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Hyperopia and Presbyopia Progression

For and about anyone having difficulty seeing near/reading.

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Weirdeyes 20 Jan 2018, 10:51

Mike

At my age I think bifocals would look weirder than a difference of 3.00 between the eyes. I like the convenience of contacts anyways.


Mike 20 Jan 2018, 07:29

Weirdeyes

Have you ever considered a Glasses/Contact combination? Not with over the counter readers but actual glasses from Zenni or some other place online. I recently tried toric contacts and was not happy with the visual acuity. I think with your situation you might be able to achieve better visual acuity and get glasses with prescription lenses that are closer in prescription to each over to address your concerns of them looking weird. What I would suggest is a sphere only contact for your left eye, then correct your astigmatism in both eyes with the glasses, and get an bifocal add of +1 to +1.5 to address your visual strain from close work.

So your glasses prescription would be something like this, plus one Sphere only contact in your left eye.

R +0.75 -0.75 166 Add +1.5

L +1.50 -1.50 16 Add +1.5 Sphere only contact +2.75

I don't think Vertex distance plays a big role at this prescription, but if it does hopefully someone with more GOC experience will chime in.

Let us know your thoughts...


Weirdeyes 19 Jan 2018, 23:21

I think one reason I canít adapt to the +1.00 glasses is because of OCD and trying to increase by too much. I might be perfectly happy increasing by 0.50 or something. Too bad they donít sell +0.50 reading glasses over the counter. I would have tried those if I could.


Weirdeyes 17 Jan 2018, 22:55

Itís amazing how much my prescription affects my binocular vision. When my left eye was undercorrected I felt like I had some weird eye tracking issues I didnít have before. This new more balanced prescription fixed that issue. No vision therapy or prism needed. I feel like people overcomplicate things when they fixate too much on binocular vision.


Lou 17 Jan 2018, 03:03

Hi Weirdeyes

Re.: Seeing better with +1.00 than nothing at all, I believe that this could suggest that your right eye prescription is too weak. It is quite a difficult thing to be definite about, as +1.00 is only one step higher than your current right eye sphere of +0.75, and if you had no astigmatism, it would be obvious that +1.00 would be better than nothing. However since you also have a cylinder of -0.75, meaning that your current right eye prescription varies from zero to +0.75 as you move between the axes, since zero to +0.75 averages out at +0.375, which is less than half of +1.00, I would presume that you would probably see better with no prescription at all than +1.00. As I said above, it is probably difficult to determine and could vary from person to person.

Although this is a different topic completely, I am thinking along the lines of what is generally done when people with small levels of astigmatism try sphere only contact lenses. My understanding is that half the cylinder is added to the sphere, with a prescription such as +1.00 Sph -0.50 Cyl becoming +0.75. The difficulty in your case, is that -0.75 cyl is probably over the threshold where you can compensate for no cylinder by reducing the sphere by half the cylinder value, which is probably why toric contact lenses generally start at a -0.75 cylinder.

Anyway, seeing better with +1.00 than nothing could suggest that your right eye prescription is too weak.

Re.: I think very itís pretty simple. The astigmatism makes letters look smaller on one axis while farsightedness makes things smaller in general. Having letters look smaller on one axis does make the too small effect worse. Iím guessing things donít look the same for you because you donít have latent hyperopia while I probably do.

I see your point, but no offence, but I don't think that you can categorically say that having the letters looking smaller on one axis will make the too small effect worse. Maybe it does for you, and not others. I however agree that having letters smaller on one axis than the other would contribute to them being harder to see. Thank you very much anyhow for clarifying what you meant.

Regarding also you last post to NNVisitor, I at one stage had a right eye prescription of +0.75 Sph -0.75 Cyl. I never thought that this was right, and that I could see more sharply with my previous right eye prescription of +0.50 Sph -0.50 Cyl. After my eye test, my optician showed me my new right eye prescription (which was a return to +0.50 Sph -0.50 Cyl) compared to my old right eye prescription. The letters were just as easy to see with both right eye prescriptions, but I saw the letters with +0.75 Sph -0.75 Cyl as slightly larger with thicker lines, whereas with +0.50 Sph -0.50 Cyl, I saw the lines as finer, which at least for me, I feel means the focus is sharper.

I fully appreciate that this is a whole prescription rather than the cylinder or axis of the cylinder, but in my opinion rather than darker, I'd look for finer lines and that the lines are equally focused at all orientations. My axis is opposite to yours at around 90 degrees, and with too little cylinder, the horizontal strokes of the letters stand out as more focused than the vertical. I aim to have the horizontal and vertical strokes equally focused with the lines as fine as possible. Whether or not that is any help to you with fine tuning your cylinder axis I don't know, but it may be useful in assuring that you have the right amount of cylinder. I'm not trying to make out that I know better than you what image to choose, just telling you what I look for, in case that it is any use to you.

Anyway hopefully this will be of some help, and I'm not sure what time it is at yours, but it is a minute past 10.00am on 17th Jan here, so presumably it is already the 17th at yours, and your eye appointment is tomorrow.

I look forward to hearing what he finds.

Best wishes

Lou


Weirdeyes 17 Jan 2018, 01:05

NNVisitor

I think I just selected the wrong axis because it looks smaller and darker. The axis closer to 180 isnít as dark, but itís easier to see things with. Axis is just hard to guess. I probably have an easier time with the left eye because the cyl is higher.


NNVisitor 16 Jan 2018, 23:45

Weirdeyes

Rigid contact lenses such as gas permeable lenses can reshape the cornea. I don't know if that happens from wearing soft contact lenses.

Many years ago I had my vision tested by an opthalmologist. I had been wearing rigid contact lenses and with the new prescription I got new glasses. It seemed that the new glasses were too strong so I called up the doctors office. An appointment was made with another opthalmologist who was the father of the one I had previously gone too. At the appointment the elder doctor was going over different letters to get the astigmatism correction right. What the doctor did was change the axis of the astimatism just in one eye. That had been the problem and it may have been due to the effect of a contact lens reshaping my cornea.


