Q&A on Contact Lenses
Q: Can I swim with my soft contacts in? How will chlorine affect my contacts? N.H., Virginia
A: I highly recommend you wear goggles if you swim with soft contacts on your eyes. Although not usually a problem, there are all kinds of nasty bugs living in swimming pools (and hot tubs as well). One of these creatures, called acanthamoeba, can cause horrible pain and damage to your eye, very often necessitating a corneal transplant.
And the water can change the way your lenses fit, making them too tight and causing severe eye health problems.
So, either take them out for swimming or wear goggles. Better safe than sorry. Dr. Dubow
When you're swimming, all it takes to get an eye infection is for one little amoeba to lodge itself between your contact lens and your eye. Prevent it by wearing goggles or using daily disposable contact lenses.
Q: I wear glasses at this point but want to try contact lenses. I am in swimming and want to know if there are any contacts you can wear swimming that are not too expensive. If not, what should I do when I am swimming so I can see? R.G., Texas
A: If you read the previous question about swimming in contacts, you will see that I recommended wearing goggles for safety.
However, if you are going to wear contacts just for swimming, you can consider one-day lenses that are meant to be worn and thrown away without ever cleaning or disinfecting them.
They are really handy (and safe) for occasional wear, as well as being convenient and affordable. Vistakon, CIBA Vision, Bausch + Lomb and CooperVision all make one-day lenses. Ask your eye care practitioner which is best for you. Dr. Dubow
[Read more about disposable contact lenses.]
Q: I wear Acuvue 2 lenses. When I put them in, how do I know that they are perfectly centered on my eye?
Do they adjust with eye movement, or do I need to place them properly? How can I tell where they should go? M., California
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A: Soft lenses generally center by themselves if they fit well. Just put them straight on the cornea, and they will go where they belong. Use the iris, the colored part of the eye, as a guide the cornea covers the iris.
Please make sure you have a competent eye care practitioner evaluate the fit of your lenses before you wear them, though. Improperly fit soft lenses can cause damage to your eyes! Dr. Dubow
Q: I have a subconjunctival hemorrhage in my eye that began three days ago. I removed my Acuvue Advance lenses right away and have not worn them since. When will it be safe to resume wearing my contact lenses? E.
A: It is wise to remove one's contact lens when one notices redness in the eye. It is also very wise to see one's eye doctor immediately to confirm the actual diagnosis, find out if there is any underlying reason for having the redness and then treat as necessary. Dr. Jovkar
Q: I'm 19 and have been wearing soft contacts for six years. My vision is horrible, and recently I learned that my blood vessels are growing toward my corneas due to overuse of my contacts.
In the past two weeks my vision has declined noticeably, even while wearing my glasses. My doctor gave me eye drops for dry eyes and said to stop wearing my contacts as much, but my vision and dryness keep getting worse.
Tonight I noticed my eyes are completely bloodshot. Do you know what could be wrong? Also, would I be eligible for LASIK once I figure out what the problem is and if it can be fixed? I hate wearing my glasses, and I can't fathom having to wear them forever. J.
A: Based on the information provided, the history seems to be compatible with contact lens overwear. The growth of corneal blood vessels is caused by corneal micro-trauma by the contact lenses and lack of adequate corneal oxygenation. Given your recent symptoms, you need to consult your eye doctor immediately.
Having contact lens-related problems does not automatically make one unsuitable for LASIK. However, you need to address whether you are a good candidate for LASIK with your eye doctor after a thorough eye exam and discussion of the pros and cons of LASIK for you. Dr. Jovkar
Q: I got contacts awhile ago. I wore them for only a short period, about three or four months, then stopped because they irritated my eyes. I would like to try wearing them again. But they have been sitting in contact solution for about 15 months. I don't know if it would be safe to just clean them and start wearing them again. Or do I need a new pair of contacts? K.L., Oklahoma
A: Come on, don't be a cheapskate! You need a new pair. Can you imagine the bacteria growing on and in those lenses? Ick! Go see your eye care practitioner. Dr. Dubow
Q: If I wear Acuvue 8.8/14.0 contact lenses and I want to start wearing Acuvue One Day, do I need a new fitting? Or can I just try the One Day Acuvue 9.0/14.2 lens? J.S., New York
A: Contact lenses are medical devices. Changing parameters should be done under the supervision of an eye care practitioner. Why take chances? Dr. Dubow
Also, if a person has a very high prescription (-7.00 diopters), would wearing contacts ruin his or her vision? K.L., Canada
A: Actually, almost all nearsighted people can wear contact lenses, no matter how high their prescription. In fact, there are contact lens laboratories that make custom lenses up to -30.00 diopters!
