Contact Lens Help

[Newbite]

Dr. G,

I’m a 21-year-old male wearing contacts for about 7 years with a prescription of -8. While I was always hygienic and never slept in the contacts, I would often wear them for 12-14 hours a day. Last winter the weather became unusually windy and I suddenly found my eyes so dry that I was losing vision. Two plugs and some drops later, my eyes are moderately dry and I’m struggling with being able to wear contacts. I used to wear Acuvue 2’s and have tried Focus Dailies (not comfortable), Acuvue Night and Day, and Oaysis. The biggest problem with the latter is that it is impossible to take out of my eye after a few hours of use. I have to use about 5-6 Genteal Moderate drops and some Opti-free solution to peel it off! After reading this forum, I am no longer considering having Lasik done and would like to know what type of contacts I can hope to wear and for how long.

Thank you!

[DrG]

If your eyes are so dry that the lenses must be "peeled off," then you have a problem. You need to have the cause of your dry eyes diagnosed, and I do mean something other than "it was caused by contact lenses." The contact lenses merely made the underlying problem worse. The question is: What is the underlying problem that causes you to be unable to wear contact lenses while millions of others can?

It seems like your eyes are not only dry, but your corneas may also be excessively flat. My suggestion to the tight lens syndrome is to try another silicone hydrogel lens material, such as the Focus Night and Day in a flatter base curve, the O2Optix, or Purevision. The 8.6 base curve in the Focus Night and Day is ideally suited for dry, flat corneas. My own laboratory and clinical research confirms that this lens has the least amount of evaporative change. If none of those work, then I recommend taking a break from the lenses.

Another thing to examine is the brand of solutions you are using. My hypothesis is that solutions may be the underlying culprit. Studies have shown that nearly 60% of patients end up purchasing something other than what their doctors recommend.

[Newbite]

Dr. G,

Thank you for your help. Other doctors I've visited have not been as familiar with dry eye syndrome, so I appreciate the advice you are providing me.

To follow up on your response, I actually have never been told about a flat cornea. Not sure if I can find this out without visiting an eye doctor again, but perhaps I can give you a bit more information to see if it confirms your hypothesis. The BC for most of my contacts range from 8.4 - 8.7. Also, while trying new lenses today, I found Bausch and Lomb SofLens 38 (BC 8.7) to be at least more comfortable in removing than the Acuvue brands previously mentioned. Not sure how relevant this info is, but didn't want to hold back anything that might be useful.

In regards to solution, I previously used AMO Complete MoisturePlus which, as you know, was recalled. Since then, my doctor said that solution didn't matter but that "Opti-free Replenish was most popular among patients." Are there any solutions you would recommend? Or any specific brand for drops while wearing lenses (currently I use Genteal Moderate)?

Otherwise, I was told by my doctor that my eyes are healthy, with the only restraint being to minimize strain (specifically through computer use) on my eyes. So in regards to your overall question (why dry eyes?) I will need to do some more homework.

Again, thank you so much for your time. Sorry I'm so uninformed on all of this...

[DrG]

The Bausch and Lomb 38 is going to be more comfortable for dry eye because it has a low water content. I suspect that your corneas are in the flatter range, hence the 8.7 base seems to fit better. The fact that your contact lens base curves have ranged from 8.4 to 8.7 is because that is the range of most disposable lenses. It is difficult to find anything flatter than 8.7.

There is a study that is being circulated by the contact lens reps showing corneal staining against a matrix of different care solutions and different contact lenses. The cleaner showing the least amount of corneal toxicity is Clear Care (hydrogen peroxide). Next in line is Optifree, and then the others.

Hope this helps you.

[Newbite]

Thank you!

[Newbite]

Dr. G,

Thanks again for all of your help. I wanted to follow up with you in regards to my progress and hopefully get your thoughts, as well.

I've found that I can wear the Bausch and Lomb SofLens 38 with more ease than before. However, I feel a great deal of burning when I put them in and began wondering whether it could be the solution I am using. As mentioned earlier, I am storing my contacts in Opti-Free Replenish nightly. While recently trying a different (generic) solution, I was surprised to find no burning when inserting the contacts.

From your experience, why might this be the case? Should I discontinue use with the Opti-Free, and if so, what factors should I use to evaluate other lens solutions?

Thanks!

[DrG]

I guess I could tell you to instill some fluorescein in your eye and then hold up a very large magnifying mirror and see if you can detect any staining, in which case your eyes would probably be already burning anyway.

Or, I could say just use the solution that gives you the most comfort.

Another suggestion is to read the labels and try to figure out which ingredients disagree with you and avoid them. Most people do quite well with Optifree and some don't. But, as I said, most do.

The other problem is which solutions are effective against the new bad bug out there: acanthamoeba. Clear Care is the most effective product against Acanthamoeba. Optifree is somewhat effective. I believe Complete Moistureplus was not, and this is why the AMO product was recalled.

You gotta be careful. Also, while you may be comfortable in a low oxygen lens, it may not be the best thing long-term.

[Newbite]

This is great -- thank you! I've been doing some research on Clear Care and noticed that some users advocate 1) rubbing the solution with the contacts for a few seconds before storing and 2) rinsing the contacts with a sterile saline after storing.

Could you comment on whether these steps are appropriate or necessary? Also, since we've already discussed the best cleaners, what is the difference between cleaners and sterile saline? What brand of sterile saline is best to buy (or perhaps it is only available in a generic brand, i.e. CVS, Walgreens, etc.)?

Thank you for your continued guidance!

[DrG]

The active ingredient in Clear Care is hydrogen peroxide.

All of the steps you mentioned are appropriate. I am not sure if they are necessary. My personal routine is to throw my lenses into the case with the Clear Care. I then rub and rinse in the morning with Unisol, the only brand of non-preserved saline on the market in the U.S.

A cleaner is typically a surfactant. A disinfecting agent kills bacteria. Saline is just sterile salt water at 0.9%. Of importance to people here with sensitive dry eyes is that they have non-preserved solutions, and so I recommend Unisol brand saline and Clear Care disinfecting system, with a rub and a rinse before or after disinfection. Many people can tolerate the other brands, such as ReNu or Optifree, but if you want the most chemical-free system, then stick with Clear Care.