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12-05-2009, 09:41 AM
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CONFIRMED 02 Optix = Air Optix Aqua
I just started wearing contacts and was provided with a pair of O2 Optix. I suspected that with the various branding changes and such that Air Optix Aqua and O2 Optix were the same and went off to find concrete proof. Then I found it, the smoking gun, a few of them actually:
1. The most damning evidence is the package insert. http://procare.cibavision.com/pdf/o2o_pi.pdf Notice everything, EVERYTHING is the same for O2 optix and Air Optix to include the wearing schedule of 6 days straight or 4 weeks with daily cleaning and such. IN fact, if you go to the us cibavision website, click on Air Optix, then click on their product sheet, it goes to the VERY SAME URL AS ABOVE, the O2 Optix PDF. 2. If you click on the "O2 Optix" website, it goes to the Air Optix website. 3. O2 Optix are not specified anywhere "current" as a 2 week change, only that they can be worn 6 days without removal. 4. The small packet that holds the lens does not specify 02 or Air, just that it's a "Cibavison Spherical. So, after seeing this and other items, I pieced together what happened. So here we go: FDA approves Silicon Hydragel for a 2 week wear period. O2 Optix hit the market. Then the FDA approves Silicon Hydragel for a one month wearing period. Now what this does is lowers the manufacturers revenue by 50% as the lenses now last twice as long. What to do, what to do? Easy? They debut "Air Optix" in the US market as a HUGE IMPROVEMENT and jack up the price. Then they make no effort to publicize that O2 Optix, the very same lens, is also a 4 week lens and, moreover, is the very exact same lense. Just like that, not only do they negate the cost of the FDA extension of the wearing schedule, they add another "product line" for the cost of a differently printed box. BRILLIANT!!! I hesitate to post this on the Air Optix Aqua section. They might hang me. No one likes to throw money away. 
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12-07-2009, 03:38 PM
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CONFIRMED 02 Optix (Almost) = Air Optix Aqua
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Welcome to Lens 101. I spotted your post and decided to check into it myself. I haven't done extensive research, but let me tell you what I've found so far. According to AirOptix.com: "Air Optix® Aqua contact lenses were introduced in 2008 as an upgrade to O2Optix® contact lenses. With the Aqua Moisture System, Air Optix® Aqua lenses provide moisture for comfort on contact, all day, every day. They’re so comfortable that from the moment you put them in you may hardly notice them." It doesn't sound like they're trying to play up Air Optix Aqua as being something totally different from O2 Optix. It's an upgrade. Air Optix.com says that the Aqua Moisture System--which makes the Air Optix Aqua an improvement over O2 Optix--"lubricates, maintains and sustains" the lenses better. Here's a link for you to check out. http://www.airoptix.com/ecp/aqua/AQUA_Moisture.shtml What you're saying sounds like "'Confirmed: Cheeseburger=Hamburger.' Don't buy cheeseburgers. I looked at the ingredients and they have the same ground beef patty, the same bread-like round bun, and the same ketchup, mustard, onion and pickle as a hamburger, yet they cost 10% more. What a ripoff!" Do you see what I'm saying? No one's trying to tell you that a cheeseburger is a hundred times better than a hamburger, but it is different and if you like the difference that slice of cheese-like substance makes, you're willing to pay the difference. If you don't, have a hamburger and keep the change. If you try Air Optix and you don't think they're all that much different than O2 Optix, then by all means, stick to the O2 Optix. Do we all feel better now?
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12-07-2009, 05:25 PM
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A Hamburger is Not a Cheeseburger
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That's a good hamburger/cheeseburger analogy Hypnoteyes. I wonder how troyohchatter will respond?
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12-08-2009, 02:55 PM
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In the desire to use fast food to one up someone you failed to acknowledge the point of the post which is that O2 Optix on this board and at every retail outlet I can find is being marketed as a 1-2 week lens and not the one month lens at half the cost that it actually appears to be. As far as Air Optix Aqua having an additional additive in the case, there is no specific text anywhere that states that when they added that to the newly named Air Optix they didn't start putting it in the O2 Optix as well.
So it's 100% confirmed that the lenses themselves are the same, as stated in the package insert I linked to. That was my only point. I would also bet real money that there is no additional additive in the Air Optix and that the only thing the Air Optix do better than the O2 Optix is lightening your wallet.
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12-08-2009, 03:51 PM
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Plausible: 02 Optix = Air Optix Aqua
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I've looked over this thread with great interest. Let me see if I've got this straight. You claim that even though Air Optix Aqua and O2 Optix contact lenses are being marketed as two different lenses, with the Air Optix having some kind of "additive" advantage over the other lens--that they are in fact the same lens? Have I got that correct? I did a little searching of my own on lens.com and discovered that Air Optix Aqua are 76% lotrafilcon B, and so, apparently are the O2 Optix. So in that respect, they are the same. It looks though like that "Aqua Moisture System" that Hypnoteyes mentioned is what makes the difference. So they're not 100% the same, just like that hamburger/cheeseburger analogy that seems to be so popular. If you compare a hamburger and a cheeseburger side-by-side, they're very much the same. One could even say identical--except for the cheese. Based on this, you cannot make the claim that a hamburger is the same thing as a cheeseburger and that one should expect to pay the same price for a cheeseburger as they do for a hamburger. Many people say a cheeseburger tastes better than a hamburger and will quite readily pay a little extra for one. I'd be one of those people. I'll take a cheeseburger over a hamburger every time. So as long as Air Optix Aqua has that "Aqua Moisture System" and last a month rather than two weeks, it's different than the O2 Optix. So if CIBA Vision wants to sell these as two different lenses at different prices, I don't see why they can't. Selling Air Optix Aqua at twice the price seems a bit much at first, but they do last longer, apparently. So after a month, you will have worn about thirty bucks' worth for either one if you bought them at lens.com. If you're willing to "bet real money that there is no additional additive in the Air Optix," then you are, of course, ready to prove it, aren't you? Thank you for your time, troyohchatter. I thank you also for providing material a very interesting thread.
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12-08-2009, 04:38 PM
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Again, everyone here is making assumptions. here's the quote right from the CIBA website in regards to the difference.
----------- AIR OPTIX® AQUA contact lenses were introduced in 2008 as an upgrade to O2OPTIX® contact lenses. With the AQUA Moisture System, AIR OPTIX® AQUA lenses provide moisture for comfort on contact, all day, every day. They’re so comfortable that from the moment you put them in you may hardly notice them. ---------- Now answer the following after reading the above: 1. IS there ANYTHING that SPECIFICALLY states what the upgrade to the O2 Optix is? 2. When it states that the "Aqua Moisture System" exists, does it anywhere in the writeup say that it is specific to Aqua Optix lenses only, that this was an all new ingredient that they came up with? Does it state ANYWHERE that it's a proprietory and unique solution that comes only with the more expensive lenses? Or are you making the assumption the marketer wants you to make? 3. If it is an proprietary ingredient that is included ONLY in the Aqua's, as in not in the O2's, wouldn't they specify that? What I am telling you, as a marketing professional of many MANY years, is that there is no difference. The insert is the same, the insert states the lenses are the same, the external packaging of the lenses is the same, and there is nothing but "creative marketing' to separate the two. The only time that O2 Optix were EVER called 2 week lenses was when the FDA allowed Silicon Hydragel's to be only used for 2 weeks. Just read the information and come up with some "black and white" confirmation that the lenses or the solution they are soaked in is different. Don't tell me, SHOW ME.
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12-21-2009, 01:41 PM
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Have you tried www.airoptix.com? There are lots of words like "unique" and "patented" to describe this Aqua Moisture System. The site also has a lot of neat charts and graphs that show what sets these contacts apart. The one picture shows the ingredients, including a surface with a "permanent plasma treatment." It also shows the wettability of Air Optix compared to some similar brands as well as how they resist lipid deposition. I'm not sure if this is the kind of information you're looking for, but I think it shows that Air Optix are not the same old same old and that they have some unique properties of wettability and resistance to deposits. As for what specifically the "magic ingredient" is, it may be a trade secret, or or maybe CIBA Vision wants to keep their information simple and accessible instead of saying "We've added a patented moisturizing layer of tri-nitrocloroacetyl-hydrosulfaluminide."
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12-23-2009, 12:36 PM
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12-23-2009, 03:31 PM
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Help Me Out Here
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Others have presented their evidence that these two brands of contacts are different, and all you've said so far is "They're the same. Read the inserts" without offering any other proof. Since I don't have the package inserts, I must rely on what I find on the Internet (i.e. "marketing mumbo jumbo"). Here's what I found at airoptix.com: What is the difference between O2OPTIX® contact lenses and AIR OPTIX® AQUA contact lenses? AIR OPTIX® AQUA contact lenses were introduced in 2008 as an upgrade to O2OPTIX® contact lenses. With the AQUA Moisture System, AIR OPTIX® AQUA lenses provide moisture for comfort on contact, all day, every day. They’re so comfortable that from the moment you put them in you may hardly notice them. This website even has a link that says "If you like O2 Optix, you'll love Air Optix Aqua!" Looking over this thread it seems that you are making the claim that O2 Optix and Air Optix Aqua are identical lenses, while others are saying the two are similar, but not identical. So what's the big deal? They're made out of the same material, but one of them has a special coating that evidently sets them apart as an "upgrade." OK fine. Then they're not identical. So stop saying "There is no difference. NONE" There clearly is a difference. Admittedly, it's a small difference, but a difference nonetheless. *Sigh* Are we done?
