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.

There is, however, an annoying tendency for the lens to touch the lid margin or the lashes at the moment of insertion and to be knocked off the finger tip. For this reason, many soft lens wearers adopt the slightly different method described below.

Having balanced the lens on your fore-finger tip, pull the margin of the lower lid well down with your second finger tip and look upwards so that a good area of the white of your eye is exposed. This part of the eye is quite insensitive and can be touched without pain or discomfort, and you will find it easy to let the lens fall directly on to it. Because the soft lens is so large, the upper half will flop on to the lower part of the cornea and if you now look directly to the front the lens will slip upwards until it is centred on the cornea. If there is any tendency for the lens to refuse to move up on to the cornea, simply keep the tip of your finger on it while you look straight ahead. This will ensure that the lens is properly centred and when you take your finger away it will remain so.

Soft lenses, especially the ultra-thin type, are rather floppy when first taken from their soakage solution. It is, therefore, sometimes advantageous to wait for a minute or two to allow each lens to become slightly more rigid before applying it to the cornea. Don’t wait too long or the lens will become quite hard and will begin to distort so that you will have to wet it again before attempting insertion.

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.

Post-cataract patients should therefore always have glasses, whether or not they wear contact lenses, and the reading glasses should be worn while everything is being made ready for the insertion of the contact lenses. Shakiness and poor co-ordination mean that lenses will often be dropped, so a towel should be spread out.

It is sometimes useful to have a spectacle frame modified, with one lens only, and with the lower part of the frame that is empty cut away. When one contact lens has been inserted through the empty half, the frame is removed and the other contact lens put in. Many post-cataract patients learn to insert lenses by touch alone; the best way for them to control the lids is the standard hard lens method described above as this helps to steady the finger bearing the lens. Some have found the sucker on the glass rod idea helpful. A magnifying shaving mirror can be a valuable— even indispensable — aid.

Such patients are usually old and the lid margins lax and sometimes turned outwards, so that the conventional skin- pulling method of contact lens removal often fails. The method in which the lid margins are pressed on to the eye with the finger tips is more likely to succeed, but this, too, is more difficult in old people than in young. Careful and informed use of squeeze-type rubber suckers may he a great help to such patients but the solid plastic type should never be risked. There is one tip which should be remembered when real difficulty is encountered. An ordinary eye bath full of salt water (1 teaspoon of salt to 1 pint of water) may be used to float the lens out of the eye. The full bath is applied to the eye, as the patient bends forward, and a few blinks under water will invariably do the trick.

Soft lenses can always be pinched off so long as the fingers are dry.

A. Generally, no. The finger-tip is much better, because it is soft and therefore less likely to cause accidental damage.

Q. Will the fitter teach me to put in and take out the lenses?

A. Certainly. This is part of the service.

Q. I have had cataract operations. Do you think contact lenses are a good idea?

A. Yes. This is one of the strongest indications for contact lenses. You will be amazed at the improvement in vision.

Q. But I’m very nervous about handling the lenses. Could I damage my eyes?

A. Almost impossible. But you will need professional instruction.

Q. I wear soft lenses. What is the best way to keep them clean?
A. Most people use cleaning and soaking solutions and have no trouble. But these contain chemicals that can eventually cause persistent irritation to the eyes or sometimes allergy.

Q. What about make-up?

A. Put in the lenses first.

Q. What about boiling them?

A. Most soft lenses can be safely boiled, but not all, so do check with your fitter before you use this method.

Q. Is boiling a good way to clean lenses?

A. Boiling is completely effective. But you must first be sure that there is no protein or other foreign material on the lenses, as boiling will make this difficult or impossible to remove.

Q. How can I get rid of protein contaminants then?

A. The best way is to use an enzyme cleaner. This comes in tablet form, to be dissolved in water. Follow the instructions.

Q. Why are there so many different kinds of contact lens solutions?

A. There are, essentially, only three kinds — cleaning, wetting and soaking.

Q. Do I need all three kinds?

A. No. You need a cleaner and a soaker. There are various combination solutions and, of course, different solutions for hard and soft lenses.

Q. Can’t I use hard lens solutions for soft lenses?

A. No.

Q. Why not?

A. The chemicals in hard lens solutions are in higher concentration and will be absorbed into the soft lenses. These will then be very likely to irritate your eyes.

Q. How should I clean hard lenses?

A. Use cleaning solution after every wear, rinse it off and then soak them overnight in soaking solution. If very dirty, use vinegar or washing-up liquid, then repeat above.