No, they will not ruin your eyes. It is essential to follow your contact lens practitioner's rules, however.
Contact lenses are extremely safe when prescribed and cared for properly. Dr. Dubow
Q: I have worn hard contact lenses for 30 years. I now would like to have LASIK surgery done. How long will I have to wear my glasses before I can have the surgery? It's already been two months, and my eyes have not reshaped yet. D.M., Wisconsin
A: Many years of hard lens wear can cause significant alterations in the way your corneas work. They can take up to a year to recuperate!
Before you have LASIK, it is critical to make sure your corneas are totally and completely stable. I tell my patients that I can't predict exactly how long this will take. As soon as I find two prescription and cornea checks that are identical, that's when they are ready for the permanent surgery.
What goes into the laser (which is run by computer) determines what comes out. In other words, if you want the best result, be patient and don't rush. It will be worth it in the long run! Dr. Dubow
Q: I am unable to wear contact lenses due to small bumps found on the inside of the eyelid. Prior to this, I noticed some discharge from the eye. S.T.
A: Small bumps on the inside of an eyelid in a person who wears contact lenses usually mean a condition called giant papillary conjunctivitis (GPC). This is an allergic condition, often due to protein build-up on contact lenses, as well as an eye allergy to components of contact lens storage solutions.
Your first step should be to see your eye care professional for a complete eye exam. Your doctor will decide if GPC is present, and then recommend treatment options. Common options include cessation of contact lens use for a few weeks and then use of topical anti-inflammatory drops. Dr. Trattler
Q: My doctor made me go to soft lenses, because in the evening I have very big pupils and my vision was kind of blurry. But with my soft lenses (especially the left side), it doesn't correct my astigmatism fully, and I can hardly read any small letters. What can I do about this? P.L., Canada
A: You have several options, short of using prescription eye drops to make your pupils smaller... just kidding!! There are extra-large gas permeable lenses that can work for large pupils without causing glare. There are also soft lenses that compensate for astigmatism.
Please go back to your eye care practitioner and explain your problems. Suggest one of the options I mentioned. Contact lenses, in almost all cases, can correct you to the same or better vision than glasses. Insist on it! Dr. Dubow
Q: If you sunbathe while wearing contact lenses, is there a potential problem with heat dispersal? S., England
A: Not really, but your corneas can swell and make your lenses fit tighter, causing some temporary redness and irritation. I recommend that my patients put some form of lubricating drops in their eyes before tanning. And remember to wear protective glasses to block the really harmful UV radiation from getting to your eyes it has been linked to cataracts, macular degeneration, etc. Dr. Dubow
[Read more about ultraviolet light.]
Q: Can I wear disposable contacts while SCUBA diving? I've done it and have had no difficulty. J.C., Guatemala
A: Sure, contact lenses are great for SCUBA diving. They can get a little tight while down under, so it might help to put some lubricating drops in your eyes before and after your dives. Enjoy! Dr. Dubow
Q: I am 17, and I wear my contacts all the time, night and day, usually for as long as two months.
My eye doctor tells me that if I don't start to take my contacts out I can cause permanent damage to my eyes. What will happen? A., New York
A: Your eye doctor is right! You are playing with fire.
Improperly worn contact lenses can cause a loss of oxygen to the cornea, which in turn can lead to blood vessels growing over the front of your eyes, infections, lid changes, allergies, corneal warping, corneal swelling and possibly even blindness.
Why roll the dice? You might have gotten by so far, but what if you do have a problem? Is it worth it? You only have two eyes! Dr. Dubow
Q: What brand of soft contacts will give me the highest UVA and UVB blocking? My prescription is OD -5.75 and OS -5.50. C.M., Missouri
A: There are a number of soft lenses that absorb UV light. They are all very good lenses. I recommend you speak to your eye care practitioner to find out which he or she prefers. Dr. Dubow
Q: I wear soft contact lenses all day, but take them out at night. What is the minimum time period I would have to wait (after ceasing contact use) before getting LASIK done? T.P.
