Diving with contacts

[Duke Dive Medicine]

Thanks. I must have edited my post while you were responding, the way I originally phrased that last part seemed a bit snarky and that's not how I wanted to come off.

So, in other words, less conservative than Dr. Butler's recommendation, but backed up by your own expertise.

Best regards,
DDM

 

[caruso]

Thanks. I must have edited my post while you were responding, the way I originally phrased that seemed a bit snarky and that's not how I wanted to come off.

So, in other words, less conservative than Dr. Butler's recommendation, but backed up by your own expertise.

Best regards,
DDM

Dr. Butler's blanket statement that RGPs should not be used for diving at all, despite no evidence other than the one vague RGP Bubble reference cited in the article is nonsense.

@2RIHappy diver reports no symptoms over 60 dives and it's reasonable to say he can can continue to use his RGPS for the duration of his diving career with no concerns as long as he remains symptom free.

Divers such as @BRT and his wife, based on the reported symptoms of regularly surfacing with blurred vision following diving with RGPs are doing nothing less than playing Russian Roulette with the only pair of eyes they're ever going to have and are being rather foolish to ignore the symptoms when the remedy might be as simple as being refit with a flatter base curve, smaller diameter lens, different and more wettable and/or breathable RGP material, or using more lubrication.

 

[Duke Dive Medicine]

@caruso Maybe there's a misunderstanding here, which is partly my fault. In my post #52, part of which was copied and pasted directly from Dr. Butler's email to me, the original reference was 65, a case report of epithelial disruption after radial keratotomy. This is not correct. I've edited it to reflect the correct reference, which was 89, a paper by Socks, Molinar and Rowey from 1988. This is a study of rigid gas-permeable lenses in a hyperbaric environment using three different dive profiles and three different types of RGP lens. To quote from the abstract, "Bubbles occurred under all lens types; they were seen as shallow as 1.98 m (6.5 feet) after the least stressful exposure. Due to the tissue offgassing half-time of the eye, it is unlikely that the bubbles are a result of nitrogen from the eye. They probably arise from the tear layer." You did mention this in your post #71 but wanted to ensure clarity.

I'm sure you would agree that this is not an obscure or vague reference. Apologies for any confusion the other post may have created. You seem to be in the business; has the technology improved since then so that the permeability may have changed?

Best regards,
DDM

 

[BRT]

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.

Or maybe I will just continue to believe it is little gas bubbles in the lens and keep using them.

 

[caruso]

@caruso I've edited it to reflect the correct reference.

I'm sure you would agree that this is not an obscure or vague reference.

Agreed. That's a much more complete and comprehensive reference and is evidence that under certain conditions microbubble formation can and does occur in the precorneal tear film beneath the posterior surface of RGP lenses.

 

[caruso]

Or maybe I will just continue to believe it is little gas bubbles in the lens and keep using them.

No worries. When Russian Roulette is played, 5 out of 6 times there's no round in the chamber.

What's truly disturbing is that while you are free to take chances with your own vision there's a potential innocent victim here - your wife who blindly takes your word for it when you say "Don't worry honey your vision will clear up like it always does, no harm done it's just gas bubbles inside the lens your eyes will be just fine". You don't know this, you can't know this.

 

[Duke Dive Medicine]

Agreed. That's a much more complete and comprehensive reference and is evidence that under certain conditions microbubble formation can and does occur in the precorneal tear film beneath the posterior surface of RGP lenses.

I hope that the typo didn't contribute to your opinion of Dr. Butler's work. He's an outstanding doc and a great guy as well. His contribution to diving medicine, and ophthalmology and diving in particular, is peerless. He also mentored me through my first publication a few years back - coincidentally, a case that came from ScubaBoard. Thank you for the dialogue.

Best regards,
DDM

 

[BRT]

Dr. Butler's blanket statement that RGPs should not be used for diving at all, despite no evidence other than the one vague RGP Bubble reference cited in the article is nonsense.

@2RIHappy diver reports no symptoms over 60 dives and it's reasonable to say he can can continue to use his RGPS for the duration of his diving career with no concerns as long as he remains symptom free.

