So, tell me all about contact lenses

In My Humble Opinion
1

I just got contact lenses today, for the first time in more than a decade! My regular glasses broke this morning, so I went to get replacement lenses, and walked out with a cute little pair of soft toric lenses. (I was able to pop the lenses onto my eyes and take them out again, no prob. Old habits, thankfully, die hard.)

I didn’t get all my questions answered in the 2 hours I was there. The optometrist was pretty busy with other customers, and the “introductory video” they had me watch had little to say… other than it’s extremely important to use only OPTI-FREE REPLENISH MPDS when I clean and store my lenses. (Use it often and liberally. A bottle and a half per cleaning should be satisfactory, according to the video.)

I have a follow-up appointment next week, and I figured that I could have some of my questions answered before then, or at least I could get some hints on what questions to ask when I go back.

One thing that struck me as odd is that there’s no weekly de-enzyming process. Back in the early '90s, I had to soak my lenses in a different solution once a week. Is that step now eliminated?

Am I stuck with the cleaner that the optometrist gave me, or are they all pretty much the same?

I’ve also noticed that the storage solution and the rinsing solution is now one and the same. Since it’s a bit more expensive than regular saline, I figured I could pick up a bottle of saline for the “often and liberal” rinsing step.

I was also surprised at how fast I got my first pair of contacts. Last time, I had to wait a week while they were ordered, but today they were stocked on a shelf in the optometrist’s office. I was thinking on getting packs of disposables, or something along those lines, on the theory that in case I lose a lens I have a backup handy. Is this logic sound? What should I ask about when shopping for a set of lenses?

My vision is no longer 20/whatever. According to the packagese these lenses came in, each eye gets 4 numbers: SPH, CYL, AX and BC. I’m not having much luck matching these up with online articles about contact perscriptions. Anyone have any pointers? (And is an SPH of 5.50 good or bad?)

If I wanted to order my contacts online, are these 4 numbers all I need?

Anyone have any tips on going back to contact lenses after 12 years?

2

You’re going to need a copy of your prescription, which you send by fax to the online contacts seller. I have only dealt with 1-800-Contacts, but I’m under the impression no reputable company will sell you contacts without proof of prescription.

3

Don’t construe this as medical advice, but I’ve been a contact lens wearer for years, worked for several years for the largest single retailer of contact lenses in the US, and am fairly knowledgeable.

There’s no longer an enzyme solution soak (whose purpose was to remove blurring and uncomfortable protein deposits). Today’s MP solutions take care of that if you follow the directions. The exception to this are RGP, or rigid gas permeable lenses, but since you wear soft contacts, you don’t need to worry about it. If you feel your lenses are getting icky despite your daily maintenance, enzyme solutions are still available.

Cleaners are all pretty much the same, and they’re all pretty much water with a tiny drop of salt and acid. That’s why they encourage you to use it liberally: as a former retailer, I can tell you that the mark-up on contact lens solution rivals, if not exceeds, that of fountain soft drinks and movie popcorn. It’s $6.99 for a 12 ounce bottle of water, for Pete’s sake. The production cost is so low that at my old job, we could basically have all we wanted for free. Having said that, don’t try making your own, especially out of tap water. MP solution may be almost all water, but it is sterile water. Cleaning contacts in unsterile water is a good way to get amoebas or other nasties in your eye.

Here’s how to read your contact lens prescription:

SPH (sphere): This is the power of the lens. If it’s positive, you’re farsighted. Negative, you’re nearsighted, which is far more common. Whether yours is +5.50 or -5.50, that’s a very average prescription. Lots of people better off than you, lots worse.

CYL (cylinder): This is how much toric adjustment your eye is receiving from the contact lens. Higher values mean your astigmatism is worse.

AX (axis): This is where, on the eye, your toric correction is located. Picture a clock face numbered from 0 to 180.

BC (base curve): This is the curvature of the lens. Most lenses come in several different base curves. This affects the comfort of wear, not the correction.

Hope all this helps! Sorry if I missed any questions.

4

If you don’t have a paper copy of your prescription, but know the name of the doctor or office where you you were examined (e.g. the Target Optical on Main Street in Duluth), the mail order retailers will be happy to request a copy of the prescription directly from the doctor for you.

5

Your doctor is required by law to provide you with a copy of your prescription, once it is valid. For most people, it’s not valid until you’ve had your final checkup. For instance, if you tried to order lenses online right now, the retailer would contact your eye doctor for confirmation of the prescription. Since you haven’t yet had your “one week check”, you don’t technically have a valid Rx just yet. The reason for that one week check is to make sure the fit and vision are good, and that wearing contact lenses is a safe and healthy option for you. Then, at the end of that appointment, you will have an Rx.

