Recommended contact lens different than glasses prescription
June 5, 2021 9:20 AM   Subscribe

Why is my optometrist recommending a different contact lens than my prescription? After a break of about nine years, I want to start wearing contact lenses again. Both eyes require progressive lenses when I wear glasses and my right eye has astigmatism. Even though contact lenses exist that are both progressive and for astigmatism, my optometrist is not giving me that contact lens for the eye that needs it. Instead, he is giving me a progressive contact for my left eye and a contact for my right eye that is for astigmatism but is not progressive.

When I asked my optometrist he seemed shocked that I asked and then started reminiscing about the good ol' days before progressive contacts existed when he would prescribe two different contact lenses on a regular basis.

Maybe it has something to do with the fact that what he is giving me are dailies and the contacts that are both progressive and for astigmatism are weeklies or monthlies? He suggested the dailies would be cheaper for me since I still plan to wear glasses at times. I said I would be willing to pay more but he didn't really respond and just seemed hurt that I would even ask.
posted by Aville to Health & Fitness (11 answers total)
Depending on your prescription, they may not even have made toric multifocals suitable for you until ~last year. Ask me how I know! I think they used to do "monovision" where they prescribed the way he did to compensate. Some people found that it worked for them, some didn't. (Soft multifocals don't have distinct zones like progressive glasses; they require your brain to screen out the non-focused input. So only having to do that work for one input may be better.) He may not be that far behind the times.

The heavier-duty toric multifocals are only biweeklies or monthlies. Which are more of a pain, although I'm having a better experience now that they're no longer claiming you can get away without doing a rubbing stage during cleaning. I don't know that they're actually cheaper, unless you are planning to spend many full days in glasses-only.

If the idea really bothers you, you can go to another optometrist. Or, since they eat the cost of the trial lenses, you can try his suggestion and see if it works. If you can get good correction in dailies, it's just easier.
posted by praemunire at 9:56 AM on June 5 [1 favorite]

Response by poster: Thanks for the help! It took a couple of reads, but I think I understand what you are saying now.

After an hour, I still can't get the lens for the eye with astigmatism in today (the one that is not for astigmatism has always went in on the first try).

My optometrist is out for a few days so I have a follow-up with a different person to address that issue. Maybe it will go better with them.

I would try another optometrist, but I have already used up my insurance with this one.
posted by Aville at 10:06 AM on June 5

I am a person who couldn't find a good fit with any toric lens my eye doctor tried. They either drifted out of place or felt like I had dust caught under the lens, or (usually) both. I ended up asking if it would be possible just to have regular (spherical) lenses that got me close enough, and that was what my doctor gave me. After switching to a new doctor I asked about whether there were newer/better/different toric lenses so I could do better than "eh, close enough," and my new doctor just kept me in spherical lenses. He said for the amount of astigmatism I have, no lens would ever be perfect, and I might as well be more comfortable than try for something that doesn't offer enough improvement. He did change brands on me, and I like the newer brand better than anything I'd had before.
posted by fedward at 10:10 AM on June 5 [2 favorites]

I've only just started to need bifocals, and I went to the optometrist about a week ago. I am trying out the monovision thing, where we undercorrect my non-dominant eye so I can use it for close-in vision, while using my fully-corrected dominant eye for far-away vision. I had two other options: get progressive lenses or fully correct both eyes and used reading glasses. My eye doctor suggested I try this first. I'm still trying to figure out if I'm ok with it. But yeah, I think that's a pretty common strategy for people who wear contact lenses. I'm not bothering to get bifocal glasses, because the optometrist said it would be expensive and probably not worth it, since I almost never wear my glasses.

It bugs me, though, that your optometrist wasn't willing to take the time to explain this to you.
posted by ArbitraryAndCapricious at 10:11 AM on June 5 [2 favorites]

Co-sign A&C's last point.

Just FYI for everyone in this situation, I am quite astigmatic and very near-sighted in addition to the usual presbyopia of middle age, I'm in the middle of trialing the newish Biofinity toric (monthly) multifocals, and they work surprisingly well. Night vision degrades more quickly than it does in glasses--I don't drive, but I don't think I'd be fully comfortable driving at night wearing them. But otherwise they are pretty good; only a mild hit in performance from what I get with glasses. YMMV, of course.
posted by praemunire at 10:20 AM on June 5 [1 favorite]

> After an hour, I still can't get the lens for the eye with astigmatism in today (the one that is not for astigmatism has always went in on the first try).

