The invention of eyeglasses made it possible for millions of people to see the world clearly. The invention of contact lenses—corrective lenses placed directly on the eyes—made it possible for them to do so without anyone knowing that they need any help in seeing clearly.
Opinions about contact lenses vary widely. They've been hailed as a major improvement over glasses; they've also been derided as merely an ego-gratifying cosmetic device. Actually, the truth is somewhere in the middle, although its position shifts slightly with each person who wears contact lenses because each person's needs are different.
As he did with glasses, Leonardo da Vinci also gets credit for creating the contact lenses concept. It developed out of his discovery, in 1508, that when he stuck his head in a large bowl of water, the pressure of the liquid pressing against his eyes cleared his distorted vision. While it was not one of his more practical discoveries (at least not at the time), he recorded his observations in one of his notebooks.
Some 300 years later, English physicist Thomas Young replaced the bowl of water with a water-filled tube and placed a lens at one end of it. He got a sharp image, and it was a more practical discovery than Leonardo's—but not by much. It wasn't until the 1940s that someone came up with a true contact lens that really worked.
Those early lenses were made of glass and covered the entire front surface of the eye. Although they did sharpen vision, they were so uncomfortable that people couldn't stand wearing them for more than a few hours.
The second generation of contact lenses arrived in the late 1940s and early 1950s. Designed to fit on top of the cornea, they were smaller, rounder, and made out of plastic. While they did produce reasonably good vision for many people, they moved up and down with each blink, were uncomfortable, and could be worn only a limited number of hours a day. If the irritation or pain didn't tell the wearer when it was time to remove them, blurry vision did.
Perfecting the Modern Lens
During the 1950s and 1960s, researchers tried different materials to make contact lenses more comfortable and also redesigned the lenses by tapering and smoothing the edges.
Doctors and contact lens makers finally figured out that while large and heavy lenses caused eye and eyelid irritation, the major source of eye pain from wearing contact lenses was oxygen starvation. The lenses were blocking the normal supply of air to the cornea. And the less air the cornea received, the more pain it generated.
As they continued their investigations, researchers also learned that small amounts of oxygen are normally dissolved in tears. Because the cornea is constantly lubricated by tears, and since contact lenses actually float on a thin layer of tears, they reasoned that the best way to ease the discomfort would be to find a way to let more tears come into contact with the cornea.
What they had to come up with was a small, smooth, lightweight lens that would not block off the cornea's oxygen supply. And they succeeded. But just as there is no one pair of eyeglasses that will serve everyone's needs, there is no one perfect contact lens. Instead, we now have a wide selection to choose from, all designed for different needs.
Who Wears Contacts?
More than 20 million Americans wear contact lenses, according to eye care industry statistics. Nearly 70 percent of them are women. By comparison, more than 114 million Americans wear glasses.
Due to increased problems with infections and the resulting bad publicity, the number of contact lens wearers has actually declined since 1984, when nearly 25 million Americans wore lenses.
Of those wearing contact lenses today, nearly 12 million wear soft daily-wear lenses; 4 million wear rigid gas-permeable lenses; 3.5 million wear soft extended-wear lenses; and 1.5 million wear hard lenses.
The cosmetic benefit of not having to wear glasses as well as improved self-image and self-confidence are the most common reasons people give for switching to contact lenses, according to Bausch & Lomb, a leading eye care products manufacturer.
The company says there are also ten other frequently mentioned benefits.
Hard Lenses
Hard contact lenses correct vision in two ways.
Hard contact lenses can correct nearsightedness, farsightedness, and astigmatism. They can also correct vision in an eye that has had a cataract operation.
They may also take months of getting used to. At first, wearers feel as if they have small pebbles in their eyes. After several weeks or months, they may begin to adapt to the discomfort. But not all do.
Try This Wake-Up Warm-Up for Your Eyes
Don't put your contact lenses in as soon as you wake up. Let your eyes "breathe" for an hour first.
Consider this a form of warm-up exercise.
In the same way that doing a series of stretches and warm-ups before a workout loosens up your body and reduces the chance of muscle aches, giving your eyes an hour to adjust to being up, open, and focused will reduce the chance of discomfort.