Sounds to me like your OD gave you a pair of disposable lenses. Very few doctors are prescribing anything other than disposable in most cases (the exception being RGP and “special fit” wearers). I’d conservatively estimate than fewer than 2% of our patients are wearing something other than disposables.

The brand you’re fit with is the brand prescribed. You don’t get to “shop” for contact lenses. You can’t just order something different. Sorta like you can’t ask the pharmacist for Xanax if your Rx says Prozac. Every manufacturer makes their lenses differently. An 8.7 made by Cooper may not fit the same way and 8.7 made by Ciba would. Contact lenses are a medical device and are regulated as such. However, your doctor is not allowed to hold your prescription hostage. I’m curious as to what brand your doctor sent you home wearing. I’m gonna guess…Acuvue Advance for Astigmatism? Or maybe PureVision Toric?

Optifree Replenish is a great solution. Yes, markup on solutions is high, but if you want to wear them, you pay it. I don’t recommend generic solutions only because you never know who made it, and brand-hopping can lead to sensitivity and allergy-like symptoms. Some generics are high in preservatives as well, which doesn’t really do your eyes any good. It’s absolutely OK to rinse with Saline. If you don’t like Opti-free, find a solution you do like, and stick with it. The best thing about Optifree is that it’s everywhere. Your local mini-mart probably carries it. Oh yeah, and just because it probably says “No Rub” doesn’t mean you can’t rub your lenses clean. You’ll get them cleaner and use less solution than doing the liberal rinsing before storage. Use a straight stroke to lower the risk of tearing your lenses.

Weekly enzyme treatments are pretty much eliminated because most lenses today are designed to be thrown away after 2 weeks of wear. Lenses have coatings which break down and make it unwise to wear for a long long time. When disposables were first introduced, there were lawsuits and stuff because a certain company was selling a “traditional” lens for something like $70 each and their “disposables” were $20/6-pack. Trouble was, the 6-packs contained exactly the same lenses as the vials that held the “traditional” lenses. So yes, today, there is a difference between lenses you wear for up to a year and lenses you throw away on a regular basis.

As far as your “numbers” go. Yes, 5.50 is pretty high. You don’t mention whether it’s +/-. But in any case, your SPH (sphere) is your distance vision (+ if you’re farsighted, - if you’re nearsighted). The CYL (cylinder) is the prescription for your astigmatism, and the Axis is the degree at which your lenses are “turned”. It will never be higher than 180, and the axis really has nothing to do with the strength of the lens, but with the position. BC is base curve, which is the “fit” of the lens. Higher number means a flatter lens, lower number means a steeper lens. This number is usually between 8.3 and 8.9 but can go higher or lower. I have keratoconus patients wearing a 7.2 BC in their hard lenses, but we don’t need to go there…

Wow, I’ve been in this business long enough to remember laughing at the “sillyness” of throwing away contact lenses every two weeks! And now, if I had my choice (and good vision with them), I’d be wearing the ones you throw away every day! Talk about healthy and perfect for the lazy (like me!) who don’t want to do lens care!

As far as tips for going back to lenses after a “hiatus”, just take it slow. Give your eyes a chance to get used to the idea again. And for heaven’s sake, give your eyes a break from the contacts now and again. It should go without saying that any unusual symptoms need to be reported right away. Today’s silicone hydrogel contact lenses are fabulous, unless, like me, you’re allergic to them.

I’ll check in on this thread as long as it stays around, in case you have any specific questions.

6

Some of us do wear soft lenses which are meant for long term. I’m not certain of my 'script, but I’m fairly sure i’m worse than -8 in both eyes. I had to get a special pair of soft toric lenses which cost $45 each. Not throwaway lenses. :slight_smile:

I’ve been wearing them off and on for a few months. Yes, the Optifree solution is grand; no, there is no need to “clean” like we used to do with our hard lenses.

The clarity is not the same with the soft lenses. My hard lenses were just as good as my glasses, if not better, at that . This took a bit of adjusting to. If you are going to do any small detailed work, you might do like I do and wear glasses to do it.

7

You may want to look into Night & Day 30-day contact lenses. I wear them, and they’re perfect for me. As the name suggests, one wears them 24/7 for thirty days straight. Not only do they save time, they also really cut down on the amount of lens fluid I need to buy. One small bottle lasts for many months. At least for me, they’re extremely comfortable; I can’t feel them at all for the first 27 or so days (and after that, I can only feel them right after I wake up). I don’t know what prescription range they’re available for, but my eyes are about -3.75 . I highly recommend them.

