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Medical Forum / General / Vision / June 2006Help: 3 Optometrists + 1 eye specialist = 4 different prescriptions!
To all people who know more about Optometry than 1: Hi, Short version: I'm trying to find the best prescription for my eyes, but my initial attempt to get a second opinion has resulted in me going to 3 Optometrists, and 1 eye specialist, and now I have 4 different prescriptions! They are pretty close, and of course no Optometrist is going to say that the *other* optometrists prescription is the one to go for, so im stuck! Which one should I choose? Long version: I'm 41, musician / IT person, and last time I got an eye test (late 90's) was prescribed -1.75. I lost my glasses years ago, and have been simply getting around without them. Main problem is driving, especially at night, and I occasionally use disposable contacts (My old contect lens box says -1.75, BC9.0, dia 14.2, if that helps) and marvel at how sharper everything is. However I needed new glasses, and hence a new prescription The first Optometrist (A) prescribed this: Prescription A: -0.75 -1.0 x110 -0.75 -1.0 x60 When I put the mock-up frames on they seemed too strong (as he said they would). He said it would take a couple of weeks to adjust! I've been getting around for ages without glasses, and this seemed just counter-intuitive. I said no offense but Id like a second opinion, he said no problem. So I rang my eye specialist/doctor, but he was away. His secretary recommened Optometrist B. I made sure I got enough sleep, and spent less time in front of the computer (in case these factors had affected Prescription A) Optometrist B gave me Prescription B: -0.25 -1.0 x95 -0.25 -0.75 x55 Ok, so its different, weaker power, and from what I understand 'significantly' different axis's (?) for the astigmatism. This Optometrist B said I needed to see an Eye Specialist, so I thought, cool, whilst I'm there I can get a third definitive opinion. A few months go by, but the Eye Specialist was very fast and very dismissive. I explained my dilemna, and showed him the two prescriptions. He smiled, and said my eyes are fine, and that I didnt need glasses. I said "well, when im driving at night things can look pretty blurry", in the end he rushed through a few really quick tests (took him less than 5 minutes). I did show him the two previous prescriptions so his contribution IS biased, but anyway here's what the Eye Specialist recommended: Prescription C: -0.50 +0.5 x15 -0.50 +0.5 x165 I realised this was a different code to the other two, and he admitted that he did this on purpose so I wouldnt worry about it anymore. I didnt really appreciate this condescending attitude. When I asked him whether this result was close to presciption A or B, (or in between), he refused to answer the question, and flippantly kept saying 'This is the right prescription for your eyes'. I was not impressed. I walked into another optometrists shop, and got the guy there to translate Prescription C to match the notation (?) of the other two, and got Prescription C: 0.00 -0.50 x105 0.00 -0.50 x75 So, he didnt think I needed *any* power correction (VERY different to Prescription A), and the astigmatism seemed different yet again! I thought to myself , 'well, I'll just go with Prescription B, it seems the middle of the road between the two'. But I couldnt help thinking about how flippant the Eye Doctor was, and since his 1st response was that I didnt need glasses, mabye I sould discard his prescription from consideration. I knew there had to be a 4th Prescription. And so it came pass, that I walked into another optometrists, and explained the situation, and without showing them my previous results, obtained: Prescription D: -0.50 -1.00 x90 -0.50 -0.75 x55 Ok, this was very close to Prescription B, and seems to be in between A which was stronger, and C which had 0.0 power.. I realise these are very similar, and I'm currently trying to decide between B and D, with the main issue being whether to go for 0.50, or 0.25. On one hand I'm told to get the one which made me read more letters ( 0.50 rather than 0.25), but otoh, will 0.25 encourage my eyes to work more, and be 'better for me'? I'll be wearing them mostly for driving, movies, and other outdoor situations (looking at views trees, clouds ) Do these results reflect the competency of the optometrists, or my subjective performance during the test? Factors such as: 1. How much sleep I'd had 2. Whether I was regularly blinking during the examination or staring, which was drying up my eyes 3. How stressed I felt (in general) on the day. 4. How much time Id spent in front of the computer that week. If Optometrist B thought I needed 0.25 power, doesn't that mean that that's how well my eyes can perform? Ie therefore I wasn't at my 'peak' when I needed 0.50? your comments welcome, Andy > To all people who know more about Optometry than 1: > [quoted text clipped - 119 lines] > > your comments welcome, Calculate the average? DrG > Calculate the average? > > DrG