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Vanity, thy name is Presbyopia, OR: What you should know about bifocal contact lensesAug 21 '01 (Updated Sep 01 '01) Write an essay on this topic.
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The Bottom Line Look for other alternatives to multifocal lenses. You'll be glad you did.
Ok I admit it. I’m vain. And when it comes to glasses, I am up there among the really narcissistic. I have worn corrective lenses for distance vision since the 6th grade—and if it wasn’t for a sneaky and highly suspicious school nurse, who somehow tricked me into a resounding failure of the annual elementary school eye test, I’d still be blissfully walking into walls all over New England. But I did in fact fail the test—which meant a succession of geeky glasses chosen personally by my parents for their obvious boy-repellant characteristics. The more I sulked and whined about ‘boys not making passes at girls wearing glasses’, the uglier the frames got. In order to get rid of whatever optical nightmare of the moment I happened to be wearing, I would have done just about anything, put up with almost any level of suffering (short of abject torture), willingly handed over the entire contents of my wallet in order to get perfect vision without glasses. To say I was thrilled beyond belief the day affordable contact lenses came onto the scene—and I could finally toss my geek glasses into the darkest recesses of my nightstand—would not be overstating the case. In a seemingly happy coincidence (at least as far as my vanity was concerned) I worked for a year at an Opticianry training school; this also allowed me to get major cost breaks on the latest in contact lens designs, provided I was willing to be an eye exam guinea pig for the students—which by the way, is not as painless as it sounds. Discounting the minor inconveniences associated with getting the more than occasional, painful poke in the eye from some academic-cellar-dwelling, "grunge-rocker-by-night, optician-in-training-by-day", I was livin’ large on the contact lens scene—and I got to try just about every type of lens design available at the time. Since then I have tried Hard, Soft, Rigid Gas Permeable, Hydrogel, Toric, Reusable, Disposable: you name it I’ve tried it. So listen and heed well the following information I am about to offer concerning bifocal contact lenses. I know whereof I speak because (in yet another delightful, vainglorious accident of fate) my current optometrist allowed me to try out—and keep—several different brands of bifocal contacts in exchange for offering myself up as—yep, you guessed it—a guinea pig for residents-in-training at the New England College of Optometry. If I actually get around to writing more reviews on this particular topic, I will tell you everything you need to know about other types of contact lenses; but this piece is for those of you who are sitting 5 feet away from your computer monitor--because if you sat any closer you wouldn’t be able to read the information I am about to impart. Presbyopia: Or, Objects in the Mirror May Appear Fuzzier Than They Are. Anybody over 35—and based on Boomer birth statistics, this is just about everyone—knows the signs of Presbyopia. As the lenses of our eyes age, they harden and become more rigid. The lens’s ciliary muscles, responsible for controlling up-close visual acuity, gradually lose their length, elasticity and flexibility, becoming less and less able to properly focus. (Think about the condition of the muscles in the rest of your middle aged body and you will understand exactly what I am talking about.) Soon (usually around the age of 40) you will have only two options from which to choose: 1. Lengthen your arms. (A somewhat costly and painful procedure that affords highly questionable results) 2. Break down and make an appointment with your eye doctor to inquire about the benefits of bifocal vision correction. This second choice is equally excruciating, but only because it damages the delicate “Boomer Psyche” more acutely than anything else—and because it means you are now officially the adult that friends from your “Once Upon A Time” youth used to warn you about. So now that you have received the official diagnosis, and your eye doctor has confirmed that your body has betrayed you yet again with another, in a continuing series of crushing midlife insults to your fragile, youth-obsessed ego, you are ready to make the last in the series of angst-ridden choices: Glasses or Contacts? Well, those silly little bifocal eyeglasses are out. You’re no fool. You won’t be caught dead wearing those things out in public. You might as well start sprouting a postmenopausal moustache to complement the fetching half-moon shape that is the bifocal lens. I mean your mother and father wear bifocals for goodness