This question is directed to a high myope.
Hello Mina, how kind of you to be so concerned with understanding what your roommate goes through as a high myope. I am a -14.0 in both eyes so I can offer some comments:
1. Vision w/o correction: We can see clearly only 2-3 inches; beyond that EVERYTHING is blurry. It's possible to see gross color differences (like a blue sky and a green hill below it) but no detail at all. I can navigate at night by seeing the differences in light and dark at a doorway that has a light beyond it, but no way could I read a bedside clock, watch TV, read a book, etc. It's like the 'Extreme Blur' photo number 50 on your website reference - we can see some color at each distance, but no detail.
2. Floaters: I have some and they are annoying but not life-changing. It's like there is a gnat or fly in the room but whenever I move my eyes to 'track' the bug, it moves away and I can't 'see' it by focusing. Sometimes there are tiny bubbles but they tend to move away. I've heard others w/ worse floaters say they are a big deal but luckily I haven't had this problem.
3. Retinal detachment risk: I am 50 and haven't detached a retina despite some high-impact sports like skiing. That said, I didn't fall much as I wasn't a daredevil skier. Now that I have been diagnosed w/ degenerative myopia and some retinal symptoms, I am stopping the skiing. It's not worth the risk to me, but of course every patient must decide how much activity to limit. Whatever your friend decides, be SURE they know the symptoms of a retina tear/detachment and seek PROMPT treatment if they ever see them.
4. Once I got soft contacts in junior high, high myopia didn't affect my life unduly until I started having retinal degeneration symptoms (which not every high myope gets). Your friend should know that there is company now that makes custom lenses in any prescription in a 'Hydrogel' material providing greater comfort and oxygen transport to the cornea. They are expensive though, and I haven't had the best luck w/ visual acuity with them - it's ok during the day when lights are bright, but evening and at night they aren't great. But your friend may want to ask the OD about alternative lens materials that might work better for dry eyes.
Glasses at this prescription level are miserable. There's a LOT of distortion and we can't see anything outside of the frame, so zero peripheral vision. Our eyes also appear 'minimized' due to the refractive effect of the lenses, so they aren't cosmetically appealing. Contacts are the only real option for decent 'getting around' vision. Watching TV, reading = glasses are ok.
I hope this is helpful to you. Thanks again for being a high myope supporter!
I also wanted to mention one last option for your friend, although I personally did not choose this for my situation. It's a 'clear lens exchange' or, basically, cataract surgery that removes the natural crystalline lens inside the eye and replaces it with a powered lens that corrects most or all nearsightedness.
The downsides to this surgery are numerous:
- Expensive: Unlike cataract surgery, it's not covered by insurance until an operable cataract appears in the natural lens. I think you can use a health care FSA account (pre-tax income) to pay the costs, but it's still out of pocket surgery which is costly.
- Surgical risk: For a 'healthy' eye free of disease, there is a risk of surgical complication (infection, detached retina, side effects) that can be avoided by not having the operation.
- Loss of near vision: Removing a natural lens from the eye eliminates the eye's 'accommodation' or ability to focus on objects close at hand. Your friend would probably need glasses to do computer work, to read, etc. There are a couple of options to this:
1. Multifocal implants: Regarding the replacement lens that is implanted, there are companies that make 'accommodating' or 'zoned' lenses that purport to allow someone to focus at all three distances (distance, intermediate, near) but many people are dissatisfied with the results. They are even MORE expensive than a 'regular' single-vision lens implant. And I do not know if these types of lens implants are available in the prescription level your friend would need, since he's outside the typical visual range of most patients.
My OD (whose opinion I trust) and a cataract surgeon I've consulted both feel these lenses do not give the results people expect, and do not recommend the multi-focal implants. They are very profitable for cataract surgeons though, and some patients like them, so I don't think they are going away soon. You can search these boards for a LOT of feedback on these lenses, both pro and con.
2. Mono-vision: If you search this board for 'monovision' or 'mini-monovision' you will learn about a second option some people choose if they have the lens replaced in both eyes - they can have the surgeon implant lenses powered such that one eye is set for 'distance' and the other is set for near- or intermediate-vision. Some people like this option; others don't.
- Accuracy of implanted lens: I was surprised when the cataract surgeon told me it's very, very hard to exactly calculate what power of lens to implant in a high myope. The reason is that a fraction of a millimeter of difference in exactly where the implanted lens is positioned in the 'capsule' (the bag that holds the natural lens, and into which the replacement lens in inserted after the natural lens is extracted) makes an enormous difference in the visual outcome. I don't recall exactly but I think he said a 1-millimeter difference in placement causes a 2.5 diopter change in vision. So, it's fiddly, difficult work to get exactly right. They just have to make the best guess of what to implant, and exactly where to put it.
It is possible to wear a low-power contact or glasses - or have LASIK surgery - after the clear lens extraction surgery, if the power of the lens turns out not to be exactly right. But of course taking all that risk and bearing the expense, one would hope that it comes out close.
If your friend ever does consider a clear lens exchange surgery, please have him consult a cataract surgeon who does 'laser' cataract surgery, and who has done a LOT of the procedures. This method of surgery uses laser energy to break up the natural lens and create the space in the capsule into which the lens will be placed. It's more precise and introduces less ultrasound energy into the eye than a traditional cataract surgery (where ultrasound energy is used to break up the natural lens). Less energy introduced into the eye = less potential for the surgery to cause a detached retina. A study did find surgeons who had performed many laser cataract procedures had better results with this method than those who just started using it, so I'd hunt til I found a 'pro' in laser cataract surgery if your friend wants to go down this road.
