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Hyperopia and Presbyopia Progression

For and about anyone having difficulty seeing near/reading.

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Charlie_Delta 24 May 2017, 08:40


In honor of your chosen nickname, I send to you my knee-jerk reaction to your stark warning (thank you for this) as spoken by the Honorable Gentleman of South Carolina's Second District:


I find it fascinating that the human eye can accommodate a prescription like yours up to about age 40. You've had a purdy heavy script, I must say. DITTO sentiment on Cactus Jack. What a godsend! He's the only resource I’ve discovered who is (a) willing and (b) effective at explaining what the hell’s going on with my sudden change in vision. I’m right at age 40 (can’t tell if you’re 40 or 45) and though I can still force my eyes to focus even very small text up about 12 inches, it isn't easy and after a short stretch of time causes a pretty bad headache and just stops being able tot focus at all. Like you though, I’m very much on edge about total dependency on glasses -- even though it's only a matter of time.

By wearing glasses, are we accelerating the natural declination of our eyes’ ability to accommodate/focus? I suppose I won’t give a damn after the day comes whereby I literally can’t focus on *anything* at arm's length, but that day isn't right now and I sure don't want it to come sooner than it has to.

Let us know how you like progressive lenses. The super cheap-ass ones I got through Zenni do out-perform multifocal contacts. Everything is super sharp now, at all distances. As example, I can no see every nuance on a slice of pizza I’m in the middle of eating, then glance at a TV across the room and back to said slice of pizza without any delay in focusing. They're awful for computer work, though.

And regarding hyper-vigilance with changing eyes, weaker eye, pondering vision in general; I share in this with you and think it's probably very common for people around our age to experience. I mean, hey, we’re losing the ability of a *major* sensory device to function as it has for a lifetime without some sort of device. Not to mention, plus lenses (progressive no less) make me now feel genuinely unworthy to hop inside a mosh pit or or doing a few keg stands at the village fraternity house. But, then again, there's THIS guy:


SC 23 May 2017, 08:44

Matt, Rubydues &others,

I think you will be shocked at what happens as you get towards 50. In your early 40s the I expect terms like comfort and HD but going forwards you will probably miss one line of the eye chart each year. This is irrespective of whether your Rx increases - even if it stays the same things will get worse without glasses.

+2.5 will likely mean the whole chart will be illegible.

Having to get glasses was never the biggest surprise - seeing my vision get worse and worse without them was totally unexpected.

Check out the vision simulators such as

This give a reasonable view of what you can expect to come.

 20 May 2017, 05:33

Matt 20 May 2017, 05:08

Thanks Charlie for your words about vision, glasses and presbyopia. I have been wearing my glasses full-time for over a week now and all is going well. Both distant and near-point vision are remarkably clear and crisp. No doubt that I should have been wearing glasses before now----just did not want to give-in to a sign of getting older----but it is really great to see items on my phone very CLEARLY and no longer be squinting, wishing for brighter lighting, or longer arms. Also, the prescription for distance is working well.

Charlie, though I am a few years older than you, there is no doubt now that I would have benefitted from glasses at age 40.

Jack, appreciate you sharing the postings. Always good to hear of others "aging eyes" experience.

rubydues 19 May 2017, 03:59


If it`s any consolation I am going through the EXACT same thing as you ( add a few diopters!).

I have always been farsighted (hyperopic) and as a child wore very strong lenses and was actually patched because of a weak eye. To this day the weak eye remains weak. The funny thing is through my later childhood, teens, 20s and 30s I rarely wore my glasses. As far as I was concerned I had perfect vision. I only remember needing them when I got tired, but got through universtiy without any need for corrective help (my prescription I think was somewhere is the range of (OS: +1.75 -.5 OD+3.75 -1.25). It was interesting when people put my glasses on and felt like they were going to have a seizure and asked how I could possibly get by without wearing them. I often wondered too, but figured I had just grown out of my condition.

Fast forward to 40....little did I know that all these years I was actually growing INTO my prescription! In the last 5 years I have come to discover and presbyopia and hyperopia are a ugly combination! I went from only every wearing my glasses when I wanted to, to NEEDING my glasses now for almost everything, and I HATE IT! ;)

I can still get by outside doing things like yard work or biking, running, etc. without having to have my glasses but life it a lot easier with them. Like you, I have had a hard time accepting this and find myself forcing myself to go without my glasses for certain stretches just to keep those muscles strong. I am not sure it is a worthwhile test!

I actually though something was seriously wrong with my eyes and went down a month rabbit hole of going to about 6 different optometrists to understand what is going on. I can say that not one of them explained this combination more accurately than Cactus Jack.

Like you, I have also had little luck with contacts. I have tried single lens, multi-focal, toric, etc. each has an element of compromise that I do not like. There also has not been one optometrist who can explain why this is.....and I like to know WHY!

Currently, I await my first pair of progressive lenses that arrive next week with the following prescription:

OS: +4.5 -1.25 Add 1.5 BO 1.5

OD: +2.5 -.-5 Add 1.5 BO 1.5

Clearly, I have the added challenge of having a significant difference in lens power, which also has never been a problem until recently which I never noticed before. AS I get older for the first time I realize how my weak eye seems to affect my overall vision . Perhaps it is because now I am very much paying attention to how I see whereas before I never gave it a thought.

Anyhow, all that to say you are not alone as you transition accepting the hyperopia/presbyopia mix!!


Cactus Jack 18 May 2017, 16:44


Glad you found the Macrae "saga" informative. It does get long at one reading, but remember that it actually occurred over several months.

One thing I don't think has been mentioned, is that vision actually occurs in the brain. Your eyes are merely biological cameras.

The brain has amazing ability to correct images IF it knows what something is supposed to look like. In fact the brain can create images without any input from your eyes. Ever had a dream or any form of hallucination?

It appears that the brain can develop and store different image processing "programs" and can load the appropriate one as necessary rather quickly. If you have a significant change in vision, it may take a few days or weeks to develop a new program to deal with the changed situation.

Often, new glasses wearers complain that their glasses have made their vision worse. Not really. What happens is that your brain has had years of experience with what you considered "normal" vision. Internal vision correction usually takes a lot of work and effort on the part of your brain. When you wear vision correction, the delivered images are already corrected optically and your brain has a lot less work to do. Once your brain has discovered its workload is less with vision correction, it really does not want to go back to the old way.

