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Contacts Lenses Fitting

Contact lenses have improved tremendously over the past 10 years. While not everyone is an ideal candidate for contact lenses, many people who in the past were unable to successfully wear contacts can do so now due to technological improvements. In addition, at Madison Eyes we offer a risk free trial for contact lenses*. While we do charge for the fitting of contact lenses, if you decide that contact lenses they are not for you we will refund your fitting fees.

If you have one of the following conditions, contact lens wear may be more difficult:

  • Astigmatism
  • Dry eyes
  • Giant papillary conjunctivitis (GPC)
  • Keratoconus
  • Post-refractive surgery (such as LASIK)
  • Presbyopia

But “difficult” doesn’t mean impossible. Often, people with these conditions can wear contacts quite successfully. Let’s take a closer look at each situation – and possible contact lens solutions.

Contact lenses for astigmatism

Astigmatism is a very common condition where the curvature of the front of the eye isn’t round, but is instead shaped more like a football. Astigmatism won’t usually prevent you from wearing contact lenses – but does mean you will often need a special kind of lens in order to see most clearly.

Lenses specially designed to correct astigmatism are called “toric” lenses. It used to be the case that many doctors told their patients that they weren’t candidates for contact lenses because of their complexity. Some patients were told they had to wear hard contact lenses to compensate for their astigmatism. Nowadays we usually are able to fit soft toric soft lenses.

In some cases, toric soft lenses may rotate too much on the eye, causing blurred vision. If this happens, different brands that have different anti-rotation designs can be tried. Some patients will feel some brands of toric lenses more than regular soft lenses. Again, a different brand or shape of lens may solve this issue. If soft lens rotation or comfort continues to be a problem, gas permeable (GP) lenses (with or without a toric design) can also correct astigmatism.

Contact lenses for dry eyes

Dry eyes can make contact lens wear uncomfortable and cause a number of symptoms, including:

  • a gritty, dry feeling
  • a feeling as if something is in your eye and/or burning
  • eye redness (especially later in the day)
  • blurred vision

If you have dry eyes, a first step is to treat the condition. This can be done a number of ways, including artificial tears, medicated eye drops, nutritional supplements, and environmental changes to prevent evaporation of your tears.

Certain soft contact lens materials work better than others for dry eyes. Also, GP lenses are sometimes better than soft lenses if there’s a concern about dry eyes since these lenses don’t dry out the way soft lenses can.

Replacing your contacts more frequently especially with Daily Disposable lenses can also reduce dry eye symptoms when wearing contacts. For an ever-increasing number of patients this appears to be the simplest, most effective, and most practical treatment option. Alternatively, for patients wearing contacts not available as daily disposable keeping their lenses meticulously clean is also helpful.

Contact lenses for giant papillary conjunctivitis (GPC)

Giant papillary conjunctivitis (GPC) is an inflammatory reaction on the inner surface of the eyelids. One cause of GPC is protein deposits on soft contact lenses. (These deposits are from components of your tear film that stick to your lenses and become chemically altered.)

Usually, changing to a Daily Disposable soft lens will solve this problem, since you just throw these lenses away at the end of the day before protein deposits can accumulate on them. Gas permeable lenses are also often a good solution, as protein deposits don’t adhere as easily to GP lenses, and lens deposits on GP lenses are more easily removed with daily cleaning.

In some cases of GPC, a prescription eye drop may be required to reduce the inflammation before you can resume wearing contact lenses.

Contact lenses for keratoconus

Keratoconus is a relatively uncommon eye condition where the cornea becomes thinner and bulges forward. At Madison Eyes we check all new patients for this condition with a special instrument called a corneal topographer as part of a comprehensive exam. The exact cause of keratoconus remains unknown, but is much more common in males, often developing at a young age. Ongoing studies appear to indicate that a treatment called “crosslinking” can retard or even reverse the worsening of keratoconus. This treatment is not approved by the FDA (as of April, 2013), but is available as an experimental treatment.