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12-28-2009, 06:46 PM
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The package insert I speak of is here: http://procare.cibavision.com/pdf/o2o_pi.pdf
Note the top, the gray area that has all of the lenses that the sheet applies to. Ok, then you read further and it says the lens specs, to include what it's made out of, soaked in, how long you can wear them, etc; and at no time does it draw a line between O2 Optix and Air Optix. From the PDF that I linked to: PRODUCT DESCRIPTION CIBA VISION® O2OPTIX®, AIR OPTIX™ AQUA, AIR OPTIX™ for ASTIGMATISM1 and AIR OPTIX™ AQUA MULTIFOCAL (lotrafilcon B) soft contact lenses are made from a lens material that is approximately 33% water and 67% lotrafilcon B, a fluoro-silicone containing hydrogel which is surface treated. That enough proof??? Read the rest of the sheet if it's not. In addition, I wanted to ensure I was correct prior to posting yet another reply so this evening I spoke to my Eye Doc. He said I was 100% correct in that the lenses are IDENTICAL. The franchise that he works for requires him to keep the Air Optix in his case with the O2 Optix, but he told me he will not sell the Air Optix, and for the last two years, hasn't sold any. The case was full of Air Optix and yes, they were the same boxes that the Cibavision rep put there two years ago.
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12-29-2009, 09:51 AM
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Plausible: 02 Optix = Air Optix Aqua
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What about that Aqua Moisture thing? Doesn't that set them apart, even if the lenses are made of the same stuff? I went to the CIBA vision page and sent a request for information. Let's see what they say. You can send them a note also if you'd like: http://www.us.cibavision.com/contact_us.shtml
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12-29-2009, 12:13 PM
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Yes, the Aqua moisture thing does exist, and it very well may be something that debuted when the Air Optix hit the market, but today, currently, the O2's and Air's are identical, the only difference being the box they come in. I confirmed this with my eye doc last night.
Both are marketed differently, O2's say that they can be worn 6 days straight and Air's are marketed to be worn for a month. The reality is, according to CIBAvision's own documentation, both can be worn for six days straight OR a month with daily cleaning. And the PDF indicates they are the same exact lens. One more thing. This all started because the FDA extended the recommended wear for Silicon Hydragel lenses from 2 weeks to a month, effectively cutting the market for these lenses by 50%. My eye doc did indicate that there have been rumblings of legal action by consumer groups in relation to the general marketing of contact lenses and this issue specifically, but he hasn't heard anything definite.
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01-19-2010, 12:31 PM
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01-22-2010, 04:05 PM
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Ask Your Doctor Which Contacts Are Best For You
Wow. This is a great post. People disagreeing without flaming. I'm not sure what to think. I tend to trust the word of professionals, and troyohchatter's doctor says that these two contacts are the same, yet the evidence available to the general public on the Internet seems to indicate something else.
For all you Lens 101 groupies out there that have read to this point and are still scratching their heads, I would recommend you ask your own doctor and follow their advice. If your doctor says that they're the same, go for the Air Optix because they last longer. If your doctor says that they're different, wear the ones that he or she recommends.
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01-25-2010, 02:46 PM
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Actually, I am getting increasingly frustrated with the concept that CIBAVISION calls O2 Optix a 2 week lens. I have linked to THEIR PDF package insert three times in this thread. The insert states that both the Air Optix and O2 Optix are the same material, soaked in the same solution, and can be worn for the same amount of time. That is the manufacturer. I have explained why the two are marketed differently (money, FDA extending SilHydro lenses from two weeks to one month, etc). I am not asking anyone to believe me, but retrace the thread and READ what CIBAVISION says about their own lenses. READ. READ.. READ. Better yet, take the FLYER I linked to, print it out, and take it to your eye doctor.
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01-25-2010, 03:29 PM
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Can't Open the PDF File
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01-25-2010, 04:32 PM
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Most websites that have documents in pdf format also have a link to the Adobe website where you can download the reader. http://get.adobe.com/reader/ knotlob
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01-25-2010, 05:51 PM
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The package insert proves nothing. The marketing materials suggests the Air Optix Aqua has a new coating. The package insert just mentions coating. That doesn't mean the coating is the same. The wording allows the same insert to be used, even if the coating is different.
That said I'd be surprised if Ciba makes two lenses, identical except for coating. The FDA website http://www.accessdata.fda.gov/cdrh_docs/pdf7/K073459.pdf suggests the coating in the Air Optix Aqua is the same coating that was approved in March 2004. I suspect the lenses are the same, but not for the reasons suggested by the OP. I'm not sure how this is bad. Ciba is giving a quantity discount to those customers who plan to replace their lenses every 2 weeks.
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01-26-2010, 07:59 AM
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01-26-2010, 09:49 AM
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The package insert says the lenses can be worn for up to 4 weeks but to check with your practitioner. It sounds like you want to use the 02 Optix lens for 4 weeks. Check with your practitioner. A different method of cleaning might be suggested for a lens you're going to use for a month. You shouldn't be complaining. You probably found a case where at least some customers can safely save money by using their lenses for longer then indicated by the price point of the lenses. You might want to "stock up" before Ciba decides to discontinue the 02 Optix lens. I'll give you the companies side, although you probably don't agree. A lot of the cost of contact lenses goes to research, development, clinical trials getting FDA approval, educating practitioners etc. The cost to mfg a small piece of plastic is small part of the total cost. contact lens companes want a certain amount of money from us each year to pay for the fixed costs. Take an extreme case. Assume a daily lens could be worn for a year. Could a company stay in business if we spend less then $10 /year? There are probably dozens of threads where posters ask if they can wear their lenses longer then suggested by he mfg. The common answer seems to be only if you don't care about your eyes. The truth is at least a few lenses can be worn longer.
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01-26-2010, 02:03 PM
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You are falling for a piece of "slight of hand" marketing speak. Here's exactly what the marketing material says, and it's the only place where CIBAVISION states as a difference between O2 Optix and Air Optix:
"AIR OPTIX® AQUA contact lenses were introduced in 2008 as an upgrade to O2OPTIX® contact lenses. With the AQUA Moisture System, AIR OPTIX® AQUA lenses provide moisture for comfort on contact, all day, every day. They’re so comfortable that from the moment you put them in you may hardly notice them." Read that outloud. Does it ever tell you that the "AQUA moisture system is unique to the Air Optix? Nope. I agree, it sure makes you THINK they are improved, but it never says that. It's brilliant marketing, and I love that kind of thing. However, understand that if the Air's had a coating that was unique and exclusive to the more expensive lens, that would be spelled out in spades. Furthermore, in every other piece of instructions or documentation, Air Optix and O2 Optix are used interchangeably or are connected with an "and" or an "or." They are the exact same lens, period. Bottom line is that there is no evidence anywhere to indicate that these lenses are different in any way. Quite the opposite. Right? If there is any statement that indicates the Air Optix Aqua are different from the O2's, post it in this thread. I don't want to steer anyone wrong. Oh, and part about my eye doc confirming my suspicions? That was no joke. I invite anyone to print out the package insert and take it to your eye doc.
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01-27-2010, 12:23 PM
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Who Else?
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01-27-2010, 12:46 PM
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01-29-2010, 04:41 PM
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02 Optix = Air Optix Aqua
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Very interesting thread here. In my quest to "make my own determination" I checked to see if there was any evidence on line that O2 Optix contains this "Aqua Moisture system," but I didn't find any. I don't wear O2 Optix or Air Optix Aqua, so the package insert is not available to me. It's interesting to note that some searches came up with the phrase "Buy Air Optix Aqua (previously O2 Optix)" and "Air Optix Aqua have replaced O2 Optix." How can you replace something with the same thing? If I want to replace a tire on my car, I'm not going to take the tire off and put the same one back on. If the tire had been replaced, then it's a different tire, right? All I'm saying is what others have been saying. My determination is that Air Optix Aqua contact lenses are very similar, but not identical, to O2 Optix contact lenses. "Identical" does not mean "very similar." That would be like saying an oval is identical to a circle or that a motorcycle is identical to a bicycle.
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01-31-2010, 10:27 AM
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Even if I allow for the coating to be different (doubtful IMHO), you cannot deny that according to CIBAvision, O2 Optix is a 1month lens, not a 2 week. It's right in the insert. Yet it is marketed and referred to as a two week lens. You do agree with this, don't you?
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02-17-2010, 08:23 AM
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Too much time on your hands
Attack that windmill Don Quixote!
Ever heard of Caveat Emptor? Perhaps you should consider writing a consumer advocacy column. Enjoy! 