Think of glasses or contacts as labor saving tools. Also, keep your sense of humor.


Charlie_Delta 18 May 2017, 12:52

Thanks Jack,

The amateur science/tech geek in me has enjoyed learning about all-things optics and the physiology behind presbyopia/hyperopia – and also; what to anticipate. It's been a lot to adjust to, both physically and psychologically, but also comforting to realize I’m not alone and that other's experiences are very similar (if not identical) to my own.

Macrae’s story points out a TON of relatable "firsts." I must stay, sifting through a “Little House on the Prairie” manuscript was a doozie, but I did gain from many takeaways. Like him, the disappearance of chronic DAILY headaches has been the biggest win of all for me, by far. I think the differential between my right and left eye had a lot to do with that. I also can relate to his comment about the appearance of lights in the dark, for example headlights in oncoming traffic. I just assumed my entire life that *everyone* saw headlights with a streaks radiating in all directions. It was absolutely MIND-BLOWING to me that glasses made that terrible annoyance disappear (making nighttime driving much safer probably, too).

Less enjoyable, I also experience something else that others have written about: dependency. Now, taking glasses off after several hours at the office makes everything significantly more-blurry at near distances (compared to prior to wearing lenses). I am NOT a fan of this and wasn't warned it might happen. That said, it's the lesser of many evils (and life in ultra HD has been truly awesome).

Just by learning from you, Jack, the blurryness I see without glasses is unfortunately becoming less of a temporary effect that gets better with a little bit of time. The obvious giveaways (like Macrae) are particularly apparent early morning with things like the bedside clock or shampoo bottle in shower. This signals to me that in a pretty short order, the ciliary muscles in my eyes are starting to relax. In addition to dependency, the other adverse impact appears to be a rapid change in required prescription to have a maximum benefit of vision correction.


* I see better at far distance within the intermediate area of the lens.

* The ADD needs a slight boost. I hold an aspirin bottle past 1-foot to read tiny print.

* My corrected near-accommodation ability is weaker in my right eye than left by 4” or 10cm (I was crazy enough to take the tape measure out of the junk drawer to actually measure this with said aspirin bottle)

Based on the above, I flipped my single-vision computer glasses upside-down, covered left eye, and looked through the weaker of the two lenses (+1.00) to see through right. Result was an extremely slight of blur at infinity. My progressive glasses Rx for right eye is currently +0.50 sph, but I think it's closer to +0.75. Left eye might still be plano.

To climb out of this rabbit hole, my main point is that for people in my predicament, it doesn't make sense to spend and arm and a leg on progressive glasses until the adjustment/acclimation phase is through. In my case, I'm still in the middle of it I think.

I do need to buy a back-up pair of glasses however, and will probably buy the same rimless frames I previously bought on Zenni, but this time around I plan to add +0.25 to right eye sphere power and another +0.25 to the ADD of both lenses. My thinking is that this pair will become the everyday pair. As I see it, a quarter-diopter adjustment is too miniscule to really do harm anyway.

If the above method works, perhaps I just wait on going back to the eye doctor until I’m past 12 months from the previous visit, and make adjustments on the script of these $67 glasses every 4 months or so.

Cactus Jack 17 May 2017, 14:35

Charlie_Delta and Matt,

I would like to suggest that you take a look at Macrae's Story on the Vision and Spex site, Fantasy and True Stories thread.

It is a well written, funny, and classic series of posts by one of our members coming to grips with the fact that he needs glasses.

Here is a link that might work.


Charlie_Delta 17 May 2017, 13:37


If it makes you feel any better man; I’m two years younger than you with the exact same thing going on. The situation kind of sucks, but I’d take glasses ANY day over crappy vision. I’d take note of the point Cactus Jack made to you, that it’s very possible – maybe even more likely than not – that your prescription will change in the coming months. I’ve personally noticed changes happening in 60 days, and I also agree w/ Jack that it’s not worth putting up with discomfort or sub-par vision after you’ve made the plunge to wear lenses full-time. My plan is to have another vision test around the six month point from starting to wear contacts (that’s when the contact supply runs out), and probably will buy a good pair of glasses and properly fitted lenses at that point in time. Best of luck!


Matt 17 May 2017, 09:01

Thanks for the contact lens information Charlie.

Much appreciated. After my presbyopia settles

down, I may check out CL mutifocals. For now,

Just trying to adjust to my old eyes and wearing

Glasses for the first time

Charlie_Delta 16 May 2017, 08:01

Cactus Jack,

Thanks a ton for the unabridged overview. Very much appreciated, albeit also sobering as I come to grips with a likely decline in vision acuity in my years ahead. Spexfan; TY as well. I’m less than enthused to become dependent on lenses and would MUCH rather preserve my focusing ability, but realize based on your and others’ experiences, and Jack’s posts, that progression of presbyopia will probably exacerbate existing hyperopia, thereby impacting distance vision too (“latent hyperopia” – I’m learning, slowly!)

Jack, Re: your Zenni recommendation, turns out I was one step ahead of you. A few weeks ago I bought a rather cheap pair of progressive glasses by using the Rx prescribed by my optometrist. My thinking was that if I hated the lens design (regardless of wrong “seg-height” or “canal wideness”) I probably won’t buy expensive/properly fitted progressive lens glasses. At any rate, the Zenni order has arrived and I was able to immediately adjust. Remarkable improvement over multifocal contacts, so there you go, Matt! Progressive lenses absolutely outperform multifocal contacts, which leaves me in a somewhat annoying crossroads as I prefer not to wear glasses (especially w/ “plus” lenses) full time. Above all, I *do* want perfect vision though, so this decision is being forced on me apparently.

There was also a discovery with this Zenni experiment concerning my distance prescription: I notice that I can see things at far distance much better through the intermediate part of the lens. At first I though this was just magnification of image, but after experimenting a little while in a stationary position, I can see letters on a sign 300’ away that I cannot see through the top part of the glasses. Curious what you all suggest I should do: go back to the eye doc, or try and improve the script myself at next Zenni order. My hope is that this is just a preliminary snafu and not a case of rapidly changing eyes after 60 days. If the latter is the case, it makes no sense to buy expensive frames and lenses until things stabilize. Damnit, getting old SUCKS!


