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Hyperopia and Presbyopia Progression

For and about anyone having difficulty seeing near/reading.

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Soundmanpt 24 Sep 2017, 10:59

I went back and reread Carrie's post from Sept 18th. Carrie said that when the doctor checked Danielle's eyes she put in stronger lenses and Danielle said that there wasn't much difference when looking at the closeup eye chart. But the smaller letters were slightly clearer with the stronger lenses. But her distance vision was a bit blurred with those lenses.

This is the reason they are suggesting that she should consider either getting 2 pairs of glasses, one for when she is at work doing close up things and the other pairs away from work for driving, watching TV or shopping. The other option is progressives or bifocals. Danielle's eyes are most likely fine with her current glasses for seeing things at a distance. Her problem is due to the type of work she does which is taking a toll on her eyes. So clearly needs a small increase now for her close up work, but no increase for distance. By putting her in bifocals or progressives they can leave her wearing the same prescription for distance and increase her close vision with the add. Now a 3rd option is to simply let her continue wearing single vision glasses and give her the necessary increase. At first, just like when she has gotten other increases, her distance vision will be slightly blurry but she is still young enough that her eyes would likely adjust after she wore them a while, But doing this will only make her even more dependent on her glasses than she is now. They know she doesn't want to wear glasses full time so they are trying to give her options so her distance vision doesn't get any worse. I'm sure the idea of wearing bifocals / progressives doesn't sound right since she isn't old enough to be needing bifocals, but this will really keep her distance vision from getting any worse. Because of the type of work she does her close vision could continue to change for a while yet.Yes the reading add in progressives is pretty small but she is young and I don't think she would have much trouble getting used to using progressives rather quickly.


Obsessed 24 Sep 2017, 06:51

@Aging Max:

OMG you and Manny together in glasses: that's gotta be such a delight! :-) Hot!


Weirdeyes 23 Sep 2017, 21:27

Miku

My right eye is +1.00 -0.75 and my left eye is +4.25 -1.50. Without my glasses I can see okay. I just struggle a lot with the computer and fail all depth perception tests. I prefer to wear my glasses fulltime because I'll get headaches and even weirder vision if I don't. Some people with my prescription claim to be blind without their glasses. I don't really understand that.


Lou 23 Sep 2017, 15:41

Sorry, for the double post. I was sure I hadn't clicked submit twice. Weird!


Lou 23 Sep 2017, 15:39

Hi Miku

I'll give you a bit of history and try to be brief. I noticed that my close up vision wasn't right around 7 years old. Text seemed to move around on the page, and I couldn't see particularly close. I was however a good reader, school eye tests didn't bring up anything, and my mum and dad never took me to the opticians.

When I was at college, I had a fair bit of eye strain, the same issue of text moving around, and found reading small parts of sheet music difficult (I'm a musician). Went for an eye test. Optician was from overseas and didn't speak very good English, and basically scared me by saying that my eye tracking was so poor, he was surprised I could read at all, and that he wanted to refer me to an eye specialist. He also said that my eyesight was borderline. I just wanted to get out of the opticians, so lied and said that I could read fine.

I struggled on until 2010, when aged 36, I was finding that I could no longer fuse images well enough to read with both eyes together.

I was diagnosed with convergence insufficiency and referred to an Orthoptist for eye exercises, who also referred me to an eye tracking specialist. I had had a couple of appointments with the eye tracking specialist when I had to postpone owing to my previous marriage failing. When I telephoned to re-appoint, funding had been withdrawn for people over 14, so I never got as far as a diagnosis. The conclusion so far was that I had eye tracking issues usually associated with dyslexia but showed no signs of dyslexia. Probably owing to years of sight reading music, the specialist found that my eye tracking issues only affect me three dimensionally and cause me no issues with reading. It is not that bad, I drive a car, but I am terrible at ball sports, just cannot seem to line up the bat and ball.

Anyway, I started wearing glasses for mild long-sighted astigmatism at the time I was diagnosed with convergence insufficiency, originally with prism, which I no longer have after eye exercises. I haven't done eye exercises for years, and my convergence isn't great, but good enough that I can manage without prism.

I don't generally read without glasses as I wear them full-time, but I can read without glasses. I can't read particularly close up probably owing to my convergence insufficiency, the focus isn't overly great and I get eye strain, but I can read ok.

Probably because I don't think that I've ever had great close up vision, it doesn't bother me particularly that my close up vision isn't overly sharp, whereas I cannot stand my intermediate or distance vision being even slightly blurred, hence why I wear a very small distance prescription full-time, and get very bad eye strain without glasses. I was very surprised by the difference in reading the near chart when the optician added an extra +0.25, but have decided to stick to my distance prescription for now.

Sorry this is rather wordy, but hopefully it answered what you asked.

Take care

Lou


Lou 23 Sep 2017, 15:39

Hi Miku

I'll give you a bit of history and try to be brief. I noticed that my close up vision wasn't right around 7 years old. Text seemed to move around on the page, and I couldn't see particularly close. I was however a good reader, school eye tests didn't bring up anything, and my mum and dad never took me to the opticians.

When I was at college, I had a fair bit of eye strain, the same issue of text moving around, and found reading small parts of sheet music difficult (I'm a musician). Went for an eye test. Optician was from overseas and didn't speak very good English, and basically scared me by saying that my eye tracking was so poor, he was surprised I could read at all, and that he wanted to refer me to an eye specialist. He also said that my eyesight was borderline. I just wanted to get out of the opticians, so lied and said that I could read fine.

I struggled on until 2010, when aged 36, I was finding that I could no longer fuse images well enough to read with both eyes together.

I was diagnosed with convergence insufficiency and referred to an Orthoptist for eye exercises, who also referred me to an eye tracking specialist. I had had a couple of appointments with the eye tracking specialist when I had to postpone owing to my previous marriage failing. When I telephoned to re-appoint, funding had been withdrawn for people over 14, so I never got as far as a diagnosis. The conclusion so far was that I had eye tracking issues usually associated with dyslexia but showed no signs of dyslexia. Probably owing to years of sight reading music, the specialist found that my eye tracking issues only affect me three dimensionally and cause me no issues with reading. It is not that bad, I drive a car, but I am terrible at ball sports, just cannot seem to line up the bat and ball.

