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30-Day Contact Lenses:
A Smart Alternative to LASIK?

By Rob Murphy; reviewed by Gary Heiting, OD

Are you tired of wearing eyeglasses or putting up with the daily hassle of removing, cleaning and disinfecting your contact lenses?

One option is LASIK surgery. But if you're not keen on the idea of having eye surgery or you are too young for the procedure (you must be 18 or older for LASIK), there's also a non-surgical option: continuous wear contact lenses.

Also called "extended wear lenses" or "30-day lenses," continuous wear lenses are soft contact lenses that are approved by the FDA for up to 30 consecutive days of continuous day-and-night wear without removal.

Like LASIK, extended wear contact lenses offer hassle-free good vision. So let's consider the relative merits of each option in terms of safety, effectiveness and cost.

Safety

Continuous wear contact lenses and laser eye surgery are safe for the overwhelming majority of patients, but each carries some risk. Sleeping in contact lenses increases your risk of eye infection. For laser eye surgery, the primary risks are dry eyes and visual disturbances such as glare and halos.

Continuous wear contacts. Extended wear contact lenses first became available in the U.S. in the 1980s. However, many people who wore their lenses for 30 days in a row began to experience eye infections. Within a few years, the FDA reduced the approved continuous wearing time for extended wear lenses to a maximum of one week.

Tired of not being able to see when you wake up? Maybe it's time to consider a 24-hour vision correction option.

So what's different now? In the late 1990s, a new contact lens material — silicone hydrogel — was introduced. Silicone hydrogel contact lenses allow six to seven times more oxygen to reach the cornea to keep it healthy, compared with regular soft contact lenses.

Today, several lens manufacturers offer silicone hydrogel lenses that have been FDA-approved for up to 30 days of continuous wear. Still, overnight wear of contacts isn't for everyone. And people who have had previous problems with contacts may not be good candidates for 30-day wear.

Laser vision correction. The vast majority of LASIK patients enjoy good vision without glasses after surgery, with minimal (if any) complications.

New refractive surgery technology introduced in the past few years has greatly reduced vision complaints after LASIK — including femtosecond lasers to create thinner corneal flaps, eye-tracking technology to compensate for minor eye movements during surgery and new wavefront-guided laser treatments that provide a customized laser treatment (custom LASIK) to treat the unique optical imperfections of each person.

In addition, years of laser vision correction experience have taught surgeons to be better at screening out poor candidates for surgery, who are more likely to experience post-surgical problems.

However, nighttime glare and dryness remain a problem for some patients, at least for the first few months after surgery.

Effectiveness

Both 30-day contacts and LASIK can produce excellent vision quality for the right candidates. But what happens if your vision changes over time?

Continuous wear lenses. With 30-day contact lenses, you can find out almost immediately how sharp your vision will be. If you'd rather have no doubt whatsoever about the visual outcome, then 30-day contact lenses may be a better option for you than laser vision correction.

With contact lenses, your prescription can easily be adjusted down the road, should the need arise. And wearers entering their presbyopic years can switch to bifocal contact lenses, or they can use reading glasses in combination with their contact lenses.

Laser vision correction. Because of advances in laser vision correction technology and increased experience among refractive surgeons, the visual acuity experienced by LASIK patients is statistically better than ever. Most patients achieve 20/20 acuity or better, according to many studies.

However, a small percentage of LASIK patients may see some change in their vision over time. This change may require them to wear eyeglasses on a part-time basis for certain activities (e.g. driving at night). In some cases, the change in vision may be significant enough that a second LASIK surgery (LASIK enhancement) may be necessary.

Also, LASIK can't completely fix presbyopia, though a monovision procedure or other presbyopia surgery can help. So if you've had LASIK, at some point after age 40 you still may need reading glasses to see clearly up close.

Cost

Continuous wear contacts. A 12-month supply of continuous wear contacts will typically cost $250 to $300. An advantage of 30-day lens wear is that you almost eliminate the cost of lens care solutions. However, you should still keep a multi-purpose contact lens solution handy in case your lenses get dry or dirty and you need to remove them prior to the end of your normal 30-day wearing period.

Laser vision correction. The average cost of LASIK eye surgery in early 2010 was about $2,150 per eye, when a single price incorporating new technologies is quoted. Most surgeons offer LASIK financing with monthly payments to make the procedure affordable to a larger patient population.

It's important to note that you don't eliminate your need for eye care and eyewear with laser vision correction. You still need routine eye exams to check for vision changes or symptoms of eye disease, and you should purchase at least one pair of nonprescription sunglasses that block 100 percent of the sun's UV rays.

You should also purchase artificial tears for occasional dry eye symptoms and buy at least one pair of safety glasses to protect your eyes when playing sports or engaging in other potentially hazardous activities after LASIK surgery.

Which Way to Go?

Before you make your final decision, get the unbiased advice of an eye doctor who is open to both 30-day contacts and laser vision correction. If the doctor says you're a good candidate for both, the choice comes down to personal preference.

Your answers to the following questions can point you in the right direction:

• What is your tolerance for risk? Contact lenses carry a lesser degree of risk than LASIK. Any kind of surgery has inherent risks to consider.
• How much convenience are you looking for? If even a once-a-month contact lens routine is too much trouble, you might prefer LASIK.
• How important is flexibility? A contact lens prescription can easily be changed in the future to adapt to your changing vision needs.
• How will you eventually deal with presbyopia?
• Is up-front money a factor? Continuous wear contact lenses are less expensive in the short term, but LASIK may be less expensive in the long term.

If you're hesitant about either option, there are two other choices:

Orthokeratology (or "ortho-k"). Like LASIK and continuous wear contact lenses, ortho-k frees you from daytime contact lens use, though you must wear specially designed gas permeable contact lenses at night when sleeping.

One-day disposable contact lenses. Though these disposable contact lenses are meant for daily wear only, they offer the advantage of eliminating daily lens cleaning and disinfection. At the start of your day, you put on a new pair of lenses; at the end of the day, you simply remove and discard them.

Expect to pay $20 to $30 per box of 30 one-day disposable contacts (although ordering an annual supply, with discounts and rebate that are often available, can reduce the cost to about a dollar a day).

Though this is more expensive than 30-day continuous wear contacts, wearing contact lenses on a daily wear basis appears to reduce the risk of eye infections, compared to overnight wear.

Also, many contact lens wearers cannot tolerate overnight wear of 30-day lenses because their eyes are too dry. For these people, one-day disposable contact lenses for daily wear are a better option. Additionally, contact lenses for dry eye are currently available on the market.

For more in-depth information, read our articles on extended wear contacts and laser eye surgery.

[Page updated October 2010]