Weirdeyes 16 Jan 2018, 16:36

One thing I notice is that I now see better with +1.00 than no correction at all.


Weirdeyes 16 Jan 2018, 15:50

Lou

I think very itís pretty simple. The astigmatism makes letters look smaller on one axis while farsightedness makes things smaller in general. Having letters look smaller on one axis does make the too small effect worse. Iím guessing things donít look the same for you because you donít have latent hyperopia while I probably do. My left eye prescription used to be +1.25. I still had terrible reduced image size. I assumed everyone at that prescription had the same issue and instantly notices an improvement. But I later learned the real prescription is way worse.


Lou 16 Jan 2018, 13:42

Hi Weirdeyes

I fully appreciated that I am commenting on a post that you made to NNVisitor, but I hope that you don't mind.

When you say: I think farsighted people without astigmatism perceive their vision as razor sharp, people who have mixed or nearsighted astigmatism perceive their vision as blurry and people with farsightedness and astigmatism perceive things as too small to see but not necessarily blurry.

I'm just not sure about this, obviously not being able to see how others see. I would describe my prescription as being just farsighted astigmatism, as like with your current right eye prescription, I have zero prescription in each eye at one axis, and +0.50 in my right eye and +0.25 in left eye at the opposite axis.

Admittedly my prescription is very small, but my right eye prescription is just one step below your current right eye prescription, which admittedly could be found to be too low when you have your dilated exam on 18th January, and without my glasses, things look slightly smudged/blurred to me, especially in my right eye with the stronger prescription, and I have never seen things as smaller.

If however you are just referring to people whose prescriptions have a much higher sphere in comparison to their cylinder, such as your prescription for your left eye, I have no idea whether you are right, as my prescription has never been higher than +0.75 Sph -0.75 Cyl.

Regarding your suggestion that astigmatism makes things look small when you are farsighted, I'm just not sure how this can be the case. Sorry, I'm not meaning to be argumentative, I'm just trying to work this out.

Lets say for example that a person has a +5.00 Sph prescription with no cylinder correction for astigmatism. I understand that their glasses will magnify the image, and believe (please correct me if I am wrong), that the image will look smaller than normal without their glasses.

Lets now take another person with the same +5.00 Sph, but this time -1.00 Cyl at 90 degrees. My understanding is that their prescription will effectively be +5.00 at 90 degrees and +4.00 at 180 degrees.

I'm very sorry, but I just can't see why the second person, whose prescription ranges from +4.00 to +5.00 at the opposite axis, would see a smaller image size than someone with a +5.00 prescription throughout the whole lens.

Or are you not saying this, and mean that in both the cases above, the person would see the image size as small, but in the case of the person with astigmatism, they just wouldn't notice the lack of sharpness just the small image size, whereas the person with no astigmatism would see the same small image size but more sharply owing to having no astigmatism? If so, I can fully understand what you mean.

Regarding image size changing when varying the axis, If I remember correctly, your axis in your right eye has changed from 180 to 160. I'm trying to get my head round how things could really look bigger when rotating your glasses just 20 degrees, since although your left eye has a moderately strong Sph value, your astigmatism values are not particularly high. If you had a prescription such as +5.00 Sph -5.00 Cyl, which I shouldn't imagine is very common, and the axis was 90 degrees out, I can understand how the axis which requires +5.00 Sph could get zero Sph, and how the axis which requires zero Sph could get +5.00 Sph, which if I've got my head round this correctly, would leave the person still requiring +5.00 Sph at the axis which has always needed it, and effectively now needing -5.00 Sph at the opposite axis, to compensate for having a +5.00 Sph on the axis which needs zero correction. Again trying to get my head around this, the image size would be too large at the axis which incorrectly has +5.00 Sph when it actually requires zero.

If I have this right, I can see your point, but I think that taking off glasses and rotating them, would effect the vertex distance, centralisation of the lens etc., which could be contributing to the change in image size, or are you rotating toric contact lenses on your eyes? Sorry, never having worn contact lenses, toric or otherwise, I have no idea if it is possible to hold them still at the wrong axis. I would have thought not owing to them both being weighted, and it being difficult to work out at what axis you are holding them.

Regarding what I say above however, since it is your right eye which you think has an incorrect prescription, and your current prescription, whether right or wrong, is only +0.75 Sph -0.75 Cyl, which is only one step higher on both values than my right eye prescription, I would have thought that your right eye prescription would be too low for vertex distance and centralisation of the lens to make much if any difference, but also, for rotating the lens to make much if any difference to the image size. I imagine that rotating your glasses would make the image more or less blurred, but I just can't see that it could make much difference to the image size. I'm really sorry. I'm genuinely trying to help rather than be argumentative.

I'm also not sure how extra plus with the correct amount of cylinder can result in ghost images.

I completely believe you when you say that the image of your left eye looked really small when you were first tested, but I believe that this is owing to your relatively high + Sph value for this eye in my opinion, rather than the amount of astigmatism, but I could of course be wrong.

It is also possible that the astigmatism axis of your right eye is causing a lot of your issues.

If you don't mind me saying, you (and I'm also guilty of this through trying my very best as a non eye care professional, to help you) are probably greatly over analysing this, making the issue more complicated than it maybe has to be.

You have an appointment in 2 days. With the nicest intention, I'd suggest trying not to worry about this too much, and seeing what the specialist finds. Since he also does laser eye surgery, he should be more than capable of determining whether your current astigmatism axis is inaccurate.

I wish you all the very best.

Lou


Weirdeyes  15 Jan 2018, 23:29

While my right eye cyl definitely isnít 1.50, I think I do see better with 1.50 cyl than no cyl.


