Distance prescription problem -- what next?

[te.mi]

I have come to a very frustrating point, and am looking for some advice as to how to get the eyeglasses I need.

I have been wearing bifocals and trifocals for at least 25 years. (I had a pair of "no lines" for about 6 months, and was glad when I lost them, but that is neither here nor there.)

Other than my first glasses (I went straight to bifocals), I have always had an easy transition between pairs of glasses. I could usually use them full time right away. This time has been different.

First, they mounted one lens higher than the other, so that the transitions didn't line up. I spotted it before even leaving the office. They got that fixed.

The other problem I spotted right away, but they urged me to try to get used to it. It isn't something I can get used to. The glasses are too strong. Things are in focus out to 20-30 feet, and get blurrier after that. My old glasses are good out to infinity, so anything far away I can see better with my old glasses.

I went back and they measured the glasses (pronounced "made to prescription") and got my eyes re-checked "same as the prescription I wrote last time" and told to go home and get used to the glasses for another 2 weeks.

After spending dozens of hours on the Internet, I know a lot more about glasses and optometry than I did before. (I am an engineer and a serious amateur photographer, so I already knew a good bit about optics, optical aberrations, etc.)

The conclusion I am coming to is that a combination of factors have probably come together in an unlikely combination that is leaving me with glasses that are not correct.

The factors I suspect:
1. My vision is better than 20/20, probably more like 20/15 or better. (I rely on that vision, and know what my eyes can do.)
2. My old glasses are better than the new prescription, so I have a crystal-clear standard to compare to. (If my old glasses had been worse, I might be happy because my new glasses were better than the old).
3. The phoropter setup uses a standard distance of 20 feet, and considers that to be "the same as infinity". If glasses are ground to focus correctly at 20 feet, but no farther, a correction of -0.164 diopter would be needed to bring infinity into sharpest focus.
4. In my case, the 0.25 diopter rounding has resulted in a prescription that is "great at 20 feet but will not allow my eyes to focus farther than that".
5. The sloppy +/-0.125 diopter standard for glasses tolerance may have pulled my glasses "in" (more +) slightly from what the Optometrist ordered, even though it is still "in tolerance".

When I go back at the end of my "try it for two weeks", what should I say that will get the attention of the people involved? The optometrist is very distant, stand-offish, "I must be right" kind of a person. The opticians were a lot easier to deal with, but can only do so much.

Sorry for intruding,
Ted

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[310]

lol no. You're probably very farsighted and they put too much plus power in the distance portion. The number they find in the exam room might be the "true" prescription, but it doesn't feel right in the glasses for various reasons, namely that your eyes want to keep the focusing muscles locked in a little instead of fully relaxing. This is one of the top reasons for remakes.

 

[fjpod]

No one can truly troubleshoot or diagnose your problem over the internet. You need to seek the help of a doctor or establishment you can trust and one that seems to take an interest in you.

 

[RadixLuminogen]

I agree with 310 - they probably need to lower your distance prescription by 0.25 or 0.50 (aka adding a bit more minus) but there's no better way of finding out if that is true than doing a subjective refraction.

 

[KHE]

The reason 20 feet is used is because it's consider optical infinity or the point at which the eyes have negligible convergence and accommodation is completely relaxed. As such, there is no compensation that needs to be made.

You should not have a new set of glasses that you see worse out of then the old one. This whole notion of "try it for two weeks and get used to it" is absurd. Sometimes when people get new glasses, they may seem a little "fishbowl" like and that can take some adjustment to but you should NOT see worse with the new ones than the old ones and no amount of time will make you get used to it.

If your new glasses have the same prescription as the old one and you see worse with the new ones, then in my experience it is almost always a base curve issue, a material issue or both.

If the Rx is different and you're happy with the old ones, I would simply ask them to duplicate the old ones.

 

[te.mi]

My prescription is not drastic (compared to some I have seen discussed).
Old:
+2.00 -1.00 87
+2.25 -1.25 69
New:
+2.50 -1.50 87
+2.75 -1.25 69
I am wearing trifocals because most of my accommodation is worn out (trifocal zones do not overlap), so don't know if it is likely that I am trying to keep some residual accommodation. My eyes regularly get pushed to the "no accommodation" position when using the middle or lower area of the trifocal.

