Your thoughts on my eye exam results?

[pharmaz88]

Hello All,

A while ago, I made a post about my eye problems, particularly with blurry vision in the morning.

I finally made it to the optometrist today, and here's what transpired. I got the usual reading lines test and the glaucoma test (negative on that), and then after using the appartus with the dials (pardon my ignorance), was told that I've just become a little more near-sighted. Since it had been a long time since my last exam, I opted for the dilation, and everything was fine with that too.

When I asked the OD if just being a little more near-sighted would account for not being able to focus for several minutes in the morning, he paused for a moment, and then opened a drawer containing an array of individual lenses. He pulled out several, and then had me look at a letter-chart while alternating lenses over my eyes (I had my glasses on), asking if "1" or "2" was better.

After doing this, he said that he wasn't going to change my Rx after all, and that the results of him doing this with my eyes dilated told him that my eyes have been "over-focusing" as he put it. He made an analogy to bicep muscles being semi-tensed all the time, and never relaxing. (I do spend a lot of time in front of a computer monitor.) He then re-wrote my Rx, with pretty much the same sphere and cylinder as I had 6 years ago, but with different values for axis.

...so, if you've made it this far through my post, what do you make of all this? Does it sound legit, or should I go to another OD and get a second opinion? Any thoughts will be appreciated!

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[cpw]

it sounds perfectly legit to me... the part about "over-focusing" is very common and he/she did what you're supposed to do in re-checking your Rx while you're dilated. If you're still having problems with the new rx after a few week, take them right back to the same OD (that way if you need an rx change it will be covered as a doctor re-do)
Good luck

 

[pharmaz88]

Thank you for the reply, cpw. It helps to put me at ease.

Could I ask you a question regarding the Rx itself? ...specifically, why would the axis values almost flip-flop? (I'm 100% ignorant when it comes to this, obviously.)

My old Rx from 1999 was:

__Sphere___Cylinder___Axis__
R...4.75.........-0.75.......05
L...4.75.........-1.25.......210


The new Rx from today is:

__Sphere___Cylinder___Axis__
R...4.75........-0.75.......180
L...4.75........-1.25.........5

(note: on the new Rx, the Right Sphere looks like he might have written "4.25". ...can't quite make it out.)

 

[sco1styear]

180 and 005 are only 5 degrees apart (we use 180 instead of zero). As far as the 210, could it be 010? (We start over after 180) Then it would also only be 5 degrees apart.

 

[pharmaz88]

180 and 005 are only 5 degrees apart (we use 180 instead of zero). As far as the 210, could it be 010? (We start over after 180) Then it would also only be 5 degrees apart.

Thanks for the info... that makes more sense now!

Regarding the 210, the first number is definitely a '2'. Then it looks like a '1' and a '0' touching each other (almost like a lower-case 'b'). I suppose it could be a sloppy '26', but it looks much more like a '210'.

 

[Opii]

it sounds perfectly legit to me... the part about "over-focusing" is very common and he/she did what you're supposed to do in re-checking your Rx while you're dilated. If you're still having problems with the new rx after a few week, take them right back to the same OD (that way if you need an rx change it will be covered as a doctor re-do)
Good luck

Hello, Remember me? I told you you were over converging and probably had accomodation problems! Glad to hear everything went well. Good thing your doc figured it out in a real eye exam. Difficult by mail. Glad everything else is well.

 

[KHE]

I do not agree that your problem is caused by "over focusing."

That is a common problem but is almost always seen at the end of the day after you have spent the day on a computer or doing near vision tasks. It is almost never seen in the morning and it isn't something that normally clears up after 2 to 10 minutes.

The most common cause of blurred vision in the morning is corneal swelling in contact lens patients, corneal dystrophies, and dryness that results from sleeping with your eye slightly open.

That axis shift is almost certainly not the cause of your problem, and filling that prescription will almost certainly not remedy it.

I would seek a second opinion.

 

[pharmaz88]

Hello, Remember me? I told you you were over converging and probably had accomodation problems! Glad to hear everything went well. Good thing your doc figured it out in a real eye exam. Difficult by mail. Glad everything else is well.