Weirdeyes 15 Jan 2018, 23:29

NNVisitor

I think the astigmatism axis is causing a lot of issues. I think it also makes me perceive things as too small to see, which I think is how astigmatism tends to look when youíre farsighted. When I rotate the lens to be closer to a 180 axis I notice things look bigger and easier to see, but maybe not as dark. When I wear extra plus over my prescription I notice ghost images in the distance, especially in my right eye. I think farsighted people without astigmatism perceive their vision as razor sharp, people who have mixed or nearsighted astigmatism perceive their vision as blurry and people with farsightedness and astigmatism perceive things as too small to see but not necessarily blurry. When they first tested my left eyeís acuity the first line I couldnít read looked impossibly small to read, but not obviously blurry. I think it was the 20/40 line or something. So I have the about the same reduction in visual acuity as anyone else with my level of astigmatism, but it doesnít look as blurry. I wouldnít be surprised if my right eyeís axis changes or even gets a bit more cyl. The cyl correction has always been wonky in my right eye and Iíve always struggled to read fast food menus until I got it corrected.


NNVisitor 15 Jan 2018, 00:36

Weirdeyes

I've had small changes at times in my prescription. Some times the amount of astigmatism and the axis changed or just the axis changed. I checked one prescription where both eyes that were -10 and astigmatism both went to -9.50 and astigmatism which also changed in one eye only so I understand that small changes do happen and can make a difference in vision clarity.

The opthalmologist will listen to your main complaints, test your vision and hopefully solve the vision problems you have. No need to worry about appearing anxious. Just relax and don't worry. Many people are anxious about their eyesight and the opthalmologist will not be looking for anxiety but will deal with your eye issues. Best of luck for a positive outcome.


Lou 14 Jan 2018, 10:52

Hi Weirdeyes

Thank you very much for the clarification. I believe that the axis in your right eye keep changing, could be some of the problem.

Yes, I agree that it will be a good idea to let him know that your left eye looks sharper to you, and to let him figure out if it is an astigmatism or balance issue.

I agree that astigmatism axis is harder for lower astigmatism, but on the flip side, in some ways it is not so critical. After having had an axis of 83 in my left eye for some time, one optician changed it to 88, saying that I kept switching between which I preferred but seem to choose 88 most often.

When I started seeing my current optician, she said that I am really easy to test as I am very definite what is better and make the same choices over and over again. One of the later tests she did the first time I saw her, was to show me two lenses which I really couldn't tell apart, and asked her if there was any difference, as I couldn't see one. She laughed and said that she would have been very surprised if I could tell the difference, as the difference was my -0.25 cyl for my left eye with an axis of 83 and 88 respectively. She said that she would split the difference and give me 85.

Whereas my current prescription is:

R: +0.50 Sph -0.50 Cyl Axis 92

L: +0.25 Sph -0.25 Cyl Axis 85

I still have a couple of pairs of glasses with my 2012 prescription of:

R: +0.50 Sph -0.50 Cyl Axis 95

L: +0.25 Sph -0.25 Cyl Axis 80

I haven't specifically compared them to look for a difference, but I can happily wear both prescriptions, with no noticeable improvement with one prescription over the other.

Since, as you no doubt aware, there are tolerances for glasses lenses, which allow a larger deviation from the prescribed and quoted axis for smaller cylinder values, it is quite possible that my 2012 pairs fall within the tolerance for my 2017 prescription. If not, they are close enough for me not to notice.

This is a tolerance chart that I saved:

Cylinder Power Axis Tolerance

≥0.125 and ≤ 0.25 Ī 16

>0.25 and ≤ 0.50 Ī9

>0.50 and ≤ 0.75 Ī6

>0.75 and ≤ 1.50 Ī4

>1.50 and ≤ 2.50 Ī3

> 2.50 Ī2

If I understand it correctly, there is a Ī 16 axis tolerance for my left eye, and Ī9 for my right, whereas there is a Ī6 axis tolerance for your right eye.

You've previously seen this before, but I've posted it in case it is of any interest to you.

All the best

Lou


Weirdeyes 14 Jan 2018, 10:09

Lou

Yes I wear toric lenses in both eyes. My right eye has always stayed at -0.75, but the axis keeps changing. With my left eye the cylinder was -1.25 for a while, but recently switched to -1.50. -1.50 seems sharper, but my left eye also seems sharper in contacts which only come in .50 increments so it could also be related to axis. Iíll let him know my left eye looks sharper to me. He can figure figure out if itís astigmatism or a balance issue. Since astigmatism axis is harder for lower cylinder it might be astigmatism.


 14 Jan 2018, 05:02

Hi Weirdeyes

Am I right in believing that your contact lenses are toric lenses with a +0.75 Sph -0.75 Cyl? Regarding your old +1.75 glasses, how much cylinder did you have for your right eye?

I'm basically trying to ascertain whether you have more cylinder correction in your old +1.75 glasses than you do in your current contact lenses and +1.00 reader combination. Or is it owing to the difference in axis? I have a feeling that you previously had an axis of 180 now it is 160 or vice versa. Could you please clarify this?

It is good that your left eye prescription is the most sharp on your most recent pair. I wouldn't mention specifically comparing old glasses, but I would make sure to tell the ophthalmologist that you feel that your latest left eye prescription gives you sharper vision than your prescriptions previous to it, as you wouldn't want him to alter your left eye prescription, if it is already very good.

I have no idea regarding over minusing masking astigmatism, sorry.

Yes, I do feel that considering that you have a big difference between your eyes, that you should tell the ophthalmologist that your left eye hates to be under corrected, and you want your left eye fully corrected even though that will result in a fairly large difference between the prescriptions of both your eyes.

Take care

Lou


Lou 14 Jan 2018, 04:31

Hi Likelenses

Very interesting, thanks. Thanks very much for posting the link.