Cactus Jack 15 May 2017, 19:13


What you are experiencing IS typical of a person who is Hyperopic (farsighted) and Presbyopia is becoming a nuisance.

What is happening is a bit complex and very mysterious if you do not understand optics or how the eye works.

People who have Hyperopia, as you do, have a rough time when Presbyopia starts creeping up on you and you start needing glasses, initially to help you focus close, and ultimately for both distance and close.

Many people who have mild to moderate Hyperopia are not even aware that they do. The reason for this is that Hyperopia is the ONLY refractive error that you can correct internally, using some of the resources of your auto-focus system (your Ciliary Muscles and Crystalline Lenses).

One of the things that often happens to people with Hyperopia is they develop what is called Latent or Hidden Hyperopia. Latent Hyperopia occurs when the Ciliary Muscles get so used to squeezing the Crystalline Lenses to compensate for Hyperopia, that they have difficulty relaxing to allow the Crystalline Lenses to return to minimal PLUS power for distance. The Ciliary Muscles are like any other muscle. If they maintain a position for a long time, it can be hard to relax the muscle. Then along comes Presbyopia to complicate the situation.

Presbyopia, which is the gradual stiffening of the protein that makes up the Crystalline Lens. When you are born, your Crystalline Lenses have the consistence of freshly made gelatin dessert. You Ciliary Muscles have no difficulty squeezing your Crystalline Lenses to focus very close. From childhood to adulthood, your Crystalline Lenses gradually get stiffer until along about the late 30s or early 40s, the lenses get so stiff that the Ciliary Muscles have trouble squeezing the lenses.

Incidentally, Presbyopia often affects people with Hyperopia at an earlier age than those with Myopia. That is because a person with uncorrected Hyperopia is using some of their Accommodation Range to add the extra PLUS needed to see distant objects clearly, which reduces the amount of Accommodation available for focusing close.

The symptoms of Presbyopia becoming a nuisance usually start with apparent need for the arms to be longer. Then the need for low power reading glasses. This need will likely increase until it reaches about +2.50 or +3.00. It strictly depends on how close you like to read and the size of the text. Phone books used to be the culprit that drove people to get some PLUS help. Today, it is Smartphones.

There is also something else going on. For their size, the Ciliary Muscles are the strongest muscles in the body. Like all muscles they need exercise. Before you get close focusing help, the Ciliary Muscles got plenty of exercise. When you get reading glasses, the amount of exercise the Ciliary Muscles get is reduced. That causes them to loose their conditioning and get weaker. That is why the reading glasses power or the Add power will increase very fast, however, it will never increase beyond about +3.00 unless you like to read close.

Getting PLUS glasses for distance can start another slow process if you have developed some Latent Hyperopia. Your Ciliary Muscles will start relaxing and your Crystalline Lenses will begin to also relax, reducing their PLUS power. That means that the missing PLUS has to be supplied externally. The relaxation process can take months if you have been hyperopic for a long time, but it will ultimately stop and your prescription will be stable for many years. It is nearly impossible to tell exactly how much Latent Hyperopia a person has or how long it will take for it to resolve. Just rest assured that it will.

Frequent glasses changes are one of the reasons we suggest ordering glasses on line, at least until your prescription stabilizes.

Hope this helps some.


spexfan 15 May 2017, 16:08

Hi all.

Posted about this earlier in the year, but regarding the recent comments:

Am currently +1.75/+1.5 with +2.25 add. Started wearing progressives fulltime about 3 years ago, aged 44. Have noticed the this really helped my eyes relax and also led to about an extra +2.5 in power for near since then. Also discovered I needed the distance rx to see anything clearly in the distance. So once you start with the near add, I think you'll find things move quickly.

My experiences with the multifocal contacts are similar to yours. If I wear them regularly/daily, my cognitive system adjusts and I get pretty good vision, slightly compromised both near and far, but definitely acceptable. Not ideal for long periods of reading though. But often forget I'm wearing them. However it's hard to switch between the glasses and contacts as the glasses give much better,pin-sharp vision at all distances. So mostly I save the contacts for public situations where I can't be bothered having the 'you wear glasses?' conversation.

Planning to have an eyetest in the next few weeks to see where I'm at, feel like I might need an extra .25 near and maybe distance also. Have been enjoying the whole presbyopia thing, but I'm a glasses fetishist, so not the average patient I guess!

Charlie_Delta 14 May 2017, 10:27

Hi Matt,

Re: glasses adjustment, I can only speak to wearing contacts all day, and/or removing them to instead wear single-vision glasses for computer work (not my full near Rx). To the latter, I’ve had a lot of “I didn’t know you wore glasses” comments at the office, to which I reply laughing “either did I.” Re: multifocal contacts; my experience has been that my single vision glasses absolutely outperform the contacts for computer work, but that contact are generally acceptable for most things. …and as mentioned, I’ve become increasingly dependent on requiring some sort of lens for doing close-up things lately, so maybe my eye muscles are relaxing for the first time (requiring lenses now). Whatever the cause, it does seem my prescription is changing a little; so I’m holding off on purchasing progressives until I have another refraction done in another few months or so.

I’d compare multifocal contacts to racing a car in all-season tires on a race car (better DOES exist), so they’re a trade-off of sorts. If you or anyone wants to try multifocal contacts, my suggestion is to NOT do what I did, by trying them without (a) having progressive glasses and (b) never having wore contacts before. This is because there are actually THREE separate adjustments to endure. The first two are physical adjustments that involve trial-and-error adjustment, those being contact lens size/type/manufacturer, and secondly being the multifocal CL prescription for refraction (which can be different from a progressive glasses script). The third adjustment is neurological, and in the contact lens world, this particular adjustment ONLY applies to the multifocal type. Basically your retina suddenly is receiving both a clear and a blurry image at simultaneously, and has to try and ignore the blurry one. Miraculously, it does! ..just not overnight, which puts your brain in hyperdrive for many days. Day-1 was screwy awful. Days 2, 3, 4 got dramatically better, and speed at focusing near-to-far-to-near continued improving for three weeks.

The problem a MF CL trial is that it’s impractical to do so if you require doing near-distance work with optical clarity. I ended up using them only for a few hours a day at first, because they were hampering my ability to get work done at the office.

