Thursday, 23 September 2010

Seeing and Being Seen

Some of you will be pleased to hear that I finally splashed out and went to the eye doctor.  I bought new glasses and have been wearing them out and about instead of contacts.  I went for the newest (and most expensive) technology to get the lenses as light and then as possible and they seem to do the trick of allowing me to see just fine.  Strangely enough my prescription hasn't actually changed from the glasses I bought sometime in the 1980s and have worn around the house - but never in public.  The huge square-ish pink frames with coke-bottle bottom lenses just were more than I could handle.  I did buy another pair - two, actually, about 10 years ago, but never wore them much as they gave me major headaches and weren't really much more attractive than the ancient ones.    I wouldn't say these new glasses were wonderful, but they are a vast improvement, with no headaches other than at the point of payment.  I shall post a picture soon so you can see them.

This afternoon I will go back to have the trial contact lenses assessed.  I'm pretty sure the opthomologist was used to seeing people wear their contact lenses for longer than intended, both longer day wear and longer without replacement of disposables.  I knew the consequence of too long day wear:  vascularisation, or growth of blood vessels into tissue to improve the oxygen supply.  This is part of what caused the industry to produce more air permeable contact lenses.  He said I showed signs of previous vascularisation which was receding.  I knew that finishing work would be good for my health on many levels, and not wearing my contacts for so long is just another one of those benefits.

My monthly disposable contacts were long over due for replacement and I'd always thought the risks would be physical, that an old lens would become scratchy and uncomfortable, so I've thrown them away as they've become uncomfortable or damaged.  He started to tell me about acanthamoeba, but I interrupted, saying I thought that was associated with tap water.  I'd worked in public health at a time when the Centers for Disease Control published an article about anathamoeba keratitis associated with using home made saline with tablets and tap water.  My boss had just got some contacts to help with the swimming part of his triathlons, and was disappointed to to learn that he'd not be able to use them after all.  I promptly stopped using the homemade solution.  There has since been an outbreak associated with an over the counter lens solution.  

I have to confess to being a major skeptic about professional advice.  I used to work for a consultant doctor who sometimes gave what I knew to be bad advice; he bragged that you could say anything and be believed if you said it with enough confidence.  About a decade ago, I bought contact lenses from SpecSavers, a chain here in Britain.  The optometrist, a young woman, insisted I buy the monthly solution along with the lenses, saying that in her 'professional experience' people who didn't have that particularly purchasing plan, which included a repeat visit within 6-9 months, didn't return in a timely fashion.   At the back of my mind I was thinking she wasn't so much a 'professional' as an employee of a big chain.  I couldn't say for sure whether she was giving me professional advice or a sales pitch.  She was right, however; having been forced -- I believed she wouldn't write the prescription if I didn't -- to spend an extra £7 per month for solution when I already had a drawer full of the same stuff, I've never gone to SpecSavers again, and I won't.  Bill has remarked more than once about how stubborn I am that way.  

So when this optometrist said that he was happy for me to do as I liked as long as he knew he'd given the correct advice, I wasn't worried he wouldn't write me a prescription and I was actually more open to hearing what else he had to say.  He did say that acanthamoeba was ubiquitous, not just in tap water (lakes, swimming pools, hot tubs, etc.), which made me wonder what one did to avoid it other than use over the counter solutions rather than homemade (and hope for the best).  The logic of infection as the rational for disposing of lenses every month fails when they say that the more I wear my glasses and the less I wear the lenses, the cheaper it is as the lenses last longer.  That suggests to me that it is about the physical life of the lens, rather than the risk of infection.

When I got home, I went to the source of advice that I trust the most, the Centers for Disease Control (they aren't selling contact lenses, you know), to see what they had to say.  I was horrified to learn that they recommend not wearing contact lenses in the shower.  Besides making life at the gym after a run more complicated, I've been known to put in contacts in order to shower, so I could see where the shampoo was.  Never in my 38 years of wearing contacts - or to be more applicable, in the 24 years since the initial outbreak of acanthamoeba keratitis in 1986, have I ever had any professional advise me not to shower in my contacts.  I suspect this recommendation is on the basis of logic rather than any statistical association between infection and showering, but I've not researched it further.  Has anyone else ever been told not to shower when wearing their contacts?

I can just add a contact lens case and some solution to my gym bag and buying a 3 month supply of contacts was a snip compared with the high tech glasses.   Life is easier with contacts in many ways, but I have to say, those glasses are looking better and better and I plan to definitely get my money's worth.  At £270, we're talking about daily use to get the lowest possible cost per wear

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