DAILIES TOTAL1®: An Exceptional CL Wearing Experience, with Dr. Steven Bennett

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In his practice, Dr. Steven Bennett of Ann Arbor, MI fits 80% of his patients in daily disposable lenses.

In this webinar, he discusses how he fits DAILIES TOTAL1® into his practice, the benefits of the lens (and science behind it), the recently expanded parameter range, and the new multifocal lens.

Finally, he touches on the Alcon DAILIES® Choice Program.
 

Charles A McBride

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What are Kirkland Signature Dailies?
 

AdminWolf

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Been wearing the DT1 MF for the past several months, they certainly do feel comfortable all day as advertised. I was supposed to see Charlie this past week to see what his slit lamp shows (but got snowed into my house for a week... a story for another day.) I suspect once I finally get there, his findings will be unremarkable.

I think Dr. Bennett mentions it in the talk, but these lenses are really slippery; it took a while to get removal down, had to make sure my fingers were totally dry. Quite unlike other lenses i've tried.
 

Dan Haas

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I've been using dt1 high powered multifocals OU the last few months, and have become a believer. Best comfort and vision yet, closest thing to my youthful vision I've ever experiences. And, I've been wearing them up to 3 days on weekends without removal, yes not approved but it's the first lens I've ever been comfortable sleeping in.

I think Alcon should approve this lens as a single use lens that can be worn up to 72 hours. This way, the cost would be less of an issue and I think this schedule fits what many folks want.
 
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Charles A McBride

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How do you feel about the value proposition on lens cost, say if you and the Mrs. both have these lenses?

Adam will have to answer this for himself, but they are less expensive now (at my office) than they were a few weeks ago before the UPP policy was discontinued.
 

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Adam will have to answer this for himself, but they are less expensive now (at my office) than they were a few weeks ago before the UPP policy was discontinued.

Well, they are expensive no doubt.

But then, lenses like this and the other 'latest gen' (Oasys 1-day, Ultra, etc) really are the highest-end of high-end contacts, right?

The amount of both R&D and manufacturing capacity required to create these products is huge (think about it - 1 days need 30x the manufacturing volume of monthlies, with QC as high or higher. This is a real manufacturing challenge.)

So I don't begrudge any lens manufacturer for coming in at this price point -- any more than I would Tesla for charging $80k for a Model S.

I know Alcon has the Dailies Choice program to knock cost down for patients wherever possible.

I also know that particularly with the multifocal, cost is less of an issue -- because getting one that works is hard.

To me the most exciting thing about the new-gen lenses is that like any tech, the price will come down (Tesla, please hurry up with that... :) ) I can only guess what will come next with new materials, but I look forward to the day when dailies become 'default' for most practitioners in the US, as they've become in many parts of Asia.
 

Joe DiGiorgio O.D.

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So I don't begrudge any lens manufacturer for coming in at this price point -- any more than I would Tesla for charging $80k for a Model S.

I know Alcon has the Dailies Choice program to knock cost down for patients wherever possible.

I also know that particularly with the multifocal, cost is less of an issue -- because getting one that works is hard.

To me the most exciting thing about the new-gen lenses is that like any tech, the price will come down (Tesla, please hurry up with that... :) ) I can only guess what will come next with new materials, but I look forward to the day when dailies become 'default' for most practitioners in the US, as they've become in many parts of Asia.

While I agree with all that I wonder for regular dailies how much better most patients really need it then say Alcon's Dailies Aqua Comfort Plus, or Coopers Proclear 1-Day. Which are both sub $400 after rebate ( I don't recall, but they are more value priced) vs say Alcon's DT-1 or Cooper's MyDay. Some of the high end lenses have a very generous rebate for year 1, which declines considerably for year 2.

My concern is the CL wearing mother plus 2 kids all in DDs. If we get all 3 DT-1s or MyDays, plus annual exam fee plus CL evaluation fees, is that going to drive them via their smart phones to hunt for alternate sources for a commodity product, or even consider LASIK, which is advertized on the radio as less than many of these lenses?

I know that the hired guns on the speaking circuit are paid to tell us that DDs are good for our practice. Are they good when mom writes a check for 600+ per family member, or do they end up on 1800 and Costco?
 

Joe DiGiorgio O.D.

