Contact lenses and diving -Questions Welcome - by Idocsteve

[JonKranhouse]

Before launching HydroOptix, I wanted to establish and promote standards to minimize risks of eye infections with contact lenses in all diving environments (e.g. generally, fresh water bodies of water have more pathogens that can attack the eye vs. ocean water). I sought an authority on contact lens infection risks who would be above reproach, and asked the chiefs of ophthalmology at Kaiser in California, Cedars-Sinai in LA, and the Jules Stein clinic at UCLA for a referral... all roads led to Suzanne M.J. Fleiszig, OD, PhD, FAAO, whom I first spoke with in 2000. She is, arguably, the world's leading authority RE minimizing risks of infection from contact lenses.

Dr. Fleiszig's research enabled Ciba Vision to receive FDA approval for 30-day-wear contact lenses. (Ciba's patented material was granted longer wear approval than any other brand of contacts.) Dr. Fleiszig is on faculty at Berkeley; her lab is an epicenter for Pseudomonas aeruginosa research; some of her 60+ papers RE infections of the eye's surface.

Dr. Fleiszig's advice: it's best NOT to sleep in lenses after swimming, and don't handle lenses after a tap-water hand-rinse. Considering that water testing in the USA finds pathogens that are not killed by many municipal chlorination protocols, and past localized outbreaks of eye infections among contact lens wearers have occurred, it's better to fingertip-rinse with sterile saline -- anywhere in the world. Despite what sales reps from Ciba might claim. Many low-probability / high-consequence events are not mitigated by the FDA. Which is why many eye docs will only prescribe the "30" day lenses for 7 or 14 days continuous wear. The cost for a quick squirt of saline is trivial - it's cheap insurance. BTW, the risk of infection when following proper contact lens hygiene protocols is vastly less than the risk of a bad outcome from botched LASIK.

 

[idocsteve]

I guess one can never be too careful when it comes to protecting their vision and ocular health.

 

[Tigerman]

Im back, without any (yet noticed) infections in my eyes (but an assload of sandfly bites) and somewhat to my surprise, the contacts was more comfortable to wear while I was diving than when Im not for some reason, which is what I intend to use them for primarilly anyways.

 

[diver 85]

I guess one can never be too careful when it comes to protecting their vision and ocular health.

Some(stupid) people never quite get the jist of that statement----------OD to patient, 'How long has your eye been red & hurting??, ---2 weeks did you say???'......

 

[JonKranhouse]

...to my surprise, the contacts was more comfortable to wear while I was diving than when Im not for some reason....

Glad your contacts worked well for you! Your contacts feel so comfortable when diving, probably, because the air inside your mask is quite humid vs. low-humidity topside air.

Another factor for increased comfort, though purely speculative...lots of peer-reviewed international research has found a significant anti-inflammatory / analgesic effect of hyperbaric oxygen in therapeutic settings (i.e. not for treating DCI). But there's no research I'm aware of RE reduction of corneal irritation exposed to hi ppO2 vs. normobaric air. There IS lots of research showing beneficial effects of HBOT for other vision conditions (e.g. macular degeneration, Retinitis pigmentosa). Were you on nitrox? If so, what % and typical profiles?

 

[cdoyal]

Dr. Steve-
I need your thoughts, please.
I'm 44 and just had cataract surgery in both eyes. This was a blessing because I was extremely nearsighted (-18 and - 20). I'm close to 20/20 now but still have a bit of astigmatism (-.75 and -1.25 if I recall correctly) but my big problem is no mid range or close vision. I wear progressive lens glasses now instead of the gas perm contacts I wore for 25 years. My problem is seeing through the viewfinder of my camera. I tried split lenses in my mask but it didn't work well. An overall +2 lens in the mask works great for the camera but makes distance vision tough. Any thoughts?
Thanks,
Chris

 

[idocsteve]

Any thoughts?
Thanks,
Chris

Ask your eye doc about a near vision contact lens in your non dominant eye, about +1.75 diopters might be a good place to start.

You're on the young side for cataracts, I'm figuring there were unusual causal factors (such as long term use of systemic steroids)?

