editor's perspective

RGPs: Good for the Cornea, Good for the Practitioner

BY JOSEPH T. BARR, OD, MS, EDITOR
OCTOBER 1999

RGP contact lens care can be very simple for the low myopic, astigmatic teenager, or more complex and challenging for those with irregular corneas, as in the case of keratoconus patients. Most eyecare practices see few keratoconus patients each year, but contact lens specialty practices, especially those associated with ophthalmology practices, spend many hours caring for them. Caring for these patients may not generate the most profit for the practice, but it's rewarding for the practitioner as a care provider, and it's critical for the more than two-thirds of keratoconus patients who can not function without their RGP lenses. The same can be said for many post-surgical and corneal trauma patients. It is always rewarding to see the look in optometry students' eyes and the change in their attitude when they realize that they are the final pathway for achieving the best vision for irregular cornea patients. This category of patient has far more of an impact on student behavior than the normal cornea patient. The irregular cornea is a sick eye that needs a contact lens, and an RGP is the lens of choice. That's quite a statement for the RGP.

Here is a letter we received that also speaks of the value of RGPs:In the February 1990 issue of Contact Lens Spectrum, Joe Barr editorialized "RGP Education Falls Short." As the millennium is quickly approaching, I thought it might be interesting to take a look back and see how profound his insights are now, 10 years later.

He stated, "The quantity of RGPs fit had decreased again in 1989. Many of us hope the RGP field will recover and thrive. Yet we wonder if it ever will."

So far he's right. RGP fits continue to slump. He noted, "One problem is certainly NOT a lack of materials," and he's right. We've gotten even better lens materials and the manufacturers don't appear to be finished with innovation yet. He lamented that "Time-consuming fitting, knowledge, intensive problem-solving, poor initial comfort adaptation, foreign bodies and drying symptoms too often overshadow the importance of good vision, long term comfort, corneal health, easy care and flex-wear
options with RGPs."

These problems have been redressed with topography, new lens designs, anesthetic use at dispensing, computer-assisted edge designs, better solutions and cleaners, better wetting materials and even punctal plugs.

Joe spoke of the "gap generation" of optometry school graduates who don't know enough about RGPs. The CLMA created the Rigid Gas Permeable Lens Institute (RGPLI), an education wing for RGPs. Post graduate training is being explored to offer RGP education to interested current ODs. My congrats to the schools for taking part in the experience and to Joe for recognizing the need.

Finally, and most critically, he challenged the manufacturers to provide better, thinner lenses with better edges, consistent peripheral curves and improved optics. Thanks in part to technology for design and manufacture, and to the dedication of a relatively small number of doctors and researchers, RGPs now stand on the brink of a bright new future. Joe's final statement in his 1990 editorial is as true now as it was then, "When it comes to RGPs, we've got a lot of educating to do."

Robert Reed Jr., O.D.