Can a person get MORE nearsighted suddenly?

(I'm waiting for my ophthalmologist to call back.)

This is weird. When I put on my contacts (distance, far-sighted, astigmatism)
early this morning (5:00 am) things in the house seemed OK, but distance stuff
(freeway signs, etc.) were fuzzy. Car lights are usually blurry, but this was
worse than usual. When it got light, things seemed OK.

Skied until 1:00, at which time EVERYTHING got fuzzy. I used rewetting drops
several times, but nothing helped. I stopped at Costco (about 45 minutes
later,on the way home), removed my lenses and put on my prescription
sungleasses. Wow. I could read stuff with the distance part, and the reading
segment required me to hold stuff 6" away to make it clear (normal is ~12"-16").
Needless to say, shopping was a real bitch.

As I was driving the rest of the way home (total distance 85 miles) it seemed to
be getting better. By the time the doc calls it may be back to normal.

A pair of my old glasses (age unknown) are now suitable for computer use in the
distance part, which is certainly convenient, if a bit odd. I'm using them
right now, but am holding my head a little closer than usual.

Altitude was 7K-8K feet for 6 hours or so. Do corneas swell with altitude?
Would that make me less far-sighted? I think the problem started this morning
when the elevation for a couple of hours was ~200-500 feet.

I SWEAR I'm not a Martian. Anybody have any ideas?

 

She called back and diagnosed corneal edema brought on by cold. Sounds about
right, it was REALLY cold in the morning. I'm going to have her fit new
contacts, but that process probably won't be finished until midsummer :-(

In theory contacts are protective. Go figure.

So does anybody have any ideas about preventing CE while there's still enough
snow to ski?

I think it was gone by 11:00 pm when I went to bed.

--
Cheers,
Bev
============================================
"People are too stupid to realize they are."
--JoHn DoH KeLm

 

High altitude = less oxygen. Dry contacts = reduced oxygen
permeability. The result is corneal swelling, or edema, more central
because that's where the lens is thickest. That would be my guess.

 

At the risk of asking stupid questions ... Bev ... ? Any way you
could have reversed your contacts, and -- based on your Rx -- could
that explain it?

I did it ONCE in my LONG history of CL wear, and SWORE that wasn't
it ... except it was ;-)

I'm skiing tomorrow. Git some!!!

 

CRAP! I'm going in to see her in half an hour, so maybe I'll find out something
useful. She fits contacts too, and I'm going to give her a shot.

--
Cheers,
Bev
============================================
"People are too stupid to realize they are."
--JoHn DoH KeLm

 

No, it was the same way with my glasses. For once in my life my left eye was
better than my right eye. Damn, it just occurred to me that my left eye wasn't
affected...I think...

I did it too, once. I liked the effect when I was inside, but it sucked badly
for driving!

Good for you! I go to Big Bear Lake in California. Where do you go?


--
Cheers,
Bev
============================================
"People are too stupid to realize they are."
--JoHn DoH KeLm

 

But it was really cold and I don't have a heater in my car.

Maybe there wasn't MUCH of it, just enough to give the effect of
nearsightedness. Ophthalmologist couldn't think of anything else it might be.
Looking back, I think I've had this for a long time -- whenever I start back
home after skiing, which happens around 1:00 pm after spending most of the
morning in cold weather.

She's going to try to figure out some new contacts to try (I now have less
hyperopia and more astigmatism). She couldn't tell (2 days later) if corneal
edema is what it was, but it just SOUNDS right and she couldn't think of
anything else it might be. I asked her if there was anything I could do to
prevent or reduce it and she said 'Don't wear your contacts when you go skiing."
She squeezed me in today and sounded really tired, so I didn't push it.

But now I'm wondering if Muro-128 (yeah, it was a bitch to find it!) or
equivalent would help (a) quickly (minutes, perhaps) and (b) would I have to
remove my contacts to use it? Everything I've read about corneal edema seems to
refer to problems resulting from either eye surgery or insufficiently
O2-permeable contacts. The only mention of cold involved lasik patients
climbing mountains, and was not helpful.

What do you think?

