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Medical Forum / General / Vision / September 2006

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Long-time contact wearer, suddenly presbyopia is a problem

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marcia_jay - 11 Aug 2006 02:31 GMT
Hi! I have been wearing contact lenses since I was maybe 16. Hard lenses. For
severe myopia. My eye doctor was a close family friend and he was worried
about how bad my eyes were getting, so he gave me contacts to help slow the
progression.

I wore them every day like forever. My glasses were only for backup.

Well, fast forward 30 years or so.  Of course, now I am in gas perms, as
"hard" lenses are obsolete.

Well, I am now getting presbyopia to the point where I really can't read in
my contacts. And I work as an editor, so I HAVE to read.

I have been popping out my contacts and working in glasses, but not only is
that a pain in the neck, it kind of makes me feel dizzy.

I would like to get contacts that I can wear all the time.  Years ago, my eye
doctor gave me a slight monovision situation, which helped...but now even
that is not enough.  And he retired.

So: I must (1) find a new eyedoctor I can trust as I did this lfetime family
friend.  And (2) figure out what to go with:  soft lense bifocals?  Can you
switch from a lifetime of hard/RGP's to softlenses?  Or should I try RGP
bifocals, although I hear that they often don't work right.  Or should I just
have my monovision made more, well, more whatever to reflect my increased
presbyobia?

OK, and  having looked at another thread on this site, here is a question:
would switching to soft lenses (bifocal) make my myopia get worse?  The hard
contacts really did check the progress. I have had the same prescription for
like a million years.

Please help me, anyone out there.  It's getting really bad.

Oh, and another thing I noticed? It seems that the entire industry is going
soft-lens.  I have been unable to find the solution I have used for years,
and found out they took it off the market. There are almost no contact lens
solutions left for hard lens wearers.  It seems these types of lenses are
becoming obsolete.

So where will that leave me?
serebel - 11 Aug 2006 02:35 GMT
You are making too much out of this. When your lenses are in, put on a
pair of reading glasses and you'll read fine. You know what they say,
presbyopia happens.
acemanvx@yahoo.com - 11 Aug 2006 03:04 GMT
> Hi! I have been wearing contact lenses since I was maybe 16. Hard lenses. For
> severe myopia. My eye doctor was a close family friend and he was worried
[quoted text clipped - 37 lines]
>
> So where will that leave me?

RGPs have little, if any effect on slowing down myopia progression. The
reason your myopia stopped getting worse is the eye becomes less
elastic in your 20s. Very, very few people still experience an increase
in axial myopia past the age of 25 and only those with pathalogical
myopia still get worse at age 30+

Monovision is one solution but not everyone likes it. Bifocal contacts
is another solution, but again not everyone likes it. You could wear
your contacts just for distance and either go without glasses for near,
wear a weak pair or get bifocal glasses.

How bad is your myopia and how well do you see with RGP contacts?
without?
marcia_jay - 11 Aug 2006 12:35 GMT
My myopia is Mr. Magoo severe. I DON'T see without contacts.  I am never
without either contacts or glasses (used to always be contacts) at any time
except after I go to bed.

With my contacts, I see fine except for reading.

>> Hi! I have been wearing contact lenses since I was maybe 16. Hard lenses. For
>> severe myopia. My eye doctor was a close family friend and he was worried
[quoted text clipped - 15 lines]
>How bad is your myopia and how well do you see with RGP contacts?
>without?
Esmerelda - 11 Aug 2006 21:11 GMT
How common is that? Mine has increased throught my 30s and into early 40s but
i don't have pathological myopia, I'm still in the mid-late -2s.
Esmerelda - 11 Aug 2006 21:15 GMT
Very, very few people still experience an increase
>in axial myopia past the age of 25 and only those with pathalogical
>myopia still get worse at age 30+

How common is that? Mine has increased throught my 30s and into early 40s but
i don't have pathological myopia, I'm still in the mid-late -2s.
Ace - 12 Aug 2006 06:03 GMT
> Very, very few people still experience an increase
> >in axial myopia past the age of 25 and only those with pathalogical
[quoted text clipped - 6 lines]
> Message posted via MedKB.com
> http://www.medkb.com/Uwe/Forums.aspx/vision/200608/1

