Eye Health

Updated 22 November 2013

Lenses or laser?

Thanks to laser treatments and modern contact lenses anyone can now see clearly without glasses. The question is which option is best for you?

The days of thick-rimmed glasses that pinch the bridge of your nose are long gone. Thanks to laser treatments and modern contact lenses anyone can now see clearly without glasses. The question is which option is best for you?

The sight of someone crawling around on the floor looking for their spectacles and bumping into the love of their life in the process is amusing in the movies. But the truth is wearing glasses is often a nuisance. You can’t find them, you can’t see through them in the rain and you’re too embarrassed to admit how often you sit on them. As for those minuscule screws that hold everything together – they fall out and you can’t find them because you can’t see.

You don’t have to struggle like this. Modern science has made giant strides in improving vision. Laser treatment or contact lenses can solve most problems – you just need to decide which option is best for you.

But the decision isn’t always that clear cut. The very thought of putting lenses in and taking them out again is enough to give some people the heebie-jeebies. Others object to lenses because they think they’re high maintenance because they have to be put in a special solution at night.

Yet contact lenses may be the best solution for some; laser treatment isn’t suitable or appropriate or effective for all eyes. Remember to consider your lifestyle and finances before you decide on an option.

1. Laser
Laser treatment is the most permanent solution for vision problems. It’s fast and painless and the success rate is good.

It’s done mostly on near-sighted patients or those with oval corneas – a condition known as astigmatism – in the hope they’ll be able to ditch their glasses for good.

How it works
An eye specialist takes a photograph of your cornea and enlarges it so every bulge and dent is clearly visible.

A small flap is cut in the outer layer of the cornea and the underlying layers are treated with a computer-controlled laser. The flap is then replaced and with time it reattaches itself. It’s a solution for those who have to wear glasses permanently. The corneas of near-sighted people or those with astigmatism are too curved. The laser basically flattens the bulge.

The procedure is done under local anaesthetic and takes about 10 minutes for each eye. Both eyes can be done at the same time and you can be back at work the following day.

If you’re sick of struggling with glasses and don’t want to wear contacts this is the best solution for most people. The sight of up to 90% of patients who’ve had the treatment is 0, even if it previously stood at -8.

The remaining 10% will have considerably better vision so they need to wear only weak glasses or contact lenses. If the cornea isn’t too thin after the procedure – in most cases patients can have two laser treatments before it becomes too thin – a follow-up treatment can be done.

The more even the surface of the cornea, the more successful the treatment.

After surgery your eyesight shouldn’t deteriorate as time goes by and the odds of complications are minimal.

But dry eyes are often a subsequent problem and you should discuss this with your doctor before the procedure so he can prescribe drops. Omega-3 supplements such as salmon oil also help the dryness because they are anti-inflammatories.

If a patient’s eyes weaken after a successful procedure it’s often because the eyes were originally unstable. Your vision must have been stable for two years to optimise the chances of a successful treatment. This is also the reason you have to be over 18 to have laser eye surgery.

Is it for you?
If you spend a lot of time outdoors, contact lenses don’t work for you or you simply want good vision without the hassle, laser treatment is the answer.

But laser treatment isn’t suitable or effective for all eyes. If your corneas are thin or malformed it won’t work. If you are near-sighted and also have oval corneas you will possibly still need contact lenses even after the treatment.

Near-sightedness and astigmatism are assessed separately and given a minus value. The greater the value, the more serious the condition.

If you have both near-sightedness and astigmatism and the minus value is too high you will still need to wear contact lenses after laser treatment but because your vision will be better you will have more choice.

If you have only one of the two conditions, don’t have corneal problems and your eyes are not weaker than -8, laser treatment should be completely successful.

Pros and cons
Laser treatment delivers the best results with near-sighted patients: afterwards you should be just like someone who has never had sight problems. Far-sightedness can also be corrected by flattening the outside edge of the cornea so the middle bulges a little more but this is not as successful.

After the age of 45 most people need reading glasses whether or not they had laser treatment because the ability to focus close up simply deteriorates.

