Eye Doctors Dry Eye Secret Treatment

Dry eyes can be a very debilitating condition. It is very common in low humidity climates like the Fort Collins area, and it can interfere with contact lens wear and comfort. It can also be a severe problem after LASIK corrective eye surgery. Optometrists have a number of different options to treat dry eye syndrome  and contact lens intolerance today, and TheraTears non preserved artificial tears have proven very useful to eye doctors. TheraTears has some unique properties that can actually help restore the eye tissues instead of just treating the symptoms of burning eyes, gritty eyes, and general discomfort.

The tear film covering the front of the eye has been the subject of extensive study by eye doctors over the last decade. It is composed of a water component, a mucous component, and a lipid component. Every time you blink, your eyes experience a resurfacing of the tear film. When things go right, the new film has adequate water and retains its integrity until your normal blink reflex recurs. When things go wrong comfort and cells that produce the tear components are compromised.

The water component of tears has a normal value for osmolarity which is related to how much the salt concentration is in your tears. When the water levels decrease, the same amount of salt is present so the relative percentage of salt in the tears increases. This draws more water out of the corneal tissue on the front of the eye and can damage the surface cells known as the epithelium layer. The high osmolarity levels also decrease the amount of goblet cells. These are the cells that produce the mucous component of the tear film that makes the tear layer slide out across the eye surface. There are electrolytes like sodium and chloride in the tear film that are essential to keep the osmolarity in a normal range and also help the proteins like lactoferrin dissolve in the tears. Lactoferrin is a protein that fights against bacterial and fungal eye infections. It also serves to reduce eye inflammation. Because the cornea tissue on the front of the eye has no direct blood supply, a healthy tear function is vital to maintain good eye health and vision. Even from this brief view of the tear film, you can see how important it is to your optometrist that this complex system is functioning normally.

So now one of the best kept secrets of eye doctors in treating dry eye disorders and contact lens discomfort-TheraTears

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And there is a little known way of using TheraTears to achieve the correct effects called saturation dosing. Saturation dosing involves taking one vial of TheraTears and emptying it into the eyes over a five minute period for times a day for at least a few weeks. It helps restore the salt content levels back to normal and allows goblet cells to regenerate. It is specially formulated to stay on the eye for about 30 minutes. The electrolyte content is similar to what a normal eye would be so it helps readjust this also. After a few weeks your optometrist can decide when you can discontinue the saturation dosing and start a single drop several times per day. Often the tear film regains a significant amount of its integrity and the burning, dry eye discomfort stops. Sometimes the simple things work best.

When You Optometrist Says You

Have Astigmatism Don’t Start

Planning an Eye Funeral

Often patients who have changed to a new optometrist find themselves being alarmed when told they have astigmatism. Frequently it is the first time they are aware of a new eye condition and it is cause for concern. In most cases, their eye doctor did not mention they had astigmatism in years past, probably because it was a low amount. On occasion, the patient believes they are being told they have a stigmata and are even more upset.

Astigmatism can be caused by curvature on the corneal tissue on the front of the eye, or by the curvature and light bending power of the lens inside the eye. About 2/3 of astigmatism is caused by unequal curves on the corneal tissue on the front of the eye. Normally, this is regular astigmatism meaning there are two different curvatures that follow a smooth pattern. It can best be visualized as an eye that is shaped like a tennis ball being squeezed on top and bottom to produce two different curvatures. Irregular astigmatism does occur in some eye diseases like kerataconus and occasionally after corrective eye LASIK surgery and corneal transplants. This is a form of astigmatism you should be concerned about. It is more like the shape of a potato with dips, valleys, and hills representing the curvature. Obviously it is hard to grind a corrective lens to this shape and often gas permeable rigid contact lenses are required to achieve crisp vision. New alternatives today include the SynergEyes contact lenses that have a soft contact lens skirt surrounding a rigid gas permeable center. Since the human tears have the same light bending capacity (index of refraction) as the cornea, when the tears fill in between the contact lens and the eye a new smooth surface is produced. If you have irregular astigmatism ask your optometrist about the new options available to see clearly.

