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Medical Forum / General / Vision / January 2006Contacts & monovision
A friend of mine is doing this - she is 43 and was finding it difficiult to focus on reading matter. I wonder if I might try it in later life but have a couple questions. - how much would one of my eyes be undercorrected? - how easy is it to get used to that? It feels like it might seem odd (I only know how it feels to loose a CL) - what ages does it typically start to be necessary - what's the kind of level of prescription that it becomes necessary? Thanks alot Ive tried monovision and find that I have to close my dormant eye and use the non dormant, undercorrected eye. How much you undercorrect depends on the person but generally around -2 diopters of undercorrection works. I find that undercorrecting BOTH eyes works better. It does not hurt your distance vision as much as you think, you may only need a thin pair of glasses over them for driving or watching movies. Take your glasses off and leave them in the car and enjoy your shopping and with the slight undercorrection youll be able to see from half meter no problem. Youll also be able to see things in the distance fine except for tiny words. Some people just stick with bifocal or progressives glasses and they see clear from near and far. Contacts are a compromise to a presbyope. I get along best with a modest undercorrection I'm new to monovision and am doing really well with it. Of course, I have very mild myopia and just starting into presbyopia, so my distance and closeup strengths are weak. My right eye is corrected for distance (-.75) and my left eye is corrected for closeup (+.50). It only took a couple hours for me to adapt. It's really amazing how the brain selects the best vision between the two eyes (or blocks out the blurred image?). Amazingly, when I working at my computer, the vision is pretty much perfect. The distance of my monitor is clear in BOTH eyes. Maybe this is because of the weak strengths? I dunno. But I like this :) -Tom in Scranton, PA USA Ace, aren't you 23 years old? If you are, your ability to accommodate to focus on near objects is significantly different than for someone who is over age 40. Glenn Hagele Executive Director USAEyes.org "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org http://www.ComplicatedEyes.org I am not a doctor. "Ace, aren't you 23 years old? If you are, your ability to accommodate to focus on near objects is significantly different than for someone who is over age 40." Unfortunately it appears to be comparable to a 40 year old. I was tested at 20/50 on the near point snellen chart with my glasses. 20/50 is NOT adequate for seeing well from near. I have whats called arm's length near vision where I can see well enough to read if I hold things with my arms fully extended. This is neither comfortable nor convinent. With even -1 diopter undercorrection I can focus down to 10-12 inches and 18 inches is clear and comfortable. Without the undercorrection, 18 inches is a strain. I expect my presbyopia to worsen as I get older. > "Ace, aren't you 23 years old? If you are, your ability to accommodate > to focus on near objects is significantly different than for someone [quoted text clipped - 8 lines] > and 18 inches is clear and comfortable. Without the undercorrection, 18 > inches is a strain. I expect my presbyopia to worsen as I get older. Ace you are not presbyopic. If an eyecare professional told that you are then unfortunately you have been given the wrong advice. You may be pseudo-myopic or have some other accommodation disorder whether organic or drug induced, but it is not presbyopia. I know this with certainty because of your age. Dom dormant? tripping again ace? >A friend of mine is doing this - she is 43 and was finding it difficiult to >focus on reading matter. I wonder if I might try it in later life but have a >couple questions. >- how much would one of my eyes be undercorrected? This depends upon your needs. If you do a lot of reading the correction into myopia (nearsighted) vision would likely be more than if you do a lot of computer work. You can try correction for different distances to determine what is best for your needs. >- how easy is it to get used to that? It feels like it might seem odd (I only >know how it feels to loose a CL) About one-third of people who try monovision don't like it. There does not seem to be any middle ground. Either your brain adapts and it works okay, or you hate it. The only way to know is with a contact lens trial. >- what ages does it typically start to be necessary When you need reading glasses or bifocals to function. >- what's the kind of level of prescription that it becomes necessary? Monovision may be appropriate for someone who is only affected by presbyopia and has no other refractive error. See http://www.usaeyes.org/faq/subjects/monovision.htm for details. Glenn Hagele Executive Director USAEyes.org "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org http://www.ComplicatedEyes.org I am not a