Vision Correcting Problems and Solutions

Eye-opening options in glasses, contact lenses, and even Lasik surgery.

Half a century ago unifocal and bifocal glasses were the only way to improve your vision. Today, the array of options could make your eyes spin. If you've been making the same choices for years, you may want to consider some of these noteworthy new developments:

    * Contact lenses that may be wearable around the clock for up to 30 days were recently approved by the Food and Drug Administration (FDA). These lenses may eliminate the daily cleanings that discourage many people from wearing contact lenses.
    * Contact lenses now offer just as many options as glasses for people who need help seeing both near and far. Those include bifocals, progressive lenses, and several other choices.
    * Glasses can be coated to prevent scratches, block ultraviolet light, or reduce reflections.
    * Laser eye surgery can now correct not only nearsightedness but also farsightedness and astigmatism, a vision-distorting irregularity in the surface of the cornea. But the procedure is not without risk (see box below).

Here's a concise guide to the new multiple choices for correcting routine vision problems.
A MONTH OF CONTACTS

Contact lenses have several potential advantages: They correct your vision everywhere you look, not just within the limits of your eyeglass frames; and they're less cumbersome and generally more attractive than glasses.

Of course, contacts are not suited for everyone. People whose eyes produce insufficient tears may find the lenses irritating. Workers in dusty, dirty environments may be unable to keep the lenses clean. Some people are allergic to the cleaning solutions. And contacts may be unsafe for people who have chronic eyelid infections or cornea problems. However, the most common obstacle is that many kinds of contacts have to be removed at the end of the day and either cleaned or discarded.

Extended-wear contacts, designed to be worn overnight and possibly for more than one day, have been available since the 1980s. But when you're asleep, your eyes produce and distribute fewer tears, which help fight infection by carrying oxygen to the corneas. Contact lenses left in overnight can aggravate the problem by blocking that flow of oxygen when your eyes are closed. So even the newer seven-day lenses, made of smaller, softer, more water-permeable materials, are more likely to cause corneal inflammation and infection than contacts that must be removed nightly.

To minimize the risk, seven-day lenses are often prescribed as daily lenses, with the understanding that users may leave them in for occasional situations, such as camping trips, when lens cleaning can be hard. (While there are permanent seven-day lenses, most should be thrown away after a week or two. Our informal survey of major Internet contact-lens stores indicates that a year's worth of the disposables costs about $180 to $415.)

Now manufacturers have created apparently much-improved extended-wear lenses. They're made of spongy plastics called silicone hydrogels, which transport five to seven times more oxygen-carrying water to the cornea than previous lenses could. Hydrogels may also make it harder for infection-causing bacteria, protein, and other foreign matter to collect on the lenses, a problem with many soft contacts.

Last fall, the FDA approved two brands of extended-wear soft hydrogel contact lenses that can be worn for up to 30 days and then discarded: Ciba Vision's Focus Night & Day lenses, and Bausch & Lomb's PureVision lenses (which had already been approved for seven-day wear in 1999). Each company submitted a large clinical trial comparing its 30-day hydrogel lens with a 7-day lens made of another water-permeable material. The two trials, involving a total of some 2,200 people, found that the 30-day lenses were no more likely than the other lenses to cause burning, inflammation, infection, ulceration, or other problems.

How those lenses will perform in everyday use remains to be determined. “Trials for FDA approval create an artificial situation with selected patients,” says Ira Udell, M.D., an ophthalmologist specializing in corneal diseases at Long Island Jewish Medical Center in New York. “The true test will come over time, when people like me, who see people with corneal ulcers, get a sense of how safe this is.” However, both lenses have already been widely used in other countries, and so far the complication rates do not seem to exceed those found in the studies.