Astigmatism is common in moderately high amounts in infants and toddlers. It often self corrects. Your optometrist may want to closely follow your child’s vision and delay eyeglasses for a few years. If the astigmatism is judged to be too high by your eye doctor or persists past the first few years of childhood, it needs to be corrected with prescription eyeglasses.

In some cases when a very young child is incapable of wearing glasses contact lenses may be used

Children may be fit with contact lenses for astigmatism that can be worn for 30 days without removing, or with daily disposable contact lenses that are removed every day by the parent. Large amounts of uncorrected astigmatism can result in a lazy eye. This can result in permanent vision loss, and with high astigmatism in both eyes it could result in bilateral loss of acuity. With proper treatment by your optometrist this is a completely preventable type of partial blindness.

Once you aware you have astigmatism there is no need for panic. You probably have had it for a number of years. Most of the population has at least some small amount of astigmatism. In most cases it changes very slowly over time. Over the course of a lifetime you will blink your eyes millions of cycles. The pressure exerted by the eyelid as it rubs across the cornea over years of blinking probably contributes to very slow changes in astigmatism. While there is no evidence supporting my theory, I do believe that tilting your head and paper along with other postural and ergonomic factors cause a slight blurring of your vision at an angle that can cause astigmatism to develop or change. Blurred images to the retina tissue inside the eye are known to cause near sightedness. Large degrees of astigmatism are found in several Native American populations, especially in the four corners area bordering Colorado. These are genetic passed on through the generations.

In most cases there is no alarm needed if you find out you have astigmatism. It will probably show only small changes over long periods of time, and in many cases stabilizes for years. When in doubt call your optometrist back and explain your concerns.

Many eye doctors office claim they provide specialty contact lenses or are contact lens experts. We know the frustration you feel when it turns out they are really only interested in simple cases they can shuffle in and out the door in a hurry.

Don’t call us if you have special contact lens challenges that you want solved in an hour.  We don’t want to waste your time.

Please do call us if you want your contact lens problems solved and are willing to dedicate the time needed.

Specialty Contact Lenses We Provide Include:

• Kerataconus-This is an eye disease where the clear corneal tissue on the front of the eye thins develops a very steep curvature with an irregular curvature. A cone shaped protrusion forms on the cornea. Many different special contact lens designs are used to compensate for this shape including soft contact lenses, gas permeable lenses such as the Rose-K designs, hybrid lenses with soft lens material on the outer edges and RGP rigid gas permeable materials on the inside, piggyback lenses that combine a gas permeable lens on top of a soft lens, and scleral lenses that extend over the white tissues on the eye. Kerataconus contact lens fitting is still very much an art form with no exact science.
• Cosmetic Lenses For Eye Damaged by Trauma: The colored part of the eye, the iris may be mishaped from birth or by trauma leaving an oddly shaped pupil. Specialty Colored Contact Lenses can be used to restore a normal pupil appearance and cut down on glare and discomfort from a malformed pupil.
• CRT or Orthokeratology Contact Lenses: Gas permeable lenses can be used in some cases to reshape the corneal tissue on the front of the eye and reduce nearsightedness (myopia). This is often done by wearing a lens overnight so the eye is prescription free during the day.
• Large Amounts of Astigmatism: New advances in contact lens technology allow for large degrees of astigmatism to be corrected by contact lenses. Usually the comfort of soft contact lenses can be  used in a disposable contact lens for health and comfort.
• Contact Lenses After LASIK Laser Eye Surgery: LASIK doesn’t always work and the eyes may be left with a very irregular surface. They may also be left with residual corrections and change with time. These issues can be solved with specialty contact lenses, when glasses may not provide a good correction due to irregularities in the astigmatism.
• Color Vision Defects: While contact lenses cannot restore normal color vision they can make it easier for some patients to discern differences.
• Nystagmus or Eye Tremors: In some cases, rigid contact lenses can supply feedback to the brain about these uncontrolled eye movements and help dampen the eye movements to some degree.
• Contact Lenses For 40+ Year Old Eyes Needing Bifocals: If your arms are getting too short too read, don’t despair-bifocal and mutlifocal lenses are available in many different designs in soft and gas permeable contact lenses. Expect to spend some time being fit.