New developments
The latest and most effective laser method is Lasik, during which a flap is cut in the outermost layer of the cornea. Until recently the PRK method was used during which the top layer is scraped off. This is still used when the cornea is too thin for a flap to be cut.

Scraping is more painful, recovery takes longer (about 48 hours) and your sight is fuzzy for about two weeks. Lasik involves using an extra laser to cut the corneal flap – previously a mechanical part of the surgery. The laser makes a cleaner cut but adds to the bill.

2. Contact lenses
No longer uncomfortable pieces of plastic, contact lenses can correct almost every kind of vision problem; in fact, some conditions, such as malformed corneas (keratoconus) or severe near-sightedness are better treated with lenses than glasses because the latter are not equally far from the eye all over and therefore don’t consistently provide an image of the right size.

Contacts are a popular, affordable alternative to glasses and are worn by about 34% of people with vision problems – that’s about 125 million people worldwide.

How do they work?
Contacts are thin, transparent plastic lenses that are placed directly onto the cornea. Your optometrist will prescribe hard or soft lenses depending on your vision problem.

In general hard lenses are more suitable for serious vision anomalies such as astigmatism and keratoconus. They’re the most expensive lenses and take longer to get used to but have the advantage of lasting up to two years, which means they’re cheaper in the long run.

Soft lenses are more comfortable but need more maintenance – you need to keep a diary of their use so you remember to replace them fortnightly or monthly.

The third option is the soft, one-day lenses you throw away every evening. They are the most expensive in the long term.

You can also ask for coloured lenses. No longer fads as they were years ago they can even be obtained on prescription.

Will they work for you?
Glasses are better in some situations such as if you’re prone to eye infections, are often in dusty surroundings or have dry eyes.

So what about all those horror stories? Contacts will never disappear behind the eye. The white of the eye is called the sclera and is covered by a membrane. There is no opening through which contact lenses can slip.

Lenses don’t tear easily either, unless you rub your eyes hard while wearing them. Torn contacts are extremely uncomfortable but they’re easily removed by an optometrist if you can’t do it yourself.

Pros and cons
The advantages of contacts rather than glasses are obvious and one of the biggest bonuses is the extra peripheral vision they give you. Frames limit the edges of your vision but contact lenses let you see everything.

Some people complain the sudden extra perspective gives them headaches but these disappear as you get used to wearing your lenses.

Contacts also let you see real-sized objects while glasses often enlarge them. But they do take a bit of effort.

You have to remove them at night and place them in lens fluid. Forgetting to take them out can cause corneal swelling because the eye is deprived of oxygen for too long. It feels as though the lens is stuck to the eye but don’t try to remove it immediately. Wait about 20 minutes after waking and your eyes will moisturise themselves, making it easier to remove your contacts.

Some people find contacts remain uncomfortable even when they fit perfectly. This irritation isn’t age related. Older wearers should give contact lenses a chance – it just takes time to get used to them.

When you first start using them you have to familiarise your eyes by gradually leaving them in for longer periods over a week to 10 days. If they still irritate you after that you should go back to your optometrist for another fitting.

Offices with air conditioning are among the biggest causes of contact discomfort as the eyes become extremely dry. The solution is simply to blink more often or use eye drops.

Dryness often worsens with age, which is one of the reasons for the misconception that older people struggle to wear contacts. If you counteract it with drops and omega-3 supplements you’ll have no more trouble wearing contacts than a younger person.

Contact wearers must also have their eyes tested more often than people with glasses (every six to 12 months as opposed to 12 to 18 months) because eyes are more prone to infection and the prescription must be perfectly accurate so the lenses don’t irritate your eyes.

Contact wearers still need glasses to give the eyes a “rest” and allow them to be exposed to oxygen. Try wearing glasses in the evenings or at weekends, or whatever suits your lifestyle.

(Health24, September 2013)


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Megan Goodman qualified as an optometrist from the University of Johannesburg and is currently practising at Tygerberg Academic Hospital in Cape Town. She has recently completed a Masters degree in Clinical Epidemiology at Stellenbosch University. She has a keen interest in ocular pathology and evidence based medicine as well as contact lenses.

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