Anyway, I started wearing glasses for mild long-sighted astigmatism at the time I was diagnosed with convergence insufficiency, originally with prism, which I no longer have after eye exercises. I haven't done eye exercises for years, and my convergence isn't great, but good enough that I can manage without prism.

I don't generally read without glasses as I wear them full-time, but I can read without glasses. I can't read particularly close up probably owing to my convergence insufficiency, the focus isn't overly great and I get eye strain, but I can read ok.

Probably because I don't think that I've ever had great close up vision, it doesn't bother me particularly that my close up vision isn't overly sharp, whereas I cannot stand my intermediate or distance vision being even slightly blurred, hence why I wear a very small distance prescription full-time, and get very bad eye strain without glasses. I was very surprised by the difference in reading the near chart when the optician added an extra +0.25, but have decided to stick to my distance prescription for now.

Sorry this is rather wordy, but hopefully it answered what you asked.

Take care

Lou


Miku 23 Sep 2017, 13:27

Lou and Carrie,

I hope you don't mind my intrusion in this conversation. I have been reading Carrie's input for a while now, so my question is for Lou, as I am a low hyperope myself. Since you don't need a reading add yet, may I ask how easy it is for you to read close uo without any glasses at all (if you ever do that)? Also, when did you start needing or wearing correction (sometimes the two do not coincide?

Thanks,

M


Lou 23 Sep 2017, 03:23

Sorry last post was from me. Forgot to input my ES Nickname.


 23 Sep 2017, 03:22

Hi Carrie

Thanks very much for your reply. I'm based in East Anglia.

I understand regarding Danielle not knowing what power lenses the optician tried on her.

I'm not surprised that she doesn't want bifocals or separate glasses for work, whilst she is still in her 30s, especially when she is finding that she can read just fine with her current prescription. You say that she was shocked to find out how much better her distance vision is with glasses. I have a feeling that rather than needing a stronger prescription for work that her eye strain was merely an indication that she is now needing to wear her glasses full-time. My prescription is tiny, but my very small amount of astigmatism was causing me eye strain without glasses, which went when I started wearing them full-time.

Regarding no-line bifocals, are you referring to progressives (varifocals) rather than blended bifocals?

I'm still wearing single vision glasses at 43, but my husband who is 59, wears varifocals. He did initially find the narrower field of intermediate vision annoying, and now has a separate pair of glasses for the computer.

If she does actually need a bit more plus for distance, as you say, that would help for close up too, without blurring her distance vision.

Having a chat with her tomorrow sounds a great idea. Regarding you having a change of prescription around aged 40, I coming up 44 and still hanging on in regards to needing a reading add, so hopefully you'll be the same.

Take care

Lou


Carrie 22 Sep 2017, 10:21

Lou - I am in eastern England.

I don't know what power lenses the optician tried on Danielle and I don't suppose Danielle knows either. Maybe she was tried with +0.75 or +1.00 and the optician told her it was only slightly stronger either to not alarm Danielle or that in the optician's opinion that is only slightly stronger.

She desperately doesn't want bifocals while she's still in her 30s. She doesn't really want separate glasses for work either. It dawned on her that she would need 2 different pairs of work glasses if she wanted to wear contacts sometimes. She would need a weaker prescription to wear over her contacts and the full stronger prescription to wear instead of her main glasses. She says she can read just fine with her current prescription. I think she was shocked to find out how much better her distance vision is with glasses.

I meant to tell Danielle about no-line bifocals as she might not be aware of them and just imagines the lined type. If/when she does need bifocals she might be happier with the no-line type.

Personally I think she would find it more comfortable to wear separate single vision glasses as that would give her a larger field of view than bifocals especially if she is looking at computer screens. She could keep her work glasses at work so she doesn't need to carry them around all the time.

As you say, she might actually need a bit more plus for distances and that would help for close up too.

My distance vision without glasses is worse now than a few years ago, it's not terrible. Danielle can see distances without glasses better than me.

I'll have a chat to her tomorrow to help her get her head around all the future possible options for glasses and contacts. I don't want to sound too knowledgeable but then I have worn glasses longer than her with a stronger prescription too. I'll pretend I've been doing research for her and me, as I will also almost certainly need a change of prescription once I get to my late 30s - early 40s


gerry 22 Sep 2017, 05:25

Julia where have you gone, i was enjoying our contact you seemed a really nice lady, you are very attractive wrote lovely mails, loved your high magnification glasses, they did not distract from your attractiveness, in fact the type of frames you choose wherever fashionable. If you have lost my email address here it is arnoldmartinjock@hotmail.com. I would love to be in touch with other eye scene fans. Take care all


Lou 22 Sep 2017, 04:45

Hi Carrie

I'm not sure where you are based, but I am a little confused regarding the advice given to Danielle. You say that the optician suggested that he could give her a slightly stronger prescription for work, but that if this continued to blur her distance vision, she would need bifocals or separate glasses. What doesn't make sense to me, is that at least in my part of the world, bifocals are not available with an add less than +0.75. This seems more than a slightly stronger prescription to me. Since Danielle said that she could notice only a small difference with tiny letters at near with the stronger prescription, wouldn't +0.50 or even +0.25 be sufficient to reduce eye strain at near but be less likely to blur her distance vision?

Additionally not to think that I know more than a qualified optician (which obviously I do not, nowhere near in fact), regarding prescribing slightly more plus than required for distance to reduce eye strain at near, or prescribing reading additions for younger people who are long sighted, I would have thought that the extra plus would lead to an unnecessary deconditioning of the ciliary muscles, and that it would be more prudent to prescribe the amount needed to adequately correct distance vision, no less and no more. Although the optician said that Danielle doesn't need to change her distance glasses, is it possible that she objectively needs a slightly stronger distance prescription although she is reading the distance chart fine with her existing distance prescription, that would reduce eyestrain at near and prevent the need for a reading add until she is in her 40s?

Best wishes

Lou


Soundmanpt 21 Sep 2017, 14:25

Plus Tony

The reason your friend keeps her glasses on when sleeping is because without her glasses all her dreams would be blurry. So with her glasses her dreams will all be nice and clear.

Seriously no matter style of glasses she wears I can't imagine lying on them can't feel very comfortable. Without any doubt she has been very lucky she hasn't woke up to broken glasses. I'm sure it's going to happen at some point. Good thig she has a backup pair.


