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Comment by siffland | Hacker News Reader

I wanted LASIK so bad starting around 2010, I had worn glasses since I was 6 for my astigmatism. The reason I did not get it was because someone I worked with had a friend who they messed up one of his eyes and he was legally blind. My sister got it in 2015 and I kept putting it off. In 2018 i was turning 40 and needed readers, the eye doctor said i should get bifocals or LASIK and readers.

I got LASIK in September of 2018, I did my 1 year checkup in September of this year and am seeing 20/15. I used eye drops as instructed and now I don't need them. I still use readers for little print (or more light), but I knew I would need to going into this.

No regrets, except I should of done it years ago.

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I was advised to skip LASIK recently, as I was told I'd need it again when I got older and expose myself to all the same risks of a bad result over again. I instead decided to invest in much nicer contacts which has been life changing. I didn't realize there was that drastic a difference between crappy contacts(not even necessarily cheap) and good ones.

How much are good ones, and how much of a pain are they vs just regular eyes? I've never worn contacts, and the thought of having something in my eye seems very weird. I also tend to get dry eyes sometimes with allergies, will that affect it?

I've worn contacts for ~20 years. I've had gas-permeable 'rigid' contacts, extended-wear (acuvue2 / oasys) contacts (that I nonetheless was advised to remove every night), and recently I've switched to daily / disposable contacts.

The gas-permeable ones were from ye olden times, I don't think most people need to bother with those anymore because materials for soft lenses these days admit much more oxygen. They were also by far the least comfortable.

The extended wear ones were an amazing transition after the previous ones. Barring manufacturing irregularities in any particular contact lens, a few seconds after they're in your eye, you can genuinely forget that they're there. My issue with these was mostly psychological: removing them every night and cleaning them proved to be annoying enough that I would justify just sleeping in them for one night. The second day was much more uncomfortable (dryness mostly). Subsequent days would be miserable, but I seldom made it all the way through day two.

I finally switched to dailies and they are even thinner (read: more comfortable), and it's effortless to take them out and switch to glasses when I'm ready for bed, so I very very seldom end up sleeping in them. (Also, if one happens to fall on the ground or get torn, it's not like you're losing a week's worth of wear on it, you were going to throw it away anyway that night. Just having that peace of mind is nice.) Finally, when traveling, I don't have to pack the travel size contact lens solution and lens case, I just bring however many days' worth of lenses (they come individually packaged). It's been amazing and I recommend it.

If the thought of having something in your eye seems weird, maybe try a trial set. Optometrists (at least all the ones I've used here in the US) will give you a pair of extended wear lenses or roughly a 10-pack of dailies to try out, so that you know how they are before you commit to a year's supply. They'll also generally coach you on inserting/removing. It was awkward for the first month but now it's just a part of my routine.

I've switched to dailies and it's wonderful. I don't normally need them, but they're wonderful for meetings in rooms with 10 foot displays, movies, concerts, etc. Since I don't wear them every day, I can buy a normal 3 months worth (90 pairs) and they'll last me a year. I don't have to worry about keeping them clean, making sure solution doesn't leak.

I work between two offices at the moment, so I keep a few pairs in both desks just in case as well as a pair in my car. I considered going back to glasses before I got dailies pretty much out of convenience alone, but I hate glasses as you don't get an undisturbed field of view and the lens distortion at the edges usually give me motion sickness. Having some dailies really is the best of both worlds.

> I hate glasses as you don't get an undisturbed field of view and the lens distortion at the edges usually give me motion sickness

The reason I switched to contacts was because this effect was so bad that I felt like it was difficult to hold eye contact with one person, and any group conversations had me swinging my head around to point my chin at whoever was talking because otherwise I couldn't meet their eyes. It was very isolating.

I wore extended wear lenses for a while (my vision is okay enough that I've been going without any corrective for years). They are very sensitive to how clean they actually stay, and I think it is quite easy to scratch them up.

How do I know if I've got the good stuff?

I’d like to know too. I’ve worn contacts since I was 12. Originally, non-disposable that I took out and cleaned every night. These were pretty good, but by the end of the year tended to get a bit ratty around the edges. It’s been too long to remember the quality of correction, but I know that contacts have always been better than glasses for me.

Then for years I wore the disposable, extended wear kind you can sleep in. Typically replaced every two to four weeks. Aside from dry eyes in the morning, these were by far the best.

They are not without risk and certainly not for everyone, but they had the highest manufacturing quality, were the most comfortable and seemed to me to provide the best correction.

For the last two years I’ve worn daily disposables. I think these are probably best for eye health since you’re not reusing one set over and over and not leaving them in for days on end, but they have the most variation between individual lenses. Sometimes I’ll get contacts that are instantly irritating. The next in the package will fit comfortably. Quality of correction varies every day too. This I just live with, as it’s not worth (to me) burning through them faster just because my distance vision isn’t as good as it could be today.

