All about Contact Lenses
All About Contact Lenses
Different styles of lenses available
The lenses I most frequently prescribe are disposable silicone hydrogel lenses. These are usually very easy to handle and to wear, and for many people, continuous wear (a month at a time without removal) is possible.
The amount of oxygen reaching your eyes is of paramount importance, and silicone hydrogels allow plenty of oxygen to most people's corneas.
Not everybody wants to wear their lenses while they sleep. For those who wish to remove their lenses overnight, we still often recommend the silicone hydrogel lenses, simply because the material is superior to most others.
There are plenty of other lens materials and styles available, and silicone hydrogels are not suitable for everybody.
Some people will be better off wearing rigid contact lenses, which are not disposable. Daily disposable lenses are available for those who like to wear their lenses on an infrequent basis.
Soft lenses are also available in non-disposable styles.
We prefer to prescribe the disposables for most people, simply because they have the best track record for avoidance of complications. Additionally, when torn or lost, disposable lenses can be replaced much more cost-effectively than custom lenses.
The price of contact lenses varies according to the material and style of the lens. Generally disposable lenses will cost anywhere between $1 and $3 per day, depending on what suits your eyes and lifestyle. An initial supply for silicone hydrogel lenses would typically be around $300 for a 6-month supply.
Custom-made soft or rigid lenses vary in price, depending on the supplier, material and design. Typically these lenses cost between $200 and $500 for a pair, and will usually last from 1 to 5 years.
There are lenses available which are specifically designed for people who have dry eyes. We don't usually use these as a first choice, because the oxygen permeability of the silicone hydrogels is better. However, if it becomes apparent that you have dry eyes and the silicone hydrogels are not comfortable, we would consider changing to the specialty dry-eye lenses.
With most styles of contact lenses, you can wear the lenses all day, from the very first day. Rigid lenses may need to be worn in more gradually, building up to all-day wear over a week to a month.
Continuous Wear
Many people can wear contact lenses that can be left in their eyes for a month at a time, without the need for overnight removal. This is an extremely convenient option for those with busy lifestyles.
If you are interested in these lenses, we will need to assess whether your eyes are suitable to wear them.
After an initial assessment and fitting appointment, I will ask you to wear the lenses for approximately 1 week on a "daily wear" basis. This means you will be taking them out every night, giving you plenty of practice in insertion and removal, and a gentle introduction to contact lens wear.
The next appointment is usually made for a Friday, as a prelude to your first overnight wear. At the Friday visit, fine-tuning adjustments can be made to your contact lenses if necessary, and you may have some questions or would like to discuss some issues about how the lenses behave in your day-to-day life. Typically this visit is relatively quick.
Next, I'd ask you to wear the lenses to bed, and return the following morning. I'd like to see you within 1 hour of waking up, so that I can assess whether your eyes are getting enough oxygen through the lenses overnight, and whether there is any entrapment of debris underneath the lenses. The assessment of these 2 factors is important in deciding whether the lenses are going to be suitable for overnight wear.
Assuming all is fine at this first early-morning visit, I'd ask you to leave the lenses in for a week and return the following Saturday morning for a repeat check. Both these checks should also be fairly quick.
Assuming all is fine at the 2nd early-morning visit, we repeat it a fortnight later. This 3rd early-morning check is a little longer, because there are a few more tests involved. At this visit, we will be deciding whether your eyes are suitable for long-term continuous wear. If they are, and if you'd like to go ahead with an order for contact lenses, the charges are $160 for the fitting fee, and approximately $300 for the initial supply of lenses (a six-month supply).
Following a successful trial, your supply of contact lenses should arrive within a few days, and I'd like to check your eyes every 3 months for the first 12 months. These aftercare checks are billed at $32.85, and $27.95 of that is refundable through Medicare. These no longer have to be early-morning visits.
If your trial is unsuccessful, or if you've simply changed your mind, there will be no charge for the contact lens trial.