Plus Tony 21 Sep 2017, 10:00

Carrie

Danielle's comment about getting her money's worth out of her glasses reminded me of a friend who likes wearing her specs so much that she regularly falls asleep wearing them. It is a miracle that they are still in one piece but she certainly gets her money's worth too! Fortunately she has a spare pair in case anything ever does go wrong.


Cactus Jack 20 Sep 2017, 22:02

Charlie_Delta,

A solution you might want to consider is Mono-Vision with contacts.

The way that works is that you wear a contact lens on one eye for distance and a contact lens on the other eye for reading or the distance to you computer display.

It takes a little getting used to, but your brain will select the sharpest image for what ever you are doing and use that image as it s primary source of visual information and supplement that with whatever information it can gather from the other image.

I opted for Mono-vision when I had cataract surgery and it works fine for me. I can function without glasses, but I wear glasses for precision work where I need the best vision. I also have some single vision reading glasses that I wear when I have a lot of reading to do.

Just some ideas to consider. Might be better than the multi-focal contacts.

C.


Charlie_Delta 20 Sep 2017, 15:26

SC,

Many thanks for responding. I think you’ve hit the nail on the head in terms of cause/effect. Since I posted this, a cheap pair of progressive glasses arrived from Zenni, filled with my most-recent Rx (written about two months ago). As was the case about four months ago, my vision at distance is clearer in the intermediate zone. This came as a surprise. Indeed it validates your theory on what's going on.

This situation is different however form the symptom I inquired about previously; intermittent defocus at distance. In those cases, the blur I experience at distance is much more significant. I looked into this online and believe these particular events are “spasms of accommodation.” They're probably quite common occurrences amidst the emergence of presbyopia. I’ve experienced these events both when focusing from near to far as well as vise versa. Happened most recently this past weekend after a four-hour workout on my road bike with single vision glasses for distant. After the workout, I wasn’t able to see my phone or dashboard. I do believe that available electrolytes/vitamins/minerals, diet, sleep, hydration, blood sugar etc. play a role in our eyes’ ability to accommodate, but so does presbyopia of course.

I’ve avoided spending substantial money on top-of-the line fames and progressive lenses, I think smartly, due to this ongoing emergence of latent hyperopia. At work (currently a military school), I just wear multifocal contacts. They're a poor compromise to optimal vision but seem to get the job done for seeing up close. Distant vision through them is unacceptably poor with a medium add (Air Optix Aqua MF). I’m a stickler on good optics but think I’ll stick with this routine until the prescription stabilizes. Hopefully that's soon. Cheers


Carrie 19 Sep 2017, 10:51

Soundmanpt - I'm sure Danielle wouldn't have done any driving without glasses. Vicky would have driven if necessary.

I sure Danielle will take the optician's advice and take more eye breaks at work. She admitted that she often spent hours looking at her screen at work without looking away. She also said that one advantage her glasses have, apart from helping her to focus, is that everything is slightly magnified which is very useful for fine detail.

She was glad she didn't need new glasses. She was also glad to find out that her eyes are healthy and there was no health reasons for aching eyes, just eyestrain.

She is in her early 30s so probably doesn't have much or any accommodation which would explain her getting more and more reliant on her glasses. Maybe presbyopia is beginning to creep in.

She joked that she is getting her money's worth out of her glasses by wearing them all the time.


Soundmanpt 18 Sep 2017, 17:54

Carrie

I'm sure Danielle and Vickie both probably was ready for a much needed rest from work. I don't think Vickie's job put all that much strain on her eyes. Plus i'm sure she is probably looking up quite bit as well so her eyes aren't constantly only looking at small print for long hours. All the changing from looking at something close up to something at a distance is really very healthy for her eyes. Doing that her eyes are always changing focus distance. Danielle is likely often looking at very detailed things most of the day. The optician gave her very good advice. The best thing she can aside from quitting her job is to make a point every 30 minutes or so to look away at something at a rather long distance and try and focus her eyes on that for a few minutes. The main thing is so her eyes are changing focus. Also it has been proven when your eyes get "transfixed" at staring at close distance for long periods of time you also tend to not blink as often as you should this is important because that is what moistens the eyes and keeps them from feeling dry. Doing all this will help but in the end she is still going to need to be wearing her glasses full time. She should be at least happy that her eyes haven't changed enough yet that she needs her glasses changed. Actually ever since she really started wearing her glasses full time she seems to need her glasses a good bit more for distance now than she used, but that is to be expected. I hope doing the breaks will help enough so she won't need stronger glasses for work. Even though she didn't notice much difference with seeing close up with the stronger lenses in the refractor the added power would be enough to relax her eyes and her eyes most likely because she is still young would adjust to the stronger prescription for distance as well. But you know what that means don't you? Once her eyes adjust to the stronger glasses she will for sure be told she needs to wear her glasses all the time. I know you said before she went on holiday she was hoping to maybe even drive without her glasses while on break. I wonder if she in fact did that on Thursday or Friday since she was bragging about not putting her glasses on until around mid day on those days? She really isn't happy about having to wear her glasses for driving. She made that clear by asking if he might one day be able to only need her glasses for reading. If she was told that she MUST wear her glasses for driving it was because without her glasses her vision is 20/40 or even worse. The only way she might have avoided needing to wear glasses for distance was pretty much back when she first started wearing glasses. if she had gotten bifocals then she might not need her glasses for distance now. By wearing glasses as much as she was and even more now her eyes adjusted to seeing distance with her glasses. But had she got bifocals with clear (no prescription) in the top segment (the distance part) there would have been no prescription for her eyes to adjust to for distance. Only her reading add. When she has gotten new glasses it wasn't because she needed stronger lenses to see things at a distance. She needed them stronger to see small print. Her eyes have only continued to adjust to her glasses. But the opticians are thinking her eyes maybe reaching a point where they won't be able to adjust anymore.


