Multifocal Contact Lenses

[davidbrady]

I gave up wearing soft contact lenses years ago because I didn't want to compromise my closeup vision. (Correcting my nearsightedness slightly diminishes my closeup vision). The idea of a nearsighted lens in one eye and a farsighted lens in the other never appealed to me. Today my optometrist suggested multifocal lenses. I have to say I'm impressed! With these lenses my closeup vision is sharp as ever and my faraway vision is good and with time getting better. Apparently I'm sampling the "simultaneous lens" which require a bit of brain adaptation. (I don't have the original containers so I can't say exactly what I'm using). I read online that with "simultaneous lens" the contact presents both nearsighted and farsighted portions of the lens to the pupil at the same time; the brain gets to choose which to look thru. Maybe someone can better explain this (Arcticdude?). With brain/vision adaptation I'm a little concerned about swapping between my eyeglasses and my contact lenses on a day over day basis; I'll let you know how it goes. So far so good!

[gondolaguy]

Interesting! Many years ago I decided to head to Canada to get lasik eye surgery to correct my severe near-sightedness. It was not yet approved in the US, but was done routinely in Canada. As one eye was astigmatic, there was a good chance the surgery would not be perfect, but the aim was to correct both eyes to 20/20 or better. It turned out, the astigmatic eye did not end up getting nearly the far sighted vision of my other eye and for weeks I felt cross eyed. Slowly, over time, my brain fully adjusted. The up side is that today they do this one eye far sighted, other eye near sighted on purpose. I'm 55 now and can see perfect far and near. Just lucky I guess.

[DOSZORROS]

David:

I find your comments very interesting. This is a comment from an analog man in a digital world.

I have worn glasses since my sub teens. I wore hard contacts many years ago and the vision was great but I had problems with the hard contacts. I was rodeoing at the time and lost one at a rodeo competition bareback bucking horse ride and overtrained and lost the other at a rodeo dance that night. It seemed like an appropriate time to quit the contacts and I have never tried today's soft contact because of the distance/closeup problems.

[Arcticdude]

All current mainstream soft multifocal contacts are a simultaneous design. You have both a distant image and a near relatively clear image presented to the retina, and thus the brain, at the same time. Your brain then decides which to "see". In a monofocal system, you also have the presentation of both images (a distant one and a near one), yet one is out of focus and thus easy to ignore. Think about being 30 years younger and looking out a window at a distant tree. The tree is in focus, so that's what your brain "sees". The window is still there, just way out of focus; so it's easy for your brain to ignore that image. Vice versa, the window is now clear and the tree is out of focus. It (the tree) hasn't disappeared, only gotten out of focus.

All the current mainstream soft multifocal contacts present both these images to your brain. Thus, it has to learn to now ignore a relatively clear image and "see" the other. That can take some time. One eye alone will be quite blurry! So DO NOT CLOSE ONE EYE AND COMPARE!!! That only reinforces to your brain that things are blurry!

Most of my multifocal patients can do rather well, but it takes some time. The first thing that should have been done was determining which eye is dominant. That eye should usually (but not always and never should have worse) have slightly better distance vision than the nondominant eye. Males are almost exclusively eye dominant as they are hand dominant. Meaning right handed, right eyed and left handed, left eyed. It's not 100%, but close. Women on the other hand are about 60% cross dominant. Right handed, left eyed and left handed and right eyed. The other 40% are right, right and left, left. Interestingly enough, this seems to onset at puberty.

As a side note, if your female significant other does shoot very well, have her swap hands. Your right handed can't hit the broadside of a barn may split pennies left handed (and left eyed)!

Anyway, back to the contacts. I find several things to keep in mind. First, your brain needs time to adjust, so don't sweat your vision with your first pair of lenses! You've got to teach your brain how to see again! Second, you're really trying for functional vision. You should be able to do 85-90% of what you normally do without readers or distance overcorrection. Third, ignore any numbers on the contacts and how they relate to what you had previously (unless those were also multifocals). The numbers can often be significantly different. Fourth, people with currently pretty good distance vision without correction probably won't like the multifocals! Don't waste your time or your do tkr's time unless you REALLY hate using readers. In a couple years, your distance will have degraded enough to get things to work. Just wait until then. Fifth, you can use readers or a distance over correcting pair of glasses whenever you need to over top of your multifocal contacts. It won't hurt it. Sixth, few people get truly 20/20 distance (or better) and truly 20/20 at near. And those that do probably won't have it next year. Your eyes are changing by the minute and sometimes you can "have it all" and sometimes you can't. Some years you'll see better than others. Seventh, there are no mainstream multifocals for patients with moderate to large amounts of astigmatism. Your only contact lens options are distance only with readers for near or monovision (one eye distance and one eye near- but see next point). Eighth, most multifocals only really give you 2 working distances. We currently really work at 3 distances- long distance, computer distance and reading distance. It's VERY rare to get all three really clear with either multifocal contacts or monovision. With only 2 eyes and 2 focus points, it just doesn't happen. You have to decide which distances are the most important and work on those. I have a patient that spends 10-12 hours a day doing paperwork and spreadsheets on the computer. They have excellent reading and computer vision with their multifocal contacts. They have a pair of glasses they out on to drive. Fortunately, we've been able to keep the same pair of glasses for 2 years now, but that may change this year.

