Is my optometrist correct?

ColoradoAmy · #1 (**permalink**) 10-07-2010, 02:38 PM

I have nearsightedness, presbyopia and astigmatism. My optometrist told me extended wear contact lenses can only correct two problems at once, so I opted to try monovision lenses. My right eye is corrected for nearsightedness and astigmatism, and my left eye is corrected for presbyopia. I'm only just trying to get used to this, but so far, I hate it. Was he right? Are there other alternatives?

Knotlob · #2 (**permalink**) 10-07-2010, 04:25 PM

Quote:

Originally Posted by ColoradoAmy

I have nearsightedness, presbyopia and astigmatism. My optometrist told me extended wear contact lenses can only correct two problems at once, so I opted to try monovision lenses. My right eye is corrected for nearsightedness and astigmatism, and my left eye is corrected for presbyopia. I'm only just trying to get used to this, but so far, I hate it. Was he right? Are there other alternatives?

Hello ColoradoAmy and welcome to the forum

I think your optometrist is probably right. I haven't seen soft lenses available in toric/astigmatism and bifocal/multifocal design.

It MAY be possible to get something in Rigid Gas Permeable lenses to suit your needs, but I am not sure of that.

If your astigmatism is minor (say -0.75D cylinder) a standard RGP lens will be able to correct the astigmatism by adjusting the base curve and therefore the tear film thickness. However, RGP lenses tend to be less comfortable than soft lenses.

I have presbyopia, am short sighted and have minor astigmatism (-0.50 & -0.75D). I wear RGP standard lenses, which correct my far distance and the astigmatism is corrected with the tear film thickness. I have to wear reading glasses for the PC or anything close up. I too would like to see close up with the contact lenses, but I am not prepared to sacrifice long distance vision.

You could do the same as me. The contacts give me the benefits I want outside (sports, no interference from rain/snow, better vision/no distortion that I sometimes have with spectacles, no steaming up coming from cold into a warm humid room, better peripheral vision, etc.)

You could also consider laser surgery to correct your astigmatism and short sightedness and then wear a multifocal contact lens for close vision or just reading glasses.

You may just need to give the monovision a bit more time to get used to it, though you will tend to loose some binocular vision, which can be detrimental in ball sports, etc. where depth perception is important.

knotlob

ColoradoAmy · #3 (**permalink**) 10-07-2010, 05:31 PM

Thanks for your response. I don't think I can do Lasik as I had PRK about 13 years ago. Prior to that I wore RGP, but got totally sick of putting them in and taking them out every day. My optometrist told me today I really should take out my extended wear lenses every day, which sounds counter-productive to what I wanted them for, so maybe going back to RGP isn't a bad idea. I don't regret the PRK, but kind of wish I had waited until the procedure corrected astigmatism (it didn't at the time).

Knotlob · #4 (**permalink**) 10-07-2010, 10:54 PM

Quote:

Originally Posted by ColoradoAmy

Thanks for your response. I don't think I can do Lasik as I had PRK about 13 years ago. Prior to that I wore RGP, but got totally sick of putting them in and taking them out every day. My optometrist told me today I really should take out my extended wear lenses every day, which sounds counter-productive to what I wanted them for, so maybe going back to RGP isn't a bad idea. I don't regret the PRK, but kind of wish I had waited until the procedure corrected astigmatism (it didn't at the time).

Your optician is correct. Extended wear lenses sell lenses for the manufacturers because some people want the convenience of not having to clean the lenses every night.

But if you wear any lenses in extended wear mode, you will increase the risk of corneal infections and corneal ulcers by about five times (more if you also smoke or have other factors). It doesn't guarantee that you will get corneal ulcers, but you have to ask yourself if the convenience is really worth the risk? Corneal ulcers can cause corneal scarring and loss of vision in severe cases.

knotlob

SandiStix · #5 (**permalink**) 10-08-2010, 10:06 AM

Quote:

Originally Posted by Knotlob

. . . if you wear any lenses in extended wear mode, you will increase the risk of corneal infections and corneal ulcers by about five times . . .

knotlob

Hi Knotlob and ColoradoAmy.

I have a question about this "five times the risk of corneal problems" statistic. What are the actual numbers? If I say "my family owns five times as many cars as yours does," and your family has two cars, mine owns a lot of cars.
If I say "I have five times as many pebbles in my pocket as you do", and you have two pebbles, I have a lot more pebbles than you, but there's still plenty of room left in my pocket, you know what I mean?

