Contact troubles

Hi, I've tried contacts off and on over the past few years and haven't
been able to find any that my eyes seem to agree with. When I'm wearing
contacts, everything seems to be fine as long as I don't turn my head at
all and if I'm in bright light (such as when driving). But the minute I
start turning my head and looking around (mainly side-to-side), I start
getting some major edge flare and blurring of vision. If I sit still
for a little bit, my vision stabilizes fairly well. In addition to the
edge flare, my contacts will fog up and sometimes I need to remove and
re-insert them to make this go away. I started wearing Acuvue Advance
for Astigmatism lenses yesterday and I'm noticing these same problems
again. What could be causing these troubles for me? My doctor said how
great these lenses are, but I ain't seeing it so far.

In article <dgvdfa$ncr$(E-Mail Removed)>, Dave <(E-Mail Removed)> wrote:

> Hi, I've tried contacts off and on over the past few years and haven't
> been able to find any that my eyes seem to agree with. When I'm wearing
> contacts, everything seems to be fine as long as I don't turn my head at
> all and if I'm in bright light (such as when driving). But the minute I
> start turning my head and looking around (mainly side-to-side), I start
> getting some major edge flare and blurring of vision. If I sit still
> for a little bit, my vision stabilizes fairly well. In addition to the
> edge flare, my contacts will fog up and sometimes I need to remove and
> re-insert them to make this go away. I started wearing Acuvue Advance
> for Astigmatism lenses yesterday and I'm noticing these same problems
> again. What could be causing these troubles for me? My doctor said how
> great these lenses are, but I ain't seeing it so far.

If you have large pupils (more than 7mm in reduced illumination) and/or
the lens moves more than 1.5-2 mm when move your eye or blink, the
problem is likely the size of the optic zone. Lenses come in different
optic zone diameters and for a properly fitted lens and "normal" pupil
size, it often doesn't matter. Sometimes, it does. Perhaps this is your
situation. Your doctor should be able to figure it out.

LB. O.D.

Wooly, you are right on in your comments. Soft contacts are available
in a limited number of sizes and optic zone diameters. When n eyecare
professional measures your eyes for gas perms, they can compensate for
your large pupils or steep corneal curves. Wearing soft contacts for
astigmatism vs. RGPs is like comparing an off-the-rack suit versus
being fit by a tailor.

In article <(E-Mail Removed) .com>,
"(E-Mail Removed)" <(E-Mail Removed)> wrote:

> Wooly, you are right on in your comments. Soft contacts are available
> in a limited number of sizes and optic zone diameters. When n eyecare
> professional measures your eyes for gas perms, they can compensate for
> your large pupils or steep corneal curves. Wearing soft contacts for
> astigmatism vs. RGPs is like comparing an off-the-rack suit versus
> being fit by a tailor.

You are wrong. On both comments.

We have the ability to customize soft toric lenses to fit most
configurations of cornea curvature and optical corrections. There are
quite a few different physical designs available from many
manufacturers---just as there are with RGPs.

There are some situations where RGPs will provide better overall optics
and others where soft torics are a better choice.

It is actually more difficult to compensate for large pupils with RGP
lenses than with soft due to the physical limitation of designing the
optic zone diameter relative to the overall lens diameter to keep the OZ
centered over the pupil. But a skilled contact lens practitioner can
indeed achieve that desired result with either RGP or soft.

--LB, O.D.

With apologies to Dan Akroyd...Larry, you ignorant slut! To suggest
for a moment that toric soft lenses can ever be as optically pure as a
rigid lens is like defending the use of snot as a protein-based meat
extender. Soft torics exist simply because we Americans are the
laziest, most comfort-oriented society in the world. We want the
immediate gratification of not feeling our contacts on our eyes, just
like we want that diet pill we saw on television make it easy to lose
weight without exercising. These "custom" soft lenses are not quite as
bad as the mass market vision condoms that are in the chain stores, but
to call them "equal or superior" to a rigid lens is a bit much. Your
example of rigid lens OZ diameter limitations is dated by about 10
years. These newer highDk lenses have Rockwell hardness ratings that
let you run the back surface central curve all the way out to the
middle of the front peripherals, allowing us to make thin lenses that
avoid flexing by acting like a trussed roof. There are NO limitations
to rigid lens design when you have the right lab working for you in
designing a product for each individual patient. Soft torics are
bedroom slippers, robes or vision condoms...but please don't delude
yourself that a 55% water bag of mucoid tears with weights on the
bottom is a "superior" vision device. Bleecchh.

