Recently, I saw a patient who was on three topical anti-inflammatory medications (lifitegrast, cyclosporine and an ester-based steroid), two oral treatments (antibiotic and omega fatty acid), an artificial tear and gel, lid scrubs, a Bruder mask and he had Lipiflow done two months ago. He also walked into the lane carrying a small plastic bag that contained a set of scleral lenses. Talk about a shotgun approach to therapy! This poor gentleman could get no relief despite toting around nearly every remedy his doctors could provide.
He informed me he’d had dry eye symptoms since his LASIK surgery one year ago. He was being managed by the dry eye center at the surgical practice and he didn’t want them to know he was seeking a second opinion before purchasing the sclerals. He estimated he had spent over $10,000 between the surgery, procedures, treatment options and now the cost of the scleral lenses.
This month’s column title quotes Falstaff from William Shakespeare’s Henry IV, Part I, and it’s apt for the topic at hand: to adhere to the Hippocratic oath and do no harm, sometimes practitioners must ignore a sacred cow of our training. Optometric education has drilled into us the notion that the goal is clear, single binocular vision. However, in this patient’s case, meeting this goal could have caused more harm than good.
Ultimately, making the patient happy and enabling them to function again are paramount and take precedence over other clinical goals.
The advent of soft disposable contact lenses permanently altered the contact lens landscape, resulting in the steady decline of corneal gas permeable (GP) lens fitting. At one point, it was even opined that GP lenses would be rendered obsolete. Although this prediction has not come to fruition entirely, GP lenses are increasingly relegated to patients with complex prescriptions or high vision demands. Additionally, specialty designs such as custom soft toric, hybrid and scleral lenses are now widely available and steadily growing in popularity. Consequently, corneal GP lenses are often overlooked as a first choice for our patients.
Research shows GP lenses can provide superior vision quality compared with soft lenses. Their smooth refracting surface in combination with the post-lens tear layer delivers crisp, stable optics, especially for patients with corneal astigmatism. Despite this advantage, practitioners are still hesitant to fit GP lenses. Let’s address a few reservations practitioners may have.
In August, a 62-year-old black female was referred to our office for evaluation of her eyes, by a well-respected diabetes clinic that treats patients who cannot afford care and have no insurance or means to pay for services. It’s also known for encouraging timely eye care.
The patient reported that she had noticed difficulty with her distance and near vision since losing her glasses approximately six weeks earlier. She reported that her last visit to an eye care provider was four years earlier.
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We are very familiar with the potential of certain oral medications to cause ocular sequelae such as hydroxychloroquine, prednisone, topiramate, tamoxifen and amiodarone. But could lesser-known medications cause ocular side effects? How would you know? Click below for more.