FWIW, I was never prescribed the lenses for astigmatism (the toric lenses) because of precisely this issue. My eye doctor said they were slightly harder to get in -- and as I was officially his worst patient ever at learning to do contacts who didn't give up, he didn't want to add any additional difficulty for me. So when I had contacts, I never corrected the astigmatism.
posted by lysimache at 4:15 PM on June 5 [2 favorites]

I recently asked and answered this question about monovision which you might find helpful. After a month, I'm really happy with the outcome. It sounds like your situation is a little different but the answers may be helpful!
posted by kinsey at 6:40 PM on June 5 [1 favorite]

Response by poster: That answers to the Lasik question were fascinating.
posted by Aville at 6:46 PM on June 5

Honestly, there isn't nearly enough info on here to go off of. The multifocal torics on the market right now are fine, but don't work awesome for everyone. The nature of the optics means the vision is a compromise. A good progressive set of eyeglasses will pretty much always be sharper than multifocal contacts. Aside from the multifocal optics weirdness, contacts are only available in certain parameters, and glasses are much more customizable.

Daily replacement lenses really are just better for weekend warriors. The only good multifocal torics are super pricey. It's recommended to still replace them monthly, and you still may not love the vision. Depending on what you communicated to them, they may have you in what they see as a great option for you. Putting someone in a multifocal in their non-dominant eye and a single vision lens in their dominant eye is a neat trick to get fairly sharp distance vision, and enough near vision for a quick text or a golf scorecard.

All of this depends on your script and your needs. It sounds totally normal to me. Once you've tried what they gave you, you can communicate what you do and don't like with them. Any decent doc will work with you to meet your needs. It's all pretty subjective when you're correcting presbyopia with contacts.
posted by piedmont at 10:28 PM on June 5 [1 favorite]

contacts are only available in certain parameters

They've drastically expanded availability over just the last couple of years. I gave up contacts ~four years ago because there weren't any multifocal torics in my prescription and I wasn't interested in using readers. Now, there are.

The only good multifocal torics are super pricey.

$240 for six months' supply at Costco.

OP may prefer monovision correction, in which case, no problem, but the product range has improved in multifocal torics just very recently.
posted by praemunire at 4:58 PM on June 6 [1 favorite]

They've drastically expanded availability over just the last couple of years...
$240 for six months' supply at Costco.

I appreciate what you're saying. I'm sorry if I wasn't clear. We know nothing about this situation. Without a manifest refraction, we can't even say that a toric contact is necessary. On a weekly basis, I have patients tell me that they're astigmatic, and they turn out to be like -0.50 cyl.. That would be corrected in glasses, but contacts aren't available in torics until -0.75. For the average single vision wearer, none of this really matters. Multifocal just makes things more complicated. I don't work with Cooper too much, and I can't remember if B&L Ultras are available with round the clock axis, but OP may have an Axis that's not available. Perhaps their astigmatism is too high to be corrected. We just don't know.

That's just to find out if OP is even a candidate for multifocal torics. A significant number of patients just flat out don't adapt to any multifocal. Some are bothered by the ghosting that occurs, some don't even notice it. In the case of being -0.50 cyl: most people will do fine in a regular multifocal, but some people are super sensitive to that difference. It's also kind of a balancing act. Most people, even ones that are successful with multifocal lenses won't see 20/20 both near and far. It kind of gets nudged one way or the other depending on what people are wanting the lesnses for. All things being equal librarian might have different demands in multifocal lenses than a long-haul trucker. They will get a different lens, accordingly. For most people this isn't a problem. It is for quite a few though.

Daily lenses are just healthier, easier to deal with, and more comfortable for the occasional wearer. Again, most people do fine with a monthly lens. Especially if they're wearing it every day. It's usually the occasional wearers that have comfort issues. I don't have my price sheet with me, but a 90 day supply of daily lenses could well run under $240. There's also the cost of solution to consider. If I remember right, the average wearer spends around $150 annually on solution.

This is all sort of like discussing SSRIs. Yes, the modern ones work awesome. Nothing is a perfect fit for everyone though. Some people aren't good candidate, others are good candidates but can't handle the side-effects. Much like discussing someone's SSRI script, it's impossible to say what is and isn't going to work on the internet. All anyone can really do is point out whether something sounds wildly unreasonable or not. This does not sound wildly out of line as a first course of action. It could be, sure. I'm in no position to say definitively. I see these scripts all day every day though, and this sounds like a reasonable thing that a lot of patients are very happy with.
posted by piedmont at 12:31 PM on June 8

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