Diving with contacts

[caruso]

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've read all I need to know about Dr Butler who throws out blanket statements that "RGP contacts are not recommended for diving" while providing not one single source of such a blanket statement and worse yet, referencing an article that doesn't support it either.

Again- I posted a link to the entire article in question, and anyone can read it and see for themselves that there is nothing in there that supports Dr. Butler's claim other than the one vague reference to someone else's study (#89 in the citation list) where they supposedly found gas bubbles in a divers tear film that was caused by diving with RGP contact lenses.

 

[BRT]

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

We are rec divers. It doesn't happen all the time but it is more likely to happen at the same time. My impression is it happens when we are closer to NDL's. It goes away quickly. My impression is that the RPG's are offgassing, but I don't know. My wife and I have both worn RPG's for many years.

 

[BRT]

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.

I use Clearcare peroxide on my RPG's and my wife uses regular stuff.

 

[BRT]

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.



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.



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

Many years ago I use disposables but always wore them during the day for a week or so and tossed them at the first sign of discomfort. I remember them costing enough that daily use was out of my budget.

Now I can't get decent vision with soft lenses or glasses so wear the RPG's.

 

[Rred]

Caruso-
"Also not all peroxide systems use a catalytic disc to neutralize the solution."
Really? I'm only aware of two brand names (ignoring the chain store copies of them) that are on the market, and both use a catalyst disk. What system(s) are you talking about?

I don't and didn't say peroxide is MORE effective than "special sauce", but rather that it performs a TOTAL KILL against anything you'll find in seawater, and that is either equal to, or better than, any chemical treatment. The new non-peroxide systems are designed to be so weak that you can take the lenses from the case, rinse them with the same active chemical, and drop them right in the eye. If that doesn't kill eye tissue--then they are weaker than peroxide, which performs a physical destruction of all living tissue. In fact, the use of peroxide on wounds is (has been for a decade) expressly not recommended, because it always kills all tissue that it contacts, leaving a nice slush of dead tissue for pathogens to grow in.

That's a total kill. The "so what if it gets in your eye" stuff just isn't that effective, even if it comes close.

"Why screw around with Hydrogen Peroxide when you can throw away the contacts after a single use?"
Perhaps you've seen disposable water bottles, shopping bags, tampon applicators, or other plastic in the oceans? Maybe you should say "Why add to pollution when you don't have to?"

In fact, the original difference between daily and monthly contacts was just the FDA certification. The plastics were the same, the oxygen permeability on a par...and the situation today is fairly similar. No manufacturer will give you a straight answer, except when it comes to smoke and mirrors like "The daily lens have special comfort magic juice in them, and that's only good for a day." Ahuh. And for 30 years folks didn't mind or notice not having that hokum?

I screw around with peroxide because it is known and proven to be safe. Has a very long track record, zero adverse effects, and if I wear lenses for two weeks instead of one day? Yeah, I've just cut the plastic pollution by about 95%. And the peroxide costs a lot lens than all those lenses, and shipping them, warehousing them, handling them...all through the process.

Sounds like someone sold you a bill of goods. Take another look.

 

[Duke Dive Medicine]

I've read all I need to know about Dr Butler who throws out blanket statements that "RGP contacts are not recommended for diving" while providing not one single source of such a blanket statement and worse yet, referencing an article that doesn't support it either.

Again- I posted a link to the entire article in question, and anyone can read it and see for themselves that there is nothing in there that supports Dr. Butler's claim other than the one vague reference to someone else's study (#89 in the citation list) where they supposedly found gas bubbles in a divers tear film that was caused by diving with RGP contact lenses.

Dr. Butler is one of the preeminent experts in the field of diving medicine. Nobody is going to do a randomized controlled trial on diving with RGP lenses, there's no other research on it, and there isn't even a series of reported cases, so what you're left with is expert opinion based on available evidence, of which there admittedly isn't much. It's a low level of evidence supported by a low level of evidence, so again it's not much, but it's what we have at present. A competent practitioner will take that into account when advising and collaborating with patients on whether to dive with RPGs or not. And, as you recommended, a well-informed patient will search the available literature and hopefully come with a list of questions for that practitioner.

Best regards,
DDM

 

[caruso]

I'm only aware of two brand names (ignoring the chain store copies of them) that are on the market, and both use a catalyst disk. What system(s) are you talking about?

