The contact lenses.

• A carrying case. Used to store and carry the lenses when not in use.
• Various contact lens solutions. The answer to the problem of cleaning, rinsing, storing, wetting, disinfecting, and lubricating. (Varies according to lens type.)
• A disinfection unit. If you are disinfecting the lenses by heat, an electrical unit is used to sterilize soft lenses. You will need an adaptor if traveling abroad.
• An accessory case. Used to organize all the above paraphernalia.
• An instruction session and educational information. Personalized instruction, training films, and pamphlets describing the techniques used to insert, remove, care for, and handle the lenses.
• Adjustments in the lenses. Needed to improve fit and vision during the first six months of lens wear.
• Warranty. Lenses are guaranteed against defects (a torn lens, a scratched lens, etc.). That is why it is so important to have the lenses checked by the doctor before you wear them.
• Office visits. Unlimited visits to the doctor’s office during the first six months to improve the fit and v_eisi_so_en_s,. and to facilitate the care and handling of the lenses.

Of all these items the most expensive part of the cost is the time and skills of your contact lens physician. The high-quality plastic from which the minuscule miracles are made costs only a few pennies to produce. It’s the skill and workmanship, time and knowledge, that are needed to transform the plastic into a well-designed lens. More important, the expertise of the eye doctor provides you with the correct type of contact lens that allows clear vision and comfort without damage to your eyes.

(Note that a reliable contact lens practitioner will refund the cost of the lenses if, after all options are reviewed and tried, you are still unable to adapt to contacts.)

Though the eye is quite durable, it’s also an irreplaceable, delicate, sensitive, and highly sophisticated organ. Your eye is directly connected to your brain by the optic nerve and is closely related to other systems of your body. It shouldn’t be considered independently, and before you walk off with a pair of contact lenses you should undergo a complete medical eye examination by an ophthalmologist.

Such an exam is much more than a simple mechanical test of your eye as an optical instrument. It determines what prescription you’ll need. It also determines whether you’ll be able 26 to wear contact lenses safely and comfortably, and reveals clues that form a picture of your optical health and your physical condition in general. It also yields the measurements needed to “fit” you with the right pair of lenses—these measurements must be extremely accurate if you’re going to be comfortable wearing lenses. To do all this, your eye doctor uses a variety of instruments and techniques that may seem baffling and mysterious to the potential contact lens consumer. Space- age technology has invaded ophthalmology, and your eye physician’s examining rooms may resemble the inside of a spaceship; the instruments approximate cousins of Star Wars character R2D2, with futuristic beeps and digital readouts. Whether your doctor has the latest in equipment or not, the examination can be a fascinating process if you let it; and you should feel free to pepper him with questions.

History. This first step may seem casual and unscientific, but it’s very important. Your eye doctor will ask you “Why are you here?” and discuss with you your motivation, occupation, leisure activities, systemic diseases and medications, eye diseases and medications, and allergies, complaints about your vision, whether you get headaches, and whether you’ve worn contacts before, what type they were and any problems you had while wearing them. (If you do wear contact lenses, you should keep them out of your eyes at least twenty-four hours before your exam, though seventy-two hours is preferable.)

Refraction. This step determines the prescription your lenses will need to correct whatever refractive error—nearsightedness, farsightedness, astigmatism, or presbyopia—you may have. We’ve come a long way from the days when a simple wall eye chart sufficed. Nowadays the doctor usually first instills special eye drops that dilate your pupils before using the two instruments, the Phoroptor and the retinoscope, to come up with your lens prescription.

First comes the Phoroptor, that familiar contraption that makes the examinee look like the ultimate bug-eyed Martian. As you gaze at the eye chart (projected on the wall), the physician tries out several lens combinations, repeatedly asking you “which is better, first or second?” Out of its billions of possible lens combinations, the examiner determines and fine-tunes your prescription. After this subjective test (you’re judging which lens corrects the best), the results are read off the Phoroptor in order to check the prescription by doing an objective test for refraction. As your eyes gaze at a distant target through the prescription in the Phoroptor, the doctor peers into your eyes with the retinoscope. Through the dilated pupils the light of the retinoscope creates a measurable shadow and light movement on your retina, which enables him to check the accuracy of the prescription.

Curvature of the Cornea. Using a keratometer, an optical scanning device, the ophthalmologist determines the exact “topography” of the cornea. A system of mirrors measures the horizontal and vertical meridians of the cornea. This determines the steepness or flatness of the cornea and its degree of corneal astigmatism, an important part of the overall refractive error picture, and instrumental in determining whether you need a hard or soft lens.