doctor. > A friend of mine is doing this - she is 43 and was finding it difficiult to > focus on reading matter. I wonder if I might try it in later life but have a > couple questions. > - how much would one of my eyes be undercorrected? There is no set answer for this - depends on the individual and his/her age and visual needs. Trial & error is a big part of the initial fitting process. > - how easy is it to get used to that? It feels like it might seem odd (I only > know how it feels to loose a CL) You'll know on the first day whether it'll work for you. There's not really an adaptation period except for accepting in your own mind that it is a compromised vision situation. > - what ages does it typically start to be necessary Typically late 40's but it varies. > - what's the kind of level of prescription that it becomes necessary? You mean what add? Again there's no set answer it depends on the individual and his/her needs. > Thanks alot Dom > - how much would one of my eyes be undercorrected? From age 40 to 50 we need stronger and stronger reading glasses. In the same way, undercorrection in MV must be increased during those years _if_ the near vision is to be corrected exactly. > - how easy is it to get used to that? It feels like it might seem odd (I > only > know how it feels to loose a CL) It's easy at 42, more difficult at 48. As it becomes more difficult, I often recommend mild reading glasses in addition to MV. Using "booster" glasses frees us to leave the MV for midrange and far, so the compromise is less noticeable far away. > - what ages does it typically start to be necessary 42 to 45. Strictly speaking, "presbyopia" means a measurable decrease in accommodation, which actually begins before 40. But it isn't "necessary" until you notice a problem in your own day-to-day function. Most of us have some problem by age 42, a few don't notice it until 45 or so. > - what's the kind of level of prescription that it becomes necessary? Whenever bifocals or reading glasses become "necessary." -MT >>- what ages does it typically start to be necessary > [quoted text clipped - 4 lines] > > -MT Mike interesting that you wrote that 45 is later than most notice it, as I would have said that 45-46 is the average time to notice it and that 48 is late. I wonder what the difference is between your patient body and mine. What lattitude are you at? (Wildy wondering if natural light allows my patients to cope for a few more years! - I am at lattitude 32.55deg sth. "Out there" theory I know. OTOH more natural light over a lifetime might be expected to hasten presbyopia.) Dom > Mike interesting that you wrote that 45 is later than most notice it, as I > would have said that 45-46 is the average time to notice it and that 48 is > late. I wonder what the difference is between your patient body and mine. I'm about 33.5 deg S (DEEP south, y'all). The only paper that comes up in PubMed searching "presbyopia latitude" is Beale 1981, saying it's more to do with ambient temperature than sunlight (can't tell more from the abstract only). It gets pretty hot here. I've always felt the silly bifocal table we had to learn in school was too aggressive - +075 at age 40, and every 50-year-old needs +250. Using the table, I overdid many more adds than I underprescribed. I think the shift from paper to VDT has had a major impact on "need". -MT > > Mike interesting that you wrote that 45 is later than most notice it, as I > > would have said that 45-46 is the average time to notice it and that 48 is > > late. I wonder what the difference is between your patient body and mine. > > I'm about 33.5 deg S (DEEP south, y'all). The only Interesting I didn't realise that the USA extended south of the equator. Unless your practising in Brazil/ Peru?or one of the more interesting African states. Regards Ian Hodgson - Isle of Man paper that comes up in > PubMed searching "presbyopia latitude" is Beale 1981, saying it's more to do > with ambient temperature than sunlight (can't tell more from the abstract [quoted text clipped - 7 lines] > > -MT >> MT> I'm about 33.5 deg S (DEEP south, y'all). The only > > Interesting I didn't realise that the USA extended south of the equator. > Unless your practising in Brazil/ Peru?or one of the more interesting > African states. I guess that was dumb, huh? Picky, picky. :) 33.5 deg N latitude, then. -MT When you say that *most of us have some problem by age 42, a few don't notice it until 45 or so* do you mean those tof us hat are corrected by contacts or people with normal vision? At 44 and -2.75 I'm still finding it okay. I wonder if that's unusual but I hope it's a good sign. A friend of 40, similar prescription to mine, struggles a bit in dim light. Do you notice many people that prefer to go back to wearing glasses and take them off to read than getting readers? You also said *From age 40 to 50 we need stronger and stronger reading glasses. In the same way, undercorrection in MV must be increased during those years _if_ the >near vision is to be corrected exactly* so for someone experiencing the