The Prince Choice Awards 2013

I am so often asked in the exam room and on the net what I recommend and what are my "favorite" products to use/prescribe. So every now and then I post them! Here are the "winners" of the 2013 Prince Choice Awards: 1) BEST DAILY DISPOSABLE CONTACT LENS: hands down it's Alcon Dailies Total 1. Possibly the most comfortable contact lens ever, excellent optics, excellent safety, excellent compliance. It's 1 knock is cost. 2) BEST TWO WEEK CONTACT LENS: Acuvue Oasys. 3) BEST MONTHLY CONTACT LENS: Alcon Air Optix Aqua, with Night & Day a close second. 4) BEST OVERALL CONTACT LENS: Alcon Dailies Total 1. 5) BEST TORIC CONTACT LENS: Alcon Air Optix for Astigmatism. I have literally never used a better, more stable toric lens in 13 years of practice. This lens rocks. 6) BEST CONTACT LENS SOLUTION: Clear Care. Absolutely cleans the best, hypoallergenic. It's 1 knock is that you must actually follow the directions. 7) BEST PRESCRIPTION ANTIHISTAMINE EYE DROP: Lastacaft. Works immediately, very long duration. 8) BEST OTC ANTIHISTAMINE: ketoifen fumarate, found as the active ingredient in Zaditor, Alaway, Zyrtec and others. 9) BEST OTC ARTIFICIAL TEAR: Systane Ultra. 10) BEST PRESCRIPTION ANTI-INFLAMMATORY: Lotemax (for surface inflammation). 10 is probably enough for now there you have them! Winners of the 2013 PRINCE CHOICE AWARDS!


  1. thought you would select PV2 for astigmatism as the best toric..:)

  2. Can Alaway and/or Lotemax have the same effect as a mast cell stabilizer? Do mast cell stabilizers offer some benefit those two don't offer?

  3. Alaway and lotemax both "stabilize mast cells" well as other properties (antihistamine, anti-inflammatory).

    No, mast cell stabilizers do not offer some benefit that the other two don't. Mast cell stabilizers like crolom are 70's technology. Nothing special.

  4. A couple of years ago you stated that pv 2 hd comes close to air optix. What happened to change your mind? I am researching now. A year and a half ago I decided to try "the best contacts in the world" Air Optix Night & Day and the last year was a living hell. The pros were: the white of my eyes was pearl white, like never before, the end of the day dryness was gone, and they remained clear and transparent for much longer then other contacts. But the cons... I felt severe burning (as if soap went in my eye) after only one or two nights sleeping in them. I had a stock for a year, but it lasted for a year and a half since, for the first time in my life, the discomfort made me wear glasses in pubic (I've been wearing contacts for 12 years). Usually when I'd forget abut the discomfort I would try them on again and the cycle repeated. Two months ago my eyes got very red and I developed a small blood vessel in a corner of my left eye (all these years the surface was vessel-free (for a naked eye). The contacts stopped being unbearable but my eye were turning red. I treated with antibiotics, thinking it was an infection (unreasonable) but I had to do something because my appointment with an actual ophthalmologist was in several months. However, the redness disappeared for a day after a week of treatment an then came back and persisted for two months. Finally an eye doctor told me that it was foolish to treat with antibiotics (it was only for a week though), and that I had a "sort of allergic reaction". Before that I've been wearing O2/air optix for about 6 years and I slept in them (a couple of times for two weeks even - irresponsible I know) and never had this sort of reaction nor discomfort of this kind. But there was always the dryness sensation at the end of the day and a very slight pinkish tint to the whites my eye (without blood vessels discernible by naked eye), and they'd get foggy after 2 or 3 day of continuous wear. So I am thinking what should I go for when my therapy is over (steroid eye drops and artificial tears with B5 vitamin). I would go for Pure Vision 2 HD, just to see whether I'll get rid of the dryness and redness (though the O2 transmissibility is amlost the same as in air-optix). I tried its older brother PureVision before and it's the worst contact I ever used: rigid, unbearable, used to get foggy fast, thick like a brick - I could always feel it. That's why I asked why is PV 2 HD not a close second to air optix anymore. And based on your experience would you recommend PV2 or AO, based on what I just wrote. (provided that I don't get an allergic reaction to any of these!) TNX

  5. After reading all that I would probably recommend:

    Not sleeping in your contacts. Between air optix and pv2 it probably doesn't matter too much.

    This actually sounds like probable GPC. Probably need dailies like DT1 and no extended wear at all

  6. Thank you for reading all that and thank you very much for the advice!

    I just took a look at the wikipedia's picture of a GPC affected eye and that's about how it looked like (but 40% less red in the corner), and secretion was much lower compared to when I had BC(once 10 years ago), my only eyes felt "slimy" at times.