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03-25-2010, 01:28 PM
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Follow Your Doctor's Instructions
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I checked www.us.cibavision.com and here's what it said about O2 Optix: "They're so breathable, you can nap in them or even sleep in them for up to six nights extended wear" with a footnote telling you to "consult your eye care professional for recommended wearing schedules" If your eye doctor tells you to change your O2 Optix contacts every month instead of every two weeks, then that's fine, but don't go making these decisions on your own based on something you read on the Internet. The final decision must be made with the input of your eye care professional who can actually examine your eyes. Good luck.
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04-07-2010, 01:30 PM
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Stylinbabe's Summary
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04-07-2010, 05:46 PM
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05-10-2010, 07:16 PM
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The actual facts on O2Optix vs AirOptix
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So many of the postings were really just plain wrong, or even paraniod as to how the process went down. Here are the facts: Ciba brought out the first silicone hydrogel, the Night and Day, as a thirty day replacement lens. Altho it had great oxygen permebility, unfortunately, its a bit thick, and very pricey compared to most two week lenses, so it was never very popular with us eye docs. (The lowest price Ive seen is at Costco, about $50 a six-pack). Also giving this wonderful new lens that name was a big mistake, since many eye doctors, including me, strongly disaprove of ANY overnight wear. (YES, SLEEPING IN LENSES IS VERY UNSAFE!!!!) In sum, it was uncomfy to many, expensive, and the name encourages a bad wearing habit. The O2Optix lens was introduced later by Ciba as a second gen silicone-hydrogel to offer a popularly priced 2 week replacement lens. Compared to Night and day, the O2Optix is thinner, more comfy, just a little less permeable, and cost SIGNIFICANTLY less (Costco sells it for under $19 a box of six). Be aware that ALL silicone hydrogel lenses are quite resistant to protein buildup, so many patients were soon gettting monthly replacement in the O2Optix, with or without their eye doctor's blessing. The "new" AirOptix is indeed exactly the same lens, but it is packaged in a different solution, with a little bit (1%) of a chemical moisturizer added to the saline. Ciba claims that this makes the lens more comfy. Personally I notice no difference whatsoever on MY eye, and have not had a patient be able to tell me which is which, when I ask them to compare them. The monthly labeling of AirOptix vs two week labeling for O2Optix was REQUESTED BY CIBA (to the FDA). The AirOptix is usually priced about twice what the O2 sells for (again as an example, Costco gets $35 a box for it). It is, in my humble opinion, aimed at the docs who are shy to tell patients to stretch the replacement time of the O2Optix. Part of the approval process of any soft lens includes the labeling the maker is allowed to use. Maufacturers go to FDA with a request for what they want to label. My guess is that Ciba had lots of feedback from the docs thru the sales reps, that lots of docs were recommending four week or longer replacement with their O2Optix patients. They may have decided to try to market a new labeling to cash in on the durability of the material. Be aware that docs can tell patients any thing we want, different from the labeling, as long as we disclose that we are doing so (it's called going OFF LABEL). Many docs are afraid to do that, but many, many do it very frequently. As for the "Aqua" additive, other Ciba's lenses have recently been given a new labeling including it, too, notably the Night and Day, and the Focus Dailies. SO it wasnt just the O2Optix that got the "enhancement"/price increase. SO, in sum, the Airoptix is an O2Optix, in a slightly differnt delivery solution, at twice the price, with an official FDA blessing for a longer replacement time. The truth is, of course, that the replacement time an individual gets, safely, is a function of their unique tear chemistry, specifically their tear protein production, which dirties a lens, their lens care, etc, and NOT some bogus approval from the FDA. Many people can NOT wear an AirOptix in a monthly replacement schedule, and some could probably wear an O2Optix for even longer than that. The ink on the box doesnt make a difference, for sure, and I am personally skeptical that the moisurizer is even there for any significant time. I have NOT seen any scientific proof offered by Ciba that the moisurizer persists inside the lens for any specific time in on the eye use. As to one's own best care, you should OF COURSE ask your eye doc, and follow their advice. He/she should hopefully know whats best for you. It depends on whether they rely on company hype, or actually read any of the three or four eyecare professional magazines we are sent, for free, every month, with articles on updated research.
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05-11-2010, 11:37 AM
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Thank You
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So in conclusion, if a patient could wear either O2 Optix or Air Optix, would you recommend the O2 Optix because they're less expensive? I'm also curious about your statement that "SLEEPING IN LENSES IS VERY UNSAFE!!!!" That seems a little strong, don't you think? Very unsafe? All caps? Four exclamation points? Really? Sleeping with a rabid wolverine is VERY UNSAFE!!!! but sleeping in contact lenses that are designed to be worn for seven days and six nights? Is it really that bad? I'd have to see some evidence.
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05-11-2010, 03:00 PM
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wolverines are safer than X wear
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As to potential risk, I would indeed choose the rabid wolverine over sleeping in a soft lens. We have a pretty effective treatment for rabies, and lacerations, but the eye infections I see in overnight wearers are SCAREY. I have personally cared for dozens of serious bacterial keratitis cases which wander into the office in pain, after some other eye doc RXed them in extended wear. I personally know of two patients who LOST AN EYE (note caps) from overnight wear. (I acquired them after that, it wasnt MY Rx.) So YES, I have "daily wear only" printed on my Rx form, and absolutely REFUSE to write an Rx OKing overnight wear... I explain to patients that: 1. Removing a lens at night puts it into an antibacterial solution (in a nice, clean case, of course) which greatly reduces germ populations. Not removing them lets germ counts increase unabated, in a warm, wet, dark, food-laden environment. 2. The fact that we dont blink while asleep lets the nitrogenous waste, which the eye naturally secretes into the tear layer, build up overnight which lowers the pH (more acidic) so the eye is irritated, and more susceptible to penetration by bacteria. 3. Simply increasing the oxygen permeability of a contact doesnt do anything to reduced the risks of 1 and 2. Thats why research has conclusively shown that rates of serious infections are significantly higher in overnight wearers, in ANY sepecific lens, regardless of Dk, and the advent of silicone hydrogels DIDNT reduce those infection rates. Historically, studies show increased rates of serious bacterial keratitis anywhere from five to twenty times higher than in daily wear. So yes, Ill take sharing a sleeping bag with the rodent from Michigan (home of my parents) anyday. What is going to be the REAL safety breakthru is hopefully coming later this year, first from Accuvue, then later Ciba. That will be DAILY lenses in silicone hydrogel material. ALL current dailies are low Dk material, so the new lenses will truly give us the best of both worlds. high air to the eye to enhance comfort and corneal clarity, and to prevent vessel proliferation onto the cornea, along with the safety of daytime only single use. I cant wait!!!!! (five !s, count em.)
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05-11-2010, 03:21 PM
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How Long?
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I must say that this is new information to me. Are there a lot of eye care professionals that believe that sleeping all night in contact lenses in any kind is a bad idea, or are you a pioneer in this field? I also have a question on your second point about nitrogenous waste building up in a sleeping eye. Wouldn't that happen whether you were wearing contacts or not? If it were true that "research has conclusively shown that rates of serious infections are significantly higher in overnight wearers, in ANY specific lens, regardless of Dk" how come there are so many people who apparently sleep safely in weekly and monthly lenses, and even the daily ones that they're not supposed to sleep in? I've never actually counted eyelids, but I always thought it was very common for people to sleep in their contacts. Why aren't we hearing from those who are experiencing bacterial keratitis, neovascularization, and nitrogenous waste buildup on Lens 101? If anything, I think they're getting too many responses from people who sleep in daily disposables and believe they're getting away with it. I don't mean to question your experience and expertise, Doctor G, but I don't see how the manufacturers themselves can recommend sleeping in weekly and monthly contact lenses if the practice was so dangerous. Shouldn't they have been sued to bits by now?
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05-11-2010, 05:11 PM
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Bad Reactions to Sleeping in Contact Lenses
"I have "daily wear only" printed on my Rx form, and absolutely REFUSE to write an Rx OKing overnight wear... "
Could it be that only certain people shouldn't sleep in contact lenses of any kind, just like some people shouldn't deep sea dive, work with children or eat soy? Does it mean that these things are bad for everyone, just because they're bad for some people?
