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Hyperopia and Presbyopia Progression

For and about anyone having difficulty seeing near/reading.

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Carrie 17 Nov 2017, 13:20

Soundmanpt - Danielle hasn't said in detail what her vision is like without glasses just they make her eyes feel more comfortable. I presumed her comment about needing stronger glasses in the spring was based on what her optician said a few weeks ago. Maybe she has found that her current prescription isn't quite strong enough for her any more, I don't know. I think Vicky will probably get her eyes tested around the same time as Danielle.

I have got an idea I want to try with Danielle. I have dug out one of my old pairs of glasses from a few years ago. I'm pretty sure that the prescription in them is L+2.00 and R+2.50. I am going to ask Danielle if she wants to try them as they are only slightly stronger than her own glasses.

Danielle and Vicky are coming over tomorrow.

Weirdeyes 17 Nov 2017, 08:31


What I mean by helping me is that my eyes never crossed when I was a kid. I've heard that crossing eyes is more likely to cause amblyopia than a difference between your eyes. I think since my eyes were lined up my brain could still used my left eye for depth perception even though it was pretty blurry and undetailed compared to my right eye. Getting corrected kind of messed things up and caused CI. I don't think I remember CI as a kid, but I did remember issues seeing my computer screen and seeing some details far away.

Plus Tony 17 Nov 2017, 06:39

Hi Younglady,

Good to hear that it is going better with the glasses.

I'm not sure that taking breaks from wearing your glasses will help in the long run. If your eyes are going to change they'll do it anyway whether you wear the glasses or not but there is no getting over the fact that when you take them off things will not look as clear as you think they looked before you started wearing them.

Whether you wear them all the time is ultimately up to you. It isn't going to do you any harm to take them off now and then if you feel more comfortable in certain situations but from my own experience I just find it easier to put them on in the morning and forget about them. If you decide not to wear them you may find that the period between taking them off and discomfort starting gets shorter though (but there may be days when you can manage just fine).

When I first got glasses it was a real effort not to snatch them off my face if I met someone who hadn't seen we wearing them before. The funny thing is I'd always liked the idea of wearing glasses but was quite self conscious about actually wearing them. So when I finally bit the bullet I worked myself up to the point where I decided that the best thing to do was just to wear them immediately and keep them on. Initially it was hard but I forced myself to leave them on even if I felt a bit uncomfortable. There is an inevitable sense of "everyones looking at me because I'm wearing glasses" but I reckon I got over that after about 3 weeks by which time I felt good about wearing them and was so happy not to have any headaches. I got lots of positive comments from female friends too which for an average guy in his early 40s was a definite bonus! I'm actually overdue for my eye test now and I'm definitely going to buy a new pair this year even if my prescription doesn't change so hopefully I might get a few more positive comments - we live in hope :-)

Just one thing I meant to mention to you before. You said you were a stay at home Mum. I don't know how old your children are but get their eyes tested as early as you can. Don't wait for school vision screening. Eyesight issues are often hereditary so getting them checked out early is sensible. Take care.

Lou 17 Nov 2017, 03:16

Hi Weirdeyes

I am not sure what you mean about convergence insufficiency possibly helping you as a child, or helping you to avoid amblyopia. Since you have a significant difference between your two eyes, I would have thought that convergence insufficiency could have encouraged you more greatly to use just one eye. I suppose it would depend on whether both or one eye tends to drift outwards at near. If your stronger eye drifted out, I suppose that it could encourage you to use your weaker eye, but I imagine that your weaker eye would be the one likely to drift out, especially if a difficulty focusing at near owing to being long sighted, was a contributory factor in developing convergence insufficiency in the first place.

My convergence insufficiency was not diagnosed until my mid 30s, when I was struggling to keep the two images fused together whilst reading music.

I had however been told at my first optician's eye test at age twenty that my eyesight was borderline (I have no idea of my rx at the time) and my eye tracking was very poor. The optician was very surprised that I was able to read at all. I could and I can. He wanted to refer me to an eye specialist. He really scared me, and I said that I didn't want to be referred as I could see ok.

Although I passed all school eye screening tests, I noticed at aged seven that there was something not right about my close vision. Everything looked slightly out of focus, words seem to jump around on the page and I used to lose my place a lot. I was however a good reader and did well academically. When we tested our own close and distance vision in science when I was around 11, the starting point for testing our close vision, was 10cm, and the idea was to move in the text gradually closer. I couldn't see the text at the starting point. I never have been able to read particularly close. For as long as I remember, when I look closely in a mirror (without glasses since I have worn them), I can see my right eye squinting. This is my eye with the stronger prescription, although my prescription for each eye is very small.