Oxysept- uses a neutralizing tablet rather than an enzymatic disc. Lensept used a neutralizing solution as did Puresept, both have been discontinued and are no longer available. Probably because of the many mistakes that were made by patients skipping the rinse step and putting the contacts directly into their eyes from the hydrogen peroxide with disasterous results.

I don't and didn't say peroxide is MORE effective than "special sauce"

I must have misunderstood your post. It appeared that you were saying that hydrogen peroxides are more effective than other types of disinfectants. Thanks for clarifying.

"Why screw around with Hydrogen Peroxide when you can throw away the contacts after a single use?"
Perhaps you've seen disposable water bottles, shopping bags, tampon applicators, or other plastic in the oceans? Maybe you should say "Why add to pollution when you don't have to?"

You're forgetting about all the waste produced by the disinfecting solutions that you're using. If anything all those plastic bottles of hydrogen peroxide add up to even more plastic then the packaging on the dailies contacts.

In fact, the original difference between daily and monthly contacts was just the FDA certification. The plastics were the same, the oxygen permeability on a par...and the situation today is fairly similar. No manufacturer will give you a straight answer, except when it comes to smoke and mirrors like "The daily lens have special comfort magic juice in them, and that's only good for a day." Ahuh. And for 30 years folks didn't mind or notice not having that hokum?

Yes and no. Many dailies are made of the same materials that 2 week or monthly contacts are made from, so a patient could use them for longer periods. That much being said, it's more of a volume discount/attitude thing. Dailies are much cheaper per lens when purchased in a 1 year bulk supply, less than $1 per day so why bother with the extra work to disinfect as well as the additional health risks of re-using a dirty worn contact lens? Also several manufacturers today do use materials that produce wetting solution from the core/matrix of the lens and after a day that solution is completely dissipated from the lens, making it a true "1 Day" contact lens.

But you're right, some people can and do purchase a bunch of the dailies contacts that are made of the same material as their 2 week or 1 month counterparts and use them as such, for a considerable savings over what they would pay for the same lens packaged as a frequent replacement rather than daily option. Not that there's anything wrong with that.

 

[caruso]

Dr. Butler is one of the preeminent experts in the field of diving medicine.

I'm sure he's all of that and more. I'm simply asking for some sort of evidence that supports his claim that RGP lenses are not worn for diving. You contacted him and he responded with a few snippets from his article that has only one cited source of a difficulty with RGP lenses. That's not "a little evidence" it's almost nothing. We've got several RGP contact lens wearers posting on this thread who are doing just fine with their lenses. Based on that I'd say "It's ok to dive with RGP lenses" and I'm offering much more evidence than the premminent Dr. Butler.

 

[Duke Dive Medicine]

I'm sure he's all of that and more. I'm simply asking for some sort of evidence that supports his claim that RGP lenses are not worn for diving. You contacted him and he responded with a few snippets from his article that has only one cited source of a difficulty with RGP lenses. That's not "a little evidence" it's almost nothing. We've got several RGP contact lens wearers posting on this thread who are doing just fine with their lenses. Based on that I'd say "It's ok to dive with RGP lenses" and I'm offering much more evidence than the premminent Dr. Butler.

I don't think it's as strong a recommendation as "don't hold your breath on ascent" or "follow your decompression schedule". You could even say it's a conservative recommendation. It's great that some people wear RGPs and don't have a problem with them, and it would be interesting to hear from more people who do, one of whom has posted here:

We are rec divers. It doesn't happen all the time but it is more likely to happen at the same time. My impression is it happens when we are closer to NDL's. It goes away quickly. My impression is that the RPG's are offgassing, but I don't know. My wife and I have both worn RPG's for many years.

It's also interesting that you essentially told the poster who originally asked about diving with RGPs that the risk isn't minimal:

@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

You're misunderstanding.

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.

From the above, and from this post,

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.

your recommendations for diving with RGPs are a bit nebulous. Would you mind clarifying?

Best regards,
DDM

 

[caruso]

it seems like your recommendation would be that it's fine to dive with RGPs until something happens, then it's not fine and you're risking your eyesight. Am I reading that correctly?

Best regards,
DDM

In the rather unlikely event that a diver repeatedly experiences blurred vision after diving with RGP lenses the symptoms should not be ignored just because they disappear shortly after completion of the dive. The problem should be addressed and rectified to avoid issues in he future, and that could mean anything from refitting lenses that are too tight, being more watchful of mask squeeze, using more or different lens lubricant or even discintustion of RGP lens wear if all other methods fail.