8

I tried going back to contacts after 10+ years, by which time my doctor suggested I try monovision lenses – distance correction in one eye, reading correction in the other. I never adjusted to them (the monovision part, not the lenses themselves). I always had ended up closing the distance eye when reading the newspaper. Maybe I just didn’t wear them consistently enough. My theory is that, because I am extremely nearsighted and have pretty strong lenses, the difference between the distance and reading lenses made it harder for my brain to learn to “ignore” what it was getting from the lense that was not needed (i.e., the distance correction when reading). Maybe one of you contact lens dudes can confirm or refute that.

9

Another vote for the night/day 30 day lens. I got sick of having to take mine out each night and I really got sick of not being able to have a spontaneous nap without taking my lenses out first.

Not being able to shop around for different brands without your optometrist’s assistance is a good thing. I tried several different brands when I was looking into contacts (in fact I had about six months of free contacts as I was given different brands and sizes to try) and from two brands with identical specs, one was very uncomfortable, where as I frequently forgot the other brand was in my eye at all. In fact, when I changed to the 30 day lenses I initially put them in over the top of my other contacts. It took a couple of minutes to figure out why they were uncomfortable and blurry.

I find the 30 day contacts to be stiffer and not quite as comfortable as my old ones, but it is well worth the convenience.

The power of mine is -0.75. In the right lighting conditions, if I’m well hydrated, and alert, I can read the 6/6 line. With the lenses in I can see a line or two smaller than 6/6.

10

Really? When I asked my optometrist for night&day lenses for my prescription (I need lenses with a rather big cylinder), they didn’t exist. Reason being that lenses tend to stick to the eye after a night of sleep, and not usually with the axis of the cylinder along the prescribed angle. Don’t your lenses stick to your eyes for the first hour after waking up, or is that just something that is isn’t that uncomfortable for you?

Do any of the contact lens dudes care to comment on the development of these kind of lenses? Wouldn’t the sticking to the eye business be an even bigger problem for nightlenses (the kind you wear during the night and take out first thing in the morning)?

11

If Subway Prophet will forgive a slight hijack*, I’d like to ask if anyone knows about the bifocal contact lenses. My optometrist is planning to put me in these soon (he’s got me in RGPs to re-accustom my eyes to contacts first). I frankly can’t see how such a thing would work, but he claims they exist and that wearers swear by them. Are they weighted to ensure the “bifocal” correction area remains on the bottom? Or are the areas of differing correction just concentric rings in the lens? How does someone train their eyes to “see” through different areas of a contact lens? It seems impossible.

*hijacks are OK if you live in the same town, right? Especially if you’re both on the same side of town. :stuck_out_tongue:

12

I said I’d check in… I’ve been in optical for over 18 years and I’ve seen a lot of what’s happened in the contact lens industry. I currently work in an ophalmology practice, so now I sometimes get to see the really horrible things that happen when people abuse contact lenses.

30-day lenses. I’m NOT a fan. I know a lot of people here on the Dope wear them, but I wouldn’t. Our doctor rarely prescribes these, and even when he does, advises removing them more often and cleaning them. There is no such thing as clean water, and even showering with your contacts in your eyes puts you at risk for acanthamoeba keratitis. Will’s Eye in Philadelphia saw more cases of this in 2005 than in the previous 5 years combined. It is believed to be on the increase due to more people sleeping/showering/swimming while wearing contact lenses. Acanthamoeba keratitis is nearly unheard of in people who do not wear contact lenses. While it IS a fairly rare infection, my eyes are entirely too important to take that kind of risk (the disease disfigures and blinds). These lenses are not available in toric. I’ll mention here that we see far more infection and corneal damage on patients who sleep with their contacts in their eyes.

For people who do sleep while wearing contact lenses, rewetting drops become very important. I recommend drops before bed and then again right when you wake up. Most people who sleep with contacts don’t remove them upon waking. Unless you are doing CRT, corneal reshaping therapy, which involves inserting a rigid lens before bed, removing it in the morning, and enjoying clear vision all day, due to the lens forcing the cornea into a different shape overnight. RGPs are usually not difficult to remove from the eye, but a rewetting drop or two doesn’t hurt.