Most likley just pseudomyopia if you do alot of near work and
especially if you dont take your glasses off like you are supposed to
be for near. Glasses are worse than useless for near for myopes. There
could be a medicial reason if your myopia worsens again after being
stable for many years. Mine has been stable since 20 like it should be
for most people by 18 to early 20s. I know I would see several doctors
if my eyes were to ever get worse to rule out any pathalogy or disease.
Mike Tyner - 11 Aug 2006 03:05 GMT
"marcia_jay" <u25162@uwe> wrote lots of questions:

The simplest and most cost-effective solution is half-eye single-vision
glasses to wear over your contacts, just as you might do if you weren't
nearsighted. I know, they're ugly but they work and they're cheap and you
can rid yourself of headaches right away until you find something better.
Which isn't all that likely.

You could probably make the transition to soft contacts, but soft-lens
bifocal options aren't spectactular and you might find you need a
combination like "toric bifocal" that gets really tricky and expensive. And
still not as good as single-vision reading glasses over your current
contacts, to supplement your partial-monovision fit.

These days, doctors aren't convinced of the "retainer effect" you get from
rigid lenses. I know, there are lots of stories but the statistics say it
isn't effective enough that we should put kids in GPs. Some studies show a
little benefit, others show none, and those aren't results that make GPs a
hands-down preventative method for myopic progression.

If you do switch from GPs to soft lenses, there might well be some changes
in your refraction but the progressive myopia you experienced when you were
younger just doesn't happen very often after 40. If your prescription
changes, it'll be because the corneal epithelium and stroma rearrange
themselves, not because your eye starts growing longer again. The old "hard"
contacts had a dramatic molding effect but the cornea simply "relaxed" to
its natural state a couple of weeks after discontinuing wear. Gas perms are
normally designed NOT to interfere with the natural shape of the cornea and
they do NOT reliably prevent axial elongation (myopia.).

There are still a couple of gas-perm cleaners available, most commonly
Boston cleaner and Lobob (http://www.aclens.com/da.asp?ID=120).

Both of those companies now promote their "all-in-one" cleaning/soaking
solutions but they still sell the separate cleaner. The Alcon soft-lens
cleaner "Opticlean" is also useful for GPs. It's like soft-scrub for
contacts.

Some people with GP lenses benefit from soft-lens enzyme treatments (if you
can find them; disposable soft lenses have virtually eliminated demand).

Finally there are still some dinosaurs like me around with GP polishing
tools.

-MT, OD

in message news:649601f77b429@uwe...
> Hi! I have been wearing contact lenses since I was maybe 16. Hard lenses.
> For
[quoted text clipped - 49 lines]
>
> So where will that leave me?
Charles - 11 Aug 2006 04:20 GMT
...

> These days, doctors aren't convinced of the "retainer effect" you get
> from rigid lenses. I know, there are lots of stories but the
[quoted text clipped - 13 lines]
> to interfere with the natural shape of the cornea and they do NOT
> reliably prevent axial elongation (myopia.).

I'm hijacking the thread a little, but is this retainer effect more
likely to be beneficial for someone (like me) who is primarily
(corneal) astigmatic?  I think I'm seeing quite a bit of it on my less
astigmatic eye, but not so much on the other.  I'm wondering if a more
rigid RGP might have more of this effect.  Why do they design RGPs to
be less rigid?  Comfort?
--
Mike Tyner - 11 Aug 2006 05:36 GMT
> I'm hijacking the thread a little, but is this retainer effect more
> likely to be beneficial for someone (like me) who is primarily
> (corneal) astigmatic?

The term "retainer effect" usually implies you're trying to slow or reduce
the natural progress of myopia, which doesn't work.

Molding the cornea temporarily with RGPs could well reduce corneal
astigmatism through the "ortho-K" effect.

Ortho-K doesn't depend on stiffness. Those lenses work because they touch in
the center and around the circumference, with a "doughnut" of stand-off area
in-between. This geometry encourages the epithelium to migrate away from the
center, thinning the center and thickening at the mid-periphery.

> I think I'm seeing quite a bit of it on my less
> astigmatic eye, but not so much on the other.  I'm wondering if a more
> rigid RGP might have more of this effect.  Why do they design RGPs to
> be less rigid?  Comfort?

Mostly, it's optics, where it's best to have a choice between stiff,
flexible and in-between, depending on individual anatomy.

