As when inserting lenses, the cornea must be well centred between the lids or it will not be possible for the lid margins to stay clear of the lens. Once you are sure of this press the lids tightly against the cornea above and below the lens. The most popular way of doing this is to place one or two finger tips on the skin at the outer corner of the eye and pull the skin back and slightly upwards so as to tighten the lids on the cornea. There is a knack in doing this and beginners usually fail because, as soon as they start pulling the skin back, they allow the lids to close over the lens. This makes it impossible for the lens to come out. In the normal course of events, pulling the skin backwards will always bring the lids together and it is essential that you should hold the lids wide (to clear the contact lens) while you are pulling — take care not to pull very hard!

Gently pull the lids back and a little upwards. If, while maintaining the lid margins tight against the cornea, you now try to blink, or turn your eye towards your nose, the tight lid margins will catch the edges of the lens and pop it out of your eye into the palm of your other hand, held conveniently close to receive it. This is probably the best method, especially for the younger wearer, whose lids are normally reasonably tight.

Older people’s lids are often quite lax and the edges may turn out slightly making it difficult or impossible to use this method. In this case, keep the lid margins against the cornea by pressing them directly on with the finger tips then bring them together to catch on the upper and lower margins of the lens and pop it out.

In using either of these methods the lens will often stick to the lashes and you may wonder what has happened to it. The expert will always succeed in dropping the lens into her hand, but until you acquire this degree of skill, do your lens removing over a flat surface on which you have spread a clean towel.

Solid plastic sucker

This is a device which I view with mixed feelings, having once or twice seen damage resulting from the unskilled application of one of these devices to the naked cornea. It is a non-squeezable gadget with a very thin-cupped business end, which grips the lens strongly. I don’t think it is possible to do any very serious harm, but there is no doubt that you can give yourself a very sore eye if you are careless. The sucker is a most efficient way of removing a hard contact lens. Unfortunately, if you happen not to have a lens on the cornea, it will grip the corneal epithelium instead, with very painful results. You will be incapacitated for a couple of days and will not be able to wear contact lenses for about three weeks.

If you should get a plastic remover stuck on to your cornea, on no account try to pull it off. Instead, try gently to slide it across to the edge of the cornea and free it as it passes on to the conjunctiva. Even if it retains its adhesion, you will do no harm by pulling it straight off the conjunctiva.

A much safer, although less efficient, type of lens remover is the hollow, compressible, type made of rubber or plastic. There is little chance of doing yourself an injury with this type of device, as you can always release it, quite easily, by squeezing. Unfortunately, however, the grip is insecure unless the device is in good condition, the contact lens properly wetted and the timing of the squeeze and release just right. The sucker is handy for removing a lens that has slipped off the cornea and become stuck on the conjunctiva, especially if it is high up behind the upper lid and cannot be eased down. But in this case it is advisable to seek the help of someone else while you turn your eye as hard as you can in the direction opposite to where the lens is sitting (turn your head up and look down).

People with arthritis, or who are very clumsy with their fingers, may consider snipping off the closed end of one of these suckers and pushing the opening thus made over the end of a short length of solid glass rod of suitable diameter. Enough of the sucker should be left free to allow squeezing. Such a device may be found useful in inserting and removing lenses. The secret is to have a source of light behind the far end of the rod, so that the contact lens wearer can sight down through the centre of the lens and the glass rod and thus ensure proper alignment. But take great care to avoid bumping the lens on the cornea — the finger tip is always preferable.

Putting a contact lens on a cornea is no more difficult than putting it on the tip of your finger but, in practice, there are several factors that can frustrate you. The first is that the eyelids can, and probably will, get in the way long before you can get near the surface of the cornea with your lens. This is a perfectly natural response and is exactly what you have been doing all your life, whenever your eye is threatened. Many experienced contact lens wearers so thoroughly learn to block this impulse that they can keep the eye wide open, without touching the lids, while placing the lens on to the cornea. But very few beginners can expect to perform this feat, so it is necessary, at least at first, to hold the lids open. Because the lid skin is very elastic and just underneath is an important flat muscle which can bring the lid margins together even if the skin is held, the only way to keep them securely apart is to hold them either very near the margins (difficult if the skin is not quite dry) or to secure them by trapping the lashes.