I could use my glasses in the morning, switch to contacts on the hill, and
switch back to glasses when I leave. Having fallen on my face twice (once I
broke my frames, once I lost my glasses in the snow AFTER they scraped a goodly
chunk of skin off my face. Nice soft goggles, which also keep the wind out of
my eyes, seem essential. It's not that I actually like to fall, it just happens
sometimes; not often, but sometimes.

This may sound like a lot of trouble to go to "just for skiing", but it's about
the only recreation I *DO* love and can do now. I need new contacts anyway,
I've had these since May 2006, although I stopped wearing them in May 2007
except for skiing last year.

 

I hope you understand how dangerous this substance is. Here are many
warnings:

http://www.drugs.com/cons/muro-128-5.html

It says that it is prescription only. It's also expensive, about 20
bucks (US dollars) for 1/2 ounce.

It is composed of two other substances:

1. Sodium Chloride. The LD50 (lethal dose) is 3000.

http://chemlabs.uoregon.edu/Safety/toxicity.html

2. Dihydrogen Monoxide. This kills tens of thousands of people every
year. Death is generally due to inhalation.

http://www.dhmo.org/


Add those two things together, and what do you get? SALT WATER!!!

That's right, salt water. For the third time: Salt Water.

Since you already tried regular drops, which are salt water, I wonder
how much this stuff would help.

 

OTC, but you're right about the expense. That's why I'm asking.

I know that too. A friend nearly died of it before she learned to use it
properly.

The concentration might possibly make the difference. If I lived near the ocean
I could get lots of it for free, but it's cheaper to buy it than drive 90 miles.
OTOH, I could boil some up in a few minutes, but if it's something that you
have to use 3 times a day for a few weeks it won't do what I want anyway.

 

And corneal steepening increases myopia. So, figure out what caused
the corneal steepening. Maybe the patient didn't notice the fog
because of the blur. Also, I didn't say "rare." I said "less." Most
cases of corneal edema related to contact lens induced hypoxia I have
seen occurred at sea level.

 

Actually, one other cause did suggest itself: corneal steepening via
mechanical means, as in a tight lens.

 

Unlikely -- the guy who fitted the lens (and I believe that he really was pretty
good at it and did the best he could) surely would have noticed that, as would
my ophthalmologist who looked at the lenses on my eyes today.

--
Cheers,
Bev
= = = = = = = = = = = = = = = = = = = = = = = = = =
'Politics' comes from an ancient Greek word meaning
'many blood-sucking leeches.' -- Mark Russell

 

Of those, cold and lack of oxygen seem like the likely culprits. Surely the
ophthalmologist would have noticed the other problems, right?

While I was skiing I used goggles, but they had a few air leaks (duct tape to
replace the old foam on the vents, don't you dare snicker!). I took the goggles
off around 12:45, and the fuzziness started soon afterward.

If it ain't broke, don't fix it. I know my prescription has changed -- some old
distance glasses now work fine for computer usage. So do my current contacts,
but the apres-ski thing had me focusing much closer than that.

The ophthalmologist is prescribing new contacts, so that should solve the lack
of O2 problem, if nothing else. She gave me my new glasses prescription
yesterday. Her prescription:

R - .50 +2.75 10 2.50 add
L +1.25 +3.50 170 2.50 add

which I converted to:

R: +2.25 -2.75 100 2.50
L +4.75 -3.50 80 2.50

Did I do it right?

 

I would like to make a few comments regarding contact lenses for high
astigmatism. I must state that I have a vested interest in what I am
about to say, but I hope most will find the information useful,
especially since I never see this discussed in this forum.

I have had a 25 year love-hate relationship with toric soft lenses,
and those patients represent the single largest pool of potential
LASIK candidates. The majority of them do not achieve the vision and
comfort that the rest of us do with soft contact lenses. Surely there
have been improvements, but the parameters are still limited, and
20/20 comfortable vision is still an elusive target for many. I have
worked with large GP lenses over the years. During the past year I
have been doing intensive research in fitting methods and design,
primarily for therapeutic applications, i.e. situations that one would
consider medically necessary. One important outcome of this is that
the lenses have become easier to fit, and very complicated designs are
now possible, including torics and multifocals. The result is that I
am fitting more non-therapeutic patients, and the scleral-type lenses
are proving to be reliable problem solvers for high astigmatism and
other situations.