Best wishes

Lou


Weirdeyes 13 Jan 2018, 23:41

I can see better out of my old +1.75 glasses than my +0.75 contact and +1.00 reader combination. It seems like this is astigmatism related like I suspected. A lot of the blur Iíve experienced with the reading glasses actually looked pretty cylindrical to me. I seem to like different axises depending on the test. I also compared my left eye prescription on each pair of glasses and itís definitely the most sharp on my most recent pair. Even though it didnít go more minus. It seems like refracting is a lot more complicated than people admit. Iím starting to learn that overminusing masks astigmatism a lot. So thereís a chance I could get quite an increase without my vision getting much more blurry in the distance. I also notice how confused my eyes feel when I wear my old glasses. I guess my left eye really hates to be undercorrected. I wonder if I should let people know this. Some people with large differences in their prescription like to be undercorrected in their worst eye.


Likelenses 13 Jan 2018, 16:37

Weirdeyes and Lou

This could be a benefit for either of you.

http://vtworks.wordpress.com/2014/04/02/vt-and-lenses/


Lou 13 Jan 2018, 05:11

Sorry, there are some editing issues with my last post, and I have mistakenly left at the bottom of my post, some of Weirdeyes' post, which I copied and pasted for reference whilst I replied.

All the best

Lou


Lou 13 Jan 2018, 05:09

Hi Weirdeyes

Our last posts crossed. It does seem that the place you were getting your eyes tested does seem biased towards making latent hyperopes wear bifocals instead of treating the latent hyperopia. I had a previous optician who seemed more biased in prescribing prism that referring to an Orthoptist for exercises to strengthen the muscles responsible for convergence.

You may very well be right that refractive error caused all your binocular vision issues, and anyone with

your rx would probably have them, as you have quite a difference between your vision and image size in each eye.

I agree that your binocular vision issues are secondary, and that they are something which you can look into getting treated once you have determined that your prescription is as good as it can be, and is not contributing to binocular vision issues.

Best wishes

Lou

Iím still open to treating binocular vision issues, but I think theyíre secondary.


Lou 13 Jan 2018, 04:59

Hi again Weirdeyes

I meant to say, that after reading your explanation on pseudo CI and Accommodative Insufficiency, I googled both briefly. I found the following:

Accommodation and convergence are coupled physiologically.

Through this coupling, when the eyes accommodate, they also

converge.

Source: Accommodative Insufficiency Is the Primary

Source of Symptoms in Children Diagnosed

With Convergence Insufficiency

LYNN F. MARRAN, OD, PhD, FAAO, PAUL N. DE LAND, PhD, and ANDREW L. NGUYEN, PhD

Optometry and Vision Science, Vol. 83, No. 5, May 2006

This concurs with what a previous optician told me, and explains why my convergence insufficiency symptoms were worse, with my previous prescription which was +0.25 Sph -0.25 Cyl too strong in each eye.

With my current prescription, which I feel is very accurate, I am barely having any convergence insufficiency symptoms other than a reduced near point of convergence, which does not bother me.

All the best

Lou


Weirdeyes 13 Jan 2018, 04:29

Lou

The place I was getting my eyes tested seems biased towards making latent hyperopes wear bifocals instead of treating the latent hyperopia. When I asked to get my eyes dilated they looked at me weird and told me they only dilate for health. My sister with a different OD at the same clinic was told she needs bifocals as well. It seems like my OD just blames my eye strain on binocular vision and ignores refractive error. I think in my case refractive error caused all my binocular vision issues. Anyone with my rx would probably have them. Iím still open to treating binocular vision issues, but I think theyíre secondary.


Lou 13 Jan 2018, 04:09

Hi Weirdeyes

Thanks very much for your explanation of pseudo convergence insufficiency. Yes, I agree that it is best to let the doctor decide regarding convergence insufficiency. Just mentioned symptoms which will help with testing sounds a good idea, and I agree that he should take close up vision complaints in a young farsighted patient seriously enough.

I'm obviously not an eye care professional, but I was surprised that your previous optician was happy to tell a 21 year old to wear over the counter reading glasses over their contacts, with no explanation why they should need to do this.

Good luck with your appointment.

Best wishes

Lou


Weirdeyes 12 Jan 2018, 10:24

Lou

Pseudo CI is when your accommodation muscles are exhausted. That could be due to accommodative insufficiency, but based on my self tests I donít have it. That will mimic CI symptoms since your eyes also go outwards. Plus lenses are more likely to help for this. I might still have some real CI as well. Iíll let the doctor decide. Maybe something completely different is going on. Iíll try to only mention symptoms that will help with testing. So Iíll probably just mention trouble seeing computer screens, trouble concentrating on reading books and eye strain looking into the distance sometimes. I think heíll take close up vision complaints in a young farsighted patient seriously enough.


Lou 12 Jan 2018, 03:34

Hi Weirdeyes

I haven't personally heard of pseudo convergence insufficiency. I know that I have true convergence insufficiency, although it is now largely resolved and intermittent. In my case, I have been told that it is caused by the muscles which are responsible for eye movement and convergence, being weak. I agree that wearing too much plus makes things worse, which probably explains why I hate being slightly over corrected. A previous optician explained it in simple terms as convergence occurring when the eyes accommodate to focus close up, saying that if you have a tendency for convergence insufficiency, being slightly under corrected and having to accommodate more greatly, helps your eyes to converge.

He says that you have two options, prism or being slightly under prescribed in terms of plus.

In my case, since my prescription is so small and I can't really be under prescribed, I think that it is a case of simply not being over prescribed.

All the best

Lou


Lou 12 Jan 2018, 03:16

Hi again Weirdeyes

I think that you have probably hit the nail on the head when you mention farsightedness masking the astigmatic blur, until most of the farsightedness is corrected and the image size is large enough to notice the astigmatic distortion.

I agree that it will be best if you keep complaints simple and answer the doctorís questions.

I have been thinking about all this, and I believe that your real concern is whether you are under corrected for distance, since you are experiencing eye strain even for distance with your current distance prescription, and at only 21 years old, despite being told that you have good accommodation, you need reading glasses over your contacts for close work.

