Multifocal contact lenses: the presbyopian cure?

[Nords]

Originally Posted by Sandy

Don't fear surgery.

I hear that, but I still fear the screwups.

Neighbors went in for surgery together and he ended up having problems while she was still recovering. He went back for a second operation but one eye is worse than it used to be.

A shipmate had a huge corona problem back when the industry was still figuring out the problems with them. I don't know how they can go back to help her.

Like your situation, life has to really suck before I'll go in for surgery. For all my whining & sniveling, reading glasses are a decent compromise. I didn't expect my spouse to be so excited by her new lenses (in more ways than one!) and it looks like a cheap bandwagon to jump on.

She's calmed down a little bit. But she's still smiling...

[msmart]

Like you, I have several pairs of reading glasses strewn about the house.

Most of them have string holder/necklaces attached to them.

I hang them around my neck and reach for them as needed.

It looks fuddy duddyish, but greatly reduces my frustration!

[Nords]

Costco has a pretty good set of contract optometrists. They keep an appointment schedule but they're happy to spend extra time with you (they're getting their money from Costco as well as from you) and they're flexible about extra fitting sessions. $67 from TRICARE for the exam, $118 from me for the fitting, and another $165 for gas-permeable multifocals.

For you military veterans, this was my first eye exam in over 25 years where I didn't feel obligated to cheat. I could cheerfully admit that it was awful hard to tell the g*$%&^n green from the @#$%ing red without an accompanying argument about being able to determine relative motion, ship's running lights, and CPAs. I didn't have to memorize all the letters on the eyechart before I covered an eye, or have to argue with ignorant doctors about periscope diopter adjustments for those of us wearing corrective glasses. Turns out that those things have nothing to do with getting contact lenses, either.

Spouse is wearing the Boston Hallmark multifocal EO concentric lenses in both eyes. So I said that's what I wanted.

I had expected this to be like walking into a dealership, asking the sales staff how much car I could afford, and waiting for good things to happen. To my surprise the doctor tried to discourage me from gas permeables in favor of disposables. The concern was that I didn't "know" how to wear gas permeables and that I would give up and blame the doctor before I adapted. (Spouse has worn them for over 20 years.) It took a while to persuade a skeptical optometrist that I wasn't going to nickel & dime their process and that I wanted to fully test all choices so that I could stop wondering "What if...". (Or maybe the doc just got tired of listening to me.) I also learned that gas permeables are "extended wear", not "24/7" wear, no matter what you see your spouse doing. I almost got my spouse busted by the eye police but she says she'll easily convince the doctor that I was mistaken.

The doctor's concern with gas permeables was that I would wear them too long and change the shape of my eyeballs (I'm still not sure how this is a bad thing). It's not just O2 or infections but also a concern about becoming more nearsighted or farsighted (depending on the prescription). She also said that most people hate wearing gas permeables because they feel uncomfortable until you've built up a tolerance. She eventually found a nasty, scraped-up, gnarly old sample lens for me to try, and it became an endurance contest between my tear ducts flushing the rocks out of my eye and her judgment I allowed as how I could work up to it. With my repeated assurances she decided that she could accept my money.

If gas-permeable concentric multifocals don't work out for me, the next step would be soft-lens concentric multifocals (not approved for extended wear) or soft-lens monovision extended wear. (Technology hasn't yet figured out a way to make soft extended-wear multifocals.) My brain had an immediate reflexive negative reaction to the monovision setup but I'm told that it'll adapt.

Spouse has realized that she needs a stronger reading prescription. Either her eyes have changed in the last week or she's finally noticing that the contacts aren't strong enough, but she's going to move up from 1.75 to 2.00. Costco sounds like they're willing to exchange her lenses for no charge, but that's before they met me. We'll see how it goes.

My new lenses will be here in a couple weeks...

[Nords]

It's been an educational week. I'm one of those people whose sensory gain is tuned a little too high, and apparently that's not a good thing with contact lenses. I've also learned not to try these major lifestyle changes when I have a tax-filing deadline.

