Current recommendations and practice regarding soft lens replacement and disinfection.

PURPOSE: We evaluate contact lens wearers' compliance with practitioner recommendations through the analysis of survey data. Trends in practitioner recommendations on discarding intervals and frequency of disinfection for soft contact lenses are analyzed and compared to actual wearer usage. METHODS: The results of two primary surveys are used. One survey measures fit and wear recommendations for contact lens patients by eyecare providers during 1994 and 1995. The second survey was conducted at the end of 1995 to ascertain contact lens wearers' practices in contact lens wear and care. RESULTS: The general trend in practitioner recommendations is towards either disposable or frequent programmed replacement intervals coupled with daily disinfection. Approximately 15% of the brands marketed for disposable use were recommended for replacement at intervals longer than two weeks--the longest interval associated with disposable lenses. We observe a discrepancy between practitioner recommendations and the lens care provided by patients, noting a tendency to replace lenses at intervals longer than recommended. CONCLUSIONS: Trends in practitioner recommendations are consistent with expectations of providers. However, the observation that patients tend to increase their discarding intervals implies that practitioners could do better in educating their patients as to discarding intervals and in prescribing products that best match patient needs for both convenience and cost. These data should alert contact lens fitters to the importance of giving clear instructions to patients on how they should wear and care for contact lenses.

Common eye disorders: six patients to refer.

Thorough ocular history taking and physical examination are essential to establish a diagnosis in patients presenting with eye conditions. Some conditions require ophthalmologic referral to avoid serious complications and even vision loss. These include corneal ulcers, retinal detachment, iritis, glaucoma, retinal artery occlusion, and endophthalmitis. Because primary open-angle glaucoma can have an insidious onset and cause irreversible damage, funduscopic examination should be a part of every complete physical examination.

Common eye disorders: six patients to treat, pitfalls to avoid.

Primary care physicians have an important role in diagnosing and treating eye disorders--including dacryocystitis, blepharitis, and conjunctivitis--and in determining when ophthalmologic referral is needed. Fundus examination for diagnosis of glaucoma and diabetic eye complications should be a part of the routine examination in all adults. Patients with HIV or AIDS should be carefully monitored for cytomegalovirus retinitis. Children should be tested for amblyopia. Orbital cellulitis can have serious complications and must be vigorously treated. Finally, careful use of ophthalmologic topical agents, especially corticosteroid drops, is essential.

Recurrent corneal erosions. Management by the primary care physician.

The primary care physician should be aware of recurrent corneal erosion, a condition that is quite common but is often misdiagnosed. Most cases are a result of minor corneal abrasion, after which the corneal epithelium undergoes a cycle of breakdown and healing that may last for months. Use of a bland antibiotic ointment twice a day for 4 to 8 weeks may be successful, but if the patient is very uncomfortable or continues to have symptoms, referral to an ophthalmologist is appropriate.

Contact lenses and collagen shields.

Contact lenses may change the topography of the eye of asymptomatic patients. Complications continue to occur requiring extreme attention to be paid to fitting techniques, care instructions, and follow-up. All physicians must be alert to complications. Early diagnosis and treatment are essential. The pediatric aphakic patient and the presbyopic contact lens wearer present a challenge. The contact lens fitter must understand the way these lenses function to fit patients more successfully. Collagen shields may be of some benefit in cataract surgery and symblepharon, but may exacerbate the effects of alkali burns on the eye.

The cataract revolution: what the primary care physician needs to know.

Older patients often come first to their primary care physicians with complaints of blurred vision associated with cataracts. An initial office-based diagnosis includes a simple patient history and examination of the retina with an ophthalmoscope. Early referral for an ophthalmologic examination is recommended. Deciding which patients are candidates for surgery depends largely on the cataract's impact on individual lifestyle and ability to function. Patients should be informed of the risks and benefits of surgery as well as some measures that may delay the need for it. Postsurgical complications, although uncommon, require immediate diagnosis and treatment.

Disposable hydrogel contact lenses for extended wear.

Nine ophthalmologists and nine optometrists conducted a premarket study of the Acuvue disposable contact lens manufactured by Vistakon, Inc. Of the 812 patients offered the lens, 733 accepted it and were enrolled in the study. These patients were fitted with the lens and followed for a period of 8 months. Over 98% of these patients had 20/25 or better vision on initial fitting; and subjective ratings of lens comfort were very good. Only 3.7% (27 of 733) discontinued wearing their lenses during the study period. Thirty-four patients (5.6%) experienced a problem while wearing their contact lenses.