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Contact Lenses

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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!

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The Rub

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!


Don’t stretch it out.

Dont' strech your contact lenses!

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.
dr.ritenour@parkslopeeye.com


Spooky Eyes

Halloween is just around the corner.  Now is the time to decorate the house, buy the candy (KitKats please), dial in your party plans, and figure out your costume.  It’s very fun to visit a Halloween store to check out what they have.  There are always the great masks, funky ‘staches, and goofy clothes.  Many stores also carry a selection of spooky contact lenses.  These are painted to make your eyes look reptilian, cat like, or just plain creepy.  However, these lenses are not just spooky in their appearance.  They are spooky deep down to their guts.  Let me explain.

All contact lenses allow a certain amount of water and oxygen through to the eye.  Engineers and chemists work aggressively to design lenses that are safe, comfortable, stable, free from bacteria, and allow for good vision.  Then they go through a many year process of research and clinical trials to become approved by the FDA.  Finally, the contact lens companies rely upon certified optometrists to skillfully fit the lenses on patients and then to regularly check the lenses and eyes for problems.  This is how a contact lens goes from being a brilliant idea in a researcher’s head to performing beautifully on your eye.  The problem with cosmetic Halloween contacts is that nearly all of them are not approved by the FDA.  It’s also illegal to sell contacts without an explicit prescription from a licensed eye doctor.  When a company wantonly ignores these regulations, it’s pretty easy to guess how interested they are in the health of your eye.

What happens when a contact doesn’t perform safely on the eye?  At the low end of the spectrum, the eyes may become red and irritated.  They can also become painfully inflamed and sensitive to light – a condition called uveitis.  Sometimes they can develop a bacterial infection or activate a latent herpes virus.  In some very severe cases, the cornea may develop an ulcer and leave a serious scar.  Nearly all of these conditions can potentially lead to permanent vision loss or other complications.  It’s not worth having “spooky” eyes one night and have “SPOOKY!” eyes for a long time afterwards.

Have a happy Halloween that’s full of candy and not eye infections!

Spencer Ritenour, O.D.

dr.ritenour@parkslopeeye.com


Acuvue TruEye contacts

Recently there has been a press release announcing a recall of the popular 1-Day Acuvue TruEye contact lenses.  It’s very important to note that this recall solely affects lenses manufactured in Japan and a few other European and Asian countries.  The TruEye lenses manufactured and distributed in the US are completely unaffected.  The problem occurred on one manufacturing line that produces contacts for Asian distribution.  It was remedied immediately.

At Park Slope Eye we have had remarkably high patient satisfaction rates with all of the Acuvue contacts that we fit – especially the TruEye lens.  In addition to having an amazing safety profile and being extremely comfortable, the TruEye lens was recently certified as being in the highest class of UV blocking contacts.  I have personally visited Acuvue’s world headquarters, their North American R&D division, and their North American manufacturing plant.  Their industrial processes at every stage of contact lens development are state of the art.

If you are interested in trying TruEyes, I would be more than happy to fit you with a pair.  Of course if another lens is more appropriate for your needs and eye health, we can try those instead.


Don’t have a bad romance!


Do you love your contacts? Most people do, but Americans are increasingly going gaga over a new cosmetic variety known as circle contact lenses. These are special colored contact lenses that give the illusion of having large “doe eyes.” Despite their innocent appearance, this type of lens can be highly unsafe for one’s eyes. They cause a dangerously low amount of oxygen to reach the surface of the eye which can lead to painful infections, ulcers, or worse. In some cases they can even lead to a permanent reduction in vision. In fact, they are illegal in the United States, but their popularity is increasing.
It’s important to remember that all contact lenses are medical devices and must be prescribed by your eye doctor. Always be sure to follow the proper cleaning and replacement instructions and have your doctor check them annually. If you’re interested in trying contacts for the first time stop by the office, and I’d be happy to fit some on your eyes!


What do donuts and contacts have in common?

Patient said “Doc, I’ve worn my contacts like this for years and never had a problem!”

Eye Doc said  “The guy who eats donuts for breakfast every day without a problem eventually has his FIRST heart attack.  Just because you’ve never had a problem does not remotely mean that you never will, or that it is the right or smart thing to do.”

Courtesy of Dr. Anthony Clark

Even if one ignored the clinical research data, common sense would lead you to believe the longer your do something that is unhealthy, the riskier it gets.  Wearing dirty contacts for long periods of times over the course of many years, just leaves your eyes open to such great risks.  The patients who come in with a contact lens related red eye, almost are always contact lens abusers.  They often are the ones who do not adequately clean them.   They are often the ones who habitually fall asleep in them.  They are often the ones who chronically stretch them out beyond their indicated replacement schedule.  Its just not worth it!

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