Hi Dr G, well, re: power , the average of 0.00 0.25 0.50 and 0.75, = 0.25, OR 0.50 Should I go for the lower one? Also, I gave Optometrist A my prescription sunglasses, so he knew what my previous prescription was, as did the Eye Specialist (Prescription C). Prescriptions B and D were done with no mention of my previous prescription. Could this have been a factor? How relevant is my past prescription in determining my prescription today? Andy Given all the information, -1.75 seems way too much power. I doubt you would be comfortable driving w/o correction if indeed that was your true prescription. Because of this, your eyes have a tendency to "prefer" more minus. Going from -1.75 to plano would seem rather extreme, and you would probably "reject" that prescription. The other prescriptions do not seem "significantly different" from each other. There is built-in error in every measurement, and the process of refraction is designed to truncate the error in favor of more plus rather than too much minus. Take it from there. DrG > > Calculate the average? > > [quoted text clipped - 20 lines] > > Andy > There is built-in error in every measurement, and the process of > refraction is designed to truncate the error in favor of more plus > rather than too much minus. That is consistent with my experience. Myopes will usually find themselves undercorrected, an progressively so, if they happen to be progressive myopes. That is why it is good to have a -0.25D and a -0.50D test lens. Sit with those, in your car on a city street, and hold them before each lens in your new eyeglasses. You will find the best (-) addition for reading signs and seeing the fluorescent displays the most sharply. With those two lenses, you can achieve up to -0.75D addition. Refining the cylinder axes and power is a bit more complicated, but it can be done indoors. I would comment further if there seemed to be interest. You might then go back to the place where you got your glasses and ask to have your lenses changed. But if they give you any sh.t, as they most likely will, you can just figure out what your prescription should have been, and order some Zennis. That could be much cheaper if you are asked to pay for your new "glass". I should add that you may prefer to be a bit undercorrected if you are getting presbyopic and don't feel quite ready for bifocals or fancier. -- Dicky (legitimate nonprofessional) > ... That is why it is good to have a -0.25D and a -0.50D test lens. Sit with those, in your car on a city street, and hold them before each lens in your new eyeglasses. ... < Please insert "at night" as follows: ... That is why it is good to have a -0.25D and a -0.50D test lens. Sit with those, in your car on a city street, AT NIGHT, and hold them before each lens in your new eyeglasses. ... > That is why it is good to have a -0.25D and a -0.50D test lens. Sit with > those, in your car on a city street, and hold them before each lens in > your > new eyeglasses. You will find the best (-) addition for reading signs and > seeing the fluorescent displays the most sharply. With those two lenses, > you can achieve up to -0.75D addition. With this technique, without careful coaching, many people choose -050 or -075 more than they really need. -MT > > That is why it is good to have a -0.25D and a -0.50D test lens. Sit with > > those, in your car (at night) on a city street, and hold them before each > > lens in your new eyeglasses. You will find the best (-) addition for > > reading signs and seeing the fluorescent displays the most sharply. > > With those two lenses, you can achieve up to -0.75D addition. > With this technique, without careful coaching, many people choose -050 > or -075 more than they really need. Well, it seems really doubtful that many people have even considered doing such a thing. But I would presume that anyone smart enough to figure out how to get the test lenses, and the right ones, would be smart enough to avoid overcorrection. Of course, you could argue that most people do not need to read signs when they drive at night. That might even be your Professional Opinion. You do not have to see very well in order to get licensed to drive, so it could be considered just an arbitrary preference to want to read signs. -- Dicky >Well, it seems really doubtful that many people have even considered doing >such a thing. But I would presume that anyone smart enough to figure out >how to get the test lenses, and the right ones, would be smart enough to >avoid overcorrection. You might think so. >Of course, you could argue that most people do not need to read signs > when they drive at night. That might even be your Professional Opinion. No it's Otis who recommends undercorrection. > You do not have to see very well in order to get licensed to drive, so it > could be considered just an arbitrary preference to want to read signs. Overcorrection gives an illusion of "crispness" without improving measured acuity. At least that's the definition I use. -MT Dear Dicky, Subject: "Prescribing" -- under YOUR