 

[Tigerman]

Glad your contacts worked well for you! Your contacts feel so comfortable when diving, probably, because the air inside your mask is quite humid vs. low-humidity topside air.

Another factor for increased comfort, though purely speculative...lots of peer-reviewed international research has found a significant anti-inflammatory / analgesic effect of hyperbaric oxygen in therapeutic settings (i.e. not for treating DCI). But there's no research I'm aware of RE reduction of corneal irritation exposed to hi ppO2 vs. normobaric air. There IS lots of research showing beneficial effects of HBOT for other vision conditions (e.g. macular degeneration, Retinitis pigmentosa). Were you on nitrox? If so, what % and typical profiles?

The mask humidity sounds very reasonable, especially as I also live in an area with fairly low air humidity.
As for the nitrox question, I was diving 32% with profiles that generally averaged out at 13-15 meters for the total dive time, max depth normally 28-30 meters for a few minutes. None of the profiles was square though.

 

[cdoyal]

Ask your eye doc about a near vision contact lens in your non dominant eye, about +1.75 diopters might be a good place to start.

You're on the young side for cataracts, I'm figuring there were unusual causal factors (such as long term use of systemic steroids)?

No other factors - just luck of the draw.

 

[diverkelly]

Dr. Steve-
... I tried split lenses in my mask but it didn't work well. An overall +2 lens in the mask works great for the camera but makes distance vision tough. Any thoughts?
Thanks,
Chris

Chris,
I had similar complaints (OK, without the cataracts), I went with a custom bifocal "look-under" mask putting the more powerful 'reader' Rx just above my normal sight horizon with great mid-vision out the middle – it works great! Best $225 investment I’ve spent on dive gear to date!

Have never worn contacts, just reading glasses starting in my 40's. I’m far sighted, and my arms got too short. I couldn't read my gauges, I had to memorize my computer’s displays, I was using my camera’s controls by braille and I was missing all the cool little critters underwater.

I tried 3 different ‘gauge reader’ masks with built-in magnifiers way down in the bottom but found them dumb - they used a dry-side paradigm designed to read something in your lap. Nothing you want to see while diving is located 12-20” in front of your belly button. Anything I brought up to my face required me to crank my head way back to see through the bottom magnifiers. And expecting to take a picture in front of me while floating prone was impossible. The limited options all leaked a bit on my face shape. Where does the water collect? At the bottom obscuring the bottom magnifiers forcing me to roll over onto my side to use them…. Hence the "look-unders" with the magnifiers at the top.

I hunted for an optician who dives and went in with my mask, regulator, computer, compass and my both video and still cameras in their housings. He loved it! I laid on his floor with my mask on and we measured everything.

We settled on a custom glued-in bifocal with slightly magnified Rx in my main sightline (under my reading Rx) and large close-in magnifiers (higher than my reader Rx) mounted above. I sacrificed great distance vision but 90% of my diving in Seattle’s Puget Sound where a 30' day is bragging material.

My new Rx assisted mid-distance vision is great from my fingertips and begins fade/fuzz at 10-15'. With the upper magnifiers, I have fabulous 12-20" vision for the camera. There is a horizontal line between the 4 glued in glass lenses just above my sightline that I never notice.

- For the first time, I can read my bearing through the side window on my wrist mounted compass while swimming prone.
- I can read every obscure feature my dive computer can throw at me.
- I can read every menu on my cameras just by tipping my head down (like looking over granny glasses). I can even manually focus!
- And I am finding some really cool tiny critters!

I chose a large window single lens mask for the peripheral vision and I would do it again. "Look-unders" work fine with standard twin lens masks. The down side of gluing Rx lenses on a large single lens mask is flex, you need be extra careful, dropping the mask or twisting the mask will begin to pop a lens - not a problem in twin-lens masks.

I’m thinking my next set-up might be glued-in trifocals – keep the same powerful magnifiers on top, a better trade-off (weaker) for mid/far-distance in the upper middle, and with arms-length magnifiers below so I can cruise 3’ off the bottom and hunt for the cool tiny lint-sized critters!