I know that you are also concerned that you right eye prescription keeps decreasing, but if you mention this initially, he could just think that you are seeing your prescription going down and imagining that this is making you uncorrected.

I think if I was in your shoes, I would write the following down, and take it with me to the appointment:

I am concerned that my distance vision may not be fully corrected, as I am experiencing a lot of eye strain even for distance, and although I am only 21 years old, and have been told by my optician that I have good accommodation, I am finding that I need to wear +1.00 reading glasses over my contact lenses for close work.

I would then say that you are listing your most recent prescriptions for reference purposes, and list enough to show him that your right eye prescription keeps decreasing. In this way you are bringing it to his attention in a way that is not directly suggesting that your concerns regarding you possibly being uncorrected are linked to you noticing your prescription decreasing.

He may think that you are linking the two, since they are on the same piece of paper, but unless you specifically say so or make a more definite suggestion, he will have no evidence to back up his thoughts, and will have to take what you say at face value.

I think that it is quite possible that over accommodating owing to eye strain is the cause of your prescription decreasing, since it happened in a way to me, although in my case, it took the form of my glasses seeming too strong when putting them on for the first time later in the day. What I believe was happening in my case, was that my eyes were accommodating to see without my glasses, causing my eyes to ache and burn, and after accommodating all day, it was difficult for my eyes to relax fully for distance. It was solved by wearing my very small prescription full-time, to prevent the over accommodation in the first place.

If your eyes are very strained and over accommodating, this may artificially make your prescription seem less than it is. This sounds like I am describing latent hyperopia and I probably am, but in my case, I don't think it was latent hyperopia per sec (I suppose it could be considered as temporary latent hyperopia owing to over accommodation over the course of the day, which disappears overnight). Since I wasn't wearing my glasses, I was simply over accommodating to see.

I'm wondering whether you could have entered a cycle of being under prescribed on one occasion, which led to eye strain and over accommodation, to the point that your eyes weren't sufficiently relaxed for your next eye exam, so your prescription went down again, only for your accommodation to increase even more and so on. I suppose that this is a description of latent hyperopia starting and progressing.

It will be interesting if he finds any latent hyperopia.

If he doesn't, you need to accept his prescription and consider a referral to look for another cause.

Good luck

Lou


Weirdeyes 12 Jan 2018, 02:43

I think have pseudo convergence insufficiency since wearing more plus helps with it. When you have true convergence insufficiency plus makes things worse. Iíll just avoid mentioning convergence insufficiency and let the doctor decide whatís going on. Unless he asks.


Lou 12 Jan 2018, 01:45

Hi Weirdeyes

Sorry, I forgot to also respond to the second part of your post. Will do this later.

Best wishes

Lou


Lou 11 Jan 2018, 16:45

Hi Weirdeyes

Since I find it very difficult to see to thread a needle and also have to enlarge text to read it comfortably, although I can read small text, just not very easily, and my ability to do both is variable, whereas my overall eyesight is very stable, I think that in both our cases, this is probably caused by convergence insufficiency.

Regarding reading music, which I remember you find very difficult to see, I struggle when the print is small and things are very close together. It starts off hard to see and often improves as the rehearsal goes on, as if it takes a while for the muscles which turn my eyes in, to get going. Sometimes it is worse than others. Last night we were playing a small copy which I could relatively easily see the week before, but last night I felt that I was really straining to see it, and asked the conductor if he had any of the large print copies left. It was one of the first things we played, so the situation may have been different later.

I don't believe that I have any latent hyperopia, and although 44 years old, my eyes have always been like this, and I don't yet have or need a reading add (I was given the option of a +0.25 add, which my optician didn't feel was necessary, so I didn't bother with it). For someone who has a very small distance prescription and no real need for a reading addition, at times I find it incredibly difficult to see well enough to thread a needle with my distance prescription, which makes me think it must be my convergence insufficiency.

I know I have it, as does my optician, so since I have always been concerned with getting my distance prescription right, I have never discussed my near issues. As I said above, they are intermittent, inconsistent and not in my opinion prescription related, so I don't bother to mention them.

I therefore think in your case, since you also have convergence insufficiency that you should wait until you are happy that you have been given an accurate distance prescription before mentioning specific near issues, other than you are concerned that your distance vision may be under corrected since you are struggling sufficiently at near to need a +1.00 reading addition at only 21 years old, even though you have been told that you have good accommodation.

What I am trying to say, is that I believe that you are interested specifically in whether your near issues are caused by your distance prescription not having sufficient plus (although I wouldn't mention this at your appointment), and I would say no more than that your distance prescription doesn't seem strong enough even for distance, and is inadequate at near to the point that you are having to wear +1.00 reading glasses over your contacts, which will hopefully result in the ophthalmologist considering whether your distance vision is fully corrected with your current prescription.

Best wishes

Lou


Weirdeyes 11 Jan 2018, 12:36

Lou

Iíll tell him I have trouble with threading a needle and seeing the computer screen since I was a kid. I also have to magnify text to see it comfortably. I think this makes it more like a visual issue. I think itís best to not focus too much on binocular vision issues. I feel like thatís distracted people in the past. I think when farsightedness is bad enough it kind of masks astigmatism. When my left eyeís farsightedness wasnít corrected the letters just looked too small to read when it was actually a pretty big line. When it had a +3.25 lens it had the usual smudged astigmatism look and it didnít look super small like before. When I read text through my left eye with no correction it looks like thereís too much contrast and the text vibrates. That could be interpreted as a binocular vision issue, visual processing issue or over sensitivity. But since glasses help I know itís refractive error. My mom has the same issue. I think it will be best if I keep complaints simple and answer the doctorís questions.