Most children by the age of 12 become concerned with their looks. Most parents breathe a little sigh of relief that they do. As we all know, this relief may also soon be followed with the horror of what teenagers equate with good appearance. The story is ancient and never changes but somehow the image they aspire to always manages to shock the previous generation. Who would have thought vampires?  Once they become teens this concern is in full effect.  Everything from their clothes, their hair, their shoes and their skin is of the ultimate concern.  Eyeglasses that once were OK to wear, may now make your teen unhappy and self conscious. They may now be interested in a new look  that wearing contact lenses may provide, while also boosting the oh so fragile self esteem of the typical middle school teenager.

With teens, contact lenses must be considered carefully.  If your teen only needs glasses for reading, contact lenses may not be a great option.  Even though they feel like they are wearing their glasses a lot at school, if their contact lens prescription is low they might be unwilling to adequately care for the lenses and discontinue wearing them within a few months. If they are determined to try contact lenses for a low eye correction and you are OK with this possibility, you and your teen then make an appointment with an optometrist for an eye exam.

Your eye doctor will be able to best advise on your teen’s vision.  If astigmatism is present, toric contact lenses may need to be prescribed for clear vision. There are new advances in contact lenses that correct astigmatism, but each case is different. Eyeglasses may offer the clearest vision on the eye chart, but the difference gained in peripheral vision may be so significant that the teen feels their vision with contact lenses is far superior to eyeglasses.

Once contacts are prescribed there will be an adjustment period.  First the teen must learn how to properly insert and remove lenses on the eye. This is a prerequisite for leaving the office with contact lenses. Sometimes it may take several office visits to reach this skill level, but most teens are so highly motivated they learn extraordinarily fast. They must also learn how to properly clean them.  This is essential to good eye health.  Hands must be washed before touching the lenses to reduce the chance of eye infections such as pink eye. The lenses should be removed each and every night and washed, then put into a contact lens case filled with disinfecting solution overnight. The contact lens case should be replaced every one to two months and not look like a teen microbiology experiment.  Even if the lenses dictate that they can be worn overnight, this is not a good idea for a teen. It is an excellent idea to use one of the new generation 30 day wear lenses for teens on a daily wear basis. I have yet to met a teenager who doesn’t fall asleep during the day at times.Unbelievably , they are often seen sleeping in class! These silicone enhanced contact lenses are super permeable to oxygen and provided an added margin of safety for that occasional nap. Extended continuous wear over night and on consecutive days can damage the cornea as well as cause painful eye infections and loss of sight when teenagers make mistakes in care and handling. As a parent, you should always be present for contact lens care instructions for first time lens wearers

Remember that teen’s eyes are still changing as their body is and eye care should be followed with regular visits to the eye doctor. Never allow a teen to have contact lenses without a pair of glasses. While they may rarely the eyeglasses, the first time they continue wearing contact lenses on an eye that is irritated may be the last time they see clear out of that eye for the rest of their life. They need the option to remove a contact lens from a possible eye infection and wear glasses until they visit the eye doctor. And yes, if you really areok with it there are vampire contact lenses.

There is a difference between eye exams for contact lenses versus eye exams for eyeglass wearers. When making an appointment for an eye exam, express your desires for either eyeglasses or contact lenses.  Typically, people already wearing eyeglasses schedule appointments to switch over to contact lenses. The motivation may be cosmetic, better peripheral vision, or for athletics. Those who have never worn glasses and find out during a routine eye exam that they need corrective lenses can discuss their options with the eye doctor. Then they can choose to either proceed with a contact lens exam and fitting or come back at a later date after careful consideration of the options that will best fit their lifestyle.

