Diving with contacts

[BRT]

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.

Happens to me and my wife on near NDL dives. Goes away soon.

 

[caruso]

Happens to me and my wife on near NDL dives. Goes away soon.

You both wear RGP contact lenses and you both experience blurred vision on a regular basis during many of your no-deco dives?

 

[Duke Dive Medicine]

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.

@caruso I'm not sure I'd say that it falls apart. if you have a choice between using contacts that can cause irritation of the eye with diving and those that typically do not, which one would you use?

Best regards,
DDM

 

[caruso]

if you have a choice between using contacts that can cause irritation of the eye with diving and those that typically do not, which one would you use?

The obvious answer would be "I'd choose contacts that do not cause irritation over contacts that cause irritation. That much being said I have no clue how that question has any relation whatsoever to the article that you posted which is based on exactly 1 study participant who showed up at the doctors office some time after the completion of the dive and complete resolution of all symptoms.

Can you ask your friend Dr. Butler, who wrote the article, how long after the dive, how long after the complete resolution of all symptoms did he examine this diver, how did he determine there were gas bubbles under the contact lens at the time of the dive, and what treatment if any was rendered?

Because as I interpreted the article excerpt, a scuba diver appeared in Dr. Butler's waiting room and said "Hi Dr. Butler, I was diving a few <hours> <days> <weeks> ago and I had a brief incident of blurred vision after the dive that immediately resolved when I took my contacts out. I have no problems or symptoms now, but I wanted to get a checkup to be sure".

At which point Dr. Butler looked at the diver's corneas with his biomicroscope and saw healthy corneas and rendered no treatment whatsoever and who made a lot of assumptions about gas bubbles under contact lenses while diving, and got an article published that might sound interesting to a casual observer but isn't worth the paper it's printed on.

 

[caruso]

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. (65) 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

@Duke Dive Medicine

I looked up the article by Dr. Frank Butler. He's not the problem. The ambiguous and misleading way you quoted his article is the problem.

He apparently treated one diver during his career that had experienced past symptoms of discomfort and blurred vision when diving with contact lenses but that has nothing whatsoever to the sentence immediately preceding that fact in your quote of his article in your earlier post (above). He attributes the RGP contact lens tear film gas bubble phenomena to a reference #89 which as per the citation summary at the bottom refers to a completely different source, published by somebody else. There's nothing in the article that even supports this questionable theory about gas bubbles. Only the 1 reference to another source and as I said unless that particular source was in the water with equipment capable of measuring tear film bubbles during the dive, it remains an unsubstantiated claim.

In fact in Dr. Butler's very comprehensive article he gives several other reasons for blurred vision while diving with contact lenses, including exactly what I stated earlier about corneal edema being the culprit.

I hate being right all the time.

Link to article is here:

https://www.uhms.org/images/MEDFAQs/September-2016/Diving_and_Hyperbaric_Opthalmology.pdf

 

[Duke Dive Medicine]

@caruso , the paragraph was not taken out of context, I just didn't feel the need to quote any more of the article than the paragraph that was germane to the discussion. I emailed Dr. Butler, he emailed me back with that specific paragraph copied and pasted into his reply, and said that he recommends that divers not use RGPs. I was passing on his recommendation, and he knows a heck of a lot more about diving and ophthalmology than I do. Anyone who wants to can feel free to read the entire article which, as you said, is very comprehensive, and better yet, discuss questions with his or her own ophthalmologist in person.

Best regards,
DDM

 

[Rred]

I would suggest that the risk of infection from seawater can be kept to zero, if you simply use a peroxide disinfectant instead of the precious chemical ones.

Chemical disinfectants have to be somewhat weak, since you take the lenses out of the solution and drop them into your eyes, taking some chemicals with them. But if if use peroxide, the platinum catalyst in the case typically converts ALL of the peroxide into water and oxygen in four hours. If the lenses are kept in that case for eight hours, as recommended, you're taking a STERILE lens out of PURE WATER when you put it in your eyes. And the peroxide can and will kill anything that was in the seawater. The fizzing and the oxygen liberated also work to clean proteins off the lens, the same way that club soda is used to take wine stains out of upholstery and clothing.

My optometrist went over the pros and cons of peroxide versus chemicals back when soft lenses were first on the market--and his opinions on this haven't changed in all the years. There's no question about what years of chronic WATER in the eye might do. On the other hand, when thimerosal (mercury) was the alternative...well, a couple of decades of mercury in the eye? Really? Same thing with all the fancy new chemicals. Why screw around with them, when peroxide is such a proven choice?

Dive, remove lens as soon as convenient/practical. And then use the nuclear option, put 'em in peroxide overnight.

 

[caruso]

I emailed Dr. Butler, he emailed me back with that specific paragraph copied and pasted into his reply, and said that he recommends that divers not use RGPs. I was passing on his recommendation, and he knows a heck of a lot more about diving and ophthalmology than I do

Ok, my apologies, assuming you cherry picked what part of the article that was included when in fact it was Dr. Frank Butler who not only provided you with a piecemeal and rather misleading small bit of the article but even worse, then follows up with "RGP contact lenses are not recommended for diving!".

That advice by Dr. Frank Butler is a) not substantiated by article as a whole and b) rather questionable to say the least.

 

[caruso]

I would suggest that the risk of infection from seawater can be kept to zero, if you simply use a peroxide disinfectant instead of the precious chemical ones.

It might sound good and feel good to say it but there's absolutely no proof whatsoever that H202 contact lens disinfecting solutions are more effective against ocular pathogens than other types of soft contact lens disinfecting solutions.

the platinum catalyst in the case typically converts ALL of the peroxide into water and oxygen in four hours. If the lenses are kept in that case for eight hours, as recommended, you're taking a STERILE lens out of PURE WATER when you put it in your eyes.

That's somewhat true and a distinct advantage of H202 systems. But it has nothing to do with the ability to kill ocular pathogens. Also not all peroxide systems use a catalytic disc to neutralize the solution.

Same thing with all the fancy new chemicals. Why screw around with them, when peroxide is such a proven choice? And then use the nuclear option, put 'em in peroxide overnight

Why screw around with Hydrogen Peroxide when you can throw away the contacts after a single use?

 

[Duke Dive Medicine]

Ok, my apologies, assuming you cherry picked what part of the article that was included when in fact it was Dr. Frank Butler who not only provided you with a piecemeal and rather misleading small bit of the article but even worse, then follows up with "RGP contact lenses are not recommended for diving!".

That advice by Dr. Frank Butler is a) not substantiated by article as a whole and b) rather questionable to say the least.

I'm not in the habit of cherry-picking stuff. Neither is Dr. Butler for that matter, but you can feel free to take this up with him directly, I'm sure his contact info is out there somewhere. Have an enjoyable evening.

Best regards,
DDM