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05-11-2010, 06:29 PM
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The J&J Acuvue TruEye silicone hydrogel daily lens is already available in the UK. I have read a lot of literature, which warns of the risks of corneal ulcers through wearing (any) lenses overnight, even with Doctor's approval and I certainly wouldn't wear them overnight unless I have a very good reason to do so. Normally the quoted risk is 5 times higher and higher still for smokers who wear contact lenses 24/7. We have one or two posters here on this forum who have developed corneal infections through wearing contact lenses overnight. Perhaps the upcoming selenium bactericide coating (which is talked about in the scientific press) will help to address these unpleasant infections. knotlob
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05-12-2010, 03:58 AM
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overnight is bad news
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It is certainly true that many people sleep in their lenses, unaware of the risks, and seeming to suffer no ill efects. I see them frequently in my practice, and have the daunting task of trying to warn them of the potential dangers. Every study done since the advent of so-called extended wear lenses in the early 1980s has conclusively shown that the risk of keratitis is significantly higher in overnight wear than in daily wear. I cannot personally fasthom why the FDA DOES approve any lens for overnight wear, since all of the science shows it to be unnecessarily risky. I seldom meet a patient who has any substantial reason, other than laziness about lens care, to sleep in lenses. Many practitioners do indeed privately admit that they are uncomfortable with recommending overnight wear, but my suspicion is that they lack the courage of their convictions to adequately warn the patients who come in "demanding" this modality. I have no such problem. Every patient I see for contacts is told NOT to sleep in them. The waste produced in a sleeping eye without a contact freely mixes with the tears, and is carried away thru the puncta, the small drain holes at the nasal corner of the upper and lower eyelids. If you evert your lid slightly, you can easily see these drain holes. With a lens sitting statically on the eye, there is no squeegee effect clearing this fluid out from under the lens, so it builds up. In busy eyecare offices like the two I work in, we actually DO see those suposedly happy contact wearers coming in with these infections. I will see 3 or 4 in a typical month, and virtually every one is an overnight wearer. Very ocasionally I will see an infection which seems attributable to swimming in the ocean in the lenses, (an activity NOT approved of by the FDA, by the way) or some other cause. It is suspected in eyecare studies that dirty cases are another potential source of bacterial risk. I would remind you that millions of people smoke cigarettes, with the full blessing of the FDA, which lacks the courage to regulate nicotine as the drug it actually is. These smokers all think they are doing fine, until reality sometimes proves otherwise. In the same way, overnight wearers subject themselves to risk of serious infection, with little or no benefit to outweigh the risk. Contact lens manufacturers care about little else but profit and market share, and the FDA currently lacks the will to do its job, which in theory, is to protect the public. Lens makers therefore develop and market products to try to pander to every segment of the demand, with little regard for what would truly be best for the patient. And FYI they DO get sued, a LOT. B&L has paid, I believe I read, over $25 million in settlements over the ReNu fusarium fungus outbreak. If you are unaware of that, google it.
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05-12-2010, 04:15 AM
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Thanks for the comments
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Ive been fitting contact lenses for 29 years, and have seen many studies quoting risk rates. The figure everyone quotes is 500% (five times), but I have even seen some claiming up to 20 times higher risk. My concern is that even if it were "only" TWICE as risky to sleep in lenses, would you really want to risk loss of your sight for such a small benefit? Also, you are quite right, that smoking raises the risk of overnight wear even higher. I guess anyone who still smokes in the face of all the risks we now know THAT poses, (namely, DEATH) isnt going to let a little risk of blindness scare them? I am really looking forward to the Silicone hydrogel dailies. I used to put virtually all of my patients in dailies until the high Dk lenses cam along, and Im going to be using the new ones a LOT, I think, if they are any good at all. As to the bacteriostatic coatings, it will be interesting to see how toxic they are to the cornea.
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05-12-2010, 04:24 AM
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yes they are bad for everyone.
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What we do know, without doubt, is that sleeping in ANY contact is at least five times more likely to cause a serious eye infection than taking it out every night is. Obviously, not everyone will get an infection. But why increase the risk, when it is SO EASY to just take them off? I once had a myopic patient who was a cervical quadraplegic, who couldnt push spex back up on his nose if they slipped, so he wore soft lenses. He had a caregiver come at bedtime, and in the morning, removing and replacing his lenses. I talked a LASIK surgeon into doing him at a big discount to ease his trouble. I think of him whenever somebody whines about how they "need" to sleep in their lenses.
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05-12-2010, 05:02 AM
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That's a good point about selenium potential toxicity to the cornea, although selenium is needed in trace quantities by the body. Hopefully the FDA Approval process will be rigorous enough to identify any risks. The trouble with all new medical procedures and drugs/medical devices, is the uncertainty associated with/in the longer term use (>10 years). I have mentioned this overnight contact lens wear risk several times on this forum, but like smoking, it's hopefully an informed choice by the wearer. However, it must be distressing as an Eye Doctor to see such needless eye trauma and possibly loss of vision for such a minimal benefit of extended wear. knotlob
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05-12-2010, 11:52 AM
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When I read the comments going back and forth between Knotlob and Doctor G, I feel like I'm in a weight room and two body builders are having a power lifting contest. I feel like I want to just tiptoe out and come back some other time.
 Not that you should stop, of course. I just feel like I have little or nothing to contribute as a non-professional. See you later . . .
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05-12-2010, 12:16 PM
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good point
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I think this digression has been talked to death, too.
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05-12-2010, 12:38 PM
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Go Blind? Seriously?
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Can someone literally lose their sight if they wear their contacts like this, and take every reasonable caution? I'm not talking about careless patients. I'm talking about the ones who know how to take care of contacts, but are apparently mistaken in their belief that O2 Optix contacts can be slept in for six nights?
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05-12-2010, 01:06 PM
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http://www.lens101.com/biofinity/22390-protein-problems-biofinity.html#post126118 The lenses were low oxygen permeability and I don't know what the optician was thinking about stating they were OK for continuous use. Certainly the problems developed in a much shorter time than would have been expected. knotlob
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05-12-2010, 02:43 PM
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Suddenly Sleeping in Contact Lenses is Bad?
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If we know this "without doubt," how come it's never--to my knowledge--been mentioned on this site until now, and suddenly it seems to be in every thread?
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05-12-2010, 03:15 PM
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keratitis..ad nauseum
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First, off, the rate quoted in eyecare journals for microbial keratitis is about 20 cases per 10,000 wearers, each year. I personally care for a population of about 10,000 contact patients, so statistically I should be seeing a couple keratitis cases a month. Lately, I have been seeing about 3 or 4 a month. As to serious damage, defined as a permanent loss of acuity, Im very pleased to say that through very agressive treatment on my part, and referral cooperation with an opthalmology office here, I have not had a single patient suffer that fate. The point to be made is, that we quickly used strong, state of the art drugs, in high, frequent doses, (topical fluoroquinolones, taken every fifteen minutes,) and dodged the bullets. BUT, the RISK for serious damage was present in nearly every one of these cases. I personally would much rather NOT be having to take these heroic measures to save the eyes, when simple common sense wearing is SO much safer. I think that one of the reasons I see a higher percentage of problem cases these days than I did in the past is because of the type of offices I now work in. I spent 24 years in my own small town private practice in California, where I preached Daily Wear to all of my patients, and I therefore saw almost NO keratitis. I "retired" and moved to Maui, and now work two days a week in Costco, and one day a week at Lenscrafters. In those offices, I often see patients who are new to our care, including many tourists on vacation. I therefore now encounter more Extended Wear patients, altho I doubt more than about one in five patients I see admit to sleeping in lenses, these days. The fact that stands out in my experience, is that virtually ALL of the keratitis I do see is seen in these EW patients. I teach ALL contact patients to rinse out seawater with rewetting drops, if they use the lenses in ocean sports, since I am well aware that here in the islands, they are going to wear lenses in the water, no matter WHAT I say about it not being safe. Adding the risk of overnight wear is just stupid, IMHO. I sometimes examine overnight wearers who seem very unwilling to change their habits, and I am always amazed at their lack of concern for the risks involved. Ulcerative Keratitis is bad news. It HURTS, and it CAN seriously scar the eye. I would NOT want to risk it for the silly convenience of not removing a contact at bedtime. Just to show Im not SUCH a nutcase, here is a link to a NY eye doc's blog about "Gambling with your eyes": http://justinbazan.wordpress.com/2007/09/02/extended-wear-contacts-gambling-with-your-eyes/ here is an article, where a Vanderbilt eye professor says they fit no EW based soley on patient request, only very special problem cases, such as babies with severe vision problems: http://www.optometricmanagement.com/article.aspx?article=102281 And, here is a link to a letter from two Aussie opthalmologists to an eye journal, where they say EW is too dangerous, and dont do it: http://www.mja.com.au/public/issues/185_03_070806/letters_070806_fm-2.html Aloha.
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05-12-2010, 03:46 PM
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Without doubt.
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EW came in 1981, and we soon began seeing more and more cases of infections. here is an abstract of the definitive article, from the New England Journal of Medicine, published way back in 1989, summarizing the risk of overnight wear: http://content.nejm.org/cgi/content/abstract/321/12/773 The FDA actually rescinded all 30 day approvals in 1989, based on this fact, limiting wear to seven days. http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm063134.pdf ..and it wasnt until the FDA in 2001 wrong-headedly approved the Ciba Night and Day that 30 day wear returned... Subsequent recent research has shown AGAIN, that pretty much any overnight wear is still as dangerous as ever. This article, which is commonly cited by other researchers, flatly states that overnight wear is the major risk factor in serious eye infection: http://www.eyecareeducators.com/site/risk_factors_for_microbial_keratitis_in_contact_le ns_wearers And, this study shows that even with silicone hydrogel high permeability lenses, we see a 500% higher infection rate in EW vs daily wear: http://unsworks.unsw.edu.au/vital/access/manager/Repository/unsworks:4349?expert=creator%3a%22Edwards%2c+Cathe rine+Patrice%2c+Optometry+%26+Vision+Science%2c+Fa culty+of+Science%2c+UNSW%22 I dont mean to blind you with science, but we DO "know, without doubt" that sleeping in contacts is significantly riskier than daily wear. Sorry if thats news to you.
