Contact Lens Spectrum hosts a very interesting and entertaining item called 'Point/Counterpoint' in which two opinions are given on a controversial topic in our industry. The prognosis of (R)GP lenses topic is featured in the August issue.  Not surprisingly, Nathan Efron wrote the 'counterpoint' portion that the future of (R)GPs is not bright (he has actively and repeatedly predicted the demise of (R)GP lenses). I was asked to write on behalf of GP lenses for the Spectrum article. Obviously, I slightly disagree with Nathan, but on the other hand I like this type of debate because both sides usually raise good points to think about, to discuss and to reconsider. In this I-site, several points on this topic will be further explored. Nathan and I will have more 'fun' with this subject at a conference in the Netherlands (NCC 2010) early next year where we will both be speaking on this topic. And pointing at each other, I am sure.

                                                                 Eef van der Worp 

 
Because visual performance with (R)GP lenses is simply superior to any other form of vision correction, this should not really be one of the key considerations for practitioners when choosing (R)GPs or soft lenses. One point that usually is key, is ocular health. Previously this has never been an issue - (R)GP lenses have always proved safer - but with the newer silicone hydrogel lenses available, it may be good to revisit the topic at this point in time. In the Point/Counterpoint article it is stated that 'it is clear that modern soft lenses have a distinct pathophysiological advantage over GPs. But when looking at recent papers by Efron et al, the rate of corneal infiltrative events is significantly lower for (R)GP than for soft lenses, including silicone hydrogels. The UCLA Contact Lens Study (July 2009) states that rigid gas permeable lenses have a statistically significantly lower average number of complications than soft lenses (including silicone hydrogels). Another article in Contact Lens & Anterior Eye has a title that nicely covers the topic discussed: How Rigid Gas-Permeable Lenses Supply More Oxygen to the Cornea Than Silicone Hydrogels. Corneal health? At least give (R)GPs that point. 

 
Comfort is probably the most important topic in this discussion. It's a battle that (R)GP lenses cannot win, although many of us know that the comfort issue is primarily an adaptation phase issue. But improving comfort during lens wear is probably the number one point that the (R)GP lens industry needs to be focusing on, but maybe not always is. Decent research in this field is required. Improving comfort by optimising lens fits (based on corneal topography) has been on the agenda for a while, but is not embraced on a large scale yet. Comfort improvements, when switched from a suboptimal to an optimal lens fit, have been shown to occur in papers such as 'optimising RGP lens fitting in normal eyes using 3D topographic data.' What also may contribute to increasing comfort, at least initially, are surface treatments. But larger diameter lenses may be the most talented kid on the block in this regard. See further the "I(n)-site-the-practice" item at the bottom of this edition of I-site.

 
Scleral lenses are believed to be among the best methods to correct and restore vision in the irregular cornea. But here are also some less known applications of scleral lens fits, typically achieved with the large diameter (20mm+) scleral lenses. Recently published indications include: scleral lenses for graft-versus-host-disease by Ann Laurenzi and for Stevens-Johnson syndrome (Patrick Caroline and Mark André) both in Contact Lens Spectrum. Earlier this year publications at ARVO also pointed towards using scleral lenses for management of exposure keratitis (Pauline Lim et al, ARVO program #4782) and even the use of an antibiotic adjunct in eyes with persistent corneal epithelial defects to prevent or manage corneal infections (Trisha Hussoin et al, ARVO program #6530).