"Extended wear contact lenses increase the risk of corneal ulcers by about five times," sounds like those weekly and monthly contacts are quite risky, but if you start out with a one in a million chance with daily lenses, that means that your chances of having corneal issues with EW lenses is only 1 in 200,000. Those are still pretty good odds. Do we have any real numbers to plug in here?

I'm not saying that wearing the same pair of EW contact lenses for a week or more doesn't have its risks, but "five times more risky than daily disposables" doesn't really give me an idea of how dangerous this practice is if I don't know how risky dailies are.

Knotlob · #6 (**permalink**) 10-08-2010, 01:57 PM

Quote:

Originally Posted by SandiStix

Hi Knotlob and ColoradoAmy.

I have a question about this "five times the risk of corneal problems" statistic. What are the actual numbers? If I say "my family owns five times as many cars as yours does," and your family has two cars, mine owns a lot of cars.
If I say "I have five times as many pebbles in my pocket as you do", and you have two pebbles, I have a lot more pebbles than you, but there's still plenty of room left in my pocket, you know what I mean?

"Extended wear contact lenses increase the risk of corneal ulcers by about five times," sounds like those weekly and monthly contacts are quite risky, but if you start out with a one in a million chance with daily lenses, that means that your chances of having corneal issues with EW lenses is only 1 in 200,000. Those are still pretty good odds. Do we have any real numbers to plug in here?

I'm not saying that wearing the same pair of EW contact lenses for a week or more doesn't have its risks, but "five times more risky than daily disposables" doesn't really give me an idea of how dangerous this practice is if I don't know how risky dailies are.

I think the figure is 1 in 1000 without smoking, etc. but that is conservative and some researchers think the risk is higher for certain groups. I will need to look at some of the previous posts/academic papers. DoctorG did discuss this is some of his posts.

knotlob

ColoradoAmy · #7 (**permalink**) 10-08-2010, 02:10 PM

Okay, day 2 on monovision leneses, and I'm still having major issues. I find my left lens (the presbyopia lens) only has a very limited focal range (two to five feet?). This lens was also extremely uncomfortable when my doctor first put it in. My left eye is also lazy, so I think that may be contributing.

So, I'm wondering whether there's a better solution. I called my optometrist's office and here's what they told me about my prescription:

Right eye: Myopia -50, Astigmatism -75, an axis of 20 with presbyopia of -150

Left eye: Myopia -25, Astigmatism -125, an axis of 160 with presbyopia of -200

I have no idea of what these numbers mean, but I'm willing to sacrifice a little of my distance vision in order to not wear readers. Should I simply correct the astigmatism in order to wear bifocal lenses?

Purpleiris · #8 (**permalink**) 10-08-2010, 02:34 PM

Quote:

Originally Posted by ColoradoAmy

I called my optometrist's office and here's what they told me about my prescription:

Right eye: Myopia -50, Astigmatism -75, an axis of 20 with presbyopia of -150

Left eye: Myopia -25, Astigmatism -125, an axis of 160 with presbyopia of -200

I have no idea of what these numbers mean, but I'm willing to sacrifice a little of my distance vision in order to not wear readers. Should I simply correct the astigmatism in order to wear bifocal lenses?

I'm not sure what kind of glasses or contact lenses you should use, but I can tell you a bit about those numbers.

I'm pretty sure you'll need some decimal points. Unless your eyes are incredibly bad, I think those first numbers should be -.50 and -.25. Those numbers, called the "sphere" measurement, tell you how nearsighted you are, since they have a minus sign in front of them. If you were far sighted, they'd either have a plus sign or nothing. Me personally, my sphere numbers are about -2, and I can see about arm's length before things begin to blur. Right now I can see my computer monitor without my glasses, and my keyboard is in between it and me. If I reach out my hand I can just about touch the monitor.

The second number is the "cylinder." That measures the level of your astigmatism. Again, your measurement should probably probably be -.75 and -1.25.

Finally the last set of numbers, what you call "presbyopia" are called the "axis" numbers and are used to indicate what angle the corrective lenses should be.

ColoradoAmy · #9 (**permalink**) 10-08-2010, 02:43 PM

Thanks, I'm sure what you said in terms of the decimal points are correct for me, but I still don't really understand how to interpret them.

