# Optical Forums > General Optics and Eyecare Discussion Forum >  What's the difference between daily and monthly contacts?

## optostudent

I'm an optometry student, and I'm trying to figure out the difference between daily and monthly contacts. A few dailies seem to have the same materials, water contents and oxygen permeabilities as biweekly/monthly lenses of the same brand. Sometimes these dailies are thicker, thinner, or the same thickness as their biweekly/monthly counterparts. So is it just the packaging and care procedures that are different, or is there some other attribute that distinguishes them?

The lenses I'm looking at are:
SofLens Daily Disposables / SofLens 59
ProClear 1-Day / ProClear
1-Day Acuvue / Acuvue Colors

----------


## Judy Canty

I'm sure that one of your professors could enlighten you.

----------


## PKCRM114

it really depends on the manufacturer. as B&L found out years ago, you are not allowed to market the exact same lens under different modalities, but depending on the manuefaacturer there are greater or lesser differences. methafilcon, polymacon as well as some other materials haved been use for 2 week, monthly, and full year modalities. but most lenses that have come out more recently have distinct materials for different packaging.

----------


## Judy Canty

I do not believe this is an Optometry student.  More likely, a consumer trying to choose for an online order.

----------


## edKENdance

Interesting question though.

----------


## fjpod

can't wait to hear what Chip tells him.

----------


## PhillyEyes

> I do not believe this is an Optometry student.  More likely, a consumer trying to choose for an online order.


+1 seems that way

----------


## optostudent

The headline was intentionally simple to attract attention, but I think it's a legitimate question. I did of course consult a professor some time ago, but he only provided a vague non-answer that wasn't very satisfying, and my curiosity has lingered since. I don't think there's any reason for mystery around the subject. I figured that practicing ECPs who were actually fitting patients might have a better knowledge of specific products and their distinguishing characteristics. I had speculated that perhaps biweekly/monthly modalities would benefit from a protein- or lipid-resistant coating that dailies wouldn't need, similar to how certain silicone hydrogels are treated with a hydrophilic plasma coating. I'm sure there are other bits of manufacturing esoterica that aren't listed in EyeDock or other contact lens databases. Why, for example, did B&L find they couldn't use the same lens for different modalities?

----------


## fjpod

Optostudent...can you tell me if daily soft lenses are spin cast or lathe cut?

----------


## optostudent

I don't know, I thought most manufacturers had moved to injection molding.

Update: Yeah, they're molded in various ways, though Ciba advertises something called Lightstream Technology, whatever that is.

----------


## Wes

> I don't know, I thought most manufacturers had moved to injection molding.


I thought so too, aside from gas perms.  Maybe it was a trick question.

----------


## drk

> I'm sure that one of your professors could enlighten you.


LOL.  So funny.  So true.

----------


## drk

Having said that, either this consumer is an engineer or something or this kid is the real deal.  Pretty intelligent line of discussion.

----------


## fjpod

OK, you gave the right answer.  Spin casting and lathe cutting are not commonly used anymore.  It was a trick question.  

Consumable health care products such as drugs and contact lenses should be used as intended by the maker and approved by the FDA.  Otherwise the safety and efficacy of the product is compromised, and the patient and you the prescriber, are put at risk.

----------


## chip anderson

In some cases it's just marketing.  Several large manufacturer's got suied a while back for marketing the same lens under several different regimens.   Probably since  then they have made sure there are some discernable differences between DW and FW and EW.  Over the years the difference has supposedly been water content, thickness, materials and whatever the FDA would give approval for the differing applications.   Sometimes it is as little as the quality controls used during manufacture.

Sorry I can't give a better explaination.   However I can say that there is a much higher risk of serious and minor complications with EW than with DW (not the lenses, just the application).   The other side of the coin is that those practices that do not advocate EW (like mine) will see a serious decline in CL patient load.

Chip

----------


## optostudent

I'm not specifically interested in off-label use, but your (fjpod's) mention of the FDA reminded me that soft contacts are considered class II devices that don't require clinical trials or premarket approval (except for extended wear). Instead, it must be demonstrated that the contacts are substantially equivalent to devices already on the market. So I checked, and Proclear 1-Day lists Proclear as its substantially equivalent device. (The SofLens and Acuvue dailies are too old to have PDFs of their applications online.) The Proclear 1-Day application simply says, "The technical characteristics, formulation, manufacturing, and sterilization processes of this lens are equivalent to omafilcon A soft contact lenses currently marketed by CooperVision, therefore no clinical data is required." The FDA determined substantial equivalence had been demonstrated.