-MT
Charles - 11 Aug 2006 14:03 GMT
> > I'm hijacking the thread a little, but is this retainer effect more
> > likely to be beneficial for someone (like me) who is primarily
[quoted text clipped - 21 lines]
>
> -MT

I've generally used the term "ortho-k effect" until now, just trying to
fit in (incorrectly)...

Anyway, what I was kind of wondering is whether it would be reasonable
for me to consider a more rigid RGP to enchance this effect?

I'm not sure where my current lenses fit on the stiffness specturm, but
since my doc was concerned with induced astigmatism due to flexure, I'm
surprised he hasn't tried going to a stiffer material anyway.  I don't
understand the other trade-offs, however.

--
marcia_jay - 11 Aug 2006 12:37 GMT
Do you mean those little glasses that you can buy in the drugstore?  I tried
that, it feels really weird to use them.  When I did try them, after I would
take them off, I couldn't see ANYTHING, it was all a blur and made me dizzy.

>"marcia_jay" <u25162@uwe> wrote lots of questions:
>
[quoted text clipped - 47 lines]
>>
>> So where will that leave me?
Mike Tyner - 11 Aug 2006 13:41 GMT
> Do you mean those little glasses that you can buy in the drugstore?  I
> tried
> that, it feels really weird to use them.  When I did try them, after I
> would
> take them off, I couldn't see ANYTHING, it was all a blur and made me
> dizzy.

Welcome to presbyopia. Start with the lowest-power readers. It's supposed to
feel weird at first.

They don't actually change your eyes for the worse; it's just that your eyes
are working so hard without them that they quickly get fond of relaxing.

-MT

>>"marcia_jay" <u25162@uwe> wrote lots of questions:
>>
[quoted text clipped - 54 lines]
>>>
>>> So where will that leave me?
retinula - 11 Aug 2006 12:19 GMT
> So: I must (1) find a new eyedoctor I can trust as I did this lfetime family
> friend

okay.  there are lots of good eye docs around.  just try one.

> (2) figure out what to go with:  soft lense bifocals?  Can you
> switch from a lifetime of hard/RGP's to softlenses?

certainly

> Or should I try RGP
> bifocals, although I hear that they often don't work right.

well they are not perfrect, but they are not worse than bifocal soft
lenses and can actually work better.  with RGPs you can use translating
bifocal contacts which can work better than simultaneous vision bifocal
contacts.

being an editor, you need to do contant near work so your near demand
is high.  probably best would simply be to use readers over your
contacts.

>Or should I just
> have my monovision made more, well, more whatever to reflect my increased
> presbyobia?

sure.  try that.  there is no one answer to these questions.  the
solution varies from person to person.  you need to find what works
best for you.

> OK, and  having looked at another thread on this site, here is a question:
> would switching to soft lenses (bifocal) make my myopia get worse?

no

> The hard
> contacts really did check the progress. I have had the same prescription for
> like a million years.

hard contacts don't affect myopia progression.  it was once thought to
be true, but more recently if has been shown to be ineffective.

perhaps it was simply coincidence that your prescription changes
stopped when you started using hard lenses.

> So where will that leave me?

go to an eye doctor, discuss your problem (which is quite common) and
start trying different alternatives.
marcia_jay - 11 Aug 2006 15:41 GMT
As for 'trying different alternatives"... do they charge you for each
fitting/pair until they get a good match? Or do they charge you just the one
time and keep trying different types till they get a good match but all under
the one initial cost.

I am embarrassed to admit that I have never paid for contact lenses in my
entire life.  My family friend eyedoctor refused to let me pay (through me
out of his office when I took out my checkboos) so all these years I have no
idea what they might cost, or whether you pay for each set that doesn't work
until you find the right match.

>> So: I must (1) find a new eyedoctor I can trust as I did this lfetime family
>> friend
[quoted text clipped - 45 lines]
>go to an eye doctor, discuss your problem (which is quite common) and
>start trying different alternatives.
retinula - 12 Aug 2006 12:30 GMT
> As for 'trying different alternatives"... do they charge you for each
> fitting/pair until they get a good match? Or do they charge you just the one
> time and keep trying different types till they get a good match but all under
> the one initial cost.