I hope this helps. Best of luck to you and your friend.
I forgot to mention one last option in my post above concerning 'clear lens extraction' surgery. There are also implantable contact lenses available, referred to as ICLs in the US. You can read this Wiki page to get a general idea of what these are like and how they work here:
http://en.wikipedia.org/wiki/Implantable_collamer_lens. Many eye care institutions have info available about ICLs on their websites.
These lenses are implanted into the cornea in front of the eye's internal, natural lens.. As a result, the ICL internally corrects vision similar to a cataract-type lens replacement surgery, but the eye's natural lens stays in place and is not removed. They are used in patients aged 21-45 whose vision has stabilized (e.g. nearsightedness no longer worsening). There are also other limiting factors such as pupil diameter which might affect whether your friend would be a candidate for an ICL.
In theory, leaving the natural lens in place will allow the patient to maintain near-vision accommodation. The only person I know who had an ICL implanted was in her late 40s, however, and as such already had lost her near vision as her natural lens stiffened with age (so she never knew if accommodation could have been maintained). She had an ICL implanted because she had cataract surgery in the other eye, and found having one eye at 20/20 and the other at -12.0 diopters was too great a disparity to function.
I never chose this surgery as I didn't have a problem with soft contacts, and there are some risks associated with the implant such as excess endothelial cell growth in the cornea, increased intraocular pressure, among others. It also has the other problems of expense, risk of infection and other surgical complications, although as I understand it the risks are lower than with a cataract surgery or clear lens extraction procedure.
From talking with my eye doctor, having having had an ICL implanted also complicates any cataract removal procedure later in life (if your friend were to develop a cataract), as the ICL must be removed as part of the procedure to remove and replace the eye's natural crystalline lens during cataract surgery.
The risk of complicating a future procedure, as well as the risk/reward profile of an ICL implant, are things only your friend and his eyecare professionals can evaluate. Good luck.
I agree with everything flossy93 told you about how you see things (or not see things) with such high myopia. I never would have had the patience to type all that!!!
Since I am probably old enough to be your grandmother, I also have cataracts which my retinal specialist has been putting off doing anything about because of the increased risk of retinal detachment which we people with high myopia already have. I am mentioning this only because if ophthalmologists keep putting off replacing cataracts (which eventually will have to be replaced), I am sure they would not be keen on doing a clear lens exchange on someone myopic degeneration who is very young.
ValveJob, I agree that an intra-eye surgery such as a clear lens extraction/replacement certainly has big retina risks for someone with myopia as high as the patient in question.
I think the ICL procedure of implanting an 'internal contact' near the front of the cornea poses a bit less risk to a patient's retina than surgery within the main body of the eye. But I've never researched the ICL procedure so I don't know how contraindicated it is for high myopes.
I've talked with two retina guys who both said to wait for cataract surgery until my cataracts were so clouded I was 'walking into walls,' before having the procedure. I'm sure they really meant 'until the cataract is materially interfering with daily tasks.'
OTOH the cataract surgeon (who does the laser-based procedure I mentioned above) said it was not a problem to do the surgery although he acknowledged the increased risk of a retinal detachment. I have mild cataracts in both eyes but am holding off having them replaced right now.
Mina, I'd first suggest your friend ask his optometrist to seek out a better contact lens material that would work with his dry eye problem. There are also various eyedrops and other medications to help with dry eye syndrome, and even minor surgical procedures such as punctal plugs (see http://www.medicinenet.com/dry_eyes/page7.htm) that can help the tears in the eyes provide the greatest possible lubrication. All of those options would be easier than any of the surgeries I mentioned, not to mention less risky. And if your friend's nearsightedness prescription has not stabilized, he won't yet be a candidate for any of those lens-related procedures anyway.
flossy93, thank you so much; you answered everything I wanted to know! I'm so grateful to you! Thank you so much, as ValveJob says, for having the patience to write all of that out – you've been so thorough and descriptive, and you've hugely increased my understanding of what my friend's going through, and I'm so, so grateful!
Thank you very much, also, for all the information about Clear Lens Exchange and ICL. My friend actually mentioned Clear Lens Exchange to me earlier today – it's so helpful to be able to talk to him about it now I have so much detailed information. I looked it up online when he spoke about it to me, but there are so many conflicting reports…it's really great to have this information from someone who has obviously learnt about both CLE and ICL from all sides.
My friend leans towards the opinion that the risks are too high; and that it's certainly worth waiting for some time to see the long-term results. His OD agrees, and, personally, so do I…I do think it's too early to tell what the long-term results are, and it would really worry me if he was thinking about having it done. But he said he didn't want to end up with more problems than he's got, which I think is definitely the best idea.
Thank you so much – you've helped me enormously. I'm so pleased to have such a better idea of what life is like for him; I feel even closer to him now.
Thank you again, flossy -- I started writing my reply before your latest post, so I didn't see it before I posted my response!
As for his poor dry eyes, he uses hydrogel lenses and drops, but I've never heard of punctal plugs before -- I'll read all about that and talk to him about it! Thank you very much!
ValveJob -- thank you also for your comments on CLE; considering the long-term problems high myopes are at a higher risk of, it's really not worth the risk. I'm very sorry about your cataracts – I wish you the best of luck with your surgery when you do eventually have them replaced!