Hey there. Thanks for the well-wishes. ...but now KHE's post is making me wonder.

 

[pharmaz88]

I do not agree that your problem is caused by "over focusing."

That is a common problem but is almost always seen at the end of the day after you have spent the day on a computer or doing near vision tasks. It is almost never seen in the morning and it isn't something that normally clears up after 2 to 10 minutes.

The most common cause of blurred vision in the morning is corneal swelling in contact lens patients, corneal dystrophies, and dryness that results from sleeping with your eye slightly open.

That axis shift is almost certainly not the cause of your problem, and filling that prescription will almost certainly not remedy it.

I would seek a second opinion.

Yeah, the OD didn't state that the Rx would fix the problem; just that I didn't really need a change in Rx.

 

[Opii]

Hey there. Thanks for the well-wishes. ...but now KHE's post is making me wonder.

You never mentioned you wear contact lenses, so where did the corneal edema due to CL hypoxia come from?. Corneal Dystrophies ?!?! your OD that saw you in person couldn't miss that, if he didn't mention it, it's because it isn't there, that will be seen when they do a slit lamp exam on you.
For over converging problems, changing the Rx would be useless. For accomodating problems Adds would be an option, but useless for convergence. If he refracted you and found the same Rx, he did the right thing by giving you the same Rx. Your in the -4.00s range so the thickness of the lenses isn't that bad, I was thinking -15's a while back, may give you a BI effect, but your range of myopia is't even high by OD's standards, just moderate. If it's the "over focusing" which is most probably true, then you need a long vacation and stare into the distance sipping iced tea and watching the ships sail by, relax from too much reading which unfortunatly we have to do. Most probably your symptoms will go away during a long break (christmas) or when you are out of school. Reading computers all day is unatural for us, all that converging didn't happen until the last few decades for humans, distance vision was the most popular way of surviving before.
Your axis is on the horizontal range which is most common in people your age range.
Over focusing = Over converging = too much near reading = CVS or Computer Vision Syndrome is used interchangably in this conversation so don't get confused with all that.
You got checked in person and didn't have pigmentary glaucoma or something serious, that's most important.
bye.

 

[Ben Chudner]

You never mentioned you wear contact lenses, so where did the corneal edema due to CL hypoxia come from?. Corneal Dystrophies ?!?! your OD that saw you in person couldn't miss that, if he didn't mention it, it's because it isn't there, that will be seen when they do a slit lamp exam on you.

Actually, corneal dystrophies can be easily missed in their early stages. I have no idea what the OP has since I have never seen his/her eyes, but I agree with Ken that the diagnosis doesn't quite make sense. I would like to see the results from the cycloplegic refraction to see if the OP is actually less myopic than the manifest refraction suggests. This would support the diagnosis, however, I doubt there would be much of a difference. Like Ken said, overfocusing is a problem that typically affects patients in the evening when we are more tired rather than in the morning after we have rested. In the rare case it affected someone in the morning, it would only get worse throughout the day as that person used their eyes, not improve after 10 minutes. I would also seek a second opinion.

 

[Opii]

Actually, corneal dystrophies can be easily missed in their early stages. I have no idea what the OP has since I have never seen his/her eyes, but I agree with Ken that the diagnosis doesn't quite make sense. I would like to see the results from the cycloplegic refraction to see if the OP is actually less myopic than the manifest refraction suggests. This would support the diagnosis, however, I doubt there would be much of a difference. Like Ken said, overfocusing is a problem that typically affects patients in the evening when we are more tired rather than in the morning after we have rested. In the rare case it affected someone in the morning, it would only get worse throughout the day as that person used their eyes, not improve after 10 minutes. I would also seek a second opinion.

I agree a second opinion would ease your mind. You might want them to give you a full exam on your accommodative status. The difference in dialated findings and undialated findings was probably the deciding factor for this doctor you saw. That would rule out a ciliary spasm or pseudomyopia.
Morning blur? Well the doc probably ruled out RCE or Dry eye during the slit lamp exam. A second opinion might clarify.
A corneal dystrophy that blurs in the morning for 10 minutes, never heard of it, unless RCE related which would be accompanied with pain. Do you get pain along with this blur?