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Now if Charlie designs and prescribes a custom RGP or custom scleral that is costly, that I feel is different, as those are non-commoditized products.
 

Larry Bickford O.D.

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I've been using dt1 high powered multifocals OU the last few months, and have become a believer. Best comfort and vision yet, closest thing to my youthful vision I've ever experiences. And, I've been wearing them up to 3 days on weekends without removal, yes not approved but it's the first lens I've ever been comfortable sleeping in.

I think Alcon should approve this lens as a single use lens that can be worn up to 72 hours. This way, the cost would be less of an issue and I think this schedule fits what many folks want.
The cost IS NOT an issue if you dispense them for three day use.

And has Dan wrote, and I posted previously, the lens is THE most comfortable lens I've worn and also like Dan, the ONLY lens Ive been able to sleep in.

Don't forget Rule #3: never pre-suppose what a patient can or might be willing to pay for his/her contact lenses. What I tell my patient is this:

"The DT1 lenses are approved and marketed for daily use and replacement. If you can afford to use them like that, that is the way to go. I personally use them for three days and sometimes sleep in them. I've tested their longevity and they might be good for even 5 or 6 days, but three days seems to be the sweet spot. Please do not use them for more than three days as this will give you the best overall wearing experience, eye health and vision. Never wear a lens that doesn't feel perfect on your eye. Do not sleep in a lens if you are ill, are around people who are ill, or have been swimming or surfing. Make certain to store them in Clear Care or Peroxiclear when they are not in your eyes and remember the three day replacement rule. And, of course, if can dispose of them daily, that is the way to go."

Thus far I have 100% compliance.

Awesome lens.
 
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Joe DiGiorgio O.D.

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Don't forget Rule #3: never pre-suppose what a patient can or might be willing to pay for his/her contact lenses.

Whose rule is this? Maybe Bickford Rule #3. (makes me wonder about #1 & #2?)

I personally use them for three days and sometimes sleep in them

Never wear a lens that doesn't feel perfect on your eye. Do not sleep in a lens if you are ill, are around people who are ill, or have been swimming or surfing. Make certain to store them in Clear Care or Peroxiclear when they are not in your eyes and remember the three day replacement rule.

I currently have a patient that was wearing Ciba/Alcon N&D. He uses ClearCare and said his current lens was only 3 days old and felt perfect. On Jan 2. he woke up and BAM. The big kahuna. He developed a life changing near blinding central corneal pseudomonas ulcer. He is still being treated with maximum medical therapy, as launched by Chicago's most famous corneal guru and a team of fellows. I would call it a nightmare case, if it were on my eye I would never forgive myself for going EW.

He can't understand it, as he has been wearing CLs for with no problem for over 20 years, and says he eye felt perfect the prior day.

So DDs are best used as DDs, and not worn EW.
 

Andrew Gore

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I don't want to say the wrong thing, but is it possible this is the Cooper MyDay?

I just used Dr. Google and it appears that Kirkland Signature Dailies and My Day have the same material, base curve and diameter. Except that the Kirkland version is cheaper. Are we surprised?

My Day has been the favorite among the 3 super premium daily disposable spheres. Out here in the Southern California desert, we need every bit of moisture retention and comfort we can get to make contact lens wear tolerable.
 
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AdminWolf

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Whose rule is this? Maybe Bickford Rule #3. (makes me wonder about #1 & #2?)





I currently have a patient that was wearing Ciba/Alcon N&D. He uses ClearCare and said his current lens was only 3 days old and felt perfect. On Jan 2. he woke up and BAM. The big kahuna. He developed a life changing near blinding central corneal pseudomonas ulcer. He is still being treated with maximum medical therapy, as launched by Chicago's most famous corneal guru and a team of fellows. I would call it a nightmare case, if it were on my eye I would never forgive myself for going EW.

He can't understand it, as he has been wearing CLs for with no problem for over 20 years, and says he eye felt perfect the prior day.

So DDs are best used as DDs, and not worn EW.

My big issue is informed consent.

Off-label use is common across all medical specialties (much to the dismay of pharma execs), it isn't just a CL thing.

But I'm curious -- when you go with this sort of modality, do you talk about it with patients & let them know it is off-label, and what that could mean? Even from a defensive medicine standpoint, it would seem the right thing to do (and document.)
 