After the first 12 months, aftercare visits are scheduled every 6 months.
Monovision
Monovision is when one of your eyes is focused for distance and the other for close tasks.
It is useful for people over 40, who have found that a single power no longer allows them to see clearly for both near and far.
Essentially, monovision is a bifocal system. Monovision sounds impossible in theory, because you would always have one "wrong" eye, whether you're looking at something in the distance or something closer. For approximately 10% of people, monovision is a dismal failure. The other 90% however, are surprised at how well it works. There are usually some compromises, but what usually happens is that your brain learns to "ignore" the "wrong" image, so that you are subconsciously concentrating on the eye which is correct for the task.
Normally I like to make your right eye your distance eye, as that seems more appropriate for driving (more happens on the right side of your field of view when you're driving).
Depth judgment is affected to varying degrees, and I ask you to be particularly careful when driving, especially when you're settling in with this new style of vision. Usually depth perception is not hampered sufficiently to be a practical problem, but for some people, this will be the reason that monovision must be discontinued.
Night driving problems are reported fairly frequently in otherwise successful monovision wearers. These may be addressed with certain strategies, or may mean that monovision is unsuccessful.
Computers may or may not be easy to see with monovision. This can depend upon your age, which dictates the flexibility of the natural lenses inside your eyes, and on how far away you normally have your screen.
If monovision doesn't work for you, you'll usually know about it within about 3 days. If, after 3 days, you still feel very conscious of one eye always being blurry, it's very unlikely to get any better. Having said that, it may just be that the powers need adjusting. Normally at this stage, I'd see whether the problem is a prescription issue, or whether it's just that monovision doesn't work for you. In the latter case, if you're still interested in contact lens wear, I would usually recommend you wear contact lenses for distance vision, combined with reading glasses over the top when required. In my experience, bifocal contact lenses offer more compromises than they're worth so we generally don't recommend them.
Insertion & Removal Techniques
To insert a contact lens:
Place the lens on the tip of the longest finger of your right hand. Ensure it's not inside-out (see Frequently Asked Questions: How Do I Tell If A Lens Is Inside-Out?). Put your left elbow in the air and use the longest finger of your left hand to wrench the upper eyelid out of the way. Pull the eyelid by the skin of the edge of the lid, not by the lashes themselves (they slip out too easily).
Use your right ring finger to anchor yourself on the lower lid, and pull it down, out of the way. Ensure you stay above the lashes.
Gently touch the lens onto the cornea. Take the right hand away when all the lens edges are touching the eye. Let go of the lower lid but hang onto the upper one with your left hand.
Look around a bit - up, down, left, right, to gently remove the air bubbles from underneath the lens. Now let go of the upper lid and blink.
The above procedure is for right-handed people; simply reverse if you are left-handed.
To remove a contact lens (for people with short fingernails - preferred for safety):
Use your right thumb and longest finger to fold the lens out of the eye. Grab it from the outer edges of the lens (on the white of your eye) at about the 3- and 9 o'clock positions. Fold firmly. You can use your left hand to move either the top or the bottom lid out of the way - whichever seems to work best for you.
To remove a contact lens (for people with long fingernails):
For the right eye, use your right hand - put the pad of your longest finger smack-bang in the middle of the lens and drag it down firmly, in one fluid motion. It will buckle in the lower cul-de-sac (space between the eyeball and the inner eyelid) and you can then pluck it off the edge of the lower eyelid. Repeat using the left hand for your left eye. Use the other hand to pull down on the lower lid so it's easier to get the lens out.
A Handy Hint:
If your lens is uncomfortable upon insertion, first look towards your nose with that eye, so that a whole pile of the white of your eye is showing on the "ear" side. With one finger, drag the lens towards your ear, then look towards the lens. This will recentre the lens, usually having dislodged the particle. If this doesn't work, do it again. If it fails to work the second time, take the lens out, check that it's not inside-out, rinse it and start again.
It's normal to feel clumsy and uncoordinated for about a week...don't let it get you down!