The doctor wasn't very interested in handing out hard lenses to a newbie, but I reassured her that I wanted to work through all the alternatives and this seemed to be the best option. I wasn't trying to be cheap and I'd give them a fair try. So she gave me exactly what I'd been asking for.

The other doctor who helped me insert them seemed surprised that I didn't immediately curl up on the floor in a fetal ball whimpering in pain, but he let me go. The "Aha!" moment was when I started the car, headed home, looked down to turn on the radio, and realized that I could actually SEE the radio. Gas-permeable lenses seem easy to put in & take out, which is ironic because because they can be worn for days. By the third day I was up over seven hours a day.

During those three days I became less aware of the edges of the lenses but my eyes still teared excessively. Every blink put a blurry film between the lens & eyeball that took a few seconds to drain/clear and the lenses would randomly migrate off my pupils. All that tearing flushed out the left lens twice and I never even saw it go the second time. I probably lost it doing yardwork but I couldn't tell that my vision had changed until I tried to focus on something close.

I kept waiting for the hard lenses (and my brain) to magically adapt to my eyes and make everything better, but it didn't happen in those three days. The prescription was a bit off as the distances were blurred (especially lights at night) and print was very blurry. (The doctors warn that they have to try two or three multifocal prescriptions to get it all correct.) At night I could actually see the translucent edges of the lenses in my peripheral vision. When I had the lenses out, my eyes were blurry for hours (overnight) from their residual orthokeratotic effect. Focus was so blurry that I couldn't even read with 2.00 glasses without also using a magnifying lens. The residual effects are a particular bummer because hard lenses are easily lost in the surf and I didn't want to have to deal with blurry vision while taking out the hard lenses in a parking lot before paddling out. I wasn't particularly happy with the whole experience but I figured I was being a wimp it was just part of the adaptive process.

As the doctor & I talked about my hard time he said that three days was long enough. Instead of replacing the lost lens he handed out a pair of soft lenses. They certainly feel more comfortable and they stay in better but they take some practice to insert & remove. On the second morning I tore the right lens trying to remove what I thought was an eyelash but what was actually a crumple from mangling the lens while removing it the night before. So this morning I'll call Costco and step up to the plate a third time.

The soft prescription still wasn't perfect and I couldn't read very well, but there were no residual effects of the hard lenses. The doctor says that my uncorrected distance vision is good so I may always feel that it's degraded by any contact lenses. Attempting to perfect the reading part of the prescription can also degrade distance vision, so it's a compromise. It's a bit more hassle to insert/remove them every day, but I can surf with them and it's probably less time than I spend juggling reading glasses. OTOH I'm not particularly patient with wrangling little pieces of plastic wrap onto my eyeballs, let alone with trying to determine whether I've twisted them inside-out.

Spouse never had any of these problems. She wore soft lenses for a couple years before stepping up to hard lenses (orthokeratotomy, the 1980s precursor to RPK/LASIK) and she's been hardcore for over two decades. She had a painless upgrade to gas-permeable hard multifocals but I might not ever share that experience.

Perhaps after a year or two of soft lenses I could give hard lenses another try. Maybe I'll get the soft prescription right on the third or fourth try or maybe not... at least the tax returns are done.

[Fireup2025]

Nords,

No matter what the topic of your posts, they are always a pleasure to read! No pertinent details left out! Good luck with your lenses!

Fireup

[enfp]

Though I'm not yet having the reading problem unless I want to read the date on a coin or thread a needle, I have had 25 years experience with contacts and a really bad experience to share. I was not faithful in taking out/cleaning my extended wear soft contacts. About a year and 1/2 ago, I got an eye infection that almost cost me my sight. Had it been a smidge closer to my cornea, I would have lost it. It was painful and awful. I have not put a contact back in my eye since. I don't trust myself to take them out and clean them, though I'd certainly know better this time. So, please follow what they tell you do to take care of them. good luck.