Carrie 18 Sep 2017, 12:16

My friends Danielle and Vicky came back from their holiday on Friday evening. We met up with them on Saturday in town. Danielle had an opticians appointment as she wanted to check there wasn't anything else affecting her eyesight. She said her eyes do feel less tired after the holiday and on Thursday and Friday she managed to get to about half way through the day before she felt she had to put her glasses on. I don't know what she said to the attractive 30ish woman who greeted her in the opticians shop but to me it was clear she fancied Danielle. (I don't know how Danielle does it - gay/bi women almost fall at her feet!) After Danielle's eye test she told us what she was told. Her prescription doesn't need to be changed just yet but would probably be better off wearing her glasses or contacts most of the time for now. She needs to take more short breaks at work for her eyes by just looking at a distant object or out of a window for a couple of minutes. If she still gets tired eyes at work even with regular eye breaks he will give her a slightly stronger prescription to use at work. During the lens flipping part of the eye test the optician tried the slightly stronger lenses on Danielle. She said they were fine at normal reading distance but couldn't notice much difference compared to her glasses, perhaps slightly clearer for the smallest letters on the close up eye chart. The stronger lenses made the distance eye chart a bit blurry. The optician told her that if he did give her the stronger prescription at her next eye test she would need bifocals or separate glasses if she still couldn't see the distance eye chart properly with the stronger prescription. Her distance vision with glasses is fine but without glasses it's below the legal minimum for driving. Trying to read without glasses should be avoided. She said she asked the optician if she would eventually be able to go back to only needing glasses for just reading instead of all the time. The optician told her that although it was down to her to judge when she needed to wear her glasses at the very least she must wear them for driving. As she gets older her distance vision might not get worse but probably won't get get much or any better. Her close up vision is likely to get worse. Bifocals or separate reading glasses are fairly likely within the next 10 years even if she doesn't require them at her next eye test.

She wasn't exactly pleased to hear she she should wear her glasses full time but hopes that this combined with resting her eyes more at work might mean she can eventually go back to just wearing them for reading and driving. She's determined that she won't need bifocals or reading glasses for a few more years - at least until she's in her 40s.

She is going to wear her glasses or contacts full time but will try going without either until her eyes start to feel strained once a week.


SC 18 Sep 2017, 09:14

Charlie_Delta

I recognise many of the issues you are describing.

Distance fuzzy after close work

This seems to be that your overall reading correction is insufficient such that you are putting your eyes under too much strain. I had and still have this - a key indicator that I need to get an eye test. It is almost that your eyes are straining to add so much plus and they can't relax. It isn't a couple of minutes - I have had it last an hour easily where there is nothing I can do to get distance focus. I can confirm that if you increase the reading correction this problem seems to go away. Most likely given your age, it is the distance that needs to increase rather than the add - it was the same for me - they key thing is that the Rx for reading is higher

Rapid changes in prescription

Yes - but I've really only had this with progressives. When I first starting wearing for hours each day it took only 4-6 weeks to find myself looking through the intermediate part for distance. The result was that I went from:

-0.25 Add 1.5

to 0.00 Add 1.5 in 18 months

and to +0.75 Add 1.75 in 4 months

So for me, a trip to the optician is mostly a problem with distance following close-up work which results in the distance Rx going up so that the Reading Rx goes up and this fixes the problem.

I'm now +1.75 Add 2.25 - I still have the problem which tells me that I'll probably need higher - just that it isn't a big enough problem to justify the expense


Lou 18 Sep 2017, 05:40

Hi Weirdeyes

I'm not sure why autorefraction showed you at one point needing +2.25 in your right eye, or how accurate autorefraction typically is. I haven't looked into an autorefractor for years, presumably because they have my current prescripton as a starting point. My optician used retinoscopy to objectively determine my prescription, and it agreed with my subjective preferences.

I can understand why you wouldn't want your right eye to become nearsighted since you already have a big difference between you eyes and a reasonable plus prescription in your left, but if it is the appearance of your eyes through glasses which you are concerned about, I wouldn't have thought that a small minus prescription would look particularly different to a small plus prescription, and I think that you would be unlikely to develop a significant minus prescription in your right eye, which would be sufficient for most people to notice that your prescription for that eye was minus. Hopefully your eyes will stabilise soon, or at least any change will be in the same direction for both eyes.

Take care

Lou


Weirdeyes 18 Sep 2017, 03:00

Lou

My autorefraction results at one point said I needed +2.25 in my right eye. Maybe the prescription just naturally reduced. At this point I think my right eye is +1.00. It also seems like my astigmatism axis is changing. My old glasses don't seem to have the best close up vision either even though they have more plus. My left eye seems to fluctuate, but not as much. Sometimes it looks like my left eye needs +4.75, but most of the time it's +4.25. I'm due for an eye test soon. Even though Cactus Jack told me not to worry, I'm still worried my right eye might go nearsighted. At one point my prescription in my right eye was plano with -0.50 cyl. So it was kind of nearsighted.


Lou 18 Sep 2017, 01:52

Hi Weirdeyes

Re.

Lou

I think with my convergence insufficiency my eyes have a tendency to converge to compensate. That makes my eyes want less plus than I need and causes my fluctuating vision. I think my right eye is maybe +1.75 or +1.50, but it ends up preferring +1.00.

If you you (and anyone else reading), doesn't mind a bit of a my eye history, I'm wondering whether my experience may be of any help to you.

I wasn't diagnosed with Convergence Insufficiency until aged 35, but am pretty sure that I had it as a child. It is difficult to know for certain, as I was diagnosed with an eye tracking disorder at aged 20, which I was in the middle of being assessed for again at aged 35, when I had to cancel my appointments owing to my marriage failing, and when I went to resume, funding had been withdrawn for those over the age of 14. All I found out, was that I have eye tracking consistent with dyslexia, but that I am not dyslexic.

Anyway, as a child, although a good reader, I never thought that text looked particularly clear, I could never read particularly close, I used to lose my place a lot, and text used to swing to the right and back again. My parents never took me to an optician, as they themselves didn't wear glasses at that time, and I never said anything. Basic school screening did not find anything.

When I was at college aged 20, I decided to have my eyes tested, as I was finding reading uncomfortable. I found the experience quite stressful as I couldn't understand the optician, who was from overseas and didn't seem to speak English very well. He said that my eyesight was borderline, that my eye tracking was very poor, and that he was surprised I could read at all. He wanted to refer me to an eye specialist. I was scared by what he was saying, didn't feel able to ask for clarification and just wanted to get out of there, so said that I could see fine.

I started orchestral trumpet playing after college, and found that I struggled with small parts and notes close together, especially when there was more than one line of music on the same stave. I also had difficulties with reading long lines of numbers, such as in bar codes, specifically in knowing how many there were of a number such as 0, if several appeared consecutively, as my eyes would swing right and back again as I tried to read the numbers.

With music, I would suddenly come to something I couldn't make out at speed, my eyes would swing to the right, then come back again. By that time I would have lost my place. Sometimes I would pan out completely and find myself looking at the whole page.

