DAILIES TOTAL1®: An Exceptional CL Wearing Experience, with Dr. Steven Bennett

[Larry Bickford O.D.]

The vast majority of my CL related ulcers have been in EW wearers. My most recent patient with the Big Kahuna central corneal Pseudomonas ulcer had been an Air Optics N&D wearer. If was on day 3 of his newly replaced lens when he woke up with a painful photophobic red eye. That was on January 2nd. He is still being treated today and still has an epithelial defect(slowly improving) and significant surrounding infiltrate and a reduction in BVA. I speculate that if he were in DDs that he removed each evening, he would have been a much happier man today.

Maybe, maybe not.

Here's where you can be the forensic detective. He was on third day of having changed out lenses and it takes pseudomonas 24-48 hours to create it's biofilm (the reason why it's a bigger problem than other, less creepy and scary bugs) which strongly suggests he caught the bug at the time of changing lenses or shortly thereafter.

He removed a possibly slightly adherent old worn out lens and took a little cornea epithelium with it. The pseudomonas is really excited now. What would be better than new lens to trap them in there. And there is comes.

You might want to try to sleuth out where the bug came from. Most likely source is outside in the garden or woods. Another source might be the water supply. Did he handle the lenses with tap water on his hands or maybe even rinse them off under the tap? That could be a serious find and the water company might want to know. You might trigger an investigation of the water treatment plant and then your city has to spends millions of dollars repairing the problem and you become either the town hero or pariah.

Either way, you write a book about this and it is turned into a made-for-tv movie and you become fabulously wealthy and are therefore offered a job in the Trump administration.

 

[Joe DiGiorgio O.D.]

Awesome Larry, I love happy endings!

 

[Stephen McDaniel]

The marketing team called... and asked you to stop referring to their lens as the DDT.

You think they'd be upset? I'm not sure where the extra D came from, guess I just like double D's.

 

[Scott Blahnik]

You need to practice good hygiene and lens care if you want to avoid infection and the pain and possible loss of vision that might go with it. Contact lenses do not cause infections. People do. Oh, actually it's bacteria and viruses, but it's people who put them in their eye. Just pay attention. For example, your contact lenses right now, on your eyes. This is the most awareness you should ever have when wearing them. If they feel dry, add artificial tears or contact lens drops. If it doesn't get better right away, take the lenses out. If you feel like there something in your eye, stop and take out the lens. If you wake up and your eye hurts and doesn't get better in 15 minutes, call me. If your eye gets red and light bothers you, take out the lens. Eye still red and light still bothing you 15 minutes later, call me. Do not tolerate any pain or light sensitivity.Infections need to treated promptly or you might be trouble. The whole idea with wearing contact lenses is to not be thinking about them until it is time to dispose of them and replace them with a fresh pair. Contacts are supposed to provide you with excellent vision and comfort so you don't have to think about your eyes.

Just remember. Wash your hands before touching your lenses or your eyes. Keep your lenses in disinfecting storage solutions when they're not in your eye. Keep you lens case clean and replace it often and replace your lenses on an appropriate schedule. No cheating. Enjoy! And please call me if you have any concerns.

Larry- I've tried to refine this as a patient handout. Good stuff!:

Extended Wear of Contact Lenses



· Practicing good hygiene and lens care will help to avoid infection and the pain and possible loss of vision that might go with it. Extended use of contact lenses does not cause infection; it’s actually caused by bacteria and viruses transmitted by hands which have not be thoroughly cleaned.

· Paying attention to how the lenses feel in your eyes can also help to prevent eye infections. For example, your contact lenses should continuously feel about the same as when you first put them in. This is the most awareness you should ever have when wearing them. If they feel dry, use eye drops such as Blink Contact lens .(it also helps to use drops each morning upon awakening to flush out debris which can accumulate beneath the lenses during sleep) If it doesn't get better right away, take the lenses out. If you feel like there something in your eye, stop and take out the lens.

If your eye gets red and light bothers you, take out the lenses! The eye may feel even worse when the lens is removed, but do not re-insert it. If they continue to bother you, call our office immediately as most likely an infection may be developing and should be treated ASAP.

 

[Joe DiGiorgio O.D.]

Extended use of contact lenses does not cause infection; it’s actually caused by bacteria and viruses transmitted by hands which have not be thoroughly cleaned.

Scott nice work. So as a patient wears lenses for extended duration it does cause an increased level of corneal edema. Additionally the CL may be somewhat adherent to the epithelium somewhat compromised by the additional edema. Does the EW modality really not increase susceptibility to infection?

Paging Dr. Berris.

 

[Scott Blahnik]

Does the EW modality really not increase susceptibility to infection?

How about: "extended use of contact lenses is not the primary cause of infection in most cases; it's usually caused by....."

Maybe Dr. Barris won't beat me up over this change in verbage

 

[Larry Bickford O.D.]

Larry- I've tried to refine this as a patient handout. Good stuff!:

Nice! I was working on a re-do for a patient hand-out/sign off and this is good.

No, Joe, I don't think you're going to get edema with a DK 160 lens, or any lens over 100DK for that matter. But what I DO see repeatedly is adherence with overnight wear. Heck, I personally even get some adherence with no lenses in at all! And when you are predisposed to RCEs, that's not fun.

Meanwhile, one thing that has always bothered me about EW/CW lens wear is cornea epithelium cell turn over. I was taught that the the surface is essentially replaced daily (at the least) with the sloughing of cells occurring naturally and with the help of the eye lid wiping over the cornea surface. Slap on a contact lens and then what?

So, in addition to all the other "this is what you should do", I've been telling EW/CW patients that when they DO remove their lens that they do so a couple of hours before bedtime and to not re-insert the lenses for an hour or so after waking. My thinking is to provide for sloughing and re-epithelializing in a healthy manner. All this proactive stuff seems to work, considering in my nearly 100% compliant patient population I have near zero complications. The ones that do have issues are ALWAYS those who don't play by the rules.

 

[Joe DiGiorgio O.D.]

So, in addition to all the other "this is what you should do", I've been telling EW/CW patients that when they DO remove their lens that they do so a couple of hours before bedtime and to not re-insert the lenses for an hour or so after waking. My thinking is to provide for sloughing and re-epithelializing in a healthy manner. All this proactive stuff seems to work, considering in my nearly 100% compliant patient population I have near zero complications. The ones that do have issues are ALWAYS those who don't play by the rules.

Larry it sounds like you were a student of Irving Fatt or Lemp & Holly.