 

[drbizzaro]

Hello All,

lenses. He pulled out several, and then had me look at a letter-chart while alternating lenses over my eyes (I had my glasses on), asking if "1" or "2" was better.

After doing this, he !

when he alternated the lenses, did you have trouble focusing on the letters? and was this done with black strips on top of the letters?

the reason why i ask, is because if you had trouble clearing both (-) and (+), then you could have an accomodative facility problem...

 

[pharmaz88]

You never mentioned you wear contact lenses, so where did the corneal edema due to CL hypoxia come from?. Corneal Dystrophies ?!?! your OD that saw you in person couldn't miss that, if he didn't mention it, it's because it isn't there, that will be seen when they do a slit lamp exam on you.

If it's the "over focusing" which is most probably true, then you need a long vacation and stare into the distance sipping iced tea and watching the ships sail by, relax from too much reading which unfortunatly we have to do. Most probably your symptoms will go away during a long break (christmas) or when you are out of school.

Yeah, I only wear glasses. I can't even handle putting in eye-drops, let alone contact lenses.

I do have a 5-week break coming up in Oct/Nov. ...hopefully with the time off there, things will improve. ...just need to stay away from the computer during that time, I suppose.

 

[pharmaz88]

A corneal dystrophy that blurs in the morning for 10 minutes, never heard of it, unless RCE related which would be accompanied with pain. Do you get pain along with this blur?

No pain with the morning blur... some soreness, even when my eyes are closed when I'm in bed at night. ...but nothing acute.

 

[pharmaz88]

when he alternated the lenses, did you have trouble focusing on the letters? and was this done with black strips on top of the letters?

the reason why i ask, is because if you had trouble clearing both (-) and (+), then you could have an accomodative facility problem...

When he did the lens-switching when I was dilated, I was somewhat able to focus on the letters. (at least with certain lenses.) I didn't notice any black strips on the letters. ...are you referring to the letters themselves, or to the 'page' of letters?

 

[Opii]

No pain with the morning blur... some soreness, even when my eyes are closed when I'm in bed at night. ....

If the soreness starts ... "when you're in bed at night"... then it is probably some kind of visual fatigue (a focusing problem).
Sometimes the eye muscles do funny things when they are very tired. It may start as an Accomodative Insufficiency then a Convergence Excess (the tense eye muscles your OD mentioned).... or a Accomodative Facility problem... Accomodative Excess.... this is some of the many scenarios that may happen with "focusing problems." That can happen in unnatural situations such as ours. Optometrists and/or Ophthalmologists that specialize in that, do exercises for it if that's the case... or just taking breaks from near work…
If the Optometrist you saw did a full eye exam with dilation, I would tend to trust those results. Maybe it's disappointing to come out with the same Rx. That's understandable.
If he didn’t charge you it may be interpreted in several ways… He didn’t trust his diagnosis or he was giving a health collegue a “freebee” that happens if the doc is in a good mood.
Since you didn’t get charged you might want to try a second eye doc, just for your peace of mind. Without seeing you in person it is difficult for us to pin point the problem. Good luck.

Who is that guy in your Avatar?

 

[Ben Chudner]

If the soreness starts ... "when you're in bed at night"... then it is probably some kind of visual fatigue (a focusing problem).

I would agree that if the soreness starts in the evening, then it could be visual fatigue, but then it should be resolved by the morning unless the OP is looking at a computer monitor is his/her sleep. Again, without seeing the patient it is impossible to diagnose, but things are not making complete sense. I had a patient with early Fuch's dystrophy that would wake up with mild corneal edema in the morning that would resolve within an hour or so. Think of it this way - when some Night & Day patients wake up they have a minor blurred vision that lasts for about 10 minutes. This is due to corneal swelling secondary to decreased oxygen at night in a healthy eye and it resolves fairly quickly. Now take a patient with guttata. Because these patients have less endothelial cells, the pump function of the corneal does not work as efficiently. In the early stages, it is possible that an eyes closed situation for an extended period of time (sleep) could cause just enough hypoxia that a compromised corneal could swell a little bit. Thus resulting in blurred vision in the morning that resolves fairly quickly once the oxygen level is restored.