early signs how much would you under correct? And what would be the maximum that could be under corrected. For example, I can't imagine that it would be possible for someone to have my prescription corrected in one eye and not the other. Thanks. >> - how much would one of my eyes be undercorrected? > [quoted text clipped - 23 lines] > >-MT > When you say that *most of us have some problem by age 42, a few don't > notice > it until 45 or so* do you mean those tof us hat are corrected by contacts > or > people with normal vision? As a rule of thumb, there isn't much difference. Correcting your far vision (precisely) with contacts should yield about the same problems as having "normal" distance vision to begin with. > At 44 and -2.75 I'm still finding it okay. I > wonder if that's unusual but I hope it's a good sign. A friend of 40, > similar > prescription to mine, struggles a bit in dim light. It's a matter of distance. At age 44, with glasses or contacts for distance vision, it's a safe bet you don't see as well at, say, 6 inches as you did when you were 24. If your daily routine doesn't have you doing anything at 6 inches (with correction), it hardly matters. > Do you notice many people that prefer to go back to wearing glasses and > take > them off to read than getting readers? A few do. Mostly you learn to mix-and-match and it's best to have alternative for different situations. Driving 300 miles at night, you might prefer glasses, removed for near, or full distance contacts plus a pair of drugstore glasses for signing gas receipts. Playing cards or socializing, you might prefer monovision contacts. Reading a long novel, you'd remove all correction and read at 14". > so for someone experiencing the > early signs how much would you under correct? I wouldn't prescribe without trying it, and I can't answer the question without knowing *your* presbyopia and *your* preferred working distance. Working on a computer at 30" I might use a +0.75 difference. For counted-cross-stitching at 14", the same person might need +1.50. And then there are the practical considerations. If your prescription is -2.75 in the right eye and -2.25 in the left, I'd want to know how well a pair of -2.25s would work, because it's so easy to put a spare left lens in the right eye, without buying a whole new box of lenses and getting so confused over which lens is which. >And what would be the maximum > that could be under corrected. For example, I can't imagine that it would > be > possible for someone to have my prescription corrected in one eye and not > the > other. Thanks. Sure it's possible, but it's a drastic difference and nobody's likely to be happy with a +275 "monovision add." Especially as young as you are. :) -MT "Strictly speaking, "presbyopia" means a measurable decrease in accommodation, which actually begins before 40." Did you hear that? He says it begins before age 40! I remember my accomodation being much better when I was a little boy. Now at 23 my accomodation has decreased. So technicially everyone gets presbyopia that gets worse the older they get. The accomodation of a 23 year old isnt as good as one of a 12 year old so this explains why im having some difficulty seeing from near with glasses unless I wear weaker glasses or take em off. > "Strictly speaking, "presbyopia" means a measurable decrease in > accommodation, which actually begins before 40." [quoted text clipped - 6 lines] > some difficulty seeing from near with glasses unless I wear weaker > glasses or take em off. The number of 23-year-olds who have genuine decreased amplitude of accommodation is pretty small, less than 1%, I'd venture. Of those, the majority are pseudomyopes suffering from accommodative spasm. The tiny remainder are presumed to have a neurological deficit. It still isn't called presbyopia. -MT I really hope im a pseudomyope because then I can look forward to my near -5 pescription being alot less as I learn to relax my accomodation. My incomplete cycloplegic refraction with cyclopentolate(cyclogyl) only resulted in a short, temporary reduction of half diopter myopia. Do you think I should go thru with cyclopegia again? Maybe I am doing something wrong and not fully relaxing my eyes when im under cyclopegia? How much pseudomyopia would you venture to guess I have if my accomodative amplitude is about 3 diopters only. > I really hope im a pseudomyope because then I can look forward to my > near -5 pescription being alot less as I learn to relax my > accomodation. Ace I also really hope you're a pseudomyope because if you get a complete cure then I can look forward an end to your posting things like (to paraphrase:) "I'm a presbyope maybe you are too" and "optometrists aren't very good at finding the cylinder" and "Your uncorrected vision should be 20/200 according to my formula" and a direct quote: "I am willing to bet my naturally dilated pupils are over 8mm and could even break the 1cm barrier! Yes you heard this right, one centimeter big pupils!" etc, etc! Dom |
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