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05-12-2010, 04:08 PM
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knotlob
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05-12-2010, 04:16 PM
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knotlob
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05-12-2010, 04:21 PM
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pau with this
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Im starting to feel like a know-it-all bully, and I never meant to do that. I love my patients, and do all I can to protect them. Hopefully out of this discucussion, someone might be saved the horror of vision loss, however remote the statistical probability. We have a saying in clinical care: "It aint rare if its in your chair". Unfortunately, I get to see these infections nearly every week I work, year after year, and often have to step in to prevent the damage. Believe it or not, many of these careless contact wearers dont even have backup glasses to wear when I treat them, despite the fact I nag them every exam to be sure that they DO.
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05-12-2010, 04:24 PM
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What's The Risk?
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Knotlob--for whom I have the utmost respect--says that he has sounded the alarm several times in the past few months. I must not have been paying attention. Now, just to clarify for the other Lens 101 readers: When you say that "sleeping in contacts is significantly riskier than daily wear" does that mean that this practice can be called "dangerous?" "Risky" is a relative term. It's risky to jump out of an airplane in flight, risky to walk down a dark alley at midnight, and risky to drink out of a public water fountain. However, not all of these things present the same level of threat. Will a reputable doctor ever tell one of his patients that it's okay to sleep in her O2 Optix contact lenses, but only for a maximum of six nights? I appreciate your input.
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05-12-2010, 04:57 PM
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Thanks. knotlob
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05-12-2010, 05:01 PM
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whats my risk?
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To summarize, sleeping in a soft contact lens, no matter which one, be it silicone hydrogels like Night and Day, Oasys, AirOptix, O2Optix, Purevision, Avira, etc, OR old polyHEMA materials, such as Accuvue 2, B&L Optima, Proclear, etc carries at least a 500% increased risk of developing a bacterial keratitis, which CAN, if not sucessfully treated, lead in the worst case to the loss of the eye. The absolute risk for any given individual is of course impossible to state. Statistically, contact lens wearers OVERALL get this infection at a rate of about 20 per 10,000 wearers PER YEAR. Personally, I think thats a bit low. Overnight wearers, (in any amount), smokers, males, wearers under 25, and recent beginners in contacts, all have further increased risk. Swimming in lenses, spitting on them, using OTC eyedrops, sharing eye makeup (as teens often do) are probably also risk factors, altho some academic may not have gotten around to publishing a study on those as of yet. Lens care solutions also vary as to how effectively they kill germs. The current FDA approval process for solutions is woefully poor, and is slated to be modified in the next couple of years, FYI. Hopefully, for the last time: The simple alternative to overnight wear, which is simply putting them in a nice clean case overnight, in fresh namebrand multipurpose solution, cuts your risk of infection by at least 500%. I cant speak for other "reputable" doctors, but IN MY PRACTICE I tell ALL patients NOT to sleep in their contacts. I dont care that the FDA is more cavalier with the health of the public. They approve medications which have potentially FATAL side effects, all the time. And then change their mind as people start dropping dead. I will now disclose that I also possess a law degree (JD), and am maybe a bit more aware of the liability issues then most eyedocs are. I assume most eyedocs mean well, and care for their patients to the best of their ability. However, I also believe that many, especially the younger ones who were not around in 1989 when the first EW poop hit the fan, (see posts above) tend to believe the hype they get from their sales reps. My Accuvue and Ciba reps are nice guys, and take us out a couple of times a year for a nice dinner, but I still take everything they claim with a grain of salt, and do what I know to be best for my patients. (again, see some of the URLs I posted in replies above to hear from other guys who believe as I do) aloha...
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05-12-2010, 05:59 PM
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I'd rather believe doctors that sales reps any day. Aloha
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05-12-2010, 05:59 PM
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I'd rather believe doctors than sales reps any day. Aloha
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05-12-2010, 06:40 PM
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I am reluctant to keep this thread going on and on, but this post has raised a three minor questions, so perhaps you could kindly clarify. You mention the widely accepted figure of 500% increased risk for sleeping in soft lenses, which are naturally porous. You also previously mentioned a build up of nitrogenous acidic waste products, which could irritate the cornea and one of your references (the gambling one, I think) uses the analogy of a windscreen wiper removing dirt from the cornea, but is unable to do so when contact lenses are worn 24/7. I accept that the majority of clients you see will wear soft lenses, what about RGP lenses? They are not porous and do not usually contain water, but do trap a tear layer between the lens and the cornea. I wear Menicon Z alpha lenses, which in theory are FDA rated as extended wear, though I have no intention to wear them 24/7. In your experience, do RGP lenses carry the same risks as soft lenses in regard to microbial kerititis? Second question relates to your comment on OTC (Over the Counter) eye drops. What do you mean by this? That I should not buy Eye Drops from a supermarket or similar outlet? Are the drops different or non-sterile compared to those sold in an optician's shop? Thirdly. You mention swimming in a swimming pool or the sea with contact lenses as a big risk factor. I have discussed this subject with opticians in Ireland, UK and Germany and none felt the risk (Acanthamoebe keratitis, etc). was a problem (but saliva and tap water were!!). Rather, the risk is more of loosing the lenses. I used to swim 5-6 nights a week, but wore goggles with the soft lenses. I wouldn't risk it with the RGP lenses and I always used a two part hydrogen peroxide cleaning system, which I believe is more secure than the biguanide based alternatives. knotlob Last edited by Knotlob; 05-13-2010 at 05:22 PM..
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05-12-2010, 08:08 PM
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three questions
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1. As to RGPs, statistics always show that infection rates are very small in daily OR EW of rigid lenses. Part of this is perhaps because so few folks wear them, these days, compared to soft lenses. I find that it is primarily much more experienced (stubborn) wearers who (still) have rigid lenses, (because softs are SO much more comfy), and maybe they take better care of them.. also, in any study, as the sample size is less, rarer risks tend to be under-reported vs the actual incidence in a big population. So, maybe there are a few more RGP problem cases we just arent measuring? In theory, the gas perms should also harbor ever-increasing bacterial populations under the closed eyelid, just as a soft lens does. However, the rigid lens covers much less corneal area (about half, in the case of a 9mm lens) than does a soft lens, so there is literally half the space for germs to grow.. Also, the soft lens essentially seals down on a closed eye, whereas a rigid lens still maintains a clearance, full of tears, even on a closed eye. Small movements in sleep (REM) can rock the lens, giving some tear exchange which we just dont have with a big old sucked down soft lens. Therefore we probably get much less waste buildup behind an RGP. Mechanical trauma to the cornea is probably a bit MORE in an RGP lens vs softs, at least in theory. Apparently that isnt a big problem..perhaps the lenses really dont rub the eye all that much when you arent blinking. Speaking of rubbing, most RGP wearers actually rub their lenses to clean them, unlike many soft wearers, so RGPs ARE probably cleaner. Tear proteins also build up MUCH worse on a soft lens, even in a very short time (a few days), giving bacteria a better hiding place/foothold.. as you probably know, RGPs coat very slowly, and can be polished when dirty enough to tell. 2. By OTC I meant any drops other than rewetting drops specifically meant for contacts. Lens wearers will sometimes use junk drops such as those sold for removing redness, or viscous artificial tear drops with soft lenses. I strongly recommend a good rewetting drop, no matter where purchased (I didnt mean to imply that all OTC products are bad) be used as needed for comfort, ease of removal if lenses are dry, and to immediately rinse any bad water the lenses may encounter (ocean, lake, pool, spa). Im surprised to find that very few experienced soft lens patients I acquire have ever been told about rewetting drops, and Im saddened that these drops are no longer provided as samples in new patient kits. I think the solution manufacturers are foolish not to provide them in starter kits, since they are SUCH a high profit item in the aftermarket. They apparently rely on the fitter to promote the drops, and clearly, many eyedocs arent doing that. 3. This really two questions. First, as to swimming: those opinions are sadly incorrect. It is clearly established in both research and clinical experience that swimming in contacts does increase the risk of infections. In the case of acanthamoeba, (which you DONT want to get, believe me..) swimming is probably the primary risk factor, since we no longer use salt tablet homemade saline, as we did in the early eighties. (Does anyone even remember the Blairex tablets, which this very protozoan blew off of the market?) The FDA, who as you know is okey-dokey with overnight wear, specifically prohibits swimming in soft lenses. Here is a URL to the FDA guidelines. http://www.fda.gov/medicaldevices/productsandmedicalprocedures/HomeHealthandConsumer/ConsumerProducts/ContactLenses/ucm062589.htm HOWEVER, many many wearers DO swim in the lenses, anyway. Here in the Hawaiian islands, many patients use soft lenses primarily for water sports, and wear glasses most of the time. SO, I try to warn them of the risks, and preach reduction of all other risk factors. I literally show every patient a rewetting drop package, and tell them to go and buy that product if they have any chance of going in the ocean, a pool, or a spa. (Spas, BTW are a great source of chamydia, which grows really nicely in the eye...fortunately, we now have Azithro as an Rx eye drop...) Bottom line is that we control the risks we easily can (no sleeping in lenses, who needs to?, and using a clean case), to survive the risks we choose to take (wearing lenses while windsurfing, surfing, canoe and kayak paddling, etc). BTW if you think about it, most tap water is probably LOADS safer than ocean or lake water as far as having icky organisms growing in it. Which would you rather drink? As to the final comment about solutions, be aware that hydrogen peroxide systems have a flaw which is often overlooked. Once the disinfection cycle is completed, and the H2O2 is neutralized, there is little or no remaining bacteriocidal action. Therfore lenses shouldnt be STORED in these systems past the first day. Multipurpose systems, such as Optifree, Complete, and ReNu continue to control bacteria for a much longer time, and are much more appropriate for the non-everyday wearer. a hui ho.