I have no idea if this is what is going on, but the symptoms that the OP are reporting just don't make sense. It can be difficult to see guttata unless you are looking for it in the earliest stages of Fuch's. If you want to try an experiment try some Muro 128 ointment at bedtime. It's available over the counter, and I imagine fairly inexpensive. If it works, then you have your answer, if not try OPII's suggestions.

 

[drmhyde]

Hello All,

He pulled out several, and then had me look at a letter-chart while alternating lenses over my eyes (I had my glasses on), asking if "1" or "2" was better.

After doing this, he said that he wasn't going to change my Rx after all, and that the results of him doing this with my eyes dilated told him that my eyes have been "over-focusing" as he put it. He made an analogy to bicep muscles being semi-tensed all the time, and never relaxing. (I do spend a lot of time in front of a computer monitor.) He then re-wrote my Rx, with pretty much the same sphere and cylinder as I had 6 years ago, but with different values for axis.

Just wondering why he did accomadative facility testing while dilated?? That was stupid..
As for your over focusing...a cycloplegic exam could tell him that or a simple NRA/PRA (undilated of coarse). hmmm

 

[pharmaz88]

If the soreness starts ... "when you're in bed at night"... then it is probably some kind of visual fatigue (a focusing problem).
Sometimes the eye muscles do funny things when they are very tired. It may start as an Accomodative Insufficiency then a Convergence Excess (the tense eye muscles your OD mentioned).... or a Accomodative Facility problem... Accomodative Excess.... this is some of the many scenarios that may happen with "focusing problems." That can happen in unnatural situations such as ours. Optometrists and/or Ophthalmologists that specialize in that, do exercises for it if that's the case... or just taking breaks from near work…
If the Optometrist you saw did a full eye exam with dilation, I would tend to trust those results. Maybe it's disappointing to come out with the same Rx. That's understandable.
If he didn’t charge you it may be interpreted in several ways… He didn’t trust his diagnosis or he was giving a health collegue a “freebee” that happens if the doc is in a good mood.
Since you didn’t get charged you might want to try a second eye doc, just for your peace of mind. Without seeing you in person it is difficult for us to pin point the problem. Good luck.

Who is that guy in your Avatar?

Thanks for all the feedback you've given on this and the previous thread! ...still trying to fully understand it all. ...I'm not sure where you got the 'freebie' thing from. ...maybe when I said he wasn't going to 'change' me, you read 'charge'?

Oh, and the guy in my avatar would only be familiar to someone who had grown up in Arizona. ...he's the beloved Ladmo, from the Wallace and Ladmo Show. It was a children's morning tv show from the '54 to the '89 here... the longest continuously running show in US history, as a matter of fact.

 

[pharmaz88]

I would agree that if the soreness starts in the evening, then it could be visual fatigue, but then it should be resolved by the morning unless the OP is looking at a computer monitor is his/her sleep. Again, without seeing the patient it is impossible to diagnose, but things are not making complete sense. I had a patient with early Fuch's dystrophy that would wake up with mild corneal edema in the morning that would resolve within an hour or so. Think of it this way - when some Night & Day patients wake up they have a minor blurred vision that lasts for about 10 minutes. This is due to corneal swelling secondary to decreased oxygen at night in a healthy eye and it resolves fairly quickly. Now take a patient with guttata. Because these patients have less endothelial cells, the pump function of the corneal does not work as efficiently. In the early stages, it is possible that an eyes closed situation for an extended period of time (sleep) could cause just enough hypoxia that a compromised corneal could swell a little bit. Thus resulting in blurred vision in the morning that resolves fairly quickly once the oxygen level is restored.

I have no idea if this is what is going on, but the symptoms that the OP are reporting just don't make sense. It can be difficult to see guttata unless you are looking for it in the earliest stages of Fuch's. If you want to try an experiment try some Muro 128 ointment at bedtime. It's available over the counter, and I imagine fairly inexpensive. If it works, then you have your answer, if not try OPII's suggestions.

Thanks for the feedback and the suggestion. ...have to work up the courage to do the eye ointment thing. ...I can handle blood, needles, and just about anything EXCEPT touching or putting stuff in my eyes. Major phobia, for some reason.