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Medical Forum / General / Vision / June 2006progressive contacts
Can someone tell me what progressive contact lenses are like? What sort of vision can you get from them? Is it the same as glasses with blur each side or are they pretty clear all across? Also can they also be for astigmatism or is that asking too much? Ann >Can someone tell me what progressive contact lenses are like? I can tell you what it's NOT like. It doesn't give you the type of vision you had before you were presbyopic. >What sort of vision can you get from them? In nearly every case, I am able to give someone "functional" vision. Functional vision means that if somehow these contact lenses were permanently glued to your eyes so you couldn't remove them, you would be able to function. You would be able to see well enough to pass the driving test, and you would be able to read magazine type print in good light. You wouldn't need a white cane or a dog, and (with time) you would adapt and be able to perform most jobs. The way I explain the sort of vision a patient would get is that it reduces a patient's distance vision by 20% to give them an 80% improvement up close. IOW, if you see great far away, but extremely blurred up close without glasses, you will see not quite as clear far away with the contacts, but you will see much better up close. Although this vision is functional, many (if not most) patients are unhappy because they would rather have crystal clear vision with glasses versus functional vision with contacts. Multifocal contact lenses, like glasses, are a compromise and not a cure or a treatment that makes you see like you did when you had a ton of accommodation. >Is it the same as glasses with blur each side or are they pretty clear >all across? They are typically no less clear to the side than they are when one looks straight. >Also can they also be for astigmatism or is that asking too much? They exist for that too, but they are more costly and there are less different brands/types to choose from. > The way I explain the sort of vision a patient would get is that it > reduces a patient's distance vision by 20% to give them an 80% > improvement up close. I am using the B&L Softlens Multifocals and have pretty good distance vision, 20/20 in my right eye and slightly less in my left eye. I am happy with the combined distant vision which is very clear. I would say I have 95% or more distance. Up close I can read everything, books, newspapers, computer screen, etc. without readers. So I call that 100%. My vision is much better with these multifocal contacts than with bi-focal or progressive glasses, or regular glasses for distance and readers for reading. Obviously everyones result won't be the same, some won't get a good result. It took three or four sets of trail and error to find the right prescription, but as they say, if I had not tried fitting them and gone beyond the first set I would not have had the good result from these lenes.  SignatureCharles >> The way I explain the sort of vision a patient would get is that it >> reduces a patient's distance vision by 20% to give them an 80% [quoted text clipped - 5 lines] >I have 95% or more distance. Up close I can read everything, books, >newspapers, computer screen, etc. without readers. So I call that 100%. Clarity is a very subjective thing. Either you aren't super critical about your vision and are very content with functional vision, or you just had a much better than average response to the contact lenses. Either way, you are a happy patient which is very important. >My vision is much better with these multifocal contacts than with >bi-focal or progressive glasses, or regular glasses for distance and [quoted text clipped - 3 lines] >fitting them and gone beyond the first set I would not have had the >good result from these lenes. That is a good point. Patients need to be prepared up front (as far as time and cost) that it might take several trial pairs to get the best combination that works best for them. > Either you aren't super critical about your vision and are very > content with functional vision, or you just had a much better than > average response to the contact lenses. I am super critical about my vision. My sister is wearing the same lenses and so is my second cousins wife. They are happy with the lenses too. But that is a small sample. Those of you who are in the vision practice no doubt have experience with the average response. I don't. It does seem these lenses are more difficult to fit that the average Optometrist might not be as up on it as they are with standard lenses. SignatureCharles > > Either you aren't super critical about your vision and are very > > content with functional vision, or you just had a much better than [quoted text clipped - 6 lines] > It does seem these lenses are more difficult to fit that the average > Optometrist might not be as up on it as they are with standard lenses. And the "new and improved" version, Purevision Multifocal is simply awesome. It is essentially the same design as the old Soflens Multiifocal in the Purevision silicone material. In the few months that they've been