sakes. Accountants have their own particularly nasty iteration of the bifocal—worn specifically to express their disapproval over their clients’ wayward bookkeeping practices. [Poor Bob Crachit wears them through most of Dickens’, A Christmas Carol—and we know what an unhappy life he led—at least until such time as “the Ghost of Christmas to Come” paid his employer a visit, ultimately forcing him to give Crachit a raise so he could finally afford to buy a decent pair of progressive lenses.] Nosirree…not in your lifetime. So you’ve sensibly decided to continue trying to hide your ongoing midlife crisis by asking your eye care professional about the new bifocal contact lenses on the market. Fear not! You won’t be the only sneaky, soon-to-be middle-aged person out there asking. According to an ophthalmology website (whose name I regrettably cannot provide—because I would have to drop the piece of paper on which its name is written onto the floor in order to be able to read it) requests for information about bifocal vision correction without glasses is the number one topic of discussion between patients and eye care professionals today. Ever alert for new money-making opportunities, almost all of the manufacturers of contact lenses have risen to the occasion with the introduction of a stunning variety of bifocal lenses—which these manufacturers have helpfully renamed “Multifocal”—in part, I am sure, to help further reassure eager-to-be-deluded middle aged folk that they are in fact not really ancient after all—just “differently aged”. Based on my experience with 2 of the more commonly prescribed extended wear, soft contact lenses marketed for correction of presbyopia (Cibavision’s Focus Progressives and Johnson and Johnson’s Acuvue Multifocals) as well as one of the less common brands of soft contacts (Blanchard Labs’, Quattro Multifocal lenses), I can confidently state that these types of lenses share one thing in common: None of them work very well. This isn’t just my opinion, mind you. After throwing my hands up in frustration after the third unsuccessful series of fitting appointments, I finally asked my optometrist, (an esteemed member of the faculty at the New England College of Optometry), if I was the only person in the world having difficulty getting good vision correction with these types of lenses. In response, she offered the following insight, which I believe is critical to bear in mind when being fitted for multifocal contact lenses. “The Bifocal contact lens is a technology trying to catch up with the demand.” I think that this was a gracious way of saying that these manufacturers have a loooooong way to go before they can offer a lens that actually corrects Presbyopia. After trying out the 3 brands I mentioned, I discovered that I could get either decent distance vision or decent up-close vision—but not both. And none of the lenses sampled afforded me the overall excellence of vision provided by a well-fitted pair of eyeglasses. How Bifocal Contacts Work Most (but not all) bifocal contact lenses have a target-shaped, concentric visual field that contains various gradients of both near and far correction. The lens works…well it works like a pair of bifocal eyeglasses actually. Part of the lens will focus the eye on the up close stuff and part of the lens focuses on the far away stuff. As your eye moves and shifts direction, your eye’s own lens will naturally fall somewhere in the visual field of the contact most appropriate for the kind of work your eyes need to do at the time. This inclusion of both near and distance visual fields of varying strength all on one lens would seem to work really well…in theory. The problem with the design of bifocal lenses is that in actual practice it hardly ever works—and when it does it never works consistently. There are a lot of reasons for this, mostly involving a less-than-perfect fit of the lens (in which case, you will walk around blind and in pain most of the time) or a temporary change in the shape of the eye itself (through such things as swelling, dry eyes, fatigue, temporary eye irritation, etc.). NOTE: If after failing with Concentrics, you want to continue being a real glutton for punishment, ask your eye care provider about trying Aspherics (like Blanchard’s Quattros and Boston’s Multifocals) or Sectored lenses (Such as the Presbylite bifocal lenses manufactured by Netherlands-based maker ProCornea). They all offer multifocal fields—but their placement on the lens is a little different than that of the Concentrics. One pair of bifocal contacts I tried (the J&J Acuvues) gave me nearly perfect up close and distance vision—but only for a brief moment immediately after blinking. These lenses didn’t fit as well as others I had tried—but the act of blinking somehow placed them perfectly (albeit very briefly) into