When a technology exists that simply, elegantly, immediately and completely solves the greatest single problem experienced by our contact lens patients, shouldnt we prescribe it whenever possible?
Painful AMD Treatment
I just read Dr. Mark Dunbars excellent commentary on exudative (wet) AMD in the April issues Comanagement Q+A (Injecting New Life into AMD). My AMD was discovered very early because I checked myself with an Amsler grid. I saw a retinal specialist and underwent four injections of Avastin (bevacizumab, Genetech). After he moved, I saw another ophthalmologist for four more injections.
So, I must disagree with Dr. Dunbars suggested explanation to give patients. He says, The injection is not painful at allthe eye is anesthetized and the treatment is very well tolerated.
On the contrary, the injection, even with the anesthetic, is extremely painful for about three seconds. After that, the eye is mildly uncomfortable, and vision is blurred for a few hours.
-Paul Slaton, O.D.
Dr. Dunbar Responds:
It is easy for me to make the statement that the injection is not painful at all, never having had an intravitreal injection myself. I obviously misstated what the patient experience is really like. Clearly, I was wrong, and for that I am sorry. I do thank you for sharing your experiences with the rest of the readers. Hopefully, the injections were successful for you.
What I meant to say (or should have said), is that the injections seem to be well tolerated by the patient, considering that they are receiving an injection into the eye, and the perception is that it would be much more painful than it seems to be. Clearly, there is some level of pain involved, but patients seem to handle it very wellat least the many patients that I have seen being injected. Thanks again for your comments, and I wish you luck with your eye and that the Avastin injections are working to save your vision.
-Mark Dunbar, O.D.
Ortho-K for Cop
The column on the potential dangers of LASIK, LASEK and PRK for a police academy candidate was very interesting (LASIK, LASEK or PRK for Cop? May 2007). With the possibilities of acuity loss, glare, dryness and flap displacement, none of these options seems like a real bargain to me. In fact, if this candidate loses a best-corrected line of vision and no longer meets the criterion of 20/20 correctable vision (as is the case with commercial pilots, as well), his or her career could easily be destroyednot to mention, he or she could file suit against the managing practitioner.
This discussion should have included the use of ortho-K. All of my patients who have ortho-K have better distance vision than all of my LASIK patients, especially those patients who underwent LASIK more than two years ago.
One of my patients is in the Coast Guard. He has Paragon CRT treatment and loves it. His vision is 20/15+ O.U., and there is no danger of flap displacement, no glare and no dryness. For people in these situations, ortho-K is certainly more safe and reliable.
-Michael Silverman, O.D.
ICL for Cop
In regards to Cornea + Contact Lens Q+A, LASIK, LASEK or PRK for Cop? in the May issue, it seems an excellent option was overlooked for this patient. Use of an implantable contact lens (ICL) would solve all of the concerns presented. It would allow for the corneal surface to remain intact, it would provide for a relatively quick recovery, and it would not increase this patients risk in the event of injury.
Given the lengthy recovery period, PRK would seem out of the question. I would also be concerned about the long term implications of LASIK or LASEK regarding night vision and loss of contrast sensitivityeven with a custom procedure. Of course, Im assuming the patient is seeking a myopic correction, since this technology is not yet available for treatment of hyperopia. All optometrists need to consider the ICL when discussing refractive surgery options with a patient.
-Brad Unruh, O.D.
O.D.s with Other Degrees?
I enjoyed your article on optometrists with multiple degrees (O.D.s with Multiple Degrees, June 2007), but I was looking forward to reading about those who have advanced degrees in vastly different areas, such as the humanities or social sciences.
I have an M.A. in philosophy, for instance, because my aesthetics emphasis ties in with my activities as a freelance art critic.
-Alfred Jan, O.D., M.A.
Ortho-K for Dry Eye Patients
Research Review, Dry Eye and Contact Lenses, in the May issue was complete with regard to the higher-visibility and more popular contact lens modalities.
I might suggest, however, that there exists a more effective, albeit less popular, FDA-approved contact lens modality to address this problem. The contact lenses currently approved for overnight contact lens corneal reshaping (orthokeratology, or CRT) enable the patient to experience the freedom and comfort of wearing no contact lens on the eye during functioning hours. This, in turn, provides a solution to contact lens-related discomfort.
Reducing overall contact lens-wear time (eight hours vs. 16 hours per day) and limiting daily wear time to overnight can only benefit the dry eye patient. The closed eye would eliminate incidental contact with potential irritants and preserve the integrity of the existing tear film.
It is true that our profession is busy and inundated with a myriad of ever-improving contact lens products. But, when a technology exists that simply, elegantly, immediately and completely solves the greatest single problem experienced by our contact lens patients, shouldnt we, as primary eye-care providers, prescribe it whenever suitable and possible?
-Bruce Williams, O.D.
O.D. of the Century
When Review of Optometry selected Irvin Borish as its Optometrist of the Century, it got no criticism of, or objection to, that choice. To Dr. Borishs peers, it was a no-brainer. We have watched this enthusiastic visionary work tirelessly to change the trade he entered in the 1930s into the respected health-care discipline that evolved by the end of the century.
Fortunately, we now have a recorded history of this pioneer and his beloved optometry. The book, simply titled Borish, is written in a very readable, understandable and appealing style by Dr. Bill Baldwin, who himself is a recognized and respected leader and activist for the profession.
This book deserves a wide readership. It records much that occurred in years not so very long ago. It documents and records many relevant events in our professions hard-fought struggle for new and expanded privileges.
Irv Borish, O.D., was the cheerleader, the agitator, the detail man, the leader, the follower and the provokerall wrapped into one. He urged and cajoled our professional colleges and our professional associations to work together for our advancement.
I hope that optometrists buy this book and read it. Not only will you enjoy the stories, relish in the history, and smile appreciatively at the successes, but you will see what one dedicated person can do.
It is fortunate that Borish was written while the subject still lives. It is nice to give him the roses while he can still smell them.
-Irving Bennett, O.D.
(Editors Note: A signed greeting from Dr. Borish will be given to anyone who contributes a gift of $100 or more to the