available, my user group, now numbering a couple of dozen (including myself), are 100% "functionally satisfied" with the majority achieving 20/20 or better distance vision and perfect near and intermediate acuity. It is indeed true that some people will not achieve the same "crystal clear" distance vision as with single vision lenses, but the gap is clearly (pun intended) narrowing. Significant stigmatism can be a deal breaker for some. Multifocal, astigmatism correcting soft lenses are manufactured by only a few companies. I have had mixed success with those. The vast majority of patients are functionally very happy with them and some do indeed achieve a good 20/20 acuity. Not all. They are more difficult to fit and more costly. Many practitioners are still unaware of the PV Multifocal as the company has only in the last few weeks begun actively marketing them. B&L is not the only company manufacturing excellent soft lens multifocals but thusfar the only one in silicone hydrogel offering extended wear capabilities. Additionally, there are RGP multifocals that for some people can offer outstanding optics. As to functionality, Dr. Anon, as far as I'm concerned, soft and RGP multifocals are a considerable step up from spectacle progressive additional lenses. My vision may not be exactly as it was 20 years ago, but it's pretty damn close, 24/7. If more people were aware of multifocal lenses and more practitioners actively fit them, I think you see a booming boomer contact lens market. LB, O.D. >> > Either you aren't super critical about your vision and are very >> > content with functional vision, or you just had a much better than [quoted text clipped - 39 lines] >multifocal lenses and more practitioners actively fit them, I think you >see a booming boomer contact lens market. Sounds promising from what most have said. I only have one eye which is where my problems begin. I can't use progressive glasses, they were hopeless, just not enough area of useful vision, and I can't carry on with two pairs of glasses. It just doesn't work. I've taken to wearing the reading glasses all the time and putting up with blur in the distance but that is now becoming a problem. I need to do something. I will phone round on Monday and find someone who can help. I have a daft problem in that I don't mind it taking time to find something that works but I always feel like I'm a bother if I have to go back and say they don't work or are uncomfortable. I gave up contacts years ago because I didn't want to keep going back. I just feel like I'm being a trouble. I suppose I shall just have to get over that :-) Ann > I have a daft problem in that I don't mind it taking time to find > something that works but I always feel like I'm a bother if I have to > go back and say they don't work or are uncomfortable. I gave up > contacts years ago because I didn't want to keep going back. I just > feel like I'm being a trouble. I suppose I shall just have to get > over that :-) Remember, they're being paid to make you happy; it's not a charity. Going back over and ofer again is a nuisance for you, but it's not a reason to feel guilty. I tried 8 pair of RGPs before giving up, and at least half a dozen pair of soft lenses -- and even then, only half of the six-packs that I ordered work correctly. I have had similar difficulties with three different practitioners, leading me to think that perhaps I was intended for a planet where everyone lives underground like moles and has no need of eyes. SignatureCheers, Bev =================================================== Red ship crashes into blue ship - sailors marooned. > And the "new and improved" version, Purevision Multifocal is simply > awesome. It is essentially the same design as the old Soflens [quoted text clipped - 3 lines] > achieving 20/20 or better distance vision and perfect near and > intermediate acuity. It is good to hear those are awesome. I am waiting to finish my last boxes of Softlens and then will have those fitted. Are you and your user group wearing the Purevision overnite? SignatureCharles >I am super critical about my vision. "Super critical" is subjective. I could just as easily say you are not "super critical" because you tolerate the fact that your left eye's vision is not as good as your right eye's in the distance when wearing your contacts. I have quite a few patients that did not stick with contact lenses because while the vision in their glasses was 20/15, with their contacts it was 20/20+. And that 20/20+ was "blurry". But as I wrote, you are "20/happy" with your contacts and that is what counts. >> Can someone tell me what progressive contact lenses are >> like? [quoted text clipped - 30 lines] > that makes you see like you did when you had a ton of > accommodation. You should iterate the various solutions for presbyopes. The OP did say progressive and you seem to be refering to multifocals but I'm wearing translating trifocals and I'm thrilled. -Quick >You should iterate the various solutions for presbyopes. >The OP did say progressive and you seem to be refering >to multifocals but I'm wearing translating trifocals and I'm >thrilled. That would be very useful. I didn't