Silicone Contacts

**optilady1** · 11-29-2012, 09:21 AM

I've been trying to wear contacts again, after about 13 years away from them, other than the occasional dinner party. It's been very frustrating! I started wearing at 12, and never had any issues. After I switched from teching to selling glasses, I figured it would be best for my patients to see me wearing them as well, so I just quit wearing the contacts. Since then, silicone hydrogel became the next big thing, and I have also decided to correct the minor astig in my left eye. I have tried so many brands, I could probably open my own 1-800 contacts! I've got a very experienced fitter monitoring all the different lenses I've been trying, and while everything 'fits' well, when I find a brand that is comfortable, I can't see out of the toric lens at all (20/40-20/50 ish), or I get great vision but my toric lens kills me.

The big winner vision wise, is Biofinity. The sphere lens feels amazing, and the vision from the toric is fantastic, but the feeling of the left lens is horrible, only at the lower lid. My fitter says it's got good movement, good centration and it's lining up perfectly for the astig, but I feel like there is a piece of sand on the lid margin. I do seem to have a dryness issue, and I've been doing blink for contacts a few times a day.

Acuvue moist, oasys, ciba dailies aqua, Air optixs aqua all have been dreadfull. Within one hour of wearing them, I feel like I have a gummy piece of rubber in my eyes.

Extreem H20's have been good feeling, and the sphere is again, great vision, but I can't see out of the Toric.

Any idea's? I know it's hard to make an suggestions without seeing my eyeball. Are there people who don't tolerate silicone? I've never noticed that I have an allergy, not that I know for sure. Can someone be such a sensitive pain in the butt that they notice the axis indicator on a lens? Could I have some weird princess and the pea syndrome? I don't want to just give up, it seems like I should be able to get a decent fit. I've been pestering my fitter for a while, and though she shows no signs of growing annoyed at me, I would like some ideas from those who have any additional knowledge.

Thanks in advance,

**wmcdonald** · 11-29-2012, 09:44 AM

This is not unusual, and should resolve on its own. Patients often complain of this sand-paper feel with SiHy lenses, because of the modulus. Time usually takes care of the issue, and the increased O2 makes it worth the effort. I wish you good luck with these lenses. I am a fan of Biofinity as well.

**ADO** · 11-29-2012, 09:48 AM

It looks like everything you have tried has been pulled out of a box. This means you are dealing with the set paramters of those lenses and you may be just sensitive enough that you are not finding the right combination of RX and comfort. You may want to try a contact lens that is custom made just for you. This gives you the ability to define all of the parameters you need. I would recommend calling Pam Lecroy at X-Cel Contancts (770-709-3338). She can help your fitter determine what parameters will give you the best opportunity for success. Good luck!

**cmarx** · 11-29-2012, 09:52 AM

This may seem silly and something you've already looked for but I'm wondering if you have any lid issues or pannus? Also what solution are you using, we find that the Biotrue helps many patients. IF you were allergic to the materials both eyes would be a problem not just the toric. Have you had topography done ? That might give you an idea as well. Just soem thoughts.

**optilady1** · 11-29-2012, 09:58 AM

You're right, I have been only trying contacts 'en-mass', lol. I have this preconceived notion that people who complain about something that shouldn't be a problem are nuts, so my brain tells me I'm crazy and shouldn't be having any problems. It probably comes from the fact that my mother has thought she has had, cancer, tumers, scleroderma, west nile, the plague, mercury poisoning, and any other disease 60 minutes or Dr. Oz talks about. It just seems since I was very successful in the past, and since I'm not old enought to have the desert conditions that come with women and menopause, that a normal lens should work.

**optilady1** · 11-29-2012, 10:05 AM

I've been using clear care for disinfecting, although some days it doesn't matter since I can't make it through a whole day with one specific lens. I've never tried bio true, so that's a thought. I've never had topography done. One of my Md's thinks I should do punctal plugs. She did some temporary ones two weeks ago, and it seems to have helped. But at the last CEC's I went to, the contact lens speaker said that patients my age shouldn't have trouble with dryness.

I'm sorry, I feel like I sound like the biggest whiner ever!

**NYSOPT** · 11-29-2012, 10:13 AM

Hi Annie,

I very recently began working for Safigel. Check it out...it is a daily disposable...great comfort and great vision. Not available in a toric right now. Only available through ECP's, so it is a great business option as well as a great clinical option for patients that have dropped out of wearing CL's or are limiting their wearing time. The lens has Sodium Hyaluronate (same compound found in Blink rewetting drops) incorporated into the matrix of the lens and creates a slow release of a dry eye drop all day long.

Good luck, I hope it works for you.