Q. Can I boil hard lenses?

A. No. If you do, you will certainly destroy them!

Q. Can polishing change the power of my lenses?

A. Yes, if excessive.

Q. Could polishing damage my eyes?

A. No, but it might cause a slight sense of ‘eye-strain’.

Q. Will my fitter polish my lenses for me? A. Possibly. Why not ask?

A. If they are, something is wrong. Contact the fitter at once.

Q. Can you tell that someone is wearing contact lenses?

A. Usually not.

Q. Can they be coloured?

A. Yes. Lenses can be tinted almost any colour.

Q. Is that expensive? A. No.

Q. I’m worried about lenses slipping round behind my eyes. Does this often happen?

A. No, never, It’s impossible!

Q. I need glasses for reading only. Would I be suitable for contact lenses?

A. No. Stick to your glasses.

Q. I have astigmatism. Does this mean I can’t wear contact lenses?

A. Not at all. Hard lenses cover astigmatism. It is even possible to have special soft lenses for astigmatism.

Q. What is spectacle blur?

A. Temporarily blurred vision in glasses after wearing contact lenses.

Q. Is that serious?

A. No. Not unless very severe and persistent.

Q. What causes it?

A. Either a moulding of your corneas into a new shape, or a slight swelling from accumulation of fluid in the corneal outer layer.

Q. My friend wears very thin, hard lenses. Is that a good idea? A. The smaller the better, so long as they give good vision.

Q. She says she never gets spectacle blur. Why is that?

A. Very small lenses are less liable to cause this, because the corneas have a better oxygen supply.

Q. Why is oxygen important?

A. Corneas, like all living tissues, need oxygen to survive. As they can’t get it via the blood because they do not contain blood vessels, they have to get it direct from the atmosphere.

Q. What happens if I get a bit of grit behind a contact lens? A. You will know all about it. This doesn’t happen often.

Q. What should I do?

A. Take out the lens and wash it.

Q. But suppose the grit stays in my eye?

A. Get someone to remove it with the corner of a clean handkerchief, or see your doctor. Don’t use your lenses meantime.

Q. Is it very difficult to insert and remove contact lenses?

A. The difficulties in insertion are largely psychological. Removing lenses is easy, but it takes a bit of practice to learn todo it quickly.

Q. Is it a good idea to use a rubber sucker to remove lenses?

A. No. Not unless you can be certain that the lens is on the cornea.

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.

A: There are several reasons: (1) Because of the aforementioned blepharoptosis, (2) because an abrasion may occur, and (3) because of the possible introduction of bacteria, fungi, or viruses.

Q: How many hours a day can I expect to wear contact lenses?

A: That depends upon the lens and your eyes. Most people are eventually able to wear their lenses most of their waking hours: about eight hours for hard-lens wearers and fourteen hours for soft-lens wearers. But every pair of eyes is unique. Some people can wear their lenses for only four hours a day; some can go for as long as eighteen hours, though this is not a good idea unless you break up the time with a rest period. This method can be used by anyone to effectively extend wearing time: Remove your lenses and let the eyes rest for fifteen or twenty minutes. This gives them a new lease on life, and lets you wear your lenses late at night after a long day at the office.

Q: But what if I want to wear contacts just for special occasions?

A: This can only be done if you wear soft lenses or gas-permeable lenses. Once you’ve adapted to hard lenses, you should wear them every day for the same number of hours. Otherwise the eye will “unadapt” and the lenses will become uncomfortable. Soft and gas-permeable lenses are less demanding where adaptation is concerned, and you can safely and comfortably wear them intermittently—for the weekend softball game, your triweekly jog, or just for social events.

Q: Is there an age barrier in contact lens wear?

A: Theoretically speaking, no. I have fitted infants and ninetyyear-olds with contact lenses, and every age in between. One of my patients is in her seventies and has been wearing contact lenses . . . a true pioneer! Infants wear contact lenses not out of vanity, but for therapeutic visual reasons.

Teen-agers adapt to contact lenses very quickly, a testimony to the importance of motivation and the role that improved appearance plays in successful contact lens wear. Puberty may herald marked changes in refractive errors; therefore these youngsters should be examined at least twice a year.