If they exist; plano contact lenses (no prescription at all) would be a cool way to get one of the three adjustments out of the way early on (the physical lens fitting). You could do that one while wearing progressive glasses. Doing all three adjustments at the same time without backup progressive glasses was nuts and I can’t believe I actually did that. On the bright side, the trial and error process was free for me, and in my case, stuck with the preliminary prescription and lens: Air Optix monthly Multifocal.

My intent is to drop some real money fairly soon on a locally-fitted, high-end pair of progressives (probably a rimless frame from Lindberg). I think my prescription is still changing though as commented in my last post, so I may hold off a little while and have another refraction before doing so. Hope that helps.. Cheers!

Ved 13 May 2017, 22:18

I can command my eyes to be blurry at near distances. I have read here that its farsightedness. How can my eyes stay blurry? So i can wear glasses than having headaches while reading, thanks

Matt 13 May 2017, 17:11

Charlie, thanks for sharing your experience. After 3 days of having glasses, I am still working to get used to wearing them and keeping them on my face full-time. How long did it take you to get where you were comfortable in glasses? Also, how you you like the multi-focal contacts? Do they work better than glasses? Thanks for your guidance.

Charlie_Delta 13 May 2017, 13:47

Informative thread here! I'm age 40 and fall in the same predicament outlined by Matt in his recent post. I've never had vision correction of any kind before about two months ago. I'm now in multifocal contacts all day long and recently have required glasses on my face (when the contacts aren't in) for doing just about anything up close. My OD said I'm slightly hyperopic in my right eye (+0.50) and presbyopic: +1.50 ADD for glasses and +2.00 for multifocal contacts.

Relevant to Cactus's recent post, I'm noticing some unexpected changes lately and these I wasn't really warned about. Cactus,

You responded just below (to Matt's post) that "it is also very common for there to be a need for some prescription changes both for distance and for reading over the next few months or maybe a year."

This explains a lot. Though I never bought reading glasses at full Rx, I did use computer glasses at Rx (+1.50 right / +1.00 left) before MF contacts, and still use those at times I want perfect vision at computer monitor distance. My frustration is that in only two months, I can no longer use those for early morning or late at night reading etc in low light (two months ago however, they great for this). I have two pair at that Rx and as a simple test, wearing one pair over the other is a substantial improvement in spite the right/left Rx imbalance. My concern is that too much ADD is going on at my age. This doesn't seem normal, especially all of the sudden. Any thoughts on that?

I'll also say that the little +0.50 boost to my right eye has been a mind-blowing life-changer for far distance clarity, and the biggest unexpected find of all; I've been cured of daily chronic headaches. Hadn't the slightest clue the root cause of those was vision strain. Voila! Killed two birds with one stone!


Charlie Delta

Soundmanpt 12 May 2017, 07:58


You're +2.00 readers are probably helping you because something is better than nothing, but you have a fairly decent amount of astigmatisms in both eyes (that's the -1.25 / -1.00 under CYL) Astigmatisms effects your eyesight at all distances which of course includes your near vision. So I get the feeling that the readers are maybe only for reading in bed at night? So for only reading maybe an hour the readers may work okay, but you probably should have gotten +2.25 or even +2.50 for that. But chances are if you were using the readers for much longer your eye would start to feel very tired.

Do you already have bifocals? You have enough of a distance prescription that driving without full correction would be unwise.

guest 12 May 2017, 05:43

I am very slightly short sighted, RE -1.25, -1.25 x 175, LE -1.25, -1.0 x 60, (ADD +3.50 both eyes). I find that +2.0 ready reader glasses work fine for close work.

Would there be any benefit in getting proper prescription reading glasses, ie with the Cyl correction included. What difference would it make?

Thanks in advance!

Matt 11 May 2017, 19:00

Thanks NN and CJ for the information. This morning I picked up my glasses--progressives--and started my new adventure. Wore them at work this afternoon---received a few compliments and some ribbing about "old eyes". Since picking them up, I have worn them full-time and both distance and near vision seem very good. Just need to discipline myself to wear for full-time use and not just a readers.

Cactus Jack 10 May 2017, 18:58


Don't worry about it. It is very common for a person, who is mildly farsighted (hyperopic), to not realize that they need vision correction. Hyperopia is the ONLY refractive error that you can correct internally, using your Ciliary Muscles and Crystalline Lenses (your auto-focus system), to supply the extra PLUS you need - often without your being aware that you are doing it. Most people notice it when Presbyopia finally creeps up on them, as in your case.

Hyperopia, Latent Hyperopia, and Presbyopia can be hard to understand if you don't understand the optics of the eye and how vision works. All three require PLUS correction even though they have three different causes.

It is also very common for there to be a need for some prescription changes both for distance and for reading over the next few months or maybe a year. Don't be surprised if it occurs. The key thing is to NOT deny that it is occurring and don't put us with discomfort. A key thing to remember is that the changes WILL stop and your prescription will be very stable for many years. There is no way to tell when or where the PLUS for distance will stop, but the Add will stop between +2.50 (40 cm or 16 inches)and +3.50 (28 cm or 11 inches)depending on how close you like to hold things when you read. At some point, you may need an intermediate lens (trifocals) to help you focus on things, such as a computer display, that is about 60 cm (26 inches)away.


NNVisitor 10 May 2017, 12:44


Your eye muscles were helping you see things close up. That's why you weren't aware.

Matt 10 May 2017, 11:46


Just got my eyes examined and was a little surprised by the outcome. I am 42 years old and had started to struggle a little bit when reading small print and trying to read up close in dimmer light. After a little period of denial, finally visited the eye doctor. Yes, presbyopia has arrived: +1.25 needed for reading. The big surprise ---- I am also farsighted. Right eye +.75 and left eye +1.25 The doctor said that I should have been wearing glasses before now. Any others had this experience? Why had I not had eye trouble previously? Trying to get used to wearing these glasses full speed.

Maurice 29 Mar 2017, 12:24

Plus Tony, good to hear from you. Glad the single vision lenses are still doing their job. Keep us posted when you graduate to multifocal lenses. Thanks, Maurice

Plus Tony 23 Mar 2017, 11:14

Hello Maurice

Not yet. I'm still wearing my single vision prescription 100% of the time but there has been so sign of any deterioration in my vision. I know that I can handle a bit of extra plus for distance from my own experiments and although I have been tempted to self prescribe I have stuck to my official prescription for now partly because I am very fond of the glasses that I usually wear. Remarkably even though I've been wearing specs full time for over 18 months I still encounter people who haven't seen me wearing them and who ask all the standard questions which I still quite enjoy. I would be happy to have an increase but I'm prepared to be patient.