----------


## optostudent

Chip: Do you remember who was sued, by whom, and/or roughly when? I'd like to look those cases up.

Update: Also, when I'm talking about dailies and monthlies, I mean daily disposables for daily wear and monthly disposables for daily wear. I'm not talking about extended-wear contacts at all. So I was confused when I was comparing dailies and monthlies, and you were comparing daily wear and extended wear.

----------


## lind2020

it was B&L regarding their vial lines -vs- the Optima I believe - they were simply packaging the vial lens in a blister and selling it as freq. replacement

I would guesstimate it was in the mid 1990's

----------


## optostudent

Oh, interesting. I had seen that the SofLens brand had replaced Optima, but I believe SofLens and Optima are both blister packs, and I thought the modalities were the same, so I'll have to look up which vial lenses were involved. I do see some sites advertise the same contacts as biweekly and monthly, and the SofLens 38 package insert actually says it's for frequent/planned replacement or traditional wear. I believe originally soft contacts were all traditional wear, then the concept of planned replacement was introduced later.

----------


## GAgal

Hey! In regards to the contacts that you requested

Soflens Dailies and Soflens 59- They are the exact same contact, however Soflens 59 cannot be sold in the US because of the same contact lens different modalities parameters set up by the FDA. Both are hilafilicon B, Dk 22X10 water content 59% and ct of .05-.75

Proclear 1day and Proclear- Proclear 1 day has a lower water content of 60% and a slightly lower DK of 21X10 vs a water content of 62% and dk 27X10

1day Acuvue and Acuvue 2 colors- I don't think there is any difference in these lenses except color which is all it needs to differentiate itself. I have heard that vistakon is planning to discontinue this lens. Not sure if this is true or not or if this may be one of the reasons.

----------


## optostudent

Thanks GAgal, I looked at the package inserts for Proclear and they back you up. It's strange that contact lens databases show different data, though.

----------


## optostudent

I found some fascinating reading about the lawsuits against B&L and J&J regarding identical contacts for different modalities:

Roberts v. Bausch & Lomb, Inc.

Kropinski et al. v. Johnson & Johnson

----------


## sharpstick777

Welcome to Optiboard Optostudent! 
Sorry for the less than friendly welcome.  We occaisionly get consumers here that pose as professionals.

In theory, daily lenses don't require surviving a daily disinfecting and cleaning regime, nor do they have to survive repeated removal and insertion.  They don't have to have the same thickness or surface treatments that 2-4 week lens have that are designed to shed protien and bacteria, and survive cleaning and removal without tearing. 2-4 week lenses always return a small degree of solution to the eye (even if its self neutralized), daily lenses don't have to cleaned so they only carry their original solution.  That is theory, in reality manfactures will interpret those options differently in their lenses.  

The real difference to me is that even 2-4 week lenses that are cleaned properly degrade due to wear, air, chemicals, UV exposure, bending, build up and cleaning solution that degrades the surface in contact with the cornea over time.  A daily lens will have less surface degradation.  Combine a pristine surface with a thinner lens and you will simply have in general more potential comfort.

I do find dailies more comfortable myself, just like new socks.





> I'm an optometry student, and I'm trying to figure out the difference between daily and monthly contacts. A few dailies seem to have the same materials, water contents and oxygen permeabilities as biweekly/monthly lenses of the same brand. Sometimes these dailies are thicker, thinner, or the same thickness as their biweekly/monthly counterparts. So is it just the packaging and care procedures that are different, or is there some other attribute that distinguishes them?
> 
> The lenses I'm looking at are:
> SofLens Daily Disposables / SofLens 59
> ProClear 1-Day / ProClear
> 1-Day Acuvue / Acuvue Colors

----------


## eyechick1969

ditto optostudent
I never saw whatever got all the uptightness on you or your question to begin with.
you just wanted some old pros real opinions. Who better to ask!
I think you know the truth. 
If the percentage of all the materials is equal, lens thickness.....etc is all the same then, you are probably busting some of the big manufacturers for their 100% similarities.  And if that's the case, rock on brother.  You'll be great for the industry if you're ready to fight corporate.  Someone has too.