Glasses are Polycarbonate safety glasses (which I wear whenever I don't have my computer glasses on).

Any other thoughts?

 

[310]

Exactly what I posted in the first response. They pushed too much plus. You'll probably need a remake to be happy.

Also, hi-index will give you better optics than polycarbonate and with good impact resistance.

 

[KHE]

My prescription is not drastic (compared to some I have seen discussed).
Old:
+2.00 -1.00 87
+2.25 -1.25 69
New:
+2.50 -1.50 87
+2.75 -1.25 69
I am wearing trifocals because most of my accommodation is worn out (trifocal zones do not overlap), so don't know if it is likely that I am trying to keep some residual accommodation. My eyes regularly get pushed to the "no accommodation" position when using the middle or lower area of the trifocal.

Glasses are Polycarbonate safety glasses (which I wear whenever I don't have my computer glasses on).

Any other thoughts?

If you were happy with the old Rx then it's not surprising you're having trouble with the new one. Jut have them duplicate the old.

 

[Optogal]

Too much plus. This doesn't necessarily mean your optometrist did anything procedurally "wrong", but 20 feet is supposed to APPROXIMATE infinity, but obviously, it literally is not infinity. 20 feet is considered equivalent to 6 m, which requires 1/6 = 0.16667 D of accommodation. This means technically/optically, you need a plus add of 0.167 D in order to see 6m in perfect focus. Thus, if you get the exact correct pair of glasses for 6 m, it'll be 0.167 D out of focus. That's probably where you're at. Doesn't make a difference at 20 feet, but sure as hell can be noticeable at infinity.

I'd print this thread out and give it to your optometrist to read if he stonewalls you on a fix. Every optometrist should know about occasionally giving too much plus. It's probably the most common cause of re-do, and again, it's not as though he did anything procedurally wrong - it's an issue of the limits of the imperfect test used to measure acuity. Dropping both eyes by 0.25 D should do the fix, but to be on the absolute safe side, you could (as already mentioned) just have him re-do the old lenses.

 

[Optogal]

My prescription is not drastic (compared to some I have seen discussed).
Old:
+2.00 -1.00 87
+2.25 -1.25 69
New:
+2.50 -1.50 87
+2.75 -1.25 69

BTW - to the optoms out there. I'm pretty sure I've never given a 069 axis. Maybe I have, if I had a patient with 4 D of cyl at that axis, and his previous glasses had exactly 069. But for 1.25 cyl? I'm pretty confident I have never prescribed that degree of precision for that "little" amount of cyl. Different strokes for different folks.

 

[hello07]

From what I see, your Rx should go back to : rt eye : +2.00= -1.25X 90 and lft eye : +2.25 = -1.25 X 70 Increase astigmatism if rt eye by a quarter only.
He gave you +.50 higher in both eyes- that I'm assuming fogged you. Whatever you get in the phoropter (machine infront of your face) you don't always prescribe. You cut back at times depending the circumstances-each case.
Was your chief complain you didn't see well with your old glasses at either distance or near?
Did you tell them your distance was blurry with your old Rx ?

Secondly, I'm sorry to tell you this when the optometrist is very distant and "stand offish" then you know it's a problem. Good competent optometrists do not distant themselves from pts if there is a problem. They welcome it. From everthing you described along with my colleagues he overplus you. Speak you mind because this not professional of him/her. He should take you to the exam room again and recheck your eyes going thru the process of explaining every step of the way what he's doing (adding or taking away plus). Subjective exam the correct way.
If you're not satisfied or he/she has not solved the problem explaining why -distancing himself from you is not appropriate. I know sometimes pts can be very difficult or illogical but from your comments you are not. Call state board of Optometry or at least tell him you will and you'll see how fast he rechecks you again
Hope it helps.
We have some losers in our field that really suck. I'm sorry for your experience.

