By Dr. W. Gifford Jones
October 19, 1987
Niccolo Machiavelli wrote in 1513 that ,"A man's wisdom is most conspicuous where he is able to distinguish among dangers and make choice of the least." This wisdom would be useful to medical consumers in 1987. Today increasing numbers of people are choosing contact lenses rather than traditional eye glasses. They are a great boon for patients following cataract surgery. But if such choice is for cosmetic or convenience reasons patients should be reminded that they rarely get something for nothing. Common sense dictates that a foreign object placed in the eye for many hours or days must result in some adjustment, be it minor or major. That's why it's important for patients to ask an ophthalmologist whether the benefits are worth the potential risk.
Dr. Mathea Allansmith of the Harvard Medical School recently shot down one myth about contact lenses. She told delegates to the Canadian Contact Lens Conference that the use of contact lenses invariably causes a change in the ocular surface of the eye even in patients without symptoms. She claimed that biopsies of the conjunctiva , the outer white part of the eye, show dramatic changes in the mucous system of the conjunctiva.
Professor Allansmith cited several reasons for eye irritation in contact lens wearers. She reminded doctors that humans blink about 20,000 times every day. This natural reaction moves a contact lens up and down over the eye ,a distance equivalent to the length of three football fields every day, she calculated.. It's illogical to assume that this repetitive trauma won't have some affect on the eyeball.
Dr. Allansmith pinpointed the worn edge of the contact lens as probably the most common cause of eye irritation. But another factor must always be born in mind, the slow but certain buildup of what she termed, "biodeposits" on the lens which eventually delivers the final blow and makes the contact lens unwearable.
Like other parts of the body the eye must be kept well-oiled to prevent irritation . Epithelial cells of the conjunctiva produce mucous for this purpose. But people who wear contact lenses manufacture more and more mucous
each year which is deposited on the lens. Patients who remove their lenses each day can reduce most of this substance. But the slow, sure buildup of "biodeposits" on the lens in extended- wear users sooner or later triggers problems.
Corneal ulcers are the most serious complication associated with contact lens wear. They're the most feared because they can result in visual loss. Doctors are not certain what initiates a corneal ulcer but in many cases it's believed to be associated with debris that collects on the lens . This causes irritation of the sensitive cornea, the window of the eye. Other ophthalmologists speculate that the lens itself may alter the cornea's natural resistance to fight infection. Other ulcers can be traced to faulty care of a lens and contaminated cleaning solutions.
Patients who suddenly develop, "red eye" should immediately consult the person who dispensed the contact lenses. But if a problem lasts more than 24 hours it's mandatory that patients see an ophthalmologist.
Dr. Allansmith reported in 1977 on a new allergic eye disease," giant papillary conjunctivitis." It was a rare problem at that time but has become increasingly prevalent due to the large number of people using extended wear lenses. G.P.C. is seen most often in patients who wear soft contacts. It's believed the soft lens attracts protein and other foreign matter more than hard or gas permeable lenses. Allergens become embedded in mucus-like material on the lens surface and trigger G.P.C.
Patients with G.P.C. complain of blurred vision, mucous discharge and a little redness of the eye. By the end of the day they feel as if the lenses are drying up in their eyes and they start squinting like Popeye. It's small wonder because underneath the eyelids are clusters of small, bump-like growths which look like mini-cobblestones. Many patients with G.P.C. can be successfully treated by improving the lens cleaning procedure, switching to another type of lens and using sodium cromolyn drops to counteract the allergic reaction.
What "choice of the least danger" would Niccolo Machiavelli make if he were alive today, and his vision needed help? I doubt he'd need 20,000 blinks to see potential danger. I suspect he'd be wearing regular glasses.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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