control. I wonder what would be the result if you did what you say -- self-prescribe. Would you over-prescribe -- or would you be more likely to get your Snellen and minus "just right". It is true that a night, you would tend to over-prescribe youself -- but I wonder by how much. What I suggest is that (as a base-line) you verify you pass the DMV -- and then go down and do it -- for final confirmation. Now, if you wish a stronger minus -- well, as you said, Dicky, you can just order some -0.75 diopters from Zenni. Workable? Best, Otis > > > That is why it is good to have a -0.25D and a -0.50D test lens. Sit with > > > those, in your car (at night) on a city street, and hold them before each [quoted text clipped - 17 lines] > -- > Dicky > Given all the information, -1.75 seems way too much power. This is a prescription i got mabye 10 years ago, I'm now 41. I doubt you > would be comfortable driving w/o correction if indeed that was your > true prescription. well, all the Optometrists have given me a much lower 'power figure' (?), and Im told this is something to do with ageing. Also there was no astigmatism before. Because of this, your eyes have a tendency to > "prefer" more minus. Going from -1.75 to plano I dont know that 'plano' means. would seem rather > extreme, and you would probably "reject" that prescription. The other > prescriptions do not seem "significantly different" from each other. Yes, and what im after is someones opinion as to whether i should go 0.25, or 0.50. Also whether prescription B is the best / average. I've been put in a position where I have to make a decision about what Prescription to go for, whilst know close to nothing about Optometry. > There is built-in error in every measurement, and the process of > refraction is designed to truncate the error in favor of more plus > rather than too much minus. I'm not sure what you mean by this.. A power of -0.25 has 'more plus' than -0.50; um, therefore is 0.25 the 'built in error in favour of more plus? Therefore I should go for 0.50? > Take it from there. Thanks, I'm trying to 'take this' somewhere, but I'm still confused. I was hoping some guru would just tell me whether to go for prescription A B C, or D. :) B and D are the average Prescriptions, the only difference is the -0.25 or -0.50 power. They are also the prescriptions where the Optometrist didnt know that i used to wear -1.75.. Andy ps, I thought Optometry would be less subjective.. During many of the eye tests, I couldnt tell the difference, especially the astigmatism tests (a bunch of dots on a hexagram (?)), I usually had to decide whether I 'preferred' the bolder fuzzier dots, to the lighter/fainter sharper ones. In hindsight, it was only in the last test that i was also concentrating on the shape of the hexagram, and using that as a factor as to which one I 'preferred'. when things are equally but *different;y* distorted, its hard to select which one is 'better', unless the patient is told what criteria to use for 'better'. At least with the eye charts, you can either read the correct letter, or not. The Optometrist D, when i later showed her the previous results and asked her if 0.25 would be ok for power simply said that I read more letters with 0.50. Does this settle the matter, or does it say more about my subjective performance on the day.. im so confused.. > well, all the Optometrists have given me a much lower 'power figure' > (?), and Im told this is something to do with ageing. Also there was no > astigmatism before. They're not all the same now are they? Of course not. The astigmatism probably comes from habitually over-accommodating to the 10 year-old prescription. SHAME ON YOU. You're not a very compliant patient, are you? > I dont know that 'plano' means. Plano comes from plane surface which means no power = 0. > Yes, and what im after is someones opinion as to whether i should go > 0.25, or 0.50. Also whether prescription B is the best / average. I've > been put in a position where I have to make a decision about what > Prescription to go for, whilst know close to nothing about Optometry. You put yourself in the position of having to decide among several different prescriptions. Maybe you should try all of them. > I'm not sure what you mean by this.. A power of -0.25 has 'more plus' > than -0.50; um, therefore is 0.25 the 'built in error in favour of more > plus? Therefore I should go for 0.50? I guess the term "error" was an unfortunate term. Let's use the term "variability." Try weighing a ball bearing on an analytical balance 5 times. You will get a different weight each time. You are literally fretting over 0.25 diopter differences, when the fact of the matter is that you have been wearing a ten year-old prescription that is off by a factor of 7! DrG > ... astigmatism probably comes from habitually over-accommodating to > the 10 year-old prescription. Excessive accomodation does not cause myopia, but it can lead to astigmatism. Live and learn! > SHAME ON YOU. You're not a very compliant patient, are you? (These Dr.s do have