One easy method of holding up the upper lid (which is the larger and more important) is to look right up so that the lashes of the upper lid come to rest just under the bone edge and then to press the centre of the row of lashes up against the bone with the middle finger of your free hand. This gives you extremely effective exposure when you look downwards, as the upper lid is prevented from following the eye down in its normal fashion. All that is necessary now is to pull down the lower lid a little, with a finger placed centrally just below the lid margin, and the whole of the cornea will be widely uncovered. By using the middle finger you leave the index finger free to carry the lens. Note the emphasis on central placement of both restraining fingers: it is no good holding the corner of the lid as this will allow the centre to sag across the cornea.

So far so good. You have now learned how to expose the whole of the cornea; but all this effort will be wasted if you turn your eyes to the side or up or down. No matter how effectively you hold your lids apart, you will still be able to get your cornea behind the lid edges so that it will be impossible to get a lens on.

All this may seem too obvious to be worth mentioning, but the reason I do mention it is that, time after time, patients secure their eyelids perfectly then frustrate the whole endeavour by rolling their eyes, usually right upwards, but sometimes to the side. Fortunately, there is an easy way out of this problem. If your lids are properly held and if the contact lens is brought up to the eye on the tip of the index finger, so that you can look straight into it, and if you continue to look straight into it until it is on your eye, then it can only go on one place — where it should go, right on to the centre of your cornea. If you are not looking straight into the lens when applying it to the eye, it will not land on the cornea.

So this is another psychological barrier which has to be overcome, and don’t be surprised if you have a bit of difficulty to start with. It goes against all instinct to stare straight at something that is getting nearer and nearer to your eye, with the evident intention of actually touching it! But it is amazing how a reflex habit of a lifetime can be overcome when you find that neither discomfort nor harm is involved.

The method I have suggested of securing the eyelids is probably the best, but some people find it awkward and prefer to hold the lids open with the fingers of one hand while bringing up the lens on a finger of the other hand, because they find it easier to control the finger on which the lens is sitting if that hand is free. It does not matter very much how you do it, so long as you really are keeping the lids wide apart and are keeping the cornea well centred.

One thing you should avoid, however, is holding the lens on a rigid rubber or plastic sucker when putting it on the eye. With such a device you are much more likely to bang the lens painfully against the cornea than if it is resting on the soft pad of your finger. I don’t advise using suckers to remove the lenses either.

While I am very much in favour of your using a method which enables you to put the contact lens directly on to the cornea, I would not like to suggest that there is no other way of getting the lens there. Some people find it very difficult to place the lens directly on to the cornea and, perhaps because they have found themselves repeatedly rolling the eyes upwards (consequently depositing the lens on the conjunctiva below the cornea), have settled for a method of doing this deliberately and then gently pushing the lens up on to the cornea. This is all right if it is done properly, but remember that the cornea bulges out fairly steeply and the edge of the lens may strike sharply against the start of the corneal curve as you push it up. If you prefer this method, the right way is to pop the lens on to the conjunctiva immediately below the cornea then, by pressing through the lid, on to the lower edge of the contact lens, to tilt the upper edge of the lens a little way clear of the eye and then push it up on to the cornea. The whole manoeuvre is done by gentle pressure through the lid.

Incidentally, if you have to move a contact lens which has been displaced from the cornea and is lying on the white of the eye, this is how to do it. Simply feel the lens through the lid, moving your eye in the opposite direction, as necessary. Even if the lens has travelled right up under the upper lid, so that it is barely visible or even completely concealed by the lid, it will be quite easy to slip it forward and down just by looking downwards and gently pushing the lens down with the finger tip placed on the outside of the lid.

Slide the lens downwards on to the white of the eye below the cornea simply by placing the tip of your finger on the centre of the lens and then looking upwards — really, the reverse of the last part of the method described for putting the soft lens on the cornea. Once the contact lens is down on to the conjunctiva you will find it the simplest thing in the world to pinch it off the eye using the tips of the thumb and first finger. If your fingertips tend to slip on the lens, just dry them thoroughly and you will have no further problems.

It isn’t really necessary to slide the lens off the cornea before pinching it off the eye and many people pinch them directly off the cornea. But if you do this, be careful to ensure that the edges of your fingernails are turned well outwards so that there is no possibility of scratching the cornea. If your fingernails are very long avoid the pinching method altogether, or cut your nails to a safer, shorter length.

