Diving with contacts

[Duke Dive Medicine]

Sorry to high jack this thread more than it already has been, but when you say “soft contacts are fine for diving” are you saying rigid gas permeable (rpg) contacts aren’t? Or, are you reassuring the OP that it’s OK to dive with soft contacts? Just want to make sure that there isn’t something about diving with RPG’s that I should be aware of.
Thanks,
Erik

Good question. The post was directed at the OP's question about soft contacts, but as far as I know the rigid gas permeables aren't problematic. I emailed a diving ophthalmologist who I know and will post when I hear back from him.

Best regards,
DDM

 

[Duke Dive Medicine]

I stand corrected re RGPs. Below is from Dr. Frank Butler, excerpted from a paper he wrote.

"Although the increased gaseous diffusion properties of rigid gas permeable contact lenses theoretically decreases the chance of bubble formation in the tear film, use of these lenses while diving has also been demonstrated to cause bubble formation under the lens with secondary corneal epithelial disruption (89) The author has treated one diver with foreign body sensation and blurred visual acuity which occurred during ascent while wearing gas permeable contact lenses. Symptoms resolved with removal of the lens after reaching the surface."

Butler FK Jr. (1995). Diving and Hyperbaric Ophthalmology. Survey of Ophthalmology, 39(5):347-66.

Best regards,
DDM

 

[caruso]

One case isn't much to base a hypothesis on. How the ophthalmologist determined there was bubble formation under the contact lens is beyond me, unless he was there and had the proper medical equipment to measure what was happening in real time, under the lens during the dive. I'm also curious what treatment would have been rendered to a diver experiencing what is more commonly referred to as corneal edema which is swelling of the corneal stroma that impacts the ability of the epithelium to remain clear and intact. It's commonly found with contact lens wearers who overuse their lenses by either sleeping in them too many consecutive days and/or not replacing them frequently enough and/or being fit with a lens that is too tight. Edema is typically short-lived and dissipates rapidly when the triggers are removed, without any treatment. As per the last sentence in the quoted article- the symptoms disappeared after removing the lens at the completion of the dive. So by the time the diver got to the ophthalmologists office, hours or days later, what was there to treat or even observe? The article falls apart under close scrutiny.

 

[RIHappyDiver]

@Duke Dive Medicine, thank you for taking the time to look into RGPs and diving for me. Unless I’m misunderstanding, the risk is minimal and the treatment is quick.

Thanks,
Erik

 

[caruso]

Unless I’m misunderstanding, the risk is minimal and the treatment is quick.

You're misunderstanding.

 

[RIHappyDiver]

You're misunderstanding.

Ok, would you care to expound?

 

[caruso]

Ok, would you care to expound?

There are 3 layers to the cornea, the outermost layer is the epithelium. The cells are able to regenerate, just like regular skin cells of the body. In fact during the early days of refractive surgery the epithelium would be completely scraped off the cornea from limbus to limbus (each edge of the cornea) and would regrow subsequent to the laser procedure being performed on the middle layer of the cornea, which is also the thickest which is known as the stroma. The innermost layer is the endothelium, it can be rather fragile and be damaged by insults to the cornea such as contact lens abuse and situations such as the one that is the subject of this thread. The endothelium does not regenerate, and it is the endothelial "pump" that regulates the osmolarity of the cornea and keeps the level of hydration in balance.

Constant insult to the cornea such as a diver who repeatedly experiences corneal edema due to the effects of diving with a rigid lens under pressure can and probably will result in irreversable damage to the endothelial cells and that doesn't bode well for good clear vision down the road.

The TLDR version is "If you get blurry when diving with contacts on a regular basis, it's a serious problem even if it clears up immediately upon surfacing and/or removing the contact lenses" and it needs to be addressed.

 

[RIHappyDiver]

@caruso, and, yet, to your point, “one case isn’t much to base a hypothesis on”. My take away from DDM is that there is a risk of bubble formation under the lens, but with only one case recorded, and the fact that I alone have done over 60 dives while wearing RGPs, means that the risk of this occurring is minimal.

 

[caruso]

I alone have done over 60 dives while wearing RGPs, means that the risk of this occurring is minimal.

To YOU. But your post specifically said "the risk" not "my risk". If you're not experiencing any symptoms while diving with your RGP lenses than you probably have nothing to worry about. But this thread is not all about you. You didn't even start it. So, if a diver is reading these posts, and wears contact lenses, especially RGP or even PMMA contacts and is thinking "my vision repeatedly blurs during dives but clears afterwards" we don't want them thinking it's all good.

 

[BRT]

@caruso, and, yet, to your point, “one case isn’t much to base a hypothesis on”. My take away from DDM is that there is a risk of bubble formation under the lens, but with only one case recorded, and the fact that I alone have done over 60 dives while wearing RGPs, means that the risk of this occurring is minimal.

I have done 100's with RGP's. So far no long term issues.