Anyway, when it finally got to the stage that I was only using my left eye to read music, I went to the opticians. I was diagnosed as having very mild long sighted astigmatism in both eyes, and referred to an orthoptist, who diagnosed convergence insufficiency and referred me to a specialist regarding my eye tracking. The specialist said that I have eye tracking issues consistent with being dyslexic, but I have no signs of being dyslexic. She said that it is definitely a developmental condition, because I also have weak thumbs and mild coordination issues with my hands. I hold a pen strangely and am not particularly dexterous. For example, I find things like peeling potatoes difficult, but I play the flute and trumpet, touch type and have no obvious difficulties, so it is obviously very mild. I never did get a diagnosis owing to a change in the NHS funding system, and funding being withdrawn for those aged 14. I could have continued privately but there seemed no point, as apart from playing ball sports (and believe me I have always been absolutely terrible), my eye tracking issues are not bothering me.

Eye exercise for convergence insufficiency have improved it to the point that my eyes rarely drift, and I can manage it myself with regular breaks from close work. Regarding the cause of my convergence insufficiency, a previous optician said that all the muscles that move my eyes are weak, and I would have been born this way. I am not sure about this, as I read at a later date, that the same muscles are responsible for both focusing and eye movements.

My guess is that I was significantly long sighted as a child. In my late teens/early twenties I started using computers for the first time, and studying business administration for two years, I spend most of my time doing close work and looking at computer screens. Quite a few of my friends became near sighted at that time, and I noticed a change in my vision from having really good distance vision to ok distance vision, and no longer seeming to struggle as much at near. My guess is that I became less long sighted at this point.

I however don't really know, as although I noticed issues with my close vision as a child, and presumably also had convergence insufficiency, since as long as I can remember, I've occasionally seen double at near and have been able to quickly fuse it, it only became a problem in my 30s. Since I don't yet have a reading add at nearly 44, it wasn't linked to presbyopia either. I presume it was owing to starting to do a lot more orchestral trumpet playing, and spending whole days at a time reading sheet music.

Anyway, I've gone on for far too long about myself, when I'm meaning to try to help you. I don't know what is going on with your eyes, but I feel that rather than guess, that it is the time to find a good optician, and see an orthoptist/eye specialist if possible. Even if you can't solve all your issues, hopefully greater understanding will help you to manage them more successfully.

I really hope that some of this will help.

Take care


Weirdeyes 16 Nov 2017, 12:08

Sorry about that. My latest prescription is R+0.75 -0.75 L+4.24 -1.50. I really do think convergence insufficiency was caused by not wearing glasses as a child. I did a lot of close work and I avoided having crossed eyes. I also think my depth perception was good for what my prescription is. I could still watch 3D movies and no one could really identify me as having poor depth perception. But I did do terribly with ball sports and people often accused me of being careless and clumsy. So this convergence insufficiency helped me out in my childhood and I think it also helped me avoid amblyopia. But now it's just throwing off my ODs. If I had crossed eyes I would have gotten glasses at a young age. I only got glasses when I was eleven and they were the extremely weak prescription of R 0.00 L +1.25.

 16 Nov 2017, 11:27

Hi Weirdeyes

Regarding your latest prescription, I presume that it is

+0.75,-0.75 and +4.50, -1.25, as you posted on 7th November. Although you do mention previous prescriptions in your earlier posts, to save me searching, can you please confirm whether your astigmatism correction is similar in the older

+1.75 and +4.25 prescription you are trying. If so, and your distance vision is improving in your right eye with wearing +1.25, it would suggest that you do have latent hyperopia.

With regards to convergence insufficiency being a response to not having enough plus, rather than it being as simple at this, I have a feeling that having insufficient plus especially during childhood, could be a contributory factor in developing convergence insufficiency.

Take care


Weirdeyes 16 Nov 2017, 11:17

When I wear the +1.25 glasses for all distances I do notice my distance gets a bit clearer.

Weirdeyes 16 Nov 2017, 09:09


At the moment I do wear +1.25 ish reading glasses over my contacts for reading. After I wore them for a while I did notice my distance vision through my +1.75 glasses was more clear. I just find those reading glasses lower the contrast for whatever reason. Maybe they're poor quality. I'm thinking of either buying an over the counter pair I like or just ordering one on zenni along with some full strength reading glasses. One problem with my +1.75 glasses is that my left eye was only corrected to +4.25. It was my request since having my 3D difference corrected feels weird. But I actually have more equal vision and depth perception when it's fully corrected, so now I think that's correct despite the weird sensations. One issues I noticed with my +1.75 and +4.25 rx is that things actually look bigger through the right eye. I believe I was overminusing myself. As counterintuitive this is to optometrists I suspect my convergence insufficiency is a response to not having enough plus. When I cover my right eye it seems like my left eye actually turns outwards. I think someone on YouTube had the same experience as me. She had latent hyperopia and also got labeled with convergence issues.

 16 Nov 2017, 03:05

Hi Weirdeyes:



Yeah. I believe I do have some latent hyperopia and serious eye strain. I just don't know of any good ODs for that. The one I currently go to overminuses. I also had some issues where my left eye was underplussed compared to my right, so that probably caused issues as well. I told my mom my issues and she understood. So she gave me one of her weaker readers to wear over my contacts. The distance is obviously pretty blurred, but my close up vision and depth perception is way better. I think that's a sign of latent hyperopia rather than needing an add at a young age. I think I'll temporarily wear some kind of add until my eye strain improves. It may be a one time thing, but I noticed my double vision was pretty much gone as well. Something fishy is going on.

