The “Contact Lens Rule,” implements the Fairness to Contact Lens Consumers Act, codified at 15 U.S.C. 7601–7610, which requires that rules be issued to address the release, verification, and sale of contact lens prescriptions. Here is one part that I have a huge issue with.
(c) Verification events. A prescription is verified under paragraph (a)(2) of this section only if one of the following occurs:
(1) The prescriber confirms the prescription is accurate by direct communication with the seller;
(2) The prescriber informs the seller through direct communication that the prescription is inaccurate and provides the accurate prescription; or
(3) The prescriber fails to communicate with the seller within eight (8) business hours after receiving from the seller the information described in paragraph (b) of this section. During these eight (8) business hours, the seller shall provide a reasonable opportunity for the prescriber to communicate with the seller concerning the verification request.
Just because nobody replied back, doesn’t mean the Rx is ok….certainly not ok to send the order! This bothers me tremendously. Patients can by pass health checks for years, simply by giving bogus doctors info. I had a patient publicly call me out on the crookedness of online contact lens vendors. The sad part, is that its perfectly legal for the vendors to sell contacts to without actually verifying if the Rx is actually correct through a time constraint loophole. Basically, if they do not get verification wihtin 8 hours, they fill the order. The work around is simply. All one does is submit a name of a random doctor and hope that doctor does not tell the vendor that they are not a patient there. There is a drop down list of doctors names. I just picked the first one and the order went trhough with out an issue. Let me make this very clear:
I was able to order contacts that are not even close to the right power, size, shape or material for my eye. Dangerous! I was able to choose a doctor whom I never heard of from a convenient drop down list.
I’m guessing the Dr. Edward Smith doesn’t exist, didn’t see the verification, or didn’t care enough to let 1800 know that I was not a patient of his. It is absolutely crazy to think that if the vendor hears nothing back from the doctor, they assume everything is fine and ship you the contacts!!!!!! That assumption is dangerous. A better solution is to have the patient email/fax a physical copy of the Rx that has the doctor’s name, signature, expiration date and contact info. A camera phone can easily take a pic and email it in. It would also free up the doctor’s office from having to do the verification process. The current system is a joke and easily gamed. Its a very dangerous game to play. You only have 1 set of eyes people, take care of them!
It was really clever marketing to call it “No Rub”. Everyone and their mom thinks all you do is take your contacts out, put them in the empty case and fill it up with solution. That is not the way to do it!
Contacts have a bunch of crap on them from being on your eyes all day. If you hold them up to the light you can see it. You have to get this stuff off or it will be as if you are rubbing sandpaper on your eyes. You have 2 options.
The first is to high pressure wash them with the solution by blasting them for 10 seconds, making sure to get both sides. This means you will go through a bottle of solution in less than a month.
Nobody has ever told me they run through solution this frequently so NOBODY is cleaning their contacts correctly with the rinse only method. Is it effective? Well Dr. Peter Rozanec thinks “No-rub contact solution works as well as no-brush toothpaste.” Nice one doc. I agree! Another friend reminds me, “Its sort of like running your dishes under the faucet and then eating off them again. And a 20-second rinse is a ton of solution! Ineffective and expensive.”
The second thing you can do is take them out and add a few drops of solution then rub them for 5-10 seconds, flip it and rub it for 5-10 seconds. Finish with a quick squirt to wash it away. This will get most of the buildup off. Look at it. Its pretty clean now. The rubbing does the best job of getting it clean.
Whatever way you clean them, remember they are still germy and dry so they need to be soaked in multi-purpose solution overnight. This is where it is disinfected and re-hydrated. So it will come out clean, disinfected and hydrated. That will keep things clear and comfortable. It will also give your eyes the best chance at staying healthy.
As always, a fresh clean contact everyday is the best. If you can wear a daily disposables, wear them!
You reply, I don’t normally have allergies BUT….
Occasionally I send patients to another clinic to get a laser scan of the back of their eye. What is this test, and why do we do it?
The official name of this procedure is called an “optical coherence tomography” scan or “OCT” for short. The machine emits a very short wavelength (~100 nm) laser beam that hits certain structures in the retina. The onboard processor is able to translate the information that the laser records into a topographical profile of whatever structure the doctor wants to see. This affords him the ability to notice any disruptions below the retinal surface.