An exam for eyeglasses consists of a series of tests performed by the eye doctor and their technician. A computer aided analysis is performed by the optometrist by asking you to stare at a certain point in an instrument. By doing this, the doctor is determining how the light wave is altered as it bounces off the inside of your eye. This gives the doctor a good starting point for the strength of prescription you need. A Refraction test is also performed with a Phoropter where you will look through a mask like device at a series of letters.The doctor flips lenses in the mask and asks when it looks the most clear. This is the dreaded point of commitment to one or two. Since it is a forced choice test (that is a psychological term for being restrained in the exam chair until you decide on two horrible, blurry options) many patients feel uncomfortable with deciding on an answer. While this may feel like a day in the voting booth, you need not worry. A vision exam never relies on a single answer. Also, the lenses may change even though the number stays the same. Occasionally patients worry that it was clearer in a previous view, or even in between changing views. Since you can’t see the exam from the eye doctors point of view, you can’t see the logic in what may appear to be faulty testing. Don’t be concerned, repeated testing sequences assure that your answers are reliable before a prescriptions is finalized. The result is a clear determination of whether you are nearsighted or farsighted, whether you have astigmatism and whether presbyopia is present.  Last, the doctor will perform a slit lamp exam and examine the inside of your eye to look for eye diseases such as glaucoma, cataracts and macular degeneration.

During a contact lens exam, the cornea surface is the center of the exam.  The doctor runs tests to assess the cornea to get the right fit for the contact lenses.  An instrument measures surface and curvature of the eye. It works like a digital camera that takes pictures of the eye and creates mathematical depictions of the curvature of the cornea surface.  This gives the doctor the sizing for the contact lens.  A microscope is used to determine the health of your cornea and your  pupils may need to be measured if you are being fit for bifocal contact lenses.Your tears may be measured with a tear film evaluation to determine the amount of eye moisture in the eye as well as a fluorescent dye that is placed in the eye to see the quantity of tears present and any cellular compromise to the cornea. Careful attention is paid toward analyzing the eyelid margins and the clear tissue covering the white part of the eyes and under the eyelids for any signs of eye disease or problems that may interfere with successful contact lens wear. After testing, the doctor will select a contact lens that best matches your eye. This lens is usually fit for a trial period to make sure your eyes are adapting in a healthy manner. More complicated contact lens fittings may require several visits to find the optimum lens for your eyes. In cases where bifocal contact lenses or contact lenses for eye conditions causing  irregular astigmatism this may take several months to reach a finalized prescription.

In its important to remember that contact lenses are never a replacement for eyeglasses. I have seen numerous cases where patients wearing contact lenses did not have a pair of prescription eyeglasses and acquired an infection, a scratched eye, or a particle of metal lodge in the cornea tissue on the front of the eye. Having no backup option when away on a trip they continue to wear thier lenses and the end result can be scarring and eye damage. Always having a backup pair of spectacles is priceless in preserving your eye health.. This is even more important with teens and children who tend to not complain until their eyes are already in an advanced state of compromise. Because they are more concerned with appearance at certain ages, they are much more reluctant to understand the necessity of eyeglasses as an emergency preventative health device.

Contact lenses are a medical device controlled by the Food and Drug Administration and should be given the care an respect as any other medical device. Part of this care is an annual eye exam that assures your eyes are continuing to have a healthy adaption to this marvel of technology, first envisioned by Leonardo da Vinci in the 16th century.

We still see allergies to the preservatives in contact lens solutions in our Fort Collins Contact Lens Clinic but at a much lower frequency than in the past.

Thimerosal, (sodium ethylmercurithiosalicylate)  is an older contact lens solution preservative whose composition is about half mercury. It as commonly used in very low doses in contact lens disinfecting solutions is an excellent preservative but causes a reasonably high number of allergic reactions. It has been used in childhood vaccines and a subject of controversy over the years as a possible cause of autism. There are no significant studies to confirm a relationship,  but similar to contact lens solutions, it is being phased out. You will often see vaccines that are touted as mercury free.

