Melanie wrote:
I recently began swimming and want to wear corrective swimming goggles. My prescription is R (-2.75) L (-1.75/-1.50/77). In my city, I have not been able to find a retailer that sells swimming goggles corrected for astigmatism, nor are there any that sell individualized lenses.
My right eye is my dominant eye and a salesperson suggested to me that I just wear goggles that correct for my right eye and forget about the astigmatism in my left. I am thinking of purchasing a pair that is -2.50 (both eyes) because they only sell them in .50 increments. My questions are: 1) Will lack of correction for astigmatism have any adverse effects on my vision in my left eye? 2) Will the stronger correction for myopia in my left eye have any adverse effects?
I tried the goggles on, and I did notice the floor looking clear but slightly distorted and I thought that since the water will be moving anyway, it might not be a problem - I just want to be able to see the clock and not crash into the bulkhead without causing vision problems later.
Thank you.

ANSWER

Melanie,
To the best of my knowledge swimming goggles are not available with astigmatism correction.  The correction you are considering buying would work fine.  To answer your questions, neither the lack of astigmatism correction or stronger correction for myopia will have any adverse effects on your vision.  If you were wearing them for hours you may develop eyestrain or headaches, but there will be no long-term problems.  Of course you will not get perfect vision out of your left eye, but as you said it will give you sufficient vision while swimming.  The vision through the goggles may seem a little funny at first because you are accustomed to having your astigmatism corrected, but this should improve with time.  Happy swimming!

Dr. Doman

Ana wrote:
I tried contacts 5 years ago and I was told I am not a candidate. I went skiing on a stormy day and had trouble with fogged up glasses I am determined to have contact lenses. I set up an appointment and was told I am a special case - It is not the cornea but the lens itself has to be corrected.
Here is what I have (Glasses)
-0.75 -075 075
-1.00 -075 075
I was given this as trial contact lenses.
-0.50 -075 080
-1.00 -075 080
Apart from the discomfort (initial?!), I have poor vision with these lenses. Though I was told I have 20/20 with these lenses, it’s nowhere close to the quality of vision that I have with my glasses. I am very frustrated and disappointed and I need better visual acuity. I have another appointment in about a week, and I was asked to wear them 8 hours a day - at least.

What Should I do? I am a private pilot and active in sports - vision quality is very important for me. Are there ANY contact lenses in the world that fit me…

ANSWER

Dear Ana,
I see from your prescription that you have astigmatism. In order for your lenses to give you clear vision, they must be oriented perfectly in front of your eyes. This is quite easy to accomplish in a pair of eyeglass lenses, because the prescription lenses can be ground precisely to the optometrist’s prescriptions and then they can be cut to fit your eyeglass frame precisely. Once they are fixed in the frame, and the frame adjusted correctly, they do not rotate. As a result, you are always looking through your exact prescription at the perfect orientation.

It is more difficult, however, to design and fit contact lenses to remain perfectly oriented on the eye. This is usually accomplished by either adding extra bulk to the bottom of the lens so that it remains bottom side down (like the pendulum on a clock), or by thickening the sides of the lenses so that the lids tend to squeeze on the lenses when you blink, keeping the prescription oriented correctly. Both of these methods can work well, but perhaps not quite as well as fixing a pair of eyeglass lenses in front of your eyes because, when fitted correctly to protect the health of your cornea, the contact lenses must move slightly each time you blink. This very slight, and temporary, shift in lens position is noticeable to some carefully observing contact lens wearers. However, most patients with a prescription like yours can achieve a quality of vision with contact lenses that is close or equal to the quality of vision that they have with their glasses
There are a number of contact lens companies that produce astigmatism correcting contact lenses in a variety of curvatures, materials and designs. Depending on your prescription and the physical characteristics of your eyes, you may be successful with one type of lens, and not another. It may take more than one set of trial contact lenses to determine which particular contact lens is best suited to your needs. Your level of comfort may also be better with one design than another, but in almost all cases, comfort improves significantly after a period of adaptation.

I would encourage you to give the fitting process a little more time.

Hope this is helpful.
Dr. Henry Smit

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