----------


## optostudent

Thanks for the welcomes. And thanks, sharpstick, for the theories on daily lens differences. Im going to bullet-point and address them:

- Theory: Monthlies are more durable to stand up to solutions, bending, and insertion/removal. / Im not sure what would make monthlies more durable other than thickness. But 2-4 week lenses dont seem particularly thicker than dailies. 1-Day Acuvue, 1-Day Acuvue Moist and 1-Day Acuvue TruEye are all thicker than regular Acuvue, Acuvue Advance and Acuvue Oasys. In fact, the thinnest contact Ive found is the plain old polymacon SofLens 38 thats been around since the 70s. Theyre less than half the thickness of most dailies. I tried searching for patents on contact lens technology that would make contacts more durable, but I didnt find anything. That may be because I dont know how best to search for patents, though.

- Theory: Monthlies are designed to shed protein and bacteria. / The only particularly protein-resistant contact lens material I could find is phosphorylcholine, which is used in the ProClear product line. But its used in both the daily and monthly modalities.

- Theory: Monthlies return solution to the eye. / This article is a good summary of internal humectants, which appear to be what enable contacts to return solution to the eye. It looks like this technology was first used in dailies, but several 2-4 week lenses now use this system, too. The biweeklies/monthlies absorb the solution theyre soaked in overnight and release it over the course of the day. The dailies also absorb the packaging solution theyre soaked in and release it over the course of the day. The systems seem pretty similar. Acuvue, the apparent leader in this technology, uses the same humectant, PVP, in both its dailies and biweeklies, whether its called Lacreon or Hydraclear.

So in summary, it still looks like there is, on the whole, no major difference between daily and monthly lenses. There are different lens technologies, but they seem to be applied to all modalities.

----------


## chip anderson

Seems to me (not totally relevant) but someone at B&L told me that they were getting away from Bottle pack because the bottle pack cost them more than manufacturing the lenses did.
Hense it may have been just as profitable to package a 6pk in blisters than to put a single lens in a bottle.

Chip

----------


## sharpstick777

Good work optostudent! Surface treaments applied during manufacturing remain a variable IMHO, with a slight nod to edge design, and stiffness,  both can shedding and contact life.  After all most manufactures use the same/similar base material but the contacts end up feeling and working with a wider range difference than the material alone applies.  I have tried wearing dailies with a regular daily cleaning regime and although they do last longer than a day, none of mine went more than a week.




> Thanks for the welcomes. And thanks, sharpstick, for the theories on daily lens differences. Im going to bullet-point and address them:
> 
> - Theory: Monthlies are more durable to stand up to solutions, bending, and insertion/removal. / Im not sure what would make monthlies more durable other than thickness. But 2-4 week lenses dont seem particularly thicker than dailies. 1-Day Acuvue, 1-Day Acuvue Moist and 1-Day Acuvue TruEye are all thicker than regular Acuvue, Acuvue Advance and Acuvue Oasys. In fact, the thinnest contact Ive found is the plain old polymacon SofLens 38 thats been around since the 70s. Theyre less than half the thickness of most dailies. I tried searching for patents on contact lens technology that would make contacts more durable, but I didnt find anything. That may be because I dont know how best to search for patents, though.
> 
> - Theory: Monthlies are designed to shed protein and bacteria. / The only particularly protein-resistant contact lens material I could find is phosphorylcholine, which is used in the ProClear product line. But its used in both the daily and monthly modalities.
> 
> - Theory: Monthlies return solution to the eye. / This article is a good summary of internal humectants, which appear to be what enable contacts to return solution to the eye. It looks like this technology was first used in dailies, but several 2-4 week lenses now use this system, too. The biweeklies/monthlies absorb the solution theyre soaked in overnight and release it over the course of the day. The dailies also absorb the packaging solution theyre soaked in and release it over the course of the day. The systems seem pretty similar. Acuvue, the apparent leader in this technology, uses the same humectant, PVP, in both its dailies and biweeklies, whether its called Lacreon or Hydraclear.
> 
> So in summary, it still looks like there is, on the whole, no major difference between daily and monthly lenses. There are different lens technologies, but they seem to be applied to all modalities.

----------


## fjpod

The REAL reason certain lenses are labeled as daily, monthly or quarterly, is based on how the manufacturer presented the lens to the FDA for approval.  Depending on what kind of product, or what niche the manufacturer wants to be in.  A lens coming to market as a daily must be accompanied with patient instructions as such, and so on...Just like a drug.  It must be used for intended conditions in a certain prescribed way.

