Contact Lenses

Q. It is amazing that you wrote 2 whole chapters on concerns of parents regarding eyesight, without mention of contact lenses!
A. Technically this is not a question. However, I did that only because I was planning to devote a whole chapter to the subject!

Q. Most kids nowadays do not wish to wear glasses at all and would prefer contact lenses for their number correction. Is it OK?
A. No, it is not OK. All kids with spectacle numbers should be encouraged to make a pair of spectacles. Older kids, may, in addition, also be allowed contact lenses at the discretion of the eye doctor.

Q. Your answer just throws up more questions! What do you mean by “older kids”?
A. I mean any child who has reached the level of maturity that the parents feel he or she will be able to wear, remove and maintain the contact lenses on his/her own, without needing nagging or help from the parents. By rule of thumb, this is around 15 years of age, around the time kids get into junior college in India. This of course could vary, after all, all 5 fingers are not the same!

Q. You are making the procedure of looking after contact lenses seem like rocket science. Surely it is not that difficult? Millions of people the world over wear lenses. Why are you being such a spoilsport?
A. If kids (or adults) do not follow the doctor’s instructions they can get their eyes into all sorts of trouble. Contact lenses should never be over-worn (generally not more than 8 to 10 hours at a stretch); most contact lenses should not be worn overnight; clean hands should be used to put on and remove the lenses; the recommended cleaning/disinfecting solution should be used to clean and store the lenses and the carrying case; the case should be changed frequently; the lenses too should be replaced as per the recommended schedule and the patient should report to the eye doctor as an emergency at the first sign of trouble, e.g. a red eye or persistent watering or pain or blurred vision. I am not trying to dissuade you from permitting your kids to wear contact lenses. I am only pointing out that patients have permanently lost eyesight due to severe infections from not following the prescribed hygiene strictly.

Q. What are the types of contact lenses available today?
A. Traditionally 3 types of contact lenses are still manufactured. They are the hard or rigid lenses, the semi-soft or gas permeable rigid lenses and the soft lenses. However, most people today use the soft lenses, with the hard and semi-soft used for special indications, such as corneas with conical shapes (keratoconus), or very high astigmatism (cylindrical numbers) or scarred corneas due to previous injury or infection. Those people who are currently using hard or semi-soft lenses and are happy with them can continue wearing them. They are perfectly safe – you do not have to switch to soft lenses just because they are available!

Q. Let us then talk only about soft lenses, shall we?
A. There is a lot of choice today, even in soft lenses and I am not talking just of the various companies marketing them! There are the conventional soft lenses, which are daily wear lenses (i.e. lenses which one removes and stores at night). These should be replaced ideally once a year or earlier if they are giving trouble. Then there are the disposables, monthly, fortnightly, weekly and daily disposables.

Q. How do I decide which type I should wear?
A. The disposable lenses require less maintenance as they are thrown away before the proteins and other impurities get permanently stuck to the surface. The greatest advantage of the daily disposables is the doing away with of the hassles of a lens case and cleaning solutions as you open a sterile pack and throw away the lenses after the day/party is over! However, all this comes with a steep price tag – the more disposable, the more the annual wearing cost! However, if you are a happy spectacle wearer and wish to wear contact lenses only for social occasions like a Saturday night party, daily disposables may be a cost effective option.

Q. Daily disposables I understand. Do monthly disposables have to be discarded after 30 wearing occasions or 30 days?
A. This is the mistake that many patients make. If you open a 30 day disposable lens pack, you must throw away the lenses after 30 days of pack opening. This is irrespective of whether you have worn them for only 10 days or 20 days or each of the 30 days after the pack was opened. The same holds true for fortnightly and weekly disposable lenses – they must be thrown away after a fortnight or week respectively.

Q. I think you have been bribed by the lens manufacturing industry. My friend wears her monthly disposables for 2months before discarding. Nothing happens!
A. Your friend is lucky. You may not be equally lucky. Most problems associated with lenses stem from their misuse. This includes using them beyond the recommended period. The chances of developing ocular allergies and infections rise exponentially with such misuse.

