farsighted

contact lens addicts

Yesterday I had the not so pleasant experience of having to scare one of my patients out of wearing contact lenses. It inspired me to write a little about contact lenses and those who (over)wear them.

It has occurred to me, over the past year or so, that some patients are addicted to wearing contact lenses. These people are like the crack addicts of the ophthalmic world. They need contacts. They'll do anything to get contacts. They will come in begging for samples. And when you suggest to them that they should quit, they freak out!

For these people, going straight and cleaning up their act means having to wear glasses. And just like any other addiction, its hard for people to quit cold turkey. They come up with all sorts of excuses like "I don't like my frames", "I lost my glasses", "Glasses make my face look fat". Well I got news for you, Chubs... Its not the glasses!

Anyway, this is where I come in. I'm like the motivational speaker on those self help tapes that tell people that they are strong and in control of their lives. "Where there's a will, there's a way" and all that good stuff. Oh and also, if they don't quit, they could go blind.

That last note usually helps me get people's attention. And it worked yesterday with my 19 year old patient who had been wearing coloured contacts (not the best quality lenses) 7 days a week for the last 5 years. She does not own a pair of glasses and therefore has been wearing her contacts from morning until night.

 

Why is this so bad?

The cornea, which is the clear dome at the front of our eyes, has a very high demand for oxygen. The only place the cornea can get oxygen is from the air around us. As you can imagine, covering the cornea with a piece of plastic will significantly reduce the amount of oxygen that gets through. The cells of the cornea starve for oxygen and start to break down causing the cornea to become less clear thus making vision blurry.

The body's response to this lack of oxygen involves creating new blood vessels into the cornea. This is called neovascularization. While this may seem like a good idea, it is actually the exact opposite. If the blood vessels grow too far into the cornea, they can begin to obstruct/distort vision. There is no way to reverse neovascularization of the cornea. It can be stopped or slowed down by decreasing contact lens wear. But if it is very significant, the only treatment is corneal transplant surgery. And believe me when I tell you, you do not want corneal transplant surgery.

Cornea with stitches, post transplant

Cornea with stitches, post transplant

 

Its sad to see a person as young as 19 be at risk of permanent vision loss. But, with a little treatment and staying out of contacts for a while, her eye health (and vision) should improve.

As useful and convenient as they are, contacts can cause a multitude of different ocular problems if worn incorrectly. All patients who wear contact lenses should have regular eye exams.

Lil' Wayne and cataracts

"You can't see me baby boy, you got them cataracts" - Lil' Wayne in Best Rapper Alive

Who said rap music is bad for you? I think its educational! Lil' Wayne may not know exactly what a cataract is, but he definitely has the right idea.

A cataract is the clouding of the lens that is inside the eye. As the lens becomes more clouded, vision becomes blurred due to light being blocked or scattered. This is the same lens that we use to focus at near objects. The same lens that stops working around the age of 45 and forces people to start wearing reading glasses (See: presbyopia in the "All Kinds of Blurry" post).

Everyone will develop cataracts at some point in their lives if they live long enough. How much and how fast depends on the individual and the environment. Medical conditions like diabetes can cause cataracts to develop faster. Sunlight is the main environmental factor. So, grab those sunglasses!

Congenital cataracts - It is possible to be born with a cataract. I recently saw a 5 year old boy who had a cataract in one eye. Another reason why kids should have regular eye exams.

Traumatic cataracts - Getting hit in the eye can cause a cataract. Wear protective lenses whenever possible!

How do you treat cataracts?

The only treatment is removal. The cloudy lens is removed and new clear plastic lens is inserted in its place. The surgery takes about 10-15 minutes per eye and requires an incision less than half a millimeter in size!

Who knows, maybe next week Kanye West will rap about Macular Degeneration... Stay posted!

 

"I spent a G on these frames, but my vision is priceless" - Lil' Wayne

 

lazy eye

"Contrary to what some believe, a lazy eye is not one that doesn't like to wake up and go to work in the morning."

- Anonymous Eye Doctor with a sense of humour

The medical term for Lazy Eye is Amblyopia

So why do eyes become lazy?