So, a lot of it DOES have to do with marketing, and what kind of product mix a manufacturer wants to have.  Years ago, manufacturers fought for bragging rights for lenses which lasted the longest.  Then it became clear that the longer you keep a lens, the greater the chance of consequences with patients.  And so, today manufacturers can make lenses so cheaply that it is safer to discard them regularly than it is to try and clean and disinfect them, under less than optimum conditions.  

It's not really about the thickness, or the material, or the surface treatments...it's all about the intended use and FDA approval.

So would you use the same q-tip more than once?  How about the same Band-aid?   What about a Kleenex? Hypodermic needle?  So why do we think it is ok to put the same little piece of plastic in the eye day after day?  We are talking about the eye...not the ear, not your finger, not your nose.  The eye is pretty important and we shouldn't be taking risks.

----------


## drk

Yep.

----------


## optostudent

Hi again, sorry it's been a while since I posted, I thought the thread had ended earlier. Someone said that planned replacement lenses were riskier, like a used Q-tip versus a clean one. But that ignores sterilization. A surgeon reuses their instruments while cutting into various patients' different internal organs, but it's not considered an appreciable risk due to sterilization. And sterilization is probably why studies show planned replacement lenses are just as safe or even more so than daily disposables.

I personally doubt that dailies are being promoted by manufacturers because of infection risk. If manufacturers' chief concern was reducing infections, they would be moving us away from extended wear lenses, which studies show increase the risk of infection several fold. They would even be moving us back toward gas permeables, which have a significantly lower risk of infection. But what they wouldn't do is move us toward daily disposables, because, although it may seem completely logical that they would reduce infections, the data suggests they actually slightly increase the risk.

For example, a 2008 British study in the journal Ophthalmology found that daily disposables carried a 56% higher risk of microbial keratitis than planned replacement lenses (although planned replacement lenses were somewhat more likely to be linked with reduced visual acuity). A 2008 Australian study published in the same issue found only a slight increase for daily disposables vs. planned replacement (2.0 cases per 10,000 vs. 1.9 cases per 10,000), but it again shows that decreasing infections isn't a data-supported reason to prescribe daily disposables.

Who knows why this may be. Perhaps people with daily disposables, who don't have to concern themselves with cleaning and overnight care, are more carefree in their use of contacts and more likely to take a shower, go swimming, take a nap in them, pop their contacts back in without washing (since they may not even have disinfecting solution), etc. (The studies tried to account for occasional overnight use, though.) My own theory is that the leading source of lens contamination is the eye itself, a warm, moist, frankly scary environment that you never wash and that you bathe your contacts in for hours at a time. Daily disposables and planned replacement lenses have a relatively equal risk of infection because they're both trapping moisture in this skeezy bacterial breeding ground for the same amount of time, and then each day a clean lens is put in. Extended wear lenses cause more infections because they incubate all the bacteria trapped between the lens and the eye for days at a time. But rigid lenses promote infection less because they don't soak up so much unsanitary lacrymal fluid as soft contacts, and because they frankly shift out of place more often and don't trap bacteria under a de facto petrie dish for 16 hours straight. But again, this is just my personal theory from the New England Journal of My Own Posterior.

The reason I really think manufacturers promote daily disposables is because, while it may cost about $100 more to produce a year's worth of all those lenses, what manufacturers actually charge is in fact several hundred dollars higher. For example, a year's supply of 8 boxes of Acuvue Oasys on 1-800 CONTACTS costs $272, but a year's supply of 24 boxes of 1-Day Acuvue Moist costs $720 and 24 boxes of 1-Day Acuvue TruEye is $864. That's hundreds of dollars in extra profit for the daily brands. Maybe it's cynical to think it's all about the money, but the data in evidence seems to suggest that this is a matter of businesses seeking to make greater profits, which probably isn't very shocking.

PS: I'll post links to those studies in a separate post that I assume will get held for moderation.