Larry Bickford O.D.

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My big issue is informed consent.

Off-label use is common across all medical specialties (much to the dismay of pharma execs), it isn't just a CL thing.

But I'm curious -- when you go with this sort of modality, do you talk about it with patients & let them know it is off-label, and what that could mean? Even from a defensive medicine standpoint, it would seem the right thing to do (and document.)
We talked about this.

FDA approves the contact lens material for physiologic safety, whether or not it is EW/CW or not based on?, and sometimes basic design parameters. Everything else is marketing.

That being said, when I inform patients, I clearly state that, in the case of DT, it is not FDA approved for overnight and continuous wear but the oxygen permeability exceeds that for which other lenses are approved. And I always indicate that is it always best to remove them at night unless you must leave them in. For examples: Late nights with crying baby, too inebriated to deal with them (but don't forget to drink lots of water!) etc. And never to leave them in for overnight after swimming or if you work in an environment subject to infection contamination (like hospital workers.)

I suggest that if they'd like to wear the lenses (in the case of DT, for example) for longer than the marketing established by the manufacturer, that they remove them if there is any indication that the lens is not performing as new. "Because that's the beauty of one day use lenses---they should always be excellent and without problems." I offer to validate the lens durability by actual observation with the scope, but in any event that they should dispose of DT lenses after three days and monthly lenses after 30 days because why not? They don't cost that much and it's not worth getting in trouble, and again, sooner than that if they don't feel right.

FYI, for Proclear 1 Day, I DO NOT recommend more than one day because I've tested them and they do not make it much past two days so why bother? And I've seen Biofinity and AirOptics lenses look pristine at 30 days.

I think I've got my defensive medicine thing, and ethical considerations figured out. I always try to do the right thing.

Why not?

PS: I've tested t he durability of DT1 on myself and my office staff, both of us with dry eye and deposit concerns, and numerous times with the same results: 4th day sometimes issues with comfort and optics. 5th day good chance issues, by the seventh day, guaranteed. So 3 days is the sweet spot. I've got one patient that does one week with no problems, and yes, I've checked carefully with the slit lamp. I got 7 days, but only once. I'm very comfortable recommending 3 days.

I have not tried MPS products with this material. Anybody?
 

Larry Bickford O.D.

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Speaking of marketing, what the hell is going on with Coopervision?

Coopervision has gone crazy with lenses/materials/naming. I can’t take it any more.



Daily: My View, Clariti, Proclear, Clearsight.

And now welcome Biofinity Energys! So what’s the difference with that and good old regular Biofinity?

And then there’s Avaira and Avaira Vitality.

Surely I want Energy AND Vitality and having Clearsight would be nice if it was in My View, but I use computers and I probably should get those Digital Zone Optics, no?

And which one can I get at Costco?

U4 and out the door!
 

Joe DiGiorgio O.D.

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PS: I've tested t he durability of DT1 on myself and my office staff, both of us with dry eye and deposit concerns, and numerous times with the same results: 4th day sometimes issues with comfort and optics. 5th day good chance issues, by the seventh day, guaranteed. So 3 days is the sweet spot. I've got one patient that does one week with no problems, and yes, I've checked carefully with the slit lamp. I got 7 days, but only once. I'm very comfortable recommending 3 days.

Larry have you done a similar trial with MyDay?
 

AdminWolf

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Any thoughts on DACP?
i wore DACP for a couple of years, my experience with them is that they were comfortable day 1, and quickly get uncomfortable after a day. Accidentally sleeping with them didn't feel great either!
 

Larry Bickford O.D.

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Larry have you done a similar trial with MyDay?
Nope. Didn't even know about My Day until recently. Cooper rep does not exist here. I did Proclear 1 Day MF because that is what I used to use. Works (optically) very similar to DT MF and is, for me, almost as comfortable, but not so at end of day or under adverse conditions (like too much tequila.)

Meanwhile, I love help out and do extended tests with My Day and what was other one with lots of letters? But I really like my DT MF and don't what to suffer for you guys. :D
 

Joe DiGiorgio O.D.