    This was a bit unexpected, I never thought about the dailies. They might also make me less dependent on the rinsing/re-wetting solutions, since I have always had big issues with them (a bit more background in the next paragraph). That's why I don't use the re-wetting drops even though my eye doctor insists that every single lens wearer has to use them. When I do they bring immediate comfort, but a few hours later I have to remove the lenses. Now the DT1 cost is just... a deal-breaker. I will give DT1 a chance since you think they're awesome and I still need some swimming lenses to have around. Could you recommend any more affordable alternative? I did (some) homework and maybe a non-extended wear of biofinity from coopervision could be a viable alternative? Other suggestions?

    Additional background: I've mostly kicked the habit of sleeping in lenses ever since I started with the Ciba N&D, partly because of the horrendous N&D experience, and partly because I'm not a kid anymore, so I finally put my health first. Though, there is a tremendous difference from waking up every day and being able to see the ceiling and carelessly falling asleep, for 6 years. I also had allergic-like reactions to Opti free (any product) or ReNu (any product) ages ago, where my eyes felt "slimy" and the contacts that stayed in these/or were rinsed by them would get extremely uncomfortable by evening that had to be removed - no way I could make it till bedtime. In the meantime my dad bought me a cheapest possible solution and it worked for me. I mean no optometrist/eye doctor was able to tell if I had a fresh pair in, they were always clean (sometimes 2 a months old lens). But I'm a bit suspicious about it (it really sounds unsafe). Nobody (on www) seems to be using it, and it took me ages to find the company's website. They repackage and re-brand it for every region (without a website available in any country). I finally found out that it's a company based in the Netherlands with the info only in Dutch, and they export to half of the planet!? The last time I used Opti-free was two years ago on a trip. I ran out of my solution and the village pharmacy only had that. I had a same reaction like a decade ago and didn't wear the contacts for the rest of the trip. Other that that I have had no allergies. I never verified this, but I think a have mild allergic reaction when eating melons, a scratchy throat (milder hay fever case?).

    Thank you again, I promise I won't congest your blog with my marathon comments again!

  7. Just read the comment section from the last august about GPC and I feel that that just could be it. I need to add some more info because you offer explanation to what's happening here, while no one before has. I can't visit my eye doctor again because I have to move soon and I can't get another appointment in time. I know I have to be checked (and I will when I move) but I want to ask whether you still think it's GPC.

    I'm a healthy 24 y.o. male. Contact lens moving while blinking, check (it started with the N&D). Fell something on my eyelid scratching my eye (I could be imagining it after reading about GPC) Not always though, just on my worst days and only on my left eye, it was always the left eye.

    1. Yeah sounds like gpc. Need steroids and dailies. Stop extended wear.

  8. No there's no cost effective alternative. No not biofinity. That lens is nothing special.

    The problem here is likely extended wear. Even if you didn't have that problem before.

    I understand the want/need for the cheapest option but you're already doing that and its not working. So... you're likely at an impasse. Either continue to have the problems you're having or consider spending more. Switching to biofinity is not the answer.

  9. Hi Doc,

    I have a few questions as a new contact lens wearer. Should soft contacts fit perfectly centered over the cornea? Does contact fit affect how clear your vision is with contacts? Do different contact lens brands affect visual clarity? Is it common for your vision to go out of focus sometimes, but come back in focus after blinking or rolling eyes? Lastly, would having both eyes with the same prescription affect visual clarity when you suspect one eye to be weaker than the other?

    I am currently using a trial pair of acuvue oasys brand contacts. The optometrist has measured my base curvature and provided the initial eye exam. I have also asked these questions but the answers were not clear cut. I am hoping you can provide me with better answers to these questions.

    Thank you for your time.

  10. Yes it should center over the cornea. Yes for affects clarity. Yes different brands affect vision differently. Yes it is common for vision to blur then clear with blinking ESPECIALLY in torics. Yes wearing the same contact lens Rx R&L would in theory affect your vision if you had eyes of differing Rx's.a

  11. Thank you for responding.

    The optometrist examined my eyes again for fit. He said my contacts were slightly off center, but not enough to cause any problems. My cornea is still completely covered by the contacts.

    Right now I am using a trial pair of acuvue oasys contacts and to my understanding, there are only two sizes available. I'm guessing other brands have a wider range of sizes for fit?

    I can see objects at far distances well, but my close up vision is a bit blurry sometimes with contacts on. For example, when Im reading an article on a computer screen or reading a document. I can see perfectly fine close up with contacts off though. This particular problem is my main reason for asking those questions before. My glasses didn't seem to give me this problem even though the prescription is the same, so I am guessing it's a fit or brand issue.

  12. Its probably not a fitting or brand issue. That sounds like an age issue. Are you over 40?

    Also, nearsighted people are almost always more comfortable reading in glasses vs contacts b/c of the base-in prismatic effect they get when they converge their eyes.

  13. I am 25, so age is out.

    I don't know. I am slowly getting use to them. I heard that if I lower my prescription by 0.25, it might help.