Monovision: Not for everyone. People who like it, love it. If you aren’t comfortable with it in the first day or two, chances are, you won’t get comfortable with it. I’m fairly certain I would NOT be a good candidate for this kind of correction. Biggest complaints are loss of “mid-range” and compromise in depth perception, neither of which I’d be OK experiencing.

Bifocal contacts: Some people love them, some hate them. Different brands are constructed differently. The “concentric rings” are pretty common. As you move your eyes down to read, the lens will sort of adjust itself so that you’re looking through the right spot. Again, not for everyone. I’m really a difficult patient and I’d probably hate these too. Chances are, if I wanted to wear contacts again (I run the department, but I really don’t like to wear them), I’d correct for distance only, and wear a pair of OTC readers when doing close-up or detailed work.

Years ago, I wore contacts as my primary correction. Today, it’s fairly unusual for me to wear them. I will wear them to the beach, the water park or the pool (daily disposables, which only correct me to about 20/30). The reason I don’t wear them is that I have very dry eyes, to the point of distraction sometimes, and it’s very hard to get a lens that is comfortable. I am allergic to the silicon hydrogel lenses, so I can’t wear them (which I would do if I could, as they have a very high water content). It also doesn’t help to learn too much, because the more you know, the more difficult you are as a patient. I’m looking for a flawless contact lens experience, which simply is not possible for me just yet.

I hope I didn’t miss anyone’s concerns…

WishIHadaCoolName, your friendly female contact lens dude

13

I was walking across a bridge one day, and I saw a man standing on the edge about to jump. I yelled “Don’t jump! There’s so much to live for!”

He said “No there isn’t. Life is pointless.”

I said “We have so much common ground! Do you wear contacts or glasses?”

[…much snippage…]

I said “Do you wear Bausch & Lomb SofLens 66 Toric, or Bausch & Lomb SofLens 66 Bifocal Toric?”

He said “Bausch & Lomb SofLens 66 Bifocal Toric.”

I said “Do you wear Bausch & Lomb SofLens 66 Bifocal Toric from the Wal-Mart on Rufe Snow, or Bausch & Lomb SofLens 66 Bifocal Toric from the Wal-Mart on Saginaw Main?”

He said “Bausch & Lomb SofLens 66 Bifocal Toric from the Wal-Mart on Saginaw Main.”

I said “Die, heathen scum!” and pushed him off the bridge.

(Apologies to Emo Phillips.)

14

Arg. I missed a “Me too!” or two in that Emo Phillips bit, which will probably confuse folks who haven’t heard the original. Anyway.

This pair I’m wearing now are Bausch & Lomb SofLens 66 Toric. It doesn’t say on the packaging whether they’re disposables, but I got them in the same visit as the checkup, which surprised me. I don’t know if that’s relevant.

So I should probably push for disposables, then? If I don’t get disposables, should I make sure I get a weekly enzyme wash?

My eyes are -5.50 (left) and -5.00 (right). I was curious as to what 20/whatever that came out to, but the optomotrist said we don’t do that anymore.

About the axis: I figured an axis of 180 should be functionally equal to 0. But my left eye has an axis of 180 - does this mean that axis-0 lenses are marked as axis-180 to distinguish them as astigmatism-correcting lenses?

15

So that was you on the Lake Worth bridge, eh? :wink:

16

Oops! :slight_smile:

17

It’s the cylinder that makes them toric. And yes, 180 is the same as 0. But they never use 0 as an axis marker. Because once you hit 180, you’re just going back around. Briefly put, cylinder power has to be at the right degree to send light rays onto your retina at the right angle. In eyeglass lenses, if the powers are **really ** high, you can actually distinguish the cylindrical shape cut into the lens.

And, FTR, I don’t mind being called the contact lens dude. In our office, I’m known as the contact lens nazi, so I’ll take “dude”.

18

I get contacts online at http://VisionDirect.com
Acuvue are by far the thinest and easiest to wear. Light weight and you can leave them in for a week.

Don’t worry about what numbers they need, as you will be faxing or emailing a scan of your prescription and they can call the eye doctor for whatever they need.

19

Out of curiosity (this thread has prompted me to look at my contact lens box for the first time), is it common for there to be a big* difference between the “axis” of someone’s eyes?

For reference, there’s a big difference in the correction to my eyes - one’s -5.5, the other -8.5.

*I think. One’s 180, one’s 10. That’s either really big or really small.

20

Not too uncommon, but that actually isn’t the case with you (see below).

Neither. It’s really close to the top, and very close to each other. 180 and 10 are basically like 12 and 1 on a clock face. :slight_smile: