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lensesesOver 140 million people in the United States wear lenseses. People whose eyes have refractive errors do not see clearly without glasses, because the light emitted from the objects they are observing does not come into focus on their retinas. For people who are farsighted, images come into focus behind the retina; for people who are nearsighted, images come into focus in front of the retina. Lenses work by changing the direction of light so that images come into focus on the retina. The greater the index of refraction of the lens material and the greater the difference in the curvature between the two surfaces of the lens, the greater the change in direction of light that passes through it, and the greater the correction.Lenses can be unifocal, with one correction for all distances, or they can be correct for more than one distance (multifocal). One type of multifocal, the bifocal, has an area of the lens (usually at the bottom) that corrects for nearby objects (about 14 in from the eyes); the remainder of the lens corrects for distant objects (about 20 ft from the eyes).

One, he didn''t think they were available from any other source," "and two, he had heard they weren''t as highly controlled as those dispensed through doctors."Neither assertion is true. got on the Internet and found her lenses on several Web sites for $35.95 for a box of six pairs. (Her doctor was charging $50 a box.) says her doctor told her that lenses offered by places like may have failed manufacturers'' quality checks. Bausch contacts and other lensmakers say there''s no difference in quality between the lenses sold through doctors and those sold directly to consumers. STATES CRACK DOWN. Attorneys general in 32 states have sued the American Optometric Association and two of the top contact-lens manufacturers (Vistakon, a division of contacts, and Bausch), alleging that the AOA tried to get manufacturers to agree to selllenses only through optometrists or other eye-care professionals. The attorneys general say they also have evidence that doctors agreed to withhold prescriptions from people who sought to buy lenses from other sources, despite the fact that at least 22 states have laws requiring eye doctors to give out contact-lens prescriptions upon request.Although the AOA says patients should be able to buy their lenses anywhere, the organization has reservations about mail-order purchases. "The difficulty when someone goes through mail order is that they don''t come back for regular checkups," says AOA president Dr. Harvey Hanlen.

Plastic frames are durable, can accommodate just about any lens prescription, and are available in a wide range of prices. They are also offered in a variety of plastics (including acrylic, epoxy, cellulose acetate, cellulose propionate, polyamide, and nylon) and in different colors, shapes, and levels of resistance to breakage. Epoxy frames are resilient and return to their original shape after being deformed, so they do not need to be adjusted as frequently as other types. Nylon frames are almost unbreakable. They revert to their original shape after extreme trauma and distortion; because of this property, though, they cannot be readjusted after they are manufactured.Fit The patient should have the distance between the eyes (PD) measured, so that the optical centers of the lenses will be in front of the patient''s pupils. Bifocal heights also have to be measured with the chosen frame in place and adjusted on the patient. Again, this is so the lenses will be positioned correctly. If not positioned correctly, the patient may experience eyestrain or other problems. This can occur with over-the-counter reading glasses.

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