  • The brain is very picky! When it is not receiving a clear image or if it is receiving double images, it begins to shut off connections to the eye that is causing it the most grief
  • This process usually happens during childhood and if it is caught before the age of 7, it can be reversed depending on how bad the situation is and how cooperative the patient is

There are two main situations in which this happens:

  • Eye turn
    • In this case, the patient probably has double vision so the brain will stop communicating with the eye that is turned in/out, which will stop the double vision
    • Sometimes surgery is needed to straighten the turned eye, other times simple wearing a patch over the good eye will help force the turned eye back
  • Difference in prescription
    • If there is a large difference and one eye is very blurry, the brain will again shut it off because it doesn't like dealing with two eyes producing different images
    • Glasses are the obvious answer. Sometimes a patch over the good eye will help force the blurry eye to work harder

As you can see a Lazy Eye problem actually becomes more of a Picky Brain problem.

And as the saying goes, "you can't teach an old dog new tricks".

So, once the brain has made all the connections it wants to make, it is very difficult to make it go back. This is why it is important to catch it early! (Before age 7 or 8)

After this cutoff, even providing a patient their full prescription may not improve their vision because no matter how clear the image is, it is not being sent to the brain.

 

FAQ:

Q: Can a person have 2 lazy eyes?

A: That is a fantastic question! And, yes. I recently blogged about a patient I had seen who had high astigmatism in both eyes. So the connections for both eyes were not fully formed during childhood due to blurry vision and at this point in her life, glasses did not help very much.

Q: What is astigmatism?

A: The answer to this can be found in am earlier post called "All Kinds of Blurry" along with info on other causes of blurry vision

Q: How early should kids have their eyes checked?

A: Both the Canadian and American Association of Optometrists recommend that children have their first eye exam at 6-12 months and again at age 3.

Contact lenses

They come in a variety of shapes, sizes, and colours...

Soft contact lenses (SCL):These are the most common and they are disposable.

  • This means that after wearing the lenses for a period of time, they are disposed of and a new, fresh pair is used
  • Lenses can be monthly (ex. Air Optix, Frequency 55, Proclear, Biofinity, etc), two week (Acuvue Oasys), and daily disposable (CIBA Dailies, Acuvue 1-day, etc)
  • Also available for astigmatism and patients over 40 who need reading glasses (more information in my post All Kinds of Blurry)

Daily disposable lenses are the healthier option for your eyes for the simple reason that a fresh, sterile lens is being used every single time. Most infections are a result of poor storage or lens care. A lot of these problems can be avoided with daily lenses.

Rigid Gas Permeable (RGP):AKA Hard lenses. Considered older technology but actually provide better optics, better oxygen flow, and less infections. Less popular simply because they are uncomfortable to begin with. But patients who get used to them, stick to them.

 

Hybrid Lenses:Combination of a hard lens with a soft "skirt". Supposed to provide superior vision of RGPs without being as uncomfortable. But, they haven't been as successful as expected.

Orthokeratology (Ortho-K):Contact lenses that are worn while you sleep. Over night, they flatten the cornea and temporarily correct near-sightedness. Also mentioned in my post Laser Eye Surgery.

Important things to REMEMBER: No matter how good a contact lens claims to be at allowing oxygen pass, or keeping your eyes hydrated, or preventing bacteria from sticking to it, at the end of the day it is still a piece of plastic in your eye.

Contact lenses are considered to be medical devices and, as such, should be looked at by a doctor before they are dispensed and any time the patient experiences any problems.

Three big NOs:

  • No sleeping
  • No swimming
  • No tap water

These are the quickest ways to cause infections which can be potentially vision threatening (see picture below).

Other uses:Contact lenses are not only used to improve vision. Here are a couple of other interesting uses:

  • Diabetic patients
    • Lens changes colour when sugar levels in tears increase
  • Bandage
    • Used to cover scratched corneas or after LASIK surgery
  • Administer drugs over long periods of time
  • Tracking eye movements in ocular studies

FAQ:

Q: Can I get coloured contact lenses even if I have no prescription?

A: Yes. But FYI, these lenses tend to be the least healthy for your eyes.

Q: How often should I replace my contact lens case?

A: Usually every 3 months or when your solution runs out. Whichever comes first.

Q: If I wear contact lenses, do I still need a pair of glasses?

A: Yes, you should always have a good pair of glasses to give your eyes a break and just in case something happens to the contacts.

Q: What if I'm on vacation and I forgot my contact lens solution and my contacts are bothering me and there isn't a pharmacy close by and my cousin says its no big deal, can I just store my contacts in tap water?

A: No. No tap water. Ever. I hope that is clear enough :)