Can a person get MORE nearsighted suddenly?

Discussion in 'Optometry Archives' started by The Real Bev, Jan 6, 2009.

  1. The Real Bev

    The Real Bev Guest

    (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?
    The Real Bev, Jan 6, 2009
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  2. The Real Bev

    The Real Bev Guest

    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.
    "People are too stupid to realize they are."
    --JoHn DoH KeLm
    The Real Bev, Jan 7, 2009
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  3. The Real Bev

    Dr. Leukoma Guest

    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.
    Dr. Leukoma, Jan 7, 2009
  4. The Real Bev

    Neil Brooks Guest

    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!!!
    Neil Brooks, Jan 7, 2009
  5. The Real Bev

    The Real Bev Guest

    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.

    "People are too stupid to realize they are."
    --JoHn DoH KeLm
    The Real Bev, Jan 7, 2009
  6. The Real Bev

    The Real Bev Guest

    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?

    "People are too stupid to realize they are."
    --JoHn DoH KeLm
    The Real Bev, Jan 7, 2009
  7. The Real Bev

    The Real Bev Guest

    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.
    The Real Bev, Jan 7, 2009
  8. The Real Bev

    Dan Abel Guest

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

    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.

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

    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.
    Dan Abel, Jan 8, 2009
  9. The Real Bev

    The Real Bev Guest

    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
    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.
    The Real Bev, Jan 8, 2009
  10. The Real Bev

    Dr. Leukoma Guest

    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.
    Dr. Leukoma, Jan 8, 2009
  11. The Real Bev

    Dr. Leukoma Guest

    Actually, one other cause did suggest itself: corneal steepening via
    mechanical means, as in a tight lens.
    Dr. Leukoma, Jan 8, 2009
  12. The Real Bev

    The Real Bev Guest

    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.

    = = = = = = = = = = = = = = = = = = = = = = = = = =
    'Politics' comes from an ancient Greek word meaning
    'many blood-sucking leeches.' -- Mark Russell
    The Real Bev, Jan 8, 2009
  13. The Real Bev

    The Real Bev Guest

    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?
    The Real Bev, Jan 8, 2009
  14. The Real Bev

    Dr. Leukoma Guest

    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
    Dr. Leukoma, Jan 10, 2009
  15. The Real Bev

    Neil Brooks Guest

    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:

    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
    Neil Brooks, Jan 11, 2009
  16. The Real Bev

    The Real Bev Guest

    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
    The Real Bev, Jan 11, 2009
  17. The Real Bev

    Dr. Leukoma Guest

    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.
    Dr. Leukoma, Jan 11, 2009
  18. The Real Bev

    Dr. Leukoma Guest

    What material are your sclerals made of?
    There is now Boston XO2, which is hyper-DK and might help with the
    Dr. Leukoma, Jan 11, 2009
  19. The Real Bev

    The Real Bev Guest

    Dr. Leukoma wrote:

    What kind of prices are involved?
    The Real Bev, Jan 11, 2009
  20. The Real Bev

    Dr. Leukoma Guest

    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.
    Dr. Leukoma, Jan 12, 2009
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