Regarding your current OD over minusing, without meaning to risk offending you, is he/she over minusing or are you subjectively over minusing yourself?

When I last had my eyes tested, my optician felt that I may have been previously been over plussed. I was completely happy with my 2012 prescription of

R: +0.50 Sph -0.50 Cyl Axis 90

L: +0.25 Sph -0.25 Cyl Axis 80

I went for a routine eye exam in 2014, and they put my prescription up to:

R: +0.75 Sph -0.75 Cyl Axis 90

L: +0.50 Sph -0.50 Cyl Axis 80

I didn't think that this was right, so I went back for a re-test. When I was shown both my old and new prescriptions without knowing which was which, I chose my new one.

I still continued to think it was wrong, and went for another test around five months later. The optician thought that my prescription was too good and that because my eyes were not having to work to focus, they were not working to correct my convergence insufficiency. He added a small amount of prism to my right eye and fine tuned the axis of each eye to 92 and 83 respectively.

Four or five months later, I was convinced that my right prescription was either too strong for distance or the prism was causing me problems for driving, as I kept finding that I was focusing on the heater elements of my car windscreen, making my distance vision blurred.

They reduced my right eye prescription and removed the prism. i.e.

R: +0.50 Sph -0.50 Cyl Axis 92

L: +0.50 Sph -0.50 Cyl Axis 83

Another four or five months later, and I was convinced that my left eye prescription also needed reducing. The optician didn't agree and changed the left eye axis to 88.

I still didn't think my prescription was right, and went back again, probably 6 months or so later. I saw a very good optician this time. She used retinoscopy to determine my prescription, as if I was unable to communicate. She agreed that my 2012 prescription was right for me, and gave me:

R: +0.50 Sph -0.50 Cyl Axis 92

L: +0.25 Sph -0.25 Cyl Axis 85*

* She went in the middle of the two previous axis readings as I couldn't tell the difference between 83 and 88 with a -0.25 cylinder.

She remarked that she didn't know why I was so worried as I was very easy to test, and consistently chose the same lens each time, which agreed with her retinoscopy findings.

If this is the case, I simply cannot understand why when my 2012 prescription worked well for me for two years, and is working well for me again, that I consistently seemed to be choosing one step higher in eye exams.

Although she wondered if I had been over plussed, and had put a note on my record that this must not be done in the future, I know that on the one occasion I went in for simply a retest, which consisted of simply comparing viewing an eye chart with both my old and new prescription, it was me who chose the new one out of the two, which ultimately turned out to be wrong.

At least some of it must have been me. Whatever happened my subjective choice and the opticians objective choice now agree, and are what worked for me well in the past, and I will be very wary of any future increases to my distance prescription.

I can only advise that you ask around for recommendations of a good optician, and ask whether you can email him/her in advance of your appointment, so that you have a chance to clearly explain in advance, all the problems which you are having. This is what I did, and the optician already understood my issues before even meeting me.

Eye strain is probably a major factor in your case. If your eyes are so strained, they are probably not relaxing enough during your eye examinations, and you are probably choosing too little plus. I know that you have already had a dilated exam, but I believe that you could do with another in combination with a really understanding optician.

If you are only 21 and really struggling at near, you possibly are uncorrected. I was once given a reading add of +0.50, and I did also get a pair of reading glasses. Talk about restrictive, they didn't even cover the distance to my lap top screen, which is only the length of my arms away, and were useless to me, who rarely reads particularly close, and I was around 42 at the time, so twice your age. This time I was given the option of a +0.25 add, but the optician didn't recommend it, as I can read fine with my distance prescription.

If you are not finding a reading add restrictive at only 21, then you possibly do need more plus, but I would guess also for distance rather than just for reading.

I hope that some of this will help. Don't give up, it can be sorted, it is just a case of finding an understanding optician.

I have one possible self help remedy, which I would like other more experienced posters on here to confirm is ethical/advisable, before you try it if you think it is a good idea, and that is to try wearing a a pair of +1.00 reading glasses over your contact lenses full-time for around a month, other than when you are driving or in a situation (such as a university lecture) when you need good distance vision. Your distance vision will start off blurred, but if your do have latent hyperopia in one or both eyes, the distance vision in one or both eyes should start to improve as your eyes become less strained. If it never does or does to only a certain degree, you can determine that you either have none or less than +1.00 latent hyperopia respectively.

Even better would be to discuss the possibility of having latent hyperopia with a good optician, and if they agree that it is likely, doing something like the above in association with the optician.