the proper position on my eye. Somehow the prospect of razor-sharp vision didn’t seem like an adequate tradeoff for the multitude of strange looks I would most assuredly get due to the madly rapid batting of my eyelids in a vain attempt to see. So what is the chronically middle aged person to do? Or: Desperation is the Real Mother of Invention Believe it or not, I’d suggest giving bifocal contacts a try—if only because of the infinitesimally small chance that some brand of lens, somehow, somewhere will be a perfect fit for you. Free samples of multifocal lenses appropriate for your eye abound. If you have an immensely patient eye care practitioner, he or she will be glad to order dozens of assorted “free trial” lenses specifically provided by the maker for contact lens fitting exams. Take them home and try them for a week. You may see some overall improvement in your vision after wearing the lenses for a few days. For example, my Quattro lenses actually improved my visual acuity over time—but “improved” did not mean “better”, at least in my case. Feel free to drive your practitioner crazy with outlandish contact lens requests, but—and this is very important—be sure to temper the excitement you feel over the prospect of throwing away your glasses forever with a healthy dollop of pragmatism. Attach the following set of admonitions to your multifocal search criteria: 1. Fit is important. If the lenses don’t fit, you must quit—or words to that effect. Your eye care practitioner wants your eyes to stay healthy: which means that just because your best friend’s cousin’s aunt’s girlfriend’s friend told you that “XYZ’s brand of bifocal lenses gave her the vision of an eagle doesn’t mean they will be right for you. Eyes are as unique as their owners—and although there is rarely such a thing as a perfectly fitted contact, badly fitted lenses can and do have the potential to cause serious injury to your eyes. Rely on the advice of your clinician to recommend what’s right for you—although you should absolutely feel free to ask about other lens brands and why they may be right or wrong for your eyes. 2. Comfort is important Don’t think for a minute you will wear a well-fitting but uncomfortable pair of lenses for very long—because you won’t—so don’t even think about wasting your time or money on a pair of lenses that continue to feel uncomfortable after the typical one-week break-in period. 3. “Improved Vision” is a relative term Most Ophthalmologists report that the happiest and most successful wearers of bifocal contact lenses share one common trait: They had lousy vision to start with. Most candid eye care clinicians will tell you upfront that those who report being the most satisfied with their multifocal contact lenses have visual acuity in excess of +.50 diopters. Unhappy multifocal patients (those with mild to moderate vision loss) can expect only a slight improvement in their vision. Some (like me) report “corrected” visual acuity that is actually worse than their uncorrected vision. My husband, whose uncorrected distance vision falls in the vicinity of 20/300 reported a much more positive experience (and better overall quality of vision) with multifocal lenses than I—although not positive enough to make him consider wearing the lenses full time. Which brings us to Point #4: With multifocal contact lenses, you will not under any circumstances experience the overall excellent visual clarity you presently experience with your eyeglasses. Even if by some miracle of chance you get sharp, clear vision in one field, the chances are almost 100% that your vision in the other field will be sub par. For example, with the Ciba lenses, I experienced exceptionally good distance vision—but for up close stuff I couldn’t hold the page far away enough to be able to read anything but the largest of print—which of course is the exact reason I needed bifocal contacts in the first place. Reading glasses worn in concert with contacts can bring wayward text into focus—but wasn’t throwing away your glasses the reason you looked into multifocal contact lenses in the first place? Right now, the cutting edge of vision technology lies on the bridge of your nose—with the same old pair of specs you slapped on your face when you rolled out of bed this morning. At present, eyeglasses are the best (reversible) option available for those who need or want the best possible vision they can get. But being the insufferably self-absorbed person that I am, I for one, was not willing to wait for the technology to catch up with my selfish need to look ten years younger than I actually am. I asked my eye care practitioner about Monovision—which, coincidentally enough, will be the subject of my next review. Until then: have a 20/20 day {Groan} Thanks for reading!  |
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