insurance covers an eye exam, want
"only what the insurance will cover" as far as frames/lenses, and pay
a $5.00 deductible. Perhaps when one gets used to paying a $5.00
deductible when their employers pay for their health/vision insurance,
how much school and what an OD does becomes undervalued?

(BTW, it's not the doctor's job to explain to you how your insurance
works, the intracies of it, why it covers vision and not medical eye
problems, etc. It's the patient's job to know what it covers. I mean
-- didn't you at least briefly read the coverage when you signed up
for it?)

Please don't tell me no other ODs ever experience this and I alone
occasionally get patients from the Twilight Zone.

</rant>
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Neil Brooks
medicine forum Guru


Joined: 24 Mar 2005
Posts: 1148

PostPosted: Fri Jun 09, 2006 3:05 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

Anon E. Muss wrote:
Quote:
On 9 Jun 2006 05:47:42 -0700, "Dr. Leukoma" <drg@leukoma.com> wrote:

If you have dry eyes, you need that addressed. Treatments include
punctal plugs and drugs such as Restasis. First, you need a dry eye
workup.

Which brings up an important point for laypersons: a good eyedoctor
does not just prescribe artificial tears dor dry eyes based on
symptomology only. A good doctor will perform a dry eye workup.

Dry eyes have various etiologies such as insufficient tear production,
excessive tear drainage, meibomian gland dysfunction. And different
causes have different treatments. Prescribing a wrong treatment
regimen for the particular cause of dry eyes can actually make things
worse (e.g., prescribing artifical tears when the cause is entirely
excessive evaporative loss due to meibomian gland disease.)

Some patients are put on topical steroids, some on hot compresses/lid
massage, some on a tetracycline, others on artificial tears, others on
RESTASIS, others on flaxseed oil, others still on punctal plugs and
other treatment modailities.

A careful workup -- usually beyond what is part of a routine
comprehensive eye examinaiton -- is normally required including things
such as a tear break-up time, fluorescein staining, and Schirmer's
testing, etc. Follow-ups are also required to gauge response to
treatment and to adjust the treatment regimen as needed. The various
treatment methods for dry eyes (topical steroids, oral tetracycline)
while normally quite safe can have serious potential side effects.

AMEN!
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Quick
medicine forum Guru


Joined: 19 Jun 2005
Posts: 343

PostPosted: Fri Jun 09, 2006 6:58 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

Anon E. Muss wrote:
Quote:
On 9 Jun 2006 05:47:42 -0700, "Dr. Leukoma"
drg@leukoma.com> wrote:

If you have dry eyes, you need that addressed.
Treatments include punctal plugs and drugs such as
Restasis. First, you need a dry eye workup.

Which brings up an important point for laypersons: a
good eyedoctor does not just prescribe artificial tears
dor dry eyes based on symptomology only. A good doctor
will perform a dry eye workup.

Dry eyes have various etiologies such as insufficient
tear production, excessive tear drainage, meibomian gland
dysfunction. And different causes have different
treatments. Prescribing a wrong treatment regimen for
the particular cause of dry eyes can actually make things
worse (e.g., prescribing artifical tears when the cause
is entirely excessive evaporative loss due to meibomian
gland disease.)

Some patients are put on topical steroids, some on hot
compresses/lid massage, some on a tetracycline, others on
artificial tears, others on RESTASIS, others on flaxseed
oil, others still on punctal plugs and other treatment
modailities.

