Casey Eye Institute has specialists in every aspect of eye care, including contact lenses. At the Contact Lens Service, we are often successful fitting contact lenses for patients who have previously been unsuccessful in wearing contact lenses. We offer:
- Variety and selection of lenses
- Specialists available for eye care if necessary
As part of Oregon Health & Science University, we are on the cutting edge of research, and are among the first to receive new instruments and products.
Steps required to get contact lenses:
You need to have a recent vision exam, which you can get through the Casey Eye Institute's Comprehensive Ophthalmology service or with your regular eye doctor. Generally this exam should include dilation, in which special eye drops are used to enlarge the pupils so the eye doctor can see inside the eyes to evaluate the eye health.
The standard dilation can cause your vision to be blurry for several hours. Most, but not all people are able to safely drive themselves home with dilated eyes. You won't know how blurry your vision will be until after your eyes are dilated, so it's safest to have a ride arranged.
The doctor will tell you if you need vision correction. You may be myopic (nearsighted), hyperopic (farsighted), astigmatic, presbyopic, or anisometropic. Contact lenses can be used to correct these conditions for most people.
You can get a glasses prescription at your vision exam. This is the starting point for your contact lens prescription. The shape of the cornea (front of eye) is also an important measurement.
Contact Lens Fitting
The contact lens specialist will use your glasses prescription as a starting point to determine what type of contact lenses are best for your vision. You may be fitted with rigid or soft lenses, depending on your prescription and visual needs. Both soft and rigid lenses can correct for astigmatism (toric lenses) and for presbyopia (multifocal or monovision lenses), in addition to near and far sightedness. With soft lenses, the more often the lenses are replaced, the healthier for your eyes, so most people are fit in disposable lenses. Some people need to use glasses in addition to their contact lenses.
For the fitting, the contact lens specialist will determine the appropriate lenses. Many patients can get lenses on the day of the initial exam. The lenses are placed on your eyes and the contact lens specialist will evaluate the health of the fit, the clarity of vision, and the comfort. Generally, you then try the lenses in "real life" for a week or more to make sure everything is good, and then come back for a follow-up visit (wearing your lenses), at which the contact lens specialist will again evaluate the lenses for a healthy fit.
Be sure to put the lenses in an hour or two prior to the visit, so the lenses are warmed up to body temperature and are saturated with your tears. If you are a new wearer of contact lenses, we will teach you how to apply, remove and care for your lenses before we send you home.
Contact Lens Prescription
The contact lens prescription cannot be written until after the fitting process is completed. Since contacts sit on your eyes, the contact lens specialist must evaluate them on your eyes.
The first contact lens tried is the lens that should work based on the glasses prescription and shape of the cornea (front of eye). The final contact lens that the prescription is written for is the one that worked well for you in "real life." Sometimes this is the same lens, but not always. More complicated prescriptions may take several visits and various diagnostic lenses before the prescription is finalized.
Why Glasses and Contact Lens Prescriptions are not the Same
Your glasses prescription is the starting place in determining the correct contact lens prescription, but the two prescriptions are not the same. You can't use a contact lens prescription to get glasses, and you can't use a glasses prescription to get contact lenses.
The contact lenses actually touch the eyes, so they must be precisely fitted and the fit must be evaluated with the lenses on the eyes to be assured that the lenses are a healthy fit. The contact lens prescription can not be finalized until the fit is determined to be healthy.
The numbers on the glasses prescription and contact lens prescription may look very different, especially if you have a big prescription. This is simply due to optical mathematics.
When you wear contact lenses, you need to have an eye exam at least once a year, or more often if recommended by your doctor. This is because, unlike glasses, contact lenses sit directly on the eye, and may affect the health of your eyes.
Make an Appointment
To make your appointment, please call 503 494-4029 during business hours (8:30 a.m. to 5 p.m., Monday through Friday) and we'd be happy to get you scheduled.
When you call, just tell us that you'd like to get contact lenses and let us know whether you currently wear contacts. If yes, we'll need to know if they're rigid or soft lenses. If you used to wear contact lenses but haven't worn them for a while, let us know that, too. If you have had an eye exam recently, bring the record of the exam to your appointment so we don't have to repeat the full exam. If you haven't had a recent exam, or if you can't get the records from your exam, you'll need a full exam in addition to the lens fitting.