Chlorhexidine is a chemical antiseptic that is very effective at killing bacteria. It was also widely used in the past in contact lens solutions prescribed by eye doctors but frequently caused red eyes, vague forms of  eye irritation, and sometimes significant conjunctivitis and  discomfort. Like Thimerosal, it has largely been phased out of contact lens care and we never reccomend it in our Ft Collins Eye Practice. It is still widely used in the dental field to treat gum disease and as a disinfectant.

Benzalkonium chloride was used in the past and is still used today is some nasal sprays, cleaning solutions, and various other hygienic products. It is a good disinfectant but at high enough levels may not only serve as an allergen but cause serious damage to the corneal tissue the contact lens rests on.

The next generation of sensitive eyes contact lens solutions proved to have about the same rate of allergic reactions, just for different people. Switching often cured the problem for those allergic to former solutions but created problems for new users.

Many generations of solutions have since come to pass. Today the large molecule preservatives are favored by optometrists since they fail to build up in the contact lens matrix, exceeding the pore size of the lenses.

The problem today rests in generic contact lens solutions, often colored and labeled to look like the brand solutions. Sometimes they are OK, at other times they are using these older toxic preservatives that should have been off the market a long time ago. To compound the confusion, the formulations may change in the middle of the shelf for the same generic brand, even though the box appears identical.

The best bet today is to stick with a brand name solution your eye doctor reccomends or use one of the hydrogen peroxide based systems. The drawback to hydrogen peroxide has always been it is too easy to make a mistake, and hydrogen peroxide is very uncomfortable when placed in your eye without neutralization!

Spend a few extra minutes during your next visit to the optometrist and ask their advice on what is the best contact lens care regimin avaialbe to keep your eyes healthy and seeing well.

Babak A. Parviz of the University of Washington is working on futuristic contact lens technology. His research includes work on contact lenses incorporating sensors for glucose monitoring for diabetics and potentially contact leness as display monitors out of the science fiction realm. If you are interested in where contact lens technology may lead to in the future his work and publications are a fun read.

In terms of futuristic contact lens technology the question remains where the corneal molding technology disappeared to. Several years back a California company had developed a permanent technique for reshaping the cornea to adjust the prescription. It involved a prescription medication to soften the collagen bonds of the cornea temporarily, and several days of rigid contact lens wear to reshape the tissue while in this malleable state. Oddly, it seems to have vanished after having some very positive reports.

Current technology not being used clinically allows determing blood glucose levels by utilizing laser or infared light directed into the fluid inside the anterior chamber, the front part of the eye. This fluid is referred to as the aqueous humor and the glucose levels allow an estimation of the blood levels.

A new type of contact lens should be on the market within a year. Developed at Harvard University it will allow constant steady release of eye medications instead of the variation in dosing levels that ocurrs with prescription eye drops. Other competitors are in the market. I have seen the effectiveness of this using todays contact lenses saturated with eye medications in off label applications. It should be a great option for certain eye diseases. I suspect glaucoma will be one of the first contact lens applications where it will deliver results like an insulin pump can for a diabetic who has wide swings in blood sugar levels when control was tried with injections.

Patents exist for photochromatic contact lenses that darken with sunlight and act as a sunlens. When this will see the “light of day” is unknown. Patents also exsist for liquid contact lenses. Researchers have looked for eyedrops to act as temporary corrective liquid lenses for years-maybe someday an eyedrop a day will keep the eye doctor at bay.

Contact lenses with added components to prevent infections are under study and probably will reach the market place in the next few years.

Custom eye specific shaped contact lenses are certainly going to be a part of the future. Wether you know it or not, you suffer from more vision problems than nearsightedness and astigmtism. You also have trefoil, quadrafoil, spherical abberation and other optical misfortunes degrading your vision. The future will only look better!

