Thursday, June 9, 2011

Lens Replacement for High Hyperopia

Question: I am a 53 year old female. I have had bad vision since the age of 2 and worn hard contact lenses since the age of l3. Since the age of 48 I have spent thousands of dollars on contact lenses to get me to wear my gas permeable contacts with ease again. I went thru menopause at 50 and was on birth control for many years. I also was a sun worshiper and I am now paying the price because I was never warned that all of these things have contributed to my dry eyes (bad) and now have difficulty wearing my lenses. I have tried doctor after doctor for almost 4 years and force myself to wear the lenses but they are getting more difficult to tolerate each and every month. My prescription with contacts is +5.75 with astigmatism. The bad dry eyes prevent me from night driving because of halos and poor vision. My astigmatism changes every year now and they say I have the beginning of cataracts. I went to 2 surgeons who told me to go back to glasses because they could not promise the outcome of Lens Replacement and my corneas are too steep for LASIK as well as having the dry eyes. My glasses are heavy and I cannot get use to them. My progressive glasses are so hard to get use to. Do you think I should continue to seek out a cataract doctor to help me or just give in to glasses?

Answer: Corneal exhaustion from contact lenses is actually not all that uncommon, particularly where there are thick heavy contact lenses involved. Yes, the hormonal changes you experienced combined with the contact lens exhaustion will prohibit you from wearing contact lenses successfully. Further, the dry eye and the high hyperopic prescription make you a poor candidate for LASIK, as you relay. Now, the fact that you have the beginning of cataracts may also be contributing to your halo and poor vision. Cataracts or not, with some successful treatment of your dry eye you may be a candidate for Lens Replacement Surgery BUT only if you can discontinue wearing your contacts for a long enough period of time so that the shape of your corneas become stable enough to take accurate measurements. The years of wearing RGP contacts, along with the instability of the astigmatism, suggests that you have corneal molding and shape change and need to discontinue contact lens wear PRIOR to the final measurements being taken for an intraocular lens implant (IOL). Considering the number of years you have been wearing contacts, it might be as long as 6 months before your corneas are stable and can be properly measured and given the severity of the dry eye you report it may take 3-4 months of aggressive dry eye therapy and treatment to get your tear film healthy enough for an easy eye surgery recovery. Your next step is to find a top Cataract Surgeon who is also a Refractive Surgeon and schedule an examination and consultation so they can guide you on the best path and options that might be available.

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