Maurice 22 Mar 2017, 12:47

Plus Tony, hope that you are seeing well. Just wondering if you had yet "graduated" to bifocals/progressives?

hooked 13 Mar 2017, 15:37

Thanks for your Explanation.

No, it is clear for me that a doctor doesn't Support any efforts in getting more myopic or hyperopic and I don't Support that, too. But I read some links and maybe there are some People who want to stay with their used-to refraction error. In any case you usually need glasses after the Operation (may it be reading glasses or some small shortsightedness) hence there may be not so much a difference.

Cactus Jack 13 Mar 2017, 10:08


I am not an Eye Care Professional (ECP), but an Amateur in the original French sense as a person who studies or learns a subject out of Love of Knowledge. Most of what i have leaned about vision is in trying to solve my own vision problems when I could not get satisfying answers from my ECOs.

My background is Electronic Engineering and Computer to solve Industrial problems. I have done quite a bit of industrial teaching and have a reputation as a pretty good explainer.

Most Eye Surgeons will offer choices when deciding what IOLs to install during Cataract Surgery. However, they try to get close to 6/6 or 20/20 vision. I am 79 and had Cataract Surgery in 2001. I opted for Mono-vision where one eye is close to 0.00 and the other is about -1.50. Mono-vision allows me to function without my glasses, but I wear trifocals when I need really good vision.

Most Eye Surgeons will install IOLs that let you remain Myopic or Hyperopic, IF you have a very good reason. The reason most of them became doctors is that they want to help people have better lives. They are psychologically disposed to try to make things "better". Some will install IOLs that make a person more Myopic or Hyperopic, but there usually needs to be a confirmed diagnosis of BIID (Body Integrity Identity Disorder)

These days, few people have the old type Cataract Surgery where the Crystalline Lens and Capsule are completely removed. There has to be a medical reason for not replacing the Crystalline Lens with an IOL. If the Crystalline Lens and Capsule is completely removed, the surgery goes from a fairly easy, low risk, Outpatient procedure to a serious, risky, surgery that often requires weeks or months for recovery. it becomes necessary to wear very high PLUS glasses which severely limit peripheral vision.

Before you wish very high PLUS glasses on another person, you need to get some experience wearing them. You can do that by doing some GOC with some high minus contacts and appropriate high PLUS glasses.


hooked 13 Mar 2017, 07:43

Thank you for that excellent explanation. I didn't know these details.

I was just wondering because I always thought hyperopia won't increase when getting older.

Are you an expert?

You mentioned cataract surgery and you mentioned one can choose the final prescription.

Do you think (or know any studies) that there are some people which won't be corrected to zero diopters but prefer to stay myopic/hyperopic?

Cactus Jack 10 Mar 2017, 08:07


The amount of her increase is very small, in the overall scheme of things. It is interesting that at age 20 her prescription was approximately +6. it decreased over the years and then started increasing at an age where Presbyopia becomes a factor. Her distance prescription is almost where it was at age 20.

The laws of Optical Physics are NOT variable and the tissue that makes up the eyeball, while not a rigid a bone, it is pretty dense and stiff. 1/2 diopter change is really tiny and the cause could be anywhere. Could the eyeball have shrunk 0.15 mm, sure, but it is more likely that there was a tiny change in the eye's lens system.

The eye's lens system actually consists of 4 PLUS lenses, but we only typically think of the Cornea and the Crystalline Lenses. The other two lenses are actually liquids. The Aqueous Humor (AH), between the Cornea and the Crystalline Lens, and the Vitreous Humor (VH), inside the eyeball, between the Crystalline Lens and the Retina. The AH does not contribute much PLUS and the VH contributes more. The Index of Refraction of the Humors can change as ones blood chemistry changes. The Humors seem to be particularly sensitive to Blood Glucose (BG) levels, that is why people with Diabetes experience vision changes as their BG changes. Often, Diabetics who do not have good BG control will have several pairs of glasses with different Sphere prescriptions so they can pick the pair that gives them the best vision at any particular time.

Typically, the changes are much more than your wife is experiencing and the changes occur at different times of the day, rather than over years.

It looks to me like your wife's vision has been very stable for years, I don't think you should expect much of an increase or change in the future, other than her Add, unless she likes to do a lot of very close work. It looks to me like she might still have some accommodation, available, but not a lot. There might be a little "trading" of PLUS between here Sphere correction and her Add. None of this is anything to get excited about.

At some point she may need Cataract Surgery and at that time, she can select what prescription she would like from that point forward.

Here is a link to a paper entitled "The Eye" you might find interesting:


hooked 10 Mar 2017, 05:26

What I can tell you. My wife's optometrist told her it is quite normal to have an increase in hyperopia starting from age 40.

Even if Cactus Jack gave an explanation I'm wondering why hyperopia increases because that would mean that the eyeballs become shorter. And I can't find any reason for that.

@Cactus Jack: I don't agree completely with your theory. My wife wears glasses all the time hence the muscles can relax and the eyes were dilated to get the amount of latent hyperopia, too. Hence I assume this increase is not due to some "uncorrected" latent hyperopia. But maybe I'm wrong.

spexfan 09 Mar 2017, 23:50

Am fascinated by the rx increases of hooks' partner ie. she seems to have gained about +3.5 diopters total since presbyopia started at 40....but +1.5 of that went to her distance rx over time.

I've always been hoping to increase my + distance rx since I got multifocals. Just got a +.25 distance increase at my last exam which was slightly blurry at first but is very clear 3 months later. I've gained a total of +2.5 since I started wearing multifocals (since about 10 years ago...I'm 47 now.) but +2.25 of that went to the add.

Maybe I've got a bit a few distance rx increases ahead?! Would be curious to hear more from hooked or others with similar situations. FYI I am currently +1.5/+1.75 add +2.25.