If you prefer to keep long fingernails, it is still possible to remove soft lenses safely but either you must wear rubber gloves or finger stalls, or resort to the method described for hard lenses in which the lid margins are pressed tightly against the eye above and below the lens and are then brought together to squeeze it off the cornea. Some people actually succeed in doing this by the standard hard lens method of pulling the skin back and up at the outer angle of the eye.

But because soft lenses are much larger than hard lenses and are more closely applied to the eye, it is difficult to ensure that the lid margins press on the white above and below the upper and lower edge of the lens and don’t just press the lens even more firmly on to the cornea. The tendency for the lids to do this is quite strong and you might well find that you are just not getting anywhere. If this is so, you would be better to fall back on the second method, placing the tips of your first or second fingers of both hands on the lid margins, and using your fingers to press the lids against your eye and squeeze off the lens. If you use this method, don’t put the fingertips back from the margins of the lids. If you do, the margins will roll outwards and not catch the edge of the lens. Also, be careful to place your fingertips exactly in the centres of the lid margins and not to the side and look directly ahead when you start squeezing.

All this takes much longer to describe than to do and once you have the knack you will wonder what all the fuss was about.

A. Yes quite easily, if the equipment is to hand. But lens adjustments, and even polishing, are becoming increasingly uneconomic and most fitters will simply order new lenses for you.

Q. Can the power of soft lenses be changed? A. No.

Q. Why do soft lenses have a limited life?

A. Surfaces become permanently contaminated or pitted, edges become nicked, lenses tear, material becomes discoloured.

Q. What will happen if I let my soft lenses dry? A. They will turn into little grey potato crisps.

Q. Does that mean they are ruined?

A. By no means — unless you snap them. Just put them back into water, or a soaking solution and they will soon be restored to normal.

Q. What are comfort drops?

A. These are viscous solutions which help to keep the lenses wetted. They are sometimes helpful in building up wearing time.

Q. I wear soft lenses. Can 1 use medical eye drops?

A. Be careful! The preservative might concentrate in your lens and cause irritation. The active ingredient might also do the same, in which case you will get more than was intended.

Q. I get hay fever. Is it all right to wear my lenses during an attack? A. Between attacks — no problem. During an attack there is a risk of losing lenses if your eyes water or you sneeze much. A specialist could prescribe useful eye-drops.

Q. Can I wear my lenses if I have conjunctivitis?

A. Positively not. And make sure that they, and your lens containers, are sterilized before you wear them again.

Q. How?

A. Thorough cleaning, enzyme and boiling (if safe) for soft lenses; thorough cleaning and prolonged soakage in solution for hard lenses. Don’t forget the container!

Q. I have glaucoma. Should I wear contact lenses?

A. Ask your specialist. Sometimes soft lenses are undesirable, but they can be used to improve the delivery of medication.

Q. At what age can contact lenses be fitted?

A. Contact lenses have been successfully fitted to new-born babies, to ninety-year-old post-cataract patients and to people of every age in between.

Q. Yes, but apart from medical indications when should young people start?

A. People with moderate degrees of short sight might start around sixteen years, but if the myopia is severe, an earlier start is justified. But in this case an adult should supervise wearing time and routine cleaning of the lenses.

Q. Do young people have many problems with contact lenses? A. Young people are remarkably tolerant and have few problems. Those that arise are nearly always due to overwear andlack of cleanliness.

Q. Which kinds of people are least likely to be successful with contact lenses?

A. Males over 40. Teenage girls almost always succeed!

Q. I am short-sighted, 45, and usually take off my glasses to read. Do you recommend contact lenses?

A. No.

Q. Why not?

A. You will certainly need to wear reading glasses on top of your lenses.

Q: Can contact lenses harm the eye?

A: Contact lenses are dangerous if you have a faulty lens, or do not maintain proper ocular hygiene, or don’t follow the recommended wearing and handling procedures. For instance, corneal abrasion can occur when the lens isn’t inserted properly. Corneal edema occurs if you overwear the lens. An eye infection may be caused by fingers or contact lens solutions that are contaminated. And foreign bodies can sneak under the lens and irritate the cornea.