Whether or not you wear your glasses during that hour is up to you. The important thing is to give your eyes a chance to wake up. Besides, for most of us, having the world slightly out of focus from time to time helps us keep it and our place in it in proper perspective.
Soft Lenses
In the late 1950s, Otto Wichterle, a Czech doctor, introduced a new soft, flexible, and water-absorbing plastic material for making contact lenses-2-hydroxyethyl methacrylate. Lenses made from the new material and its derivatives contain between 25 and 75 percent water. The water can come either from the wearer's normal tears or from the solution the lenses are stored in.
Like hard contact lenses, the soft lenses also float on a layer of tears. But they are flexible and larger, and they let the cornea breathe more normally.
The larger diameter means that the top and bottom edges remain underneath the eyelids as long as the lenses are in the eyes. Thus there is less edge for the eyelid to rub against every time the wearer blinks.
All of these qualities add up to more comfort.
Unlike hard lenses, which require weeks or even months of limited daily use to build up "wearing time," soft lenses are often comfortable the first time they are put in. People typically say that they can feel their soft lenses at the start, but add that the sensation is not an uncomfortable one. After a few weeks of wearing soft lenses all day every day, most wearers barely notice them at all. No wonder millions of people have traded in their glasses for two tiny, flexible disks.
Extended-Wear Lenses
The next logical development after a soft contact lens that could be worn comfortably all day was a soft contact lens that could be worn comfortably all day and all night, and all day and all night, and so on.
Researchers knew that such a lens would have to be thinner than a regular soft contact lens, have a higher water content, and allow even more oxygen to pass through its surface.
When extended-wear lenses were first introduced in the mid-1970s amid suitable hope, hype, and fanfare, millions of contact lens wearers wanted to try them. The promise of being able to trade those old put-in-take-out-and-clean-every-day contacts for new lenses that could be worn for weeks at a time was hailed as the next best thing to being able to trade old eyes for new.
The celebrating was both enthusiastic and premature. Yes, the new lenses were comfortable, extremely comfortable. They could be left in the eyes for long periods of time without causing any discomfort. And that led to new problems.
Because they were in the eyes for such long periods, any debris that found its way into the tears—such as dirt and natural mineral deposits—wound up on the lens. While some of these deposits could be cleaned off, there was usually some residue left. But even if it could all be removed, that still required taking the lens out more often than many people wanted to.
If they had to take them out all the time, they asked, what was the point of having them?
That was only one problem. The next one was more serious—infections. More and more people got them.
Why?
Like the rest of our body, the human eye is a complex combination of parts, pieces, chemicals, and compounds operating in perfect balance. Change the balance, and ... well, it's like those old jokes that all end with the punch line: "It's not nice to try to fool Mother Nature."
The eye "knows" when something isn't in perfect balance. It knows when there is a foreign object there. No matter how good a contact lens is for vision, it is not a natural part of the eye. Its very presence can disturb the delicate balance of microbes in and around the eye. And the constant rubbing of the lens can make the cornea susceptible to bacteria.
Not everyone who wears extended-wear contact lenses is destined to develop a corneal infection. But those who do may be left with scarred corneas and decreased vision. Such episodes can, on occasion, even lead to blindness. That's why learning how to wear contact lenses is only part of the process. Learning when not to wear them, and when to call your doctor about signs and symptoms, is equally important.
If there is any pain, redness, or decreased vision, check with your eye doctor.
No matter what you may have heard, a month of continuous wear without cleaning the lenses is too much. Remove the lenses at least one night a week and give them a good cleaning and disinfecting. Then leave them out overnight. A good cleaning will be almost as beneficial for your lenses as not wearing them for one night will be for your corneas.
If you can wear daily lenses, they may be better for your eyes in the long run than extended-wear lenses. But if extended-wear lenses are the only ones you can comfortably wear, you might consider taking them out each night anyway and treating them like daily-wear lenses.
A Nasty Reaction to Dirty Lenses
Giant papillary conjunctivitis (GPC) is an irritative and possibly allergic reaction to the gunk your contact lenses collect.
Most commonly found in people wearing soft or extended-wear lenses, GPC develops because the material used in those types of lenses tends to attract protein and other foreign material more easily than hard or gas-permeable lenses do. While people wearing the latter types of lenses can also get GPC, their odds of avoiding it are better.
