Contact lenses and diving -Questions Welcome - by Idocsteve

[idocsteve]

Hey Doc do you have any info on the effect of medications on eyesight? I've been taking 5 mg of enalapril and 20mg of simvastatin for several years now and I've noticed that my eyes seem to be much more photosensitive

There are so many systemic medications out there and so many side effects that there's no way I would know off the top of my head which side effects may occur with those particular drugs, although I can tell you that photophobia is a common side effect of many systemic medications.

At one time I'd consult a PDR on my desk when a patient would present with ocular symptoms but nowadays it's easier to simply Google the medication along with "side effects".

A quick look shows no ocular side effects with enalapril however "dry mouth" is reported. There IS a correlation between dryness of mucous membranes such as the mouth and nasal passages; and dry eye, which can cause photosensitivity.

Regarding simvastin, I found this: Stevens-Johnson syndrome is associated with this particular medication, and that syndrome can result in severe dryness of the eyes and mucous membranes of the body.

I cannot advise you on what alternatives may be available for your systemic conditions, and whether or not your symptoms are due to your prescription medications, however I suggest you mention your symptoms and concerns to the prescribing doctor.

Another consideration may be to use over the counter "dry eye" products to keep your eyes properly lubricated and to always wear quality sunglasses when outdoors.

 

[MikeMarlow]

Hi Doc,
So, how long after LASIK/PRK etc should one wait before diving? I've had it come up in class before from students considering getting the procedure and didn't have a good answer for it. I've had LASIK myself and haven't had any complications at all (knocking on wood...) but I also didn't dive for several months after.

Thanks,
Mike

 

[idocsteve]

Hi Doc,
So, how long after LASIK/PRK etc should one wait before diving? I've had it come up in class before from students considering getting the procedure and didn't have a good answer for it. I've had LASIK myself and haven't had any complications at all (knocking on wood...) but I also didn't dive for several months after.

Thanks,
Mike

Give it at least a month, preferably at least 3 months. I don't know how thoroughly this topic has been studied, in fact I do not recall reading about even one controlled study regarding Scuba Diving and LASIK...but it's better to err on the side of caution.

By 3 months the cornea is as healed as it's going to get.

 

[MikeMarlow]

Thank you Doc, I appreciate it.

Mike

 

[Akitakoi]

Hi iDoc,

I just got contacts after years of not wearing them. I have a pretty bad astigmatism in both eyes so they had to special order in some trial lenses. These lenses, I assume have a weight in them to keep them in my eye correctly. I have noticed that if I look down to read or hold my head at an angle they go out of focus. I have not dived with them yet and don't know if this will be a problem.
Also I can't read very well with them in.
Any advise appreciated.

Scott

 

[idocsteve]

Hi iDoc,

I just got contacts after years of not wearing them. I have a pretty bad astigmatism in both eyes so they had to special order in some trial lenses. These lenses, I assume have a weight in them to keep them in my eye correctly. I have noticed that if I look down to read or hold my head at an angle they go out of focus. I have not dived with them yet and don't know if this will be a problem.
Also I can't read very well with them in.
Any advise appreciated.

Scott

Astigmatic contact lenses from most of the major companies depend on "thin zones" to keep the lenses centered on the eye and minimize rotation, although there are still some toric contacts available that use "prism ballast" to "weight" the contact lens and keep it in place. Sometimes prism ballasted lenses have comfort issues because they are thicker on the bottom and there is more lens awareness.

If your lenses are going out of focus when reading or looking to the side then they are not fitting you well. This is something that can usually be fixed by going to another contact lens from another manufacturer, and by using a different lens design; sometimes going steeper on the fit or larger on the diameter with the same brand contact lens will do the trick.

Be sure that your eye care practitioner suggests trying this option. If they say "that's as good as it's going to get" without ordering a contact lens from another company, then find another doctor.

Regarding your reading ability, that may be an age thing. If you're over 40, you may need to consider toric bifocal contact lenses, a "monovision" correction, or reading glasses over your contact lenses. That's a virtual certainty if you currently wear bifocals or progressive eyeglasses or if you remove your distance eyeglasses for reading.

 

[Akitakoi]

Wow that was fast! You must be at home enjoying the snow fall.

What I have as a trial pair are Frequency 55 CE Toric.
Left -0.00 -4.75 x 175
Right +0.75 - 4.25 x 010

Does that all sound right?

I'm 43 and I'm in the optional range for reading glasses. I can read fine with my glasses on but not with the contacts.
I have to go back for my first fitting and will make some notes of what to ask the doc about.

Thanks,

 

[idocsteve]

Wow that was fast! You must be at home enjoying the snow fall.

What I have as a trial pair are Frequency 55 CE Toric.

Thanks,

Yup, I called the first snow day in my office in as long as I can remember. I would have gone in, but patients aren't going to show.

Ask your doc about Hydrosoft Quarterly Contact Lenses for astigmatism. You'll need a mild reading correction in the form of eyeglasses over the contacts, or...try a mild cutback in your nondominant eye to aid your near vision.

When a nearsighted person enters their early 40's, they experience a rapid drop off in their near vision. Due to complex optics relating to "principal planes" which is way beyond the scope of this thread, nearsighted individuals will first notice near vision blur with their contact lenses, and then ultimately with their eyeglasses. Farsighted individuals will have the opposite occur, in that they will first be blurred at near with their eyeglasses, and then their contact lenses.

 

[Akitakoi]

Thank you!

I'll let you know what happens.:mrcool:

 

[idocsteve]

I just found out today that I have become alergic to my own body fluids in my eyes, which causes major problems with my contacts. There is a possibility I will never be able to wear contacts again, so I imagine I will have to go with a prescription mask.

Here's part of a post I found on another thread that's rather interesting.

This diver suggests that he is "allergic to his own bodily fluids in his eyes", which are causing him problems with his contact lenses, to the point that he may "never be able to wear them again".

He seems to be under a few misconceptions, which I will address here.

1- There is only one fluid inside the eye, and that is called the Aqueous Humor. This is a thin, watery fluid, present in the anterior chamber. It is completely sealed within the eyeball and the only way it could get OUT of the eyeball would be due to a serious penetrating injury which would cause a "deflation" of the eyeball, complete loss of intraocular pressure, and significant vision loss (possibly even blindness), among other problems; the least of which would be a possible allergy to this substance, which has NEVER been documented in any literature I have ever seen.

2- Perhaps this diver meant that he is allergic to his own bodily fluids on the outside of the eyeball. The only fluid outside the eyeball would be the tear film, which is composed of 3 layers. The mucous layer, which helps the tears stay in contact with the ocular membranes, the saline layer which is...um...salt water...and the oil layer which slows evaporation. There is no known documented allergy to any of these 3 layers, except in the following scenario:

Before the advent of disposable soft contact lenses, it was not uncommon for a patient to have a reaction to the byproducts of the ocular metabolism (proteins, calcium, others) that were left on the contact lenses for extended periods of time, due to their reaction with heat disinfection and less commonly with chemical disinfectants and preservatives within those solutions; as well as the fact that the buildup of these substances caused abrasions and irritation of the eyelids. The most common resultant ocular condition was "Giant Papillary Conjunctivitis" which presents as bumps under the upper lids and causes symptoms such as contact lens intolerance, lens awareness, and resultant decreased wearing time.

As I said, nowadays with disposable soft contact lenses these conditions are rarely seen and are usually treatable by temporarily discontinuing contact lens wear, treatment with topical agents, and then refitting with a different type of contact lens, oftentimes a "daily disposable" which does away with the need for any disinfecting solutions.