With regard to the vast number of contact lens wearers, though, such complications have been remarkably rare.

Q: What is corneal edema?

A: It is the most common contact lens complication and the main reason you can’t wear lenses for twenty-four hours (except for extended-wear contacts). Edema means swelling, which is what happens to your cornea when you wear your lenses too long and deprive the cornea of oxygen. Even though gas-permeable lenses, soft lenses, and lenses that allow optimum tear exchange reduce the chance of edema, there is always less oxygen than normally reaches the naked eye. You’ll know when you’ve been wearing your contacts too long: your eyes will burn, turn red, be light sensitive; maybe you’ll see halos or rainbows around lights. Unless you’re too stubborn or highly motivated, the most appealing thought in the world will be that of removing your lenses, which is exactly the right thing to do. In minor cases your cornea will recuperate in a few hours (better yet—overnight). If you really overdo it, recovery may take several days and corneal abrasion may follow.

Q: What is conjunctivitis?

A: This is an infection of the conjunctiva, the mucous membrane that covers the white part of the eye and lines the underside of the eyelids. Conjunctivitis and other eye infections can afflict the contact lens wearer who doesn’t clean (and disinfect, in the case of soft lenses) his lenses according to instructions. It can also occur when wearers clean and wet the lenses with saliva, which is loaded with bacteria, viruses, and perhaps fungi. In addition to the ordinary garden-variety conjunctivitis (”pink eye“), there’s another form called “giant papillary conjunctivitis,” which is caused only by contact lens wear (the contact lenses themselves, deposits on the lenses, or any of the contact lens solutions). In treating the individual with this type of conjunctivitis I discard the contact lens and prescribe a steroid (cortisone) eye drop. Resolution of the disorder may take days or even weeks. Once the conjunctiva has healed, I order a new lens and then instruct the patient to use different solutions. For the hard contact lens wearer the correct solution is determined by trial and error. For the soft contact lens wearer I permit only the use of unpreserved saline and the heat method of disinfection. Happily, this type of conjunctivitis, when treated properly, rarely recurs. If it does reappear, cessation of contact lens use may be the only solution.

Q: What’s corneal abrasion?

A: Corneal abrasion is the term used when the surface layer of the cornea is scraped or scratched off. This can occur when you wear the contact lenses too long (overwear syndrome); with improperly fitted lenses; or by inserting, removing, or recentering the lens improperly. Sleeping with daily-wear lenses on often leads to corneal abrasion. The symptoms are decreased vision, burning pain, sensitivity to light, the sensation of having something in your eye, and copious tearing. Abrasion that follows corneal edema may not be evident until hours after the contact lenses have been removed. Healing is mercifully rapid: usually within thirty-six hours. You may take aspirin for the pain, and cold compresses may help. Consult your ophthalmologist to make sure there are no complications; he may also recommend that you wear a tight eye patch for the duration of the recuperative period to keep the eye immobile. Though most cases of corneal abrasion are minor, a severe infection can invade the damaged cells. While this is unlikely to occur, it is a possibility, so don’t treat corneal abrasions lightly.

Q: Can contact lenses cause drooping of the eyelids?

A: It’s rare, but the results of one study indicate that in a very few cases, contact lens wear can lead to a condition called blepharoptosis, resulting in eyelids that appear to droop. All the patients studied had been wearing hard lenses, some for many years. The researchers’ most likely explanation is that the condition was caused by excessive manipulation and rubbing of the eyelids, usually because of difficulties in inserting and removing the lenses. The trauma caused eyelid muscle damage. This condition can be corrected surgically.

Other than that there’s almost no adaptation time to speak of. Patients usually go on an extended-wear regimen after one week of daily wear.

Minor symptoms to be on the lookout for are excessive tearing, redness, stinging, burning, itching, blurry vision, halos around lights, and light sensitivity. If any of these occur, remove the lens for at least three hours. If the problem ceases, your lens may be the source of the problem and you should check to see if cracks or chipped or ripped edges are present. Do not reinsert the lens if it is damaged. Put it back in its case and return it to the doctor, who will order a replacement. If you see dirt or an eyelash (or any other foreign matter) use the enzyme solution, clean, and disinfect the lens. Then you may reinsert it. If any of these problems persist, consult your doctor.

