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Medical Forum / General / Vision / February 2006

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Eye exam advice?

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nospam@everest.net - 28 Dec 2005 21:56 GMT
I gave up trying to get a new trifocal prescription a few years ago
after not being able to see out of the new lenses from different eye
drs. So I just kept my old lenses. Now my lenses are cracked and
scratched so I'm forced to go through this again.
I think I've isolated the prescription problem. A while back I noticed
that I can actually see distant objects much clearer through the
middle part of the trifocal than I can through the top part when I'm
indoors or outdoors after dusk. So when I drive at night I tilt my
head back and look out of the middle part.  But the distant objects
are much clearer through the top part when it's light outside. I think
the low level of light during the failed exams caused those
prescriptions only to work at dimmer light levels. How do they deal
with this during the eye exam? Is there any way I could get a
prescription that would allow me to see the most clearly at medium
light levels?  That would be preferable.  I'm getting a stiff neck :)
Just had my picture taken and I looked like an idiot with my head
tilted halfway back looking at the camera :(

HELP!
Mike Tyner - 28 Dec 2005 22:15 GMT
> are much clearer through the top part when it's light outside. I think
> the low level of light during the failed exams caused those
> prescriptions only to work at dimmer light levels. How do they deal
> with this during the eye exam?

This is pretty rare, only when conditions like nuclear sclerosis causes more
refractive change in the center of the crystalline lens than at the
periphery.

Otherwise, refractions are generally _more_ accurate in low light, when
large pupils reduce depth-of-field, so that brighter light (smaller pupils)
increase the range of vision with a given refraction.

> Is there any way I could get a
> prescription that would allow me to see the most clearly at medium
> light levels?  That would be preferable.

Ask the doctor to perform refraction with the room lights up, then "trial
frame" the prescription outside the exam room. With your new prescription in
a trial frame, loose lenses can be held up momentarily to show that more,
and less, correction are not as clear.

-MT
William Stacy - 29 Dec 2005 01:50 GMT
OK for starters your Rx is WAY OFF.  You are using them incorrectly for
a that reason, and the only way to fix it is to fix it. Try another doc,
and make sure that the doc is not too young (a lot of young docs don't
seem to "get" the idea of trifocals.

w.stacy, o.d.

>I gave up trying to get a new trifocal prescription a few years ago
>after not being able to see out of the new lenses from different eye
[quoted text clipped - 17 lines]
>
>  
Dick Adams - 29 Dec 2005 05:03 GMT
With regard to the condition reported in news:f506r196uonl5d6d0vl53rgicnqonnfv8t@4ax.com...
I had similar experience attributable to a small central cataract.
Newly prescribed eyeglasses were fine for the affected eye in
dim light, but vision in daylight was not very sharp.  Also it may
be mentioned that developing cataracts may shift one's vision
toward nearsightedness.  Your eye care provider should be
able to notice a cataract if you have one.  Well, maybe not if he
happens to be one of those here -- these are too busy blasting
me and Otis and Ace.

--
Dicky
William Stacy - 29 Dec 2005 06:12 GMT
  Your eye care provider should be
> able to notice a cataract if you have one.  Well, maybe not if he
> happens to be one of those here -- these are too busy blasting
> me and Otis and Ace.

I for one am not going to blast the DOA group (double entendre' fully
intended)any more, because it is a big waste of time. You could be right
about an incipient cataract, but it could also be diabetes.  My take on
the o.d.s here is that any of them could easily do the diagnosis and
correct the problem.

w.stacy, o.d.
nospam@everest.net - 15 Feb 2006 01:13 GMT
>I gave up trying to get a new trifocal prescription a few years ago
>after not being able to see out of the new lenses from different eye
[quoted text clipped - 15 lines]
>
>HELP!

Here's an update from my previous post.  I finally went to the eye
doctor and got a new prescription, frames and trifocal lenses.  The
first prescription was nearly 3 times the strength of my glasses.  It
was a dismal disaster.  I couldn't see very well inside, and when I
went outside, I was nearly blind.  So he wrote a new prescription,
reducing the sphere in both eyes by .50.  Then I could see very well
inside, but when I went outside everything was still blurry.  But at
least I didn't trip over any garbage cans this time!

After comparing the vision through each of the 4 lenses (2 in the old
frames and the 2 in the new frames) and switching eyes to look through
each one, and with no glasses at all.  I found that my very best
vision outside in the daytime was with my old, weak glasses, and the
very best vision inside at lower light levels was with my new,
stronger glasses.  Driving at night with my new stronger glasses is an
absolute pleasure!

So now my outdoor daytime glasses are my old ones which are:

R: +.75 +.79 x 179 deg
L: +.50 +1.00 x 007 deg

And my new (indoor & outdoor night) glasses are:

R: +1.75 +1.25 x 162 deg
L: +1.00 + 1.50 x 177 deg

Here's the problem.  Because the new ones are twice as strong as the
old ones, I can't see very well at levels of light that are halfway
between those two extremes through either set of glasses.  Also, due
to the nature of my work, I have to go back and forth many times per
day between differing levels of both indoor and outdoor light.  My job
requires pretty good vision at all levels of indoor and outdoor light.