SIX SIGNS YOU MAY HAVE GPC

FROM YOUR CONTACT LENSES

• Itchy eyes as contact lenses get older

• Lenses that slide and stick under the upper eye lid

• Irritation Every Time You Blink

• Mucous Discharge and Foggy Vision
  

• Lenses That Discolor and Develop a Film
  

• Intermittent Red Eye With Feeling Something is Scratching Your Eye
  

In the early years of soft contact lenses there was one choice, the Bausch & Lomb Soft Lens. The cost of a single pair of these miraculous new soft, comfortable lenses was between $300 and $400 when first introduced in 1971. Accounting for inflation, today that would be almost $2000. There was a very strong financial incentive to make the lenses last as long as possible. Using enzyme cleaners and sending lenses off for a special factory cleaning were common procedures. Lenses were often used for 3 to 4 years until they were yellowed and covered with numerous deposits from components of the tear film. Lipid bumps, calcium and mineral deposits, protein deposits and frequent tears and little missing chunks of the lens edges were tolerated well past the healthy tolerance of the eyes.

A new eye problem begin to show up in a number of the wearers of these new soft contact lenses. As lens technology progressed and prices came down lenses were replaced more frequently and the mystery red eye syndrome seemed to drop off. Then in 1981 the Hydrocurve soft contact lenses was introduced as the first contact lens for over night wear, the advent of extended wear contact lenses.  Cases of this new eye problem started to show up again and become common enough to recognize and diagnose.

The typical patient would come in to see the optometrist complaining about eyes that were red and irritated, possibly itching, and contact lenses that would slide around on the eye, sometimes falling out with blinking. On further questioning the lenses usually were sliding up as they would occasionally adhere to the underside of the upper eyelid. Frequently there would be some clear mucous or discharge from the eye, and some contact lens wearers would tell their eye doctor they kept seeing little spots on the surface of the lenses when they were handling them.

People have often admitted to me they turned their upper eyelids inside out as kids. For some unknown reason, girls more than boys, at least by admission. What was found in the 1980’s when inverting the upper eyelid is now referred to as Giant Papillary Conjunctivitis, or GPC. Usually it is referred to as GPC. There is a clear tissue that covers the white scleral part of your eye and extends underneath the eyelids as their surface lining. In GPC, giant papillae  (bumps of swollen tissue) form under the upper eyelid. These are described as giant but actually are about 1/3 millimeter in diameter. They do feel giant due to the highly sensitive nature of the clear tissue on the front of your eye, the cornea. Every blink rubs these bumps across the cornea and creates discomfort.

The cause of GPC has been disputed for years but most eye care providers agree there are two components, a mechanical irritation and an immunological reaction.

The lens edge constantly engages the underside of the eyelid with each blink that results in a form of low grade irritation and inflammatory reaction in a small percentage of contact lens wearers. There are probably multiple reasons such as how taunt or floppy the lid is, how the secretions make it more prone to slide over or stick to the lens, the variations in lid curvature that apply pressure to the lens at different areas, and if the conjunctiva tissue has a higher number of inflammatory mediators already present. Deposits on the lenses can also cause a mechanical type of reaction.

The immunological reaction is related to deposits that build up on the lenses. These can be your own tear lipids,proteins, preservatives in contact lens solutions that build up in the lens matrix, environmental allergens that build up on the lens, and in rare cases possibly the material the lens is made of. Since soft lenses are about half water they act like a sponge absorbing larger molecules and retaining them resulting in increasing levels over time.

Wearing the same pair of lenses for several years obviously caused an increase in this condition.  The hard lenses worn prior to soft contact lenses can still cause GPC, but because they are inert and do not absorb any water the incidence is very low. With the advent of extended wear, the eyes were given constant exposure to the mechanical and immunological irritants with no recovery time so the incidence started climbing again.