Cactus Jack 07 Mar 2017, 11:10


Your wife likely had some Latent Hyperopia along with her actual Hyperopia, but there is really no way to tell, now. True Hyperopia is caused by a mismatch between the total PLUS optical power of the eye's lens system and the distance from the Crystalline Lens to the Retina. The typical cause is that the eyeball did not grow quite enough in adolescence. The distances involved are small, only about 0.3 mm per diopter.

Hyperopia is the only refractive error that can be corrected internally using one's Ciliary Muscles and Crystalline Lenses. Often without a person even being aware that they are doing it. Over time, the Ciliary Muscle gets used to the constant correction and has difficulty relaxing. When that happens, the condition is called Latent Hyperopia. That typically works until Presbyopia begins to become a factor and an Add is needed. As the Add increases, and takes over the focusing workload, the Ciliary Muscles begins to relax and more PLUS is needed for distance vision along with more PLUS for close focusing help.


hooked 07 Mar 2017, 08:42

I had some spare time and read this thread form the beginning.

It is still quite interesting.

10 years ago I wrote that presbyopia sets in. I was 41 at that time. Now I need reading glasses and even for things far away glasses may help (for the right eye, the left one is still fine).

And then an update on my wife's progression of hyperopia and presbyopia.

Age 20: + 6 (average, for OL subtract 0.5, for OD add 0.5)

Age 25: + 5.5

Age 30: + 5

Age 40: + 5.5 ADD + 1

Age 45: + 5.75 ADD +1.5

Age 48: + 6 ADD 2

Age 51: + 6.5 ADD 2

I always thought hyperopia won't increase but it might be the case.

I must admit (we're kind of a fetish side) I like that her farsightedness increases.

And there is a big difference in magnification and cut-out (as the opposite to cut-in) between the + 6 and the + 6.5 glasses. But this might also be due to the different kind of frames.

Cactus Jack 02 Mar 2017, 08:37


The difference is only 1.75 diopters, it just happens that your Right eye is a bit nearsighted (-1.00) and the Left Eye is a bit farsighted (+0.75). Nothing to get excited about except that it affects your depth perception and 3-D vision and makes you vision system work harder than it should have to. You are probably doing close work with with your Right Eye and distance with your Left.

You really should get glasses and wear them full time for about 2 weeks before deciding how often to wear them. I think you will be amazed at how comfortable it is to have both eyes working as a team, rather than independently.

Vision actually occurs in the brain. Your eyes are merely biological cameras. You brain has been working overtime to correct your vision. It is better to correct your vision optically and relieve your brain of the extra work. You may think, after wearing your glasses for 2 weeks, that the glasses have made your vision worse. That is not true, all that has happened is that your brain has learned to work with high quality images and has set aside the image processing algorithm it has been using. You can force it to go back to the old algorithm by not wearing your glasses, but it will probably complain.

In some ways, glasses or contacts are just labor saving tools. Most of us are "hooked" on things that make us comfortable or save work. Could you become "dependent" on your glasses? Yes. I am pretty dependent on clothes and shoes because I don't have fur or hard surfaces on my feet to protect them from stones in the walkway. I am also dependent on my glasses because I like seeing comfortably and well.

May I ask your age and where you live?


BB1 02 Mar 2017, 06:30

Cactus Jack

I didnt know its pretty common. Most people i know who wear specs are nearsighted in both eyes. I was just diagnosed w/ antimetropia. My prescription is OD -1.0 OS +0.75. My eyesight is somewhat fine, I just have difficulty driving at night, and occ headaches.

Should i get glasses? And if i should, should i wear it full time?


Cactus Jack 02 Mar 2017, 05:56


It is fairly common. What makes it rare is if there is a large difference. It its more rare for the eyes to have exactly the same prescription. Differences of 1 to 3 diopters are pretty common, but usually they are on the same side of 0.00, but they don't have to be.

Eyeball growth is usually at the heart of any Refractive Error and nothing requires that the eyeballs grow at the same rate. The actual cause of Myopia or Hyperopia is a mismatch between the total optical power of the eye's lens system and the distance from the back of the Crystalline Lens to the Retina. In an adult eyeball of about 25 mm diameter, because the eye's lens system is inset, the distance is about 17 mm and the total power is about +59 diopters. If you do the math, it is about 0.3 mm per diopter.

The most common problem, caused by a big difference or a difference on opposite sides of 0.00, is the difference in image size on the Retinas. That can cause symptoms of double vision, that typically cannot be corrected by prism in the glasses.

May I ask your prescription and the problems you are having?


BB1 02 Mar 2017, 01:59

anyone here have antimetropia / 1 eye nearsighted and 1 eye farsighted?

Cactus Jack 20 Feb 2017, 23:30


It takes a little explaining, but I think I can help you understand how the test works.

The first thing you have to remember is that corrective lenses are just that. They have the opposite sign of the actual refractive error. To keep the numbers straight, I call the reverse of the glasses your "Eye Power" or EP. For prescriptions below about +/- 4.00 your glasses power and your EP will be the same but with different signs.

Because you are Hyperopic, your EP is -1.75R/-1.50L A person who is Myopic will have a + EP corrected by - lenses.

The only purpose of the + reading glasses is to move the point where the text just gets fuzzy around the edges to an easily measured range of less than arms length.

However, you don't want it too close, because it actually gets harder to measure the distance accurately, which causes errors. The test is crude enough without encouraging errors. if I suspect or know that a person has a pretty low refractive error, I suggest +1.50 or +1.75. Because you are Hyperopic with a known prescription and Presbyopia. We have to modify the test slightly.

You should do the test with your glasses on, which should correct you to about 0.00 for distance.

Theoretically, you could do the test using your reading Add, but I think it would be easier and more accurate to wear readers over your glasses.

The math is not difficult to understand, but you have to remember what I talked about in the first paragraph and understand the fundamental formula in optics.

Lens power = 100 cm or 39.37 inches / focal distance.


Focal Distance = 100 cm / Lens power

Step 1 is to calculate the Focal Distance of the OTC readers you will be using.

lets say that you are using +1.75 readers. The Focal Distance is 100 cm / 1.75 = 57 cm.

If a person is significantly Hyperopic or Myopic you have to adjust the OTC reader power, which may be difficult or do the test with their glasses on and the OTC readers over them.