Divers such as @BRT and his wife, based on the reported symptoms of regularly surfacing with blurred vision following diving with RGPs are doing nothing less than playing Russian Roulette with the only pair of eyes they're ever going to have and are being rather foolish to ignore the symptoms when the remedy might be as simple as being refit with a flatter base curve, smaller diameter lens, different and more wettable and/or breathable RGP material, or using more lubrication.

I have worn contacts since 1975. I have/had kerataconus with grafts in '86/'87. I have worn all kinds of soft and hard lenses and RPG's give me the best vision. After many years of diving with them I'm not too worried about suddenly destroying my vision. I have had lots of time to think about "the only pair of eyes I will ever have". I have had no residual symptoms after diving beyond a short period of foggy vision. No soreness, no needing to take my lenses out sooner in the evening. No other symptoms. But on near NDL dives my wife and I sometimes both notice the "foggy" vision. I believe it is in the contact and has no effect on my cornea. Believe me, with the scar tissue left over from the corneal grafts I have had lots of different base curves and lots of different types of RPG's. For a number of years I wore disposables under the RPG's as a "bandage". I dove that way too. And if memory serves got the fogging sometimes. My wife, on the other hand has eyes with no other problems than being nearsighted and she wears her RPG's while diving and also sometimes gets the fogging, usually on the same dives that I do. Also without any long term issues. Why can't the fogging just be in the lens?

 

[caruso]

Thank you for the dialogue.

Sure thing, all good.

But on near NDL dives my wife and I sometimes both notice the "foggy" vision. I believe it is in the contact and has no effect on my cornea

It's highly unlikely that the fogging is inside the lens, it's much more likely that you are experiencing blurred vision from corneal edema especially given your history of corneal pathology. But we are begging the question here. Why do you just assume it's the contact lens - in both you and your wife's situation, and completely dismiss other possibilities that might be fixable?

Refer to this DAN Article that is partly based on Dr. Butler's article and gives several different reasons for blurred vision while wearing RGP contact lenses while diving. None of the given reasons are "gas bubbles in the contact lens".

DAN | Medical Frequently Asked Questions[/QUOTE]

Why don't you stop messing around with your already compromised vision AND your wife's vision and conclusively determine the underlying cause of the blurred visoin rather than making guesses and continuing on doing the same thing because you haven't yet experienced any long term problems? I propose an experiment that just might turn on a lightbulb in your head, although it's admittedly not a controlled clinical scientific study and is somewhat subjective and prone to bias on the part of the subject, but like I said it just might open your eyes.

Next time you go out on a dive boat, take your eyeglasses with you. Hopefully the Rx is current but even if it's not, this will still work. Immediately prior to the dive take a look around with your glasses on. Fixate on 3 different objects- something at a distance, say on shore. Another at an intermediate distance, say towards the other end of the dive boat, preferably something with writing such as a placard. For the 3rd visual target use your cellphone or dive computer. Try to get an idea of how clear everything is at the various distances. Then put in your contacts and do the same thing. Then go diving. During the dive, try to simulate the typical conditions that usually result in blurred vision at the end of the dive but of course do not put yourself in danger in order to do this.

At the end of the dive, look at the 3 targets with your contact lenses and decide if they're blurred compared to the pre-dive vision. If not, then try the experiment on another dive. If so, as soon as possible remove your contacts and put your glasses on and view the 3 targets again. If the problem lies with "bubbles inside the contact lens" then obviously there should be no difference with the vision while wearing the glasses as compared to prior to the dive.

 

[BRT]

No worries. When Russian Roulette is played, 5 out of 6 times there's no round in the chamber.

What's truly disturbing is that while you are free to take chances with your own vision there's a potential innocent victim here - your wife who blindly takes your word for it when you say "Don't worry honey your vision will clear up like it always does, no harm done it's just gas bubbles inside the lens your eyes will be just fine". You don't know this, you can't know this.

Sometimes the cylinder is larger than that. So far since starting diving before my certification in 1985 the bullet hasn't come out of the barrel. I don't know how many dives we have. We stopped logging in the early 90's at about 200. Some years we get in 40 just in Mexico so we have a few. I have never dove without contact lenses and the majority of my dives have been with RGP's. You talk about corneal edema. I think I have as much experience with that as anyone. With the fogging I get no symptom or sensation that would suggest edema.