Knotlob · #10 (**permalink**) 10-08-2010, 02:46 PM

Quote:

Originally Posted by ColoradoAmy

Okay, day 2 on monovision leneses, and I'm still having major issues. I find my left lens (the presbyopia lens) only has a very limited focal range (two to five feet?). This lens was also extremely uncomfortable when my doctor first put it in. My left eye is also lazy, so I think that may be contributing.

So, I'm wondering whether there's a better solution. I called my optometrist's office and here's what they told me about my prescription:

Right eye: Myopia -50, Astigmatism -75, an axis of 20 with presbyopia of -150

Left eye: Myopia -25, Astigmatism -125, an axis of 160 with presbyopia of -200

I have no idea of what these numbers mean, but I'm willing to sacrifice a little of my distance vision in order to not wear readers. Should I simply correct the astigmatism in order to wear bifocal lenses?

Explanation of the numbers:

Right Eye/OD:
-0.50D (Sph), -0.75D (Cyl), 20 Deg (Axis), -1.50D Add

Left Eye/OS:
-0.25D (Sph), -1.25D (Cyl), 160 Deg (Axis), -2.00D Add

The Sph figure is your long distance vision (not astigmatism). In your case the correction is very small.

The Cyl figure is the Astigmatism power correction. Cyl stands for Cylinder. Sph stands for Spherical.

The Axis is the angle at which the cylinder correction is positioned to correct your astigmatism (between 0 and 180 deg).

The Add figure is the close up/reading correction. You have written it as -1.50 D and -2.00D. As you sure it is not +1.50 and +2.00D? I don't think the minus figure is correct!

I take it this is your spectacle prescription since you have myopia, astigmatism and presbyopia in that prescription, but your mono vision lenses will only correct two of three for each lens.

If your right eye is optimised for long distance, you could discuss with your optician changing the power of the left lens to give more close vision correction at the expense of the long distance.

knotlob

EDIT: I see purpleiris beat me to it! But the presbyopia is the lack of accommodation of your eye to focus over a wide range from far to close up. When you are young, you have (usually) very good accommodation, but as you get older 40-50 years, then the accommodation will start to reduce/your eye lens becomes stiffer & less flexible. So there comes a point at which you will have difficulty reading and need reading glasses or some other form of vision correction.

BigJim · #11 (**permalink**) 10-08-2010, 03:41 PM

Quote:

Originally Posted by Knotlob

Explanation of the numbers:

Right Eye/OD:
-0.50D (Sph), -0.75D (Cyl), 20 Deg (Axis), -1.50D Add

Left Eye/OS:
-0.25D (Sph), -1.25D (Cyl), 160 Deg (Axis), -2.00D Add

The Sph figure is your long distance vision (not astigmatism). In your case the correction is very small.

The Cyl figure is the Astigmatism power correction. Cyl stands for Cylinder. Sph stands for Spherical.

The Axis is the angle at which the cylinder correction is positioned to correct your astigmatism (between 0 and 180 deg).

The Add figure is the close up/reading correction. You have written it as -1.50 D and -2.00D. As you sure it is not +1.50 and +2.00D? I don't think the minus figure is correct!

I take it this is your spectacle prescription since you have myopia, astigmatism and presbyopia in that prescription, but your mono vision lenses will only correct two of three for each lens.

If your right eye is optimised for long distance, you could discuss with your optician changing the power of the left lens to give more close vision correction at the expense of the long distance.

knotlob

EDIT: I see purpleiris beat me to it! But the presbyopia is the lack of accommodation of your eye to focus over a wide range from far to close up. When you are young, you have (usually) very good accommodation, but as you get older 40-50 years, then the accommodation will start to reduce/your eye lens becomes stiffer & less flexible. So there comes a point at which you will have difficulty reading and need reading glasses or some other form of vision correction.

What would we do without you Knotlob?

ColoradoAmy · #12 (**permalink**) 10-09-2010, 09:48 AM

Thanks for your thoughtful replies. If I cannot get used to the monovision lenses (and although it's only day three, I still find them very difficult to tolerate), do you think it might behoove me to forget about correcting the myopia so that I can have bifocal contacts? I'd really like to not have to use readers.

Knotlob · #13 (**permalink**) 10-09-2010, 03:29 PM

Quote:

Originally Posted by ColoradoAmy

Thanks for your thoughtful replies. If I cannot get used to the monovision lenses (and although it's only day three, I still find them very difficult to tolerate), do you think it might behoove me to forget about correcting the myopia so that I can have bifocal contacts? I'd really like to not have to use readers.

