o.d. to o.d.
Extended Wear Reborn
Preliminary approval of CIBA Vision's 30-day modality holds needed promise for us.
BY NEIL B. GAILMARD, O.D., M.B.A., F.A.A.O.
Chief Optometric Editor

I remember fitting my first extended wear contact lens. It was heady stuff back in the late seventies. This new modality offered great potential to forever change vision correction.

At the time, I thought it could launch my practice, and all of optometry, into greatness. The first 30-day FDA approval was for aphakic lenses only (this was back in the days when we actually had aphakic patients, not just pseudophakes) and cosmetic extended wear followed.

That was then

We all know that problems ensued with red eyes and ulcers. Eventually, the modality was criticized in medical journals and then in the consumer media. Back then:

• Lens designs and materials were rudimentary. They were thick, coated easily and, at first, they weren't even disposable.
• Lens care products were in the Dark Ages compared with today. Patients made their own saline, and disinfectants caused many reactions.
• Optometrists didn't have the current level of advanced training in diagnosing and treating infections and inflammations. And prescriptive authority for necessary drugs wasn't clear in most states. When complications arose, treatment was frequently delayed.

The FDA eventually reduced maximum wearing time to 7 days, attempting to reduce complications. Our profession lost confidence in the modality, and turned to daily wear for most patients.

This is now

All of the above factors have changed now, making the outlook for safe extended wear much stronger. And there's one other factor that's different now -- refractive surgery has become an accepted form of vision correction. Long-term extended wear offers a non-surgical alternative, and we will now compare the risks of extended wear to LASIK, not daily wear contacts.

When complications do occur with extended wear, and they will, we can remove the lenses and treat the condition. That's more than we can say for some LASIK complications.

A risk with everything

We should openly discuss potential complications of extended wear as we present the option to patients. It's not only our duty as doctors, but it will help educate a very confused public that contact lenses, like any medical treatment, carry risk.

Understanding that risk can actually be good for the contact lens industry. Managing that risk is what creates the need for doctors and ongoing professional care -- rather than salespeople and mail-order replacements. 

(Please post your comments and questions on the OM message board at www.optometric.com.)