----------


## optostudent

And those studies I mentioned can be found at:

http://www.ncbi.nlm.nih.gov/pubmed/18597850

and

http://www.ncbi.nlm.nih.gov/pubmed/18538404

----------


## chip anderson

Optostudent:
Amen   (for those of you who do not know, Amen translates: *Truth* "

Chip

----------


## fjpod

> Hi again, sorry it's been a while since I posted, I thought the thread had ended earlier. Someone said that planned replacement lenses were riskier, like a used Q-tip versus a clean one. But that ignores sterilization. A surgeon reuses their instruments while cutting into various patients' different internal organs, but it's not considered an appreciable risk due to sterilization. And sterilization is probably why studies show planned replacement lenses are just as safe or even more so than daily disposables.
> 
> I personally doubt that dailies are being promoted by manufacturers because of infection risk. If manufacturers' chief concern was reducing infections, they would be moving us away from extended wear lenses, which studies show increase the risk of infection several fold. They would even be moving us back toward gas permeables, which have a significantly lower risk of infection. But what they wouldn't do is move us toward daily disposables, because, although it may seem completely logical that they would reduce infections, the data suggests they actually slightly increase the risk.
> 
> For example, a 2008 British study in the journal Ophthalmology found that daily disposables carried a 56% higher risk of microbial keratitis than planned replacement lenses (although planned replacement lenses were somewhat more likely to be linked with reduced visual acuity). A 2008 Australian study published in the same issue found only a slight increase for daily disposables vs. planned replacement (2.0 cases per 10,000 vs. 1.9 cases per 10,000), but it again shows that decreasing infections isn't a data-supported reason to prescribe daily disposables.
> 
> Who knows why this may be. Perhaps people with daily disposables, who don't have to concern themselves with cleaning and overnight care, are more carefree in their use of contacts and more likely to take a shower, go swimming, take a nap in them, pop their contacts back in without washing (since they may not even have disinfecting solution), etc. (The studies tried to account for occasional overnight use, though.) My own theory is that the leading source of lens contamination is the eye itself, a warm, moist, frankly scary environment that you never wash and that you bathe your contacts in for hours at a time. Daily disposables and planned replacement lenses have a relatively equal risk of infection because they're both trapping moisture in this skeezy bacterial breeding ground for the same amount of time, and then each day a clean lens is put in. Extended wear lenses cause more infections because they incubate all the bacteria trapped between the lens and the eye for days at a time. But rigid lenses promote infection less because they don't soak up so much unsanitary lacrymal fluid as soft contacts, and because they frankly shift out of place more often and don't trap bacteria under a de facto petrie dish for 16 hours straight. But again, this is just my personal theory from the New England Journal of My Own Posterior.
> 
> The reason I really think manufacturers promote daily disposables is because, while it may cost about $100 more to produce a year's worth of all those lenses, what manufacturers actually charge is in fact several hundred dollars higher. For example, a year's supply of 8 boxes of Acuvue Oasys on 1-800 CONTACTS costs $272, but a year's supply of 24 boxes of 1-Day Acuvue Moist costs $720 and 24 boxes of 1-Day Acuvue TruEye is $864. That's hundreds of dollars in extra profit for the daily brands. Maybe it's cynical to think it's all about the money, but the data in evidence seems to suggest that this is a matter of businesses seeking to make greater profits, which probably isn't very shocking.
> ...


Surgical instruments are made of a very high grade stainless steel which is virtually impervious to permanent contamination.  It can be cleaned down to the metal and totally sterilized (autoclaved) without damaging the item.  Contact lenses on the other hand, are absorbent plastic polymers.  They attract and retain dirt, germs, spores, etc. down in the matrix of the plastic even after cleaning.  Contact lenses are not sterilized (except perhaps from the factory).  They are "asepticized" by the patient after opening.  Some dirt, germs, and spores always remain.  So, you really cannot compare the two.

Also, you cannot compare a surgeon using instruments that he has supervised the sterilization of in a highly regulated setting, to a patient using a device (in this case a CL)

When you are in practice, you will learn that in spite of teaching patients how to handle their lenses, solutions, and cases (and drugs, for that matter), they will do the damnest things, which makes them more susceptible to infection and injury from their contacts.  You will be surprised how many patients, in spite of education, do not rub and rinse their lenses before putting them away...how many don't put new solution in the case every night, they just add a few drops...and how many patients never wash the bioslime out of their cases as instructed on a daily basis.  Don't forget the patients that decide to refill their small solution bottles from a bigger bottle for their traveling convenience, thereby introducing untold infection risk.

So when you are looking at whether daily CLs vs. reusable CLs are more safe and effective, you have to look at the whole process.  Don't just look at the plastic and conclude that the CL manufacturer's are trying to rip you off.