Still, leaving any lens in overnight theoretically poses at least some increased risk of corneal problems. So if you decide to try wearing these or any other lenses for more than a day at a time, you need to be vigilant. Remove the lens promptly if your eye becomes uncomfortable, teary, or red; your eyelid gets inflamed; or your vision changes. And call your eye doctor if the problem worsens or doesn't clear up within two to five hours. When the problem can't be easily solved, many optometrists will exchange lenses for a different brand or strength within the first 30 days of wear. A years' worth of 30-day lenses (12 pairs) costs about $170 to $280.
DAILY-WEAR CONTACTS

For people who don't want to take a chance with extended-wear lenses, there are several options for wear during the day. (Costs listed below are for the lenses themselves, but most are sold as part of a package, which should include an eye exam, lens fittings, follow-up visits and instruction, and cleaning solutions.)

    * Nondisposable daily-wear soft lenses. Their ability to absorb water helps make them comfortable and less likely to pop out, and they transport more oxygen to the cornea. However, they're more fragile than rigid lenses, and more likely to soak up potentially irritating fumes as well as soap or hand lotion from your fingertips. The cost: About $45 to $80 a pair, plus the cost of cleaning solutions.
    * Rigid gas-permeable lenses. These take longer to get used to than soft lenses, but they give clearer vision and can be marked for right and left eyes. They don't rip or tear and they're less likely to absorb foreign matter. And they give the best results for people with astigmatism. They're harder than other contact lenses to fit properly, so the costs of the initial examination and fitting are higher. The lenses cost only about $65 to $100 a pair, plus cleaning costs.
    * Disposable soft lenses. These can be thrown away after one day's wear. But convenience comes at a price: $360 to $710 or more per year.

OTHER CONTACT OPTIONS

Contact lenses provide many options for people who have trouble seeing both near and far away. No single option works best for everyone, so if you don't like one type you can usually try another without additional cost. A year's supply of these lenses, which are generally disposable, can cost anywhere from about $160 to $775.

    * Bifocal contacts have two corrections, one for near vision and one for far. Since rigid gas-permeable lenses move around more than soft contacts, the rigid ones are weighted so that the near correction for reading stays on the bottom.
    * Progressive contact lenses have seamlessly connected sections for seeing not only up close and far away but also middle distances, such as your car speedometer or computer screen. It may take a few days or more to adjust to these lenses, and some people never do adjust.
    * Annular lenses alternate five concentric rings for near and far vision. “Your eye sees it and your brain sorts it out” says Douglas Becherer, O.D., current chairman of the American Optometry Association's contact and cornea section.
    * Monovision pairs two different lenses, one for near vision and one for distance. Usually within a few weeks, people who adjust to monovision no longer notice that they're wearing unmatched lenses. Unlike the other options, monovision can reduce depth perception, particularly in the middle distance.

What to look for in good glasses

In addition to bifocal, trifocal, and progressive lenses, the main choices in eyeglasses are the materials—glass and various plastics—and the coatings. First, here are the material choices:

    * Glass. Glass resists scratching; scratches scatter light, reducing clarity. Even though glass can be hardened, it still can break and injure the eyes, and it's heavy, particularly in big frames. A recent CONSUMER REPORTS survey indicates you can expect to pay about $65 to $75 for both lenses, excluding the cost of the frames.
    * Regular plastic. It's lighter and somewhat less breakable than glass, but it's thicker and more easily scratched. Some manufacturers include a scratch-resistant coating. The cost: about $65 per pair.
    * High-index plastic. Light and thin, this makes a slimmer lens for people who are nearsighted. Cost: about $115.
    * Polycarbonate. This plastic lens is the most impact-resistant, which makes it a good choice for children, athletes, and people with only one good eye. The cost: about $95.

Protective coatings offer yet another round of choices. Scratch-resistant and ultraviolet coatings generally cost an additional $15 to $20. Those protections are built into high-index and polycarbonate lenses, so if your eyeglasses will be made from either of those materials, you shouldn't be asked to pay extra money for the coatings. “If you are, someone is trying to rip you off,” says Nancy Kirsch, director for ophthalmic dispensing at the State University of New York College of Optometry.