Bring your contacts and glasses to your exam or fitting, and bring any recent glasses or contact prescriptions you may have. If you wear soft lenses, wear the contacts to the exam, and bring your glasses. If you wear rigid gas permeable (RGP) lenses, you may wear them to the exam or stop wearing them three to five days before the exam and bring them with you. If you wear your RGPs to the exam, we can find the glasses prescription that will work best for you in the evening after you remove your RGPs. If you discontinue wear three to five days prior to the exam, we can find a glasses prescription that will work better for you in the morning, or if you need to wear glasses for a few days. The reason for this is that since RGPs are hard, they can mold the front of the eye and cause a change in your prescription. If you wear your RGPs just before having your prescription measured, we will find a prescription that works well right after you remove your RGPs, but may not continue to work well if you refrain from wearing your RGPs and allow your corneas (front of eye) to return to their natural shape.
Patient History Form
Before calling to make the appointment with us, call your insurance company to find out which providers and what services your insurance covers, and to what amount. Vision insurance varies in what it covers. Most insurers do not cover contact lens fitting fees. You should plan to pay for these on the date of service in our office. If your insurance plan requires authorization, please call your primary care provider to obtain it.
Insurance can be very confusing. There are many different insurance companies and plans, so we cannot know what your insurance covers. You should call your insurance company before your exam so you know how much they will cover. Anything over this amount is your responsibility. When you talk to them, they may not realize that the contact lens exam, fitting and materials are separate charges. You must specify this when you talk to them. Years ago, eye doctors charged a single fee for contact lenses, the fitting, and the exam. Now we must separate the fees for each part of the service.
Contact Lenses 101: An overview
Medical Contact Lens vs. Elective (Cosmetic) Contacts
Contact lenses are considered medically necessary if a patient can see well only with contact lenses, and not with glasses. Usually, this is due to an irregular front surface of the eye (cornea) that causes the incoming light to be scattered rather than focused on the back of the eye (retina). Some of the more common causes of this are corneal trauma, post surgical corneal irregularity and keratoconus. Keratoconus is a condition that causes a progressive steepening and deformation of the corneal surface. The cornea becomes thin and "cone shaped" and in some cases requires surgery if contact lens wear is not successful.
In all these cases, the contact lens creates a smooth surface on the front of the eye that allows light to be focused on the retina. Usually rigid gas permeable lenses are prescribed to correct corneal surface irregularities. If you cannot tolerate these lenses customized soft lenses or a combination of soft and rigid lenses are used.
If you suspect you might have such a condition, you need an eye exam to diagnose which condition you have. You may arrange an eye exam at Casey Eye Institute, or with your regular eye doctor. If you see fine with glasses but would like to wear contact lenses for any reason (better side vision, no raindrops on your glasses, better for sports), it is called an elective or cosmetic contact lens fit. We do both types of contact lens fittings at the Casey Eye Institute.
Some insurance companies will provide benefits for medical contact lens fittings. Coverage varies from one carrier to another. We encourage you to check your coverage with your insurance company prior to contact lens fitting.
Daily Wear vs. Extended Wear
Many people want the convenience of putting their lenses in and leaving them in for a week at a time, sleeping with the lenses on. This is called extended wear, and is very convenient. However, it is less healthy for the eyes. "Daily wear" lenses are removed each evening for cleaning and disinfecting, and are more healthful for most patients. Sleeping in contact lenses can cause many problems, including greatly increasing the risk of eye infections.
Eye infections can be serious, and if an ulcer forms in the 'line of sight", the part of the eye you look through, your vision could be permanently reduced. If the contact lenses are worn overnight, especially if are made of old-style material that doesn’t let in much oxygen, new blood vessels may grow into the cornea to help bring oxygen to the cornea, but these vessels are abnormal, and if they grow long enough, into the "line of sight", may reduce your clarity of vision. Also, if the vessels become very long, no doctor will prescribe contacts for you, in order to protect your vision. Finally, sleeping in contact lenses can cause edema, which is swelling, and if the cornea (the front of the eye) is swollen, it becomes cloudy and you can't see through it very well. So, please, don’t sleep in your contact lenses unless specifically told by your doctor that you should.
RGPs vs. Soft
There are two main types of contact lenses, soft lenses (hydrogel or hydrophilic) and rigid gas permeable (RGP) lenses. The soft lenses are very flexible, and are larger in diameter than RGPs. The soft lenses are generally very comfortable right from the start, but in some prescriptions may not provide vision as crisp as RGPs. Soft lenses are preferably disposable (see section on disposables vs. conventionals), as it is healthier to change the lenses regularly. RGPs are stiffer (they are the improved 'hard' lenses), and smaller. They are comfortable after you become accustomed to them, and may give crisper vision for certain prescriptions. A pair of RGPs generally are used for at least a year. Both soft and rigid contact lenses are good. Your prescription will determine which type of lens will give you the best combination of comfort and clarity.