Muscle Range and Coordination. How well do your eyes work together? Do they point to and focus at various distances equally? How well do you judge distance and space (depth perception, or stereopsis)? To find out, the eye doctor uses a muscle light and special prisms.

Outer and Middle Layers of the Eye. Next comes the slit lamp, an electrical microscope that lights up and magnifies your eyelids, cornea, iris, lens, and fluid of your eye in order to reveal any disease, damage, inflammation, or other abnormality. A special stain called fluorescein is used in conjunction with a cobalt-blue filter to detect any corneal defects or abrasions not visible with the naked eye.

Inner Layers of the Eye. Through the dilated pupil, the retina and its blood vessels can be seen with an ophthalmoscope, which illuminates and enlarges the doctor’s view. This is the point at which early signs of diabetes, hardening of the arteries, hypertension, and other general disorders of the body can be detected.

Eye Pressure. This is the “glaucoma test.” The doctor anesthetizes your cornea with special eye drops, and measures the pressure of the eye fluid with a tonometer. Though the instrument actually touches your cornea, you don’t feel a thing because of the anesthetizing eye drops. This test is especially important for anyone over the age of thirty, although it is unusual for glaucoma to occur before the age of forty. There is also a “noncontact” tonometer which utilizes a puff of air to measure the eye pressure. Although not as accurate as a tonometer, this instrument is an excellent screening device and eye drops are not instilled.

Tear Function. Tears lubricate and cleanse your eyes and also provide the cornea with oxygen. A sufficient supply of tears is a must for comfortable contact lens wear. “Dry eyes” can be countered with special eye drops if the problem is slight. To make sure it isn’t a contraindication, the ophthalmologist performs the Shirmer test: special strips of paper placed under the lids to gauge the amount of tear production. After about five minutes the test strips are removed and the amount of tear absorption is measured and evaluated.

Visual Field. In certain instances (suspicion of glaucoma, retinal abnormalities, optic nerve disorders, neurologic disorders, headaches, and so on) a test of your peripheral vision is important. To measure your peripheral (side) vision, a special computerized instrument is used. (If you like video games, you’ll love this part of the test. If you don’t, the challenge may leave you a bit limp.) First each eye is tested separately, then together. Your head is kept immobile as you face a large dome, perforated with a scattering of pin-sized holes. As you gaze ahead steadily at a red-lit cross in the center of the dome, minuscule flashes of light go off through the holes, one at a time, at various distances from the center cross. Every time you see a “star” light up in this mini-planetarium, you hit a button; meanwhile the computer keeps score by adding up the correct “strikes.”

Your ophthalmologist will evaluate all the information thus gleaned from all parts of the ocular examination and decide whether or not you—and your eyes—are a good candidate for contact lenses, and if so, what type. Those who “pass” the exam then go on to the next step, the contact lens fitting.

Of course, there are some patients who have a high tolerance for pain and can accept almost any type of lens, or who don’t mind less-than-perfect vision. Nevertheless, intelligent consumers will demand excellent vision and comfort from their contact lenses. The perfect contact lens requires time, patience, and expertise that you can only find in the hands of an expert professional eye practitioner.

The difference between a pair of cheap lenses and an expensive pair lies not so much in the lenses themselves—it lies in the professional behind the lenses. You “buy” years of experience and professional service along with those little plastic discs. To repeat, an expert practitioner doesn’t attempt to make the eye fit the lens; he fits the lens to the eye! The eye always comes first. This important philosophy among contact lens practitioners can spell the difference between a successful and an unsuccessful contact lens wearer. Not all practitioners, however, are perfect. If you’ve been told “you can’t wear contact lenses” or if you’re not completely happy with the pair you have, consider going elsewhere for a second opinion. Patients have adopted this practice for many other medical matters, and buying a pair of contact lenses should not be any different.

When you consult a private ophthalmologist or optometrist who specializes in contact lenses, you’ll be fitted more accurately and with greater ease. Instead of having a pair (or two!) of ill-fitting, inaccurately prescribed lenses lying dormant in the dresser drawer, you’ll be wearing comfortable lenses that provide excellent vision. Follow-up care will be of high quality as well. Correcting problems of poor fit, discomfort, and faulty vision; maintaining the health of the eyes; replacing damaged or lost lenses; switching to new improved lenses, and so on are the hallmarks of care that only an expert contact lens practitioner can provide. He will never forget the criteria for successful contact lens fitting: long-term, full-time comfortable wear, with good vision and healthy eyes. Remember, you only have one pair of eyes. So please don’t take them for granted. They’re responsible for an estimated 80 percent of the information that your five senses tell you about the world you live in. A durable but sensitive organ, your eyes are irreplaceable. Badly fitted lenses may cause permanent damage, so economize elsewhere.

