My big issue is informed consent.
Off-label use is common across all medical specialties (much to the dismay of pharma execs), it isn't just a CL thing.
But I'm curious -- when you go with this sort of modality, do you talk about it with patients & let them know it is off-label, and what that could mean? Even from a defensive medicine standpoint, it would seem the right thing to do (and document.)
We talked about this.
FDA approves the contact lens material for physiologic safety, whether or not it is EW/CW or not based on?, and sometimes basic design parameters. Everything else is marketing.
That being said, when I inform patients, I clearly state that, in the case of DT, it is not FDA approved for overnight and continuous wear but the oxygen permeability exceeds that for which other lenses are approved. And I always indicate that is it always best to remove them at night unless you must leave them in. For examples: Late nights with crying baby, too inebriated to deal with them (but don't forget to drink lots of water!) etc. And never to leave them in for overnight after swimming or if you work in an environment subject to infection contamination (like hospital workers.)
I suggest that if they'd like to wear the lenses (in the case of DT, for example) for longer than the marketing established by the manufacturer, that they remove them if there is any indication that the lens is not performing as new. "Because that's the beauty of one day use lenses---they should always be excellent and without problems." I offer to validate the lens durability by actual observation with the scope, but in any event that they should dispose of DT lenses after three days and monthly lenses after 30 days because why not? They don't cost that much and it's not worth getting in trouble, and again, sooner than that if they don't feel right.
FYI, for Proclear 1 Day, I DO NOT recommend more than one day because I've tested them and they do not make it much past two days so why bother? And I've seen Biofinity and AirOptics lenses look pristine at 30 days.
I think I've got my defensive medicine thing, and ethical considerations figured out. I always try to do the right thing.
Why not?
PS: I've tested t he durability of DT1 on myself and my office staff, both of us with dry eye and deposit concerns, and
numerous times with the same results: 4th day sometimes issues with comfort and optics. 5th day good chance issues, by the seventh day, guaranteed. So 3 days is the sweet spot. I've got one patient that does one week with no problems, and yes, I've checked carefully with the slit lamp. I got 7 days, but only once. I'm very comfortable recommending 3 days.
I have not tried MPS products with this material. Anybody?
) I can only guess what will come next with new materials, but I look forward to the day when dailies become 'default' for most practitioners in the US, as they've become in many parts of Asia.