I’ve always used whatever brand my optometrist recommended (which I’m sure is whatever they’re being paid to promote). If there is some gold standard brand I should be asking for, I’d love to know.

I trialed 3 different brands of dailies this year. It was a pain, but one of them did end up standing out in terms of comfort for me. My doctor said there is no pattern - it’s really person dependent which is best.

Dailies changed my life. They only started making dailies in something close to my prescription a few years ago.

I’ve had dailies for a long time and now really love acuvue moist. Way less dry. if the delta between weeklies and dailies is 1, moving to acuvue moist has been another 0.3 or so

There's Acuvue and there's everything else. I tried probably half a dozen brands over the years recommended as good by opticians - supposedly premium brands priced accordingly, and Acuvue are dramatically better than all of them.

If there's anyone else who have got close in terms of comfort, quality of vision etc, it's a well kept secret.

> There's Acuvue and there's everything else

That helps confirm someone else's comment that this differs by person, not manufacturer. I kept trying Acuvue and found them very uncomfortable, instead favouring Focus Dailies. Now I am on Costco own brand which seemed even more comfortable.

Apparently Costco's Kirkland contacts are CooperVision MyDay lenses.

CooperVision brands under like 50 different names for every store they sell in. I think Wal-Mart calls them Ultraflex or something.

If it's not Acuvue for soft contacts it's almost always going to be one of the CooperVision chain brands.

Get Acuvue Dailies. I suggested them to multiple people and everyone seems to be happy

I tried multiple ones and always got eyes very dry, life was a pain, then I switched to the most expensive I could find, « Dailies total 1 » is the name. No more dry eyes, problem solved. Each lense cost 1€, but I would even pay more for it to be honest.

Can confirm, Alcon dailies total one and Acuvue TruEye are the acceptable ones for the drier eyes. Personally I found Total 1 slightly more comfortable in general, but it lacks the UV filter or something that makes them notably worse than TruEye in sunny weather.

Also, the drops make huge difference: since a better doctor told me to use only preservative-free ones like hylo-comod, I can wear lenses for 20 hours straight without image quality degradation.

What are the good contacts you're using now? I gave up on contacts years ago, but I've never done any research and experimenting to find if there was anything better than the usual Acuvue stuff.

I switched from Acuvue to CIBA vision (now Alcon) Air Optix about a decade ago. I completely forget that I’m wearing them. They are monthly contacts that are approved for multi-day wear. I usually take them out every night, but if I’m on a trip I might keep them in 3-4 days. They have been fantastic. I did have to get a slightly wider diameter to prevent halos at night.

Of course, they were just a recommendation by the optometrist, I wore a pair of trials and they were good enough that I stuck with it.

I was also told in 15 to 20 years i might need glasses again (late 50's, early 60's). I am cool with that.

I once had contacts, they did work OK. My issues were that i suck at putting things in my eye. I never got comfortable putting them in, i know that is a personal issue not the fault of the contacts. Also my contacts had to be weighted for some reason (i cannot recall why), and if my eye got dry they would shift and things would become blurry and i had to use eye drops or tear up (didn't happen a lot, but enough to annoy me). Plus i still needed a set of glasses.

Kind of off topic, my other half, she was making fun of my reading glasses, one day she was struggling to read something and i slapped them on her face and her response was OMG. I laughed, went to take them off her and lets just say i had to go buy myself a new pair (she confiscated them). It is interesting that people think readers are only for older people or you need a prescription, she wishes she would of gotten a pair 5 years ago.

Do you have astigmatism? Every time I've tried contacts, this has been the achilles heel, because the contacts inevitable rotate a bit and then my vision is intolerably blurry until they get back into place. Maybe it's just my prescription, but my eye doctor straight up told me that I'd never be satisfied enough to switch to contacts (from glasses) full time.

At one point about 16 years ago, I was prescribed hard contacts that dealt with astigmatism. They seemed fine but the irritation, the pain of daily installation, plus the warnings about never falling asleep with them on made me pass on these. I never experienced the blurriness that you mention in the few weeks that I wore them so perhaps there is some mitigation for the rotation?

> Do you have astigmatism? Every time I've tried contacts, this has been the achilles heel, because the contacts inevitable rotate a bit and then my vision is intolerably blurry until they get back into place.

I have astigmatism. I had the same problems with older-generation contacts.

I switched to Alcon's top of the line daily disposable contacts and now my contacts almost always line up correctly. The new contact lens technology is amazing.