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Meanwhile, I love help out and do extended tests with My Day and what was other one with lots of letters? But I really like my DT MF and don't what to suffer for you guys. :D
I would be happy to send you some for a road test, but they are only SV, so...

DACP Alcon Daily Aqua Comfort Plus.
 

Joe DiGiorgio O.D.

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i wore DACP for a couple of years, my experience with them is that they were comfortable day 1, and quickly get uncomfortable after a day. Accidentally sleeping with them didn't feel great either!

I like Dailies that give one day performance. Sounds like a perfect choice for proper compliance.
 

Joe DiGiorgio O.D.

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Generous offer here. What happens after year 1?

upload_2017-1-22_7-36-33.png
 

Dan Haas

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The cost IS NOT an issue if you dispense them for three day use.

And has Dan wrote, and I posted previously, the lens is THE most comfortable lens I've worn and also like Dan, the ONLY lens Ive been able to sleep in.

Don't forget Rule #3: never pre-suppose what a patient can or might be willing to pay for his/her contact lenses. What I tell my patient is this:

"The DT1 lenses are approved and marketed for daily use and replacement. If you can afford to use them like that, that is the way to go. I personally use them for three days and sometimes sleep in them. I've tested their longevity and they might be good for even 5 or 6 days, but three days seems to be the sweet spot. Please do not use them for more than three days as this will give you the best overall wearing experience, eye health and vision. Never wear a lens that doesn't feel perfect on your eye. Do not sleep in a lens if you are ill, are around people who are ill, or have been swimming or surfing. Make certain to store them in Clear Care or Peroxiclear when they are not in your eyes and remember the three day replacement rule. And, of course, if can dispose of them daily, that is the way to go."

Thus far I have 100% compliance.

Awesome lens.
I agree with most of this, but I think it's a mistake to allow reuse. I think it should be marketed and used as a "single use lens that can be worn up to 72 hours"

If you are going to remove, store and reuse than it's no longer a single use lens
 

AdminWolf

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If you are going to remove, store and reuse than it's no longer a single use lens

Does most of the microbial risk associated with CL wear come with handling the lens? Or are there other risk factors that develop as the material ages? Or all of the above...
 

Dan Haas

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Does most of the microbial risk associated with CL wear come with handling the lens? Or are there other risk factors that develop as the material ages? Or all of the above...
It's the concept and experience that is important. "Every lens worn comes out of factory sterile, non preserved solution to deliver the ultimate in contact lens convenience, safety and comfort. No expense or need to use a case or a storage solution."

When you tell the patient they can store and re use the lens, then you've just ruined the wonderful experience that most enjoy with daily disposable lenses.

We don't "sell lenses" we solve the patient's vision problems, and the happiest patients are those that have get the best vision with the least inconvenience. Multifocal lenses are the closest thing to youthful vision I've ever experienced and are a great practice builder, and patients in daily disposable multifocals love them. I have an advantage over younger OD's, at age 58 with now a solid +1.00 ds distance rx I'm the multifocal contact poster child. I rotate through all the different lenses on about a monthly basis and there is no substitute to actually using the lenses when it comes to learning the best way to fit each.

I still think manufactures are missing a great opportunity with the new silicone "daily" disposable lenses by not approving them for single use up to 48 or 72 hours, but it'll probably never happen. Doesn't mean I can't use them this way off label, and I sometimes do.
 

AdminWolf

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I still think manufactures are missing a great opportunity with the new silicone "daily" disposable lenses by not approving them for single use up to 48 or 72 hours, but it'll probably never happen.

I wonder if one of the reasons is b/c compliance would become difficult -- that would be an odd wearing schedule for people (did I keep it in three days or 4? who cares, i'll stretch it another day..)
 

Larry Bickford O.D.

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I wonder if one of the reasons is b/c compliance would become difficult -- that would be an odd wearing schedule for people (did I keep it in three days or 4? who cares, i'll stretch it another day..)
It is unfortunate that our week has an uneven number of days. Wife uses an hormone patch. Says to change twice each week. So what does that mean? Ran into the same problem with my garden drip system timer. We need 8 day weeks. Period. But wait! Just set a reminder on your computer/phone. Whoops. Still wont work.