Hygiene
It is imperative that your hands are washed thoroughly before handling your contact lenses. We recommend Palmolive medicated pump pack soap, which is readily available in supermarkets.
Many other "antibacterial" soaps, particularly those in pump packs, contain cosmetic oils, which can contaminate your lenses and impair your vision.
For drying your hands, we recommend (practically) lint-free paper towels. These are no longer readily available in supermarkets; we have some in stock for $12/box - they're quite dear because we have to source them through medical suppliers. The use of paper towels minimizes contamination your hands may otherwise suffer, as a result of handling multi-use towels in the bathroom. The more lint-free the towels are, the less likely it is for you to have comfort problems on inserting your lenses.
Please don't ever soak your contact lenses in water or saline solution. Water contains bacteria and amoebae that can cause nasty infections and permanent sight problems, and saline solution is an ideal medium for growing bacteria.
Please don't ever lick your fingers or your lenses.
Aftercare Visits
If you wear your contact lenses fewer than 4 times per week, we like to ensure your eyes are checked at least once yearly.
For more frequent wearing schedules, once every 6 months is more appropriate.
For the first 12 months of continuous (day and night) contact lens wear, we prefer to see you every 3 months for the first year, then 6-monthly afterwards.
We do this to clarify that no early changes are occurring (some of which may not yet have caused symptoms) which are better addressed before they become troublesome for you.
Every 2 years we will combine your aftercare with non-contact-lens testing, such as a retinal check and a glaucoma test, as part of a "Comprehensive Consultation." These are billed at a higher rate, and again, most is refunded through Medicare.
To give your eyes the best chance of remaining healthy, it is the policy of this practice to withhold the supply of contact lenses if aftercare schedules have not been maintained.
Fitting & Fees
Before fitting contact lenses to your eyes, we need to ensure that they are suitable for contact lens wear. If you haven't had a full eye checkup within the last 2 years, this involves a consultation normally costing $65.65, of which you can expect to receive $55.85 back from Medicare.
Once the initial pre-assessment has been completed, and assuming your eyes are suitable for contact lenses, a fitting consultation can take place. This involves placing the lenses in your eyes, checking how well they fit, how comfortable they are, and how well you can see. We then progress to a lesson on insertion, removal, and lens care, and I'll ask you to return within a week or two to see whether any fine-tuning needs to be undertaken on the fitting, comfort or vision of your lenses.
On some occasions, the lenses we select for your first fitting will not be the final lens design. I may want to change the material, shape or power of the lens for optimum fitting, vision and comfort. For some patients, several return visits are required before the correct lens fitting can be determined.
Our fitting fee is $160 (or, if you have a corneal condition called keratoconus, $188.65). Most patients will not receive any of this back through Medicare. If you are eligible for a Medicare refund, Julie will advise you of this, and Jane and Kath can facilitate the refund process. Otherwise, the $160 charge is a flat fee, and is payable upon successful completion of the contact lens fitting process, or upon placement of an order for contact lenses.
The same fee applies whether your fitting requires only 2 visits or many more, and there are no charges for the trial lenses fitted.
When we are fitting disposable lenses, if at any time you elect to discontinue the fitting process, the fee is waived altogether.
As you can appreciate, there are "swings and roundabouts" involved here - for some of our patients, we spend a lot of time in the fitting process, only to discover that contact lenses simply aren't for them. Others are very straightforward, and the first pair we trial is the correct pair for them.
Once your fitting process (for disposable lenses) has been completed, the fitting fee is charged and we place an order for your lenses.
If the lenses are custom-made non-disposables, the fee is charged when the lenses are ordered, usually at the end of the first fitting appointment. Fine-tuning adjustments can still be made via warranty exchange orders, and if we discover that contact lenses are not going to work for you, a partial refund may be available on the lenses, depending on the supplier. Contact lens fitting fees in these cases are not refunded.