A: Most docs will have you wait at least a week. Other, more conservative surgeons may stretch it out to two or three weeks. Dr. Slonim
Q: I have worn RGP contacts most of my life, but now I would also like to wear glasses at least part of the time. My optometrist tells me I will never be able to have an accurate glasses prescription while I continue to wear the RGP lenses. Is there anything I can do? J.C., Florida
A: RGP lenses can be prescribed to have less effect on the cornea and provide more oxygen, allowing you to wear glasses part-time. There are RGP materials and designs that your doctor can use to satisfy your request. If he or she is unable to do so, I'd recommend seeing an optometrist who specializes in contact lenses. Dr. Dubow
Q: I wore contact lenses exclusively for 42 years first the "hard lenses" and then RGPs from the '70s onwards. Now I cannot see properly through my new eyeglasses. I was told I would never be able to see through them because I have been wearing my contact lenses for too long.
Apparently, I should have alternated contact lenses and glasses, but I was too vain! Do you have any information on this, please? M.R., Dublin
A: Both hard and GP contact lenses exert pressure on the cornea (the front of the eye). This pressure, along with a lack of oxygen, can change the shape of the cornea sometimes in strange and unpredictable ways.
You've worn some form of rigid lenses for many years, so there's probably a good chance your corneas are fairly warped. How much depends on the fit and oxygen permeability of your current GP lenses.
We call the problem you're having "spectacle blur." This does not mean you'll never wear glasses again. And it's really not necessary to alternate between contacts and glasses. It does mean that you should see a highly competent contact lens practitioner who can refit you with super-permeable GP lenses that don't put pressure on your corneas.
This corneal "rehabilitation" can take several months, but it will allow you to switch to eyeglasses with much less visual discomfort and blur. Dr. Dubow
Q: I recently have started to wear my contacts again after not wearing them for three or four months (I've just been wearing my glasses). My eyes keep getting really bloodshot with them in. Is this an issue, or is it just my eyes readjusting to the contacts? My eyes get really "veiny," so to speak. B.V., Idaho
A: Bloodshot eyes are a sign that something is not right. It could be as simple as a solution allergy or dirty lenses. But it could also be a sign that your corneas are not getting enough oxygen. Go see your eye care practitioner and find out why your eyes are so red! Dr. Dubow
Q: After a long history of successful contact lens use I recently returned to my doctor for an overdue, yearly exam. Two weeks later my contacts arrived but did not feel right, fit right, or adequately correct my vision. A second visit and exam again left me frustrated with my new "eyeballs." Are there any measures I can take to help obtain an accurate reading and exam? N.M., Texas
A: Good question! I guess the best answer is to go to a competent professional whom you trust. If you are unsatisfied with your contacts, get a second opinion. There is nothing I know of that you, the patient, can do other than cooperate as best you can and follow directions. Dr. Dubow
Q: Is it possible to change the color of one's eyes (or at least accentuate their color) sans using contact lenses? For example, my eyes are predominantly green, but there is a ring of brown immediately around the pupil; the brown dominates the green. Is there any way to emphasize the green color and de-emphasize (or even completely remove) the brown color without using colored contact lenses? Thank you for your time. B.O., Florida
A: Nope. Dr. Dubow
Q: RGPs are supposed to be a custom fit lens, but mine move a lot when I blink. I also wanted the segmented style, but the doctor said I should be fine with the ringed style. Well, I'm not. He said to give it time, but I can't see: vision is very blurry at distance and not strong enough to read. Should I put my foot down? R.C., Florida
A: Sure, and if you put your foot down right on the lenses, they will break, and the doctor will have to start all over!
Seriously, there are many designs and materials for RGP lenses. You are referring to what we call simultaneous vision multifocals, which can actually work extremely well and provide not only far and near vision but intermediate vision as well. All RGP lenses move with blinking, but it should not be excessive. Go back and talk to your doctor about your concerns they can be resolved. Dr. Dubow
[Read more about multifocal contact lenses.]