Though contact lenses can be worn at any age, eager parents should wait until a child is ready to use them. The child should be motivated, versed in hygiene, mature enough to accept the responsibility for caring for the lenses, and have the necessary motor skills for handling these tiny, delicate lenses. This usually occurs around the age of twelve. In certain cases parents may be taught to insert and remove the lenses for those too young to have the manual dexterity to do so themselves.

Q: If my prescription seems to change frequently, can I still wear contact lenses? Won’t it be more expensive than changing the prescription of my eyeglasses?

A: Unless a medical contraindication exists, there is no reason you cannot wear contact lenses—even if the prescription changes frequently. The cost of the new contact lenses usually is comparable to that of new spectacle lenses. In fact changes of spectacles may prove to be the more expensive of the two.

Q: Is there some magic formula for being able to wear contact lenses successfully?

A: Yes, in a way. And there are three ingredients:

1. The eye practitioner. Select an expert eye practitioner who specializes in contact lenses. An ophthalmologist or optometrist in private practice is your best choice. With proper medical care, you’ll be most likely to wear your contact lenses comfortably and without damaging your eyes. Don’t forget: you get what you pay for. Unfortunately there are a multitude of unhappy contact lens wearers who bought “bargain lenses” and then discovered that they were no bargain at all.

2. Motivation. Depending upon the type of lens and your own unique physiology, contact lens wear brings some initial discomfort. You must be sufficiently motivated to tolerate this initial adaptation period, as well as any little difficulties that may crop up later.

3. Follow instructions! Many unsuccessful contact lens wearers simply didn’t take care of their lenses and eyes properly. The result is reduced lens life, wearing discomfort, poor vision, and possible eye injury.

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.

Q: Can the eye become dependent on contact lenses?

A: No. Wearing contact lenses neither improves nor worsens vision. The only “dependence” is a psychological one. The excellent vision correction provided, the convenience, and the improvement of one’s appearance make many wearers contact lens “addicts.”

Q: Why is my vision blurry while wearing eyeglasses after I remove my contact lenses?

A: This condition is called spectacle blur. It usually occurs with hard lenses and is due to corneal molding. The cornea is pliable and its shape is changed slightly by the contact lens, much as the skin of your finger becomes indented by a ring. Just as the indentation on your finger disappears after the ring is removed, your cornea gradually assumes its original shape. In the meantime you have an irregularly curved cornea causing a kind of “induced astigmatism,” for which your spectacles were not ground to correct. As a result of this temporary and artificial refractive error your vision is slightly blurry when you switch to spectacles. This situation may last from a few minutes to a few hours.

Q: Why do I see differently when I switch back to glasses?

A: See discussion of spectacle blur. Also this difference in vision may be due to the fact that spectacles for nearsightedness reduce the size of objects and those for farsightedness magnify objects (especially for aphakics, who are very farsighted). With contact lenses there is no such effect. When you switch from contacts to glasses, your brain becomes momentarily confused and interprets the smaller or larger image as blurry. Again this phenomenon is fleeting and only mildly annoying if you wear contacts most of your waking hours. Should you decide to return to full-time spectacle wear, your brain will adapt to this different way of seeing in a short period of time.

Q: Why can’t I use saliva to clean contact lenses?

A: Though the composition of saliva makes it a very efficacious wetting solution for hard lenses, it is absolutely unacceptable to use it for this purpose. Saliva contains bacteria (and possibly viruses and fungi) that are safe for the mouth, but dangerous for the eye.

Q: Can I use hard contact lens solutions for soft lenses and vice versa?

A: Absolutely not. These solutions were designed for specific types of plastic. Because hard lenses and soft lenses have very different properties, their accompanying solutions contain different ingredients. In addition soft lenses will absorb the chemicals in the hard-lens solutions; these chemicals can later be released into the eye, possibly causing irritation or ocular damage.

Q: Can contact lenses be used in sports?

A: The bony structure (orbit) that forms the eye socket was designed to protect you from injury, and it does its job extremely well. But if you’re very active in sports, for instance, hard lenses may pose problems. If you are hit directly in the eye with a racquet ball, wearing a hard contact might result in greater ocular injury than if you were not wearing lenses. That a contact lens would shatter, however, is highly unlikely: the plastic from which it is made requires the force of a hammer striking it on a cement surface in order to break it. Of course, soft lenses are safer. In some instances a contact lens can actually act as a barrier and shield the eye from scratches. However, for contact sports and racquet sports you should wear special protective glasses, goggles, or masks, whether you wear contact lenses or not.