Once the fitting process has ended, we enter the "maintenance" phase, when Medicare becomes interested in your consultations again. Usually a contact lens aftercare appointment costs $32.85, and of this, you will receive $27.95 from Medicare as a refund. These aftercare appointments are usually performed every six months, except during the first year of continuous-wear (day and night) contact lens wear, in which case we like to check your eyes every three months.
Maintaining Your Supply of Lenses
If you're wearing disposables, you'll need your supply replenished from time to time. Where possible, we will estimate when this is likely to be, and will call or e-mail you to check that you'd like the new lenses ordered.
This is not always possible for various reasons, and if you need a new supply of lenses ordered, we ask that you contact us 5 working days before your previous supply has run out.
If you're having difficulty picking up your lenses, we have a phone credit card payment service and will happily post your lenses and receipt to you. We prefer to use Express Post, as unfortunately the "normal" post has occasionally taken two weeks to deliver to Brisbane addresses. The cost of Express Post is $7.70 per parcel, which we would add to your account.
Frequently Asked Questions
How do I tell if a lens is inside-out?
Place the lens onto your inserting finger. Look at its profile. If it looks cup-shaped (spherical), then it's the right way around. If its edges stick outwards a little, like a plate, it's inside-out. Often the difference can be subtle. Some lenses have words etched on them, which make it easier. If you're unsure if a lens is inside-out, flip it over and have a look the other way. Most of the time, contact lenses "like" to be the right way around, and will often show signs of resisting being made to go the wrong way.
What if a lens goes in my eye inside-out?
Sometimes it doesn't make any difference. Theoretically, your vision should be no different, and a lot of the time, the lens will also feel just as comfortable. Often though, an inside-out lens will feel uncomfortable and will be unstable. It may move around more on your eye and perhaps fall out. In a nutshell, if on some days you just can't tell which way is which (and we all have those days), pop it in and see how it feels. If it's fine, leave it in.
Can I wear the contact lenses when I go swimming?
We recommend that you wear goggles for swimming. This is to minimize the risk of your lenses becoming lost, and also to minimize the risk of microorganisms (bacteria and amoebae) becoming trapped underneath your contact lenses. Some of these can have devastating consequences (including blindness), so if you don't wear goggles for swimming, at least remove your lenses after the swim and give them a rinse with your disinfecting solution.
Can a contact lens get lost behind my eye?
No. They can go for a wander sometimes, usually when your eyes are overly wet or when you give your eyes a hard rub. Sometimes this results in your lenses moving just off to the side - usually this is easily resolved - simply cast your gaze in the direction of the lens, perhaps giving it a helping hand with your finger (through your lower eyelid if your hands aren't clean). Sometimes a wandering lens will move up underneath your upper eyelid. Look down as far as you can go and give it a gentle shove through the upper eyelid. If you can't see it, ask a friend to look at the top of your eyeball while you look as far down as you can. Feel free to pop in to the practice if you're concerned.
Can I rub my eyes while wearing contacts?
Yes, but it's best not to do it hard, or with the heel of your hand. Simply close your eye and rub gently through the upper eyelid.
Can I wear my prescription sunglasses over the contact lenses?
No. You'll need to wear non-prescription sunglasses. Contact lens wearers are usually a bit more sensitive to glare than when they're not wearing their contacts
Should I wear a lens that's been accidentally left out of solution?
Sometimes people think they've put a contact lens into its solution, only to discover it sitting, dried up, beside the case the next morning. This does tend to change the way it fits, and increases the risk of contamination. We would recommend throwing the lens away and starting afresh with a new one.
Can I sleep in my lenses?
Only if they've been specifically designed for overnight wear. Up to 1 hour (a "cat nap") is OK for most other lenses. If in doubt, call me at any time on 3368 3644.
What if the lenses go into the wrong eyes?
Sometimes it makes no difference. If your vision is blurry in one or both eyes though, you may have done this. Everybody does! Switch them over and see if this helps. If you wear monovision, check if you can see your watch with your "reading" (usually left) eye.