[clifp]

Lasik.. It changed my life. Now after 8 years, I do have a pair of reading glasses. But honestly, they are only for reading prescriptions in dim light or Oahu guide maps at night. I can read books, magazine in poor light with no trouble.

My vision situation completely mirrors your wife, so the 10 minutes after my Lasik surgery was one of the happiest moments of my life. Of the 6 people I know who've had the surgery only one my roommate had any complications and now her vision is fine.

I once was lost but now am found,
Was blind, but now, I see

[Janet H]

Nords - you'll get better at the soft lense routine.

I do the mono vision thing and use Bausch and Lomb 30 day soft lenses (taken out every night). It's a good compromise. The daily disposables are much thinner and hard to handle - also my personal experience is that the optics just aren't as good.

When I first started using a contact there was substantial entertainment value at the bathroom mirror for DH. It took me a few months to get really good at handling the lenses. I dropped em in the sink - turned them inside out, then right side out and they still felt wrong, then inside out again....

I found that the brand of lens solution made a big difference in personal comfort and affect tearing. In the last 2 years both brands I like have been recalled... but I persevere. Seeing well is worth the hassle. I hate wearing glasses - it's like looking through a window.

[Nords]

I hear you guys about the soft lenses, especially over the bathroom sink. It's been 48 hours with the second set and I'm cautiously optimistic. I'll see the optometrist next week for a final exam but this might be the winning combination.

They're a little stronger in the reading prescription so the distance vision is a bit blurry but "good enough". The dominant eye gets less correction (so it can still see distance) and the weaker eye gets the stronger reading-vision correction. When I look at the clear sky or a distant green tropical backdrop I can barely see the boundary between the lens's multifocal sector and its clear part, but otherwise it's not noticeable. I can see sharp out to about 50 feet. I can read the computer monitor without glasses, see what's on my dinner plate, scan the dashboard, and even handle 12-point printing. I can read a large-print book without reading glasses (hey, don't laugh, the library's large-print books have a lot fewer reservations!) but I still need 1.25s readers for the typical paperback or for the fine print on labels & paperwork.

Soft lenses are much more comfortable than hard gas-permeables. No tearing, no fatigue issues, no naptime problems, and still no residual blurriness when I take them out at night. The optometrist says he wears them when he's surfing, which sounds a lot better than dealing with lenses in the parking lot. (I'll personally verify that claim tomorrow or early next week.) I think the hassle is worth the benefit.

It's still hard to shove a sliver of plastic wrap under your eyelid. Like Janet it took me 20 minutes to get one lens in yesterday, but it went better today. By next week I hope I'm an expert.

This isn't the perfect solution but it's close enough. After a couple years of declining vision, just being able to read the computer monitor without glasses is huge. I probably shouldn't be surprised by how low my standards have sunk, but I can remember when I used to fuss over the slightest periscope/binocular adjustments and expect to be able to see everything from six inches to 10 miles with total clarity & focus. Now I'm just happy to be able to squeeze out most of the blur.

I'm starting to see local ads for "multifocal intra-ocular lens implants" like this one. Note the website's eagle-eyed ol' surfer geezer checking out the swells with his granddaughter hot chick snuggled up alongside. (You also have to appreciate the foresight, so to speak, of an ophthalmologist's website that includes a text-size button.) It all sounds great and I really want to believe but I can't help wondering if artificial flexible lenses are just too good to be true.

I guess I'll put up with soft contacts for a few more years or reconsider when the surfer's cataracts kick in...

[Nords]

Update.

Thanks again to everyone who contributed to this thread and the other two:
A rant for the presbyopic
LASIK for presbyopians?
Today I'm not much smarter but I'm a lot more experienced, and I appreciate the comments now more than ever before.

I've had soft 30-day multifocal contact lenses for over six months, and the habits I've developed are different than I anticipated. Before presbyopia I had nearly flawless vision, and I'm told that I'm unreasonable very particular about finding the right lenses to get back to that state.

