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LASIK & Contact Lenses, Which Is Right For You?

Convenience & Comfort

What about the differences in convenience between contact lenses and LASIK?
In the past 20-25 years, contact lenses have undergone dramatic attempts to achieve the strong desire of patients to "wear no lenses at all." These changes began in the late 70's with the introduction of Extended Wear Contact Lenses which were marketed and prescribed for patients to be worn continuously for as long as 30 days. This was indeed a very convenient type of vision correction option for patients and one in fact that patients truly desire.

The personal goal of almost all patients is to have the most convenient form of vision correction. Unfortunately, after several years of widespread patient acceptance Extended Wear Contact Lenses did not demonstrate that they could in fact be worn for 30 days or even for considerably lesser times on a continuous basis without a worrisome incidence of significant complications. As a result, the desired convenience of "wearing no lenses at all" could not be achieved with contact lenses. After the FDA requested that the Extended Wear Contact Lenses be removed from the market, almost all contact lenses prescribed were worn on a daily basis and required that they be cleaned, disinfected and reinserted in patients' eyes each and every day.

This really did not meet the desire of most patients to "wear no lenses at all." In order to improve the convenience of contact lens wear, contact lens manufacturers began to first improve on the contact lens care systems and solutions so that there would be much less care involved in maintaining the lenses and thus they would be more convenient. This in fact was achieved with a number of care products reducing the number of steps necessary and the number of actual solutions necessary to maintain the lenses. These solutions, typically called "Multipurpose" Solutions provide the ability to clean, rinse and disinfect soft contact lenses with a single solution. Examples of these solutions are Allergan Complete Moisture Plus Multipurpose Solution, Alcon Opti-One Multipurpose Solution, and Bausch & Lomb Renu Multi Purpose Solution. Further, along with this, considerable improvements were made in the manufacture of contact lenses so that they could be produced at exceedingly low cost. Because they were able to be produced for literally pennies, the contact lens manufacturers were now able to offer the next step in contact lens convenience-"Frequent Replacement Contact Lenses."

The Frequent Replacement Contact Lenses allowed patients to purchase boxes of lenses that could be discarded frequently, on a planned basis in order to avoid contact lens complications. The ultimate planned Replacement Contact Lenses are Daily Disposable Contact Lenses which are worn for a day at time and then discarded, eliminating the need for any care products or disinfection-certainly more convenient in terms of care but not really any more convenient in terms of being able to wake up and just start your day.

In addition, because Frequent Replacement Contact Lenses were made of a newer generation of polymers that contained a greater amount of water, they were in fact able to allow the cornea to "breathe" more efficiently so that they would allow them to be kept in for several days at a time if not perhaps a full week. The extended wear of Frequent Replacement Lenses once again offers the possibility of the desired convenience of "wearing no lenses at all" as they are simply removed each week and discarded and new ones inserted into the patients eye the following day. This is indeed an improvement in convenience for contact lens wearers. In the early 2000's, thanks to the further advances of even newer breathable polymers, called "silicone hydrogels", that have surfaces that are believed to stay clean and avoid adhesion by debris and microorganisms, a number of contact lens manufacturers have again resumed the marketing of "30 Day Lenses." Examples of these lenses include Bausch & Lomb PureVision, Acuvue Advance and Ciba Night & Day Lenses. These lenses are a bold attempt to bring patients the convenience and comfort they desire of "wearing no lenses at all." Certainly if contact lenses can be worn for 30 days at a time without removing them this would give patients about a month at a time of "convenience." Even with the introduction of 30 day contact lenses, of the 30-35 million contact lens wearers in the United States, only about 20% are actually wearing Extended Wear Contact Lenses. Time will tell if these more breathable Extended Wear Contact Lenses can in fact be worn safely for 30 days and approximate the convenience that patients are desiring.

What about comfort?
Certainly having LASIK and wearing "no lenses at all" is the ultimate in comfort. But do contemporary contact lenses, even the most advanced lens materials such as silicone hydrogels, offer a comfort level that approximates "wearing no lenses at all?" According to an article by highly regarded contact lens research experts, Brien Holden, Ph.D, D.Sc. and Desmond Fonn, MOptom recently published in the April 2005 issue of Contact Lens Spectrum.

"Contact lenses really haven't made the grade yet. Some 2.5 billion spectacle wearers around the globe still outnumber contact wearers by a 25-to-1 ratio. As many as 500 million people need and can afford contact lenses, yet only 100 million wear them, according to data compiled in 2003 by the International Association of Contact Lens Educators."

These comfort issues with contact lenses seem to be responsible for a significant number of patients "dropping out" of contact lens wear and abandoning their contact lenses. Fonn, in his paper, "Preventing Contact Lens Dropouts" (Contact Lens Spectrum. 2002;17:26-32) reported that in the United States, an estimated 2-3 million people of drop out of contact lens wear each year. This represents up to 10% of the entire contact lens wearing population dropping out of lens wear each year, with the primary reason being unsatisfactory comfort. It is believed that the newer silicone hydrogels previously discussed may help address the contact lens comfort problem.

By far the main reason for discomfort with contact lenses does indeed seem to be related to dryness. According to the February 12, 2006 edition of CL Today, "of the 31 million soft contact lens wearers, 21 million, or 67%, self report that eyes feel dry during contact lens wear. There are nearly 2.7 million contact lens dropouts annually. Many of these dropouts say dryness was a major reason for discontinuing lens wear".

So then, which is more convenient and comfortable option, 30 day Contact Lenses or LASIK? There can be little doubt that LASIK offers a much more convenient lifestyle than contact lenses and one that actually achieves "wearing no glasses at all" for the ultimate comfort.

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