Glasses or soft contact lenses can sometimes be utilized for patients with mild keratoconus. Gas permeable contact lenses are the treatment option of choice for moderate keratoconus. Because they are rigid, GP lenses can correct vision problems caused by keratoconus that cannot be corrected with eyeglasses or soft contacts. At Madison Eyes we are certified in the treatment of keratoconus with a “hybrid” contact lens that has a soft skirt for improved comfort and a central rigid component to compensate for the irregular corneal shape in keratoconus.

Uncommonly keratoconus progresses to the point where a patient’s corneal becomes so irregular or contacts become intolerable and eye surgery is necessary. A corneal transplant for keratoconus has a success rate of well over 90%. After a corneal transplant most patients do still require vision correction—often with contact lenses—and there is a fairly long rehabilitation.

Contact lenses after corrective eye surgery

Millions of Americans have had LASIK or other surgery to correct their eyesight. In a very small percentage, vision problems remain after surgery that can’t be corrected with eyeglasses or a second surgical procedure. In these cases, gas permeable contact lenses can often restore visual acuity and eliminate problems like glare and halos at night.

GP lenses are also used to correct vision problems after corneal transplant surgery, including irregular astigmatism that cannot be corrected with eyeglasses. A corneal transplant may be performed in patients with eye diseases such as keratoconus or due to trauma.

Fitting patients with contacts after eye surgeries is both rewarding and challenging. Special lens designs and unusual prescriptions are often necessary making the fitting more time consuming, but worthwhile due to the greater benefit received by the patient contrasted with eyeglasses. At Madison Eyes we maintain an inventory of specialty lenses to fit these difficult cases and have affiliations with custom lens manufacturers to produce contact lenses of any size, shape, and power.

Contact lenses for presbyopia

Presbyopia is the normal loss of focusing ability up close usually between the ages of 40-50.

Today, there are many very good designs of bifocal and multifocal contact lenses to correct presbyopia. For good candidates, bifocal and multifocal contact lenses are successful in 70-80% of patients.

For those unsuccessful with multifocal contacts or others that aren’t good candidates, another option for presbyopia is monovision. This is wearing a contact lens in one eye for distance vision and a lens in the other eye that has a modified power for near vision. There are also blended fittings utilizing the benefits of both multifocal lenses in a modified monovision format.

In the past and to a less frequent degree today, many patients have worn OTC readers on an as needed basis over their distance contact lenses.

During your contact lens fitting we can help you decide which method may work best for you. At Madison Eyes we will offer free diagnostic contact lenses to best compensate for presbyopia.  At the least we will tell you what strength OTC glasses will make sense when appropriate.

Find out if you can wear contact lenses

If you are interested in wearing contact lenses, call our office to schedule a consultation. Even if you’ve been told you’re not a good candidate for contacts because you have one of the above conditions or for some other reason, we may be able to help you wear contact lenses safely and successfully.

*Limitations in our risk free offer do exist, please call our office to find out how our risk free offer applies to you.

Contacts Lenses Fitting

What Is Vision Insurance?

What Is Vision Insurance?

Vision insurance gives to you coverage for ‘wellness eye exams’. A wellness eye exam is easier to explain by what it isn’t. It isn’t an exam where the patient has a medical concern as the chief reason for their visit. In other words, the patient isn’t coming in because of a concern for an eye disease, but rather expects that everything is healthy though might suspect that they have a change in vision due to a prescription change in their glasses or contact lenses.

A vision exam includes a determination of a patient’s prescription for contact lenses and/or glasses and if either is recommended. Usually, vision insurance provides coverage for wellness eye exams once every one or two years for at a very modest copay. Some vision plans also cover a significant portion of the cost of eyeglasses and/or contact lenses. A vision exam also includes a battery of tests to verify that a patient’s eyes are healthy.

At Madison Eyes, we accept a number of different insurance vision plans. Aetna, EyeMed, Horizon Blue Cross Blue Shield, and VSP (Vision Service Plan) are the most common vision plans we see. This is not a complete list. For all these plans, and many others, we will handle all the paperwork and submit your claim for you.

What if there is a medical eye problem or eye disease?

