Contacts will fix everything right?

I think this may be a popular belief.  You are hitting 40 and now having trouble with things up close. A friend told you they just pop in contacts and see fantastic.  You do have options but nothing in life is perfect.

If that friend is used to wearing contacts and is blind without them, they are ecstatic when they pop on contacts that will let them see the distance and up close.   This isn’t the case with everyone and the patient that has seen like an eagle their entire life usually takes the longest to adjust.  We’ll go over the 3 most common contact lens options for once you start to lose your near vision.

Keep in mind my biggest recommendation is to always have a pair of glasses that you feel comfortable wearing because they will be the gold standard. What does that mean? It means that they will be the clearest option that contacts will never match. If you did not have glasses, you will overwear your contacts.

Distance contacts with readers over.  This is a great option for a patient that currently wears contacts and wants the crispest vision possible for the distance.  Whenever the patient looks at something up close, they pop on a pair of readers over their contacts.  This is obviously not a great option for someone that already sees well in the distance and just needs help for up close.

Monovision.  This is where one eye is corrected for the distance and one eye is corrected for up close.  This means when you look in the distance there will be one clear eye and one blurry eye. When you look up close, the eye that was clear in the distance will now be blurry and the eye that was blurry in the distance will now be clear.  With both eyes open you now have an eye that can see distance and an eye than can see up close.  This will be BLURRIER than if you were just wearing contacts that corrected for the distance.  If you have no distance prescription it will be BLURRIER than if you had no contacts in at all.  In monovision you sacrifice distance clarity in order to get up close.   It takes brain adaptation for this to work.  Your brain has to preferentially pay attention to the input from the clearer eye at any given distance.  If you pay attention to the input from both eyes equally things are incredibly blurry and it is hard to adapt to.   The more help a patient needs up close, the harder the lenses are to get used to.

When we put contacts of this type in, I don’t even check the person’s vision for the first 10 to 15 minutes.  It can take up to 3 days to see if it is tolerable and sometimes longer to see if it is something a patient wants to pursue. It is sometimes necessary to ease a person into their full prescription.

If I check a patient’s vision the first day they wear contacts, it will be far worse than if they came back in 2 weeks.  Even if it is the same prescription.  Their visual system over time adapts to the new normal.  That’s why the contact lens wearer that’s been wearing monovision for 10 years sees like a champ and tells their friend how amazing it is.  The friend comes in and expects instant amazing vision with contacts.  The story of the first few weeks to months of adaptation, struggle, and compromise to get to the vision they have now has been forgotten.

Multifocal. This is where you get to see both distance and near in both eyes.  They get to work together as a team.  This is my preferred option unless a patient has prescription that multifocal lenses are not made for. The lens design is like concentric circles each with different powers for a different distance as show in the picture above.  With multifocals, just like monovision, there is a considerable amount of adaptation that has to happen when a patient first starts wearing the lenses.  Because of the contact lens design, the most common complaint is a shadowing effect. This is caused by seeing through the multiple powers of the lens simultaneously.  As your visual system gets used to the lens, your brain will edit out the blurry part and keep the clear.

Just like with monovision, if I check a patient’s vision the first day they wear the lenses, it’s far worse than if I checked it in 2 weeks.  If a patient has a particularly difficult time adapting, we can modify things a bit to make the visual change easier.

As you can probably tell, each person’s experience and tolerance of changes to how they see is different.  When you are exploring the option of contact lenses, I think it’s very important to set expectations appropriately.  Think about where you would be willing to compromise and if you are willing to struggle through the adaptation period that is often needed for first time wearers.  With first time monovision or multifocal wearers I usually see them 2 to 3 times to make adjustments before finalizing a prescription. I try to emphasize that even in the final prescription it won’t be perfect at all distances.  Our goal is not perfection but to give the patient vision good enough to get them through the majority of their day.

This is why having a good pair of progressive glasses is important.  For any fine detail, with both monovision and multifocal lenses, glasses will always be the clearest option.  If a patient has to drive a long distance at night, glasses will always be the clearest option.  I stress this point so that the limits of what the contacts can do are understood.  Contacts are never meant to be used as a stand alone option.

If you would like to explore the option of contact lenses, please call/text us at 512-651-5186 to set up an exam or email appointment@westlakehillsvision.com.

Dr. Susan Elizondo

Dr. Susan Elizondo

Dr. Susan Elizondo has been practicing optometry for 10 years, and proudly took ownership of Westlake Hills Vision Center in 2019. She has a passion for nutrition and practices a plant based approach to health and healing.

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