Q: I have a teenage daughter who is nearsighted and wants to wear colored contact lenses. I do not feel she is responsible enough for the proper care and handling of contacts. Even though she has been warned about sharing cosmetic colored contact lenses with her friends, I have caught her wearing them a couple of times. Is there literature or a web page you can recommend that shows good pictures about the dangers of swapping lenses? I just need some support. Mary, Texas
A: I agree, Mom. Your daughter could be treading on dangerous ground by sharing contact lenses with her friends. Everyone's tears are filled with normal bacteria, but transferring these bacteria to someone else's eyes is not a good idea. And not only is there a risk of infection, if the lenses don't fit, the eye can suffer from a lack of oxygen or develop other problems.
I don't believe in scaring my patients into compliance. Usually a bit of education does the trick. Have your daughter talk to your eye care provider about the risks of poor contact lens habits. Oh, and by the way, have you considered that your daughter may actually be able to handle contact lens wear with the proper education and monitoring? Contact lens practitioners are usually very adept at handling teenage wearers! Dr. Dubow
[Read more about teens and contact lens wear.]
Q: How well do contacts correct strabismus? Is it more noticeable with the lenses in? Can surgery be effective when a child gets older? Is there any correction option other than glasses? Patti, Connecticut
A: Strabismus is a condition where the eyes turn up, down, in or out. Many people refer to strabismus as "crossed eyes." Contacts can work well with certain kinds of strabismus, making it less noticeable. But contacts can also make some kinds of strabismus more noticeable. Talk to your eye care practitioner about contacts and strabismus.
Yes, surgery can be effective at making the eyes look straight when a child gets older. Again, it depends on the kind of strabismus. You might also think about seeing an eye care practitioner who specializes in vision therapy, a process in which the eyes are trained to be straight, using exercises and computerized stimulation techniques. Dr. Dubow
Q: Is an eyeglass prescription ALWAYS higher than one for contact lenses? If yes, is there any difference if the contacts are soft or RGP? O.A.H., Maryland
A: Eyeglass prescriptions are higher than contact lens prescriptions because contact lenses sit on the eye, whereas eyeglasses sit in space in front of the eye. We call this the vertex distance.
The closer a lens sits to the eye, the less strength is needed to focus light on the retina. And the stronger the prescription, the more the power adjustment. This is true for both soft and RGP lenses. Dr. Dubow
Q: I have been wearing prescription colored contacts for three years, and recently I heard that there was a surgery able to change your color of your eyes. I've considered surgery because I have astigmatism and have trouble seeing. G.G., Illinois
A: I know of no surgery that changes eye color. The color of your eyes is determined by the pigment in your iris, which is a muscle surrounding the pupil. The iris muscle opens and closes the pupil in reaction to how much light is hitting the eyes. What's wrong with colored contacts? They can be fun! And there are brands that correct astigmatism as well. Dr. Dubow
Q: I have been diagnosed with dry eyes but would still like to continue wearing contacts from time to time. Is it true that a lens lower in water content is better for me? J.S., New York
A: Some contact lens practitioners find that, in fact, lenses with lower water content can sometimes be better for people who have dry eyes. But some patients actually do better with high-water content lenses. It has long been felt by some practitioners that the thicker the lens, the better, as well.
But why not try and alleviate the dry eye condition itself? My recommendation is to ask your doctor about the possibility of lacrimal or punctal occlusion, which plugs up the tear drainage system to keep more moisture in your eyes. Dr. Dubow
Q: I am 13, and my eyes are changing pretty fast. I have glasses for nearsightedness and astigmatism. I am on the computer a lot, and the doctor has suggested bifocals with distance, intermediate and reading, to slow down my vision change. I don't know if I could get used to this or if I should just choose two different pairs of glasses. I don't care for contacts. I am 20/60 without my glasses. What would your suggestion be? Thank you. D.S., Illinois
A: Your doctor is very smart it has been shown in studies that wearing a reading prescription can slow the progression of nearsightedness. Keep in mind, however, that studies also show that rigid contact lenses have a greater effect if your vision system is suitable and you want to wear them, which you say you don't.
