PCON Symposium final day features phakic IOLS, wavefront technology, contact lenses

NEW YORK – Contact lens care, phakic IOLS and refractive surgery were the highlighted topics on the final day of the Fourth Annual Primary Care Optometry News Symposium here. A presentation by Jennifer L.Smythe, OD, MS, FAAO, and Loretta Szczotka-Flynn, OD, MS, FAAO, discussed the expanding modalities for silicone hydrogel lenses. While these lenses have traditionally been marketed for extended wear, their high oxygen transmissibility makes them desirable for a wide variety of applications, Dr. Szczotka-Flynn said.

“If oxygen is so great, why shouldn’t we have it for daily wear?” she said. “Why not have it for the patient who wears their lenses from 16 to 18 hours a day, and who may sometimes sleep in them, whether they tell you or not?”

“Dr. Szczotka-Flynn cited findings claiming that by the time most patients reach the age of 50, they will have had their eyes closed for about 16 years. “For patients in their 4th, 5th and 6th decades of life, you might want to consider silicone hydrogels, because these are patients whose endothelium is already somewhat compromised.”

“Dr. Szczotka-Flynn cited a study by Dwight Cavanagh, MD, in which epithelial cells that had been washed from contact lenses worn overnight by subjects were then exposed to Pseudomonas bacteria. “The highest binding of the Pseudomonas was to the lowest Dk lenses,” she said.

“Dr. Smythe said silicone hydrogel lenses can be used for therapeutic purposes as well.

““Focus Night & Day [CIBA Vision] did receive Food and Drug Administration approval as a therapeutic lens,” she said. Silicone hydrogels can be used as a bandage contact lens for ectatic conditions, post-trauma and post-surgery, Dr. Smythe said. Another application could be pressure patch/pain relief, she said.

“Although LASIK remains at the forefront of refractive surgery technology, the recent FDA approval of the Verisyse (AMO) lens appears to have ushered in an exciting new era for phakic IOLS.

““While LASIK still remains king of refractive surgery, I can see these lenses challenging LASIK over the next 5 or 6 years,” said Eric Donnenfeld, MD. “The year 2005 is going to be an landmark year: the year phakic IOLS and lens implants in general become important to all of our practices.”

“Dr. Donnenfeld, along with Marc R. Bloomenstein, OD, and Paul M. Karpecki, OD, FAAO, presented on the topic of “The Role of Phakic IOLs in Today’s Refractive Practice.”

“Dr. Donnenfeld said patient satisfaction is one of the most notable features of phakic IOLS. “There’s nothing quite like taking a patient who is –17 D and offering them vision that is better than anything they have ever had,” he said. “That creates extraordinarily happy patients.”

“Dr. Donnenfeld said in the future, phakic IOLs could be preferable to LASIK for emerging presbyopes. “What if I could say to my patients that I could put a lens in their eye with multifocal optics?” he said. “It will revolutionize refractive surgery.”

“Dr. Donnenfeld also discussed combining phakic IOLs and PRK/LASIK. This combination, called bioptics, has achieved excellent results, he said.

““IOLs still have faults. They can’t correct astigmatism, and they can’t correct higher-order aberrations. So when I see a patient for phakic IOLs, I tell them there is still a chance that I will bring them back for laser surgery.”