There is not currently a multifocal lasik, only monovision. There ARE multifocal implants for cataract implants. We ALL will get cataracts, unless we die young. The is at least one focusing implant out there, which has the potential, with a little luck and good surgical skills, to get us seeing very well at distance and very well at near without any glasses! Time will get that better. Something to look forward to as we get older!!

That covers the absolute basics. Ask any questions you have, please.

---

I also forgot to add that some years some multifocal patients will see much better with monovision the the multifocals and vice versa. Keep an open mind, because its all about being functional without the need for readers and glasses most of the time. Whatever works at that point in time is what you get prescribed by me.

[RetDA]

Interesting discussion. I too wore glasses that became progressively thicker, then bifocals and finally trifocals. Early last year, my Optometrist said I had cataracts, but unfortunately they were not "ripe" for surgery. An ophthalmic surgeon friend of mine suggested that I go for a surgical exam, and relate that excessive glare, extremely diminished night vision was making it dangerous for me to drive, which indeed it was. Bingo! The surgeon said I could have my cataracts removed and suggested I go for the Lasix with the new technology lenses. I did and thanks to Uncle Sam, and Medicare Part B. I now see 20-20 in my right eye and 20-25 in my left eye. The out of pocket expense was less than what I would have had to pay for new glasses. Unbelievable, now I can see like the Good Lord intended, except sometimes I have to use $10.00 Wally World reading glasses when trying to read extremely small print.

For all my brother and sister senior citizens who are drawing their "entitlements" go see about having this done, especially if you are beginning to develop cataracts. You will not regret it.

[patticake]

I went through the same thing as Tommy. For the first time in over half a century, I don't have to wear glasses.

[RetDA]

(09-10-2013 10:30)patticake Wrote:  I went through the same thing as Tommy. For the first time in over half a century, I don't have to wear glasses.

It had gotten to the point to where cost of prescription glasses was as much a factor as improving my vision. Eye exams, new trifocal lenses, and sometime frames was escalating. Anywhere from $200.00 to $300.00 on up to $600.00 or more. But, the benefit of not having to wear glasses, priceless....I started wearing glasses in my mid-teens as well. Now I can see sweat on a frog's forehead at 100 yards. I still don't drive much at night (especially the bird) but I can if I want to - the glare is gone.

[pgchin]

Great thread and info!
I too wore eyeglasses starting in the 6th grade for distance, switched to soft contacts when they first came out and my doc asked it I wanted to be in a "trial", if successful, they were free! Had Lasik done in the mid 90's when motorcycling kept drying out my eyes and contacts so badly I could not see and glasses in the rain were NOT an option under a full face and shield. Presto 20-300 to 20/20. Yep love no glasses, EXCEPT sun glasses (oakley wraps)to protect the eyes in the Florida sun and elsewhere. Now at the ripe old age of 59, computer glasses for the screen and reading glasses for the books, so I come full circle and STILL wear glasses! David, good luck, let us know how you are doing.....John and others, thanks for sharing! FWIW still have 20/20 so the surgery was a great deal 20 years later and as others have stated!

My story is the "diaper" syndrome! You start off in diapers and if you are lucky enough to live a long and healthy life, you eventually wind up in diapers!

[Arcticdude]

Pete,

You could also trial the multifocal contacts, if you are bothered by the readers for the computer or reading. Yes, you will give up some of the crispness of your distance, but you could also give up the readers if successful. If you're not bothered by them, then I'd say stay with them. The multifocals can work beautifully for many, but you do "rob Peter to pay Paul", giving up some distance to gain the near. As I said earlier, it's "functional vision". You can function without glasses most of the time. At least that's my goal when fitting these.


It really comes down to what you brain will tolerate. If you a strong type A personality, especially about your vision; then you're probably not a good candidate for multifocal contacts. But if you're nearsighted (or were before surgery), then you can often do very well with them. Nearsighted people just don't see that gnat's butt a mile away like a farsighted person does. So the nearsighted do better with having some distance changes than the farsighted patients do in their early reader stages. Once the farsighted patients lose that crispness of distance, then they become equally as good a candidate for the multifocals.

This getting old stuff ain't for sissies!

[pgchin]

(09-10-2013 13:12)Arcticdude Wrote:  This getting old stuff ain't for sissies!

No Lie there John, seriously!!!!!!! Thanks for the suggestions, I actually never thought about it that way before and you make a very compelling case, so I sincerely thank you for the very sound advice. I do not ride that much anymore due to tinnitus and a "balance issue" so the dry contacts on the bike are no longer an issue so you really gave me something to think about and execute. I also have a "vision" plan that includes contacts or glasses annually and I am due in Q4 for my annual so I may try them. If I do, I'll update the thread so the community has feedback from both David and I to "chew on"! Thanks again!!!!! Man, no diapers again, hot diggity dog!!!!!
FWIW the glasses really do not bother me as I had them all my life however I really did love the contacts, that was cool back in the day so you definitely peaked my interest and gave me a new way to look at the problem! Also, based on your use case descriptions on who would be more successful, I fall into the more successful category, truly Thanks!
David, thanks for sharing and bringing this up, I love trying new things!