What if the lens doesn't feel comfortable when it goes in?
It's either inside-out, it's damaged, deposited, or it's got a bit of fluff underneath it. The tiniest bit of dust can feel like a brick when it's trapped under a contact lens.
If your lens is uncomfortable upon insertion, first look towards your nose with that eye, so that a whole pile of the white of your eye is showing on the "ear" side. With one finger, drag the lens towards your ear, then look towards the lens. This will recentre the lens, usually having dislodged the particle. If this doesn't work, do it again. If it fails to work the second time, take the lens out, check that it's not inside-out, rinse it and start again.
If the problem continues, let me know.
What if a disposable lens is torn before I even touch it?
Disposable lenses are manufactured in vast quantities. Some of them slip through the quality assurance net. If you come across a lens that's "just not right" - either torn while it's still in the sachet, or just never felt right or never gave you good vision, you have what we call a Dodgy Lens. Chuck it out, wear your next one and let us know. We'll replace it with a complimentary lens from our trial stock.
I use medicated eye drops. Can I still wear soft contact lenses?
Yes. Just ensure that when you're putting your eye drops in, your contact lenses are out of your eyes, and stay out for at least 5—10 minutes. Medications can soak into contact lenses and some can then cause continual stinging.
The same applies to certain over-the-counter eye drops (such as Visine), but lubricating drops (artificial tears, eg Refresh) are usually designed to be perfectly safe for use with contact lenses.
If you wear rigid lenses, you don't have to remove them when using any eye drops. Rigid lenses will not absorb medications.
What sort of deposits get onto contact lenses?
The main deposit we see on contact lenses is protein. This is a natural substance, which acts as an antibiotic in our tears. When it sticks to a contact lens, it goes hazy. It can be uncomfortable and blurry if it's significant, and sometimes people develop an inflammatory reaction in the lining of their upper eyelids if they have chronic protein deposition.
Oils from our hands, face and tears, and mucus from our tears, can both deposit on contact lenses. Occasionally calcium from our tears will deposit on contact lenses. The occasional rust speck happens too, as well as the odd bit of makeup.
Any deposit can cause irritation and blurriness. Keeping your eyes and lenses moist is one of the best ways of avoiding too much deposit formation. If deposits are a real problem, often the way we address them is to improve the moisture levels on the surface of your eyes - deposits find it harder to stick to wet contact lenses.
Do the days I don't wear the lenses "count"?
No. If you wear lenses every second day, "monthly" lenses will last for 2 months. If you wear the lenses for less than a full day though, it should be counted as a full day, as handling still accounts for lens degradation.
Why do I have to throw away the lenses? Can't I stretch them out a bit longer?
People who try to save a few dollars by wearing their monthly or fortnightly lenses for longer than they should are increasing their risk of sight-threatening complications. You can never get all of the deposits off contact lenses, which is why they must be discarded according to the manufacturer's directions. The invisible "biofilm" which builds up on even the cleanest-looking lenses can harbour sight-threatening bacteria.
What To Do If There's A Problem
Contact lenses are terrific and can really make a positive difference to your lifestyle. When they're looked after properly, your chances of suffering any complications are quite low. Complications (such as infections) can still happen to the most careful people though, and some of these have the potential to leave you with permanent sight problems. It's absolutely vital that you follow all instructions carefully, know how to recognize a problem, & know what to do about it.
If your eye is ever sore, red, light-sensitive or producing a discharge, remove the lens/es immediately and call us on 3368 3644.
If you have a complication such as an early ulceration, quick diagnosis and appropriate management is essential to maintaining good sight. Some complications can result in permanent vision problems, and immediate attention is your best defence against serious ulceration and scarring. Julie is qualified to prescribe eye medications and can address infections immediately for you.
After hours, phone calls are diverted to Julie's mobile phone and you are always welcome to call. If your eye is hurting at 3am, call at 3am. Please forgive Julie's husband if he answers the phone at this time.