If you have a medical eye problem and you have vision insurance, you also will have medical insurance, which can be applied towards the cost of your visit (sometimes in conjunction with your vision insurance).  A medical eye problem would include situations where you have noticed redness, discomfort, or pain in one or both eyes. Medical insurance would also cover your visit if you were to notice a change in your vision and you suspected or had been previously told you had a relevant medical eye condition such as a cataract, glaucoma, or floating spots. This is a very incomplete list, so if you have any questions about your insurance or which type of insurance might apply, please call our office and ask to speak with Sharon or Nicole.

Where can I get vision insurance?

Many employers offer vision insurance to their employees. Usually the employee must contribute at least a portion of the cost for the plan through regular payroll deduction. The employee will usually receive an offer to enroll in the plan in the fall. The employer determines what the benefits are of the vision plan. These benefits vary significantly. Some plans cover only the employee; others will cover the spouse or family. Some plans include yearly eligibility for an eye exam and $400 or more towards materials (eyeglasses/contact lenses) each year. Others only include an eye exam with a significant copay every two years with no materials benefits.

What Is Vision Insurance?

Macular Degeneration

Macular Degeneration

Macular degeneration, (also called AMD or age-related macular degeneration) is a disease in which the central part of the retina, called the macula, breaks down and loses its ability to create clear vision. The macula is responsible for central vision – the part of our sight we use to read and drive. AMD is the leading cause of vision loss and blindness in Americans of ages 65 and older.

Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). Neovascular refers to growth of new blood vessels, which are damaging to the retina and can leak blood into the macula causing further damage.

Dry AMD, always the first type a patient develops, is more common – about 85% to 90% of all cases of macular degeneration remain the dry variety.

Dry AMD – AMD is associated with aging and results in changes in the appearance of central retina that Drs. Naftali and Lacotte always check for during a comprehensive examination of all patients regardless of their ages. Dry macular degeneration is diagnosed when yellowish spots called drusen begin to accumulate in the macula. Drusen are believed to be deposits or debris from waste products form the retina. Vision loss from this form of the disease ranges widely from slight to severe, but is usually only mild.

Wet macular degeneration – Wet AMD, while less common, is usually a more damaging stage of the disease. In about 10% of cases, dry AMD progresses to wet macular degeneration.

With wet AMD, new blood vessels grow beneath the retina and leak blood into the retina. This leakage can cause permanent damage to light-sensitive cells in the retina.

A major study conducted by the National Eye Institute (NEI) looked into the risk factors for developing macular degeneration. The study, called the Age-Related Eye Disease Study (AREDS), and published in 2001, revealed that high levels of antioxidants and zinc significantly reduce the risk of advancement of AMD and its associated vision loss by about 20-25%. A large follow-up study, AREDS2, is due to be published in 2013.

Macular degeneration signs and symptoms

Macular degeneration is painless and the loss of vision may be gradual so is not always obvious to the patient. AMD often progresses in one eye in advance of the other so many patients do not notice the vision loss in one eye as long as the other eye is seeing well. Early signs of vision loss associated with AMD can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision. In some cases, wet AMD may cause a sudden loss of central vision. Patients with AMD should use an Amsler grid or other method to check themselves regularly for early signs of progression of their AMD.

What causes macular degeneration?

AMD is linked to aging. Research also suggests a gene deficiency may be associated with almost half of all potentially blinding cases of macular degeneration. Smoking is high on the list of risk factors for macular degeneration. Other risk factors for AMD include having a family member with AMD, high blood pressure, lighter eye color and obesity. A heart healthy diet with lots of dark vegetables appears to be protective against the development of AMD.

How is macular degeneration treated?

There are no FDA-approved prescription treatments for dry AMD, although nutritional intervention is valuable in preventing progression to the more advanced, wet form. There is as yet no outright cure for macular degeneration, but in 2006 a revolutionary advance in the treatment of wet AMD was approved.

There are now several FDA-approved drugs aimed at stopping abnormal blood vessel growth and vision loss from the disease. All these treatments are currently administered as injections into the diseased eye. Further improvements are likely over the next decade. Laser treatment of the retina is no longer often recommended.

Testing and low vision devices

Detection and monitoring of AMD resolve around several non-invasive tests. At Madison Eyes we start with a check of a patient’s visual acuity, which often decreases with the development of AMD. We also perform ‘ophthalmoscopy’ which means visually examining the retina with a microscope and special magnifying lenses.