----------


## optostudent

I know contacts are never sterile, even new ones as they're not created in cleanrooms, but sterilization was the word in my toolbox. I hadn't even heard of asepticization. And my example of surgical tools was simply to use an extreme comparison to clarify a point, not to equate the two. That point was that using and disinfecting planned replacement contacts is not like reusing a dirty Q-tip, and the study results do indicate that, regardless of how much sense it makes that using new lenses every day is safer, the instances of keratitis are not actually reduced. The best thing we could do to reduce infections, the data suggests, would be to go back to RGPs, the contacts that are worn and reworn for months on end.

Of course, they cost $200-300 a pair. While being made of even cheaper polymer than polymacon.

----------


## uncut

Crossing the street, without looking both ways has it's risks, too.   The concept of wearing a contact lens in the *safest possible manner* gets lost on the buzz of convenience, and unfortunately, gets catered to by manufacturers, IMO.   :Wink:

----------


## fjpod

> ... the instances of keratitis are not actually reduced...


  Clinically speaking, I would disagree with that.  

RGPs present their own set of problems in clinical practice.  You are correct that they may have a lower incidence of microbial keratitis...BUT...do you know what the other considerations there are for RGPs?

----------


## chip anderson

Yes fjpod:  You have to be astute at fitting, follow-up and adjustment with your own hands.  More than people whose main concern is "chair  time" are willing to invest.

Chip

----------


## fjpod

> Yes fjpod:  You have to be astute at fitting, follow-up and adjustment with your own hands.  More than people whose main concern is "chair  time" are willing to invest.
> 
> Chip


Don't forget "chair time" in the patients mind translates to "get me the hell out of here...I don't have time to come back".  Or more politely said, "  doc, I'm busy too, if you can't fit me in a time efficient manner, maybe I should find somebody more skilled".

----------


## chip anderson

FJ:  I just don't think there are many things we see eye to eye on.

Chip

----------


## fjpod

> FJ:  I just don't think there are many things we see eye to eye on.
> 
> Chip


I agree.

----------


## MarieCR

I don't think all the contacts from different manufacturers are the same even when they are all daily contacts. So if you want to get to know better, you should keep in one manufacturer or just a few ones. And compare between the brands.

----------


## SeaU2020

> I do not believe this is an Optometry student.  More likely, a consumer trying to choose for an online order.


Ditto.

----------


## chip anderson

Why did his research seem too thourough?

----------


## sharpstick777

Agreed.  He/she is either the real thing or the most educated consumer in Optiboard history, and beats 'bout half the people on here for good info. 
Why the doubt?  Really?  Compared to some of the posts I have seen, I would nominate Optistudent as a moderator here.  

Good job Optistudent, and again I am sorry for the crappy welcome and continued doubters here.  Why such harsh treatment for just one good question?




> Why did his research seem too thourough?

----------


## sharpstick777

MarieCR, Welcome to Optiboard!  We are thrilled you are here!

Although the difference between dailies and 2 week are small, try wearing an Acuvue Daily for 2 weeks and see how it goes. I did.  It wasn't pretty.




> I don't think all the contacts from different manufacturers are the same even when they are all daily contacts. So if you want to get to know better, you should keep in one manufacturer or just a few ones. And compare between the brands.

----------


## fjpod

I dunno...I would think a student would want to learn the ins and outs...the pros and cons...of the various types of lenses and fitting techniques before deciding to "condemn" the whole industry for trying to pull the wool over the eyes of the public.  I also don't think an optometry student would equate surgical instruments with CLs, and then try to defend it...or a Q-Tip for that matter.  And I would think he was taught in college level microbiology what the difference is between sterilization/autoclaving, and asepticizing/disinfecting.  I'm leaning more consumer than before...but not necessarily an informed consumer...just a consumer...because they are not expert in the field, even though Chip may agree with him/her.

----------


## oxmoon

I've worn CLs daily for a half a century and never had an eye infection or any other problem.  Why?  Because the doctor who prescribed them intially, on my 13th birthday, spent so much time indoctrinating me about the protocol to keep them clean and scaring me to death about what would happen if I didn't.  I think Clear Care and such is a tremedous help for people trying to be clean with their lenses.  But I've never heard it recommended by any docs, who seem to instead push Opti-free and a lens case, and very little of the scare tactics I got as a kid.

