Contact Lenses

Contact Lens Options
By Scott Burge, O.D.
Introduction

For those patients who choose not to have refractive surgery, our practice has complete contact lens service available. Fitting contact lenses is both an art and a science. We will outline the different types of contact lenses here and then discuss the services we offer at Maryland Eye Associates. For a definition of eye terms used in this section please see the narrative on REFRACTIVE SURGERY.

History of Contact Lenses

Contact lenses were first attempted in the early 1940’s. The lenses were large bulky scleral hard lenses, which covered most of the front of the eye. Needless to say these were very uncomfortable and were not well accepted by patients. Since then there have been many advances in contact lens materials and fitting techniques.

Although the oldest, hard contact lenses are still very useful and many patients enjoy their benefits. They actually float on the corneal tear film. Their advantages are low cost and easy maintenance.

Gas permeable lenses look and feel like hard lenses but allow more gas (oxygen) through the plastic. The corneal surface requires oxygen to maintain good health. This property makes the contacts more comfortable to wear and may permit longer wearing times. These are more expensive than hard contacts.

Soft contact lenses were developed in the 1960’s. These drape over the cornea, much like a tablecloth over a table. There are a variety of soft lenses today, including:

  • Daily wear – must come out nightly and last for 12+ months. Require considerable maintenance such as daily cleaning and periodic enzyme treatments.
  • Extended wear – sleep over lenses-no longer recommended because of risks of infection.
  • Disposable – for day time wear, but throw out every 2 or 3 weeks. Minimizes maintenance.
  • Toric – for correction of astigmatism.
  • Bifocal – for patients over age 40 who want to avoid spectacle bifocals.
How Contact Lenses Work

Exactly what do contact lenses do on the cornea of the eye? First let’s review a simple lesson in optics.

In a patient with MYOPIA or nearsightedness, the eye is too long for the curvature of the cornea. The image focuses at a point in front of the retina (the retina is the tissue that receives and transmits the light image to the brain). Contact lenses, glasses, and refractive surgery project the image back onto the retina.

In a patient with HYPEROPIA or farsightedness, the image is projected behind the retina. Contacts, glasses and the new laser surgery bring the image forward to focus on the retina.

In a patient with ASTIGMATISM (non-symmetric corneal surface, i.e., shaped more like a spoon than a ball) no image focuses on the retina because there are two blurred focal points. Contacts, glasses and refractive surgery all bring the 2 images into 1 point and project it onto the retina.

In a patient with PRESBYOPIA, or literally “old vision,” the natural lens in the eye can no longer focus on near objects. This occurs to some degree in the patients over age 40. This is solved with bifocals, reading glasses or bifocal contacts.

In general, any type of contact lens must fit properly, move when blinking, be comfortable and stay clean of mucus and debris, as well as focus properly. Professional fitting of contacts is essential to achieve these goals. Follow-up visits are also important in managing good eye health with contacts.

Contact Lens Fitting Philosophy

Dr. Burge takes pride in devoting all of his time and energy to the total care of contact lens patients, and his fitting philosophies follow:

Hard/Gas Permeable Lenses
  1. When refits are indicated, Dr. Burge will immediately refit the patient without requiring any discontinuation of CL wear and the need to wear glasses for a few weeks.
  2. During the refitting period, typically 3 to 4 weeks, some lens exchanges may be necessary as parameters are adjusted to achieve optimum fit. These are done at no additional charge.
  3. At the completion of a successful fit, a final refraction is done in order to give the patient an accurate eyeglass prescription.
  4. All follow-up office visits during the fitting period are included in the initial fee.
Routine Soft Contact Lenses
  1. Patients with uncomplicated refractions are often best fit with soft contact lenses, especially the disposable lenses. Disposable lenses maximize comfort, convenience, clarity, and safety. Dr. Burge utilizes all quality brands in his fitting inventory. No single brand works best for all patients. Often, patients are given samples of various types to compare for optimum results.
  2. From time to time, a unique wearing problem for a specific patient surprises Dr. Burge with a new challenge; not all patients are routine.
Astigmatic Patient
  1. Astigmatism is corrected by either soft toric lenses or gas permeable hard lenses.
  2. Soft toric lenses have improved dramatically in the past several years, however, they usually do not correct vision as clearly as eyeglasses or gas permeable hard lenses. Patients fit with soft toric lenses, in most cases, receive initial sample lenses selected by Dr. Burge from quality manufacturers in order to confirm success. In some cases several manufacturer’s lenses are evaluated to achieve best results.
  3. Gas permeable hard lenses correct vision equal to or better than eyeglasses. For the new wearer, an adaptation period of one week is usually required to achieve comfortable wear. During the fitting period, lens parameter changes may be necessary. New lenses are ordered and exchanged with lenses previously given to the patient, at no additional cost.
Bifocal Cases and Monovision
  1. Current technology with these products is not ideal, however, some degree of success is possible on a case by case basis.
  2. After discussing your options and goals Dr. Burge will try various lens combinations and parameters in order to achieve a successful fit.
Special problems such as:
  • Keratoconus (pointed steep corneas causing dramatic blurry vision)
  • Post-op surgical cases
  • Cornea plano (extremely flat cornea)
    1. Dr. Burge enjoys the challenge of fitting these difficult cases (Most other doctors are hesitant to fit these patients and typically refer them elsewhere.)
    2. Key words describe fitting these cases: TIME, PATIENCE and lens parameter changes and lens exchanges, all included in the one initial fee.
    3. In most cases, medical insurance will provide coverage for these special patients.
If you have any questions regarding contact lenses, please ask your Eye-MD. You may send your questions to Maryland Eye Associates or e-mail Dr. Scott Burge at drburge@marylandvision.com
Dr. Scott Burge graduated from the Southern California College of Optometry in Los Angeles, CA. Entering private practice in 1979, Dr. Burge has gained extensive experience in contact lenses in a busy practice environment. He also provides Low Vision services for the partially sighted, when standard optical aids are insufficient.