Best wishes


Soundmanpt 15 Nov 2017, 14:51


Maybe Danielle has finally realized that her eyesight isn't improving like she hoped. I'm sure now whenever she takes her glasses off everything is noticeably more blurry to her. Also because she has been wearing her glasses so much in the past few months she should be starting to feel more comfortable wearing her glasses now. Remember for you and Vickie it was much easier for you to become comfortable wearing glasses because you both wanted to wear glasses. Danielle clearly hasn't been as comfortable wearing glasses. Her worse fears were becoming dependent on her glasses and like it or not that is exactly what has happened to her. She really can't function as well anymore without her glasses for not only reading but also for things like driving her car. Bases her comment to her friend she must already be noticing that her glasses aren't quite as strong as they need to be now if she thinks she is going to need stronger glasses in the spring. I'm really surprised that Vickie sin't getting the urge to get her eyes checked in hopes that she will need stronger glasses as well.

Cactus Jack 15 Nov 2017, 09:52


You did not mention your age or your wife's age. Typically, Presbyopia does not become a problem until the late 30s or early 40s. However, that is not a hard and fast rule. Everyone is different and has different visual needs.

Presbyopia is normally caused by the slow stiffening of the transparent protein that makes up the Crystalline Lens. Your Ciliary Muscles and Crystalline Lenses are the active part of the "Auto-Focus" system in your eyes. While the stiffening of the Crystalline Lenses is the primary cause of Presbyopia, the secondary cause is reconditioning of the Ciliary Muscles. For their very tiny size, they are the strongest and best conditioned muscles in the body. When you wear reading glasses to help you focus, you relieve your Ciliary Muscles of some of their work load. and that helps them become weaker.

Wearing the reading glasses is not particularly harmful, but they will speed the onset of the symptoms of Presbyopiar sooner than they will, inevitably, naturally occur.

The key for deciding when to wear readers or not wear readers is visual comfort when reading. The time difference between the readers being optional and naturally mandatory is probably just a few months. If you have any underlying Hyperopia, it will happen faster.

If you or your wife has not had an eye exam recently, it would be a good idea to get an exam to establish a base line and also check for lurking diseases whose presence is often first discovered during eye exams.


Weirdeyes 15 Nov 2017, 09:16


Yeah. I believe I do have some latent hyperopia and serious eye strain. I just don't know of any good ODs for that. The one I currently go to overminuses. I also had some issues where my left eye was underplussed compared to my right, so that probably caused issues as well. I told my mom my issues and she understood. So she gave me one of her weaker readers to wear over my contacts. The distance is obviously pretty blurred, but my close up vision and depth perception is way better. I think that's a sign of latent hyperopia rather than needing an add at a young age. I think I'll temporarily wear some kind of add until my eye strain improves. It may be a one time thing, but I noticed my double vision was pretty much gone as well. Something fishy is going on.

Pat 15 Nov 2017, 08:06

My wife got glasses for close about a month ago, and is getting used to wearing them more and more, mostly for reading. She says her reading is much more comfortable. When she first got them I tried them but they didn't do anything for me. She got a spare pair, and has encouraged me to use them for reading, which I have. While at first they made no difference in my close vision when I put them on, if I wear them for a longer time (20 min?) I do notice a difference when I take them off. Small print blurs a bit until my eyes re-adjust and then I can see ok. (For reference she says that when she takes hers off the small print does not clear up.) She likes to see me wearing them, but will I do irreversible harm if I continue wear these glasses?

Lou 15 Nov 2017, 06:13

Hi Weirdeyes

I'm in the UK, and I don't know if there is a minimum age limit to buy ready readers, but an adult could definitely buy them. If however you don't mind me saying, I feel that since you are only 21, that it would be better for you to visit an optician, getting a second opinion if necessary. You say that you feel that your existing prescription is not strong enough. Do you mean overall or just for reading? I personally feel that a 21 year old who is long sighted for distance shouldn't really need an additional reading prescription, and it could be a sign of latent hyperopia artificially reducing their distance prescription. If I remember correctly however, you have already considered this and have had a dilated eye exam. Possibly the dilation agent wasn't sufficient, and your eyes could relax sufficiently with a stronger distance prescription to see clearly in the distance, over time. My understanding is that once all latent hyperopia is corrected, long sighted eyes cannot relax any further, and too much plus will then result in blurred distance vision, as it will effectively make the person myopic. Therefore if your eyes were able to gradually relax into a stronger distance prescription, this would be evidence that you do have more hyperopia left to correct.

If I was in your situation, I would ask for recommendations from friends/family of the name of an optician in which they have a lot of confidence, and ask them to check both your near and distance vision, and if you do need a stronger prescription for near, whether they feel that it is just a case in helping your eyes to relax into this prescription full-time, or whether you do need a reading addition.

I hope that this will help.

Best wishes


Weirdeyes 14 Nov 2017, 19:13

How can I discretely buy some over the counter glasses? I'm 21 and I just don't think my hyperopia prescription is strong enough. My OD doesn't believe me. I'm thinking of buying some glasses that are +1.25 or +1.50 to wear over my contacts for close up work. Is it normal for 21 year olds to buy readers?