I put up with this until at age 35, I found that I just couldn't fuse the images with both eyes together, and was having to use one eye. I finally found the courage to visit an optician.

My first prescription was R and L +0.25 Sph -0.25 Cyl with 0.25 Add and 2.5 Base In prism.

I couldn't get used to the prism, so it was reduced to 1.25 Base In Prism, and I was referred to an Orthoptist. I still couldn't get used to the prism and never wore my glasses, but my optician would not reduce it further. I admit that I then did a naughty. I photocopied my prescription which was simply on white paper, tippexed out the prism, and took it to a different optician.

These glasses seemed ok but not righ,t and I wanted to try a pair without the +0.25 add. I was also getting eye strain at the end of the day, and wondered whether my distance prescription would help. I had my distance prescription made up and found it better or all distances, than my glasses with a +0.25 add.

When I next had my eyes tested (2012), the optician gave me:

R: +0.50 Sph -0.50 Cyl 90

L: +0.25 Sph -0.25 Cyl 80

This prescription was very good, but I did notice the fluctuations in my distance vision, which I mentioned previously.

I was totally happy with this prescription, but it was changed at my 2014 eye test to:

R: +0.75 Sph -0.75 Cyl 95

L: +0.50 Sph -0.50 Cyl 80

I wasn't happy and this prescription seemed wrong. Whereas circles seem slightly wider than high without glasses, and perfectly round with my old prescription, they seemed taller than wide with this new prescription, and this just did not change.

I went back for a re-test and they found the same prescription. It still seemed wrong.

I went back again, the optician felt that it was right, but that his opinion (I know consider it to be wrong) was that my eyes were corrected so well that there was nothing left to correct, and since my eyes were not having to work to correct my vision, they were also not working to correct my convergence sufficiency. He said that there were two choices, to go back to my 2012 prescription, or as he recommended owing to me being 40 at the time, to keep to my new prescription and add +0.50 base in prism to my right lens, as my right eye was the one drifting out.

Since I wore the same prescription for driving, I found that since the prism was effectively replicating my right eye turning in, that it tended to trick me into focusing up close on rain spots on the windscreen. I still also felt that my right eye prescription was too strong for distance.

I went for another test, and my prescription was reduced to the following, and the prism removed:

R:+0.50 Sph -0.50 Cyl 92

L:+0.50 Sph -0.50 Cyl 83

A few months later, I felt that my left eye prescription was too strong. I went back to the optician, and they thought it was fine. I didn't agree, and felt that it was giving me poor vision on my left hand side when driving at night.

After getting out my 2012 glasses (prescription as higher up) and finding them a lot better, I went back again last February and saw a really good optician (one of the directors).

She agreed that my 2012 prescription was better for me. I asked her if I was now under prescribed and was simply happier this way, but she said no, and that her objective refraction had found the same. She said that she felt that previous opticians had been bumping up my plus, despite me keep returning saying that I was unhappy with my prescription, and has put a note on my file saying that this is not to be done with me.

I didn't ask her why they would bump up the plus. Maybe it is owing to my age, that I have convergence insufficiency and this is a prescribing guideline for people with convergence insufficiency, or maybe the optician wasn't choosing to bump up my plus, but I was subjectively choosing more plus during the test, which the optician then prescribed, since they were going along with my choices. If the last suggestion, maybe she has put a note on my file along the lines of requesting that future opticians go with the objective refraction even if I subjectively prefer more plus.

Whatever, the return to my 2012 prescription worked and my inconsistent distance vision later in the day, which I had also noticed back in 2012, has finally gone after three months of wearing my glasses full-time.

This very long rant, is my way of saying that I am wondering whether convergence insufficiency is not causing you to prefer more minus, hence why your plus prescription is decreasing, rather that it may have been previously bumping up the plus, and this lower plus prescription is more accurate.

I am pretty sure since I was happy with my prescription in 2012, only happy once I had returned to my 2012 prescription in 2017, and was unhappy with all interim prescriptions, finding circles taller than wide which never went away, that my prescription had really been stable since 2012, and the interim increases were not right.

I really hope that this will help someone now my five year difficulty in getting the right prescription appears to be finally over

Best wishes

Lou


Weirdeyes 17 Sep 2017, 17:24

Lou

I think with my convergence insufficiency my eyes have a tendency to converge to compensate. That makes my eyes want less plus than I need and causes my fluctuating vision. I think my right eye is maybe +1.75 or +1.50, but it ends up preferring +1.00.


Lou 17 Sep 2017, 16:12

Hi again

I've been giving this some thought, to see if I can be of any help to people experiencing fluctuating distance vision.

Fluctuating distance vision was driving me crazy too, and was really starting to get me down. I just couldn't understand why I was intermittently experiencing it in the evenings, and only knew that it occurred far less often when I had been wearing my glasses all day.

I am British and asked about this via the Ask the Optician section of the Specsavers website.

The Optician advised that for many people, the refraction of the eye alters very slightly during the day, owing to factors such as tiredness, light level (which causes the pupil size to alter) and the eye very slightly changing shape as the day progresses. He said that you could find a very slight change in prescription between an eye test in the morning and one later in the day.

I decided to book an appointment for a re-test as late as possible in the day. My prescription was identical to my eye test four months previously, and my optician advised that when she did an objective refraction like she would with somebody unable to communicate, that she would prescribe exactly the same as I had chosen during the subjective part of the exam.

She said that I am very visually sensitive, and always chose exactly the same lens for each eye, however many she tried, and that the severe eye strain I suffer from without glasses is owing to my natural vision being like a lens I like less during the test, whereas my vision with my glasses is with the lens I most like. She demonstrated it by lifting her own glasses up and down, and describing it as a lens I like versus a lens I don't, and said that I will always suffer eye strain even though my uncorrected vision is 6/6 (compared to 6/5 + 1 with glasses), because I am noticing the difference and trying to correct for it.

She suggested full-time wear and advised that she had also told me that four months earlier at my last test. I honestly don't remember her saying that. She also advised putting my glasses on the minute I wake and wearing them through to when I go to bed.

Hating the eye strain, which was resulting in my convergence insufficiency starting again, and hoping that wearing glasses full-time would stop my inconsistent distance vision later in the day, as it already happened less often when I had worn my glasses all day, I followed her advice.