GPC's symptoms are blurred vision, mucus discharge, redness, excessive lens movement, and little bumps (papillae) on the inside of the upper eyelids.
Interestingly, an antiallergy eyedrop, Opticrom, helps relieve symptoms in many patients with GPC. This might suggest that GPC is an allergic reaction. But more likely, mast cells—the cells that contain histamine and other allergic mediators—are stimulated or irritated by the constant rubbing of the contact lens on the inner lining of the upper lids.
Gas-Permeable Lenses
Gas-permeable lenses combine some of the benefits of both hard and soft lenses.
Like hard lenses, they are rigid and durable, and they do not collect a lot of deposits. But like soft lenses, they are made of material that lets more oxygen pass through to the cornea.
While usually not as comfortable as soft lenses, gas-permeable lenses are still much more comfortable than hard lenses, and much, much more easy to get used to.
As technology improves, these lenses are becoming even more comfortable and may be worn for longer and longer stretches. They are already being tested by some doctors as extended-wear lenses.
Disposable Lenses
While disposable contact lenses offer comfort and convenience, there are some drawbacks.
They are extended-wear lenses, made to be thrown away after one or two weeks of wearing. They are not meant to be taken out and cleaned like regular extended-wear lenses, but they do get dirty and can cause infections.
Some people try to save money by cleaning and reusing them. This is not a good idea. Disposable lenses aren't made to be cleaned and disinfected, and you could wind up doing more harm than good.
You might think that disposable contact lenses are much more expensive than nondisposable lenses. But if you have to change lenses every year or so anyway, as do most extended-wear lens wearers, and if you add in the price of cleaning solutions and equipment, the price difference isn't really that great.
Extended Wear—Extended Danger
No matter what the advertisements for extended-wear lenses might say, wearing any contact lenses continuously for more than one week could lead to serious eye problems—including blindness.
After extensive testing, the Food and Drug Administration has determined that people who wear extended-wear contact lenses are five times more likely to develop eye infections than those wearing ordinary lenses that are removed at night. The specific infection looked for in the study is ulcerative keratitis. It can lead to permanent eye damage, even blindness. The condition develops when bacteria grow in the oxygen-starved space between the contact lens and the surface of the eye.
Researchers have found that extended-wear lens wearers are also prone to other eye infections and irritations. So for best results, remove your contact lenses every night and let your eyes sleep in the nude.
Soft Astigmatic Lenses
While most people with astigmatism wear hard or gas-permeable lenses, there are soft lenses available, too. But they don't work for everyone.
Standard contact lenses have the same degree of correction throughout. This means they can rotate on the eye without there being any concern about which edge is "up." Astigmatic lenses, on the other hand, have varying degrees of correction on various parts of the lens surface to compensate for the shape of the section of the eye directly underneath. If these lenses rotated while on the eye, it would be like looking through a different pair of glasses every time you blinked. To prevent this, the bottom edge of each lens is weighted to hold it in place.
Astigmatic soft lenses are costly and hard to fit properly, and they don't always work. But while hard and gas-permeable astigmatic lenses are less expensive and more dependable, not everyone with astigmatism can—or is willing to—adjust to them.
Caring for Your Eyes and Your Contact Lenses
It is important to remember that if contact lenses are not treated properly, they can do more damage than good. Treating them properly includes keeping them clean.
The biggest single reason your lenses get dirty isn't dirt, smog, or even dust in the wind. It's your tears. Like the ocean, tears contain a lot more than just water. They contain mucus, which helps coat the cornea and spread the tears out evenly over the entire surface of the eye. Old, worn-out cells from the surface of the eye also get mixed with the tears, along with dust, dirt, general air pollution, sweat, and—if you wear it—eye makeup.
All of this debris tends to gather at the corner of the eye, where it can harden and turn into what some people call "sand" or grit. If you're wearing contact lenses, some of it sticks to the lens. Failure to clean it off can lead to infections as well as dirty lenses.
Lenses, by the way, are a lot like dishes. The sooner you clean them, the easier they are to clean. Anyone who has ever waited a day or two to scrape dried egg yolk off a plate knows what we mean.