know there were so many different options. Ann > Can someone tell me what progressive contact lenses are like? What > sort of vision can you get from them? Is it the same as glasses with [quoted text clipped - 3 lines] > > Ann Most multifocal soft lenses work on the principle of concentric optics. As such, the results are very pupil dependent. As well, early prebyopes who require the least amount of near correction seem to do the best. I fit lots of progressive contact lenses, and I would be very sceptical of promises of 100% success. The fact is that some patients will do better with monovision. To my knowledge, I believe that there is only one company making a toric multifocal contact lens for astigmatism. I wear contact lenses for distance, and progressive eyeglasses for reading because I hate compromised vision. DrG Triton bifocal soft contact lenses promise uncompromised distant and near vision as well as astigmatism correction. Has anyone had experience with these contacts? Approximate cost? > Triton bifocal soft contact lenses promise uncompromised distant and > near vision as well as astigmatism correction. Has anyone had > experience with these contacts? Approximate cost? *Snicker* Yes, I have a trial set. They are translating-type, i.e. the near correction is in the bottom half of the lens. The lens is prism ballast and is truncated. The design is similar to the translating RGP types of bifocal lenses. The cost is about the same as the RGP bifocal. They are NOT disposable. DrG > > Triton bifocal soft contact lenses promise uncompromised distant and > > near vision as well as astigmatism correction. Has anyone had [quoted text clipped - 9 lines] > > DrG The reason for the *snicker* is the promise of uncompromised vision. It's a bit extravagant. DrG Dr. G, please elaborate on potential problems with the Triton lenses. I like to be as informed as possible before I spend (waste?) my money, so your comments will be appreciated. > Dr. G, please elaborate on potential problems with the Triton lenses. > I like to be as informed as possible before I spend (waste?) my money, > so your comments will be appreciated. The single biggest problem I have encountered is that they aren't as comfortable as other soft lenses, but YMMV. You should be able to go through a trial fitting without committing to purchasing the lenses, so maybe you should try them out. DrG >Triton bifocal soft contact lenses promise uncompromised distant and >near vision as well as astigmatism correction. There are NO contacts that consistently deliver on that promise. In fact, IMHO, there are no contacts that can promise that for even the vast majority of my presbyopic patients. >> Triton bifocal soft contact lenses promise uncompromised >> distant and near vision as well as astigmatism [quoted text clipped - 5 lines] > In fact, IMHO, there are no contacts that can promise > that for even the vast majority of my presbyopic patients. Do you mean across the entire near range (anything not distant)? Or for a fixed near point? If the latter why not translating RGPs (not considering compliance)? -Quick >>>Triton bifocal soft contact lenses promise uncompromised distant >>>and near vision as well as astigmatism correction. [snip] >>In fact, IMHO, there are no contacts that can promise that for >>even the vast majority of my presbyopic patients. > >Do you mean across the entire near range (anything not >distant)? Or for a fixed near point? I meant what I said: There are NO contacts (that I/colleagues I have spoken to have used) that consistently provide "uncompromised distant and near vision" for the vast majority of my presbyopic patients who would like to wear contact lenses (VMofPPwwltwCLs). The VMofPPwwltwCLs will not tolerate vision with contact lenses that is inferior to that which they obtain with spectacles. With contact lenses I can give the VMofPPwwltwCLs great binocular distance vision or great binocular near vision. Monovision typically compromises binocularity to an unacceptable level for the VMofPPwwltwCLs. Aspheric and concentric designs typcially compromise acuity, make patient require more light, cause glare, haloes for VMofPPwwltwCLs. >If the latter why not translating RGPs (not considering compliance)? === [ASIDE: Compliance is a HUGE factor here as well as in other areas. For example, a huge percentage of my amblyopic patients are amblyopic not because they were not diagnosed early enough or they wouldn't have been amenable to therapy, it's because they were not compliant with therapy.] === This type of lens, in theory, would provide the *least compromise* (note: NOT uncompromised) for VMofPPwwltwCLs. However, the VMofPPwwltwCLs are turned off by the price, time factor, adaptation issues with these type of lenses. The VMofPPwwltwCLs initially have unrealistic expectactions and when I explain to them the cost, possible amount of follow-up visits, adaptation, etc. they decide it is not worth it to them. I give them a honest, realistic (NOT overly optimistic) opinion and the VMofPPwwltwCLs expect a quick/cost-effective (relative to spectacle) fix. Do they provide acceptable distance and near vision for some patients? CERTAINLY. If they