My eye strain disappeared almost immediately, and although my inconsistent distance vision had almost disappeared by the end of the first week, only now almost three months later, have I had absolutely no signs of it for over a week. It seems to have taken an absolute age to disappear!

I am convinced that out of the factors suggested by the Optician via the Ask the Optician service, that tiredness was the cause in my case, and that preventing my eyes from getting so tired is what is stopping inconsistent distance vision from occurring later in the day.

Rather than convergence insufficiency causing this, I'm wondering whether convergence insufficiency simply causes the eyes to be more tired, and that it is then the tiredness rather than the convergence insufficiency which results in the inconsistent distance vision. I really don't know, only that in my case, inconsistently wearing glasses was causing inconsistent distance vision later in the day.

Hopefully this long rant will help someone.

Best wishes

Lou


Cactus Jack 17 Sep 2017, 13:04

Charlie_Delta,

The good news is that it won't take 15 years for your vision to stabilize. Less than 2 is more likely. Remember, suggested intervals is just that, suggestions. You get to look at your vision problems every waking hour. YOU are the best judge of when you need to see your ECP, the calendar has almost nothing to do with it.

Remember, you can order quality glasses, in most prescriptions, inexpensively, online. Let us know if we can help.

C.


Lou 17 Sep 2017, 12:59

Hi Weirdeyes

Re:

Lou

I wear glasses full time, but I still experience fluctuations. I think convergence insufficiency makes my eyes go more minus at times. It's driving me crazy.

I fully understand. Fluctuating vision is really annoying. I have convergence insufficiency too. I did loads of eye exercises to get rid of prism originally (I believe I had 1.5 base in in each eye, reduced from the 2.5 I couldn't get used to), which I hated, as I felt that I was wearing blinkers.

A couple of prescriptions ago, I had 0.5 base in prism in just my right lens, but since I didn't wear my glasses full-time then, I found I had to adjust to it every time I wore my glasses, and I found that I needed it some times and not others. Given a choice at my next eye examination, I chose to get rid of it. My optician suggested starting eye exercises again at my last eye test, as my convergence was pretty poor, but since wearing my glasses full-time and not suffering eye strain, it seems better again. Basically I find that I can compensate for my convergence insufficiency most of the time.

I'm not sure whether eye strain owing to convergence insufficiency causes fluctuating distance vision.

Best wishes

Lou


Lou 17 Sep 2017, 12:59

Hi Weirdeyes

Re:

Lou

I wear glasses full time, but I still experience fluctuations. I think convergence insufficiency makes my eyes go more minus at times. It's driving me crazy.

I fully understand. Fluctuating vision is really annoying. I have convergence insufficiency too. I did loads of eye exercises to get rid of prism originally (I believe I had 1.5 base in in each eye, reduced from the 2.5 I couldn't get used to), which I hated, as I felt that I was wearing blinkers.

A couple of prescriptions ago, I had 0.5 base in prism in just my right lens, but since I didn't wear my glasses full-time then, I found I had to adjust to it every time I wore my glasses, and I found that I needed it some times and not others. Given a choice at my next eye examination, I chose to get rid of it. My optician suggested starting eye exercises again at my last eye test, as my convergence was pretty poor, but since wearing my glasses full-time and not suffering eye strain, it seems better again. Basically I find that I can compensate for my convergence insufficiency most of the time.

I'm not sure whether eye strain owing to convergence insufficiency causes fluctuating distance vision.

Best wishes

Lou


Weirdeyes 17 Sep 2017, 11:54

Lou

I wear glasses full time, but I still experience fluctuations. I think convergence insufficiency makes my eyes go more minus at times. It's driving me crazy.


Lou 17 Sep 2017, 11:16

Hi Charlie-Delta

I know what you mean by fluctuating distance vision. My prescription is tiny (R: +0.50 Sph -0.50 Cyl Axis 92, L: +0.25 Sph -0.25 Cyl Axis 85). I'm an orchestral musician and found that glasses made sight-reading easier. I never however could cope with taking them on and off. Once I had worn them, things looked annoyingly slightly out of focus without them, and I would get eye strain. Since my glasses help with all distances, I used to only wear them on orchestra rehearsal days, and put them on for the first time when I left the house to drive to the rehearsal venue, which is often later in the day.

I went back to see my optician in June, after experiencing two annoying things, bad eye strain when not wearing my glasses (my eyes were burning and really aching), and inconsistent vision with my glasses later in the day. If I put them on for the first time in the morning, my distance vision would always be significantly better than without glasses,but if I put them on for the first time later in the day, particularly in the evening, my distance vision would vary between being significantly better with glasses like in the mornings, to little difference, to sometimes even worse than without glasses.

Owing to me being very visually sensitive and also having convergence insufficiency (which after eye exercises I can manage most of the time without prism (which I've worn previously) and an eye tracking disorder, considering the amount of eye strain I was experiencing, my optician recommended wearing my glasses full-time from the minute I wake up.

I've followed her advice and the fluctuations in my distance vision later in the day, have really decreased. It is now only when I am really tired, do I find that my distance vision is slightly better later in the day without glasses.

My understanding is that although I have a plus sphere in negative cylinder notation, that really my entire prescription is for astigmatism, as my prescription is plano sph and +0.50 and +0.25 cylinder respectively in plus cylinder notation. Obviously this however equates to a lens for each eye which varies between plano and plus, and presumably owing to straining all day to try to correct my small amount of astigmatism (which I understand to not actually be possible, because the eye cannot self correct for astigmatism owing to the two points of focus), the result was that I was ending up with too much plus later in the day.

Wearing my glasses all day has had the joint effect of not only preventing eye strain but stopping my glasses from seeming to have too much plus later in the day.

Therefore if you are not already wearing your distance glasses full-time, it may be worth a try to see if this reduces the fluctuation in your distance vision.

Take care

Lou


Charlie_Delta 17 Sep 2017, 10:05

Lou and Cactus Jack,

I’ve succumb to the reality that I’m in the midst of rapidly changing eyes, and therefore; a silver bullet for correction through lenses isn’t achievable until things stabilize more. Basically, two things are going on: a longer-term manifestation of so-called “latent hyperopia,” and a daily fluctuation in distance acuity. My last post/inquiry was motivated by driving for an hour, around dusk on a highway, after being awake and working since 3:00AM. My eyes defocused a lot when looking out into infinity (and when the did that, it’s wasn’t a little bit of defocus but rather a significant amount). My hunch is that everything from sleep to hydration to diet (vitamins/minerals etc.) to exhaustion influence daily fluctuations like this, particularly for an emerging hyperope. It sucks!