Please correct me if I'm wrong, but I'm guessing that the problem is
that those two pairs of glasses each require a different optimal pupil
size for my eye configuration, i.e., the weaker pair only focuses the
light directly on the retina when the pupil is smaller, and the
stronger pair only focuses directly on the retina when the pupil is
larger.

I was guessing that if I were to try to use filtered flip-up
sunglasses attached to my stronger (low light) pair of glasses to
somehow increase the pupil sizes when I'm outside, I might be able to
see outside with them as well.

So today I bought a pair of gray, polarized flip-ups, but nothing
outside was as clear with them flipped down.

Supposedly, the green portion of the white light spectrum is
responsible for changing the pupil size.  So I'm assuming that this
would be the color to filter out in order to make the pupil dilate
more.  But I don't know what sunglass lens color is required to do
that.

Any help would be most appreciated.

Half Blind Half of the Time
Dan Abel - 15 Feb 2006 17:16 GMT
> Please correct me if I'm wrong, but I'm guessing that the problem is
> that those two pairs of glasses each require a different optimal pupil
> size for my eye configuration, i.e., the weaker pair only focuses the
> light directly on the retina when the pupil is smaller, and the
> stronger pair only focuses directly on the retina when the pupil is
> larger.

The laws of physics say that you are wrong.  Note that I am not a
physicist or an eye care professional, and I have no experience with
trifocals.  Other than that, I'm your expert!

:-)

> Any help would be most appreciated.

Most people wear more "plus" lenses indoors because things are usually
closer, and less "plus" lenses outdoors because things are usually
farther away.  When you are comparing your two pairs of glasses, are you
comparing the same segment (perhaps the upper segment of the lens)?  
People wear trifocals so they can see far, middle and close all with the
same pair of glasses.

Signature

Dan Abel
dabel@sonic.net
Petaluma, California, USA

nospam@everest.net - 17 Feb 2006 02:05 GMT
>> Please correct me if I'm wrong, but I'm guessing that the problem is
>> that those two pairs of glasses each require a different optimal pupil
[quoted text clipped - 17 lines]
>People wear trifocals so they can see far, middle and close all with the
>same pair of glasses.

Perhaps I didn't elaborate enough.  Let me try this again.  Yes, I
realize that it's an unusual  problem.  I've had it for 10 years, and
it's taken me that long to figure out that my vision changes too much
as the level of light changes.

With these glasses:
R: +1.75 +1.25 x 162 deg
L: +1.00 + 1.50 x 177 deg

*Distant* objects are in focus at low levels of light, i.e., driving
outdoors at night.  But as the level of light increases these glasses
become increasingly too strong to see distant objects.

But with these glasses:
R: +.75 +.79 x 179 deg
L: +.50 +1.00 x 007 deg

*Distant* objects are in focus outdoors during the daytime.  But as
the light level decreases these glasses become increasingly too weak
for me to see distant objects.

In both cases I can still focus on nearby objects by looking through
the middle or lower segments *because* I can position my head at the
proper distance from those objects without having to move my body
closer to those nearby objects.

Obviously this is impossible to do with the distant objects.

Here's the pattern with the stronger glasses at higher levels of light
(like outdoors in the daytime):

The maximum distance that  I can still focus properly on objects
through the upper (distance) segment is 5'.  This should be farther
away, like infinity.

The maximum distance that I can still focus properly on objects
through the middle segment is 16".  This should be farther away.

The maximum distance that I can still focus properly on objects
through the bottom (reading) segment is 8".  This should be farther
away.

But at lower light conditions, I can focus on infinity, and can focus
on nearer objects through the appropriate middle or lower segments, at
the proper distance.

So the darker the environment becomes, the more in focus the image
becomes through all 3 segments, and it's the best at night.

With the weaker glasses everything is in focus at too far of a
distance through all 3 segments.  I can move my head farther away from
the nearby objects and still bring them into focus, but the distant
objects will still be out of focus.

I don't think this violates the laws of physics.  In a moderately
farsighted person without corrective lenses, when  the pupil dilates,
the focal length changes, so the image is focused past the retina.
But  the brain sees the slightly out of focus image and sends a
message to the ciliary muscles to change the shape of the lens, which
causes the image to become properly refocused because the this causes
the focusing point to be moved farther forward to the retina.

In my case, I think that the pupils are becoming the proper size for
the lumens of light, but that the focusing mechanism is just too weak.

Because the focusing distance of the glasses is fixed and the pupil
size has been set to a fixed position for that level of light  by the
brain, the image will only become focused directly on the retina at
"x" distance.  That " x"  distance is now determined only by the size
of the pupil because the focusing mechanism isn't strong enough.

So it's like a camera with a faulty, weak, focusing mechanism.  You
can still change the size of the aperture, but the object won't be in
focus unless you're at the proper distance.

I'm trying to determine a way to use the stronger glasses outside
during the day by using some sort of tinted flip-up shades to reduce
the light level.  I'm thinking that because I can see very well out of
them at night when the pupil is larger, I might be able to make the
pupil larger during the day.

I would really appreciate it if someone could make some suggestions.
It's like I need a dozen pairs of glasses to cover the different
levels of light.

Sorry for the long post.  But I just didn't think I was getting the
point across.  
 
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