Q. I have astigmatism. Can I still wear soft lenses?
A. Yes, astigmatism or cylindrical number is a ‘focusing number’. Nowadays, you get ‘toric’ soft lenses which correct astigmatism as well. They are of course a little more expensive than the regular soft lenses. However, if the cylinder number is less than 0.75, regular soft contact lenses will also give you adequately sharp vision.

Q. Lately I find that my eyes feel quite tired at the end of the day; my contact lenses are sometimes difficult to remove and the eye feels a little sore. There is a mild redness on removal of the lenses. I feel better when I splash some water into my eyes after lens removal. Another thing I have noticed is that I could easily wear my lenses for 10-12 hours at a stretch earlier. Now I want to remove them after 6-8 hours. What is happening?
A. You have described at length “dry eye” induced by your contact lenses. This occurs in a small percentage of contact lens wearers even if they follow all the instructions given by the eye doctor. The contact lens causes our normal tear film to become a bit unstable; it promotes evaporation of tears leading to mild ‘dry eye’. This leads to all the complaints you described. This phenomenon is commoner in patients who abuse their lenses. It is also frequently seen in those who are constantly glued to the small screen – TV, laptops and desk top computers. This is because you are so engrossed in watching the screen that you inadvertently blink less, leading to inadequate spread of tears across the eye and greater evaporation from the ocular surface.

Q. Enough about the problem. What is the solution?
A. First, try and blink more often when sitting in front of the screen. Secondly, try and close your eyes for 20-30 seconds every 20-30 minutes. These simple tips reduce evaporation and promote adequate spread of tears across the eyes. If your eyes do feel tired at the end of the day, in spite of this, try and remove the lenses during your lunch hour for 30 minutes or so. You can then re-wear them for another 8 hours, rather than wear them for 16 hours at a stretch. Temporarily, you may use lubricant eye drops which are over the counter medications – they can be safely put in the eye even with the contact lens in place. The frequency of instillation can be decided by you – they will give you tremendous comfort and increase your wearing time and reduce your soreness on removal of the lenses a the end of the day. Splashing tap water in the eye on lens removal is not such a great idea. Putting these sterile artificial tear drops is a better bet!

Q. Do I need to see an eye doctor at all, if I am happy with my lenses? They unnecessarily charge consulting fees. Why not buy my replacement lenses directly from the shop?
A. You should see your eye doctor at least once a year, eve if you have no problem with your lenses. Do try to be off lenses for at least 48 hours before you visit him. This enables him to recheck your spectacle and therefore contact lens number with greater accuracy. He also looks for early signs of trouble such as growth of blood vessels towards your cornea, early signs of dryness, allergy etc. Also he takes a close look at your retina, which only he is trained to do. All myopes or shortsighted people are at greater risk of developing retinal problems such as retinal holes, tears and even retinal detachments. The risk remains the same, whether you are wearing glasses or contact lenses! As they say, a stitch in time saves nine.

Q. I am past the age of 40 years and have been a contact lens user all my adult life. Can I get bifocal contact lenses?
A. Yes, bifocal lenses are available in India for an increasing range of powers. It takes a little getting used to but is a good option for those above 40 and requiring reading glasses over their lenses.

Q. I have keratoconus. Can I wear lenses?
A. Keratoconus is a condition of the eye in which the cornea assumes a conical shape. It manifests in your teens and may progress or remain stationary. In the early stages, glasses give adequate vision. However, as the cone steepens, quality of vision with glasses leaves much to be desired. These can be corrected with regular contact lenses initially. Various specialty contact lenses are available when the regular lenses too do not work, such as “Rose –K” lenses, piggy back lenses, scleral lenses etc. However, you need to have a detailed discussion with your eye doctor who will determine which lens is best suited for your eye condition.