Corneal Changes After Suspending Contact Lens Wear
Posted: Mon 21 Feb 2011 12:07 pm
Somehow or other, I ended up on the mailing list for the "Eye & Contact Lens: Science & Clinical Practice" journal. I usually avoid looking at anything that drops into my inbox, because (not unlike reading those "Doctor's Answers" type of magazine at the newsagent) you can convince yourself that you've got the symptoms of all sorts of terrible afflictions ! And it’s hardly likely to rival “Hello!” magazine for attention grabbing content…
However, anything specifically mentioning Keratoconus I do glance at, even though my understanding of some of the terminology is necessarily limited (my O Level grade "B" in Biology was something of a miracle and I wisely decided not to venture any further into the world of medicine).
The article in the link below (apologies, you may get the summary, you may just get a nag to ask you to register, hopefully they let everyone see the abstract...) is about cornea changes after cessation of RGP lens wear:
http://journals.lww.com/claojournal/Abs ... ar.11.aspx
What was interesting to me wasn’t the conclusions (“Conclusions: Changes in the optical and structural parameters of the cornea after suspending lens wear are likely to be dependent on a multitude of factors, such as the lens fitting and the biomechanical properties of the cornea.”) which to the untrained ignorant like me sounded like stating the flippin’ obvious.
What was surprising was that this subject is seemingly so little researched and not properly understood. The upshots appear simple and yet complex at the same time –
a) that not all corneas are the same – even Keretoconic ones
b) that not all RGPs fit the same (okay, being a Keratoconus patient, I should have maybe guessed that one…)
c) the interplay of the various factors can’t easily be predicted and the current research is too limited (the study was on two – yes two – patents over – gasp – 7 whole days)
Which brings me to a reoccurring theme in the management of Keratoconus. It doesn’t appear that you can look in a medical library and find stacks and stacks of material available (in the same way as, say, coronary care or oncology). Getting that research done requires – seemingly, and I may be wrong on this one – a pay off either in terms of kudos to the researcher or a bottom line return to the pharmaceutical company seeking to market a new product. Neither of which seems very likely when considering Keratoconus.
The next point probably belongs more rightly in “Let off Steam” but I’ll say it here anyway. The real issue facing all of us with Keratoconus is the financialisaiton of health care. Somewhere along the line, we’ve all ended up locked into the notion of a healthcare “market” (even if we are in the NHS for treatment, make no mistake, we’re in a “market”)
The problem is the market for medical services in the UK bears no resemblance to an efficient market, in which buyers and sellers possess an equally good understanding of the merits of the goods and services being offered. Patients rarely reject a professional’s recommendation for a course of action; the vast majority accept whatever tests, procedures or treatments he recommends. At most, patients might get a second opinion for a high risk or high cost procedure.
Some readers may be wondering why I’m so concerned with the free market ethos, the NHS and their impact on Keratoconus management for the patient. Aside from the fact that it’s a major public policy problem in the UK at the moment, it is also a prime example of bad incentives, information asymmetry, and conflicted behaviour. It thus makes for an important object lesson: where information is lacking to either the medical professional or the patient – or both – you risk getting treatment that may be sub-optimal.
The only fix I can think of in the short term is for patients to keep asking questions and not stop until they’ve heard convincing answers…
Chris
However, anything specifically mentioning Keratoconus I do glance at, even though my understanding of some of the terminology is necessarily limited (my O Level grade "B" in Biology was something of a miracle and I wisely decided not to venture any further into the world of medicine).
The article in the link below (apologies, you may get the summary, you may just get a nag to ask you to register, hopefully they let everyone see the abstract...) is about cornea changes after cessation of RGP lens wear:
http://journals.lww.com/claojournal/Abs ... ar.11.aspx
What was interesting to me wasn’t the conclusions (“Conclusions: Changes in the optical and structural parameters of the cornea after suspending lens wear are likely to be dependent on a multitude of factors, such as the lens fitting and the biomechanical properties of the cornea.”) which to the untrained ignorant like me sounded like stating the flippin’ obvious.
What was surprising was that this subject is seemingly so little researched and not properly understood. The upshots appear simple and yet complex at the same time –
a) that not all corneas are the same – even Keretoconic ones
b) that not all RGPs fit the same (okay, being a Keratoconus patient, I should have maybe guessed that one…)
c) the interplay of the various factors can’t easily be predicted and the current research is too limited (the study was on two – yes two – patents over – gasp – 7 whole days)
Which brings me to a reoccurring theme in the management of Keratoconus. It doesn’t appear that you can look in a medical library and find stacks and stacks of material available (in the same way as, say, coronary care or oncology). Getting that research done requires – seemingly, and I may be wrong on this one – a pay off either in terms of kudos to the researcher or a bottom line return to the pharmaceutical company seeking to market a new product. Neither of which seems very likely when considering Keratoconus.
The next point probably belongs more rightly in “Let off Steam” but I’ll say it here anyway. The real issue facing all of us with Keratoconus is the financialisaiton of health care. Somewhere along the line, we’ve all ended up locked into the notion of a healthcare “market” (even if we are in the NHS for treatment, make no mistake, we’re in a “market”)
The problem is the market for medical services in the UK bears no resemblance to an efficient market, in which buyers and sellers possess an equally good understanding of the merits of the goods and services being offered. Patients rarely reject a professional’s recommendation for a course of action; the vast majority accept whatever tests, procedures or treatments he recommends. At most, patients might get a second opinion for a high risk or high cost procedure.
Some readers may be wondering why I’m so concerned with the free market ethos, the NHS and their impact on Keratoconus management for the patient. Aside from the fact that it’s a major public policy problem in the UK at the moment, it is also a prime example of bad incentives, information asymmetry, and conflicted behaviour. It thus makes for an important object lesson: where information is lacking to either the medical professional or the patient – or both – you risk getting treatment that may be sub-optimal.
The only fix I can think of in the short term is for patients to keep asking questions and not stop until they’ve heard convincing answers…
Chris