So clean your lenses as soon as you take them out. Just make sure your hands are clean before you go to work on your lenses. Also make sure that the cleaning solutions you use are fresh. Most labels tell you how long a solution is good for after it's been opened. Mark the date on the bottle, and if you haven't finished the bottle by the expiration date, throw it out anyhow.
Once the lenses are clean—be sure to follow the manufacturer's suggestion for the specific lenses you have—the cleaning solution should be thoroughly rinsed off. Soft lenses need to be disinfected with either heat or chemicals. Again, follow the manufacturer's instructions. Hard lenses do not require disinfection, and may be stored either in saline or special soaking solution or kept dry.
Selecting a Lens Cleaner
There are numerous brands of contact lens cleaning solutions. Shop around until you find the one that you like best, then use it every time you take your lenses out.
But please keep this in mind while you are doing your shopping. Regardless of the advertising claims, there are some things that just don't seem to make much sense. One of them is the notion that a single all-purpose contact lens fluid can be equally effective as a cleaning, wetting, and soaking solution.
First, let's consider the nature of soap and other cleaning agents. Such products are designed to dissolve and break up particles of dirt and other foreign matter so they can be rinsed away. But will soap irritate your eyes? We all know the answer to that one, especially if you're going to leave a soap-cleaned lens in your eyes for 8, 10, or 12 hours.
On the other hand, if a soaking solution is gentle enough to go into your eyes without irritating them, how good a job can it be doing at dissolving and breaking up the gunk that collects on your lenses?
There are cleaning solutions and there are soaking solutions. Rinse one off before you use the other.
And no matter what brands you use, follow the directions.
If you ever drop a lens on the floor, into grass, or into the soup, clean it thoroughly before sticking it back on your eye. Remember, though, that putting a lens in your mouth is a great way to get it dirty—not clean. There are bacteria in your mouth that your eyes just can't handle.
Never forget that contact lenses are not natural. Even when they are well cared for, they can still cause or aggravate some eye problems. If your eyes hurt, or if they are red, watering more than usual, or unusually sensitive to light, take the lenses out and see your doctor immediately. Any blurring of vision is another warning signal.
Like glasses, contact lenses do not change your natural vision. They just give your brain a clearer image of what your eyes see. Wearing them will not stop, prevent, or even slow down the natural changes your eyes will go through. Nor will it speed them up. At a certain age you will need reading glasses, whether or not you wore glasses or contact lenses in the past.
The Case for the Case
Of course you have to keep your contact lenses clean. That goes without saying.
What still needs to be said, however, is that you have to keep your contact lens case antiseptically clean, too. In fact, doctors are finding that more and more instances of corneal infection among contact lens wearers can be traced to their contact lens cases and the soaking solutions their lenses are stored in.
Contamination is most likely to occur if the soaking solution is not changed daily, or at least every other day. If your lenses are stored continuously for several days or weeks, they should be cleaned and disinfected before you put them back in your eyes. The bacteria that cause many corneal infections grow best in cases that are left closed with soaking solution in them.
The solution in your case should always be dumped out when you put your lenses in your eyes. While you are wearing your lenses, wash out the case thoroughly in hot water and let it air dry, upside down, on a paper towel. Refill with new solution when you put your lenses back in the case.
Choosing the Right Lens
Choosing the right type of contact lens isn't nearly as complicated as choosing a new car, a home, or even what color sweatband to wear with your new passion-pink-and-purple polka-dot sweatpants.
The choice of lenses will be heavily influenced by the type of eye problem you have, your budget, your habits, and your doctor.
Make sure you have a doctor or eye-care professional you are comfortable with, one who has a lot of experience fitting all of the different types of contact lenses.
The fitting process can be long and difficult. Make sure you know what the lenses will cost and how much help the doctor or the doctor's assistant will be in teaching you to put them in and take them out. Many doctors offer an all-inclusive fee covering eye tests, lenses, and "lessons."
In some ways, learning how to use your contact lenses is like learning how to ride a bike. But instead of falling and scraping your knees, you will poke yourself in the eye with your finger a few times. You will also "lose" the lens underneath the eyelid. But don't panic. The lens cannot get back behind the eye. If it's in there, it can be removed.