Two pairs of glasses is really a nuisance for most people. In my experience, most patients stop switching back and forth after a time. Good luck! Dr. Dubow
Q: I have used contact lenses every day for 10 years. Now, when I wear my glasses, my eyes are not so comfortable as with the lenses. They are more sensitive to light and also watering more. Is this normal? Is it because I have used my lenses too much? They are six-month soft lenses, -2.5 on each eye. Thanks. Karina, Denmark
A: Quite a few of my patients report this same feeling. I think it is similar to taking off a bandage you have worn for a while and feeling the air on your skin. If you leave your lenses off for a few days, this feeling would go away. To the best of my knowledge, however, there is absolutely no danger to your eyes. Dr. Dubow
Q: Why am I suddenly suffering from constant eye infections (pink eye) when I wear my contacts? They are daily wear disposable soft contacts and are sterile each time I put them in. J.F., British Columbia, Canada
A: As I've said previously, I cannot actually make a diagnosis for you without seeing your eyes. However, from what you've written, I suspect you are not having recurring episodes of pink eye. My guess is that you may be using a solution to which you have become allergic, or perhaps your contacts are fitting too tight.
You really need to see your eye care practitioner to find out what is happening it's not a good idea to put up with unexplained red eyes. Dr. Dubow
Q: I have worn RGP contact lenses for over 10 years. I would like to switch back to glasses, but the shape of my cornea has changed dramatically. An optometrist told me not to wear the contacts for three days, then performed a vision test. I purchased glasses based on this prescription. These glasses are not strong enough to correct my vision. Is there a certain amount of time it takes for corneal recovery? M.B., Michigan
A: RGP lenses can cause warpage of the cornea both from mechanical pressure and from a shortage of oxygen through and under the lenses. In most cases this warpage is reversible over time.
Unfortunately, three days is not enough time. Studies show that it takes an average of about 21 days for corneas to reach stability after rigid lens wear.
I recommend you return to your optometrist and have your prescription rechecked. It is likely that a change of lenses will return your eyes to good vision. Dr. Dubow
Q: I started wearing contacts about a week ago, but I'm not comfortable with the color. Is there any way I can darken the color without getting a new pair? My eyes are not white they have brown spots on them, and now I just don't like the way my eyes look. I'm of dark complexion. N.T., Bahamas
A: Nope. Please, please do not use food coloring or some other dye. It can be very dangerous, and you only have two eyes! Go back to your contact lens practitioner he or she may be able to send your lenses back to their manufacturer, under warranty, and get you a new pair of a different color. Dr. Dubow
Q: I usually wear RGP contact lenses. When I switch from them to my glasses after the recommended 8-12 hours, I have a difficult time focusing for at least an hour. The prescription is supposed to be the same. Why does this happen? M.L., Minnesota
A: Rigid gas permeable (RGP) lenses are, as the name implies, rigid. They can put pressure on the front of the eye, causing it to temporarily change in curvature. They can also cause some degree of oxygen loss, which also changes the eye curvature. We call the blur you experience upon taking your lenses out "spectacle blur." It is quite common and not harmful if it disappears within an hour or so.
However, if you have distorted and blurry vision for several hours or more, you should see your eye care practitioner. Higher oxygen lenses can minimize or eliminate this annoying situation. Dr. Dubow
Q: My wife has worn soft contact lenses for many years and has always relied on heat for disinfection. Recently my aseptor gave up the ghost, and now I can't find any store that carries them. Is everybody using chemicals now? Does anyone still use heat to disinfect their lenses? J.D., New York
A: When Bausch + Lomb first began marketing soft lenses, they adapted baby bottle warmers to use in disinfecting them. This worked, but it also created a lot of problems with protein accumulation on and in the lenses, lid irritations and allergies, lens degradation, etc.
Most contact lens practitioners do not recommend heat. We usually prescribe a peroxide-based system for patients who are converting from heat disinfection.
There is a new system now approved by the FDA called Purilens that uses ultraviolet radiation and ultrasound to sterilize and clean soft lenses. We have found this product to be very effective, economical and easy to use. Ask your contact lens practitioner about it. Dr. Dubow
[Read more about soft contact lens care.]
Q: My girlfriend recently purchased "gas permeable" contact lenses and has been rather pleased with them. However, she often perceives irritation in her eye(s) after gusts of wind, and must remove her contact to relieve her symptoms.