Carrie 13 Nov 2017, 14:07

I think my friend Danielle has admitted that she does need her glasses full time. We were in town at the weekend and a colleague of hers came over to say hello. She noticed that Danielle was wearing glasses and commented that she thought Danielle only wore glasses occasionally and mainly for work. Danielle told her that she was sort of correct and that she used to only wear glasses for reading and close up but her eyesight has got worse and she now wears glasses or contacts all the time. She also told her colleague that she might need a stronger prescription in the spring.

It was interesting to hear her talk about her glasses without saying that full time wearing was a temporary thing. It was also interesting to hear her tell her colleague that she might need stronger glasses next year.

Soundmanpt 13 Nov 2017, 13:55


Yes you're going to get more reliant on your glasses if you wear them all the time like you were told, but the upside is that you won't be bothered by headaches. Wearing your glasses full time isn't going to make your eyesight any worse if that is your fear.

Lou 13 Nov 2017, 06:33

Hi Onlooker

My suggestion would be for your wife to get a second opinion.

If it comes out much the same again, she could query with the optician why they she is comfortable with +1.50 readers. It could be simply down to her preferring to read further away, and the optician not taking this into consideration.

I hope that this will help.

Best wishes


OnLooker 13 Nov 2017, 04:54

Thanks all for your reactions.

The thing is that she is not convinced the optometrist gets it right that she needs +2.75 for close up as she feels she is fine with +1.5 readers. She tried +2.00 readers and says they seem too strong.

Younglady 13 Nov 2017, 03:43

Hi Tony,

Yes, feeling a lot better. But I'm not sure if I should have time away from using them as to prevent becoming too reliant? But, no headaches or eye pain when wearing them. Only come back after not using after a few hours.

Thank you.

Plus Tony 11 Nov 2017, 23:50

Hi Younglady,

It can seem like that but it is basically just your eye muscles relaxing. Effectively they're saying thanks for the extra help. Your vision hasn't changed it is just that your eyes aren't as strained having to do all the work.

How are you getting on with your glasses? Headaches gone I hope?

Younglady 11 Nov 2017, 23:06

Hi all,

Sorry just another question if that's ok? Does wearing glasses all day make your sight worse? Eg... do you rely on them more? I feel like my sight has got worse but might be my imagination. Thanks.

Willy 09 Nov 2017, 10:57

OnLooker -- Just to pull the reins in a bit, just because your wife has been given a distance prescription, does not necessarily mean that it would be illegal to drive without glasses. Plus prescriptions work a bit differently from minus (for myopia). A -1 distance prescription would be definitely necessary for driving but I'm guessing your wife is still able to compensate well enough at distance so that she does not yet really need the +1 to see clearly at distance. But that will come...

Soundmanpt 08 Nov 2017, 16:13


At her eye exam the doctor must have found that she doesn't just need glasses for seeing close up, but also for seeing distances. Now the doctor has reduced her to a little weaker prescription but he clearly wants her to wear her glasses for distance as well as reading. She would be much better off getting the progressives with the weaker distance prescription because her eyes would be much more able to adjust to the weaker distance prescription then something stronger. Like the others have said, at first her distance vision might still be slightly blurry but after wearing her glasses for a week or so her eyes will adjust to them. I assume that your wife still drives? Because she has been told by a doctor that she needs glasses for distances if she continues to drive without glasses she is breaking the law.

Charlie_Delta 08 Nov 2017, 13:34


Cactus Jack did a superb job breaking this all down. Of everything he said, though, this is the simplest line he wrote to sum it all up:

"The Add of +1.75 in the reading segment of your wife's prescription corrects her Presbyopia AFTER the underlying Hyperopia is corrected and you are right that the total is +2.75."

Reason she's been struggling with close-up vision, simply put, is because she was wearing, effectively, +0.50 strength reading glasses. Given her age, and your both having learned she's slightly hyperopic in general (a general refractive error that isn't related to aging of the eye), she's effectively canceling-out the intended strength of her reading glasses by one diopter (+1.00).

This nonsense happened to me earlier in the year. What I can tell you is that an additional +0.50 added to my own refractive error (also +1.00) makes everything blurry at distance, but +1.00 makes everything almost shockingly clear.

If she DOES opt to correct for distance, the second most important line Jack wrote about concerns "latent hyperopia." I experienced this -- the Rx went up another +0.50 a few months later, and a bit of astigmatism emerged. I filled that Rx and honestly am not sure I've ever seen this clearly before. It was worth it. Hope that helps!


Willy 08 Nov 2017, 12:22

OnLooker -- You may want to encourage your wife to rethink her reluctance to get bifocals or progressives. From her prescription and age (i.e. her relative youth) I would think it very likely she will have another change or two in the next couple of years (both distance and near) to the point where some distance correction is really necessary, for comfort at least if not clarity/safety/driving. Bifocals and progressives are easier to get used to at lower prescriptions. Let us know how it goes.