First, the little buggers are tougher to put in and take out than I expected. It was a couple months of daily practice before I got proficient. The method I learned at the optometrist was too difficult for my Neanderthal forehead deep-set eyes and I finally found a better way on another contact-lens website. Then it took me a few more weeks to realize that, unlike hard lenses, soft lenses are never supposed to feel painful. I'd frequently roll under an edge as I was inserting the lens, feel the twinge in my eye, not realize that it was a problem, and just live with it. One day the lens slid off my eyeball, rolled up like a grain of rice, and actually trapped itself in my lower lid against my eyeball. I didn't find it until the next morning. But I eventually figured all of that out and it's fine now.

Second, multifocal lenses are an imperfect compromise between distance vision and reading vision. My left eye is 20/15 without the lens, but the lens has a "plastic wrap" feel that blurs my distance vision. I could no longer clearly see the mountain range 10 miles away, admire a nice bikini longboard from 100 feet, read a license plate from 50 feet, or even pick out smaller street signs before I got to the intersection. I tried a couple different prescriptions but there doesn't seem to be a solution to this acuity problem for multifocal lenses. When I had a prescription that could see "OK" for distance, I'd have trouble reading fine print. If I could read fine print then anything outside 40 feet would always be blurry.

Third, you can surf with soft contacts. Splashes are no problem and soft lenses will even stay on your eyes underwater for a few seconds. However it's a pain and I was always checking my eyes to make sure the lenses were still there. It's not much easier to remove/insert them in the parking lot, either, so I'd end up leaving them at the house.

Fourth, they were dry. I'd wake up from a nap with the lens literally stuck to my eyeball and have to wait for my tears to get going or squirt in solution. After 8-10 hours I'd generally be done for the day, and I never developed the stamina to go longer.

So this month I went back to the optometrist. We decided to ditch the Bausch&Lomb PureVision 30-day multifocals for an Acuvue Oasys 15-day monovision lens. No multifocals-- I just wear a 2.00 reading lens in my right eye and I don't wear anything in my left eye.

My left eye has always been very dominant and now I have my distance vision again. I can read street signs & license plates and see everything I want without the plastic-wrap effect. My brain hardly ever uses my right eye so I have to "force" the switch to reading vision. I can handle the computer monitor for a couple hours before my right eye gets tired. I can read for 20-30 minutes before I get tired, but when I add a pair of reading glasses then I can go all day. I’m told that this will get better as my brain learns to make the switch.

But already the nicest thing about having a reading-vision lens in my right eye is that I can immediately switch back & forth between distance & reading vision with no problems-- I can walk around the grocery store, see what I want at the end of the aisle, and read the fine print at the label all without having to squint or back off. I'm almost never fumbling for a pair of reading glasses.

The 15-day lens is a lot "wetter"-- no dryness or stuck eyeballs. It's also tinted slightly blue (instead of the perfectly clear multifocals) so I can actually see it in the lens case. It's no easier to insert/remove and I still wouldn't wear it surfing, but it's a lot less fuss to handle one blue lens in the parking lot.

In my case, multifocal lenses were a cure but not the cure. I didn't really pick up on monovision from reading the other posts, and I'll give these lenses another six months, but I'm surprised to learn that I already strongly prefer monovision over multifocals. (I'm never going back to hard lenses.) If I was confident that my presbyopia wouldn't get even worse, or if materials science developed a really really flexible artificial lens (maybe Restor already is), then I'd immediately have them LASIK my right eye or stick in an implant. If my lifestyle leads to cataracts then I'll choose to come out of the surgery with monovision.

The reality is that I take out the monovision lens every night and still put on my reading glasses every morning. I don't put in the lens until I'm going out, and if I'm staying around the house all day then I might never put in the lens at all. But being able to simultaneously read street signs and grocery-store labels is well worth the effort.

I'm a lot less grumpy about presbyopia than I was a year ago…

[Martha]

I have wondered how bad the presbyopia gets. I am up to a 3.00 on my reading lenses.