LASIK & Contact Lenses, Which Is Right For You? Safety and Risk Factors

LASIK & Contact Lenses, Which Is Right For You?

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LASIK & Contact Lenses, Which Is Right For You?

Safety and Risk Factors

An important consideration in whether you should have contact lenses or LASIK has to be based on the safety profiles of contact lenses compared to LASIK Eye Surgery. Over the past 25 years, contact lenses have been "consumerized" to where there are literally thousands of outlets where patients can buy contact lenses on line or by calling a toll free phone number without the direct dispensing and supervision of an eye care professional. Contact lenses are a medical device and regulated by the Food and Drug Administration (FDA). Even when prescribed by an eye care professional, minor as well as significant complications can occur in cases where hygiene and lens care has not been maintained or in cases where wearing schedules are not adhered to, typically involving sleeping in contact lenses, or extended wear. Even when things go well with contact lenses, annoying complications such as contact fit related problems, contact lens induced dry eye, giant papillary conjunctivitis can occur. Fortunately all of these complications are non-sight threatening.

Giant papillary conjunctivitis is an allergic type of inflammation that occurs on the inner surfaces of your eyelids, the "tarsal conjunctiva." It occurs most often in patients who have been wearing lenses for some number of years and who have not used the utmost in care in keeping their lenses clean. The buildup of protein on the contact lens surfaces causes an inflammatory process to occur whereby your lenses become itchy and your eyes actually begin to produce even more protein and mucous than normal. These secretions then cause even more irritation, itching and discomfort, ultimately causing you to have to stop wearing your contact lenses. There are anti-inflammatory and anti-allergic drops that can be prescribed by your eye care professional in order to alleviate the symptoms. However, even after using these drops and getting new contact lenses, and being absolutely meticulous in their care and wearing schedule, some patients are just unable to resume contact lens wear. While the complication of Giant Papillary Conjunctivitis is not sight threatening, it is inconvenient and troubling to those who desire the convenience, cosmetic and functional benefits that contact lenses can offer.

Contact lens induced dry eye occurs in some patients who may have had a marginally dry eye before they were fit with contact lenses or may actually be the result of contact lens wear. A normal and stable tear film is necessary in order to be a successful contact lens wearer who does suffer from symptoms of dryness and grittiness. To have good tear film stability means that the normal natural tear film is able to maintain itself in a fairly uniform layer on the cornea. Mother nature has provided us with a mechanism for achieving normal tear film stability in the form of certain anatomical features found on the outermost layer of the cornea, the corneal epithelium. The normal healthy corneal epithelium is covered with microscopic "hairlike" structures call microvilli. These microvilli act to provide a "roughened surface" for the normal tear film to adhere to and thus give it stability in between each time you blink your eyes. Unfortunately, over years of wearing contact lenses, it is believed that constant rubbing and movement of the contact lens across the surface of the cornea may in fact damage and deplete the presence of these epithelial microvilli resulting in a less stable tear film and contact lens induced dry eye symptoms. Again, this is not a sight threatening complication, but one that makes contact lens wear less comfortable and sometimes results in an inability to wear your contact lenses, even if you change lens materials and use lubricating eye drops. Once you have completely discontinued wearing your contact lenses, it is thought that the microvilli will resume their normal presence over some period of time and in most if not all cases, the tear film will return to normal.

According to the United States Food and Drug Administration (http://www.fda.gov/fdac/features/1998/298_lens.html), "The most serious safety concern with any contact lens is related to overnight use. Extended-wear (overnight) contact lenses--rigid or soft--increase the risk of corneal ulcers, infection-caused eruptions on the cornea that can lead to blindness. Symptoms include vision changes, eye redness, eye discomfort or pain, and excessive tearing."

James Saviola, O.D., Chief of the Vitreoretinal and Extraocular Devices Branch at FDA's Center for Devices and Radiological Health states, "The risk of corneal ulcers for people who keep extended wear lenses in overnight is 10-15 times greater than for those who use daily wear lenses only while awake." Dr. Saviola explains, "When the eyes are open tears carry adequate oxygen to the cornea to keep it healthy. But during sleep, the eye produces fewer tears, causing the cornea to swell." The swelling and lack of oxygen leaves your eyes vulnerable to infection.

Even though the FDA has approved extended wear contact lenses for overnight use, there are risks with use of extended-wear lenses, "even if it's just one night," says Dr. Saviola. Unfortunately, for those patients who are seeking convenient vision correction, extended wear or "30-Day" lenses may not provide a choice without certain safety concerns as indicated by the FDA's opinion. These safety concerns should be weighed carefully when considering LASIK and contact lenses as the conventional wisdom that contact lenses are a "simple on-line consumer purchase" may not reflect the reality. On the other hand, daily wear lenses that are removed daily for cleaning and are a safer choice, provided they aren't worn during sleep. Unfortunately, daily wear contact lenses do not provide the convenience LASIK can provide and so the decision needs to be weighed even further.

Another potential sight threatening concern is the infection Acanthamoeba Keratitis, caused by improper lens care and possibly bathing in hot tubs or even swimming. This difficult to treat parasitic infection's symptoms are similar to those of corneal ulcers. For patients considering whether to wear contact lenses or to have LASIK, if they need clear vision while swimming, they may wish to consider this potential serious infection in the risk profile. Or, they may wish to simply not wear contact lenses while swimming—but again this negates the benefits you are trying to achieve in terms of lifestyle, functioning and convenience.

So, while contact lenses have been reduced to being an on-line purchase implying a "care free, trouble free and risk free" form of vision correction, this may not be entirely correct. In fact, recent reviews and publications (Mathers, W.D., Archives of Ophthalmology, October 2006; Vol 124: pp1510-1511) of the safety and risks of wearing contact lenses as compared to having LASIK indicate that LASIK is indeed less risky over the long haul .

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LASIK & Contact Lenses, Which Is Right For You?

LASIK Eye Surgery Information to help the
Consumer and understand LASIK Vision Correction