I felt that in Dr. Barry Weiss-mans article, Correct Common Contact Lens Complications (June 2004), his description of 3 and 9 oclock staining as one of the most common problems associated with gas permeable lenses was a bit dated. Current GP wearers do not show a recent history of these complaints.

A review of the contact lens-related complaint files at the FDA confirms the very low incidence of GP-related problems. While about 12% of the lens-wearing population are fit with GP lenses, the FDA database complaint file reports (2002 to 2004) show that 0.005% (two complaints out of 380 received during that time period) of contact lens complaints come from GP wearers, with no serious long-term effect.

I searched the reference materials used by Dr. Weissman, and I find that most of his GP-related clinical data predates 1986. One could draw the conclusion that GP lenses have improved significantly over the past 20 years, because we must reference data from articles written 20 or 30 years ago in order to have good clinical reference materials on GP complications.

Very few articles have been written in industry journals about GP 3 and 9 oclock staining because manufacturing consistency and materials have greatly improved in the past six to seven years. This would indicate that the problem is in decline.

I am not suggesting that this condition no longer exists, but the incidence of this type of complication has become less problematic for GP wearers and is now considered rare. Requests for information and responses from young practitioners to the Rigid Gas Permeable Lens Institutes (RGPLI) web site indicate high success rates for GP fits, and some studies indicate growth in the GP patient population as bifocal wearers respond to consumer advertising.

I believe that the GP industry has solved many problems through improved technology and materials. Oxygen transmission, UV protection and long-term corneal health are benefits that we can document through a chronological review of clinical topics associated with GP lens wear.Daniel Bell, Vice Presi-dent/Chairman CLMA Regulatory Affairs Committee, DBELLMD@aol.com. 

Dr. Weissman responds: I thank Mr. Bell for his letter regarding my recent Optometric Study Center article.

Every procedure in medicine has complications and problems that occur in various prevalence rates. We know that wearing spectacles, for example, has the occasional complication of irritating the nose and ears.

I remain an enthusiast for GP contact lenses because I feel they achieve enhanced vision at reduced risk of complications for my patients. Still, GP contact lenses continue to have complications, and I stand by my statement that probably the most common complication among patients who wear GP contact lenses remains 3 and 9 oclock staining.

This impression comes from my personal clinical practice and my reading of the literature. I agree that not much is being written or reported about GP complications. I think this unfortunately may be as much a reflection of the overall reduced use of these excellent devices as it is of the subsequent lack of GP complications, because another common GP complication remains tolerance.

I chose the references listed because I felt they were the most important articles on this topic. I agree that many are somewhat dated. Others might call them classics. You should note that the latest in the published list was from 1997, however, not 1986, and I could have also noted several other excellent papers published as recently as last year had space permitted.^1-3

My clinical impression (and this seems supported by my reading of the literature) remains that GP lenses, in general, have fewer complications than traditional hydrogel lenses (excluding both silicone hydrogels and one-day disposables), and that of these, 3 and 9 oclock staining is the most common.Barry A Weissman, O.D., Ph.D.

1. Schnider CM, Terry RL, Holden BA. Effect of patient and lens performance characteristics on peripheral corneal desiccation. J Am Optom Assoc 1996 Mar;67(3):144-50.
2. Itoh R, Yokoi N, Kinoshita S. Tear film instability induced by rigid contact lenses. Cornea 1999 Jul;18(4):440-3.
3. Van der Worp E, De Brabander J, Swarbrick H, et al. Corneal desiccation in rigid contact lens wear: 3- and 9-oclock staining. Optom Vis Sci 2003 Apr;80(4):280-90.

Optometric Troops

The article, Serving Those Who Serve Our Country (June 2004), was timely, informative and appreciated. However, it would have been that much better if Dr. Miller would have included input from one of our own serving in Baghdad.

Maj. Bruce Flint, O.D., has been in Iraq since late spring and has been stationed at Camp Anaconda. He provides both visual and medical eye care to our soldiers as well as some nationals. To my understanding, he is one of two O.D.s currently in the country serving the eye and vision-care needs of our troops.

I believe an opportunity to highlight one of our own, and get an optometric perspective on the topic was missed.Jeffrey Urness, O.D., Kennewick, Wash. Jeffrey.Urness@pcli.com.

Focus on the Profession

I just had to agree with Dr. Samuel J. Simon who wrote in the June issue (Letters and E-mail, June 2004) about the focus of our profession. I totally agree that we are focusing too much time on disease management and not enough on basic optometry.

I know there are a few great optometrists that are really good at disease management, but the vast majority of us are just regular everyday optometrists that fit contact lenses and glasses most of the time. We do need to know a lot about disease, but some of our journals are looking like we are junior ophthalmologists.

I have always seen the difference between the two of us, and I think we should stop trying to become ophthalmologists with our continuing push for more of their area of expertise. If I have a patient with more than a mild corneal problem, I want him or her to see an ophthalmologist. There is a lot of basic optometry and business management that most of us would rather read about.

We still need to review diseases, but it has gone too far. I know some of you will disagree with me, but most of you agree with me; you just dont want to say it out loud.John Chatelain, O.D., Houston, drchat@sbcglobal.net.

Guess what I can do?
 
In response to Dr. Simons letter on the focus of the profession (June 2004): News flash! Guess what I can do? I can provide clear and comfortable visionand diagnose and treat eye diseases. The primary reason for the profession and its focus should be on eye care as a whole, not just acuity refinement.   I deal with disease management daily, more often than low vision or binocular vision problems.

I fail to understand the authors conclusion that the professions focus on pathology and the promotion of diagnostic doctors, results in a proliferation of commercial optometry. Refracting just isnt that technically difficult and definitely doesnt justify $75,000 worth of post-graduate education. If the optometry schools dont focus on pathology, what should they focus on: modern refracting techniques?  

In order to offer comprehensive eye care, it is vital to understand ocular and systemically-related pathology. Those subjects are vast, challenging and constantly changing, and therefore deserve a larger scope of attention. You can always repair a refraction problem; screwing up pathology can make things much more difficult.

Does the author really feel that clear and comfortable vision is being sacrificed because of the additional disease and therapeutic knowledge? Are optometric offices throughout the country throwing out their dispensaries for retinal cameras and Optos machines? As stated in the editorial, will there be another historical transition from jeweler to optician?

I feel that optometry, as witnessed today, is the next evolutionary step upward on the ladder. Maybe the authors frustration stems from not feeling comfortable with the heights.Mark Cutler, O.D., Bloomington, Indiana.