Follow-up Visits

It’s very important that you return to your eye practitioner for follow-up eye examinations. It is recommended that these occur:

• After the first twenty-four hours of extended wear.
• After the first three days of extended wear.
• After the first week of extended wear.
• After each month of the first six months of extended wear.
• After each six months of extended wear.

Care and Handling of Extended-Wear Contact Lenses

The procedures used in extended-wear lens care and handling are essentially the same as for conventional soft contact lenses. The main modification is the frequency with which these are done. There are also a few additional amendments of which the extended-lens wearer should be aware that will make these lenses more comfortable and safer.

Lens deposits are the most frequent cause for discomfort and replacement. That these lenses are worn longer and are very high in water content encourages deposits to form even more readily than on conventional soft contact lenses. Proper care and hygiene are therefore even more important, and the diligent cleansing of extended-wear lenses adds appreciably to their useful life.

For cosmetic wear the lenses may be worn up to fourteen days. On the fourteenth night the lenses should be removed, cleaned with a surfactant and / or saline and enzyme solution, disinfected, and then reinserted the next morning. However, some patients find they must remove and clean their lenses more frequently. The patient can perform these procedures himself, except when he goes for checkup exams. At that time the lenses are removed, cleaned, and reinserted in the office by the doctor or his technicians.

Aphakes wear their lenses longer in general: from one month up to six months, with an average of three months of extended wear. These patients usually leave the cleaning procedures to the doctor, who performs them whenever the patient goes for a checkup. Sometimes a neighbor or relative can be instructed to clean, remove, and insert the lenses for the patient between office visits if the wearer is unable to do this for himself.

Extended-wear lenses may be disinfected either thermally or chemically. If the heat method is employed, a “low-heat” unit should be used to avoid shortening the life of the lenses.

Lubricating the Lenses while in place

Whenever the lenses feel dry, scratchy, or don’t move freely on the eyes, relief may be obtained by instilling a few drops of saline solution or lubricating solution formulated for use with soft lenses. These eye drops may be used as often as you like.

They are especially helpful in the morning upon awakening when the eye and lens are their driest, and as a way to lubricate the lens before removal, since even a partially dehydrated lens can tear when it is removed.

For some, more involved measures are indicated in order to increase the comfort, slow down the progress of deposits, and reduce the incidence of “red eye.” In between scheduled removals and cleanings you can give your eyes a saline bath while the lenses are in place. Dr. H. Johnson Kersley, the London ophthalmologist who devised this method, recommends that you use the unpreserved premixed saline solution, which comes in single-unit packets. Use one quarter of the packet in an eyecup for each eye, each morning and each night. (Thus one entire packet is used each day.) Apply the eyewash in the eyecup, keeping the lids partially closed, so that the eye, lids, and lashes are rinsed.

Alternatively, you could shower the eye and the lens by carefully and gently pouring a stream of saline into the open eye, head tossed back, blotting up the excess with a clean tissue.

These measures may help extend the length of time that the lenses can be worn without removal for cleaning. Even so, many extended-wear patients will have to remove and clean their lenses more often than every two weeks. A large number are on a once-a-week schedule, but even those who need to remove them every other day or every three days welcome the freedom from the inconvenience of daily care and the opportunity to lead fuller, more normal lives.

First find the contact lens either by opening the eyelids widely and looking in a mirror or feeling for the lens through the eyelid while it’s closed. Never touch the lens with your finger and push it around on the eye. This can scratch your cornea. As with insertion there are several methods from which to choose.

METHOD # 1

Look in the direction of the contact lens, and the cornea will slide beneath the lens and recenter automatically.

METHOD # 2

Keeping the eyelids closed, gently exert pressure through the eyelids to push the lens toward the cornea with your fingers.

METHOD #3

Gently push the lens into position with the upper and lower lid margin. If the lens is under your lower lid, tilt your head down, look up, and use the lower lid. If it’s under the upper lid, tilt your head back, look downward and use the upper lid margin. If the lens is to the side toward your ear, or in the corner toward your nose, place your fingertips on both upper and lower lids and use both lid edges to nudge the lens back in place.

METHOD #4

Sometimes the lens may adhere to the undersurface of the upper lid. In that case merely turn the upper lid inside out and remove the lens.