what is BEST for vision correction: glasses vs contacts

Discussion in 'Glasses' started by max, Sep 24, 2003.

  1. max

    max Guest

    my age: 45

    my rx:
    OD -7.00-0.75x15
    OS -6.50-1.50x175

    my situation:
    right eye: Amblyopia. vision is about 20/50 "corrected". eye is pretty much useless
    left eye: about 20/20 to 20/25 "corrected"

    it is very very frustrating to not be able to see clearly.
    it has been like this as long as i can remember.

    what is my best option ?
    - stick with glasses
    - RGP contacts
    - toric contacts
    - some combo

    i swear i remember seeing better 20+ year ago in college
    when i tried soft lenses ( i have no idea what my rx was back then)


    thanks so much in advance
    max
     
    max, Sep 24, 2003
    #1
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  2. max

    Dr. Leukoma Guest

    Forget the toric soft lenses.

    Spectacles vs. RGP lenses would be comparable. However, RGP's - as with
    any contact lens - would result in a larger image size than spectacles.
    Also, should there be any irregularity on the corneal surface, the RGP lens
    would correct that as well.

    The negatives of RGP lenses, which are fairly well known, are sensation of
    a foreign object during the adaptation period, discomfort from foreign
    matter under the lens, occasional surface dryness degrading the image
    quality if there is a problem with the tear film. Also, given your age,
    the need for reading glasses will soon become apparent, even more so with
    contact lenses.

    I don't see that a contact lens will restore vision to the amblyopic eye,
    unless the amblyopia is due to a corneal surface defect. If you have an
    itch, you should scratch it and arrange for a trial fit for lenses.

    DrG


    (max) wrote in
     
    Dr. Leukoma, Sep 24, 2003
    #2
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  3. max

    RM Guest

    There are various opinions on this topic I'm sure.

    Spectacles give clear vision but tend to have abberations at higher powers
    (distortions when viewing out of the periphery of the lenses, etc.).
    Spectacles can include a bifocal add which you likely need now and will
    become more and more dependent on to see at near with as time goes by.
    Also, and very importantly, spectacles can protect your left eye from
    possible injury. Since you have only one high acuity eye, it is a very good
    idea to keep a spectacle lens in front of it to be sure it doesn't get
    injured.

    Contacts could work fine also but they do have a slightly higher risk of
    causing infections, etc. that need to be avoided in your good left eye (to
    protect you high acuity in that single eye). You could wear contacts safely
    but you need to follow your doctors advise and perhaps he will want to
    monitor you more closely. RGP's or soft toric lenses are fine. You would
    be most likely successfully fit in a soft toric disposable lens and it would
    probably be safest if you choose to go with this option. You will probably
    still need reading specs over your contacts to see at near so you won't be
    getting away from glasses entirely.

    If you were my patient, I would offer you both options but I would lean
    toward keeping you in glasses.

    OD, Ph.D.
     
    RM, Sep 24, 2003
    #3
  4. max

    Dr. Leukoma Guest

    I was also taught to be conservative with respect to prescribing for
    amblyopes. At that time, the most advanced contact lenses were Boston,
    Polycon, and Permalenses. The risk of infectious keratitis in a person
    wearing a daily wear contact lens is 1/5000 or less per year (even less
    with an RGP lens), and the chances of that person losing vision is about
    1/60000. Soft torics might be "fine," but I wouldn't bet money on them
    providing vision as good as RGP lenses or spectacles. But, thankfully he's
    not betting with my money.

    DrG, O.D.
     
    Dr. Leukoma, Sep 25, 2003
    #4
  5. max

    RM Guest

    Good statistics. I had a similar "feel" but its nice to see the numbers.

    I agree with you on the issue of prescribing for amblyopes. I tend to let
    the patient make an educated decision on whether or not to wear contacts. I
    sleep pretty comfortably knowing my amblyopic patients are wearing soft
    lenses and RGPs but I make clear that they need to be compliant with
    cleaning, disposal times, avoiding extended wear, timely follow-ups, etc.

    With regard to soft torics I personally have had very good success with
    disposables like SofLens 66, Encore, Acuvue etc. I find these to be much
    more acceptable to patients than the discomfort/adaptation problems
    associated with RGPs. Just my personal experience.

    -------
     
    RM, Sep 25, 2003
    #5
  6. max

    Dr. Leukoma Guest

    I agree with you that soft toric lenses now perform better and circumvent
    the adaptation problems of RGP. However, I believe that the poster seemed
    not to be happy with the visual acuity resulting from his habitual
    prescription and is seeking an improvement. In terms of BVA, where would
    you rank soft torics with spectacles and RGP lenses in the presence of
    slight to moderate with-the-rule astigmatism? I would answer that
    spectacles and RGP lenses would vie for first place, with soft torics a
    distant third.

    DrG
     
    Dr. Leukoma, Sep 25, 2003
    #6
  7. max

    RM Guest

    Based upon my training and my own personal experience wearing contacts I
    would also agree that glasses & RGPs give superior visual acuity compared to
    soft torics. However, on a practical level, I am constantly surprised that
    many of my soft toric wearers describe their acuity as better or equal in
    contacts than through glasses.

    I know for certain that my success rate of getting a satisfactory fit with a
    soft toric lens (with cyl less than 2.50D) is much better than trying to fit
    a 1st time RGP wearer simply because of the comfort/adaption issue
    associated with gas perms. But maybe I'm not a good RGP fitter ;)

    RM
     
    RM, Sep 26, 2003
    #7
  8. max

    Dr. Leukoma Guest


    Then I think we agree. Perhaps I am not such a good toric lens fitter as
    evidenced by the thousands of different disposable trial lenses taking up
    space in my clinic such as the B&L Soflens 66, Encore, Proclear
    Compatibles, Biomedics, Focus Toric, Acuvue.....I just can't seem to find
    one that works as good as I would like. 8^)

    DrG
     
    Dr. Leukoma, Sep 26, 2003
    #8
  9. max

    drfrank21 Guest

    I'd probably just go spherical soft on the right eye since it's amblyopic
    and critical vision will not be attained with any modality (ie glasses
    or rgp's) and a soft toric on the left. There might be a slight visual
    clarity advantage with the rgp but outweighed by the comfort issue.

    With any amblyope, I tend to keep a closer eye on those with contact
    lenses and have many times refused to fit an amblyope that insisted on
    extended wear usage or be a poor complier.

    frank
     
    drfrank21, Sep 26, 2003
    #9
  10. max

    max Guest

    i just want to thank everyone for their response to my original posting.
    i'm still mulling over what to do, but you've given me a lot to think about.

    max
     
    max, Oct 4, 2003
    #10
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