There are numerous techniques to use with your contacts, and you will have to keep fiddling with a number of them until you find what works best for you. If you keep at it, you will find that putting your lenses in and taking them out takes nearly as little time as putting your glasses on or taking them off.
Many people have more problems getting their lenses out than they do putting them in, especially when there is dust or dirt causing discomfort in the eye. When all else fails, stick your face in a sink full-of water, open your eyes and let the lenses float off. Just make sure you have the sink stopper in.
Some Pros and Cons
Hard lenses are the easiest to put in and take out. But they are also more likely to come off at the wrong time—during a sneeze or a cough, for instance. Losing one at a critical moment and having to crawl around on the floor looking for it can be very embarrassing. It is also easier for dirt or dust to get underneath a hard contact lens.
Hard lenses and gas-permeable lenses are the most economical and most durable. Not only are they cheaper than soft lenses, they can last up to ten years. Soft lenses, especially extended-wear soft lenses, generally last only a year or two. But their added comfort explains why approximately 80 percent of all contact lens wearers choose soft lenses.
The harder the lens, the longer it will take to adjust to it. And if you stop wearing hard lenses for a while, you might have to start getting adjusted to them all over again. Since there are times when you shouldn't wear your lenses—when you have an eye infection, a cold, or a black eye, for example—this can be an important consideration. If you do switch back to glasses for a while, your vision could be distorted by "spectacle blur," the result of your cornea having been temporarily molded into a new shape by the hard lens. The cornea, however, will eventually go back to its normal shape—probably just when you decide it's time to switch back to hard contact lenses again.
Gas-permeable lenses have some of the same problems, but to a much lesser degree. They are also more comfortable than hard lenses, are easier to adjust to, and cost about the same.
Soft lenses are the most comfortable. Because they are also bigger and cover more of the eye, they tend to stay in place more easily. And because they let in more oxygen, they can be worn for longer periods. If you do have to switch back to glasses for a while, that adjustment is also easier, because there is usually no spectacle blur.
Don't Wear Your Lenses If ...
Colds, the flu, and allergies can make wearing contact lenses uncomfortable. Under such circumstances, the lenses could even damage your eyes. So if your lenses irritate your eyes when you're sick, don't wear them.
Also, if you're the sort of person who cries easily and you expect you're going to be crying—whether they be tears of laughter or of sadness—leave your lenses at home.
But some people, usually those with a moderate to large astigmatism, are just physically incapable of seeing as clearly through soft lenses as they are through hard lenses.
A person with an astigmatism has an eye that is not completely round. A hard or gas-permeable lens functions like a girdle to help shape the eye—making it more perfectly round. A soft lens, however, just drapes over the eye, like the soft piece of plastic that it is.
Soft lenses are also harder to take care of and require regular disinfection as well as cleaning.
It is important to remember that some people never adjust to contact lenses. You can insure yourself against wasting the price of lenses you'll never wear by finding one of the growing number of eye doctors who is willing to refund your money or exchange your contact lenses for a new pair of glasses if the lenses don't work out after a specified length of time.
Examining Contact Lens Options
As they say on Madison Avenue: Never try to sell someone plain, ordinary soap when you can sell them new, improved, plain, ordinary soap instead. Although there aren't as many features and secret ingredients that can be added to contact lenses as can be added to soap, stereo systems, or station wagons, the manufacturers are trying.
Bifocal Lenses
Because many people who wear contact lenses also need reading glasses, manufacturers have come up with bifocal contact lenses—two different kinds of them.
One type looks like a miniversion of a lens in a pair of bifocal eyeglasses. The normal vision portion is on top and the bifocal or reading vision portion is on the bottom. Even though the bottoms of the contact lenses are weighted to keep them in the right place, they rarely stay there. Every time the person wearing them blinks, the lenses shift—and only occasionally shift back into the proper position.
The second type of bifocal contact lens has the bifocal portion all around the rim, leaving the center portion for normal viewing. To see normally (distant vision), you have to look straight ahead, sort of like looking through the hole in an optical doughnut. You get the bifocal (near vision) effect by looking up, down, or off to one side. If you want to see something normally that's off to one side, you have to first turn your head to face it so you can look at it straight on. All in all, this type of lens is not yet one of the industry's crowning achievements, but improvements are on the way.
