charlie_hiller

help me know how my first contact lense trial is going.


my spectacles Rx:
OD -7.25 -0.75x20
OS -6.50 -1.50x180

the doc has used Bausch & Lomb 66 Toric softlenses on the left eye
and Bausch & Lomb 59 (spherical) on the right.

after a few back and forths we've arrived to where
the left is pretty darn close to being acceptable, but not quite
there.
the right is good for acuity, but sometimes has a ghost image on my
left field of vision.

she tells me that this is as good as it gets.

i questioned her as to whether switching brands could help. she says
no.
IS THIS TRUE ?

i questioned RGPs. she said that i would need bitoric RGPs, and
success is very difficult
and fitting is a long ordeal. its pretty clear she did want to go that
way.
she said the problem involves the fact that my right eye's astigmatism
is almost entirely lenticular.
and that i'd have a hard time keeping the lense in place.
i wonder if there is some qualitative question i should be asking her
to understand the issue with RGPs so as to help me decide if i should
pursue it with a different doc.
its hard for me to believe that they dont stay in place - then they
would be unacceptable to anyone.
perhaps it's something particular to the shape of my eyes ?
perhaps i am just seeking the holy grail, and i just wasnt made to
wear contacts ?

and just as a comment: there is so much resistance from all doc's
offices i've called when
i broach the subject of RGPs. you'd think they were a medieval torture
device.
yet i know 4 people who have been happily wearing them for years.

thanks in advance
charlie

dr judy

Possibly. Did she try some other brands during the fitting process?


Did you mean left eye, not right? If the astigmatism is lenticular, not
corneal, then the reasons why the soft lens vision is not perfect (lens
rotation) will be the same with the RGP.


Most people with RGPs have corneal, not lenticular astigmatism and RGPs work
well for that. If you current doctor does not like to fit RGPs, ask for a
referral to someone who does and get their opinion of how difficult the fit
would be. You could also ask your doctor to try a non bitoric RGP on your
eye from her trial set, so you could see for yourself what the vision is like.

chopperhorn

Dr Judy,
My responses below.
Thanks
Charlie


No. She did not use any other brands.
She just played with strengths of the B&Ls.
That is why I was surprised when she said that it can not get any
better
by switching brands.
I had the impression from reading this newsgroup that all I might
need is for her to try a different brand.
Its close to being good enough, but its not quite there.
It feels like I'm wearing glasses that are a few RX's old

I did mean the right eye. I'm surprised (as a layperson) that I get
this ghosting because i thought
OD -7.25 -0.75x20 was a mild enough astigmatism (especially against
the -7.25)
the right eye defintely ghosts.
on an early visit i thought the doc said that neither
regular RGP, nor soft toric,
could help the right eye because almost all of its astigmatism is
lenticular. that the right eye could only be made better with bitoric
RGP.


I believe she said that the remaining vision problem i am having
in my left eye (which is using a soft toric) is due to lenticular
astigmatism. I suppose this means that the left eye has both corneal
and lenticular.

The referral is a good idea. It never occurred to me to ask one OD to
refer
me to another OD.


OK.

Thanks very much Dr Judy !


- Charlie

larrydoc

Charlie,

Although the B&L lenses with which your doctor chose to fit you are a
reasonable choice, at least as a first choice, the fact that you are not
satisfied with the result is a good enough reason to try something else.

I would first try an aspheric soft lens for the right eye (that
sometimes helps with the ghosting and off-axis flare) and a different
desigin of soft toric for the left. IF your cyl is closer to -1.00 than
-.75,and if you notice the difference adding the cyl over the soft lens,
in place, I would use a toric soft there, too.

My second choice would be an aspheric RGP for the right and a toric
design for the left if you have at least some cornea toricity. Fitting
RGP torics on a spherical cornea is difficult and often less successful
that a soft toric.

If your expectations are not met with the current lenses, I'd ask for a
referral to someone who can fit you with something else if she's not
willing to do so.

--LB

--
Dr. Larry Bickford, O.D.
Family Practice Eye Health & Vision Care

The Eyecare Connection
http//www.eyecarecontacts.com
larrydoc at eye-care-contacts dot com (remove -)

charlie_hiller

LarryDoc,
thanks so much for the reply.
i just want to be sure i understand.

as for the right eye: i had not heard of aspheric soft lens. it is
different than both spherical and
toric in that it is essentially spherical, but focuses image more to a
point ?
also, just to be clear, the right eye produces a ghost image.
it does not smear the image as i, as a layperson,
would expect from the astigmatism. the "main" image is actually well
defined.
is she perhaps expecting my brain to learn to ignore the ghost image ?
is this ghosting NOT due to the astigmatism (thus the reason
she is not trying soft toric), but is due to the shape of my eye
with respect to the characteristic of soft lenses ?
no ghosting with my spectacles.

as for the left eye: the b&l soft toric is frustrating close to
acceptble.
if YOU were my doc, would you be trying a different brand at this
point
because different brands have different characteristics and, in fact,
a different
brand may work better FOR ME. she has made it clear that the Rx is the
"best" we're going to do
and that switching brands wont help.
i have gotten the impression from
monitoring this news group that you other docs would not agree with
this
assessment

thanks so much in advance,
charlie

larrydoc

The aspheric optics are sometimes "more forgiving" of off-axis and
astigmatic errors and provide increased contrast. Sometimes the effect
is quite noticable and other times not so. Depends upon the source of
the abberations relative to your pupil size. And yes, they are
different than standard spherical lenses and are not toric.


IF you have no ghosting with specs, you should be able to achieve
likewise with contacts. Sometimes, ghost images are caused by a lens
with an optic zone smaller than your pupil size. Do you have unusually
large pupils? That alone can be a cause of the distortion. I cant tell
you what the source is based on your discourse, but, in any event, if
you have astigmatism there, correct it or at least use an aspheric lens
and one that has an optic zone at least as large as yours.

I'd first do an "over-refraction" to determine the "extra" power needed
to resolve the acuity to maximum possible. If that can be incorporated
into the toric lens power (eg: it is available in brand inventory), than
go that way. If not, then change brands or live with it. Sometimes
absolute perfect isn't realistic. If it is your dominant eye, it's worth
the try, if it is your non-dominent eye, it probably isn't worth the
hassle.

Hope that answers your query.

--LB

--
Dr. Larry Bickford, O.D.
Family Practice Eye Health & Vision Care

The Eyecare Connection
http//www.eyecarecontacts.com
larrydoc at eye-care-contacts dot com (remove -)

charlie_hiller

thanks larryDoc,

you've been very helpful (and patient :-) )
just one final clarification ...
for the left eye is the point of switching brands
to get a better fit basecurve, better fit diameter, or better fit power/cyl/axis
and/or could it be that even with the same parameters, just switching
to a different brand could bring the world into sharper focus.

thanks

larrydoc

Yes, to all of the above. The question is: will the difference be
noticable and worth the time and cost?

--LB

--
Dr. Larry Bickford, O.D.
Family Practice Eye Health & Vision Care

The Eyecare Connection
http//www.eyecarecontacts.com
larrydoc at eye-care-contacts dot com (remove -)

charlie_hiller

great,
thanks doc