didn't, they wouldn't exist for long. Do they for VMofPPwwltwCLs in my practice? No way. Note: I practice in a general primary care optometry setting. This may be different for someone who works in a contact lens specialist or referral center. >>>>Triton bifocal soft contact lenses promise uncompromised distant >>>>and near vision as well as astigmatism correction. [quoted text clipped - 51 lines] >may be different for someone who works in a contact lens specialist or >referral center. This is all so complicated. So what do you suggest for a one eyed person who isn't after perfect vision because I haven't had perfect vision for a long time? I need something that is useable. I read a lot on the web today and lots of times they talk of one eye being set to this and the other to that. Of course I don't have that option. so do you do you think it is at all feasible that I will get something? Ann > This is all so complicated. So what do you suggest for a one eyed > person who isn't after perfect vision because I haven't had perfect > vision for a long time? I need something that is useable. I would recommend a Hoya Summit ECP progressive lens in Trivex material, with a balance lens in front of the non-seeing eye. Forget the bifocal contact lens. DrG [snip] >This is all so complicated. It certainly can be. This is a science-related newsgroup. I don't intentionally try and confuse laymen is my discussions here, but OTOH, I assume a certain audience. >So what do you suggest for a one eyed person who isn't after perfect >vision because I haven't had perfectvision for a long time? I need >something that is useable. I second what Dr. G wrote. For a monocular patient, my first choice would be the highest quality progressive in TRIVEX which is arguably the Hoya Summit ECP, although I have had great luck with the Kodak Precise and Concise which are supposed to be available now in TRIVEX. And as Dr. G wrote, contact lenses are usually the last choice for a monocular patient for both medicolegal and functional reasons. > This is all so complicated. So what do you suggest for a one eyed > person who isn't after perfect vision because I haven't had perfect > vision for a long time? I need something that is useable. IMHO, if you really want to try contacts, your best bet would be translating RGP lenses or the Triton translating soft. Most of the multifocal contact lenses work best when there are two eyes working. The patients in my practice who are the hardest to fit and have the lowest level of satisfaction with simultaneous vision multifocal contacts are those who are monocular, like you, or strongly one-eyed dominant and/or not binocular. Those folks often to well with monovision correction or that type of lens design. LB, O.D. >> This is all so complicated. So what do you suggest for a one eyed >> person who isn't after perfect vision because I haven't had perfect >> vision for a long time? I need something that is useable. > >IMHO, if you really want to try contacts, your best bet would be >translating RGP lenses or the Triton translating soft. Okay. Thanks. I can't use progressive glasses. I've already tried them and the small corridor is just not good enough. So if I don't try a contact lens then I've nothing left to try. At the moment I am not functioning well. >Most of the multifocal contact lenses work best when there are two eyes >working. The patients in my practice who are the hardest to fit and have >the lowest level of satisfaction with simultaneous vision multifocal >contacts are those who are monocular, like you, or strongly one-eyed >dominant and/or not binocular. Those folks often to well with monovision >correction or that type of lens design. Yes, I read more about it and they seem to say that each eye is often treated differently to complememt the other so only having one is not good enough. Oh well, I will have to have more of a think. Ann > I can't use progressive glasses. I've already tried them and the > small corridor is just not good enough. So if I don't try a contact > lens then I've nothing left to try. At the moment I am not > functioning well. There is something called a trifocal with focal lengths for distance, arm's length, and 16 inches. There are two distinct lines separating them. The field of view is wider than on progressives. DrG > Can someone tell me what progressive contact lenses are like? What > sort of vision can you get from them? Is it the same as glasses with > blur each side or are they pretty clear all across? > > Also can they also be for astigmatism or is that asking too much? The best ones (RGP) I tried on were like having real eyes. If I looked at something close, even if it was above my head, it was in sharp focus. If I looked at something in the gutter in the far side of the street, it was in focus. It was wonderful. The bad part was that due to the angle of my astigmatism they wouldn't stay in place and I only got that perfect vision for one second out of 60. YMMV and probably will. Good luck. SignatureCheers, Bev =================================================== Red ship crashes into blue ship - sailors marooned. |
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