There are a few drawbacks, including cost and limited availability,
but once I point out the positives, the patients are more receptive to
trying them. The positives are: better vision, comfort, and lower
annual replacement costs than disposable lenses. I have had some
patients go as long as 3 or 4 years between replacements, and 2 years
is probably the norm. Most of the upfront costs go to the initial
design and fitting, and replacement costs are quite reasonable, i.e.
about the same as a set of custom toric soft lenses. The vision is
nothing short of stunning, with many patients stating that they have
never seen so clearly, and most report no lens awareness at all.
Because the oxygen permeable polymer contains no water, it doesn't dry
out, and a few blinks are enough to wet the surface without having to
rehydrate the entire lens mass. One of my patients is a family friend
with 5 diopters of against-the-rule astigmatism. Contact lenses had
never worked for him for optical reasons and dry eye. He developed a
corneal condition (corneal surface irregularities following cataract
surgery) that warranted a therapeutic lens, and so I put him into
small bitoric scleral lenses. His quote: "I have never seen this
clearly, and I often forget that I have them in when I go to bed." He
is more than 70 years/old.

While there is a significant learning curve to fitting these lenses, I
know that there has been a dramatic interest in them from practioners
around the world. I also believe that this type of lens will prove to
be a great platform for advanced optical design, such as wavefront
optics.

 

Moved to the Rockies, so I'm skiing some beautiful CO places.

Big Bear's just over a mile high, IIRC, so I'm not sure how much the
altitude is affecting central corneal thickness, but ... look at this:

http://www.ncbi.nlm.nih.gov/pubmed/17413958

Where I'm going, I'm at 11-12,000', at the top. After the ski day,
despite my scleral lenses (fluid-filled RGP), I'm noticing pretty
significant signs of edema -- pain, ghosting and haloes, primarily.

I can frequently drive TO the mountain, but cannot drive FROM it.

I also notice pretty significant increased pain after removing the
sclerals.

 

Nice. I've never gone anywhere except SoCal. I'm kind of afraid that if I go
somewhere else I'll be spoiled...

Then this is more likely to bother farsighted people than nearsighted people,
right. God really has it in for us.

No pain, just rotten vision :-( Next time I go (Tuesday, probably) I'm going to
bite the bullet, wear glasses and hope that I don't fall on my face or fall
anywhere I can lose them. I'll wear my old ones just in case.

It must have been the early morning cold then -- coldest day of the year so far,
but it's always cold in the early morning in winter. I CAN drive without my
glasses, I just can't read any road signs :-(

I read some articles on scleral lenses, none of which made me think they'd be a
good option for me. There are no miracles.


--
Cheers, Bev
==========================================================
"It's no piece of cake, but it sure beats listening to Ted
Kennedy on the Senate floor."
- Jesse Helms describing heart surgery

 

Yeah, well a scleral lens is any lens that vaults the cornea and rests
on the sclera. The definition does not include the diameter, it
doesn't specify the material, and it doesn't specify the thickness,
nor any of the many shape parameters that are possible. I've seen
scleral lenses that look like shot glasses, and I've seen some that
look like large soft lenses. The devil is in the design and the
details. So, I bet bitoric scleral lenses could be a GREAT options
for you.

50% of my scleral fits are for non-surgical patients. I have fit them
on teenagers and adults for whom other options had not worked very
well. I've even done a multifocal scleral lens.

It's just a matter of time before their use becomes more widespread
and they outgrow the stigma of being thought of as lenses for people
with disfigured eyes.

 

What material are your sclerals made of?
There is now Boston XO2, which is hyper-DK and might help with the
edema.

 

Dr. Leukoma wrote:

What kind of prices are involved?

 

Well, that is a pertinent question. There is a big range. I believe
that the high end of the range is $8500. I know that some insurance
companies who are enlightened enough to cover therapeutic scleral
lenses for keratoconus, or irregular astigmatism, will often reimburse
up to $1400 or so. If you want to specifically know my fees, then go
to my website, which is www dot leukoma dot com and follow the link to
my email address. My fee is closer to the low end of the range.
Additional or replacement lenses are quite reasonable, and are
comparable to custom toric soft lenses.

Thanks for asking.