When you do the test, the difference in the measured focal distance and 57 cm is the refractive error or EP. If the measured focal distance is MORE than the calculated focal distance, their EP is (-) MINUS and they likely need more PLUS to correct it. If the measured focal distance is LESS than the calculated focal distance of the readers, their EP is (+) PLUS and they likely need more MINUS to correct it.

The amout is easily calculated by dividing the difference between the calculated and the measured distance into 100 cm.

Hope this helps. Review what I told Fubius and see if it makes sense. He got some funny results on the second test and I am still trying to figure out what is going on. I hope he responds soon with answers to my questions.

Let me know if you need more help.


spexfan 20 Feb 2017, 20:49

Cactus, could you explain the formula you've applied to calculate Faubius' hyperopia? ie. the plus power lens/legible distance/under-or-over correction?

I'm wearing +1.75R/+1.5L with a 2.25 add and am curious to know how I'd tolerate a little extra plus power. Would be interested in doing some experiments.


Cactus Jack 20 Feb 2017, 15:35


Sorry about repeatedly getting your name wrong. The spell checker is changing it and I didn't catch it. Spell checkers are great, sometimes, but other times they are a nuisance.


Cactus Jack 20 Feb 2017, 01:58


Post below is for you. Sorry about the typo.


Cactus Jack 19 Feb 2017, 16:14


I am a little confused by the results of your second test.

The first test with the +2.00 reading glasses indicated that you may be a bit hyperopic. The +2.00 glasses were OK, and the 58 cm results indicate that. If you had a 0.00 prescription the distance should have been 50 cm with the +2.00 glasses. 58 cm indicates that your refractive error, early in the morning is about +1.75 (100/58 = 1.72) with the +2.00 glasses. The difference is about -0.25. When dealing with eye prescriptions, you have to remember that the glasses or contact prescription is the reverse sign of the actual refractive error in the eyes. -0.25 in your eyes means that you need +0.25 to correct it. In other words, mild Hyperopia.

However, based on your 2nd test results, after a day of close work, I thing there is something going on that we have not identified. That is not to say that it is serious, we just need to figure out what is going on so you can describe it to the Optician.

Were you wearing the +2.00 glasses for the 2nd test?

I would have expected that after a day of close work, you might be temporarily a bit Myopic. If so, and you were wearing the +2.00 glasses, I would have expected the fuzziness to start at a closer distance than 50 cm, not 77 cm. If you were NOT wearing the +2.00 glasses and got 77 cm, it just means that you have some temporary "Pseudo" or false Myopia which is easy to address.


I may ask you to do some other tests.


Faubius 18 Feb 2017, 03:09

Cactus Jack

i've done the test procedures you described,unfortunately i had to use a +2 pair because i didn't find the one you asked for,i hope it's not a problem.

However with test procedure 1,the fuzziness was between 57cm and 59cm for an average distance of 58cm.This test was in the morning at inside home with a good sunlight not too bright as you suggested.

And test procedure 2,which was more hard to measure since the fuzziness started beyond my full arms lenght,so take in count that maybe ther's a slight margin of error,anyway in this case the fuzziness was between 75cm and 78cm for an average distance of 77cm.This test was done at with artificial light settled at medium level and after doing extensive close work.

i also casually noticed that my eyes are not the same since my left eye during the misurations had an average difference with my right eye of around 10cm.

I hope i've provided enough datas,what does all that mean?

P.S.I also tried to look around the web to test my eyesight for near with some eye charts and it happens that i could read around half of it in most cases,i don't know if it's important just wanted to add more informations

 17 Feb 2017, 15:56


An eye exam is not like an exam that you might take in school and there is really no way to study for it. However, you can prepare for it and learn about your role in the exam. The best eye exams are a team effort between you and the Examiner. Part of the preparation is to learn what to expect, particularly if this is your first eye exam.

One important thing you need to keep in mind is that the Examiner has no way to experience what you are seeing. He/she has to depend on your answers to questions.

There are two parts to an eye exam. The first part is the Objective part. This part consists of:

1. Taking a Visual History where you describe your vision and the kinds of problems you are having.

2. Checking the internal pressure in your eyes for symptoms of Glaucoma. This is one of the very few parts of an eye exam that is even mildly uncomfortable and the discomfort only lasts for a few seconds. There are two basic ways to do the pressure test.

A. Using a special instrument to lightly touch your Cornea. Not to worry here. Before doing this type of test a drop of mild anesthetic will make sure you don’t even feel it.

B. There is a new type instrument that uses a puff of air directed against your cornea. No anesthetic is required, but the puff will startle you. The puff of air is harmless and there are huge benefits. Detecting Glaucoma early, before it can do damage can save your eyesight.

3. The examiner will also get a preliminary estimate of your refractive error by using an Auto-Refractor or manually by using a small hand held instrument called an Ophthalmoscope or Retinoscope.

The Auto-Refractor is a relatively new instrument that was developed in conjunction with NASA to check Astronauts vision in space. You look into the machine with each eye individually where you will see a scene or a pattern. The machine will adjust its internal lenses to focus the image you see on your retina. The Auto-Refractor only takes a few seconds for each eye and it then prints out your estimated prescription.

Some Examiners prefer to use manual methods that have been used for many years. Using an Ophthalmoscope or Retinoscope and a Trial Lens set or a Phoropter (a fancy machine with a built in lens set), the Examiner will look into your eyes and select the lenses that allow him to see your retina, most clearly.

The object of this part of the exam is to get a starting place for the Subjective part of the exam where you have to describe what you see.

Typically the Subjective part of the exam starts with the Right Eye shutter open and the Left Eye shutter closed.

Step 1 is typically determining the cylinder and axis of any Astigmatism correction you need. This is actually the hardest part of the exam because you will be asked to judge relative blurriness of two images rather than the sharpness of an image.

You will be shown a line of text and a supplemental lens will be rotated into place. This lens is a cylinder lens that is mounted on a 45 degree pivot and can be flopped back an forth to bracket a trial axis or orientation of the long axis of the cylinder lens. The thing that is confusing about this test is that the straight lines (strokes) of the letters will alternate in clarity as the lens is flipped back and forth depending on their direction. I suggest concentrating on an “O” if possible. Depending on your answers, the examiner will adjust the axis knob unit the image you see is equally blurry with the supplemental lens 45 degrees each side of the selected axis.

At this point the Examiner will probably swing the supplemental lens out of the way and may change the cylinder power while asking you which lens in clearer.

