Israel Medical Association Journal

Background: Most corneal damage induced by contact lenses is due to interference with corneal oxygenation.

Objective: To investigate the effect on the rabbit cornea of a rigid gas-permeable contact lens with a newly designed periphery.

Method: We fitted New Zealand white rabbits (n=12) with RGP[1] contact lenses that were identical in all respects except for the design of the periphery. In each animal, one contact lens had an innovative periphery consisting of a microscopic diffractive relief lathed on the back surface; the other contact lens was of a conventional design. The lenses were worn continuously for 7 days. During this experimental period and for 1 additional week we assessed the corneal damage by daily testing lactic dehydrogenase activity in the tears.

Results: On the last day of the experimental week and the first 3 days of the healing period, mean tear LDH[2] activity was significantly lower in the eyes with the new contact lens design than in eyes with the conventional lenses.

Conclusions: The novel periphery design reduces corneal damage resulting from contact lens wear, as reflected by LDH levels in the tears. The new design probably facilitates the flow and exchange of tears under the contact lens, resulting in improved metabolism of the cornea. These findings may also prove applicable to soft contact lenses.

Background: With market failures characterizing the health care sector, societies are continuously searching for ways to achieve an efficient and fair allocation of resources. A natural source of opinion on the desired allocation of health resources is the public. In fact, several governments have recently involved the general public in decisions about resource allocation in their health systems.

Objectives: To investigate the views of the Israeli Jewish public aged 45-75 on horizontal equity in medical care; specifically, the characteristics (including a lottery) for determining which of two individuals with similar medical need should be treated first, against a background of limited resources.

Methods: A sample of 2,030 individuals was chosen to represent a population of about 800,000 urban Jewish Israelis aged 45–75. Data were collected in face-to-face full sit-down interviews by trained interviewers between October 1993 and February 1994.

Results: The three most preferred prioritizers were chances of recovery, number of dependants, and young age. Random prioritization was preferred by only 8% of the population. Age, level of education and religiosity were the main characteristics associated with the choice.

Conclusions: The Israeli adult public does not favor strict horizontal equity in health care. As in other social programs, “equals” were defined in a multi-criteria manner, based on both medical need and other personal characteristics. The preferred prioritizers seem to reflect universal tastes and cast doubt on the traditional distinction between efficiency and equity and between horizontal and vertical equity when applied to health care.