Safigel.com

**jmainwar** · 11-29-2012, 05:35 PM

We have just started using Waveform Individualized soft contacts, http://www.waveformlenses.com/html/t...ogy/wfgcl.html with good success.

You can give them a call at 877-928-3676 and they should be able to see if their is a provider in your area.

**uncut** · 11-29-2012, 05:41 PM

Originally Posted by optilady1

I've been using clear care for disinfecting, although some days it doesn't matter since I can't make it through a whole day with one specific lens. I've never tried bio true, so that's a thought. I've never had topography done. One of my Md's thinks I should do punctal plugs. She did some temporary ones two weeks ago, and it seems to have helped. But at the last CEC's I went to, the contact lens speaker said that patients my age shouldn't have trouble with dryness.

I'm sorry, I feel like I sound like the biggest whiner ever!

You are correct in complaining......don't stop. Perhaps some corporate contact lens manufacturer's light bulb will come on! They might actually pay attention!

You used clearcare, and what else? Any saline for rinse/insertion?

**optilady1** · 11-29-2012, 10:14 PM

The newest optifree

**OHPNTZ** · 11-29-2012, 10:28 PM

There is alot of info that you have neglected to provide or analyze:

What is your rx?
What are your K readings?
Is your astigmatism corneal or lenticular?
What is your corneal diameter?
What type of dry eye?

Forget the age and dry eye comment...nonsense. You can have dry eye at any age. I've suffered since early 20's...

I also don't think you will have better success with a multipurpose solution. Manual rubbing of the lenses and hydrogen peroxide cleaning are really hard to beat....

**fjpod** · 11-30-2012, 04:23 AM

I have mixed feelings about SiHy lenses. Many patients feel they are not quite as comfortable as say, Acuvue 2, yet they give improved oxygyn...but oxygyn isn't everything. I have had some good success lately with Acuvue Advance Plus over Oasys.

While I have been a fan of Clear Care in the past when lenses were a) kept longer, and b) older multi-purpose solutions were more toxic to ocular surfaces, today I think there is very limited need for it. In fact, I think clear Care is not the best solution for SiHy in that it does not "cushion" the lens.

**uncut** · 11-30-2012, 07:45 AM

Good sage advice, from fjpod....Try old Aosept(no trial kits available, in Canada, anyway). Find aerosol saline(Blairex) in U.S., I think. This will eliminate any possible influence of chemicals. Find a toric that works first. I did not see the Proclear, or many of the Cooper products on your try list, Optilady.

**uncut** · 11-30-2012, 07:59 AM

The biggest comfort faux pas the manufacturers are making is the one size fits all, oxygen is everything, and people will tolerate a molded lens edge.....corporate philosophy.
You can supply oodles of oxygen, coat and molecularly realign your silicon..........you still have a lump of coal in some people's eyes.

Optilady, if you possibly wore B&L lenses a few years back, your eye certainly remembers the beautifully thin feeling, and invisible appearance of those lenses.

Mission: Find a toric, that is both comfortable and visually accurate, match the sphere to it, both in base curve, diameter, and material.

**OHPNTZ** · 11-30-2012, 09:57 AM

Originally Posted by fjpod

I have mixed feelings about SiHy lenses. Many patients feel they are not quite as comfortable as say, Acuvue 2, yet they give improved oxygyn...but oxygyn isn't everything. I have had some good success lately with Acuvue Advance Plus over Oasys.

While I have been a fan of Clear Care in the past when lenses were a) kept longer, and b) older multi-purpose solutions were more toxic to ocular surfaces, today I think there is very limited need for it. In fact, I think clear Care is not the best solution for SiHy in that it does not "cushion" the lens.

I say no way on Acuvue 2 being more comfortable , especially for dry eye. Do a monocular trial on 20 patients, if the majority take Acuvue 2, you can call me crazy...

Try it on yourself. I think most balk because of price.

For the original poster, PM me your info if you want...

**fjpod** · 11-30-2012, 01:19 PM

Originally Posted by OHPNTZ

I say no way on Acuvue 2 being more comfortable , especially for dry eye. Do a monocular trial on 20 patients, if the majority take Acuvue 2, you can call me crazy...

Try it on yourself. I think most balk because of price.

For the original poster, PM me your info if you want...

Would you like a list of names of my ACV2 wearers that ultimately rejected Oasys?

**optilady1** · 11-30-2012, 01:33 PM

Originally Posted by uncut

The biggest comfort faux pas the manufacturers are making is the one size fits all, oxygen is everything, and people will tolerate a molded lens edge.....corporate philosophy.
You can supply oodles of oxygen, coat and molecularly realign your silicon..........you still have a lump of coal in some people's eyes.