I take retinal pictures of every single patient in order to examine key anatomical and functional components of the eye. Retinal photos are a brilliant form of technology that allows me to see very detailed things. Occasionally I also utilize special lenses to determine if a problem is present. However, these two techniques are sometimes not detailed enough to examine key hidden structures.
Instead of thinking about the retina, let’s use an apple analogy for a moment. If you take a picture of the side of an apple, you could see that it is red. You could see the outline and perhaps infer that it curves outward towards you. You wouldn’t be able to tell how deep the apple was or what the insides look like. Taking an OCT of the apple would be like cutting it in half and observing a cross section. You would now be able to see that red color is actually a very thin skin. You could also measure the depth of the apple, see that the majority of it’s volume is composed of a fibrous network, and notice a small cavity in the center that’s filled with seeds. If the seeds were displaced to the side, a traditional camera picture wouldn’t notice anything out of the ordinary since the external appearance is untouched. However, an OCT would be able to tell that they are not in their proper position. For almost every patient, a retinal photo is way above the standard of care that’s required to examine their eyes. However, some patients’ eyes either present with abnormalities or have a suspicious appearance. Those patients require the detailed level of imaging and analysis that an OCT can provide.
It’s important to clarify a few misconceptions about getting an OCT:
-Does it hurt?
It doesn’t hurt at all. It’s actually slightly more gentle than a camera flash
-Will it fix my problem.
No. There are many types of lasers that doctors use on the eye. An OCT does diagnostic imaging only. That means that it shows the doctor what is the issue and does not fix it.
-Why didn’t my doctor see what the laser saw?
A doctor only orders an OCT when a known or suspected problem lies in an area of the retina that’s not visible to human eyes and traditional machines. Unless your doctor has x-ray vision, he won’t be able to see the deep hidden retinal layers.
-Come on doc. Is this really important?
Absolutely! With many retinal pathologies the OCT reading is how the doctor determines what treatment or monitoring protocols he will use. Additionally, he now has a snapshot of the retina at a given time and can track it’s evolution in the future.
-Why doesn’t my doctor have an OCT?
Most patients don’t require such a scan. Typically I will see only 1 patient who needs an OCT each week. Although I can perform the scan and interpret the results with ease, I prefer my patients to be scanned by a doctor who does 10 a day and specializes in that type of care.
-You’re sending me to a disease specialist? I must have something really bad.
Needing an OCT does not mean that you have a serious disease. It does mean that your eyes present slightly atypically and an extra scan is the prudent thing to do. Frequently the doctor who does my scanning will say, “It looks okay. We’ll just monitor it. Go see Dr. Ritenour in a year.” Some patients I know are healthy, but have an elevated risk for developing a problem in the future. In theses cases, the OCT scan is a baseline “snapshot” that we can always compare back to in the future.
Leave a comment or email me if you have any questions or concerns.
Spencer Ritenour, O.D.
“I’m really blind without my glasses.”
Everyday several people come into my office saying those words. What they mean is that they are very nearsighted or myopic. In fact about 41% of the US population (2004 data, ages 12-54) have some degree of myopia. Eye doctors quantify myopia and all other types of prescriptions in units called diopters (D). A diopter is simply a measurement that indicates the degree to which an optical system bends light. Most forms of myopia may be classified into three different categories:
Low myopia: -0.25D to -3.00D
Medium myopia: -3.00D to -6.00D
High myopia: -6.00D and greater
We correct myopia with glasses, contacts, or sometimes procedures like LASIK. For low and medium amounts this is typically the end of the story. However, with high myopia there are some other concerns beyond getting the right prescription. Most people with this type have high prescriptions due to longer axial lengths in the eye. The axial length is the distance from the very tip of the cornea the deepest tissue layers in the back of the eye. This puts a special type of tension on the retina, and statistically gives the patient a higher risk of developing a retinal detachment. That is when the retina pops off it’s supporting basement structures and can lead to severe vision loss.