  14. must be the prismatic effect, then. or you're over-minused. or you're accommodative-insufficiency.

  15. hey ,

    I just want to know which one is better among these two..

    air optix aqua spherical and biofinity spherical as im in a lot of consufion over the dk/t values and comfort as both of them are in tough competition. Please advise me.

  16. they're comparable as far as Dk/t and comfort. the toric design of the air optix is better IMO b/c it's more stable

  17. Hi,

    I was given a chance to try a different pair of contacts and I had no problems with them. It seems the fit of the oasys lenses bc 8.8 were a bit off.

    My optometrist let me try biomedics 55 bc 8.6, but as I understand they are an older product and aren't as healthy for my eyes. I asked for the avaira brand lenses to try as well and now it seems I am having similar problems as I did with the oasys lenses, but in this case the avaira lenses have a bc of 8.5, so that may be the reason why.

    The only other options I have are monthly contacts since they have more size choices as I am told.

    Are monthlies thicker lenses than weeklies? Is it more noticeable? Thanks

  18. No, monthlies are not thicker. have yet to list a lens that I like. I don't fit any of those routinely.

    8.8 acuvue lasts: very few people can wear bc of the flat base curve

    Avaira: one of the biggest flops in the history of contact lens marketing

    Bio 55: old technology

  19. Are air optix aqua classified as monthlies, dailies or weeklies?

    Thank You.

  20. air optix aqua are monthlies.

    and the aboue should read * 8.8 acuvue oasys. dang autocorrect.

  21. Hey! :)

    I made an appointment with an OD whose website said that he was knowledgeable on GPC. He is costing me a ton, but he seems to know what he is talking about because he prescribed me Lotemax, and when I get back into contacts, he said that he would suggest DT1.

    I'm also taking Claritin daily (self prescribed) because maybe I have allergies (IDK)--figure it couldn't hurt to take it.

    I noted the extreme dryness of my left eye too, and he examined it and said I have a few blocked glands. He said do hot compresses and massage technique, which concerned me with GPC but he said it would not affect it (what do you think?).

    I also told him I did hot compresses for a few months awhile back with no improvement in the blocked glands and asked if he could refer me for Lipiflow or something, and he said that my condition was mild and didn't warrant that treatment. I want a really aggressive and affective treatment for unblocking the glands though....Any suggestions?

    He also did not have any explanation for my left eye's intermittent blurriness--which is really concerning me!
    1st visit: left eye was seeing at 2 with glasses
    3 weeks left eye was seeing at 3 with glasses
    1 week later, today: He said left eye was seeing at 2 again

    Do you have any suggests as to what is causing this fluctuation? Is it just a coincidence that the eye having dryness and more severe GPC is also the one experiencing the severe blurriness?

  22. "He said do hot compresses and massage technique, which concerned me with GPC but he said it would not affect it (what do you think?)"

    yes, fine.

    "I want a really aggressive and affective treatment for unblocking the glands though....Any suggestions?"

    not really. lipiflow is pretty extreme...

    the left eye intermittent blur is almost certainly related to the left eye "extreme dryness".

    "Do you have any suggests as to what is causing this fluctuation?"

    well, not really.

    "Is it just a coincidence that the eye having dryness and more severe GPC is also the one experiencing the severe blurriness?"

    no, they're probably related...but coming up with a fix for this is going to be tough. those are all standard treatments. when a person doesn't respond to those the next step is...remove the patient from contacts.

    1. "I want a really aggressive and affective treatment for unblocking the glands though....Any suggestions?"

      not really. lipiflow is pretty extreme...

      Depends on how much obstruction there is (Grade..??)
      Blinking exercises work well and are recommended even for patients who have had the lipiflow treatments too, to maintain the oil flow from the ducts.
      GPC may also lead to a secondary morphological changes in the Meibomian glands which can cause the obstruction of those glands. Contact lens may also cause the morphological changes in Meibomian glands (Arita et al. 2012)
      what do you think princeidoc?

  23. How about best toric dailies? Any particular brand that your patients loved? :)

  24. best toric dailies is still probably Focus Dailies Toric...but in truth there isn't really one at all that I consider to be just outstanding.

    1. thanks for getting back to me - unfortunately, I guess I'm doomed with an axis that no one wants to make, except for acuvue moist... which isn't that moist at all. :(

    2. agreed. toric wearers are kind of hung out to dry in the contact lens world. not a lot of cutting-edge tech yet for us for 2 reasons: 1) there's not near as many of us as there are spherical (or near-spherical) myopes and 2) the designs are more difficult to come up with and make

  25. Just trying the Total 1's now; coming from TruEye. It's only the first day, so I'll see how my eyes adjust during the week. So far, for me, the comfort is pretty good - better than TruEye in general, but not light-years ahead. My up-close visual acuity has suffered a bit though: with TruEye I was able to sit in front on my computer screen without using my reading glasses -- I definitely need them with the Total 1's.


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