My next choice: Oasys? Or an aspheric lens?

Discussion in 'Optometry Archives' started by TomMonger, Feb 1, 2006.

  1. TomMonger

    TomMonger Guest

    I just found out that Oasys is now available in plus powers. My
    optometrist said that when he gets his trial lenses in, he will call me
    and I can then stop in and try on a pair (+.50 OS and -.75 OD). I am
    currently in Acuvue 2, which are the most comfortable lens I've ever
    worm, but they sometimge dry out and stick to my corneas by day's end.
    I have tried Acuvue Advance for a week, but they sting too much and
    give me poor vision. I always have to remove them after about 2 hours
    due to excessive discomfort (which feels like someone is chopping
    onions too close to my eyes!).

    After reading up from the experts here, I am VERY interested in
    aspheric lenses, but only if they will help with my mild presbyopia.

    I want to ask the EXPERTS here what they would recommend I try next:

    - Aspheric distance-only lenses (perhaps I won't require closeup
    power)? My current distance prescription is -.50 OS and -.75 OD.

    - Monovision (+.50 / -.75) in an aspheric lens to make things
    "crisper"? If so, which brand?

    - Something else???

    Thanks!
    -Tom in Scranton, PA
     
    TomMonger, Feb 1, 2006
    #1
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  2. TomMonger

    Dick Adams Guest

    Zenni eyeglasses to your prescription. Start with a $19 pair. Save your
    eyes, save your money.

    If you favor a weird solution, try it first on your nose.
     
    Dick Adams, Feb 1, 2006
    #2
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  3. TomMonger

    drfrank21 Guest

    He's talking about CONTACT LENSES sport.

    frank

     
    drfrank21, Feb 1, 2006
    #3
  4. TomMonger

    drfrank21 Guest

    A couple of thoughts:
    I would try the monovision first - I am partial to the Night and Day
    and 02 optix (Ciba)
    contact lenses but there are many very good cl's out there( cooper
    proclears etc). Many people are disappointed in the progressive
    multifocal scl's in your range of prescription. Aspherics (sph's) would
    not likely help much unless in near vision at this point unless
    your near demand is forgiving. But don't count on it to boost the near
    vision.

    frank
     
    drfrank21, Feb 1, 2006
    #4
  5. TomMonger

    p.clarkii Guest

    i agree with drfrank. i wouldn't hold my hopes up that aspheric lenses
    are going to give you good near and distance vision. they do give you
    a SLIGHT boost at near but not enough to satisfy most presbyopes.
     
    p.clarkii, Feb 1, 2006
    #5
  6. TomMonger

    otisbrown Guest

    Dear Dicky,

    I agree with you, but Tom is on a roll, and
    wants that "sharpness" of that minus lens.

    Who are you and I to argue with that?

    (I loved that extreme sharpness as a kid also -- but
    I learned, oh how I learned.)

    But Tom should have what he wants -- and support
    from the "experts" and not us.

    Best,

    Otis
     
    otisbrown, Feb 1, 2006
    #6
  7. TomMonger

    Dan Abel Guest


    I'm wondering if he knows that? Maybe that's what his remark means?

    I tried monovision with glasses. My OD told me it wouldn't work. I
    explained to him why it didn't matter. He said it was worth a try.
     
    Dan Abel, Feb 1, 2006
    #7
  8. TomMonger

    drfrank21 Guest

    So ya think that a monovision cl correction with the distance eye of
    -75 in an
    early presbyope will lead to a destructive "stair-step" myopic
    posture?? And
    the sad (scary) thing is that you're not joking.

    frank
     
    drfrank21, Feb 1, 2006
    #8
  9. TomMonger

    LarryDoc Guest

    I beg to differ with you, doc. I've quite a few patients in silicone
    hydrogel aspherics getting .75 to 1.00 add and some for whom it doesn't
    do a darn thing. Depends, I think, upon residual astig, how evenly the
    lens vaults the central cornea and pupil size.

    I also have a fair number of folks who absolutely love their apsheric
    multifocals. I just dispensed today two pts with toric multis with
    excellent distance and midrange acuity (as good or bette than specs!)
    and very good (perhaps not excellent!) near point vision. Up to 1.50
    add works great, beyond that it gets iffy but is often ok.

    Just tried a soft toric multi on me. As my patients, awesome distance
    and mid range vision and quite acceptable near. (I may simply over-plus
    the near eye .25 or so for *perfect* near.) I still, however, prefer my
    RGPs and am waiting for the sil-hydro multi's.

    LB, O.D.
     
    LarryDoc, Feb 2, 2006
    #9
  10. TomMonger

    TomMonger Guest

    Thank you, all, for the very prompt and informative responses! I now
    have some great information to discuss with my OD on my next visit.

    Since monovision seems to work really well for me, I'm probably going
    to try Oasys lenses and hope I don't have the same negative reaction as
    I did with Advance. If that doesn't work, I will give N&D or O2 Optix.
    Perhaps I will take Dick's advice and get a pair of Zennis to wear OVER
    my monovision lenses for any night driving (which is uncomfortable for
    me in monovision).