OPHTHALMOLOGIST (M.D.)

This is a medical doctor who specializes in the diagnosis, treatment, and surgery of the eye. He or she prescribes whatever eye treatment you may need, including prescriptions for glasses and the fitting of contact lenses. All ophthalmologists can provide a prescription for glasses and contact lenses; half of them also specialize in fitting contact lenses. Ophthalmologists spend a minimum of eight years training after college: After four years of general medical study at an approved medical school, they then spend an additional one to two years in general internship, and at least three more years in special ophthalmologic residency training at an approved hospital.

OPTOMETRIST (D.O.)

A doctor of optometry spends four years in specialized optometric study after college. He or she is trained to examine the eyes, to prescribe, and to fit glasses and contact lenses. There are about twice as many optometrists as there are ophthalmologists, and a large proportion of them fit and dispense contact lenses.

OPTICIAN

An eye practitioner who is trained (usually for two years in an optician’s school) and is authorized to fill the prescriptions of ophthalmologists and optometrists (but not prescribe himself). In some states he or she may fit contact lenses.

If you have decided that you would like to wear contact lenses, I strongly recommend that you first go to an ophthalmologist for a medical eye examination. The next step is to choose the contact lens specialist (it may be the same ophthalmologist) who will fit and order your contact lenses, as well as provide you with follow-up care. For this it’s best to go to an ophthalmologist or optometrist in private practice who specializes in contact lenses. He or she is probably the most trustworthy, reliable, and knowledgeable source, and though you may spend ‘more initially than if you went to a different type of eye specialist, this is one case where you get what you pay for. An ophthalmologist can best detect any present, past, or latent eye diseases and potential problems of the eye that might not only interfere with contact lens wear, but may affect your vision in general. By examining your eyes he can also detect signs and symptoms of diseases elsewhere in the body. Diseases that exhibit early ocular symptoms include diabetes, high blood pressure, arteriosclerosis, kidney disease, blood disease, and certain neurologic disorders. Thus you not only save money by not buying lenses that you won’t be able to wear successfully, but you might also be saving your sight—and perhaps even your life. Even if your ophthalmologist doesn’t fit contact lenses himself, you should go to him for your initial medical ocular examination. He will then refer you to an eye practitioner who is specially trained to fit contact lenses. In all cases you should remain under the ophthalmologist’s care, supervision, and responsibility. An optometrist, although lacking the training of a four-year medical school, does have the background training to diagnose many eye disorders. However, he cannot treat any ocular diseases.

Then there’s the matter of prescription and fit. You simply stand a better chance for a successful fit under the care of a private contact lens specialist, be he an ophthalmologist or optometrist, because of his virtually unlimited choice of lenses. The contact lens specialist isn’t committed to any one manufacturer, and can therefore choose exactly the lens which will best suit your individual needs. Having access to hundreds of lenses manufactured by many different companies is important because no one brand can fit everyone; all brands were not created equal.

There are some “optical stores,” on the other hand, which may buy large quantities of contact lenses from one or two manufacturers in order to obtain volume discounts that they can pass on to their customers at low markup. While you may benefit from lower prices because of the large inventory, it may be the store’s policy to try to fit you with one of their stock lenses because of their financial commitment. You forfeit having the choice of all the types of lenses in order to choose the one that specifically meets your own visual correction needs. It is unlikely that these stores hire ophthalmologists. Therefore the all-important initial medical exam is missing. Usually cursory eye exams are often the rule as well as a quick and sometimes inadequate instruction session. These shortcuts are two of the most often-cited reasons for contact lens dropouts. 92 percent of past contact lens failures were refitted successfully when they went to optometrists and ophthalmologists who specialized in contact lenses. In another survey of contact lens dropouts 78 percent of the patients had gone to low-cost dispensers and almost that many admitted they hadn’t been thoroughly briefed on the importance of the meticulous care and handling the lenses required. Should you balk at the higher cost, remember that quality seems expensive at first. But when you can wear a comfortable pair of lenses that provides excellent vision, it is cheaper in the long run. What is the difference between a bargain contact lens and an expensive pair? You can liken the plastic of a contact lens to a bolt of fine silk. In the hands of a mass-production firm, the silk can be fashioned into an inexpensive shirt. By contrast, in the hands of a fine couturier, the raw silk material becomes an exquisitely made, well-fitting, good-looking article of clothing that, although expensive, you will wear with pride for many years. The silk, though it may be of high quality to begin with, accounts for only a fraction of the cost of the final product. The inexpensive shirt that may fit poorly and not look so great may turn out to be no bargain if not worn. On the other hand that expensive silk shirt that you wear frequently will, in reality, be the bargain!