 

[rkl_OD2be]

Base curve on the new glasses might be different than the old ones. A lens with a different base curve can change the image size on the retina and lead to visual discomfort.

I would politely ask that the new glasses be made with the same base curve as the old pair.

 

[Optogal]

He gave you +.50 higher in both eyes- that I'm assuming fogged you.

Actually, 0.25 more OD, 0.50 more OS. The OD cyl was increased from -1.00 to -1.50, so total spherical equivalent increase of only 0.25

 

[Optogal]

To OP.

Acid test for our suspicions. He needs to take -0.25 "trial lenses" out of his box, put them in front of the glasses he made for you, and have you look at a distant target. The lenses should make the target immediately clearer. If so, the current glasses are "too plus" for you.

 

[PBEA]

The factors I suspect:
1. My vision is better than 20/20, probably more like 20/15 or better. (I rely on that vision, and know what my eyes can do.)
2. My old glasses are better than the new prescription, so I have a crystal-clear standard to compare to. (If my old glasses had been worse, I might be happy because my new glasses were better than the old).
3. The phoropter setup uses a standard distance of 20 feet, and considers that to be "the same as infinity". If glasses are ground to focus correctly at 20 feet, but no farther, a correction of -0.164 diopter would be needed to bring infinity into sharpest focus.
4. In my case, the 0.25 diopter rounding has resulted in a prescription that is "great at 20 feet but will not allow my eyes to focus farther than that".
5. The sloppy +/-0.125 diopter standard for glasses tolerance may have pulled my glasses "in" (more +) slightly from what the Optometrist ordered, even though it is still "in tolerance".

1) "20/15" vision in a 65- 70 yo? possible but not probable. Knowing what your "eyes can do" quantifies nothing and is almost meaningless from the doctor's perspective. I'd guess that you likely have some other problem affecting your vision, one not necessarily amenable to being fixed with "new" glasses.

2) people will sometimes say that or think that "the old glasses are better", only too be shown head to head on a re-check that indeed they do NOT see better with the old ones. They are merely neuroadapted or comfortable with old rx. A period of adaptation is common and expected.

3) false, human eyes are not robot eyes, refraction is not static it is dynamic. applying rudimentary geometric optics to the human eye is misleading.

4) no

5) no

Obviously it is possible that the rx is wrong, frankly with such minor change I'm surprised the OD changed the glasses rx. Unless you were complaining about the old rx I wouldn't have changed anything (and even then I might not). Were you complaining of "blur", etc? Why did you get new glasses? It's an easy fix to change back to the old rx, just have them do that. Lastly be cautious applying your engineers rationale to the human eye.... it's not a "camera", you need a bit more wiggle room then that.

 

[JMK2005]

1) "20/15" vision in a 65- 70 yo? possible but not probable. Knowing what your "eyes can do" quantifies nothing and is almost meaningless from the doctor's perspective. I'd guess that you likely have some other problem affecting your vision, one not necessarily amenable to being fixed with "new" glasses.

2) people will sometimes say that or think that "the old glasses are better", only too be shown head to head on a re-check that indeed they do NOT see better with the old ones. They are merely neuroadapted or comfortable with old rx. A period of adaptation is common and expected.

3) false, human eyes are not robot eyes, refraction is not static it is dynamic. applying rudimentary geometric optics to the human eye is misleading.

4) no

5) no

Obviously it is possible that the rx is wrong, frankly with such minor change I'm surprised the OD changed the glasses rx. Unless you were complaining about the old rx I wouldn't have changed anything (and even then I might not). Were you complaining of "blur", etc? Why did you get new glasses? It's an easy fix to change back to the old rx, just have them do that. Lastly be cautious applying your engineers rationale to the human eye.... it's not a "camera", you need a bit more wiggle room then that.

i agree.

is possible that taking off 0.25 to 0.50 diopters would help, but visual complaints are out of proportion to glasses Rx.

teaching point to students, be careful making changes to Rx of engineers as they have a tendency to over-analyze. there is undoubtly mild cataracts that is contributing to visual complaints as well.

 

[ldsrmdude]

SDN is not the appropriate place to ask for medical advice. Closing this thread.