----------


## fjpod

> I've worn CLs daily for a half a century and never had an eye infection or any other problem.  Why?  Because the doctor who prescribed them intially, on my 13th birthday, spent so much time indoctrinating me about the protocol to keep them clean and scaring me to death about what would happen if I didn't.  I think Clear Care and such is a tremedous help for people trying to be clean with their lenses.  But I've never heard it recommended by any docs, who seem to instead push Opti-free and a lens case, and very little of the scare tactics I got as a kid.


Sometimes that works real well as in your case.  Often enough, it does not work.  Maybe you being in the business helps...

----------


## opty4062

> When you are in practice, you will learn that in spite of teaching patients how to handle their lenses, solutions, and cases (and drugs, for that matter), they will do the damnest things, which makes them more susceptible to infection and injury from their contacts.  You will be surprised how many patients, in spite of education, do not rub and rinse their lenses before putting them away...how many don't put new solution in the case every night, they just add a few drops...and how many patients never wash the bioslime out of their cases as instructed on a daily basis.  Don't forget the patients that decide to refill their small solution bottles from a bigger bottle for their traveling convenience, thereby introducing untold infection risk.


This is so true. Just today I had a patient who had been wearing the same pair of Avaira lenses since her last exam, 14 months ago. She insisted that since 1. She slept in them so she only handled them once every 6 to 8 weeks (*head explodes*)and 2. by her memory the doc had given her these "forever lenses" (I solemnly swear, her words, "forever lenses")  that she was a perfectly compliant contact lens wearer. Now, since she had done this for the past year with no problems as far as she knew, she had a real hard time accepting the idea that the lenses were, in fact, planned replacement and that she needed to purchase boxes of lenses. 
So, this begs the question in my mind, how did those lenses last that long? I mean, this particular patient is not going to hear me when I say, "after 10 to 14 wears, the lenses won't feel as fresh, your vision may not be as crisp, as they begin to deteriorate as intended by the manufacturer..."

----------


## chip anderson

ClearCare or any of it's predessor names, *does not clean  contacts.* It mearly disinfects them with peroxide  which has had salt added.  The little bubbles are not cleaning the lens (despite label claims to the contrary) they are mearly free oxygen bubbles being released.  Once it was packaged with an enzyme cleaner, aerosol saline, and a cleaner with microbeads.  This was a near perfect contact lens regimine but a: Patients would put the lenses in with unneutralized peroxide due impatience or general stupidity. b: Practioners being too lazy to explain the regimine.  c: Contact lens and solution manufacturer cutting back on starter package expenses.
Lenses need the friction cleaning of manuel digital on removal.  Enzymes don't hurt occasionally either.

Chip

----------


## Jubilee

opty4062, what I told patients was that while they may not have seen/felt a difference, the doctor can tell on the inside of the eye. Just like there are indicators of when you are having too much sugar/fat/salt in the diet, there are indicators of when you are overwearing and being non compliant with your contacts. Typically the eye isn't as able to breathe as well, and starts to develop additional, albeit weaker bloodvessels to compensate. (Neovascularization) Those vessels can break, cause scarring, which can cause a loss of vision, etc. Or due to changes occuring, they won't find their contacts as comfortable in the future, and after another year or two of abuse, will not be able to wear them period..

----------


## fjpod

> ClearCare or any of it's predessor names, *does not clean  contacts.* It mearly disinfects them with peroxide  which has had salt added.  The little bubbles are not cleaning the lens (despite label claims to the contrary) they are mearly free oxygen bubbles being released.  Once it was packaged with an enzyme cleaner, aerosol saline, and a cleaner with microbeads.  This was a near perfect contact lens regimine but a: Patients would put the lenses in with unneutralized peroxide due impatience or general stupidity. b: Practioners being too lazy to explain the regimine.  c: Contact lens and solution manufacturer cutting back on starter package expenses.
> Lenses need the friction cleaning of manuel digital on removal.  Enzymes don't hurt occasionally either.
> 
> Chip


Chip, you're right, clear care is NEAR perfect.  The problem is the patients perception of compliance.  They will do the damnest things no matter how well you teach them.  I have treated many a keratitis induced by clear care, usually when some patient goes out and buys it unknowingly.  So the bottom line is we have to dumb things down to keep patients safe.  RGPs are pretty safe, even when mishandled (although only rare patients ae willing to try them).  When it comes to soft lenses, single use lenses are the safest.

