I am an active outdoor sport enthusiast and I suffer from extreme hyperopia.
I’ve had a lot of difficulty finding full coverage sunglasses or goggles with my prescription that aren’t too distorted or too magnified to prevent motion sickness. Over the past few years I’ve visited several good optometrists who have tried to find a solution without luck. We’ve tried many things, from 1.71 high index plastic aspheric to 1.60 polycarbonate and other lenses. As you know, many of these lenses are very expensive and each attempt to find a solution has left my optometrist almost as frustrated as me.

It’s clear that curved lenses, like those used in sport goggles or sunglasses work against plus prescriptions. Meaning the more curved the shape, the greater amount of distortion in the lens, especially the peripheral vision - this makes any kind of activity very disorienting. When I complained of this, they all wanted to heat the lenses and frames and bend them from curved to flat. This decreased the level of peripheral distortion but didn’t resolve it completely. This also left large sections around my eyes unprotected from the sun or snow, thus defeating the purpose of sport sunglasses. In addition, these lenses felt very magnified when wearing them, a feeling similar to holding binoculars up to your eyes and trying to drive
- very disorienting. I believe the extreme magnification issue to be related to the quality of the lens itself, as I’ve noticed a significant difference between 1.67 aspheric lenses in the same lens size between different manufacturers. It should be noted that for the most part, I can see quite sharply from all these lenses. That is to say, that in the doctor’s office, reading the vision chart, I can see very clearly, so the prescription is probably correct.

So, my question is what are we doing wrong? Perhaps there simply is not a reasonable solution to this issue - i.e. I can’t have my full prescription in a larger, curved sunglass lens. Which brings me to my next idea, which is to make the highest plus prescription possible in the lenses I want. For example, maybe we can only get a +3.00 or +2.50 in an aspheric lens without astigmatism correction to work without distortion. Why can’t I just get as much power as I can in the lenses that will work for me and squint through the rest? Now I don’t wear prescription lenses when skiing or bike riding - isn’t some correction better than no correction? I’ve tried to convince my many optometrists to do this, but they all have refused - in the end, they get stuck with the cost of making and remaking lenses that don’t work anyway.

Background:

I wear clear lens prescription glasses for my everyday tasks without any of these issues; no magnification problems and no peripheral distortion. These lenses are Seiko 1.67 aspheric with A/R. the lens size is 48mm x 28mm, in a frame with 18mm bridge, 135mm width (across the front) and they’re almost flat.

My current prescription:

+4.50 -0.25 180
+5.00 -2.00 180

FYI, I have had lots of difficulty with contact lenses as well - rotating on the eye, irritation, limited wearability, etc - I’ve spent 22 visits with the same doctor for an entire year for this. Not many good products are available in my correction. So, just wearing contacts under regular sunglasses has been tried without much success - and I am happy to outline the troubles I’ve had there as well if you like.

Any and all discussions are appreciated. Please don’t tell me that I just need to spend more time with a good doctor, I need good information so that I am informed well enough to help them help me. My wife is a doctor, so any complicated verbiage can be understood.

J. Evan

ANSWER:

Dear Mr/Mrs Evan

I understand your problem for which there is not a lot of solutions.
Considering that your needs are mainly for outdoors activities, I would strongly recommend the use of daily disposable contact lenses with UV protection (ACuvue 1-Day Moist) to correct the full amount of hyperopia on each eye. I know that last experiences with contact lenses were not successful but daily disposable are the most comfortable and convenient mode of wear. Each day you have a new lens, delivering enough oxygen to the cornea to maintain its healthy structure. The UV blocker of ACuvue is the better in the market covering over 99% of the rays.
THe problem of instability with contact lenses comes from your left eye which requires a specific correction for astigmatism. With daily disposable it is not possible to cover your prescription but considering that the hyperopia would be corrected, astigmatism could be easily incorporated in a pair of sunglasses.

If you ever decide to go on with contact lenses on a more permanent basis, with the newest designs on the market, toric lenses are nowadays stable than ever and can provide sharp and good vision. Again Acuvue is the leading lens with Oasys for Astigmatism, a 2-weeks disposable. That is an option also.

The last solution is surgical. If you are under 45-50 y.o. an implant can be placed on the surface of the iris, correcting for hyperopia. It is a safe procedure but you have to be referred to a good surgeon to perform it.
Astigmatism on the left side could be addressed by a LASIK (laser) surgery afterward. Hyperopia at your level is not treated effectively with lasers but astigmatism represents a day-to-day procedure.

If you are over 50, you can have a clear lens extraction procedure. This is a surgery similar to a cataract surgery, as easy as the latter is. The surgeon will replace the natural lens of the eye (cristalline lens) with an implant. Nowadays, toric implants are available and therefore you can compensate for both hyperopia and astigmatism with the same device. This is a permanent solution, safe and easily manageable by your optometrist who can make follow-ups of your condition in the future.

In summary, solution no.1 would be UV-protected daily disposable lenss with a pair of sunglasses correcting astigmatism on the left side; solution no. 2.
would be 2-weeks dispposable contact lenses correcting hyperopia astigmatism with a pair of regular sunglasses (without correction).

Other options are surgical and considered safe but still are more invasive. Some risk factors are involved and 1-2% of the cases can have to face post-op complications which are, for the most, manageable.

Dr Langis Michaud, O.D. M.SC. FAAO
Associate Professor - Un. de Montréal - École d’optométrie

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