Contact Lenses vs. Surgical Vision Correction: What You Should Know

The Big Picture: The Myopia (Nearsightedness) Epidemic

Nearsightedness (myopia) is rising at an alarming rate worldwide. A major meta-analysis predicts that by 2050, nearly half of the global population will be myopic and one in ten will be highly myopic, increasing risks for retinal detachment, myopic maculopathy, and glaucoma (Holden et al., Ophthalmology, 2016). This growing dependence on glasses and contact lenses underscores the need for safe and effective vision correction options.

How Do We Treat Myopia?

Once nearsightedness develops, there are several ways to correct or manage it—each with unique benefits and considerations:

• Glasses: The simplest and safest form of correction. Modern lens designs reduce glare, filter UV, and enhance clarity for daily and outdoor activities.

• Contact Lenses: Offer wider visual fields and better performance for sports and active lifestyles, but require diligent hygiene and maintenance.

• Orthokeratology (Ortho-K): Overnight rigid lenses that reshape the cornea temporarily, allowing clear daytime vision. Studies suggest they may help slow myopia progression in children when carefully monitored.

• Low-Dose Atropine Drops: Daily use of low-concentration atropine (0.01–0.05%) can reduce the rate of myopia progression by 30–60% in children with minimal side effects.

• Refractive Surgery: For adults with stable vision, laser procedures like LASIK, PRK, or SMILE permanently reshape the cornea to correct myopia—providing freedom from glasses or contacts.

• EVO ICL (Implantable Collamer Lens): A popular choice for people with high myopia or thin corneas who are not good candidates for laser surgery. The ICL is a tiny, biocompatible lens placed inside the eye (behind the iris and in front of the natural lens). It offers high-definition vision, is reversible, and does not cause dry eye.

The best approach depends on age, eye health, lifestyle, and visual goals. For many active adults or those frustrated with lens wear, refractive surgery or ICL implantation can be a safe and lasting solution.

Types of Contact Lenses and Their Materials

1. Soft Contact Lenses

Made from hydrogel or silicone hydrogel, these lenses are flexible and comfortable. Silicone hydrogel lenses allow significantly more oxygen to reach the cornea than older hydrogels, reducing hypoxia but not eliminating the risk of infection or inflammation.

2. Rigid Gas-Permeable (RGP) Lenses

Provide crisp vision and excellent oxygen permeability. These lenses are durable, easy to clean, and ideal for patients with astigmatism or irregular corneas. However, they require an adaptation period.

3. Scleral Lenses

Large-diameter, vaulting lenses that rest on the sclera, creating a fluid reservoir over the cornea. Commonly used for keratoconus, post-transplant irregularities, or severe dry eye.

4. Orthokeratology (Ortho-K)

Overnight-wear rigid lenses that reshape the cornea temporarily to reduce myopia during the day. Effective for certain patients, but strict hygiene is essential due to increased infection risk.

5. Specialty Lenses

Toric lenses correct astigmatism, multifocal lenses address presbyopia, and cosmetic lenses enhance or change eye color. Even decorative lenses require medical supervision to avoid complications.

Contact Lens Care: The Golden Rules

• Never use tap water on lenses or cases—water exposure is linked to Acanthamoeba infections (CDC, 2023).

• Rub and rinse lenses even with “no-rub” solutions—rubbing removes biofilm and lowers infection risk.

• Always use fresh solution—never “top off.”

• Replace your lens case every 1–3 months and air-dry it face-down daily.

• Hydrogen peroxide systems are highly effective for disinfection but must be fully neutralized before lens use.

• Do not sleep in lenses unless prescribed for extended wear.
  
  

Corneal Infection: The Hidden Danger

Microbial Keratitis (MK)

• Daily-wear soft lenses: ~3–4 cases per 10,000 wearers annually.

• Extended/overnight wear: ~20 cases per 10,000 wearers (6–7× higher risk) (Cheng et al., Ophthalmology, 1999).

• Severe keratitis requiring hospitalization: ~2.5 per 10,000 for overnight wear vs. 0.5 per 10,000 for daily disposables (Sund et al., Acta Ophthalmol., 2024).

Pathogens

Pseudomonas aeruginosa is the leading cause of contact lens-related bacterial keratitis, capable of causing corneal melting and scarring within 24–48 hours if untreated. Fungal keratitis is a severe corneal infection that can be caused by misuse of contact lenses.

Acanthamoeba Keratitis

Daily reusable lens users have a threefold higher risk compared to daily disposable wearers (Carnt et al., Ophthalmology, 2023). This infection is rare but often sight-threatening and difficult to treat.

Orthokeratology Safety

When hygiene is excellent, infection rates can be similar to those of daily-wear lenses—but overnight wear inherently raises risk.

Why Refractive Surgery Can Be a Safer, Simpler Alternative

Modern refractive procedures like LASIK, PRK, SMILE, and EVO ICL have evolved dramatically, offering long-term freedom from lenses with low complication rates.

1. Infection Risk

Post-refractive surgery infectious keratitis occurs in only 0.003–0.004% of cases—far below cumulative infection risks from years of contact lens wear (Shahgoli et al., Clin Ophthalmol., 2023).

2. Outcomes and Satisfaction

The FDA’s PROWL studies show >95% of LASIK patients achieve 20/25 vision or better and report high satisfaction, though some experience temporary dryness or glare that usually resolves (JAMA Ophthalmol., 2017). EVO ICL recipients report similarly high satisfaction with fewer dry-eye symptoms and excellent night vision.

3. Lifestyle Advantage

For climbers, travelers, athletes, and professionals in demanding environments, refractive surgery or ICL implantation eliminates dependence on lenses and the risk of waterborne or hygiene-related infections. No more lens cases, cleaning solutions, or fear of losing a lens mid-adventure.

Practical Guidance

If You Wear Contact Lenses:

• Choose daily disposables if possible.

• Never sleep, swim, or shower with lenses.

• Replace cases regularly and avoid “topping off” the solution.

• At the first sign of pain, redness, or blurred vision, remove lenses and call your eye doctor immediately.

If You’re Tired of Contact Lens Hassles:

• Consider an evaluation for LASIK, PRK, SMILE, or EVO ICL. Your corneal health, prescription, and lifestyle will determine the safest, most effective procedure for you.
  
  

References

• Holden BA et al., Ophthalmology 2016 – Global prevalence of myopia and projections to 2050.

• CDC 2023 – Contact Lens Hygiene Guidelines.

• Cheng KH et al., Ophthalmology 1999 – Risk of microbial keratitis by lens type.

• Sund MH et al., Acta Ophthalmol. 2024 – Hospitalized corneal infection rates.

• Carnt N et al., Ophthalmology 2023 – Acanthamoeba risk and lens modality.

• Shahgoli SS et al., Clin Ophthalmol. 2023 – Post-refractive surgery infection rates.

• FDA PROWL Study, JAMA Ophthalmology 2017 – LASIK outcomes and satisfaction.
  
  

Bottom Line:
Contact lenses are safe when used correctly—but even with perfect care, infection risk never fully disappears. For the right candidate, refractive surgery or EVO ICL implantation offers clearer, safer, and simpler vision—especially for those who live life at high altitude, on the move, or under demanding conditions.