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Medical Forum / General / Vision / February 2006My next choice: Oasys? Or an aspheric lens?
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 > I want to ask the EXPERTS here what they would recommend I try next: > [quoted text clipped - 5 lines] > > - Something else??? 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. -- Dicky No MD, no OD, not stupid. He's talking about CONTACT LENSES sport. frank > > I want to ask the EXPERTS here what they would recommend I try next: > > [quoted text clipped - 14 lines] > Dicky > No MD, no OD, not stupid. > He's talking about CONTACT LENSES sport. I'm wondering if he knows that? Maybe that's what his remark means? > > 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. 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.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA 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 > Dear Dicky, > [quoted text clipped - 12 lines] > > Otis 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 > 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??? 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 > A couple of thoughts: > I would try the monovision first - I am partial to the Night and Day [quoted text clipped - 7 lines] > > frank 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. 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 > 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 [quoted text clipped - 13 lines] > > LB, O.D. 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 > 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. 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, > 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. Indeed. The cheap-o multipacks are often not nearly as good as the longer term lenses. But sometimes they are! > 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. Torics are certainly a challenge! Chair time, chair time, chair time............. LB, O.D. 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. > 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 [quoted text clipped - 21 lines] > Thanks! > -Tom in Scranton, PA 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 > If the problem is dryness, what do you think would be accomplished by > using different optics? 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 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 |
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