For your first exam, you may be uncomfortable asking the Examiner to let you fine tune the Cylinder Axis, but I have found that most will appreciate your wanting to actively participate. The way that works is that he will place your hand on the Axis control knob. This time, you move it back and forth a few degrees looking for the sharpest image. It is a bit like “Fine Tuning” an old Analog TV set or moving the tuning knob on an analog AM radio for the best signal.

The next step is determining the Sphere correction. This is an easy part of the exam because all you have to do is pick the sharpest image, but there is a tricky part. Your auto-focus mechanism will try to help, if it gets a chance. The Examiner has a couple of ways to minimize the action of your ciliary muscles and crystalline lenses.

The Examiner can, in effect, sneak up on your Sphere prescription or he can use drops to Dilate your eyes. Lets talk about sneaking up on your prescription first. There are actually 4 lenses in your eye’s lens system. All of them are PLUS lenses and the total power is about +56 to +60 diopters. The only variable focus lens is the crystalline lens whose PLUS power is controlled by your ciliary muscles. For distance, your Crystalline lens is fully relaxed and has somewhere around +15 diopters. When you focus to read, your Ciliary Muscles squeeze the Crystalline lens to increase its PLUS power by the amount necessary to focus which depends on the distance to the object.

This will take a little thought to get your mind around, but if you are nearsighted, your lens system has too much PLUS for the distance from the lens system to your retina and you need MINUS lenses to neutralize some of that excess PLUS power. You ONLY have the ability to increase the PLUS power of your lens system. You have NO ability to reduce the PLUS power of your Crystalline lenses more that fully relaxed.

To try to keep your Ciliary Muscles and Crystalline lenses from getting in the act, the examiner will start with NOT ENOUGH MINUS or TOO MUCH PLUS (same thing) and gradually increase the MINUS one or two steps at a time, while reducing the size of the line you are asked to read. He will not tell you what power lens or what line you are looking at. Eventually, he will reach the 20/20 line and a lens power that lets you read it with no mistakes.

He will then follow the same procedure with your Left Eye.

When he has completed both eyes, he will open the shutters and you may see two images. This part of the test is to check your muscle balance using some prisms. He will probably ask you to tell him when the two images are aligned horizontally and then vertically. While the images are separated, you have an important check to make. Compare the sharpness of the two images. If they are not equally sharp, be sure and tell the Examiner which image is clearer. If there is a difference, he will likely reduce the sharpness of the clearest image until they match. The important thing at this point is that they match. That lack of sharpness will be corrected in the next phase with both eyes working together.

Next he will fuse the images so both eyes are working together and repeat the Sphere procedure by gradually increasing the MINUS or decreasing the PLUS until you see the smallest line of letters very clearly.

That pretty much completes the exam except for checking your near vision with a small chart about 14 to 16 inches from you.

Many people, who wear glasses, actually look forward to eye exams. Once you have become accustomed to having very good vision, you will probably find anything less, unacceptable. Many times, after the exam, it will be suggested that you get another exam some time in the future. Note that I used the word “suggested”. it is NOT a Command. If your detect a problem or if your vision seems uncomfortable, please don’t wait until the “suggested” date to seek an appointment to get your vision checked.

Let me know if you have more questions


Cactus Jack 17 Feb 2017, 15:54


I would like to suggest two things. There is a relatively easy test you can do at home to get an idea of your vision. The test is a practical application of the principles of optics codified by Sir Isaac Newton around 1700.

You will only need 3 things to do the test.

1. A pair of Over-the-Counter (OTC) Reading Glasses of +1.50 or + 1.75 power. These glasses will cause some artificial Myopia to make the test easier to do and more accurate and get the distance where the letters just become fuzzy around the edges into an easily measured range

2. A measuring tape that can measure about 100 cm.

3. A book or newspaper with average small print. (The target)

Test Procedure 1: Morning test when you are fresh.

In good, but not BRIGHT light, put on the Reading Glasses.

1.Hold the book or newspaper about 30 cm from your face and gradually move the Target away from your face until the text just starts to get fuzzy around the edges.

2. Note the distance from your face

3. Repeat steps 1 and 2, Three times and average the results.

4. Tell me the results.

Test Procedure 2:

1.Repeat Test Procedure 1 when you have been doing extensive close work.

2. Tell me the results.

Be sure and tell me th power of the glasses and when the test was performed.

Also, I suggest you read "How to Study for and Eye Exam", which follows in the next post.


Faubius 17 Feb 2017, 14:54

Hello i'm a 22 year old guy from Italy,i found this website while searching informations about glasses and vision.

In the last months i've noticed that my vision is not perfect anymore,at first i thought it was caused by allergies or tired eyes since i started to work in front of a computer screen for many hours at day.

But now i'm thinking that maybe i have hyperopia because the symptoms i'm actually having are:when i start to read a book/journal or at the screen of the computer/tablet/smartphone my vision is perfectly clear but after 1/2 minutes it gets really blurry to the point i can barely make out the letters even if they're quite big,and when i look far it's still blurry(only for some minutes and for small things),although blinking and squinting very much and putting things a bit far,help in reducing a bit the blurriness to a manageable level it still give me a lot of eye strain and headaches.

I wanted to hear your opinion about it before booking an eye test to the optician,my last eye test was 10 years ago and at that time i had perfect vision so maybe something changed,i don't even remember what happens during the eye test so if you could give me informations about it,it would be great

So what's your opinion?Do i have hyperopia?Am i going to get glasses?

P.S. Sorry for my bad English,i should've studied it more in high school

Catwoman 12 Feb 2017, 10:28

Cactus Jack:

Thank you for the wealth of information. I had no idea of "true and false" myopia or anything about the crystalline lenses and celery muscles. :)

The 2 pairs of cateyes that I wear on the weekend do have progressive lenses, while the 5 pairs I wear the rest of the week are regular bifocals. I use the computer all the time at work, and I have plenty of light in my office. I have not noticed any problem with reading the screen, home or away. At home I read more close-up, mainly newspapers and magazines, quite often during commercials of TV programs, so the multi-vision (as opposed to single-vision) lenses help.

For very small print I may take my glasses off and look at it a few inches away, as not even my +2.75 add can do the trick. The same applies for when I apply makeup or eye shadow (only for special occasions anymore).

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