Perhaps most importantly, in 2010 we invested in a high definition ‘OCT,’ a non-invasive instrument that can reveal what might otherwise be hidden signs of emerging macular degeneration. Using these tests in combination with patient histories we have diagnosed many cases of AMD. A smaller number of these cases were of the early wet AMD type allowing us to begin treatment early and save or even improve a patient’s vision.

If you have already suffered vision loss from AMD, low vision devices including high magnification reading glasses and hand-held telescopes may help you achieve better vision than regular prescription eyewear.

Macular Degeneration

Multifocal and Bifocal Contact Lenses

Multifocal and Bifocal Contact Lenses

Multifocal and bifocal contact lenses are available to allow clear vision for all distances; from reading on your smart phone to seeing road signs while driving. Most people develop the need for two different prescription strengths somewhere between the ages 40-50.

When this occurs, without the correct near reading strength you may need to hold reading material – like a menu or newspaper – farther from your eyes to see it clearly. This condition is called “presbyopia.” When you need to hold things too far away, it may be the right time to consider this category of technologically advanced contact lenses.

There are many brands of these lenses and ‘multifocal’ and ‘bifocal’ are somewhat arbitrary distinctions; the purpose of these lenses are the same, but Drs. Lacotte and Naftali have years of experience in determining which type and brand are most likely to work best for your circumstances. We stock multiple brands of diagnostic contacts. Most patients can leave the same day as their initial evaluation with multifocal contacts in their correct prescription strength.

While multifocal contact lenses are available in both soft and rigid gas permeable (GP) materials, and the GP materials work very well, the majority of patients opt for the soft multifocals due to the ease of comfortable adaptation. Most patients can comfortably wear soft multifocals for hours from the very first day of wear. GP multifocals usually take a longer period of time to adapt to full time wear, but they did offer the probability of even clearer vision, especially in patients with moderate astigmatism.

Types of multifocal contact lenses

Based on design, there are basically two types of multifocal contact lenses:

1.Simultaneous vision lenses: With these lenses, both distance and near zones of the lens are in front of your pupil at the same time. As a result, most patients wearing these lenses enjoy excellent vision for middle distances (such as a computer screen or a friend’s face at conversation distance), but may offer less sharp vision for very far or very near vision. Simultaneous vision lenses are, by far, the most popular type of multifocal contact lens. They are available as soft or GP lenses. Another advantage of these lenses is that they work without you having to look through the lower part of a lens as one might have to do with a pair of bifocal or progressive glasses when looking at a computer screen.

2. Alternating vision (or translating) lenses: These are GP multifocal lenses that are designed like bifocal eyeglass lenses. The top part of the lens has the distance power, and the bottom part of the lens contains the near power. When you look straight ahead, your eye is looking through the distance part of the lens. When you look down, your lower lid holds the lens in place while your pupil moves (translates) into the near zone of the lens for reading.


Will multifocal contact lenses work for me?

With the improvements to these lenses over the past few years, most people who try multifocal contact lenses are happy with them. But some compromises may be necessary when you wear these lenses. Some patients will occasionally use supplemental over-the-counter mild strength readers when reading smaller print for extended periods.

In some cases, a better solution for presbyopia may be a ‘monovision’ In monovision, you wear a single vision contact lens on one eye for your distance vision and a single vision contact lens on the other eye that has a prescription for your near vision.

Take a risk free trial*

To determine the best contact lenses for your vision needs when you reach “bifocal age,” call our office for a consultation. When we fit patients for contacts we do charge for the fitting of the lenses, but not only do we give to you free diagnostic contact lenses, there no obligation to purchase contacts, and if you decide against contact lens wear we will credit your fitting fees (limitations do apply, please contact us for details). *

Multifocal and Bifocal Contact Lenses

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...This is a partial list, please click here to see the complete list and eligibility limitations.

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I was a patient and good friend of Dr. Charles Bloom. When you acquired his practice, I was somewhat skeptical of the change. However, you have proven to me that you are an extremely competent doctor and have helped my wife and me immensely. You have a great ability to connect with a patient and take the time to discuss their situation.

Mr. Leslie Metsky
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