It is my thinking is that poor hygiene is the primary cause of contact lens induced infection, either dirty hands or exposure of lens to pathogens during the day. Or, of course, improper storage between uses. Do you folks observe your patients when they're in for cl check up? How many wash hands before plucking out the lenses (without you saying something)? Do you check their storage case? I've actually taken some away and tossed them in the trash (or recycling bin) right in front of them. I once saw one that almost made be barf. Brown fuzzy stuff growing on the lid. Gross.

How many of YOU wash up between patients? (Thought I'd throw that in. Think about it.)

Back to lens wear: I'm going with 3 days continuous wear and toss 'em. Best bet for me. Love DT1 MF.
 

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How many of YOU wash up between patients? (Thought I'd throw that in. Think about it.)

Back to lens wear: I'm going with 3 days continuous wear and toss 'em. Best bet for me. Love DT1 MF.

I am much more careful since having a kid.... :eek:
 

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Speaking of marketing, what the hell is going on with Coopervision?

Coopervision has gone crazy with lenses/materials/naming. I can’t take it any more.



Daily: My View, Clariti, Proclear, Clearsight.

And now welcome Biofinity Energys! So what’s the difference with that and good old regular Biofinity?

And then there’s Avaira and Avaira Vitality.

It's worse over here - I think your Avaira Vitality is called "cAir" (capitilisation correct) over here, pronounced "care".

Well done marketing dept 10/10
 

Joe DiGiorgio O.D.

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It is my thinking is that poor hygiene is the primary cause of contact lens induced infection, either dirty hands or exposure of lens to pathogens during the day. Or, of course, improper storage between uses.

The vast majority of my CL related ulcers have been in EW wearers. My most recent patient with the Big Kahuna central corneal Pseudomonas ulcer had been an Air Optics N&D wearer. If was on day 3 of his newly replaced lens when he woke up with a painful photophobic red eye. That was on January 2nd. He is still being treated today and still has an epithelial defect(slowly improving) and significant surrounding infiltrate and a reduction in BVA. I speculate that if he were in DDs that he removed each evening, he would have been a much happier man today.
 

AdminWolf

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The vast majority of my CL related ulcers have been in EW wearers. My most recent patient with the Big Kahuna central corneal Pseudomonas ulcer had been an Air Optics N&D wearer. If was on day 3 of his newly replaced lens when he woke up with a painful photophobic red eye. That was on January 2nd. He is still being treated today and still has an epithelial defect(slowly improving) and significant surrounding infiltrate and a reduction in BVA. I speculate that if he were in DDs that he removed each evening, he would have been a much happier man today.

Indeed. We've had numerous manufacturers have docs give presentations here, stating that all things being equal, daily is the way to go. But the patient base in the US isn't there yet.

What I like about Dr. Bennett's talk above (hit play on page 1 to listen) is that it is pretty clear that he's made DT1 his 'default' lens - price be damned, he'll present it first. And a significant fraction of his patients are in the lens.

I lived not far from his practice when I was in college; Ann Arbor is a relatively affluent college town. But it ain't Beverly Hiils. How is he able to pull this off, and what is holding other docs back?
 

Larry Bickford O.D.

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The vast majority of my CL related ulcers have been in EW wearers.
Understood. And I maintain that is the doctor's fault.

Wearers need to understand the benefits and the risks. They need to be taught how to take care of their eyes and contact lenses. They need to understand how to respond to ocular discomfort. And if they don't behave responsibly, get them out of your office.

Here's what I tell patients, after personally teaching and demonstrating insertion and removal starting with a trip to the bathroom.

You need to practice good hygiene and lens care if you want to avoid infection and the pain and possible loss of vision that might go with it. Contact lenses do not cause infections. People do. Oh, actually it's bacteria and viruses, but it's people who put them in their eye. Just pay attention. For example, your contact lenses right now, on your eyes. This is the most awareness you should ever have when wearing them. If they feel dry, add artificial tears or contact lens drops. If it doesn't get better right away, take the lenses out. If you feel like there something in your eye, stop and take out the lens. If you wake up and your eye hurts and doesn't get better in 15 minutes, call me. If your eye gets red and light bothers you, take out the lens. Eye still red and light still bothing you 15 minutes later, call me. Do not tolerate any pain or light sensitivity.Infections need to treated promptly or you might be trouble. The whole idea with wearing contact lenses is to not be thinking about them until it is time to dispose of them and replace them with a fresh pair. Contacts are supposed to provide you with excellent vision and comfort so you don't have to think about your eyes.