Disposable, Planned Replacement and Conventional Lenses
These terms are used for soft lenses. We use the word "conventional" when referring to a soft lens that is used for an entire year. These are generally used for very high prescriptions that require custom-made lenses. "Disposables" are lenses that are tossed out after one use, or used for just two weeks before being discarded. Planned replacement lenses are tossed on a schedule, ranging from monthly to every six months, depending on the lens and the condition of the eyes.
The advantage of replacing the lens more often is that it's better for your eye health to have a fresh clean lens periodically. The more often the lens is replaced, the better. You toss the lens before the "gunk" (tear debris) has a chance to build up, and before the lens has time to deteriorate. The one-day lenses are the best, as you don't need to clean them at all, and you have a fresh, sterile lens each day. The one-day lenses also eliminate reactions to cleaning solutions, since you don't have to use or buy solutions. However, not all prescriptions come in the one-day lenses.
Since the disposable and planned replacement lenses were developed, there are many fewer complications from contact lens wear.
RGPs (rigid gas permeable lenses) are worn for at least a year, but we consider them separately from the soft lenses and don't call them "conventionals." The material they are made from does not deteriorate in the way soft contact lens materials can, so RGPs can be healthful to wear for longer than a year.
Special Uses of Contact Lenses
Contact lenses have many uses in addition to replacing glasses. If your glasses are very thick, or if you have a very complicated prescription, contact lenses may be used with thinner glasses to give you better vision than with glasses or contact lenses alone. The glasses can be a bifocal if needed, and will be thinner and lighter weight than they would be without the contact lenses.
If one eye has a prescription much different than the other eye (anisometropia) so that the glasses lens is much thicker over one eye, you can wear a contact lens can be used in only one eye. Then both glasses lenses can more equal and thinner. Also, many people with this type of prescription wear contacts only, without glasses.
Bifocal Contact Lenses
Presbyopia is a condition in which the eyes won't focus up close the way they used to. It is a normal, but annoying, aspect of aging, and usually starts sometime after age forty. There are several contact lens options to help with presbyopic eyes.
We can prescribe contact lenses to give the best distance vision with each eye, in conjunction with reading glasses. This works best for people who must have the best distance and/or near vision possible, or those who don't mind reaching for reading glasses.
The other options for helping near vision in presbyopes with contact lenses compromise clear vision somewhat, so you must be motivated to want to get away from glasses enough to accept slightly blurred vision at distance and at near. Both of the next two options can be done in either soft or rigid contact lenses.
Bifocal contact lenses are available. They offer less clarity of vision than bifocal glasses, but they do allow both of the eyes to see at distance and up close without the inconvenience of using reading glasses.
Monovision is where we set one eye for distance vision and the other eye for near vision. It takes the brain a few weeks to adjust but, as with bifocal contact lens wear, works quite well after you adapt. Driving at night can be more difficult with monovision, at least until you are used to it.
It used to be that people with astigmatism couldn't wear contacts, or could only wear rigid gas permeable (RGP) contacts. New technology has allowed the development of soft "toric" lenses (that's what we call lenses for astigmatism) for almost any prescription. These lenses are custom fit over several visits. The vision is generally very good with toric lenses, but might not be as crisp as with glasses, especially for people with a high amount of astigmatism. Depending on your prescription, eye health, and vision needs, we may recommend either soft or RGP lenses.
Colored Contact Lenses
There are several brands of colored contact lenses now available. The one-day and two-week disposables are favorites with most patients. There are colored lenses that add just a little extra color to blue and green eyes, and there are lenses that completely change the eye color for eyes of any color. There are also fancy, scary lenses for Halloween.
Brands of Contact Lenses
There are many different brands and types of contact lenses. Each has its own use. The lens best for you depends on your visual and eye health needs. After we've analyzed the data from your eye exam, we can tell you which lenses would work best for you. If there are several options, we will involve you in the decision making process. Our goal is to get you into the type of lenses which will be the most comfortable and healthy for your eyes, and give you the clearest vision, at the least expense for you.
Reading a Contact Lens Prescription
The prescription for contact lenses includes more information than the prescription for eyeglasses. Special measurements will need to be taken of the curvature of the eye. In addition, the physician will determine if the eyes are too dry for contact lenses, and if there are any corneal problems that may prevent a person from wearing contact lenses. Trial lenses are usually tested on the eyes for a period of time to ensure proper fit.
The contact lens prescription usually includes the following:
- Specific name (like the make and model) of the contact lens
- Contact lens power (measured in diopters, like eyeglasses)
- Contact lens base curve
- Diameter of the lens