Cactus Jack 08 Nov 2017, 09:37


If your wife does start wearing +1.00 for distance, it is likely that her distance vision will initially be blurry. Over a week or so, her distance vision will clear as her very likely Latent Hyperopia gradually resolves. This may happen several time, depending on how much Latent Hyperopia she has, but it will ultimately settle down and there will be very few prescription changes after that.


Cactus Jack 08 Nov 2017, 09:31


Presbyopia and its causes!

There are really two factors in the onset of Presbyopia. The primary factor is the very slow stiffening of the Crystalline Lenses. The other factor is the very rapid de-conditioing of the very tiny Ciliary Muscles that squeeze the Crystalline Lenses to increase their PLUS power for focusing close.

For their size, the Ciliary Muscles are the strongest muscles in the body, because the work constantly to focus the images as you look at things at different distances. Wearing reading glasses of any type is actually a two edged sword. They let you focus close again, but at the same time, they do some of the work for the Ciliary Muscles. If you don't exercise a muscle, it gets weak. That can happen very quickly. When the Ciliary Muscles get weak, they have more trouble squeezing the stiff Crystalline Lenses and your Presbyopia seems to suddenly require more correction than it did.

It happens to almost everyone and there is nothing you can do about it except get stronger glasses until you reach your limit. That is why OTC readers are typically offered powers from about +1.00 to +3.50 or +3.75. Many people go thru all the powers.

You are not really doing your wife any favors by not ordering bifocals for both distance and reading. As you get older, Presbyopia reduces your Accommodation Amplitude. At 43, she is very fortunate to have much Accommodation left.

There are 3 formulas that are used to calculate estimated Accommodation Amplitude.

Minimum Amplitude 15 - (0.25 * age in years) 15 - (0.25 * 43) = 4.25 diopters

Average Amplitude 18.5 - (0.30 * 43 ) = 5.6 diopters

Maximum Amplitude 25 - (0.40 * 43) = 7.8 diopters

Remember everyone is different and those are just estimates or averages.

In your wife's case, she is using up some of her precious Accommodation Amplitude to correct her +1.00 measured Hyperopia and an unknown amount of Latent Hyperopia. The rest is what she has to focus close using her internal resources. Those resources will be disappearing faster than anyone wishes and she will need more focusing help. Don't be surprised when that happens.


OnLooker 08 Nov 2017, 08:47

Cactus Jack

Thanks a lot for all this explanation.

Well her age is 43, and no she could not wear her +1.5 readers for distance. We are talking of close up vision, like reading especially. For now she opted not to have glasses for distance so she will just have glasses the reading prescription which the optometrist lowered to 2.25 to allow her some distance vision which the 2.75 would not allow.

She is puzzled by the fact that her +1.5 readers were working fine and that all of a sudden she is told she needs +2.75. What is the explanation for that, if any?

OnLooker 08 Nov 2017, 08:47

Cactus Jack

Thanks a lot for all this explanation.

Well her age is 43, and no she could not wear her +1.5 readers for distance. We are talking of close up vision, like reading especially. For now she opted not to have glasses for distance so she will just have glasses the reading prescription which the optometrist lowered to 2.25 to allow her some distance vision which the 2.75 would not allow.

She is puzzled by the fact that her +1.5 readers were working fine and that all of a sudden she is told she needs +2.75. What is the explanation for that, if any?

Mike 08 Nov 2017, 07:39


I find this Red Green chart to be easy to tell if you need more or less + or - Just need to open it on a big enough screen that you can view from 10 feet away or more.

I messed around with a few pairs of old glasses, and I could tell the difference right away. With +0.5 the green was a little sharper, with +1.0 they are the same in the morning and the red is a little sharper when I tested at the end of the day.

Cactus Jack 08 Nov 2017, 07:25


It appears that your wife has two separate, common, problems. The separate problems have different causes, but both require correction with PLUS lenses. Unless you really understand Optics and Vision work, the two together, can be very confusing.

Hyperopia or Farsightedness is the fundamental problem. Hyperopia is typically caused by a mismatch between the TOTAL PLUS power of her eye's lens system and the size or length her eyeball. She may also have some Latent or Hidden Hyperopia. It is very common for a person who has had Hyperopia for a long time to also have some Latent Hyperopia.

You did not mention her age, but I strongly suspect she also has the second problem. Presbyopia creeping up on her.

The first problem, Low Hyperopia, is corrected by the Sphere +1.00 component in her prescription. Hyperopia is typically caused by the eyeball not growing quite enough from childhood to adulthood. Hyperopia is unique among the different types of refractive errors because it is the ONLY refractive error that can be corrected internally using some of their built in focusing power that is normally used for focusing close, when you are young, provided Presbyopia has NOT limited that ability. Often the person with Hyperopia is not even aware that they are internally correcting it. They just think that they have exceptional distance vision. However, at some point, usually in their late 30s or early 40s (not a hard and fast rule because varies with the genetics of the individual and can even happen in the teens) Presbyopia rears its ugly head and their ability to correct their Hyperopia and also focus close, begins to diminish.

