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Medical Forum / General / Vision / July 2005

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What happened with my refraction?

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Quick - 27 Jul 2005 19:27 GMT
(I  gather it's called a refraction)
I got fitted for contacts.
I wanted bi/multi focals. I've been using +2.00
store bought readers for a couple of years now.

First exam the doc dilated and used the machine
you look through at the projected eye chart on the
wall. "better?", "how about now?", "and now?". One
eye at a time. Things looked pretty sharp. He trialed
me with acuvue bifocals. Outside distance was really
bad. Out of focus, blurry, maybe multiple images. I
figured it would take time for my brain to deal with
the multiple images.  Over about three weeks I went
back multiple times and he must have checked me
with the machine at least 3 more times. Once with the
contacts in. The distance never got much better. I
really didn't have a noticeable problem with my distance
vision before and this was notably worse. He said I
had a small astigmatism in one eye and very slight in
the other. I got the impression that he thought it wasn't
significant enough to take into account.

We started with:
Right: +0.75 add +2.50
Left:    +1.25 add +2.00

Then went to:
Right: +1.00 add +2.00
Left:    +1.50 add +2.00

Near was pretty good all the time. I got the impression
that he was pretty much done with me (like I'd used up
my trial shot and it was time move on). I suggested that
we try less distance power since it was *way* better
uncorrected.

Last shot:
Right: +0.50 add +2.50
Left:    +0.50 add +2.50

I had had asked to try a bit more add and I think the
+2.00 was a bit better. Too bad they don't come in +2.25.
The distance got much better but still the same problem
just not as bad -- actually about half as bad?

Anyway the last visit he said we'd tried just about everything
and "95% of people would be really happy with this vision".
Basically I think he was just done with me. I don't think he
was a quack or anything (nice enough guy) but I ended up
with the impression that when I signed up he was going to
put me in acuvue bifocals and that was it. I'm just writing it
off and will start over with another doc. I just told him to send
my supply to me with the last script -- probably just end up
tossing them. I really want to try RGPs.

I probably should have had him send me +0.00 add +2.00?
My main objective is to get rid of the readers.

My question is this: It seemed that I could see very sharply
when tested. Better than uncorrected maybe at distance.
Darkened room with projected eye chart. Looked to be about
15 to 20 feet. But only once for a bit did he have me looking
through both eyes at the same time. But outside of the exam
room my vision is worse at distance. Maybe past 20 or 30 feet
to infinity.

Any ideas? thanks,
-Quick
firebrandfaerie - 28 Jul 2005 13:26 GMT
If the room was a bit short, then far distance would be blurry and you
would have ended up with a stronger prescription. however, the OD
should know the room is a bit short and be able to compensate.
Dr Judy - 28 Jul 2005 16:41 GMT
> (I  gather it's called a refraction)
> I got fitted for contacts.
> I wanted bi/multi focals. I've been using +2.00
> store bought readers for a couple of years now.

snip
\ He trialed
> me with acuvue bifocals. Outside distance was really
> bad. Out of focus, blurry, maybe multiple images. I
[quoted text clipped - 3 lines]
> with the machine at least 3 more times. Once with the
> contacts in. The distance never got much better. >

snip

> Near was pretty good all the time. I got the impression
> that he was pretty much done with me (like I'd used up
> my trial shot and it was time move on

snip
> My question is this: It seemed that I could see very sharply
> when tested. Better than uncorrected maybe at distance.
[quoted text clipped - 3 lines]
> room my vision is worse at distance. Maybe past 20 or 30 feet
> to infinity.

If you had tried progressive glasses, single vision distance glasses or
single vision distance contacts, you likely would have also noted clear
distance vision in the real world.  Multifocal contact lenses do cause some
"ghosting" of distance vision that about 10% to 15% of people can't
tolerate.  If you are determined, you could try another fitter who has more
than one brand of multifocal to offer and who has lots of experience.  And
you might give monovision (correcting one eye only for near) a try.

In a case like yours, I would have considered trying the B&L multifocal to
see if it gave a better result.  Or would have tried a modified monovision
fit, using something like +0.50/ +1.50 add or pl/ +2.00 add in the right eye
and +1.00/+200 add or  +0.50/+2.50 add in the left.

It does take some fiddling to get multifocals to work.  I find that fitting
people who are used to just readers with no distance correction are among
the most challenging.  And some people's brains just won't accept any
multifocal contact.

Dr Judy
Quick - 28 Jul 2005 20:20 GMT
>> (I  gather it's called a refraction)
>> I got fitted for contacts.
[quoted text clipped - 44 lines]
> challenging.  And some people's brains just won't accept
> any multifocal contact.

Thanks for the response.

It's sounding a bit depressing as I was really looking
forward to the best case -- 6 million dollar man eyes
and no need to carry the readers... I am determined
to keep plugging and throwing money at it for a while.

I already have an appointment with the next doc. He
said he doesn't fit (many?) Acuvues or CIba because
he has too many failures with them. At least we'll be
into other brands.  I'm pretty determined to try RGPs
to at least see what they're like.

I guess if multifocals just don't work for me the next
choice would be translating bifocals? I really don't
want to do monovision as I don't want to sacrifice
depth perception.

How much of the flare off of lights is attributable to
multifocals as opposed to single vision?

If I went from multifocal soft lenses to translating
RGPs would I expect to see a noticeable reduction
in the flare and halo effect? (and the distance problems
I'm currently experiencing)?

thanks,
-Quick
doctor_my_eye@msn.com - 28 Jul 2005 21:55 GMT
Yes.  The quality of vision in gas perm multifocals is vastly superior
to soft lenses.  They are never even close to each other in quality of
vision.   I have 30 happy gas perm bifocal wearewrs for each "happy"
soft bifocal wearer.

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