One thing is for certain: the myope has it much better presumably, as these sort of daily fluctuations, as I understand it to be, anyway, don’t really happen. Myopic eyes seem to be able to enjoy a pretty “absolute” refraction -- whatever Rx is determined by the ECP (assuming it’s accurate) is a silver bullet for the most part.

I’d be first in line for a laser treatment to do away with the need for glasses/contacts, but common sense tells me I’m be stuck using contacts/glasses until my focus muscles relax and presbyopia has run its course. That could be a while – 15 years maybe. If I eventually go that route, I’d rather be corrected in both eyes to see at near without correction because (a) I do a ton of work up close, and (b) I’m not a fan of the appearance of plus glasses.

In December, I plan to have a properly dilated eye exam at the University of Pennsylvania. They’ve taken photos of my retina for 15+ years due to a harmless/hereditary condition commonly known as “optic nerve cupping.” Could become an issue if the surrounding tissue thins (hence photos every two years). I’m two years overdue for another set of photos and will request a refraction while me eyes are dilated. All that really would tell me is how much latent hyperopia is in there – I don’t think it’d influence my prescription much, because un-dilated, I can’t accept +0.50 more for distance at present. The random defocus issue at distance is intermittent and I probably have to live with this annoyance for the time being. Agree?

Charlie

ps: Cactus, we've chatted on here in the past and I do have an ADD (+1.50). Near Rx is OD +2.50 sph, OS +2.00 -0.25 axis 175 and I generally require that to work on a computer now.


Weirdeyes 16 Sep 2017, 11:17

Cactus Jack

My eyes haven't been dialated in a while. I am pretty close to my true prescription.


Cactus Jack 16 Sep 2017, 07:51

Weirdeyes,

First of all, your eyes are NOT particularly weird. Your two eyes develop independently as a 3 diopter difference is not anything to get excited about. A few years ago, I had a neighbor who had about 5 or 6 diopters difference. His right eye was about -2 to -3 and his left eye was about +3.00. He wore glasses. I did not know him well enough to discuss it in detail.

Are your eye exams, dilated?

C.


Lou 16 Sep 2017, 01:50

Hi Charlie_Delta

When you say:

Things at distance are out of focus (by a lot, it seems) after looking at something up-close w/ single-vision glasses for distance. I can concentrate and bring everything into focus, seemingly without much effort, but the default to blur is happening on increasing regularity now.

If you don't mind me asking for clarification, are you saying that if you look at something close with your distance glasses rather than reading glasses, then look into the distance, everything is initially blurred then clears.

If so, then I would say that rather than latent hyperopia, this is caused by a delay in the eyes switching from close to distance, and is a symptom of Presbyopia.

I'm coming up 44, and have noticed this exact same issue for the last year. I presume that it in my case it is the start of presbyopia. I currently only have distance glasses and my optician said that there isn't really any need yet for a different prescription for reading, although she could give me an extra +0.25.

Since you also have reading glasses, I think that in your case, it is just an indication that you need to switch to your reading glasses for close work.

I hope that this will help.

Lou


Weirdeyes 15 Sep 2017, 17:35

Cactus Jack

Why is the prescription in my right eye dropping while the left eye is more stable? It's getting pretty annoying. I don't want my eyes to get more lopsided. Could this be caused by spending too much time on my iPhone? I also find it challenging to get a well balanced prescription. Could that be causing the annoying fluctuations as well?


Cactus Jack 15 Sep 2017, 15:54

Charlie_Delta,

What you are experiencing is common. Presbyopia itself is caused by the Crystalline Lenses becoming stiff and hard to focus. That also means that after the Ciliary Muscles succeed in increasing the PLUS power of the Crystalline Lenses for close focusing, they are also slow to relax, which they must do for distance vision. While the Crystalline Lenses are focused for close work, you are actually Myopic.

One of the things that cause people with Hyperopia AND Presbyopia to get confused is that both are corrected with PLUS lenses, but for different reasons.

I would urge you to consider getting a dilated (wet) exam. Be sure and try to NOT do much close work, prior to the exam. Typically, the dilating agents that are used these days are not very persistent and wear off in just a few hours. All the dilating agents do is temporarily paralyze the Ciliary Muscles. They have no effect on the Crystalline Lenses. You want your Crystalline Lenses to be as relaxed (minimum PLUS power) as possible for the distance part of the exam to hopefully need another prescription change very soon.

You are not going to like this part.

It is time to consider an Add to help you focus close for reading or using the computer. There are many possible solutions. Bifocals, trifocals, progressives, mono-vision, and even multi-focal Intra-Ocular Lenses. Your visual environment is very important in choosing which solution is the best. In some instances, progressives are nice for social occasions and bifocals or trifocals are better for a wide field of focus with little or no distortion. The solution there is two pair of glasses.

Be sure and tell the examiner about your visual environment and all the problems you are having with your vision. This is no time to let vanity get in the way of good vision.

If you are getting a dialed exam, your near vision is checked before the dilated part of the exam. If your Ciliary Muscles are paralyzed, you can't focus close anyway. It is very likely that you will try to focus on the small text, try to no work too hard on that, because not having enough Add for the task, will cause you to need an increase sooner than you typically would.

Hope this helps some. Feel free to ask more questions here or in a private message if you want to discuss your situation in more detail.

C.


Charlie_Delta 15 Sep 2017, 14:41

Have others on here required more than one correction within 6-9 months due to latent hyperopia? I’m again struggling at distance – seems to be getting progressively more annoying. Things at distance are out of focus (by a lot, it seems) after looking at something up-close w/ single-vision glasses for distance. I can concentrate and bring everything into focus, seemingly without much effort, but the default to blur is happening on increasing regularity now. My last eye exam was due to similar symptoms and. This was a few months after first being prescribed glasses (40 y/o). The distance script went up +.5 in each eye. What is interesting however is that my initial prescription, reading glasses, is only +.5 more in each eye (L +1.0, R +1.5) and those are more fuzzy at distance my current distance Rx (L +0.5 / R +1.0). FWIW, the last visit did uncover slight astigmatism in left eye, but its too negligible I think to even mention (-0.25).

I’m not a Greatful Dead fan by any means but concur in their “what a long, strange trip it’s been” line when it comes to my vision experience in the past seven months!