Presbyopia is the gradual stiffening of the gelatin dessert like protein that makes up the Crystalline Lenses. The Crystalline Lenses and Ciliary Muscles are the active part of your Auto-Focus system. it actually starts in childhood, but usually does not become a nuisance until the 30s or 40s. The Add of +1.75 in the reading segment of your wife's prescription corrects her Presbyopia AFTER the underlying Hyperopia is corrected and you are right that the total is +2.75.

I suspect that your wife has been wearing the +1.50 reading glasses for both distance and reading and if she tried to wear +2.00 or +2.75 for distance, they would be too strong because things in the distance would be blurry. With glasses that are that strong for DISTANCE, she would actually have become Myopic, but she would probably be OK for reading.

Confused Yet?

If not let me add a little bit to the confusion. Your wife's prescription will probably change a bit over the next couple of months. There are two culprits. Latent Hyperopia and increasing Presbyopia. The good news is that this new prescription is pretty close to the limit on how much her prescription will increase.

Latent or Hidden Hyperopia is caused by a person using their Ciliary Muscles and Crystalline Lenses to correct their Hyperopia for a long period of time, sometimes years. The Ciliary Muscles get used to doing that correction and have a lot of trouble relaxing. Imagine that you held even a small weight at arms length for month or years. After some time, you would have trouble lowering your arm because your arm muscles would have trouble relaxing. The same thing happens to your Ciliary Muscles in your eye. When you get glasses that initially only correct part of your Hyperopia, your Ciliary Muscles will gradually begin to relax and the distance Sphere correction will need to be increased a bit to make up for the extra PLUS the Crystalline Lenses are no longer suppling. It can sometimes take months and 2 or 3 prescription changes (increases) to resolve all of the Hyperopia. At the same time, Presbyopia is increasing and the Ciliary Muscles are probably getting weaker, which will require an increase in the Add. The good news again is that the Sphere increase will probably not exceed an additional +2.00 and the Add will probably not exceed +3.00 unless your wife likes to do some very close work or read in bed. At some point your Auto-Focus system can no longer help with focusing (it happens to almost everyone) and the amount of focusing help you need is strictly related to the distance to the object, AFTER the underlying Hyperopia is completely corrected. The formula is easy to understand and use. If you like to work in inches, divide the distance from your eyes to the object and divide it into 40. If you like cm, divide the distance into 100. The result is the required PLUS power to focus at that distance.

I know all this seems very complex, but in some ways dealing with these complex changes is like eating an Elephant. One bite at a time.


OnLooker 08 Nov 2017, 01:33

Hi all

My wife has just had an eye exam. She has been struggling with close up vision for some time and used to wear +1.5 readers especially for reading. At the optometrist's it turned out that she needs a +2.75 for close up. Her prescription reads Sphere : +1 Add: +1.75

Can someone explain why she has been fine with jus +1.5 readers and that whenever she did try +2,5 or even +2 she found those too strong??

Weirdeyes 08 Nov 2017, 01:04

I got a pretty bad headache today. Not sure if it's eye strain or just a headache.

Weirdeyes 07 Nov 2017, 18:48

I just got my new trial lenses. They are +0.75,-0.75 and +4.50, -1.25. When I tried the red green test on my iPhone I did see the green side better, but I don't know if that means much since I was focusing up close.

Soundmanpt 07 Nov 2017, 10:07


You can certainly try wearing contacts if you want but I think you will find that it isn't as simple as you seem to think it will be to wear them. You seem to think you simply stick them on your eyes and forget about them. First of all you're going to need to be fitted with special contacts because of your astigmatisms. They are called "toric lenses" and they cost about 4 times more than contacts that correct nearsightedness. Also in many cases they really aren't very comfortable to wear. They are weighted so they won't spin around on your eyes. But they do tend to rock back and forth and that will cause things to look out of focus to you until resettle in position on your eyes. Contacts must be cleaned every night and you can't get by with only wearing contacts. You will still need glasses so your eyes can get a break from the contacts at least one to 2 days a week. I think in the long run it is much easier to wear glasses because you do simply put them on and go.

NNVisitor 06 Nov 2017, 21:29


Contact lenses can correct astigmatism in two ways at the same time. The natural tear layer of the eye together with the prescription of the lens can correct the astigmatism. The contact lens specialist will examine the cornea of each eye to decide which contact lenses work best. Depending on the shape of the cornea some or all of the astigmatism is corrected by properly fitted contact lenses. For many people it can be partly by the lens and partly by the natural tear layer under the contact lens working together to provide the visual correction. If you see better with glasses you should be able to see better with contact lenses which offer more peripheral vision than eyeglasses are able to do.

Lou 06 Nov 2017, 04:39

Hi Younglady



Lou- I guess I kinda have to now, I can't cope with severe headaches constantly. I don't think frames is really an issue, it is just the fact of having to wear them. I'd prefer contacts that I could "forget" about. Thanks for your help Lou. Good luck, what instruments do you play?

