Patients Say the Funniest Things

on July 30th, 2007 | Filed under Optoblog

I was in the contact lens room watching a patient put in the contacts that I wanted to give him. I mentioned how the prescription would be good for 2 years per Utah law.

“Wow, is that new?” he asked.
“Umm, it’s pretty new. The state lawmakers got together and decided that’s how it should be,” I answered.
Then he said, rather sardonically, “Why, because they’re all doctors?”

I laughed out loud. It’s so true. When lawmakers decide to micromanage an entire healthcare profession by telling us how long we have to make a prescription good for, then I think they better have some proof that this new policy won’t cause more problems than it helps. Where is their research that supports such a sweeping change? And the research can’t come from 1-800 or Canada because we know they have a biases.

Now, the Utah law does say that I can make it for less than 2 years as long as I document some medical reason why it should be less. So…since nearly every contact lens patient I see was brought up on AV2 contacts (or some other low oxygen lens that is cheap), I think I could probably make a one year expiration on most everyone since most everyone in that category has mild corneal neovascularization.

So do I? No, because I switch almost everyone into a high oxygen lens, my preferred method for treating K-neo, so if they’re wearing an AV Oasys or Ciba Night and Day, what more can I do to help them?

But if they refuse to switch to a more costly (yet healthier) contact lens, then I explain how we should decrease their wearing time, maintain an approved replacement schedule, and monitor it next year.

One question for you all. Why do you insist on telling your patients that it’s okay to throw away their Acuvue2 lens once a month?!??!! IT’S A TWO WEEK LENS!! You are the reason I see so much K-neo. I hope you’re proud of yourself.

15 Comments

15 Responses to “Patients Say the Funniest Things”

  1. A. InterestedOD says:

    What is Canada’s bias? I’m not sure that any provinces cover exams for those 18-64 now. And the rest are eligible for annual exams. Enlighten me.

  2. A study from Canada showed that people only need eye exams every 3-10 years.

    The Canadian government pays for health care. These doctors deny any government involvement in their research, but I think it’s possible that their Canadian culture could lead to a bias of wanting to prove that yearly or biyearly eyecare is overkill; therefore, it would cost the government less (and possibly reduce taxes) if we prove that less frequent eyecare is acceptable according to the averages.

  3. A. InterestedOD says:

    You should look into health care (specifically eye health care) in Canada before making these claims. Your biases are shining through. 🙄

  4. So they don’t cover routine vision exams for ages 18-64, but U.S. Medicare doesn’t cover routine eye exams either, yet eye exams still get done (by finding out a medical diagnosis related to chief complaint) and patients are told they should come back at specified intervals.

    It doesn’t even matter that they don’t allow routine exams. What matters is they are socialized medicine; therefore, it’s beneficial for them to keep the patient flow down to keep costs down. What a perfect way to justify it by claiming that eye exams are only necessary every 3-10 years.

    So let’s see some studies about eye exam intervals not performed in socialized medicine environments and not sponsored by internet/mail contact lens resellers.

    And don’t roll your eyes at me, Mr Anonymous poster not even brave enough to tell the world your real name along with what you think.

  5. David:
    Please note that I posted my name so you can be assured that I am brave enough to make comments in a public manner.
    Who says AV is a TWO WEEK LENS? The AV rep? Perhaps you should use some clinical judgment instead of listening to the AV rep and likely every other rep that comes in to sell you something. I have seen neo on people wearing an AV with daily removal and 2 week disposal. I have seen neo on people in daily removal and 2 week disposal with a high DL lens. I have seen a clean white eye with NO NEO on a person wearing a regular AV without removal or replacment for SIX MONTHS.
    I take the time to examine the people in my chair. Some will need to dispose of an AV every two weeks, some can go a month. Not everyone needs or benefits from the new high DK lenses. Giving everyone a high DK lens an assuming they will be OK for two years is poor judgment in my view.
    I examine people every year because they need it. Tear chemistry changes, O2 demands change, people develope GPC, that 7D myope is at risk for detachments ( I have seen a 20/20 eye with no symptoms and the macula almost off). Standard of care is 1 year exam not what some lawmaker says. They aren’t on the hook for malpractice, you are.
    In short, I determine a wearing and disposal schedule for each person. That may cut into your contact lens sales but so be it.
    I could go on and on here but I won’t. Let Canada take care of Canada. They seem to be doing just fine.
    Mike Judkins, OD Ogden Utah. (And yes, I do have some Pride. Do you?)

