TRIED & TESTED; THE VISION THING

Soft or hard, disposable or longer-lasting - which contact lenses are safest and best? Our panel investigates
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The Independent Culture
CONTACT lenses aren't what they used to be. Not so long ago, the choice was a straightforward one between hard and soft. If your eyes couldn't cope with either, you quietly denied you were ever vain enough to want contact lenses anyway and retreated to your trusty specs. Over the last few years, however, there has been an explosion of choice - so much so that visiting an optician for a new pair of lenses can be a confusing experience. Where do potential lens-wearers begin?

Contact lenses aren't exactly a new invention. They were first worn in the 1880s, when they were hand-blown from fine glass. Today's lenses, now considerably more comfortable than these pioneering efforts, are designed with the aid of computers and made from sophisticated materials that have made hard lenses virtually obsolete. The choice now ranges from durable gas-permeable to extra-soft daily disposable, and there are even lenses designed to protect the eyes from the sun's harmful rays. Lenses can now be bifocal or correct problems like astigmatism (an irregularly shaped cornea). They can also enhance or completely change your eye colour.

Furthermore, advances in lens-care products have made them easier and quicker to look after. The newer "all-in-one" solutions look set to make the time-consuming soaking and squirting with different liquids a thing of the past. There's still the problem of cost, however. Solutions can add around pounds 110 a year to the basic cost, and insurance can add another pounds 20 a year. The price of the lenses themselves can vary widely depending on where you buy them, the quality of the lenses and the type of after- care service - the prices below were those most frequently quoted in our snapshot survey.

THE PANEL

Optometrists Grant Reid (who has a practice in Cornwall) and Judith Morris, director of the Institute of Optometry in London; Elizabeth Holmes, school teacher and veteran contact- lens wearer.

THE TEST

We asked the two professionals to consider the advantages and disadvantages of a range of different types of lens, taking into account comfort, ease of use and the health benefits and drawbacks of each. Our amateur tester gave her views on the three types she had tried personally. The cost of one year's wear, including solutions, was another factor in awarding our star ratings. (Note that all non-disposable lenses should be changed annually).

**DAILY DISPOSABLE

Approximately pounds 500 a year if they are worn every day

Daily disposables, which are soft lenses, were launched in the UK for the first time this year. Following the premise that the more often you replace your lenses, the healthier it is for your eyes, daily disposables are the logical conclusion. At the end of the day, you just throw them away and put in a brand new sterile pair next time. You don't need solutions, so they are relatively hassle-free. The main problem is price. They cost about twice as much as other lenses if you wear them every day - which is why they are usually recommended for part-time users. Grant Reid is a big fan. "We've been waiting for these for years," he says. "It's a huge advantage being able to put a fresh, clean lens in each time. I wear them myself when I'm playing sport, and the fact there are no solutions to carry around mean they are good for travelling." Judith Morris agreed, but she pointed out that it can take people time to get used to lenses, so inserting a new one each day could be offputting.

***GAS PERMEABLE

Approximately pounds 95 initial cost; total pounds 205 a year with solutions included

Semi-rigid and covering part of the iris, these combine some of the properties of old-fashioned hard lenses and soft lenses. Made from a mixture of acrylate and fluorosilicone, which allows the eyes to "breathe", they are more comfortable than the original hard lens. Largely because of their oxygen-richness, Judith Morris picked these as her ideal contact lens. "Gas permeables cover a smaller eye surface area than soft lenses," she said, "and are less bulky. They therefore allow more oxygen to get to the eye, and are easier to look after. The main disadvantage is that some people find them harder to get used to." Grant Reid agreed, and said some people also have problems with them because it's easier for grit to get underneath the lens. Elizabeth Holmes wore this type of lens for two years, but wasn't converted: "They always seemed to be dropping out of my eye," she said, "which was frustrating and embarrassing, especially in front of a class full of children."

*STANDARD SOFT

Approximately pounds 75 initial cost; total pounds 185 a year with solutions included

Unlike gas permeables, soft lenses cover the whole iris. They are made of flexible material, and the eye gets used to them very quick1y. Their water content ranges from 30 to 80 per cent depending on the exact type of lens - the higher the water content, the more oxygen gets to the eye. Standard soft lenses are at the cheaper end of the price range and have a lower water content. They deteriorate more quickly than gas-permeables, and can make eyes more prone to infection. Because they are flexible they can also tear - and it's too easy to insert them inside out.

Grant Reid had strong views on standard soft lenses. "Outdated," he said. "I don't even prescribe them these days. The main problem is that no matter how carefully you look after them, they become less oxygen permeable as they age - and that's bad news for eyes." Judith Morris was less critical, but also had reservations: "I wouldn't recommend these to someone wearing lenses all day, but they are suitable for a lot of people." Elizabeth Holmes recently stopped wearing them. "I was an optician's nightmare," she admits. "I never used protein removers or cleaned them properly, and wore them 12 hours a day. Not surprisingly, they were often uncomfortable."

****FORTNIGHTLY OR MONTHLY DISPOSABLE

Approximately pounds 290 a year fortnightly, or pounds 220 a year monthly (solutions included)

Again, the fact that these soft lenses are disposable is important for eye health and comfort. After fortnightly or monthly wear (taking them out each night) they are thrown away and a new pair worn. Because they are thrown away regularly deposits don't have much of a chance to build up. You still need solutions, but there's no need for protein remover tablets. Fortnightly lenses are thinner and more delicate than monthly ones, and tend to be more hygienic because you wear them for a shorter time. Grant Reid is a devotee. "Marvellous," he said. "The simple fact that you get a fresh lens so regularly is very important. Fortnightly is the lens I am dispensing the most now, followed by monthly disposables."

These lenses still need plenty of looking after, but they are easier to maintain than standard soft. Judith Morris thought more and more people would be switching to them, and Elizabeth Holmes has just done so (from standard soft to fortnightly disposable). "I'm convinced they're better for my eyes," she says, "but one drawback the optician didn't mention is that they are so delicate. It's quite difficult to put them in your eye, and they tear easily, too. Not for people without a delicate touch."

*COLOURED SOFT

Tinted about pounds 110 initial cost; total pounds 220 a year with solutions. Coloured/opaque about pounds 130; total pounds 240 with solutions

Tinted soft lenses enhance the colour of your eyes - by making grey-blue eyes a truer blue, for example. They are particularly effective if you have pale-coloured eyes and want them to look a little different. Coloured or opaque lenses mask the iris, making it appear a completely different colour. The wearer sees through a clear area in the centre of the lens. Both opaque and "enhancing" tints can be worn even if a prescription is not required. Judith Morris had worries about them. "Because the lens is coloured, a solid tint in particular will cut down the amount of oxygen getting to the eye. I'm also concerned that because some people wear them purely for cosmetic reasons, they don't take as much care of them as they should." Grant Reid pointed out that some of these lenses can look very artificial.

**UV PROTECTION LENSES

Approximately pounds 220 a year (including solutions)

Ultra-violet protective lenses contain an invisible filter that can block out up to 90 per cent of the sun's harmful rays. Grant Reid felt that these lenses, which are usually disposable, would be useful for some people, but not for the majority. "They aren't just a gimmick: there is a connection between degeneration at the back of the eye and exposure to UV light. If I spent a lot of time outside - if I was a professional athlete or worked outdoors a lot - they might be a sensible choice. But most people don't spend enough time outside to make them necessary." Judith Morris reached much the same conclusion. "I don't really see them as being of much benefit for the majority of people," she said.

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