Lou 11 Jan 2018, 04:25

Hi Weirdeyes

Thank you very much for clarifying the date of your appointment, and letting us know that you are female, so that we can refer to you as she/her. I wouldn't see it as a worse or best outcome, rather as the first step in solving your vision issues. Even if he finds your prescription to be the same as your last undilated appointment, you at least have the opportunity to query why your correct full distance prescription gives you eye strain even for distance, and why at only 21 years old and when you have been told that you have good accommodation, that you need to additionally wear +1.00 readers over your contacts for close work. Hopefully he will be willing and able to give you an explanation, or be prepared to look into your concerns further. You can also ask if he thinks that there is any particular reason why your right eye prescription keep decreasing whilst your left is remaining pretty constant. I'm sure that he will consider this to be a reasonable question.

I fully appreciate that it would be reassuring if your symptoms can be explained by latent hyperopia being present, but if it is not found, you need to politely insist that your eye strain is so uncomfortable, that you really need to get to the bottom of it, and would ask what other tests he can do, and if there are no further appropriate tests, whether he can refer you for some type of vision therapy or to another type of eye care professional who specialises in helping patients with eye strain. As long as you are genuinely experiencing eye strain symptoms such as aching, burning, or other discomfort, I'd be inclined to exaggerate to some extent how bad these symptoms are, so that something is done about them, and would not mention headaches or migraines, only the symptoms which you have which are directly related to your eyes, so that they are put down to being eye related and not to another cause.

If you are suffering from headaches rather than actual eye symptoms, I'd suggest keeping a diary of what you have been doing visually, to see whether they definitely appear to be caused by eye strain, as as much as you want your problems solved and want an accurate eye prescription, if they are only considered as a primary eye problem, and they do in fact have another or other causes, this could lead to these other causes failing to be diagnosed or more importantly treated.

I know my last paragraphs seem contradictory, but as greatly as I personally believe that you do have genuine eye problems that are contributing to your already underlying anxiety, I feel that it is very important not to self diagnose and to find the true cause of your symptoms. In my opinion, if the eye strain symptom are occurring in the eyes, this is suggestive of it being an eye problem. If you are primarily suffering from headaches, it could be owing to eye strain or it could be another cause, and I personally would want to see a pattern between specific visual tasks and headaches, to be confident that they are definitely eye sight related, as you don't want to see the wrong specialist or have the wrong type of treatment.

I wouldn't mention having previously had a failed dilation, as you will appear to be self diagnosing that there was previously something to find and the dilation failed to find it. I believe that if latent hyperopia is not found this time, that you need to accept that this isn't the cause, and it is now the case of asking for further tests/referrals to ascertain what is causing your symptoms.

I shouldn't think that eye colour is a factor. If your pupils are small, the ophthalmologist will not only notice, but fully understand what affect if any, having small pupils, would have on your vision/eye comfort.

Additionally, regarding the 20/20 line looking small, the problem is that neither you or me either in that regard, really know just how small it is supposed to look. As you already know, a visual acuity of 20/20 is the minimum level of normal human vision. To have 20/20 vision rather than 20/15 or even 20/10, the 20/20 line must be the smallest one you can read. This suggests to me that people with 20/20 vision are supposed to see it as the smallest line they can possibly see, with in turn means that it must have to look small. That you can read it means that you have 20/20 vision or better.

I fully appreciate that there are two reasons why somebody can't read a line, the first is that they have a refractive error which is blurring/distorting the letters, and the second is that the letters are just too small to see at that distance. However in practise, the two probably rather go hand in hand, with the better the focus, the smaller the minimum letter size which you can see. This makes sense in that if the lines of the letters are very sharp and well defined, the individual lines of the letters remain distinct at a smaller size, than if there is any fuzz or distortion to them.

You mention that the letters do not look blurred or distorted only very small. If you were simply long sighted with no astigmatism, I can fully understand this being the case. You however have more astigmatism than me, and with my very small amount of astigmatism, I see blur and distortion rather than a small letter size. Why is this? Maybe it is simply because you are a different person and it is simply how your brain interprets what it sees? I don't think that I would mention image size, as I believe that the laws of optics determines image size, and the image size you see, should be consistent with your prescription.

Since you are unhappy with your current prescription and feel that it may not be correct, I would explain to the ophthalmologist that you are worried about giving the wrong responses during the subjective part of the test, as your last few prescriptions haven't seemed quite right when worn on a daily basis, and would they mind objectively determining your prescription via a retinoscope, to see whether you choose the same prescription as they would prescribe if you were unable to communicate. My optician did this for me, when I told her that I was worried about ending up with a wrong prescription owing to not responding accurately, and it enabled me to relax in the certainty, that my subjective prescription choice agreed with the objective prescription determined by the optician. I feel that you too will probably be more confident in the accuracy of your prescription, if you feel that you and the optician have come to the same conclusion.

Regarding how to act, I would suggest being calm, and demonstrating that you are willing to listen, and have trust in the professional. I don't think that there is any need to appear particularly anxious, as this is just a routine appointment. You however obviously need to show that you are interested in being at the appointment, and in getting to the bottom of your problems.

I really hope that all of this will help you.

Best wishes

Lou


Weirdeyes 10 Jan 2018, 12:13

I do try to use laymen terms. I just notice they misunderstand me a lot. I guess Iíll just look at my notes where Iíve written down my most concrete symptoms like eye strain at the distance, my unstable right eye prescription and trouble seeing my computer screen and small details.


Lou 10 Jan 2018, 10:08

Hi Weirdeyes

I will still reply properly later, but for now a quick answer.

I wouldn't mention any self-testing, or appear to have any knowledge over that of a lay-person, as the Opthalmologist could dismiss your concerns as those of someone who has been reading up on the subject and self diagnosing.

I would simply act normally, as it is only a routine appointment, not overly anxious, but not too laid back either. I would make polite conversation, answer what you have been asked, but otherwise appear interested in listening to his findings (I'm not for one moment suggesting that you wouldn't do any of this).