Cactus Jack 15 Sep 2017, 09:28

Weirdeyes,

There is a relationship between focusing and convergence, but I doubt it could cause Latent Hyperopia. Latent Hyperopia is typically caused by using your Ciliary Muscles to internally correct Hyperopia for a long time, often years.

It is extremely unlikely that you will become nearsighted.

C.


Weirdeyes 15 Sep 2017, 02:34

Can convergence insufficiency create latent hyperopia? I mainly notice it in my right eye. It used to be be +1.75 with -0.75 cyl. It went down to +1.25 and later on +1.00. My eyes don't feel relaxed. My left eye has kind of fluctuated between +4.25 and +4.00. It's more stable for some reason. I'm scared my right eye will be nearsighted one day. My most recent ECP suggested prism. I just don't want to be dependent on prism. I love wearing contact lenses. Especially with my uneven eyes.


Soundmanpt 11 Sep 2017, 09:48

Carrie

One thing for sure, Danielle is one very determined young lady.She just doesn't want to accept that she needs to be wearing her lasses full time now. Her eyes don't feel as tired since she started wearing her glasses full time because her eyes aren't straining as much so her eyes are more relaxed. A reduced workload helps a bit as well but it's mostly because she has been wearing her glasses full time. Being on holiday for a week is not only good for her eyes but she is probably mentally ready for a break as well. She has been wearing her glasses full time for a good while already so her eyes should be pretty dependent on her glasses by now so I wonder how well she is going to be able to see without her glasses anymore. If she wants to read a book she is going to need her glasses that's for sure, if she wants to watch TV I think she is going to find out rather quickly her eyes aren't going to very comfortable doing that if she is even able to see the TV very well without her glasses. And since she was told that she needs to wear her glasses when she drives she shouldn't even try driving without her glasses. I don't know what the laws are in the UK but here in the US if your told by your optometrist that you need to wear glasses for driving that over seeds what your driver's license may have as restrictions. In other words if you were able to pass the drivers vision test but 6 months later you had your eyes examined an were told you need to wear glasses to drive that is considered the law. But regardless of what the law is in the UK I really hope if she is driving she wears her glasses. Otherwise if she wants to glasses free all week that's up to her. But no matter what she does over this week once she is back at work I think she will be back wearing her glasses full time again anyway.She sure feels different about wearing glasses than her lovely mate Vickie.


Carrie 11 Sep 2017, 06:22

My friend Danielle is still wearing her glasses full time (around +2). She said her eyes don't feel so tired but isn't sure if that is because she has been wearing her glasses all the time or that her workload has reduced. She is on holiday this week so she is hoping that the break will help her eyes and she can go back to wearing glasses mainly for reading and working. She'd like to not need her glasses for driving and watching tv but has a feeling that won't happen. She accepts that she will always need glasses for reading and working. She would never get surgery. She occasionally wears contact lenses.


Aging Max 08 Sep 2017, 17:08

What a surprise last evening. After dinner, Manny got ready to read a book and to my shock and delight, he pulled out a pair of glasses. He had never given me any hint that he was going to have his eyes examined. He told me that the doctor said his eyes had reached the point they could use some assist with close-up work. Left eye +1.00 and Right eye +1.25. The glasses are dark framed half-rims. Rock n' roll. Glasses now rule the household of Manny and Max.


Aging Max 31 Aug 2017, 07:16

Thanks for the suggestions. Let's see if I can get Manny to the eye doc.


Cactus Jack 30 Aug 2017, 05:18

PhillinEngland,

Sometimes, the server is slow and often people click more than once on the Submit button. The clue that your submission is acceptable, is that the Submit button changes to Reverse Video - White letters on a BLUE background. When that occurs, your submission is in the queue and you just need to be a bit patient and wait for the server to respond. It is rare for it to take more than 10-15 seconds, but it can seem like forever. It is worse than waiting for a traffic signal to turn Green, when you are in a hurry.

C.


PhillinEngland 30 Aug 2017, 00:36

Sorry about the double post!


PhillinEngland 30 Aug 2017, 00:34

Cactus Jack

I agree with every word you said, and you said it much more succinctly than I ever could!

I am now very much "converted" and I see (no pun intended) the benefits of having a regular, quality eye test.

My previous post was really to pass on my experience of how stubborn I was in resisting an eye test. I really can be a stubborn bugger especially if my darling wife gets on my case. There was a fair bit of denial involved too: acknowledging my deteriorating vision was like accepting the aging process and the fact that I was aging. In the end it was my poor visual acuity and me deciding something needed doing that got me through the optometrist's door.

It's a very fine line between trying to persuade someone of what's in their best interests and their perception of being nagged (in my experience).


PhillinEngland 30 Aug 2017, 00:34

Cactus Jack

I agree with every word you said, and you said it much more succinctly than I ever could!

I am now very much "converted" and I see (no pun intended) the benefits of having a regular, quality eye test.

My previous post was really to pass on my experience of how stubborn I was in resisting an eye test. I really can be a stubborn bugger especially if my darling wife gets on my case. There was a fair bit of denial involved too: acknowledging my deteriorating vision was like accepting the aging process and the fact that I was aging. In the end it was my poor visual acuity and me deciding something needed doing that got me through the optometrist's door.

It's a very fine line between trying to persuade someone of what's in their best interests and their perception of being nagged (in my experience).


Cactus Jack 29 Aug 2017, 19:12

PhillinEngland,

A quality eye exam, particularly one with dilation (sometimes called a “wet exam), does a lot more than just check your vision, The eyes are a window into the body and often High Blood Pressure, Diabetes, and other non-eye diseases are first detected on an eye exam. Also, internal eye pressures are checked for early detection of Glaucoma.

Most people think think they have good vision, even if they don’t. Vision actually occurs in the brain, the eyes are merely biological cameras. The brain has amazing image processing ability, IF it knows what something is supposed to look like.

That said, it is probably best to not be too forceful in mentioning much about your vision with your glasses. Manny, might view it as you trying to “force” him to get an eye exam. Often that causes a person to “dig in their heels” and delay getting an eye exam on their own. It is OK to answer questions about vision with your glasses, but don't volunteer much.

If you need a couple of prescription changes and he asks about that, you can just mention that you have what is called Latent or Hidden Hyperopia in addition to Presbyopia and it might take a few changes to completely correct your vision. It is just the nature of the beast.

C.


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