    * Ultraviolet coatings. Exposure to ultraviolet (UV) light may increase the risk of cataracts and macular degeneration. Glasses with UV-resistant coatings may lessen that risk, particularly for people who spend a lot of time outdoors.
    * Scratch-resistant coatings. Since scratches are most often caused by careless cleaning, these coatings are useful for those who don't clean carefully.
    * Antireflective coatings. These lessen the glare around headlights; they also keep you from seeing an image reflected on the inner surface of the lenses. However, glasses with the coating need to be carefully cleaned, and the coating adds about $65 to the cost of the glasses.

The cheapest eyeglasses are nonprescription reading lenses, available in different strengths from a drugstore. If you do try these glasses, you'll still need regular eye exams to check for glaucoma and other diseases.
Summing up

When your eyesight needs correction, you have a growing number of choices:

    * Newly approved contact lenses can be worn for as long as 30 days, and several types of multifocal lenses can treat presbyopia (age-related difficulty with near vision). Remove any contact lens immediately if your eyes become red, sore, or teary. Call your doctor if the symptoms don't resolve within two to five hours.
    * New eyeglass lens materials resist breaking, while coatings can reduce scratching and protect against glare and ultraviolet light. But don't pay extra for built-in protection.
    * LASIK, the newest type of laser eye surgery, can free some people from eyeglasses or contacts. But you need to know its limitations and risks, whether you're a good candidate, and how to find a good surgeon (see box on page 6).
    * Even if you're legally blind or nearly so, new devices can enhance your remaining sight (see box below).

WHO DOES WHAT FOR YOUR EYES?

OPTICIANS are technicians who make and fit eyeglasses and, in some places, contact lenses, but who cannot prescribe eye care or diagnose diseases. Some but not all states license them after training or an apprenticeship. In the United States, most vision exams are given by OPTOMETRISTS, who earn a four-year doctor of optometry (O.D.) degree after graduating from college. Optometrists examine eyes, diagnose eye diseases, and prescribe glasses and contacts. In most states they are licensed to prescribe some medications for eye disease. An OPHTHALMOLOGIST is a physician—an M.D. or a D.O. (Doctor of Osteopathy)—who has several years of residency training in the diagnosis and treatment of eye diseases in addition to four years of medical school after college. Unlike optometrists, ophthalmologists can perform eye surgery.

LOW-VISION BOOSTERS

If eye disease has weakened your vision, special devices can maximize your remaining sight. Even if you're legally blind or close to it, you can find aids to help you see and learn ways to stay independent. Your local vision-advocacy group, such as Lighthouse international (800-829-0500), can steer you to vision rehabilitation specialists who can teach you coping strategies. The group can also tell you about special benefits your state may provide, and suggest helpful devices such as these:

    * OPTICAL AIDS. These include special eyeglasses with built-in telescopic, magnifying, or contrast-enhancing lenses, hand-held or stand-mounted magnifiers, glare filters, and even special cameras strapped to your head to convey images to the eyes.
    * THINGS THAT TALK. Spoken books are now available on CDs as well as tape. And special pill boxes have reminder beepers.
    * ENLARGED PRINT. Magazines, books, and certain newspapers come in large-type editions. Clocks, watches, calculators, telephones, and health-care devices such as scales and blood-pressure monitors can also be had in easier-to-read formats.
    * HOUSEHOLD HELPERS. Bright-colored light switches, lamps with magnifiers, and wallets with pockets for different denomination bills are all available.
    * CLOSED-CIRCUIT TELEVlSION. These project reading materials onto a screen, letting you adjust the contrast and print size. Because they enhance contrast, they are particularly helpful for reading newsprint.
    * COMPUTERS. These offer special software with magnified characters for spreadsheets, word processing, graphics, and other tasks. Programs translate spoken words into print so you can, in effect, dictate to your computer.
    * READING AND WRITING GUIDES. These are sheets of dull black paper, cardboard, or plastic with “windows” that let you focus on one line of text at a time or guide you in signing your name or writing checks. They can be store-bought or home-made.

Last updated Jan 4/07