Another alternative for people who need bifocals is to wear two entirely different lenses. One lens gives one eye normal distance vision, and the other lens gives the other eye the strength it needs to read or do close work. The "dominant eye" is usually the one corrected for distance. The "nondominant" eye usually gets the reading lens.
To determine which of your eyes is the dominant one, either aim through a rifle sight or roll a piece of paper into a tube and look through it. The dominant eye is the one you automatically "sight" with.
As you can imagine, having each eye corrected for different degrees of vision can take more than a little getting used to. But more and more people are opting for that approach.
Tinted Lenses
Tinted lenses don't change what you see when you look out of your eyes, just what people see when they look into them. As the title of an old country-and-western song puts it: "Don't That Make Your Brown Eyes Blue."
Actually, the lenses usually aren't dark enough to totally change your eye color, but they will slightly alter or enhance whatever natural color is there. The tinted lenses use dyes, approved by the Food and Drug Administration, that will not harm your eyes.
By the way, most eye doctors recommend that you get your hard lenses tinted either light blue or light gray. This is done not for any cosmetic reason, but to make the lenses easier to locate when they are out of your eyes—in a sink full of water, on the pillow, or on the carpet, for example.
X-Chrom Lenses
As with so many other "new" discoveries, lenses to help color-blind people distinguish colors have been around for a lot longer than you might think—more than a century, in fact. It was back in 1857 that red and green filters were first mounted on spectacle frames to help red-green color-blind people distinguish between colors. Red-green color blindness is the most common form of the condition.
Today, people can use a single X-Chrom contact lens and get the same effect. The lens is red and is placed over one eye. By filtering out specific wavelengths of light in that one eye, it creates a contrast with what the other eye sees that helps the wearer differentiate between red and green objects. In one study, 33 of 40 red-green color-blind people given an X-Chrom lens reported a significant improvement in their ability to distinguish colors.
Bandage Lenses
Occasionally a contact lens is used as a "bandage" to help an injured cornea heal. The lens protects the cornea from the eyelid's blinking and from dust and other debris that might be blown into the eye.
Bandage lenses are usually clear; they have no correcting power. They are designed to help an eye heal, not to improve its vision. If you normally wear contact lenses, you will have to go back to your glasses while the bandage lens is in place.
Since these lenses are sometimes left in place for months at a time to give the cornea enough time to heal, deposits and infections can occur. People wearing bandage lenses need to have their eyes and lenses examined regularly.
Keratoconus Lenses
Keratoconus—from the Greek words kera ("cornea") and kõnus ("cone")—refers to a relatively common hereditary problem that causes a person's cornea to change from its normal round shape to a cone shape. Hard keratoconus contact lenses are used to correctively "round" the surface of such an eye in much the same way that hard contact lenses help "round" the eyes of people suffering from astigmatism.
Orthokeratotic Lenses
Orthokeratology is an expensive, time-consuming, and potentially dangerous process that doesn't work very well or very often. The procedure is performed by a small number of orthokeratologists, and it is designed to correct nearsightedness by flattening the cornea of the eye.
While a rigid contact lens will correct vision while it is being worn, orthokeratotic lenses are supposed to permanently reshape the eye.
The cornea of a nearsighted eye is often a little on the steep side. To correct this steepness, a patient is given a series of progressively flatter lenses every four to six weeks for a period of 18 to 30 months, until either the nearsightedness has been eliminated or the cornea is incapable of being bent any further out of shape.
Even after the eye has been reshaped, the patient must wear a "retainer" lens to hold it in shape. Orthokeratologists do claim, however, that patients can go without the lens for days or even weeks at a time.
Scientific studies contradict these claims. They show that the procedure is not predictable and that the amount of nearsightedness that can be corrected is very small.
Furthermore, the quality of the "corrected" vision is never stable, nor is it as good as could be achieved with glasses or conventional lenses. Many people who have undergone the process say their vision is distorted—as though they are looking at the world through a dirty windshield or a fish bowl.
Then there are the additional concerns about expense, time, and the constant pressure on the cornea that could lead to eye problems a lot more serious than nearsightedness.
Makeup Tips for Lens Wearers
Your contact lenses will automatically collect all sorts of pollutants. How you apply eye makeup and the type you use could add to the problem. Here are some tips.