In the first era of contact lens technology lenses were frequently machined on a lathe when dry then re-hydrated. Bausch & Lomb developed spin casting the liquid material in a mold. Today automation and molding manufacturing techniques allow for much more precise and smooth lens edges. Lens that were hand inspected under a microscope in the past are now quality controlled by automated systems. These have been quantum  improvements in lens quality that have helped decrease lens edge induced GPC problems.  Extended wear contact lens materials are starting to be designed today to help resist deposits better.  For a number of years now the major contact lens manufacturers have been using large molecule preservatives that exceed the pore size of soft contact lenses. This greatly reduces the possibility of toxic preservatives inside the lens over time. Unfortunately, many generic solutions appear similar but often contain the older small molecule preservatives that can lead to GPC.

Even though the occurrence is much lower today, GPC can still be a major eye irritant and contact lens problem. There are several approaches to managing GPC. Switching to daily disposable lenses eliminates coating reactions completely since the lenses are thrown away daily and never exposed to disinfecting solutions. Usually, contact lens wearers with GPC have been wearing their contacts well beyond the suggested replacement cycle and become lax in cleaning the lenses. Returning to a normal 2-4 week replacement cycle and  discontinuing or decreasing overnight wear may be all that is required to return the eye to normal health.

Prescription eye drops are also a large part of treating GPC. A class of eye drops called mast cell stabilizers work to stabilize the cells membranes from releasing histamine that starts the inflammatory cycle. These eye drops are very safe and can be used year round when needed. Other options are available and today GPC is no longer the end of your contact lens career, only a small bump in the (eye) road.  Vision Insurance like Vision Service Plan Frequently offer plans that include medical treatment for conditions like GPC. You should do an annual review of all of your medical and vision coverage to make sure you are providing the best benefits you can for your family.

Call For Student Special

970-226-0959

College students have special requirements for contact lenses. Most importantly they should be wearing disposable contact lenses and replacing them of on a prescribed schedule, not when it becomes uncomfortable.

Daily disposable contact lenses eliminate hygiene issues if the lenses are thrown away each night. Though you may find it hard to believe, some college students for mysterious reasons do fall asleep in their lenses at times. These individuals require the silicone hydrogel superpermeable contact lenses like the Biofinity to add a margin of safety. Students participating in overnight hiking and camping trips are probably better off with this type of lens since it is quite difficult to have clean hands in the wilderness.

College Dorm rooms are a microbiologists dream for exotic new species so using solutions as instructed and replacing contact lens cases every month is very important. Your friends half full glass of tap water is the wrong place to plop your lens in overnight if you want to keep seeing. Also, your friends contact lenses belong on their eyes,not yours. Eye infections are easy to pass around. If that’s not enough to convince you, things like HIV have been found circulating in tears (but no known cases this way yet). Chlamydia is also a nice eye disease you can acquire.

Those bottles of solution do have expiration dates (for a reason). Cosmetics get really old and grow interesting bacteria also-they deserve to be pitched on a regular basis.

Last, but not least-tap water is not bacteria free. Some of the worst cases of eye infections come from hot tubs. Leave the lenses off and should look hotter (OK its a really bad pun but true, acanthamoeba is a terrible bug associated with soft contact lenses and hot tubs primarily).

CALL: 970-226-0959 For Your All Contact

Lens Needs at Colorado State University

Contact Lenses are regulated by the Food and Drug Administration (F.D.A.) as Class 3 Medical Devices. Class 3 medical devices are defined by the FDA as those  that support or sustain human life, are of substantial importance in preventing impairment of human health, or which present a potential, unreasonable risk of illness or injury.

Class 3 medical devices require the highest level of evidence for Premarket approval (PMA),  which is a  process  to evaluate  safety and effectiveness before the product can be brought to market . Clinical studies, scientific documentation, and reviews are required. There can also be post marketing surveillance studies after a new contact lens is released to look for further problems. Prescription drugs require a similar but much more involved process before they reach the market place.

