Published: 18 June 2020

Help! Growing Older and Can No Longer Read with My Contacts! More middle-aged and older adults are wearing soft contacts than ever. And one of the biggest reasons they decrease or stop wearing contacts is the difficulty they face reading with their contacts after presbyopia begins to set in around the early 40’s. Presbyopia is the diminished ability of the natural lens in our eyes to focus up close on near objects. It begins with the occasional medicine bottle being a struggle to read and then over time more and more gets blurry. It can be very frustrating to stare at something up close and have it be blurry regardless of what you do. So there are three basic choices a contact lens wearer can do to aid their reading while still wearing contact lenses. Reading Glasses Initially, the use of an over-the-counter reader or prescription reading glass for occasional use works well for people in the early stages of presbyopia. They are worn over distance contact lenses so there is little adjustment and vision is clear near and far. However, they need to be with you, not left in the car or at work, and oftentimes people end up just wearing readers all day since it is just that much clearer. Monovision This fitting technique can be used with any type of contact lens. The brand of lenses you are currently wearing can often be used to fit you with monovision. Your dominant eye is determined. Then the non-dominant eye prescription is adjusted to compensate to make it a reading contact lens. So once fitted you have one eye for distance and the other for reading. Yes, it sounds really crazy, but it actually works quite well. Your brain initially has to adjust to using each eye individually to obtain the sharpest vision, but once this is achieved, year-to-year adjustments can be made to the reading eye to allow comfortable distance and reading vision for many years. Monovision fits are not always successful. Some people just cannot adjust to it regardless of motivation or desire. It seems to work best when someone has had some difficulty with reading and they are noticing more and more that they need their readers. At that point, they can appreciate the ability to read and their brain seems to adapt more readily. When I wear my contacts this is the option I have used for myself. Multifocal Contacts Another option is multifocal contact lenses. Most every major manufacturer of soft contact lenses has some type of disposable multifocal lens available. They do not work like multifocal glasses. They use a technique called simultaneous viewing where you are actually looking through all the powers at once. To visualize this, imagine a vinyl record with the label in the center and the various tracks extending outward. Most of the lenses are made with the strongest reading power located in the center where the label would be, then each ring further out gradually becomes weaker until you reach your full distance power. So essentially you are looking “around” the reading part for distance then through the center for reading. It works, sort of. Multifocal lenses work better on younger patients, say 40-50 years old, for help with reading. There is no adaptation period to these lenses like monovision. What you see is what you get. But if you have any significant amount of astigmatism or if you wear a toric contact that corrects for astigmatism, multifocal lenses are not for you. And because the reading is central in the lens, if you make it too strong for reading then you blur the distance vision too much, so oftentimes a multifocal lens wearer after age 50 faces a dilemma to either wear reading glasses to boost their reading needs or change to monovision. Conclusion In conclusion, while none of the options are perfect they all may present some level of relief in your quest to continue to wear contacts into middle age, retirement, and beyond. But some options may better serve you at a certain point in your life or career than others. Talk to your eye doctor to see what choices are best for you Article contributed by Eugene Schoener O.D.

Published: 10 June 2020

When soft contact lenses first came on the scene, the ocular community went wild. People no longer had to put up with the initial discomfort of hard lenses, and a more frequent replacement schedule surely meant better overall health for the eye, right? In many cases this was so. The first soft lenses were made of a material called HEMA, a plastic-like polymer that made the lenses very soft and comfortable. The downside to this material was that it didn’t allow very much oxygen to the cornea (significantly less than the hard lenses), which bred a different line of health risks to the eye. As contact lens companies tried to deal with these new issues, they started to create frequent-replacement lenses that made from SiHy, or silicone hydrogel. The oxygen transmission problem was solved, but an interesting new phenomenon occurred. Because these were supposed to be the “healthiest” lenses ever created, many people started to over wear their lenses, which led to inflamed, red, itchy eyes; corneal ulcers; and hypoxia (lack of oxygen) from sleeping in lenses at night. A new solution was needed. Thus was born the daily disposable contact lens, which is now the go-to lens recommendation of most eye care practitioners. Daily disposables (dailies) are for one-time use, and therefore there is negligible risk of over wear, lack of oxygen, or any other negative effect that extended wear (2-week or monthly) contacts can potentially have. While up-front costs of dailies are higher than their counterparts, there are significant savings in terms of manufacturer rebates. In addition, buying contact lens solution is no longer necessary! While a very small minority of patient prescriptions are not yet available in dailies, the majority are, and these contacts have worked wonders for patients who have failed in other contacts, especially those who have dry eyes. Ask your eye care professional how dailies might be the right fit for you. Article contributed by Dr. Jonathan Gerard