it could work either way but most eye docs have you pay 1 fee and then
try their hardest to fit you in the most acceptable contacts for that
one fee.  this is much easier for the eyedoc to digest if you are using
soft disposable contacts since they are provided free of charge by the
companies who manufacture them.  with RGPs however it is not quite so
simple since every little "tweak" or adjustment usually means that the
lab has to remanufacture a lens.  the labs who sell these RGPs to the
eye docs can sell them as "warranted" meaning that free changes are
allowed but usually this means a reasonable number of changes (e.g. 1
or 2 remakes).  when you are a detail oriented presbyope it can take
MANY attempts to finally find the solution that is best for you.

probably the most important thing you as the patient need to realize is
that perfect (or even near-to-perfect) distance and near vision is not
possible with bifocal or monovision contacts.  YOU MUST SIMPLY ACCEPT
THAT SOME SLIGHT LOSS IN VISION ACCURACY AND VISION COMFORT IS
UNFORTUNATELY NECESSARY now that you are presbyopic and have lost your
internal ability to adjust focus readily within your own eyes.  in my
experience, once a patients expectations are managed appropriately, i
can usually get them to a place where they are satisfied with their
distance and near vision.  it won't be as good as a good pair of
bifocal glasses, or a pair of distance-focused contacts and using
reading glasses over them for near, but close enough.  some peoples
personalities, or visual demands, make bifocal or monovision contacts
unacceptable to them.  for them the alternative is simply use readers
over distance contacts or get used to wearing glasses full time.

> I am embarrassed to admit that I have never paid for contact lenses in my
> entire life.  My family friend eyedoctor refused to let me pay (through me
[quoted text clipped - 55 lines]
> Message posted via MedKB.com
> http://www.medkb.com/Uwe/Forums.aspx/vision/200608/1
Hold2File - 17 Aug 2006 22:00 GMT
> > As for 'trying different alternatives"... do they charge you for each
> > fitting/pair until they get a good match? Or do they charge you just the one
> > time and keep trying different types till they get a good match but all under
> > the one initial cost.

The following is based upon my personal "experiences" in wearing
progressive lenses for the last 14 years.  It has taken me that long to

be able to quantify how badly made and fitted some of those glasses
have been.

Your observations and criticism of my comments would be very greatly
appreciated in validating my analysis, and possibly having my
experience be of help to others.

--------------------------------------------

A Method for Verifying the Alignment of Progressive Lenses

One of the virtues of progressive lenses is that the wearer is able to
"see clearly" and adjust the focal point for viewing an object by
merely changing the horizontal viewing angle to match the magnification

necessary for clear vision.  This essentially gives the wearer the
advantages of bi-focal glasses "without the (bifocal) line" with a
seemingly continuous range of viewing magnification.

Unfortunately, this frequently means reduced peripheral vision, because

the focal point for both eyes is essentially a range in narrow vertical

area in front of each eye.  While adjustment to progressive lenses is
usually easy, it requires the wearer to move their head horizontally to

face the object being viewed, and then raise or lower their head to
bring the object into focus.  Complications occur, however, if the lens

is too far forward or too close to the eye (usually caused by
misaligned nose pads), or tilted too far forward or backward (usually
caused by a skewed frame), or if the vertical visual areas are not
aligned with the focal point of the eyes (usually caused by an
inaccurate positioning of the lenses).

Vertical misalignment is difficult to verify since it is barley
noticeable and usually subjective, but it can be a major source of
discomfort and dissatisfaction with progressive lenses since only the
dominant eye focuses on the object and causes the recessive eye to
sense a "double vision."  While not exactly painful, the resulting
discomfort is mentally exhausting, irritating, and inhibits reading and

reading coherence.  Most Optometrists and patients assume that if the
visual areas are close enough to the alignment of the eyes, the muscles

of the eye will make an adjustment.  Instead, in many cases the lack of

accurate close vision is NOT noticed but is instead mistaken for
decreased "mental function" by the wearer since most daily
functions do NOT require precise visual coherence.  The lens
misalignment also obviates accuracy of the Optometrist's or
Ophthalmologist's prescription.

While a competent Optician can easily and properly adjust the problem
by precisely adjusting the lenses, the diagnosis and verification of
visual accuracy is normally subjective.  Accuracy of close vision can
be determined by looking at a point about 2 feet away with the
recessive eye covered, covering the dominant eye, and then un-covering
the recessive eye.  The need to move the head either left or right to
bring the point into focus indicates that the progressive visual area
is NOT in alignment.  The necessary lens adjustment, however, can be
quantified by the use of two different water-soluble thin-tipped
colored felt markers and a digital display device such as a digital
clock viewed in a somewhat darkened room.