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05-13-2010, 05:30 AM
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Many thanks for your insights. Most useful. You are probably right that only stubborn or wearers who are lightly to take care of their RGP lenses will continue to wear them. I realised that the clearance is higher on these lenses because they are more prone to 'grit' getting behind them and they can also be specified to give some minor astigmatism correction without the need for a toric design. In my case I think the 'grit' is dried tear/lens solution products and I have been trying different solution products to improve this. (Many years ago I tried to wear the original hard lenses, but worked in a factory, which made a rather abrasive powder. This powder sometimes blew in the wind and made hard lens wear almost impossible, as the dust was so abrasive. It was OK when I subsequently switched to soft yearly lenses). I also agree with the lens rubbing statement you make. But my Menicon Z alpha lenses are to be 'deep cleaned' every week with sodium hypochlorite (bleach in UK English/Javal? in the US?Canada) and Potassium Bromide - pretty powerful cleaners. There should be less suitable surface (non porous) on a RGP lens for deposits to grow, though the material is of course different. OK, I think I understand the difference in the OTC Eye drops. I guess we are looking at the difference between the horrendously expensive contact lens rewetting drops and a large bottle of eye wash solution - typically Optrex in the UK. Probably more of a buffered saline than a hyaluronate solution. We had a lot of discussion on this forum 2-3 months back about the Acanthamoebe keratitis organism, so hopefully many of our members should be aware of this problem (A boxer going almost blind after using saliva to 'clean' his contact lens, etc.  ).I remember the days of the saline tablets. I think I used to use high purity laboratory distilled water, which I had access to, though it probably wasn't guaranteed sterile! Re the hydrogen peroxide, I use a two part system with the neutralising done when I choose, using a solution of catalase. I don't like the platinum/palladium catalyst type system, though I think it probably is the only option in the US/Canada. I occasionally stored the soft lenses in the 3% peroxide and it never seemed to damage the hydrogel soft lenses. Finally, as regards water sports and swimming pools, I know that Jacuzzis Hot Tubs/Spas are certainly rather unhealthy, unless heavily dosed with chlorine. I didn't know about the chamydia though . I guess it is best to wear a pair of disposables for swimming and then junk them after swimming. Then refit the regular lenses (RGP or Monthly Silicone Hydrogel, as worn normally).Many thanks again for your thoughts on my questions. I'm sure they will be useful to other forum members also. knotlob Last edited by Knotlob; 05-13-2010 at 05:19 PM..
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05-13-2010, 03:15 PM
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dailies good accessory to O2 for sports
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The "deep cleaning" you refer to has been available for many years as an in-office procedure, but is virtually unknown to RGP wearers in the USA. We have a relatively new manufacturing technique called "plasma coating" available for rigid lenses, to improve comfort, and Id fear that that harsh chemical regimin you do would degrade it. Back in the day, I used to teach RGP wearers to occasionally (monthly?) clean their lenses with white toothpaste, mixed with a small pinch of baking soda. My favorite RGP cleaner was/is MiraFlow, originally by Cooper, later made by Ciba. It has a bit of alcohol in it, and cut deposits quite nicely, while enhancing wetability. I really DONT recommend using anything for an in-the-eye drop for soft lenses except proper rewetting drops. First off the small bottle size ensures that they dont get too old, and possibly contaminated, and secondly, the small bottle is FAR more likely to be carried to the activity, and therefore more likely to actually be used. The rewetters available in the USA include the Equate brand sold by Walmart at only $4 US for a pack of two 15ml bottles, so it certainly isnt prohibitably expensive. Alcon's Optifree rewetter is about $6 US for 5ml, so yes, its a bit pricey. BTW these solutions, at least in the US, contain buffers, a viscosity agent or two, (altho NOT hyaluronate based), and non BAK preservatives, often sorbic acid and EDTA, which were the main preservatives in "saline" solutions thru the mid 80s. Im assuming you are referring to your current RGPs, regarding the H2O2 system. Be aware that in the US we never use soft lens disinfecting systems with RGPs. They are simply stored in a viscous, mildly preserved RGP storage solution, such as the Boston, (now branded here as B&L). Nobody worries much about disinfection of RGPs since vietually NO ONE sleeps in them, and more and more, hardly anyone even has them any more. The three biggest historical brands of solutions for them (Alcon's Soaclens, Barnes-Hind's pink bottle Storage Solution, and Allergan's Wet-N-Soak) are all no longer available. My favorite soaking solution is actually a local California brand called Lobob. The problem with delayed neurtralization of peroxide systems, especially in the case of soft lenses, is that you need to do it before you can wear them, so the lenses are not immediately available for use. Actually, as to water on the lenses (recall that it is a complete NO-NO under FDA guidelines) You are quite right, what I often do, is to write a second Rx for dailies for water sports only, for my Silicone-hydrogel patients. In addition to their usual Oasys or O2Optix (huzza! back on topic!) lenses worn most of the time, for the great oxygen performance, I tell them to get a 90 pack of dailies, (usually with the power equalized/averaged so they can get by with only one box, if at all possible) for water sports. We then pitch them out after that use, rinse the eye with rewetter, and return to the good lenses. I dont know how many actually do this, but its what I advise. The dailies can be had here for about a half-dollar a lens in 90 packs.
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05-13-2010, 04:11 PM
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Many thanks. Some of the threads here do drift off a bit so will try to be brief. Re the deep cleaning, my lenses are by Menicon (Z alpha) (Japanese origin) and they do have a plasma coating to improve wettability. I believe they are one of the few to be FDA approved for extended wear. Menicon recommend their Menicare Plus solution (which is a viscous biquanide based solution, but I found it a bit troublesome forming 'grits' after a few hours wear. I checked with my optician and then Menicon directly, if I could use the hydrogen peroxide system that I had used for 30 off years with soft lenses. They agreed this was OK. Boston cleaning products must NOT be used with the plasma coated lenses, as at least some of the Boston solutions contain an abrasive/polishing compound. So that rules out toothpaste also, which used to contain chalk as a filler and then aluminium hydrate, before reverting to chalk over fears associated with aluminium and Alzeimers Disease. I didn't realise the professional 'deep clean' was a chemical clean like the Menicon Progent solution. Menicon state that cleaning is once/week but for a maximum of 30 minutes each time, otherwise the lens will be discoloured. Re the peroxide neutralisation, because I use a catalase neutralising solution, I could wear the lenses within 10 minutes of start of neutralisation, not the 6 hours needed for the platinum catalyst. Rewetting drops. I never needed them for soft lenses but was using them for the RGP lenses. But the bottle is 15 ml and costs about US$9.50 and may only last 2 weeks in the extreme. OK, it's easy to carry with you, as opposed to a 330ml bottle. Even that is about the cheapest I can find and is an own brand from the optician chain that I use. WalMart used to be here for a few years but sadly their culture just didn't seem to gel with that of the Germans and they closed up and moved on  - so no cheap solutions now. The Rewetting drops I use are 0.1% hyaluronate, polyhexanide, sodium edetate, isotonic phosphate buffer & purified water. They all seem to be rather similar in composition. I just changed cleaning solutions for these lenses and hopefully I can get away with not using the rewetting drops.I'll go with your advice re the cheap Daily Disposables for water sports. At present in Germany we don't technically need a prescription to buy contact lenses, though that will change shortly once the European Union introduce legislation like that in the US. Once again, many thanks for your words of wisdom. knotlob
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05-13-2010, 04:55 PM
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CONFIRMED 02 Optix = Air Optix Aqua?
Okay, so let's get back to the original question raised in this thread, which is this: Knotlob, Doctor G or anyone else who can respond to this question. Are O2 Optix (1-2 Week) and Air Optix Aqua (Monthly), in fact, one and the same contact lens sold in different boxes for different wear times?
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05-13-2010, 05:12 PM
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The 1-2 weekly O2 Optix is similar to the Air Optix (Monthly) except for the packaging and the fact that the Air Optix has an additional component in the storage solution, which is supposed to make it more comfortable (for a short time). It is questionable if this additional comfort agent is of any benefit to the average wearer, but Doctor G has explained all this clearly in his post. knotlob
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05-13-2010, 05:25 PM
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A Few Questions, Please
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One more, and then I'll stop bothering you. When your patients compared these lenses, did they have one in each eye, or did they try one for two weeks and then the other one? Thank you for your time.