Your spherical (long distance) correction is only -0.25 and -0.50D, so in theory you may be able to get away without that correction. But you would need to discuss with your optician if your uncorrected long distance vision is legally good enough to drive a car, etc.

Also, does your employment, etc. require you to have fully corrected vision, etc?

The problem is that I don't think you can get multifocal AND astigmatism correction together in a single soft lens (but maybe possible in a RGP if the eye care specialist can correct the astigmatism just by varying the base curve/tear film thickness using a multifocal/non toric RGP design of lens).

So even if you didn't correct your myopia fully, the correction that you would require for the reading (i.e.the ADD prescription, would be enough to make your long distance vision totally unacceptable for driving and possibly other things also. Of course you could wear spectacles for driving, but you are going to miss out on a lot of other sights, if you don't have good long distance vision.

Your reading prescription may also get worse as you get older. Mine is +2.50D but even that is not enough for very close stuff like tying knots in fine fishing line or for Goldsmithing that I do as a hobby). So with my long distance vision corrected and astigmatism almost completely corrected with RGP lenses, I cannot read the small figures on the car dash or more especially in a Navi Programme, that I have on my Mobile (Cell) Phone. I would love to have multifocal lenses, which corrected close range AND did not compromise long distance vision. Maybe in a few years, the contact lens manufacturers will have a solution for that.

knotlob

ColoradoAmy · #14 (**permalink**) 10-09-2010, 05:21 PM

Thanks Knotlob,

I have getting along without any correction for 13 years and have had no problem passing driver's tests, etc. I'm a chef, so I do need close-up vision pretty regularly. I think that correcting my astigmatism would go a long way to giving me good distance sight. I'm going to wait and see if the monovision works out (my next appointment is on the 20th). If it does, I'll stick with it, if not I think I'll discuss only correcting the astigmatism and presbyopia. Thanks! I'll keep you updated.

Knotlob · #15 (**permalink**) 10-09-2010, 06:34 PM

Quote:

Originally Posted by ColoradoAmy

Thanks Knotlob,

I have getting along without any correction for 13 years and have had no problem passing driver's tests, etc. I'm a chef, so I do need close-up vision pretty regularly. I think that correcting my astigmatism would go a long way to giving me good distance sight. I'm going to wait and see if the monovision works out (my next appointment is on the 20th). If it does, I'll stick with it, if not I think I'll discuss only correcting the astigmatism and presbyopia. Thanks! I'll keep you updated.

OK, I wish you luck. Maybe the optician has some exercises that can help you get used to mono vision. I've not heard of any, but I would think they must exist.

To correct the astigmatism AND presbyopia, you may need to consider RGP lenses.

knotlob

ColoradoAmy · #16 (**permalink**) 10-09-2010, 07:14 PM

I'm totally cool with RGP lenses...wore them for years prior to my Lasik.

BettyBoop · #17 (**permalink**) 10-11-2010, 10:22 AM

Quote:

Originally Posted by ColoradoAmy

I'm totally cool with RGP lenses...wore them for years prior to my Lasik.

So you had Lasik surgery and you still need vision correction? I thought those lasers were supposed to fix everything.

SandiStix · #18 (**permalink**) 10-18-2010, 04:49 PM

Quote:

Originally Posted by BettyBoop

So you had Lasik surgery and you still need vision correction? I thought those lasers were supposed to fix everything.

As cool as lasers are, they're not 100% effective for correcting vision, unfortunately.

ColoradoAmy · #19 (**permalink**) 10-21-2010, 12:38 AM

I had a follow-up visit with my Optometrist today. I told him I didn't think I would ever like the monovision contacts, so we discussed options. In the end, he ended up backing off my presbyopia lens to give me a little better distance vision out of that eye, and I now think I may actually be able to get used to monovision lenses. Woohoo! I am to call him in ten days to let him know. But, I no longer dread putting in my lenses each day.

Knotlob · #20 (**permalink**) 10-21-2010, 04:04 AM

Quote:

Originally Posted by ColoradoAmy

I had a follow-up visit with my Optometrist today. I told him I didn't think I would ever like the monovision contacts, so we discussed options. In the end, he ended up backing off my presbyopia lens to give me a little better distance vision out of that eye, and I now think I may actually be able to get used to monovision lenses. Woohoo! I am to call him in ten days to let him know. But, I no longer dread putting in my lenses each day.

That's some progress. Keep working with your eye care professional and keep us updated

.

knotlob