In article <(E-Mail Removed) .com>,
"(E-Mail Removed)" <(E-Mail Removed)> wrote:

> With apologies to Dan Akroyd...Larry, you ignorant slut! To suggest
> for a moment that toric soft lenses can ever be as optically pure as a
> rigid lens is like defending the use of snot as a protein-based meat
> extender. Soft torics exist simply because we Americans are the
> laziest, most comfort-oriented society in the world. We want the
> immediate gratification of not feeling our contacts on our eyes, just
> like we want that diet pill we saw on television make it easy to lose
> weight without exercising. These "custom" soft lenses are not quite as
> bad as the mass market vision condoms that are in the chain stores, but
> to call them "equal or superior" to a rigid lens is a bit much. Your
> example of rigid lens OZ diameter limitations is dated by about 10
> years. These newer highDk lenses have Rockwell hardness ratings that
> let you run the back surface central curve all the way out to the
> middle of the front peripherals, allowing us to make thin lenses that
> avoid flexing by acting like a trussed roof. There are NO limitations
> to rigid lens design when you have the right lab working for you in
> designing a product for each individual patient. Soft torics are
> bedroom slippers, robes or vision condoms...but please don't delude
> yourself that a 55% water bag of mucoid tears with weights on the
> bottom is a "superior" vision device. Bleecchh.

I really, truly enjoyed your commentary. Especially the "mass market
vision condoms". Can I use that?

And you're right on most accounts. I will admit that I personally use
RGP lenses and do so because, for my prescription, for my needs, they
are optically vastly superior to any soft lens currently available. I
also fit probably more RGP lenses than anyone around these parts. So
there it is. I'm out of the closet and I'm OK with it.

But you know what? It is technically possible for what I need to be made
in a soft, well, at least in a silicone hydrogel lens, not the good old
55% water bags. And it will happen as soon as the manufacturers' CPAs
and advertising execs develop an understanding that they can make good
bucks with it.

Of course there's a catch: I totally, sadly agree that Americans are
sold on the quick and comfortable, and many add cheap to the equation.
And our colleagues are too often locked into old technology either
because of laziness of financial "commitments" or "considerations",
neither a good excuse. The manufacturers only care about one thing, and
the mass market quick-and-easy chain stores and mail order resellers are
ruining it for everyone. Oh----except the manufacturers.

The reality is that for some people, prescription, cornea curvature,
cornea diameter, pupil size and lid tension issues come together in a
way that allows soft lenses to do a damn good job of providing an
excellent vision experience. And as I said, sometimes equal to or
superior to RGPs. Certainly not routinely. Certainly not never.
Sometimes what works is a surprise to me. I guess the eye is indeed more
than just a box camera ;-)

And you are also correct about the very cool new(er) high DK RGP
plastics and the unique things we can do with them. But for some people,
no matter how wonderful the material or design it will not be a
comfortable experience. Of course the same holds true for soft lenses.
How many people out there are just tolerating the end of day discomfort
and variable vision in a soft lens that could be improved upon by simply
switching to a different plastic or design? I've even switched people to
RGP lenses for better comfort, not to mention vision. Yup, it happens
that way, too.

There's no doubt that looking through a stable optical surface provides
better vision than seeing through a sponge of a lens. I think aspheric
and high DK silicone hydrogel lenses change that, a bit, just as high DK
controllable flexibility RGP lenses and custom topography assisted lens
designs do the same. Very nice. There's a place for both. It would be
nice if more contact lens practitioners believed that. It would be nice
if we could meet more people's real-life needs with contact lenses so
there would be less cutting-and-melting LASIK.

The really important new contact lens technology in RGP, soft and
hopefully now hybrid lenses is pretty darn recent stuff coming after
decades of little innovation. I think we might finally be getting
somewhere.

I'm glad we've had this discussion and I hope it has a message for our
colleagues and readers interested in contact lenses.

LB, OD
(still waiting for my perfect lens and a little bummed that some of my
patients have it better than I. ;-( For now.)

I follow this thread with bemusement. Basically, the patient will vote
with his/her pocketbook. If the patient is unhappy with the discomfort
of an RGP, they will go to someone who will fit them with a soft toric
lens. Then, when they become unhappy with the vision of the soft toric
lens, they will go somewhere else for LASIK.

DrG

In article <(E-Mail Removed) .com>,
"Dr. Leukoma" <(E-Mail Removed)> wrote:

> I follow this thread with bemusement. Basically, the patient will vote
> with his/her pocketbook. If the patient is unhappy with the discomfort
> of an RGP, they will go to someone who will fit them with a soft toric
> lens. Then, when they become unhappy with the vision of the soft toric
> lens, they will go somewhere else for LASIK.

.......and when they become unhappy with their LASIK results, they're
back to the doc for RGP contacts! The circle will be unbroken, the race
around the ring being driven by the almighty dollar. Again.

LB, OD

No. When they become unhappy, only a few are back to the doc for RGP
lenses. Most just live with the outcome.

DrG