A careful workup -- usually beyond what is part of a
routine comprehensive eye examinaiton -- is normally
required including things such as a tear break-up time,
fluorescein staining, and Schirmer's testing, etc.
Follow-ups are also required to gauge response to
treatment and to adjust the treatment regimen as needed.
The various treatment methods for dry eyes (topical
steroids, oral tetracycline) while normally quite safe
can have serious potential side effects.

rant

I get some people -- mostly people who have well-vision
insurance through which we are participating providers,
but their medical insurance elsewhere (e.g., HMOs) -- who
want me to treat their dry eyes without peforming such a
workup without getting properly reimbursed because of
cost or convenience, or simply not performing a
workup/followups.

o "Can't you just tell me which drops I should try?"
(implied: without me having to do [read: PAY for] the
workup and follow-ups).
o "Can't I just try RESTASIS?" (implied: without me
having to pay for the workup and follow-ups)
o "What do you mean you don't know what is causing my
dry eye? You just performed an eye exam."
o "I don't want (have to) to go through my HMO. It will
take at least a couple weeks to see a specialist -- I
will have to go to my primary care doctor and then he
will have to schedule an appointment with a specialist --
that will be at least two days off work and the hassle of
dealing with my HMO (but I don't want to pay for a dry
eye workup and associated followups). Can't you just
tell me what I should try?" (implied: without me having
to do [read: PAY for] the workup and follow-ups).

Laymen should realize when you do things like that, you
put the doctor in an uncomfortable position. No matter
nicely how you state it, some patients will feel that the
"rich" doctor is being "greedy" (rather than the patient
is being frugal) -- "You're already getting paid for an
exam by the insurance" (note: at an already reduced
reimbursement rate over usual & customary fee!) or the
patient will feel like the doctor is accusing them of
being "cheap"

And some other patients still will say "That much! Just
for dry eyes??!!" These typically aren't cash patients
who are used to paying the normal U&C fees for an eye
exam, but those with well-vision insurance who come in
only when the insurance covers an eye exam, want "only
what the insurance will cover" as far as frames/lenses,
and pay a $5.00 deductible. Perhaps when one gets used
to paying a $5.00 deductible when their employers pay for
their health/vision insurance, how much school and what
an OD does becomes undervalued?

(BTW, it's not the doctor's job to explain to you how
your insurance works, the intracies of it, why it covers
vision and not medical eye problems, etc. It's the
patient's job to know what it covers. I mean -- didn't
you at least briefly read the coverage when you signed up
for it?)

Please don't tell me no other ODs ever experience this
and I alone occasionally get patients from the Twilight
Zone.

I agree with what you say except for your assumption that
it's entirely motivated by cost. A very good number of
us patients are just plain lazy. We got other stuff to do
without the inconvenience of taking care of our bodies.
That's why we came to you. There are some of us who
take great interest in ourselves and make a point to put
forth the effort to become as educated a participant in
our health care as possible, but that's not everybody.

It is a hassle/inconvenience to go to the doctor's. And
even more so to go through the HMO process, etc. There
is always the hope of taking the "quick shot". "Heh doc,
just try something, maybe we'll get lucky. If not, well,
then we'll have to go the prescribed route."

Yes I can well imagine the price thing. Especially with
something like eye care. There is a perception factor.
You go to the eye doc and there are glasses, frames,
and stuff up front for sale. The docs and assistants
usually aren't wearing white lab coats and full hospital
gear. It has a sort of commercial atmosphere. Like you're
at the mall. You go to your GP and the atmosphere is
different (granted, less pleasant). For some reason you
expect the charges at your GP to be mysterious, numerous,
and huge. I won't get into that. Back to the post.

Absolutely true. It's not your responsibility to know how
my insurance works and what I'm supposed to do to
submit a claim. BUT... that's going to be a huge factor
in my decision to use your services. You have no idea
the impression it makes when the person at the front
says "Yes, we take that. I see you have this option so
your co-pay will be this". "uhhh, do I have to call my
PCP, submit this form here and that one there?". "No,
I'll take care of all that for you". Inside I'm going "YES!".

I would guess it to be cost effective for your office
management to have someone up front to keep up
on all this and handle it.

-Quick
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Dr. Leukoma
medicine forum Guru


Joined: 30 Apr 2005
Posts: 1283

PostPosted: Fri Jun 09, 2006 9:24 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

Quick wrote:

Quote:
I agree with what you say except for your assumption that
it's entirely motivated by cost. A very good number of
us patients are just plain lazy. We got other stuff to do
without the inconvenience of taking care of our bodies.
That's why we came to you. There are some of us who
take great interest in ourselves and make a point to put
forth the effort to become as educated a participant in
our health care as possible, but that's not everybody.