    I wanted to mention that I DO wear progressive bifocals. They're OK for
    most of my vision needs, but when I am in front of a computer, I can
    actually see BETTER with them off (no correction). I was told I may
    need to have my next pair adjusted so the add portion begins earlier?

    I also wanted to mention that I *did* try RGPs two years ago. My
    previous OD tried a pair on me, but I couldn't keep them in my eyes
    more than a few moments. Then she tried a second pair, and I
    encountered the same problem. It felt like something was cutting into
    my eyes and I couldn't keep my eyes open more than a split second at a
    time. I tried for days to try and adapt, but it was impossible.


    Thanks again :)
    -Tom in Scranton, PA
     
    TomMonger, Feb 2, 2006
    #10
  11. TomMonger

    drfrank21 Guest

    Larry, it's interesting the different experiences providers have with
    contact
    lenses. I've haven't had much luck counting on any meaningful plus on
    early presbyopes with the spherical hydrogel silicone aspherics. I will
    try undercutting the minus (or add more plus) by +.25 on the
    non-dominant
    eye which helps but that's getting closer to more a monovision fit.

    And it seems that those patients with a low distance correction (+/- 75
    )
    with fairly decent unaided visual acuities don't fare well with the
    multiple-
    packaged soft multifocals. Invariably they state their distance vision
    is
    worse off compared to unaided. The success rate seems much higher
    with those who have a higher distance correction.

    I recently tried the ciba toric multifocal on a patient with limited
    success; I
    refit him to a gas perm multifocal and it was a night and day
    difference. He
    stated that the gas perms were much clearer even though the va's of
    both
    the soft and rgps were the same.

    frank
     
    drfrank21, Feb 2, 2006
    #11
  12. TomMonger

    Dr. Leukoma Guest

    If the problem is dryness, what do you think would be accomplished by
    using different optics? The underlying problem is your tear film, in
    which case you treat the tear film. In lieu of treating the tear film,
    you can try various polymers that resist on-eye dehydration, or whose
    optics are less affected by dehydration. The ideal lens for that would
    be low water, i.e. 38% or less. This includes most of the silicone
    hydrogels, except Acuvue Advance. The one exception is the Proclear
    Compatible, whose polymeric structure causes the surface of the lens to
    stay hydrated. Personally, of all the silicone-hydrogels, I have found
    the Acuvue Oasys to be the most comfortable on my own eyes. But, some
    don't do well with any silicone-hydrogel because of an altered tear
    lipid profile.

    I have seen patients endorse various kinds of lenses on the internet,
    including the aspheric Definition AC. In reality, this is a
    methafilcon material with a mid-water content similar to the AV2,
    Biomedics 55, and many, many others, with the exception that it is
    thicker. The thicker lens contributes to the ability of the lens to
    mask low amounts of astigmatism as well as less on-eye dryness, but at
    the expense of oxygen permeability. The aspheric design helps to
    reduce the inducement of additional spherical aberration.

    DrG
     
    Dr. Leukoma, Feb 2, 2006
    #12
  13. TomMonger

    TomMonger Guest

    Dr Leukoma,

    Dry eyes was the reason I'd like to try Oasys.

    My interest in aspheric lenses was in hopes it might help with
    presbyopia, so I wouldn't have to do monovision. I *should* have made
    it clear that I was interested in SILICONE aspherics, not just any
    aspheric (because of the occasional dry eye issue).

    My OD also agrees that multifocals would not benefit me. He literally
    said, "The suck for very mild myopics." I know people who wear them and
    they all say that they're OK, but not all that great. I have no
    interest in them at this point.

    Thanks...
    -Tom
     
    TomMonger, Feb 2, 2006
    #13
  14. TomMonger

    LarryDoc Guest

    Do take into account that refits from low DK lenses (and pts who wear
    lenses past their useful like expectancy!) tend to accept more plus as
    the cornea adapts to the increased oxygen. That increase is quite
    variable and is often .25 and as much as .62 over a period of two or
    three weeks post new fitting.

    I am not at all a fan of monovision (except those lucky few who are
    naturally mono and/or with little or no stereoscopic vision). But over-
    plussing the non-dom eye by .25 is a very reasonably thing to do if the
    near vision is substantially improved,
    Indeed. The cheap-o multipacks are often not nearly as good as the
    longer term lenses. But sometimes they are!
    Torics are certainly a challenge! Chair time, chair time, chair
    time.............


    LB, O.D.
     
    LarryDoc, Feb 2, 2006
    #14
  15. TomMonger

    Dr. Leukoma Guest

    Tom, there are more soft bifocal choices now. Some of my patients do
    quite well with them, others not. I find it impossible to predict
    without doing a trial fitting. I've had the greatest success lately
    with the Proclear Multifocal. For those who can tolerate them, RGP's
    probably result in crisper vision. There are a number of tricks, such
    as using a single vision lens on one eye and a bifocal on the other,
    etc.

    DrG
     
    Dr. Leukoma, Feb 2, 2006
    #15
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