Are small dirt particles or irritants permeating her lenses and irritating her eye? She did not have this problem with "non-permeable" type contacts. P.R., Illinois
A: Unlike soft lenses, rigid gas permeable (RGP) lenses are smaller than the cornea (the clear covering over the iris, the colored part of the eye). They actually float on the tears, moving up and down with every blink. A gust of wind can blow dust and other airborne material into the tears, which then carry this material under the lenses upon blinking. This happens less often with soft lenses because they are like a cellophane wrapping covering the entire cornea.
RGP lenses have some significant advantages, however, despite this minor problem. They breathe more oxygen than soft lenses (hence the "permeable" designation) and can provide sharper, crisper vision. They can also slow down the progression of nearsightedness, compensate for large amounts of astigmatism and provide good optics for bifocals.
Tell your girlfriend to carry some eye drops in her purse they come in handy when dust gets under a lens. In a pinch, she can also push the lens onto the white of the eye by manipulating it through the eyelid, allowing the dust to wash away, and recentering the lens the same way. Dr. Dubow
Q: When I first began wearing RGP contact lenses, I had difficulty removing them. I was given a tool that my doctor referred to as a "plunger," a small suction device that I used to remove my contacts very easily. Where can I get another? R.A., Illinois
A: "Plungers," or DMV removers, are available through eye care practitioners and many pharmacies. They do work well, but I recommend you learn to remove your lenses using your fingers as well. What if you are in a situation where you can't use your plunger? As they taught me in Boy Scouts: Be Prepared! Dr. Dubow
Q: I wore contact lenses about four years ago. I have dry eyes from prescription Premarin, which I must take for the rest of my life. Have there been any updates since that time to ensure a longer contact lens wearing period? J.A.
A: You bet! There are several contact lenses for dry eye on the market. Ask your eye care practitioner to try Proclear Compatibles or Preference lenses from CooperVision, or Extreme H20 from Benz. These are the dry eye lenses I am familiar with. They can really expand your comfortable wearing time. I highly recommend you also use non-preserved contact lens care products. Ask your practitioner about the Purilens system.
There is also a procedure called lacrimal occlusion or punctal occlusion whereby your eye doctor can block some of your tear drainage, keeping more tears in your eyes. This is a simple procedure taking only a few minutes and done right in your doctor's office. It can work wonders for folks with dry eyes. Dr. Dubow
Q: I have worn soft contact lenses on and off for 15 years, and I chronically have red, bloodshot eyes. I've gone for periods of weeks and months wearing only my glasses and avoiding contacts, but honestly my eyes seem less bloodshot when I wear my contacts.
What can I do to clear up my eyes so they are not bloodshot? And does the fact they are chronically bloodshot indicate any eye health problems or disease? M.A., Georgia
A: The known causes of red eyes take up volumes in the ophthalmic literature. It sounds like you need to obtain a diagnosis for your condition so that the appropriate treatment can be prescribed.
Allergies and dry eye syndrome are probably the two most common causes of red eyes. Wearing contact lenses on top of an already inflamed eye can only lead to further problems. A thorough examination to determine the etiology of your bloodshot eyes is needed. Dr. Slonim
Q: I am a 22-year-old woman. I have been wearing spectacles for more than 10 years now. I wear contact lenses too sometimes. My vision had stabilised for some years, but recently my left eye has started weakening. I am very worried about it. Please advice me on how to stop this or if possible to improve my vision. Laju, India
A: A "weakening" of one eye can happen for a number of reasons. If you are wearing soft contact lenses, one may have changed in curvature or cleanliness. Soft lenses don't do much to hold back vision changes.
If you are wearing rigid gas permeable (RGP) lenses, again one may have changed in curvature. RGP lenses work better to delay vision changes than do soft lenses. I recommend you visit your eye care practitioner to find out why your eye has changed. Dr. Dubow
Q: I wear nonprescription soft contact lenses, and I wanted to know if it is safe to wear them when I go to sleep. T.O., Arizona
A: Some soft contact lenses are approved for extended wear (sleeping) by the FDA. These lenses have been tested for safety, but it is essential to follow the rules as prescribed by your practitioner.
It is NOT safe to sleep in daily wear lenses. Your eyes could experience permanent damage due to a lack of oxygen, among other things. Having or not having a prescription in the lenses makes no difference in their safety, whether they are daily or extended wear. Take care of your eyes you only have two! Dr. Dubow
[Read more about extended-wear contact lenses.]