  6. “I examine people every year because they need it.”

    I think we’re arguing for the same thing here, so I’m not so sure why you’re giving me grief. Oh, you take exception to my AV2 is a 2 week lens statement. I’m not the only one taking that position. It also says so on the label.
    If K-neo is so unpredictable in its presentation-even in high Dk lenses, then why not take the conservative approach? You think you’re going to be the patient’s best friend by saving them a few dollars on contacts? I prefer to do no harm (prevent K-neo in this case).

    “I take the time to examine the people in my chair.”

    But if it’s the first time you have ever seen them, why would you tell them to wear an AV2 for one month (patient remembers 2 months)? Are you just going to wait for them to present with k-neo next year (patient remembers to come back in 2-3 years)? When they finally have k-neo, then would you back them down to the recommended replacement schedule of 2 weeks like the package insert says? You know, the recommendation based off of their design, study, and testing of the lens.

    Recommending a 2 week replacement schedule for a 2 week lens has nothing to do with the rep. It’s called science.

    At least we agree that we don’t recommend eye exam intervals based on what legislators say. It should be based on good science, and I’m just saying let’s get some data from unbiased sources.

    But even if studies confirm 2 years is okay, that wouldn’t have helped the woman I saw last month. She had been getting yearly routine vision exams from another eye doctor, but came to me this year. Her vision was, and always has been, just fine. She just wanted more contacts. An abnormal FDT visual field, mild proptosis, and optic nerve rim tissue elevation led to further studies confirming a mass behind her orbit. Does anyone think any study claiming eye exams intervals should be every 2-3 years is going to convince me or that woman?

  7. Look at your shampoo bottle, lather, rinse and repeat. I am sure that advice is the result of extensive study as well. Do you follow it?
    The package insert on AV says “Wearing and replacment schedule should be determined by your eye care professional.” They (Vistakon)only recommend 2 weeks.
    I am giving you a hard time because you assume I am causing harm to my patients by actually thinking, using clinical judgment, and setting an appropiate wearing and replacment schedule for each person. Cost of the lenses is not a factor in that decision.
    Even if it is the first time I have seen a patient I usually know what they are in and how they are wearing the lens. Call for their old RX, ask them how they wear the lens (and believe only half of what they say), and bring them back for return visits as needed.
    Assuming everone needs a high DK and 2 week replacment is just as bad as telling everyone to wear an AV extend wear for 30 days and to come back in a year.
    I could go on but I have to take the family camping.
    Take Care.

  8. Ida says:

    Hey people. I’m a 27 year old female from Norway. I’ve been wearing contacts pretty much every day since I was 18, and all day long. I haven’t let my eyes rest by wearing glasses. In January I noticed that I had developed alot of blood vessels on the white part of the eyes. On the sides, and also under the eyelids. Since I discovered this problem I’ve worn my glasses as much as possible, but the vessels have not disappeared or been reduced at all. Is this corneal neovascularization? And is it possible to get rid of the vessels, with some kind of treatment (laser?). This is such a big problem for me, I’m having a hard time facing people because of how my eyes looks.

  9. I wouldn’t make a diagnosis over the web. I would encourage you to make an appointment with an eye doctor in person for a thorough evaluation.

    Here is a good example of the type of condition we were talking about:
    http://www.uihealthcare.com/depts/med/ophthalmology/contactlens/picofthemonth/corneovasc.html

  10. John Coghlan says:

    I think that what we all agree on is that every patient is different. You need to set recommended follow up on a case by case basis. This is where any legislation can fall down as it just works on averages. With silicone hydrogels you have a greater chance of causing GPC in some patients. Sone patients never deposit lenses and a clean AV lens at 3 weeks probably breathes as well as a 2 week one. Some people could use them for 3 months! What happens with single use lenses. You can use these many times if you want too. We then get into the issue of deposits and secondary tissue irritation etc and what materials deposit more……arguments on this go on forever

  11. Yeah. I the thing I really took exception to was the capatalized statment that AV was a two week lens. Every person in the chair is differnet and I fit the lens according to the patinet not what some taylored study or the rep says.

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