I fully understand and you are very welcome. I don't see anything wrong with inquiring about contact lenses

I play trumpet in orchestras and cornet in a brass band.

Take care


Lou 06 Nov 2017, 04:39

Hi Younglady



Lou- I guess I kinda have to now, I can't cope with severe headaches constantly. I don't think frames is really an issue, it is just the fact of having to wear them. I'd prefer contacts that I could "forget" about. Thanks for your help Lou. Good luck, what instruments do you play?

I fully understand and you are very welcome. I don't see anything wrong with inquiring about contact lenses

I play trumpet in orchestras and cornet in a brass band.

Take care


Weirdeyes 05 Nov 2017, 17:51


You never know what your full prescription will be. My first optometrist never warned me I'd need +3.00 or +4.00. He said I had a mild prescription I only needed for reading probably to make me and my parents feel better. But looking back on things I think he did know I'd be around that prescription. When I had +1.75 in my left eye he told me to start wearing them full time. Since I made a bad frame choice I was very stubborn about wearing them. I was also stubborn about wearing them because they hardly made any difference. But I did get good results from wearing both of my glasses at the same time. I should have told my eye doctor that. But on my next exam with a different doctor I got about the same prescription anyways. So don't be stubborn like me and wear your glasses when you feel the need. Even if you feel your prescription is mild. That doesn't mean your vision problems are actually mild.

Younglady 05 Nov 2017, 15:40


Lou- I guess I kinda have to now, I can't cope with severe headaches constantly. I don't think frames is really an issue, it is just the fact of having to wear them. I'd prefer contacts that I could "forget" about. Thanks for your help Lou. Good luck, what instruments do you play?

Weirdeyes- your story sounds similar but more severe. The optometrist said my right eye needs further correction so you're probably correct on that too. Ahhhh....


Weirdeyes 05 Nov 2017, 14:13


Mainly because your prescription is pretty low and your left eye is -0.50 cyl which might be high enough for you to notice, but not enough for contact lenses to correct. But I strongly suspect both the sphere and cylinder correction will get stronger. When I got my first glasses I was R 0.00 and L+1.25. Pretty weak glasses. But my optometrist knew I didn't just have a mild vision problem. My left eye noticeably didn't see as well as my right eye and I'm guessing it was around 20/50. It was like things were shrunken. So the 20/40 line looked like the 20/10 line through my left eye. My left eye was considered lazy. Eventually I got -0.50 cyl in both eyes and +3.00 ish in my left eye, that was when I was about 13. My left eye could still only see 20/30. Right now my prescription is R +0.75,-0.75 L +4.25, -1.50. Both my eyes can now be corrected to 20/20. So there might be a chance you can get better correction in your right eye one day.

Lou 05 Nov 2017, 13:06

Hi again Younglady

No, your realise that you were simply being reluctant regarding wearing your glasses, and that they are stopping your headaches, are you now planning on wearing them full-time?

If so, if you don't mind me asking, did you spend the time choosing a pair that you really liked, or were you originally planning on only wearing them for driving, so chose a reasonably priced pair which wouldn't have been your choice if you expected to wear them all the time.

If the latter, and you have the money to hand to change your glasses, I feel that you are more likely to feel comfortable wearing glasses, if you have a frame that you are happy wearing.

Take care


NNVisitor 05 Nov 2017, 09:40


If you decide to get contact lenses you will need to go to a qualified contact lens specialist. If you know people who wear contact lenses you can ask them if they know of one that they have confidence in them. You can also contact your optometrist office and ask them. Fitting contact lenses is different than fitting glasses as your cornea's shape will be examined. Both gas permeable and soft lenses are used for astigmatism. You should inquire about which would give you the best vision. If you do get contact lenses there will be an adaptation period with a timetable for the hours of use per day just to adapt to them. I have worn gas permeable lenses for over thirty years. In the adaptation period one can feel them on the eyes. With regular daily wear most of the day there may be an awareness that they are on the eyes. For me I feel them when I put them on my eyes then I typically don't even feel them. Not everyone's experience is the same however millions of people wear contact lenses. It's one option for dealing with vision correction and of course it enables people to see clearly without wearing glasses.

Soundmanpt 05 Nov 2017, 09:01


I'm glad you wore your glasses as suggested by a number of us and that you didn't have any "hassles" Even better you were headaches free until later that evening when you took your glasses and the headache returned. If you look back to Nov 2 2017 21:09 you will see I tried to tell you then that your headaches was due to your astigmatisms and I think proves it. So now that you have found out that by wearing your glasses full time will keep you from getting headaches do you plan on wearing your glasses full time now?

Lou 05 Nov 2017, 03:15

Hi Younglady

A randomn search result from Google to explain Convergence Insufficiency:

All the best


Younglady 04 Nov 2017, 21:50

Weirdeyes- Can I ask why?

Weirdeyes 04 Nov 2017, 21:28


With your current prescription I don't think you're a great candidate for contact lenses.

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