Q: What is my condition? From overuse of contact wear, I was told by an eye doctor that my blood vessels are growing into the color of my eyes (behind the color). The employees who work at the vision centre would not prescribe contacts for me again. What should I be expecting to happen within the next few years? T.R., Ontario, Canada
A: When a contact lens is overworn we find that the cornea has been starved for oxygen during overnight wear. This oxygen deprivation stimulates the growth of new blood vessels (neovascularization) from the conjunctiva (the membrane that covers the white of the eye) to grow into the cornea where blood vessels typically don't exist. The farther into the cornea they grow, the more problematic they can be.
When the contact lens wear is stopped, the blood vessel growth stops. The vessels themselves remain, though the blood within them may disappear (referred to as ghost vessels). Depending on the severity of this neovascularization, resuming contact lens wear may not be possible. Sometimes returning to daily wearing of lenses with a higher oxygen permeable lens material may allow the patient to remain in lens. Dr. Slonim
Q: What are the advantages of using soft lenses? And what are the disadvantages? F.S., South Africa
A: Soft lenses are perceived by most patients and practitioners alike to be more immediately comfortable while adequately correcting vision. They come in all formats even toric (for astigmatism) and bifocal. Disposable soft lenses take minimal (but important) care to maintain their safety and usefulness.
Soft lenses do absorb elements from the tears and the environment. They can change in fit with their age and cleanliness, perhaps causing a lack of oxygen to the eyes. Their surfaces break down rapidly, causing a decreasing sharpness of vision.
On the other hand, many patients feel they see sharper and more clearly with rigid gas permeable (RGP) lenses. RGPs become very comfortable after adapting to them. They are easier and less expensive to maintain, last longer and are available in all formats toric, bifocal, etc. RGPs can more easily be custom designed to offer a wider range of vision correction than soft lenses. They can breathe more oxygen, don't deteriorate as fast and don't absorb things as easily as soft lenses.
There is a definite place for each of these lenses in a contact lens practice. Each patient is different. While most end up wearing soft lenses, RGP lenses offer a wonderful alternative for many, many patients. Dr. Dubow
Q: The blood vessels in my eyes are growing to my cornea, and my doctor is making me go to hard contact lenses. Are there any contacts that get oxygen to your eyes instead of going to hard contact lenses? Holly, Kansas
A: It is said that the very best contact lens is one that is 8 mm across with a 9 mm hole in it! New blood vessel growth into the cornea can be very serious. Your doctor is acting in your best interests in prescribing rigid gas permeable contact lenses to prevent further problems. Unfortunately, soft lenses cover more eye surface and can further the growth of the vessels.
However, having said that, there are ways to increase the oxygen to the cornea with soft lenses. You could ask your doctor about silicone hydrogel soft lenses, which are fairly new. Dr. Dubow
[By the way, RGPs are more rigid than soft lenses, but they are not "hard." In fact, they are very oxygen-permeable, so they let air reach your eyes, which is essential for good health. Among eye care practitioners, the term "hard contact lenses" refers to the small, hard lenses made of PMMA plastic that used to be in widespread use. As far as we know, they are no longer prescribed in the United States. Editor.]
Q: I just started wearing soft disposable contact lenses a few days ago. Today, hours after removing my lenses, my right eye felt uncomfortable and irritable, with two red patches near the eye black. Why is this so? Am I allergic to the lenses, or am I suffering from an infection? How is this possible? Shireen, Singapore
A: As I told another questioner, I can't diagnose your problem without seeing your eye please e-mail it to me for examination... Just kidding!
What you are describing is probably not an infection. It could be caused by several things, such as a rip in your lens or a reaction to the solution the lens was stored in. It could also be an inflammation called an infiltrate, which is an accumulation of white blood cells in the cornea. This can be caused by solutions, tight lenses, etc. Please go back to your practitioner and find out what is happening. Dr. Dubow
Q: Should I be concerned about ordering contacts online if I have my prescription? Would there be a concern with purchasing a different brand from what I am currently wearing? I am currently wearing Proflex-38 made by Sterling. Do you have any recommendations? Left eye is -750. Right eye is -550. L.M., Pennsylvania
A: Contact lenses are a prescription medical device. By law, they cannot be sold without a valid prescription. I see nothing wrong with ordering your lenses online as long as you have a valid, up-to-date prescription from your eye care practitioner AND you are having regular check-ups to make sure your lenses are fitting well and your eyes are healthy.
