Tuesday, June 14, 2011

Lens Implant after Contact Lens Wear

Question: For 15 years I have worn a single +4.00 D contact lens for reading with no problems. I now have a cataract in this eye and my ophthalmologist sent me for biometry prior to surgery. It was discovered I have quite severe astigmatism (which has never been a problem to me) and there is now a problem deciding whether to have a toric lens implant or a regular lens implant. I do not want to wear glasses to read and my other eye is fine for driving and distance. Any advice enormously appreciated.

Answer: You do not say whether you are wearing a soft or a rigid contact lens. If you have been wearing a rigid contact lens, it is highly probable that after 15 years of wearing a thick +4.00 D contact lens, you would not know that you had astigmatism, as the rigid lens would correct it.

However, if you have been wearing a contact lens for that long, it is also possible that the contact lens has changed the shape of your cornea and induced astigmatism that was not present before-and thus it may very well be transient. That is, you will need to discontinue the contact lens for some period of time until the cornea returns to a more normal and stable shape. With rigid lens wear, it can takes weeks or even several months, to achieve stability. The corneal molding effect can even happen with soft contact lenses. Thus, the key step here is discontinuing your contact lens and to have the ophthalmologist perform serial corneal curvature measurements, serial corneal topography measurements and serial refractions over a period of weeks or longer, until you have demonstrated stability of these parameters, so that an accurate set of measurements can be taken for the calculation of lens implant type and power.

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