I’m in the same boat as you, I stuck with contacts as the risks of the surgery and age-related need for glasses didn’t make much sense when contacts got me really great vision and no complications. They go in when I wake up and come out when I sleep and I rarely know I have them in.

Somewhat surprising because I am very near-sighted and have astigmatism.

If contacts weren’t as good a solution I probably would have gone for laser surgery. I hated wearing glasses - the biggest aspect was how they distort your vision a little. I can see much better with contacts than glasses.

I used to be the same - 10+ years of waring contacts, I could pop them in and out of an eye without thinking about it in seconds.

But then when I got older I started getting more eye infections and each time you can’t really use contacts as it irritates the eye, so back to glasses.

And then I started reading a bit more about how you can get resistant bacteria infections from contacts (basically guaranteed blindness) I realized I was risking my eyes each and every day anyway, better to bite the bullet and go for a surgery. Risk once and be done with it.

I think the feeling of freedom and one less thing to worry about that I got after the successful LASIK was akin to when I first switched from glasses to contacts. I think its totally worth it.

(https://medium.com/@ivankerin/a-humble-mans-account-of-the-l... a bit more in depth account if anyone’s interested)

I liked the freedom contacts provided me in most situations, but I found two main problems:

1. I couldn't rub my eyes anymore in public. Rubbing my eyes would often end to with one of my contacts in my hand.

2. I had to always plan when I was going to sleep. This pretty much made napping impossible. Going to sleep with contacts was horrible.

Are there better contacts where the above two problems aren't an issue?

Ortho-k lenses.

My prescription is moderately strong -6.5 and -7

Yes. I wear extended wear contacts that are supposed to be replaced once a month. I take them out and replace them when I notice a significant deterioration in vision, or when my eyes feel scratchy. For me has varied between a month and about 18 months. YMMV

I have very occasionally rubbed my eyes to the point of accidentally removing a contact, mostly this is a habit I have trained myself out of

Most days and nights I forget that I have contacts in, I always sleep in them, makes getting up in the night to pee much safer, and other night time activities more enjoyable

That's great! Having to take contacts out every evening and to then clean them was quite a hassle. I should try contacts again.

>makes getting up in the night to pee much safer

Is that really the case? My vision is only slightly better than yours (although my last check was years ago) and I feel like I could do most things without glasses just fine. Anything that requires reading is difficult though, unless it's on my phone where I can just bring it very close to my face.

Depends on the probability distribution of single Legos in your nocturnal environment.

On a more serious note, when a fire alarm has gone off in the middle of the night and I have to grab a sleeping child and get out of the building, then it's one less thing to worry about for sure

For soft contacts there's two primary types in use. Regular hydrogels and silicone hydrogels (SiHy's). Most doctors will prescribe SiHy's now as they provide some key benefits. Those being: better air permeability (dk/t number) and the ability to be used for continous wear (overnight).

The SiHy's had a bit of a tradeoff though, despite being able to let a lot more oxygen through (which the corneas need, they can directly absorb it), they are not inherently wettable. Silicone is hydrophobic, it naturally repels water. So 3 generations of silicone hydrogel are in use. 1st gen has an external wetting agent that rubs off over time. 2nd gen has an internal wetting agent that some people are allergic to. 3rd gen has the molecular structure arranged in such a way they are inherently wettable.

I wear 3rd gen SiHy's now. Cooper Biofinity is the name brand. These are approved for extended wear up to a week. I have done longer than this but risk of complications increase. However, these were a huge improvement over the regular hydrogels I used to wear. If I had them in over 17 hours or so my pupils began to dilate from my eyes being oxygen starved. They are a little stiffer (and hence, slightly less comfortable than my regular hydrogels were). They also have a slightly higher chance of feeling dry due to higher water content than most other SiHy lines.

Anyways, hope that helps. There's a lot of options on the market and for you it might be better to look for a higher water content with lower stiffness, if you need to wear them when sleeping that really limits you to 4 or 5 continuous wear brands. Don't wear a non-approved regularly for sleep, it'll screw up your eyes in a mess of different ways (vascularization and such).

Thank you very much for the write up! I had no idea that things had improved so much. I had switched back to glasses several years ago because of the complaints above. It sounds like I should check out contacts again.

I had mine done in 2011. I went to a highly reviewed specialist who charged a lot. No coupons for me! One of the best things I ever did. In 8 years, not a single day has passed where I haven't taken a moment to appreciate my 20/15 to 20/10 vision -- no hyperbole. Eye drops for a while. Then less often. Then nearly never.

Now, what I wish I had known is that apparently a knock to the head can dislodge the flap. Still would have gone for it.

Edit: I do have a bit of halo at night with bright lights. A total non-issue for me as my lenses were always scuffed, causing more halo that I get now. And I'll take an eye drop once a quarter or less.

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