DO NOT let any contact lens company change the brand or type of lenses you are wearing. Lenses with the wrong fit, or not enough oxygen, can cause permanent changes to your eye health. If in doubt, ask your eye care practitioner.
P.S. Please expect to pay your eye care practitioner for his or her expertise in prescribing your lenses and managing your care. Dr. Dubow
Q: I have double vision and would like to know how prism in glasses helps to cure this. Also, is there any way I can wear contacts to correct this? Tina, Florida
A: A prism bends light. Prism in glasses can kind of fool your eyes into thinking they are working together without strain. Prism can also help with double vision by aligning the two images into one. I prescribe a lot of prism for my patients, with excellent results.
Some patients who require prism can wear contact lenses, and some can't. It depends on the kind and the amount of the prism.
In fact, some kinds of prism are corrected better by contact lenses than by glasses!
See your eye care practitioner for more details. Dr. Dubow
Q: About 12 years ago I had a corneal ulcer. I wore contact lenses at the time. Is there a type or brand of contact lenses that I may be able to wear? C.D., Ohio
A: Contact lenses have changed tremendously in the past 12 years. I don't know about your specific case, but many patients who have had corneal problems in the past can now wear contacts safely and successfully. Go see a contact lens specialist for more detailed information. Dr. Dubow
Q: Can my contact lenses roll up behind my eyes and get stuck there? S.S., New Jersey
A: How else do you think people can develop eyes in the backs of their heads?
Seriously, absolutely not. The eye is basically a closed "pocket" that is totally separated from what lies behind. Contact lenses can and do slide off the cornea, the clear "watch crystal" covering the front of the eye, and they can also get stuck in the corners of the "pocket," but it is not dangerous, and the lenses can easily be removed once they are located. If you think you have a contact lens someplace in your eye, and you can't find it, call your eye care practitioner. Dr. Dubow
[Read about what to do if a contact lens gets stuck in your eye.]
Q: Why do some contact lenses feel more dry than others? Is it better to go with lower water content or higher? R.D., Georgia
A: This is a very technical question. Contact lenses are made from different plastics and silicones that have different characteristics. Some have more water content than others. All contact lenses are subject to evaporation while on the eye. In other words, the environment sucks the water out of the lenses. The rate of this happening depends on many factors: humidity, wind, temperature, your health, what medicines you are taking, how much you blink, the care system you use, how clean the lenses are, etc.
Some eye care practitioners believe that high water content lenses perform better for those with dry eye, while others believe just the opposite. A few lenses are now available that are made from plastics that resist dehydration and evaporation. They include Proclear from CooperVision and Extreme H20 from Benz. The Preference line of lenses from CooperVision also has been touted for dry eye patients.
I also would suggest trying silicone hydrogel contact lenses such as Night & Day and AirOptix from CIBA Vision, PureVision from Bausch + Lomb, Acuvue Oasys from Johnson and Johnson, etc. For a contact lens solution suitable for someone with dry eyes, I recommend Clear Care (CIBA Vision).
An in-office procedure is also available that blocks some of the tears from draining away. Tiny punctal plugs are inserted into the tear drainage holes in the eyelids. This is called lacrimal occlusion. It is very safe and effective for those with clinically dry eyes and can really help with comfortable contact lens wear. Dr. Dubow
Q: Why can't I switch contact lens solutions depending upon what is on sale? Rosemary, New York
A: Sometimes cheaper is better, and sometimes it isn't. This is one of those cases where it isn't.
Each contact lens care solution has a different chemical makeup. Some use harsh preservatives that cause sensitivity and even allergy in a high percentage of users. Some can discolor a patient's contact lenses, making them unwearable.
Sometimes the chemicals in one lens cleaning system can improperly combine with the chemicals in another system when they are used in combination, causing a reaction for the user.
I hope you are getting my drift here. It is better to spend a few more pennies and be sure your care solutions work for you, not against you. One of the leading causes of contact lens dropout is improper care. If in doubt, ask your eye care practitioner! Dr. Dubow
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[Page updated August 2013]
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