Optilady, if you possibly wore B&L lenses a few years back, your eye certainly remembers the beautifully thin feeling, and invisible appearance of those lenses.

Mission: Find a toric, that is both comfortable and visually accurate, match the sphere to it, both in base curve, diameter, and material.

This made me chuckle, because I do remember about 5 years ago I did try a B&L, I want to say it was the soft lens 38? Or the FW? It did feel like there was nothing there. The biggest problem with the lens was it stuck together. Like fused itself if it folded, and would rip if you tried to separate. The biggest problem with being an optician and having check ups or fittings are sometimes the charting falls to the wayside.

I feel like I'm insane, because I would hate me as a patient. Yesterday I found an extra biofinity, and just put the sphere in my left eye because I couldn't take it anymore. Of course, the comfort was great, but I was a little off in the VA.

Here's my RX:
-3.00
-3.00 -.75 x 85

I know from optical school that my right eye is a perfect sphere, but I don't remember what the numbers were. I know my left has corneal astig.
As for dry eye, I don't feel like it's a problem during the day with my glasses on, but I can blow my eyes out with all the reading I do. I take my contacts of when I get home, Haven't slept in them since an extreemly drunk navy ball night. Ah! Gotta go, them darn patients!

**uncut** · 11-30-2012, 11:32 PM

That's a small amount of cyl......and becomes questionable whether a toric is worth the physical difference. Eyes tend to react sympathetically, so, opt to fit both eyes with a toric, or the one eye will tend to notice the difference in lens textures.

I didn't notice the Proclear(Cooper) toric on your list of "tried....but failed". I would also try a sphere Proclear, and check the residual cyl....the result might be that most of the corneal cyl is masked.

**OHPNTZ** · 12-01-2012, 12:23 AM

Originally Posted by fjpod

Would you like a list of names of my ACV2 wearers that ultimately rejected Oasys?

Have you personally tried a monocular trial? Try it on your staff, or even have Optiboarders here try it...

Why fit the AV2 anyways? At this day and age there are many more contacts out that can provide either better comfort or higher oxygen or both. Plus why fit a lens that can go to Walmart and get for probably less than you can purchase it?

**OHPNTZ** · 12-01-2012, 12:32 AM

Again, what are your K readings?

The slightly flatter BC and larger diameter of the toric Biofinity is what you may be noticing... Since you like the Biofinity, you may want to try the Avaira since it has a different base curve.

Also, with against the rule astigmatism, you really do need a toric. A sphere will not cut it.

**fjpod** · 12-01-2012, 08:02 AM

Originally Posted by OHPNTZ

Have you personally tried a monocular trial? Try it on your staff, or even have Optiboarders here try it...

Why fit the AV2 anyways? At this day and age there are many more contacts out that can provide either better comfort or higher oxygen or both. Plus why fit a lens that can go to Walmart and get for probably less than you can purchase it?

Who said I was fitting ACV2? Years ago, I fit a lot of them. When you try to move a patient out of a lens that they are doing really well with, and they have no symptoms with, you WILL have some failures, even if the new lens gives three times more oxygen. And I don't usually fit a certain type of lens simply based on my profit margin.

**OHPNTZ** · 12-01-2012, 12:26 PM

Originally Posted by fjpod

Who said I was fitting ACV2? Years ago, I fit a lot of them. When you try to move a patient out of a lens that they are doing really well with, and they have no symptoms with, you WILL have some failures, even if the new lens gives three times more oxygen. And I don't usually fit a certain type of lens simply based on my profit margin.

Assumed you were based on your "list" of av2 wearers...

No biggie... So may I ask what your top 3 go to contact lenses are for dry eye patients? What solution or rewetting drops work for you?

**fjpod** · 12-01-2012, 01:02 PM

ah, now you want my trade secrets....

One days, one days, one days. No solutions. IMHO, the best is ACVTruEye, second,Acuvue one day moist.

I never was a fan of Cooper, Proclear, Biofinity or Ciba. Nothing to do with politics, just lens performance as reported by patients. Not based on what manufacturer's claim.

**Fezz** · 12-01-2012, 01:37 PM

Gas perm!

**optilady1** · 12-01-2012, 10:34 PM

Originally Posted by fjpod

ah, now you want my trade secrets....

One days, one days, one days. No solutions. IMHO, the best is ACVTruEye, second,Acuvue one day moist.

I never was a fan of Cooper, Proclear, Biofinity or Ciba. Nothing to do with politics, just lens performance as reported by patients. Not based on what manufacturer's claim.

I couldn't wear the one day moist for more than a few hours. I felt like I had a cloudy foggy piece of rubber in my eyes. I haven't tried true eyes in a long time but dont remember what they felt like.