----------


## optilady1

I'm still convinced that there is something in contact lenses that leaches out into patients brains and make them crazy.  I'd like to see optostudent do a study on that.

----------


## vcom

optilady1, I beleive that all psychological evaluations should start with the following question; "Do you currently wear, or are interested in wearing contacts?"

All other questions are irrelevant.  It isn't the contacts that make them crazy, the crazy was already there.

----------


## chip anderson

Geeze:
  I can remember when the "Baylor Group" had a suggested questionair for contact lens candidates that included:  "Do you take the pill? (at that time 90% of those I asked over 14 said yes and I was afraid to ask those younger) also at that time we were blameing a lot of contact lens problems on the pill, which I disreguarded since all most all of the breeding age females were on same.   Do you have middle smarts syndrome?   Are menses regular?  Have you ever been exposed to whatever?

One could say  that one is crazy for wanting to put something in the eye,  in many cases you could say one was crazy for wanting spectacles instead of contacts.    And a lot of people wonder about refractive surgery and those who submit to it.

One must remember that appearently in our society, if it's profitable it must be OK, the more profitable the more it's O.K.

Chip

----------


## Aarlan

> Hi again, sorry it's been a while since I posted, I thought the thread had ended earlier. Someone said that planned replacement lenses were riskier, like a used Q-tip versus a clean one. But that ignores sterilization. A surgeon reuses their instruments while cutting into various patients' different internal organs, but it's not considered an appreciable risk due to sterilization. And sterilization is probably why studies show planned replacement lenses are just as safe or even more so than daily disposables.
> 
> I personally doubt that dailies are being promoted by manufacturers because of infection risk. If manufacturers' chief concern was reducing infections, they would be moving us away from extended wear lenses, which studies show increase the risk of infection several fold. They would even be moving us back toward gas permeables, which have a significantly lower risk of infection. But what they wouldn't do is move us toward daily disposables, because, although it may seem completely logical that they would reduce infections, the data suggests they actually slightly increase the risk.
> 
> For example, a 2008 British study in the journal Ophthalmology found that daily disposables carried a 56% higher risk of microbial keratitis than planned replacement lenses (although planned replacement lenses were somewhat more likely to be linked with reduced visual acuity). A 2008 Australian study published in the same issue found only a slight increase for daily disposables vs. planned replacement (2.0 cases per 10,000 vs. 1.9 cases per 10,000), but it again shows that decreasing infections isn't a data-supported reason to prescribe daily disposables.
> 
> Who knows why this may be. Perhaps people with daily disposables, who don't have to concern themselves with cleaning and overnight care, are more carefree in their use of contacts and more likely to take a shower, go swimming, take a nap in them, pop their contacts back in without washing (since they may not even have disinfecting solution), etc. (The studies tried to account for occasional overnight use, though.) My own theory is that the leading source of lens contamination is the eye itself, a warm, moist, frankly scary environment that you never wash and that you bathe your contacts in for hours at a time. Daily disposables and planned replacement lenses have a relatively equal risk of infection because they're both trapping moisture in this skeezy bacterial breeding ground for the same amount of time, and then each day a clean lens is put in. Extended wear lenses cause more infections because they incubate all the bacteria trapped between the lens and the eye for days at a time. But rigid lenses promote infection less because they don't soak up so much unsanitary lacrymal fluid as soft contacts, and because they frankly shift out of place more often and don't trap bacteria under a de facto petrie dish for 16 hours straight. But again, this is just my personal theory from the New England Journal of My Own Posterior.
> 
> The reason I really think manufacturers promote daily disposables is because, while it may cost about $100 more to produce a year's worth of all those lenses, what manufacturers actually charge is in fact several hundred dollars higher. For example, a year's supply of 8 boxes of Acuvue Oasys on 1-800 CONTACTS costs $272, but a year's supply of 24 boxes of 1-Day Acuvue Moist costs $720 and 24 boxes of 1-Day Acuvue TruEye is $864. That's hundreds of dollars in extra profit for the daily brands. Maybe it's cynical to think it's all about the money, but the data in evidence seems to suggest that this is a matter of businesses seeking to make greater profits, which probably isn't very shocking.
> ...



It's going to be fun having you around.  keep up the good posts.  

AA

----------