I would simply said that you are experiencing eye strain even in the distance with your current prescription, you cannot understand why at only 21 years old and after having been told that you have good accommodation, why you have to wear +1.00 readers over your contacts, and query whether this could mean that for some reason your eyes are not accepting your full distance prescription, meaning that you need to wear additional glasses for reading. Putting it in these layman terms and not mentioning latent hyperopia or needing extra plus etc., should in my opinion give you the best chance of being taken fully seriously.

I'll reply properly tomorrow or Friday.

Take care

Lou


Aaron 10 Jan 2018, 08:01

Cactus Jack, thank you so much for the information. Most helpful. I last had my eyes examined 5 years ago, so am not surprised by the changes. Anyway, I like wearing glasses.


Lou 10 Jan 2018, 06:50

Hi Weirdeyes

Thank you very much for your detailed reply. I'm short of time today, so will take the time to reply properly either tomorrow or Friday.

Best wishes

Lou


Weirdeyes 10 Jan 2018, 02:35

Lou

My appointment is on Jan 18th. Iím trying to prepare for the worst and hope for the best. For me the worst case scenario is not finding significant latent hyperopia and just having ďlazy eye musclesĒ and being a neurotic female. The last time I got my eyes dilated it didnít reveal any latent hyperopia besides my left eye being +4.75.

Another weird thing is when I was wearing a +3.25 contact lens in my left eye I think the autorefractor said I was +2.25 in both eyes. I wasnít even dilated. But with that dilated exam I remember +1.75 was less than sharp in my right eye. I didnít notice any vision changes besides not being able to focus up close. Iím hoping they used those weak dilation drops that often donít work for people. I really hope cyclo drops work well for my eyes. Should I mention the failed dilation or will that just prove I donít have latent hyperopia? Maybe this happened because of my brown eyes. I also think I have pretty small pupils compared to other people.

Iím mainly scared of being seen as neurotic which is why I avoided mentioning my symptoms before. Iím still trying to work out which symptoms are worth mentioning. Should I even mention I find the 20/20 line tiny and almost impossible to read or that I stick my head forwards a lot of the time to try to see better? Should I even mention migraines or will all my symptoms just be blamed on migraines?

Should I even mention some experiments/tests I do at home. I know that testing is a classic OCD compulsion. But I do have genuine interest in eyes. Iíve been interested in eyes and vision long before I even got glasses. I bet Iíd be on this site asking a bunch of people what itís like to need glasses if I had perfect vision. Iím just worried my interest in eyes will make me come across as a hypochondriac.

I donít even know how I should act. Should I try to be calm and matter of a fact? Or should I let a bit of anxiety and emotion show? I know acting too emotional causes problems, but Iíve heard not acting emotional enough also causes problems. Being an OCD female going to the doctor is the worst. I think everyone here is tired of my OCD, which is why Iím not too popular. It seems like Likelenses hates me because I have OCD. OCD really sucks.


Lou 10 Jan 2018, 02:05

Hi Aaron

Thank you very much for confirming your age.

Hi Weirdeyes

Did you see my couple of questions?

Best wishes to you both

Lou


Weirdeyes 09 Jan 2018, 21:22

It seems like overminusing/underplussing masks astigmatism. When I wear the +1.00 glasses I notice how inconsistent my toric lenses really are. Often times it gets more fuzzy when my eyes feel dry. When Iím just wearing the lenses I donít notice as many changes in clarity. I guess this explains why my right eye has always been more inconsistent.


Cactus Jack 09 Jan 2018, 20:46

Aaron,

I suspect Presbyopia is beginning to happen and you may have a little Latent Hyperopia.

Presbyopia happens to almost everyone. It actually starts in childhood, but typically does not become a nuisance until the late 30s or early 40s. It seems to happen a little sooner to people with Hyperopia.

Hyperopia is the ONLY refractive error that you can correct internally, using your Ciliary Muscles and Crystalline Lenses. People with low Hyperopia often correct it, without their being aware that they are doing it. When your Ciliary Muscles squeeze your Crystalline Lens to correct Hyperopia, for a long period of time, the Ciliary Muscles have difficulty relaxing completely for distance vision. That difficulty is called Latent or Hidden Hyperopia. When you correct Latent Hyperopia with Plus glasses, your Ciliary Muscles will very slowly relax and your need for external Plus will increase. Depending on many factors, complete relaxation may take weeks or months. As it happens you will need more plus in your glasses. It probably won't be a very large number.

At some point, you will probably need either Bifocals or Progressives. As your Ciliary muscles relax, that will make more close focusing accommodation available, which in turn may delay your need for Bifocals or Progressives, but it will inevitably happen.

When all this happens depends on your Visual Environment and requirements.

Hope this helps,

C.


Aaron 09 Jan 2018, 18:48

I am 37


Lou 09 Jan 2018, 15:27

Hi Aaron

Would you mind saying how old you are.

Many thanks

Lou


Aaron 09 Jan 2018, 14:27

Been wearing low plus lenses since I was in college. Primarily have used my glasses when reading, studying and computer work. Went to the eye doc last week and received a new prescription---+1.25 (r) and +1.50 (l). An increase over previous prescriptions. The doctor recommended that I wear these glasses full-time now. I still see well at a distance w/o glasses, but have been trying diligently to comply with the doctor's recommendation. Is this need for full-time glasses wear just part of the old eyes process? Are progressives on the near horizon? BTW, so far the glasses are working well for me, at all distances.


Lou 08 Jan 2018, 05:45

Hi Weirdeyes:

Re.:

-----------------------------------------------------------

Lou

I definitely think my personality/OCD is playing a role in my vision issues. Just not in the way a lot of people think. A lot of people think being OCD makes my issues less legit. But I think in a way itís the opposite because Iím more likely to compensate harder. So my problems are harder to catch. So it looks like Iím exaggerating to people. So I avoid mentioning symptoms to not seem neurotic. The positive to this for me is no amblyopia. My left eye can be corrected to 20/20 or even 20/15 in some lighting. I also remember asking to get my eyes tested at five years old and no one finding any problems. This extends to other health issues as well. Doctors donít tend to believe I have certain health problems because I donít look sick enough.