A press release from the National Eye Institute in 2008 stated a phase1 gene therapy clinical trial showed  promising  results for a blinding disease known as a congenital form (present at birth) of Lebers Optic Atrophy. The retinal pigment epithelium is the layer of the tissue lining the back of the eye, the retina, that nourishes the rod and cone cells we see with. A mutation in a retinal pigment epithelium gene causes these cells to respond very poorly to light and results in loss of vision. Frequently we see news on gene therapy and are led to believe everything will be cured by in short order. Patients in the study received a sub-retinal injection to replace the defective gene in areas of the retina that were still relatively healthy. Each patient had visual impairment that had been present since birth due to the defective gene. Over a 90-day period there was significant improvement in vision. Day vision was improved by 50-fold and night vision by 63,000-fold compared to pre-treatment levels. Restored vision was localized to the area of treatment in the treated eye.
We tend to think of new drugs and medical devices as overnight miracles but researchers have been working for 15 years to get to this point. The new generation of 30 day wear contact lenses actually started with research done in the 1970’s.  All new prescription drugs and medical devices face the funding and regulatory structures that are required to pass the requirements for approval. While this process is frustrating and fraught with problems, if you spend a little time reading about the equivalent processes and equivalent oversight agency in China, you will gain a greater appreciation for the system we do have in place.

Clinical trials for prescription drugs proceed in four phases over a period of years and millions of dollars.  Actually there is a new phase zero but since it is still in transition we will cover only the 4 main phases.

The first testing of drugs in humans as referred to as phase 1. Typically this involves healthy individuals in a group less than 50. The main goal of phase one trials are the to make sure there are no glaring safety issues and gain some understanding of how the drug works and is processed in the body. Normally, a small (20-50) group of healthy volunteers will be selected.

Phase 2 trials are mostly just an extension of phase 1 with several hundred patients. They also pry a litle more into the amount of drugs needed to be effective in treatment and what time intervals are needed to administer the medication..

Phase 3 studies are what brings a new drug  to the corner pharmacy. Phase 3 trials may base tentative approval on only several hundred patients, and typically no more than 2000-3000 are in this phase. For you, that does mean a 1 in 10,000 lethal effect may not be known initially, or some other surprises may not be uncovered for several years. In Phase 3 patients are split into groups with one group receiving  placebos (no active medication) and another group receives the actual medication, Researchers typically don’t know who is getting what until the end of the study. Occasionally, it becomes so evident that a drug is saving lives or vision that the study is stopped as it is not ethical to deprive the patients receiving placebos of the full benefits of the new drug. The Women’s Health Initiative study on hormone replacement therapy for menopause was an example of this. The study was terminated early when  it was determined  that  hormone therapy increased the risk of breast cancer.

Phase 4 is where the good, the bad, and the ugly comes out. This is also called the Post Marketing Surveillance Phase. Phase 4 trials involve the long term safety monitoring where the 1 in a million problems start to be seen over time. Also the interactions with other medications may become more evident, and idiosyncrtic reactions (really strange ones specific to an individual) may appear. Long term effects (Remeber Phen-Fen the diet drug that caused heart problems)  may show up after a number of years.

Our Fort Collins office has taken part in several optometrist clinical studies with contact lenses as some of you know and participated in. These are somewhat like the phase 3 clinical trials for medications. A lens may be studied by eye doctors on 500-600 patients prior to approval. While there is no such thing as a placebo lens, a contact lenses that has been approved in the past can be used on one eye as a comparison control. It a lot of fun to be involved in these emerging contact lens products but also a lot of record keeping, and when patients don’t keep their appointments the stipulations are pretty rigid about dropping them from the study. Generally we do not expect the same type of serious complications with contact lenses that can be seen with new medications.

One final bit of information. Sometimes things works out in odd ways. While drugs may have undergone all 4 phases and have approval for specific conditions, that does not restrict doctors from using medications “off label” in ways they have not been studied and approved for.The Food and Drug Administration regulates drugs and medical devices, not Doctors. Currently, the standard of care for certain eye infections is “off label eye drops.” It would be considered  substandard care to use the FDA approved medication in these special cases. This a very uncommon occurrence indicative of some weak point in the system where clinical experience is ahead of the curve. Someday there will be a way to account for these situations. Until then, we will continue to do the best with what we know today.