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Published on November 24, 2017

Thomas Ambrose, MD and Gregory Hill, DO

The Right Lens for the Right Occasion

For his work as an orthopedic surgeon, and his favorite avocations of fishing and hunting, Thomas Ambrose, MD, needed optimal vision without dryness or irritation in his eyes.

When his long-time standby lenses were no longer working for him, Ambrose, who practices with Avera Orthopedics in Sioux Falls, turned to his colleague, Gregory Hill, OD, with Avera Medical Group Eye Care.

“I had been wearing rigid gas-permeable lenses for well over 25 years, and my current pair was several years old. Over time, they were hard to keep clean. If I was out hunting, I would suffer tremendously with dust particles that would get under my contacts. Once, I had to sit out for several days of hunting because my eyes were so irritated,” Ambrose said.

In the operating room, Ambrose’s eyes tended to get dry, because he wears what’s called an exhaust gown through which air circulates. “Inside the gown, which covers the surgeon from head to foot, it can get extremely dry. My eyes would get very dry and tired by the end of the day.”

Hill’s first recommendation to Ambrose were scleral lenses. “Scleral lenses stay put better and provide a fluid reservoir in the eye. This was a good fit with Dr. Ambrose’s love of outdoor sports, and the demands he places on his eyes as an orthopedic surgeon,” Hill said.

Finding the Right Fit

Scleral lenses are larger than conventional size contact lenses. They cover the entire corneal surface and rest on the “white” of the eye, or the sclera. They are less likely to accidentally dislodge from the eye. They can be worn comfortably for more hours of the day. A space between the back surface of the lens and cornea acts as a tear reservoir to keep eyes moist.

Ambrose had never heard of scleral lenses, but once he tried them, he was immediately sold. “The dust can be blowing, the wind can be howling but I don’t even know I have contacts in. I can spend the whole day in the OR and my eyes don’t even react to the dryness.”

Scleral lenses are more expensive up front than the typical soft contact lenses, but they also tend to last up to five years with proper care, so the investment pays off – especially for patients whose vision does not change.

Having settled on the type of lens, the next step was to figure out the best vision correction for Ambrose.

Like many adults age 50 and over, Ambrose needed correction for both distance and up-close vision.

Experimenting With Options

Ambrose first selected multifocal contacts, which are similar to bifocal or progressive eyeglasses. “These contacts have multiple powers built into the same lens for up-close vision, like reading glasses, and for distance vision. There’s a time of adjustment, but for most people, the brain learns how to focus the eye for both near and far vision,” Hill said.

Ambrose liked the multifocal contacts for his up-close work as a surgeon, as well as everyday distance vision needs, such as driving.

“I could go to lunch with friends and see the menu, while they were pulling out their reading glasses,” Ambrose said.

Yet he wasn’t yet satisfied with the distance vision that these lenses delivered. “Because of the multifocal aspects of these lenses, the distance vision can be compromised, especially long distances,” Hill said.

So, Hill prescribed a special set of scleral lenses for Ambrose that are especially for distance. He wears them only when he’s at the water or in the field. While these lenses don’t allow up-close focus for reading, Ambrose typically isn’t reading when he’s out hunting or fishing, so it’s a good trade-off.

“My distance acuity with these lenses is fabulous. I can tell between a redhead or canvasback at 50 yards,” Ambrose said. These waterfowl are very similar, yet the canvasback has a white back and the redhead has a light grey back. Yet distinguishing between the two ducks is important for hunters, because of the daily limits in South Dakota of two redheads and two canvasbacks.

“Work as an orthopedic surgeon takes up a tremendous amount of time, so I like to enjoy as much time as I can fishing during the summer and hunting in the fall. I’ll hunt anything that has a season. And my free time in the winter is spent keeping warm,” he said. The improvements in Ambrose’s vision through two new sets of contact lenses is helping him to enjoy all seasons without tired, irritated, dry eyes.

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