Just remember. Wash your hands before touching your lenses or your eyes. Keep your lenses in disinfecting storage solutions when they're not in your eye. Keep you lens case clean and replace it often and replace your lenses on an appropriate schedule. No cheating. Enjoy! And please call me if you have any concerns.

New patient get a copy of that in writing. Patients are queried about their usage habits at every encounter.

The result of doing this stuff is, in my practice, is near 100% compliance and near zero health complications. Seriously.
 

Joe DiGiorgio O.D.

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Indeed. We've had numerous manufacturers have docs give presentations here, stating that all things being equal, daily is the way to go. But the patient base in the US isn't there yet.

Additionally DW reusable lenses removed each evening, in my experience, has had a safer outcome then lense worn on EW modality.
 

Stephen McDaniel

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Add me to the list of DDT1 believers. Only CL I've ever been able to wear for more than a few hours. I'm OU 20/20 Dist and 20/20 ish at near. Can wear over 12 hours before my eyes get tired. have low add OU, slight spec cyl sp LASIK and +1.75 spec add. Wearing low add OU.
 

Charles A McBride

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Add me to the list of DDT1 believers. Only CL I've ever been able to wear for more than a few hours. I'm OU 20/20 Dist and 20/20 ish at near. Can wear over 12 hours before my eyes get tired. have low add OU, slight spec cyl sp LASIK and +1.75 spec add. Wearing low add OU.

The marketing team called... and asked you to stop referring to their lens as the DDT.
 

Joe DiGiorgio O.D.

Well-Known Member
Aug 16, 2008
39,185
8,020
113
School/Org
ICO
City
Orland Park(27 Yrs in Chicago)
State
IL
Understood. And I maintain that is the doctor's fault.

Wearers need to understand the benefits and the risks. They need to be taught how to take care of their eyes and contact lenses. They need to understand how to respond to ocular discomfort. And if they don't behave responsibly, get them out of your office.

Here's what I tell patients, after personally teaching and demonstrating insertion and removal starting with a trip to the bathroom.

You need to practice good hygiene and lens care if you want to avoid infection and the pain and possible loss of vision that might go with it. Contact lenses do not cause infections. People do. Oh, actually it's bacteria and viruses, but it's people who put them in their eye. Just pay attention. For example, your contact lenses right now, on your eyes. This is the most awareness you should ever have when wearing them. If they feel dry, add artificial tears or contact lens drops. If it doesn't get better right away, take the lenses out. If you feel like there something in your eye, stop and take out the lens. If you wake up and your eye hurts and doesn't get better in 15 minutes, call me. If your eye gets red and light bothers you, take out the lens. Eye still red and light still bothing you 15 minutes later, call me. Do not tolerate any pain or light sensitivity.Infections need to treated promptly or you might be trouble. The whole idea with wearing contact lenses is to not be thinking about them until it is time to dispose of them and replace them with a fresh pair. Contacts are supposed to provide you with excellent vision and comfort so you don't have to think about your eyes.

Just remember. Wash your hands before touching your lenses or your eyes. Keep your lenses in disinfecting storage solutions when they're not in your eye. Keep you lens case clean and replace it often and replace your lenses on an appropriate schedule. No cheating. Enjoy! And please call me if you have any concerns.

New patient get a copy of that in writing. Patients are queried about their usage habits at every encounter.

The result of doing this stuff is, in my practice, is near 100% compliance and near zero health complications. Seriously.

Nice Larry.

I like review C&H with each patient and advise to DCW if RSVP.

We also have it on our form about RSVP Redness, Sensitivity to light, Vision change or Pain.

I also tell them that EW means extended risk. I did a check and did find these warnings and the written care sheet signed by Mr. Pseudomonas in his electronic chart. He acknowledged that I have told him each year about the extended risk. He commented that he has worn CLs for 20 years, and that this issue came out of nowhere. He had 5 corneal fellows at the university looking at him within a few hours of the onset. Bam!!! The big Kahuna. You should see this guy's cornea. I am definitely glad we were following FDA protocol, and not going off label.
 
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CECOP USA