New Beginnings The Time is Right

This missive marks the first of my new, regular columns in mivision.

I’ve been writing contact lens and eyecare related columns for over 30 years now in a variety of journals and magazines in South Africa, NZ and Aus as well as having articles published in journals in the US, UK and Asia. It’s been an enjoyable and interesting journey. I’ve learnt much along the way, shared this with readers and covered a wide variety of issues.

My focus is on contact lenses, emerging technologies, the Internet, instrumentation and eye care in general. From time to time I get drawn into the commercial and political issues that challenge our professions. My ‘In Contact’ column in New Zealand Optics magazine recently celebrated its twentieth anniversary. It was interesting to reflect on and review the issues that have arisen over that time. It appears to be the longest running, continuous column of its type. I hope this new mivision column will have the same longevity.

Over the years we discussed the possibility of me writing a column for mivision but the time was not right. It is now

My column includes various interactive hyperlinks to relevant items that expand on and detail what I’m referring to, without having to make it too long winded. The hyperlinks also serve as references, so as to avoid a long list of references, which are now part of every paper and CPD article, which few readers ever actually review.

In the print version these links show up as underlined blue hyperlinks (as in the paragraph above) but online you will have direct access to the linked information.

Keeping an Eye on Things

I’ve been keeping an eye on mivision since its fledgling edition around ten years ago. mivision recently celebrated its 100th edition. Congratulations to the publishers on that milestone. The publication has gone from strength to strength and features a number of regular and guest writers that cover a broad spectrum of eye care, business, fashion, medicine and much more.

Over the years we discussed the possibility of me writing a column for mivision but the time was not right. It is now. I’ve got to know the publishers Mark Cushway and Todd Tai over the years from our short encounters at conferences and the like. Of late I realised that I share many interests with them. These range from a passion for photography, drones, the Internet of things, publishing, typography and layout. We also share an interest in eye care and the patient pathway that was covered in depth in the recent July edition of mivision. Mark is a world famous mobile photographer and one of the top rated Instagram photographers, with more than 60,000 followers and a recent exhibition to boot.

This edition serves as an introductory column. I’ll get into some of the issues that affect our professions in future editions. This will include reviews of papers, new lens technologies, clinical case reports, apps and future technologies. I’ll also cover treatment and management strategies that face clinical practitioners in everyday practice.

I will stand up for what I believe in and support independent practitioners. I will try and counter the dumbing down of our profession that’s occurred as a result of commercialisation and corporatisation, where it seems patients are now considered merely as shoppers that frequent stores.

My Favourite Things

For now, let me share some of my favourite things.

• Boston XO RGP material remains in my view the best ever RGP contact lens material. It has a high Dk (100 units) and wets well. It is stable and robust and provides my patients with extremely safe contact lens wear, with minimal compromises and is long lasting. Many of my patient’s lenses last five or even 10 years. I’ve made complex custom SAKS design lenses that range from a record 9.50mm BC, +33.00D to a 4.75mm BC, -30.00D, with a wide range of spheres, torics and multifocals in between. If one had access to only one RGP material this would be my choice.
• Alcon’s Dailies Total1 has become my first choice daily disposable lens for both normal and abnormal eyes, where I use it for piggybacking. Now all we need are plus powers and a range extension to say -15.00D. One would assume torics and multifocals will come, down the track.
• For those who know me I’ve long been a strong proponent of daily disposables. I converted much of our practice to dailies back in 1998 and have never looked back. We rarely see any problems. Everyone is happy.
• Cooper’s Biofinity Torics, Acuvue Oasys for Astigmatism (with a nice range extension to -2.75cyl) and Bausch + Lomb’s Purevision HD for astigmatism are three toric lenses that provide me with excellent results on many challenging cases. If only B+L could get their supply chain sorted we’d all be a lot happier.
• Lindberg spectacle frames are my favourites. They’re super minimalist and lightweight. I often forget I’m wearing them and are much more robust than one might imagine: I’m pretty rough on my glasses and they take quite some abuse. Many of my patients are also converts.
• AOSept remains the best of all the soft contact lens disinfecting solutions. It’s tried and tested over three decades and a great problem solver (and problem avoider). All too often we see complications that arise from solution-lens interactions and patient sensitivity with multipurpose solutions.
• When it comes to RGP solutions, Abbott’s Totalcare 1 would be my pick. It has fewer preservatives than Boston Advance and avoids the sometimes problematic, chlorhexidine.
• LOBOB Sofpro2 cleaner (that contains 15.7 per cent isopropyl alcohol) is the closest thing we can get to the discontinued Miraflow, that so many found to be the best for RGP and soft lenses.
• The Medmont Topographer, Topcon’s TRK-1P 4-1 (autorefractor keratometer, tonometer and pachometer), KOWA’s fundus cameras and Reichert’s Ultramatic Rx phoroptor remain the best instruments I’ve used, with excellent repeatability and reliability over many years.
• The best slit-lamp I ever owned was my Takagi SM-90. The optometrist who inherited it from me in my former practice agrees.
• My Volk Digital wide-field fundoscopy lens has also wowed me over the years, as it has a recent graduate who loves to borrow it.
• Of course my Welch-Allyn Li-ion halogen streak retinoscope and Keeler specialist ophthalmoscope also fall into the category of well-made, time-proven equipment.
• On my wish list are a super-widefield Optos Laser retinal imaging system and a Heidelberg anterior and posterior segment OCT.

So that’s it for openers. I hope to provide you with some interesting things to read and consider over the coming months and years. Thanks to all of you who’ve supported me. I always enjoy catching up at conferences and thanks for all feedback, it’s much appreciated.

Keep in contact and let me know what issues interest you. Feel free to share ideas, concerns, cases and anecdotes. I will always try and include these in my column.

Alan Saks is a third generation optometrist based in Auckland, New Zealand and columnist for mivision. He is actively involved in the profession, having served multiple terms as President of Contact Lens Societies and arranged numerous conferences. He’s also served on education committees, as examiner in contact lenses and clinical optometry examinations, lectured contact lenses to ophthalmology registrars and written several columns about eye health and the practice of optometry.