The adjustment measurement involves using a focal point (a digital
clock or a point on computer screen) at distances of 2, 4, 8, and 16
feet away alternately covering the recessive eye and the dominant eye,
and then viewing the focal point with both eyes.  With the recessive
eye covered, the wearer uses a thin colored marker to put a dot on the
front of the dominant lens to match the visual focus point.  The wearer

then covers the dominant eye, uncovers the recessive eye, and uses the
same marker to put an "identical" dot on the front of the recessive
lens matching the visual focus point.  The wearer then views the same
focal point at each successive viewing distance with BOTH eyes
uncovered and uses a DIFFERENT colored marker to place a dot on BOTH
lenses WITHOUT MOVING THE HEAD to matches (cover) the focal point.  The

space between the two differently colored dots on the recessive lens at

each viewing distance is the measurement of the vertical focal area's
displacement of the lenses for that viewing distance and quantifies the

lens' vertical misalignment.  Accurate alignment should have both
colored dots match at the same point and same viewing distances for
both lenses.

This test is simple, inexpensive, fast, and an objective way of
measuring the visual accuracy of progressive lens alignment.

(There is a graphic of the lens and the colored marks on them resulting

from the trials, but I do not know how to include it in this post, my
first to Google.)

Essentially the graphic looks like:
 o = lens allignment points
 , = 1st colored dot (comma) with both eyes open (left eye dominant)
 . = 2nd colored dot (period) other eye covered and head NOT moved
 | = outside of lenses

               left lens                    right lens
          |                                                         |
16 feet    |             ,.                      ,.                  |
12 '       |  o         ,.   o   bridge     o     , .           o    |
 8 '      |           ,.                          ,  .              |
 4 '      |          ,.                             ,   .           |
 2 '      |         ,.                                ,    .        |
          |                                                         |

This attempt at a "graphic" may not be "to scale."  The space between
the two differently colored dots (comma versus period above) on the
recessive right lens at each viewing distance is the measurement of the

vertical focal area's displacement of the lenses for that viewing
distance and quantifies the lens' vertical misalignment.
Dan Abel - 08 Sep 2006 20:16 GMT
> Hi! I have been wearing contact lenses since I was maybe 16. Hard lenses. For
> severe myopia. My eye doctor was a close family friend and he was worried
[quoted text clipped - 13 lines]
>
> I would like to get contacts that I can wear all the time.

1.  Talk to the people you know.  Find out what OD they see and what
they like and don't like about that doctor.  Pick one.

2.  I wore contacts for 10 years.  I had them set for distance and wore
OTC reading glasses over them for close.  That worked for me, but not
for everybody.  Sometimes I wear little glasses and a short push down
the nose lets me see far and near.  When using the computer, I use
bigger glasses and less plus.

3.  See an OD and explain your problems.  Estimate how many hours a day
you spend at the computer and reading, separately.  Measure the distance
from your eyes to the computer and for reading.  They may or may not be
different distances.  Pick comfortable distances, not the ones that give
the clearest image.  Ask your OD to recommend strengths for computer use
and reading.  They may be the same.

4.  Popping contacts in and out during the day doesn't appeal to me.  
Putting on and taking off reading glasses does.  It's a personal thing.

5.  I am not an eye care professional and am just relating what worked
for me.

Signature

Dan Abel
dabel@sonic.net
Petaluma, California, USA

marcia_jay - 24 Sep 2006 18:22 GMT
Hi, all, remember me?

I finally went to the eyedoctor.  

He spent a long time examining me, and then announced that he is going to
make me have one regular lens for far vision, but scaled back a bit from what
I have (because I squint in that eye now), and the other would be a bifocal
lens.

Both would be RPG lenses.

He didn't actually give me a bunch of choices or anything.

The first return I could see nothing from either lens, which I thought was
kinda strange, and that is when he made the decision to do a  bifocal in one
and regular in the other (I don't know what the two weak ones were that he
had me try on).

Does anyone have any opinions about this?  Does it sound like a reasonable
plan?  I thought I had heard mostly negative things about RPG bifocals.

Just a reminder, I am VErY nearsighted (like -11 or -12 or something like
that).  My old lenses correct me to 20 20, but the presbyopia has come into
play.

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