--------------------------------------------------------

I fully agree with what you say, and think that your eye worries are adding to your anxiety rather than being caused by anxiety. This is the reason that I strongly feel that you shouldn't mention anxiety unless you are specifically asked, and even if/then, make it very clear that your visual worries are contributing to your anxiety and NOT the other way round.

Just for interests sake, would you mind saying whether you are male or female. Not that it makes any difference, but it would be nice to accurately say either he or she, or his or her, when referring to you.

Also, would you mind letting us know the date of your appointment. I'd like to wish you luck the day before, and look out to see how you got on. One of the issues with the style of this forum I find, is that you cannot receive notifications when someone posts to a thread that you are following.

Best wishes

Lou


Likelenses 08 Jan 2018, 01:12

Weirdeyes

It would not surprise me if the doctor would put you on a cycloplegic for several weeks to months, to keep your accommodation paralyzed while getting used to the new glasses, which would be needed full time, and perhaps be bifocals.

After this period of time on these eye drops,you will be totally dependent on glasses,

Here is an article describing the process.

Hyperopia

E. Harb, in Encyclopedia of the Eye, 2010

Examination Techniques of Hyperopia

Optical correction should be based on both static (normal accommodation) and cycloplegic (e.g., 1% cyclopentolate) retinoscopy, accommodative and binocular assessment, and AC/A (accommodative convergence/accommodation) ratio. The correction should then be modified as needed to facilitate binocularity and compliance. Plus-power spherical or sphero-cylindrical lenses are prescribed to shift the focus of light from behind the eye to a point on the retina. Accommodation plays an important role in determining the prescription. Some older patients with hyperopia do not initially tolerate the full correction indicated by the manifest refraction, and many patients with latent hyperopia do not tolerate the full correction of hyperopia indicated under cycloplegia. However, young children with accommodative esotropia and hyperopia generally require only a short period of adaptation to tolerate full optical correction. Patients with latent hyperopia who prove intolerant to the use of full or partial hyperopic correction may benefit from initially wearing the correction only for near viewing; or alternatively, trial use of a short-acting cycloplegic agent may enhance acceptance of the optical correction. Patients with absolute hyperopia are more likely to accept nearly the full correction, because they typically experience immediate improvement in visual acuity.

Read full chapter


NNVisitor 07 Jan 2018, 23:40

Weirdeyes

I've gone to several opthalmologists over the years and I don't recall any time I had to fill out forms. They would thorougly check my eyes and my vision. This is what opthalmologist's do.

Let's leave anxiety and related issues out of this important appointment. Lots of people are anxious. The opthalmologist is an eye specialist. Not a psychologist etc. It's better not to divert attention away from the vision issues which are the reason for the appointment.

Best of luck for a positve outcome from this appointment.


Weirdeyes 07 Jan 2018, 18:36

Lou

I definitely think my personality/OCD is playing a role in my vision issues. Just not in the way a lot of people think. A lot of people think being OCD makes my issues less legit. But I think in a way itís the opposite because Iím more likely to compensate harder. So my problems are harder to catch. So it looks like Iím exaggerating to people. So I avoid mentioning symptoms to not seem neurotic. The positive to this for me is no amblyopia. My left eye can be corrected to 20/20 or even 20/15 in some lighting. I also remember asking to get my eyes tested at five years old and no one finding any problems. This extends to other health issues as well. Doctors donít tend to believe I have certain health problems because I donít look sick enough.


Lou 07 Jan 2018, 14:51

Hi Weirdeyes

I fully understand, and agree that it would be nice to know if you have latent hyperopia, and whether this is causing your symptoms. I can fully understand why you are concerned regarding having eye strain at distance with your current rx.

Sorry, I have no idea regarding depth perception. As well as seeing an Orthoptist regarding convergence insufficiency, I also saw somebody else regarding my eye tracking, which has always been poor. When I was twenty, an optician queried how I was able to read at all.

The lady I saw regarding my eye tracking, said that I had eye tracking difficulties consistent with having dyslexia, but I did not appear to be dyslexic. She was also surprised that although having poor eye tracking, two dimensionally I am able to complete tasks such as finding an x in grids of o's (or vice versa, I forget), not only within normal timescales, but on the quick side of normal. I put this down to having sight read music from a young child, and having read a lot as a child. The conclusion was that although I have eye tracking difficulties, they do not particularly cause me problems two dimensionally.

Three dimensionally however, I didn't do particularly well on the tests, which is not surprisingly as I am a terrible tennis player, as I cannot line up a bat and ball, have terrible aim (I once played Quasar as an adult, a group shooting game with laser guns and sensors on players vests, and they thought that my gun was faulty, as my score was consistent with a four year old. I don't think that it was!), and can only catch small objects, if I turn my head and use one eye. Since I do not enjoy ball sports, probably because I am useless at them, can do what I enjoy and have successfully driven a car for many years, I have never worried about or considered my depth perception. It is either normal, or normal for me, to the extent that I know how to deal with it, in much the same way as in spite of my eye tracking difficulties, I can read music, and perform well on 2D eye tracking tasks.

I had to cancel my next eye appointment owing to personal difficulties, and when I went to re-appoint, funding had been withdrawn for people over the age of 14. I couldn't afford to pay, and didn't feel that it was worth it for something which wasn't bothering me, so I never got a diagnosis, other than the initial one that I have a developmental condition which has the symptoms of weak eye muscles, eye tracking difficulties, and weak thumbs. I have never been particularly good with my hands either, struggling to peel veg for example, even though I successfully play the trumpet and flute. Although neither bother me, I would say that I have extremely minor coordination issues with my hands (probably owing to having weak thumbs) and not great hand eye coordination. Since I was born this way and manage perfectly well except for ball sports, which I don't do, I don't worry about it at all.

Hopefully this will be of some interest to you.

Best wishes

Lou


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