What do we do about this? Unfortunately there is no way to completely prevent a retinal detachment from happening. However, we can help minimize the risks. Blows to the head are especially risky for high myopes. The sudden shock can cause the already threatened retina to cross a tipping point and detach. Two weeks ago I saw a girl with a -8.00 prescription. She hit her head ice skating and wisely came in to be examined (thankfully she was okay). One can’t live in a padded cage, but it’s important that people with these prescription be vigilant about protecting their head and eyes. If you wear -7.00 glasses then boxing may not be a good hobby. Patients with high myopia must immediately let their doctor know if they ever see flashes of light, experience any changes in their floaters, see “curtains” coming down, or any other odd visual occurrences. Both Dr. Bazan and I believe that it’s important for everyone to get an annual dilated exam. For high myopes, this is not only important – it’s critical. We do a very thorough dilation exam to ensure that the retina is healthy and that there are no signs of any impending detachments. Speed is the name of the game if a detachment is detected. There are a variety of procedures used to heal the retina based on the type and location of the detachment. An eye doctor will ensure that these procedure are done inside an appropriate time frame. With proper care the lasting effects of a retinal detachment can be very minimal.
I will include a special point for high myopes who have had LASIK or are considering LASIK. It’s true that post-LASIK you effectively have no prescription. However, the laser simply compensates for exceptionally long eyes by altering the curves of the cornea. The axial length of the eye never changes. LASIK is a fantastic option for many of these patients and their vision. It does not change the important of being dilated annually or lower the risk of a detachment.
Feel free to contact me if you have questions about high myopia, retinal detachments, or any other eye issues.
Spencer Ritenour, O.D.
Some contact lenses are to be changed daily. Others last for 2 weeks. Some last for a month. Why are they all different, and is it important to change them regularly?
Contacts sit on the eyes’ corneas. Light is able to pass through our corneas because they’re clear and don’t contain blood vessels. Consequently, oxygen, water, and other nutrients must be supplied to the cornea via the air, tears, and eyelids. When ANY contact lens is on the eye, the cornea receives dramatically lower amounts of these elements. As you can imagine, this opens the door to a lot of potential issues. Therefore it’s critical that patients and their eye doctors carefully manage the use of contact lenses.
Every type of contact lens differs in it’s physical and chemical properties. The amounts of water and oxygen that permeate through them hinge on the fit, material, prescription, and wearing schedule of the contact lens. The first three are largely concerns of one’s eye doctor. How the contacts should be worn is determined by the doctor, but the responsibility to follow said schedule is up to the patient.
I’ll illustrate by using CooperVision’s Biofinty contact lenses as an example. This lens is approved for 30 days of wear. To arrive at that number, CooperVision worked with many doctors, researchers, and the FDA to determine how long these lenses may be worn safely. Like all contacts, they permit less oxygen to reach the eye as compared to not wearing contacts at all. Experts have found that this is largely not a problem as long as the lenses are worn for 30 days or less and the patient regularly sees her optometrist. After 30 days of wear the story takes a turn for the worse. The amount of oxygen that reaches the eye is lower than professionally determined critical thresholds. This opens the floodgates for a lot of potential complications.
On the low end, wearing a contact lens for too long may cause the eyes to become slightly red. On some patients this can stay at a cosmetic level. However, frequently it’s the first warning sign of serious impending problems. With the eyes defenses reduced, bacterial and/or viral infections are much more likely to occur. It’s somewhat common for the cornea to respond to low oxygen levels by developing “subepithelial infiltrates.” These are inflammatory cells that arrive on the scene when the cornea is threatened. They interrupt a dense network of nerves in the front of the eye and are very painful. In some cases of contact lens overwear, the iris may become severely inflamed. This is a highly uncomfortable condition called iritis or anterior uveitis. The treatment for this condition is weeks of steroid drops and dilated eyes – not anyone’s idea of a good time. If left unchecked, a reduced oxygen level can even lead to ulceration of eye tissue.
The good news about all of these problems is that they are largely avoidable. By wearing your contacts lenses for the prescribed schedule, the risk of all these issues is quite low. Beyond simply wearing your contacts properly, it’s important to have them evaluated at least once a year by your optometrist. It’s his job to ensure that your eyes aren’t showing any signs of being “angry” with the lenses. It’s far better to stay on top of any complications than allowing them to run free.
Feel free to send an email if you have any questions or concerns.
Spencer Ritenour, O.D.
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