By the same token, "we" have better things to do than shuffle papers.

(snip)

Quote:
I would guess it to be cost effective for your office
management to have someone up front to keep up
on all this and handle it.

I'm not sure it is ever cost effective. The person who files insurance
claims cannot also be doing patient care things. Yet, that person adds
to the overhead of running a practice. Patient X, who used to pay $Y
for a service, now has insurance that reimburses $0.7Y for the same
service. When every provider is on the same panel, all that has been
accomplished is that additional layers of cost have been added to
service the same patient.

Yes, we're doing more for the same amount of money, or less money
usually, but it isn't related to patient care or services.

DrG
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Scot
medicine forum beginner


Joined: 18 Jan 2006
Posts: 18

PostPosted: Fri Jun 09, 2006 11:23 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

I think the issue is less about lazy patients and more about the lack
of valuable information out there. Nowhere have I found this more
apparent than in dentistry, with eye procedures and practices being a
close second Smile Much of the information you do find is biased and
there are a great number of doctors out there who are basically sales
people for different brands. I know this isn't always the case, but
from the consumers standpoint it is a bit disconcerting.

At this point patients don't know what to ask for. Just the fact I am
asking this here says something, and I would rate myself as a
persistant searcher for information.

As for my condition, I will be seeing the doc next week so its all
good, just looking for more information. To the question of "dry eye" I
never really seem to have an issue except with contacts. The longer I
wear them, the dryer my eyes get. I take em out, and viola I am fine
again. Must be nice to be one of those people who can just pop them in
early and take em out at midnight.

Scot
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Dr. Leukoma
medicine forum Guru


Joined: 30 Apr 2005
Posts: 1283

PostPosted: Fri Jun 09, 2006 11:51 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

Scot wrote:

Quote:

As for my condition, I will be seeing the doc next week so its all
good, just looking for more information. To the question of "dry eye" I
never really seem to have an issue except with contacts. The longer I
wear them, the dryer my eyes get. I take em out, and viola I am fine
again. Must be nice to be one of those people who can just pop them in
early and take em out at midnight.


Scott, trust me. I routinely fit RGP lenses on very challenging cases.
If you don't have enough tears to float them, they will stick. Of
course, that isn't the only variable, but it should not be overlooked.

DrG
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Anon E. Muss
medicine forum Guru Wannabe


Joined: 22 May 2006
Posts: 136

PostPosted: Fri Jun 09, 2006 11:52 pm    Post subject: Re: RGP/Ortho-K Dry Eyes/Sticking Contacts Reply with quote

On 9 Jun 2006 16:23:36 -0700, "Scot" <scot.kight@gmail.com> wrote:

[snip]

Quote:
To the question of "dry eye" I never really seem to have an issue
except with contacts. The longer I wear them, the dryer my eyes get.
I take em out, and viola I am fine again.

This is pretty intuitive and obvious, but in all likelihood means you
have just a mild case of dry eyes.

Sometimes people like you can consider RGPs. For some patients, they
make their dry eyes less symptomatic; for me, they aggravated it.
HEMA-based soft contact lenses were not much better. I tried ionic,
non-ionic, low-water content, high-water content and all combinations
of such -- I really didn't notice much difference that couldn't be
attributed to normal "good days" and "bad days".

Quote:
Must be nice to be one of those people who can just pop them in
early and take em out at midnight.

It is. And for probably 95% of the time, I can do that with silicone
hydrogel contact lenses.

I have other patients that silicone hydrogel lenses do not provide any
symptomatic improvement of their dry eyes, BUT I would have to say
that the majority of patients have less symptoms of dry eyes on
silicone hydrogel contacts vs HEMA lenses.
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