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05-13-2010, 05:47 PM
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Which Windmill?
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05-14-2010, 07:11 PM
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menicon
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http://www.ncbi.nlm.nih.gov/pubmed/12769149 Personally I cant imagine why anyone would bother to sleep in an RGP. it feels SO nice to take them off! I have heard a patient call lens removal after a long day an "eyegasm"! I wore hard lenses, then RGPs for a total of about seven years. Since I was sensitve to thimerosol, I couldnt use any early soft lens solutions. With the advent of alternatives, I switched to soft, and never wore a rigid lens again. I once knew a hard lens patient who wore her lenses for several months without removing or cleaning. She just slid them into her lower fornix each night, and recentered them each morning. She was also a chain smoker. She worked in a tropical fish store I patronized in Berkeley, and I could never get her to come in and see me. I bet her lenses were GROSS! The peroxide system is very safe, of course, it just doesnt do anything for surface wetability, like proper polyvinyl alcohol based RGP solutions like Wet-N-Soak did. The B&L Boston storage solution is harmless, but their daily cleaner does indeed have an abrasive, tiny polymer beads. I wouldnt suggest the old toothpaste and soda thing to newer plasma lens wearers, of course. The in-office super cleaner in the olden days was called Reno-gel, and its so long gone I couldnt get a single hit on it on google. Our rewetters here in the US have other viscosity agents than yours. I didnt feel like spelling them all out, sorry. We can indeed get the Equate for $2 a 15 ml bottle in the two pack at walmart...maybe you could buy these online, from Canada? Remember that swimming in lenses probably IS at least a little risky. I have not seen any study quantifying that, so I cant say why FDA is so against it. Dailies are probably the safest plan, removed immediately after lake or ocean exposure, followed by a nice eyerinse. As to Rxing lenses, I like to think that the bother of seeing me annually at least gives the wearer a chance to be educated as to risks and benefits of lens wear.
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05-14-2010, 07:38 PM
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Thanks for the reply and the Menicon article link. I like that Eyegasm. I must remember that one Yes, I agree about the Peroxide and lack of wetting. It seems OK for a few days, but then becomes uncomfortable (presumably as any remaining wetting agents are removed). I did experiment with the 2 part peroxide and then after neutralising, put the lenses into a RGP Wetting/Storage solution. A bit of a hassle, but in the interests of finding the best option. I just switched to another (multi purpose RGP) solution, which initially at least, seems better. WalMart have a presence in the UK (as ASDA) so when I am across in a few weeks time, I will see what they have in terms of Eye Rewetting Drops and also Multi Purpose RGP Solutions. I do buy a lot of stuff on-line, though not contact lens solutions. Postage is usually the deciding factor, plus European Union Taxation. It is certainly useful to have an Eye Care Practitioner who is willing to answer questions. I certainly give mine a hard time with some awkward questions, but she does her best to answer and tells me straight if she doesn't know. It's off topic but the question I did ask was 'what actually sets the limit for 30 days on a manufacturer's Monthly Lens'? She initially said it was because the lens lost porosity and therefore, oxygen permeability, but of course a silicone hydrogel lens uses the silicone molecule as the vector for oxygen transmission, not water as in the case of the hydrogel lenses. Do you have an opinion on this since you are in contact with the lens company reps? One small point re swimming. I accept all you say about the risks and wearing a Daily Disposable is a good option if you want to see while doing water sports, e.g. kayaking. You mention binning the disposable lens, then flushing the eye with rewetting drops. Is that necessary, as the eye will naturally flush the eye with tears when the disposable lens is removed, or does it just speed up the flushing of the eye? knotlob
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05-14-2010, 07:49 PM
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FDA vs FTC
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As I stated in a post above, the lensmaker asks the FDA to also approve the "indication" (suggested use, and labeling) of the product when they submit for sales approval. In the case of the AirOptix, Ciba asked for one month approval. They had already been approved for two week labeling for O2Optix, several years ago. It is not unusal at all for a maufacturer to have several different approvals for the same product. B&L made a lens which was labeled at least four different ways in the 1990s. For example, Optima, for two week replacement, and Occasions, for daily wear, were the same lens. Accuve 2 and One Day Accuvue are the same lens. They were approved at different times, with different labelings. The explanation from the makers is, that it gives the doc a choice as to how we want to guide the patient's wearing, by which package we recommend. As to the comment about the FDA protecting the consumer, I almost spit out my Kool-Aid when I read that! The FDA approves for marketing the claims of the maker, if certain requirements are met as to safety and effectiveness of the product. Value doesnt enter into their thinking. The government agency which protects the financial interests of the consumer is the Federal Trade Commission. They did indeed sue three of the big contact lens companies a few years ago, for allegedly deceptive marketing, for this multiple packaging thing, (claiming that Dailies are somehow different than two week lenses) which was of course all done with the blessing of FDA. The lenses are all still sold, with very minor changes in their advertising and labeling. As to comparing the O2Optix and AirOptix, I have actually placed one of each on a patient, on many ocassions, asked if they could discern any difference, and have given trial pairs of each to try for longer. I feel no difference, and as I already siad, no patient has said to me that they could notice any difference.
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05-14-2010, 08:07 PM
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rinse em
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if you want to reply with yours, Ill reply. protein buildup does reduce Dk, Im sure. I wouldnt think of silicone as a "vector" of O2. Its just not much of a barrier, compared to conventional polyHEMA. Silicone in a lense doesnt "transmit" O2 in exactly the same way water does. In both cases, the 50% or so of water soaked up into the lens lets O2 diffuse across the lens, and the silcone has a loose physical polymeric matrix, too. BUT the warer actually absorbs the oxygen, too, whereas the silicone doesnt. One could surmise that the water actually traps some of the available O2 IN the lens, whereas it just cruises by the silicone. remember that silicone hydrogels still have a significant water content. I want patients to ensure all of the icky water is gone. Also, since the drops are preserved, I hope that adds to safety.
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05-14-2010, 08:23 PM
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If I have a question, I will PM you with my email if you are happy to answer it. I need to reread the journal papers where they discuss the oxygen permeability of silicone hydrogels. I had thought of it as atmospheric oxygen attaching itself to the silicone, while at the same time the previously silicone bonded oxygen is freed to move onto the next silicone molecule, etc. etc. hence the process of oxygen transmission. Something like electrons flowing along a wire - this is getting deep!. If (as is likely) the water is contributing to the oxygen transfer, then l see that permeability would be potentially reduced by protein build up, though this should be less with a silicone hydrogel lens versus a hydrogel lens. But the Dk with water alone (non silicone lens) is around 40 maximum, but with silicone hydrogels 128-140 or so. Back to the papers I guess .knotlob Last edited by Knotlob; 05-17-2010 at 04:11 PM.. Reason: Amendment to data
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05-17-2010, 11:18 AM
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A Freebie
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05-17-2010, 01:44 PM
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giants
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05-17-2010, 03:57 PM
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Not a Gullible Lot
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Check your facts before you post on Lens 101, folks. These members are sharp!
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05-18-2010, 02:36 PM
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05-18-2010, 07:09 PM
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its all here
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05-19-2010, 11:58 AM
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How Can That Be?
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Breaking it down to a daily cost, the Acuvue 2s cost about 79 cents a day while the 1-Day Acuvues cost around 83 cents a day--for the same lenses. (If my figuring is correct. By all means, double-check it.) That's Lens.com. Most places will charge you more. How is that fair? Is there spme kind of special coating or something on Acuvue 2s or something that makes them last longer?
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05-19-2010, 03:41 PM
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Reality check
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As I have already explained above, just like in the case of a new DRUG, contact lens manufacturers develop a product, and then head off to the FDA in washington, with an application in their hands, asking for an approval to sell that product. The application states what the maker wants to claim, as to how the lens is to be sold and used. The FDA then approves clinical trials, which the maker conducts, with the help of a group of real life eyedocs the maker asks to participate. if the data from the trials supports the safety and effectiveness of the product, as claimed in the application, the approval is granted, and labeling is approved for whatever the maker asked for. THEN, if the maker wants to, they can go back to FDA with a DIFFERENT application, using the same product, and seek a different labeling for it. they submit NEW clinical trial data, and get a new approval, just like it was the first time for that lens. And of course, they can charge whatever they like for either one. What the makers are doing, is to try to use technology they already own, to cover more market niches. A lens which can work for two weeks, and has been sold that way for years, can damn sure also work for one day, if later approved for THAT. therfore, Accuvue 2 was able to go back and get an approval as One-day Accuvue, very easily. Cooper did the same thing with the Proclear lenses. two week lenses also became dailies. They then explain that they have given the doctors a choice as to how to recommend the lens, based on the labelings. We of course, as doctors, can follow or ignore the labeling, since the FDA doesnt regulate doctors, ("the art and practice of medicine") only products. We DO have to inform the patient if we go "off label" in the advice we give. What was a bit unusal in the case of O2Optix and AirOptix, to get back to the topic of this thread, was that their second approval was for a longer replacement schedule. Ciba now makes the claim that putting a little bit (1%) of an industrial chemical moisturizer, called Copolymer 845, in the solution it is floating in, makes the lens last twice as long. The cost difference here is much greater than in your example, $3 a lens for 02Optix vs $6 a lens for AirOptix at costco. if you wear both as FDA labeled, the cost is comparable, but if you were to notice that they are the same design and material, and wear them the same, the cost is doubled if AirOptix is worn. Obviously, it doesnt cost twice as much to make the 'monthly" lenses. Im sorry that you dont "see how that is legal." Its called "Free Enterprise". And it is fueled and nurtured by partisan politics and big money. If you are lucky, your eye doctor will be honest with you, and guide your choices as to how you should purchase and wear lenses. You certainly should not count on your government to do that. You surely must realize that he same thing happens in the case of every DRUG sold in America. I used to Rx an eye allergy medication called Zaditor, which sold for eighty-five dollars for 5ml for many years. Now available as an over the counter drop since last year, the same drug (ketotifen) is sold by B&L as Alaway for about $11 for 10ml. Always ask your eye doctor for advice, since they should know you and your eyes. They may have good reasons for the choices they help you make.
