<rekuci[at]gmail.com> wrote in message
news:1140663510.586877.146720[at]g14g2000cwa.googlegroups.com...
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in the latter few years. I always cleaned them at night. I decided to ditch
the contacts for good. You only have one set of eyes. Why put them in
jeopardy.

John

rekuci[at]gmail.com wrote:
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Well, I bet odds that there was an epithelial defect in the center of
those white blood cells such that it would have shown a little bit of
fluorescein dye uptake.

DrG

Dr. Leukoma wrote:
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I'm leaving for my appointment in half an hour, had to at least wait
til the office was open to call. In all fairness, it wasn't yet an
ulcer when they saw me. They saw white blood cell accumulation but no
other sign of infection, and said the antibiotic was a precaution.
It's hard to find any level of competence in doctors or otherwise where
I live - I still don't have a general practice doctor because every one
that I try out is worthless, most seem more like a drug sample vending
machines than doctors. Some degree of diagnosing or at least educating
yourself is therefore necessary. You need to know what to ask for, or
else you don't get it. I definitely never had any culturing or
staining done for the last ulcer, but don't remember how soon the
follow-up was. That was already a full-blown infection when he saw me.

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I agree, and I intend to never wear contacts at work again. It's a
little pointless to wear them anyway, since I just have to wear safety
glasses in place of prescription glasses. On the other hand, my
glasses don't really adequately protect my eyes given the nature of the
chemicals I work with. Employers are required to provide prescription
safety glasses, but it'll probably be a serious hassle to obtain.

I hate to say this, but the standard of care involving a corneal ulcer
is professional follow-up within 24 hours. You need to go back to the
doctor regardless, as you are not in a position to diagnose yourself.

My opinion is that you should not be wearing contact lenses at all in
your current working environment. Regarding the article you quoted,
research on the effects of overnight wear of silicone-hydrogel lenses
on the corneal epithelium indicates little or no adverse effects on the
epithelium when viewed under high magnification confocal microscopy.
On the other hand, overnight wear of conventional low-DK soft lenses
does lead to significant epithelial compromise.

The silicone-hydrogel market is growing exponentially. Consumers have
also spoken loudly regarding their preference for low cost, no frills
eye care, abbreviated eye exams, and cheap contact lenses.

DrG

It's hard to tell if the ulcer is any worse this morning. It's
definitely no better in terms of pain. And I'm starting to get redness
now. This seems quite bad if this is bacterial in nature and it's not
responding to a fluoroquinolone. The antibiotic information sheet says
that up to 10% of patients experience side-effects including things
like keratitis, extra irritation and inflammation etc...keratitis is
basically a corneal ulcer so how can one tell if the antibiotic is
working if there is a fairly large chance it could *cause* one? I tend
to doubt the Wal-Mart vision center is going to culture my eye
(although they seem as much if not more competent than any other
optometrist office I've been to, which is why I go there), but I'll
ask. It does hurt for a few seconds after putting the antibiotic in but
goes away pretty quickly.

Perhaps the silicone hydrogels would be ok so long as I don't wear them
to work, but after this I'm afraid to risk it. Interesting paragraph:

"While the precise etiology of the hyperopic shifts with silicone
hydrogel lens wear is not clear, it is likely that both increased
oxygen supply compared to their previous hydrogel lenses and an
"orthokeratology-like" effect are involved. A study of patients who
wore low-Dk hydrogels on an extended wear basis when refitted with
silicone hydrogel lenses (also worn on an extended wear basis)
exhibited a mean hyperopic shift of 0.37D within a month (1).
Initially, this change in refractive error was attributed to recovery
from the myopic shift commonly reported to occur following chronic
corneal hypoxia (2-4). However a subsequent study found similar but
smaller hyperopic shifts in silicone hydrogel lens wearers who had no
previous lens wear experience (5). This finding suggests that silicone
hydrogels, which are relatively stiff compared to conventional soft
lens materials, may flatten the central cornea leading to an
"orthokeratology-like" effect and two studies have reported central
corneal flattening during silicone hydrogel wear (1,5)."

With conventional soft hydrogel lenses, the oxygen permeability is
directly related to the water content. In a low humidity environment,
the water in the lens is evaporating, which drives the growth of blood
vessels into oyour corneas. With silicone-hydrogel lenses, the oxygen
permeability is inversely related to the water content -- with pure
silicone being the most permeable. I have not noticed any issues with
Purevision, as I sell all brands of silicone-hydrogels.

I have been doing research on the dehydration characteristics of
various types of contact lenses, both in the lab and on the eyes of
patients. So far, what I have found agrees with most of the
literature, which is that FDA Group 1 lenses show the least amount of
drying, while Group 2 exhibits the most. Groups 3 and 4 are
intermediate. Purevision is classified as a Group 3 lens. Focus N&D
and Acuvue Oasys are Group 1 lenses.

Silicone-hydrogel lenses have shown a lower rate of infectious
keratitis than conventional hydrogel lenses. However, non-infectious
sterile corneal infiltrates are still occurring. At this point, we
don't really know if your ulcer is sterile, bacterial, or protozoan.
Unfortunately, it is very difficult to obtain a viable culture,
especially after antibiotic treatment.

DrG

First things first. The problem is an autoimmune problem at this point.
The major culprit are toxins from bacteria and the first line of
treatment is antibiotics. Whether the lens is the problem is not
determined. PureVision lenses are surface treated and just don't build
up deposits or bacterial adhesions such as your old lenses did. They
also will dehydrate much less than your Optima's did for most people.

Once the infiltrates have subsided, a change of design is warranted,
try Acuvue Oasys or Advance, Ciba Night and Day as alternatives. Forget
about optic zone, it is of little relevance to most people.

dr grant

In article <1140663510.586877.146720[at]g14g2000cwa.googlegroups.com> ,
rekuci[at]gmail.com wrote:

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Yes.

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The Optima is very low on the oxygen permeability list and you mentioned
you have neovascularization. That would make Optima a poor choice for
any use at all. As you've read, you should be looking at a silicone
hydrogel lens, perhaps a Proclear brand lens or no lens at all.

Do let us know what you learn following your doctor visit tomorrow.

LB, O.D.

With all your problems due to contacts, why not stick to glasses? Its
completely safe and if your pescription isnt very high, youll quickly
get used to them. Some people would be thinking about lasik but that
isnt a safe option either. Only glasses is. I very rarely wear contacts
and I view it as a luxury since they arent comfortable for long and dry
my eyes. I know ill be asking for problems if I wear them more than
occasionally.

Thanks for your reply, I'll be sure to ask about the potential for it
to be fungal or protozoan. At least those shouldn't replicate nearly
as fast as bacteria, but it sounds like a good deal of damage comes
from your own immune response anyway.

I think I oughta stick with what worked for me (other than the oxygen
issue, which should be solved by wearing them infrequently instead of
16 hours/day). The change in thickness and rigidity combined with
drying out is too much, especially for the ridiculously abnormal
environment of the lab I work in.

When I tried on Acuvues, I experienced large blurry areas all around my
peripheral vision. They seem to go cheap on the optical correction
area in the center compared to B&L (and they are cheaper after all).
Not sure if it's the same in all their lenses, but you usually don't
have the luxury of trying on several different pairs.