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05-19-2010, 05:29 PM
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Okay, the contact lens manufacturer brings a new lens to the FDA and asks for approval to sell them as two week lenses. The FDA approves and they go their merry way. Six months later, they return to the FDA with the same lens and ask for approval to sell them as daily disposables. Wouldn't the FDA people at this point ask "Isn't this the same lens we approved for two week wear when you came in here six months ago?" When the contact lens company admits that this is true, wouldn't the FDA then step in and say "You can't sell these as a two week AND a daily lens. One or the other"? Is it the principle of "if replacing them every two weeks is good, then replacing them every day is better"?
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05-19-2010, 09:13 PM
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nice lawsuit reference
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As I said in post 68, the FDA isnt directly concerned with the issue of whether or not you as a consumer are getting screwed, but the FTC DOES care, sort of. Here is a short FTC position paper explaining that eye doctors are all screwing the public, by not releasing contact prescriptions to patients. http://www.ftc.gov/os/2003/09/contactlens.shtm and here is the full text 64 page long report on the same subject. http://www.ftc.gov/os/2004/03/040329clreportfinal.pdf The FTC made a rule requiring such release soon after this. Meanwhile, the issue of selling lenses at different prices HAS led to consumer lawsuits. Here is a VERY nice writeup about how B&L was sued in the 90s for selling the same lens at different prices: http://www.rand.org/pubs/monograph_reports/MR969/MR969.ch5.pdf Despite all this, the practice is still seen. To comment on your last statment, it IS better to replace a lens sooner, rather than later. Ill be happy when I can Rx high permeability silicone hydrogel lenses (like we have in two week packaging, and monthly packaging,) in daily wear. Ill tell patients that removing a lens, and throwing it away, every day, is very healthy, and will hope they actually do that. If Im asked wheteher or not the material is similar to, or the same as, the longer wear lenses, Ill tell the truth, and advise that ANY lens gets dirty, and that daily wear IS safer, if both lenses breath equally well on the eye. In the meantime, I always write for O2Optix, virtually never AirOptix, since I dont really WANT to encourage longer use. I advise all patients to immediately replace any lens which seems even slightly dirty, no matter how long it has been worn, and advise them that the FDA approval for the O2 is two weeks..
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05-20-2010, 11:29 AM
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I also agree with you that you should replace your contacts sooner rather than later. That's a very good rule to live by.
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10-16-2010, 09:18 PM
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Same in content, not in brand targeting
Of course the Air Optix Aqua has the extra thing added. I don't think any rational person would argue that was not true. The thing is they added it to several lens also including the O2 Optix. You will find nowhere on the O2 Optix packaging saying it is free if this extra thing. Adding it to one and not the other surly would be cost prohibitive.
Marketing is about giving people what they want and a lot of the time that is just packaging or price. Some want to pay less and some want to pay more.
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10-17-2010, 09:28 AM
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I haven't seen it said that O2 Optix had the Copolymer 845 ingredient added. The Air Optix lens family replaced the O2 Optix family of lenses, so there is no 'cost prohibitive' issue at stake as far as I can see. Some people who previously used the O2 Optix, liked the lens, but when it was discontinued and their eye care professionals prescribed the new, all singing & dancing 'improved' air optix, their problems started. knotlob
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10-18-2010, 05:26 AM
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O2 not discontinued
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10-18-2010, 06:12 AM
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OK, I must be mistaken, as I thought from several posters that the O2 Optix was unavailable/being discontinued. Must be a regional thing. Lens.com (this site's sponsor) lists O2 Optix, but the UK Contact Lens stores only list Air Optix and searches for O2 Optix bring up the Air Optix lenses in the UK. Sorry for the confusion .knotlob
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10-18-2010, 09:44 AM
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02 Optix = Air Optix Aqua
This is a very long thread, and I checked it over quickly to see if this answer had already been given. I didn't see it, so please forgive me if I'm repeating a post.
I went to the Air Optix FAQ page and this is what I found. Q: What is the difference between O2OPTIX® contact lenses and AIR OPTIX® AQUA contact lenses? A: Both AIR OPTIX® AQUA contact lenses and original O2OPTIX® contact lenses are made of the same material - lotrafilcon A silicone hydrogel. However, AIR OPTIX® AQUA lenses provide additional benefits, like the AQUA Moisture System. The AQUA Moisture System helps lenses start and stay comfortable with a unique moisture agent that binds with the lens surface to create a silky layer for comfort. AIR OPTIX® AQUA contact lenses also offer a blue visibility tint. Here's the link to the page I found this on: http://www.airoptix.com/faq/index.shtml OK? Are we done?
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10-31-2010, 01:24 PM
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11-01-2010, 11:19 AM
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In Conclusion, Finally
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11-09-2010, 08:43 PM
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Great thread - thanks especially to the docs
This thread provides answers to questions I've wondered about for years. I've been happily wearing Ciba Focus 1-2 wks for a decade. I knew something was up at the beginning of the year when I got a coupon from Ciba encouraging me to try Air Optix. I took it to my Opthamologist who was unaware (not sure anyone was in Jan 2010) that the Focus 1-2 wks were to be discontinued as July 2010. His stance was why change if my vision was clear and eyes comfortable. I agreed and continued until I went online to order replacements and found out they were unavailable last week.
I will go with the Air Optix Aqua if I don't switch to Avaira. PS. I personally know someone who has good hygiene who developed a problem within his first year of extended wear. Personally I prefer to take a couple of minutes at night to remove my lenses. Every eye doctor I've been a patient of would not prescribe extended wear.
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11-10-2010, 03:30 AM
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I'm glad to hear that your eye care specialists won't prescribe extended wear mode lenses, despite the manufacturers' claims that they are safe to wear. Corneal ulceration is a big price to pay for the convenience of not having to take the lenses out each night to clean them. Good luck with the Air Optix Aqua or Avaira, whichever ones you find best, please lets us know how you like them. knotlob
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11-10-2010, 10:25 AM
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Focus 1-2 Week Discontinued?
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I checked Lens.com and it looks like they have both Focus 1-2 Week and Focus 1-2 Week Visitint. I don't see anything on the site that says that they're going to be discontinued. If you see something I missed, please post here to let the people of Lens 101 know about it. http://www.lens.com/contact-lenses/department93.asp
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11-16-2010, 09:01 PM
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I'm happy the shortage occurred (I believe that they are indeed discontinued) because I've been looking for years for an active forum for contact lens wearers and am happy to have found lens 101. As a marketing method it worked as I just made an order for 8 boxes of Avaira from lens.com. I decided to skip doing an Air Optix Aqua trial because the Avaira completely agree with my eyes. I can wear them all day with no discomfort, blurring or redness and they're easy to handle. The clarity is so good with these I feel like I could drop the strength down a notch. I know this isn't the Avaira forum but this thread had such great content I was compelled to post here.
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11-17-2010, 03:18 AM
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Have a look around the forum and feel free to respond to any questions you feel you would like to answer. knotlob
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11-17-2010, 11:15 AM
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12-13-2010, 03:44 PM
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Tell Us More
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01-12-2011, 02:57 PM
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They are NOT the same
I know this is a reply to an old post, but I came upon it when I had the same question.
The Air Optix Aqua lenses DO have a different feel in the eyes AND even in your hand. I had the opportunity to wear one of each for a period of time after my eye doctor ordered the wrong type. I put in the O2optix and had discomfort for 2 weeks. I tried a new one, same story. For me, they were no where near as comfortable as the Air Optix Aqua. Even when cleaning them in my palm, the Aqua lens slid around my hand and off my finger tip in the cleaning solution. The O2optix stuck to my finger like a sticker. This is the same feel I had in my eyes. Everyone is different, and may have different experiences, but take it from someone whose eyes are sensitive to different contacts - the two lenses are not the same. If you have sensitive eyes, give the Aqua lenses a try.
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01-12-2011, 03:44 PM
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Thanks again for stopping by. I'm sure there are other places on this forum where you can help out some more.
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01-27-2011, 05:50 PM
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The End?
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