their weapons!) -- Dicky > Excessive accomodation does not cause myopia, but it can lead to astigmatism. > > Live and learn! Indeed it can. In fact, people with convergence insufficiency use their accommodation all the time to help them converge. This inevitably leads to against-the-rule astigmatism, with/or without a small amount of accommodative myopia. We can teach, but it's up to you to learn. DrG Dear DrG- Subject: Isley Brothers Yes, indeed, it would be very difficult to beat "Who's That Lady" for PURE funk at the threshhold. O'Kelly Isley first propounded the theory that singing in falsetto could prevent progression of myopia in African-American males. When you look BACK on the Motown era, how many high myopes DO YOU see? This is a scientific, NOT MEDICAL method of evaluating the fundamental harmonics of a damned good music group who ONCE had Jimi Hendrix as their lead guitar player. Best, Odis Rock Legend in his Own Mind > Dear DrG- > [quoted text clipped - 16 lines] > of a damned good music group who ONCE > had Jimi Hendrix as their lead guitar player. Yes, the Motown Era was a remarkable time for the study of the Fundamental Eye in the average environment of Detroit, and the use of harmonics, stepping and jiving to avoid myopia. DrG Dear DrG- Subject: the end of an era DrG> >Yes, the Motown Era was a remarkable time for the study of the Fundamental Eye in the average environment of Detroit, and the use of harmonics, stepping and jiving to avoid myopia. Odis> There has been no music since that time that could be deemed a "replaecment." Odis> Therefore, it is safe to say that myopia prevention among mid-1960's musicians was primarily accomplished via the "rhythm method." For more information, I would suggest you visit: www.smilingfacessometimes.org Best, Odis White Man's Overbite Dancer Extraordinaire > > Excessive accommodation does not cause myopia, but it can > > lead to astigmatism (?). > Indeed it can. In fact, people with convergence insufficiency use > their accommodation all the time to help them converge. This > inevitably leads to against-the-rule astigmatism, with/or without a > small amount of accommodative myopia. Frankly, that makes no sense at all to me. But I don't know about the "rule", as in "against-the-rule". There is always some new thing up your sleeve. New facts like rabbits out of the hat. > We can teach, but it's up to you to learn. All I ever really wanted from you guys was a pair of eyeglasses with which I could read the blackboard, and read highway signs at night before I overshot. Those frustrations are, indeed, related to a learning problem, and the possible appearance of being lost. You definitely can dazzle with your words, and these days with all of the high-tech gizmos in your workplaces, and high-tech trade names at you fingertips. -- Dicky > Frankly, that makes no sense at all to me. But I don't know about > the "rule", as in "against-the-rule". There is always some new thing > up your sleeve. New facts like rabbits out of the hat. Like I didn't see that remark coming. > All I ever really wanted from you guys was a pair of eyeglasses with which > I could read the blackboard, and read highway signs at night before > I overshot. Those frustrations are, indeed, related to a learning problem, > and the possible appearance of being lost. Poor Dick. > You definitely can dazzle with your words, and these days with all > of the high-tech gizmos in your workplaces, and high-tech trade names > at you fingertips. Eat your heart out. DrG > Indeed it can. In fact, people with convergence insufficiency use > their accommodation all the time to help them converge. This > inevitably leads to against-the-rule astigmatism I didn't know that. What did I miss? -MT > > Indeed it can. In fact, people with convergence insufficiency use > > their accommodation all the time to help them converge. This [quoted text clipped - 3 lines] > > -MT Unfortunately would have struck the "inevitably" in favor of often, but had already hit the send button. I don't know what you are missing. Perhaps you haven't seen many. DrG DrG> You are literally fretting over 0.25 diopter differences, when the fact of the matter is that you have been wearing a ten year-old prescription that is off by a factor of 7! Otis> I believe that she said she had not worn any "prescription" for may years. The result was that her refractive state "improved" and now here "old" glasses are over-prescribed by a factor of 7 -- as you say. But... DrG > SHAME ON YOU. You're not a very compliant patient, are you? Dicky> (These Dr.s do have their weapons!) Best, Otis > Prescription A: > -0.75 -1.0 x110 > -0.75 -1.0 x60 > > When I put the mock-up frames on they seemed too strong (as he said > they would). Possibly those kind of frames hold the lenses further from your eyes than you eventual personal frames will. Your personal frames may not hold the lenses as flat to your face as the mock-up ones. > Prescription B: > > -0.25 -1.0 x95 > -0.25 -0.75 x55 > Prescription C: > > -0.50 +0.5 x15 or 0.00 -0.50 x105 > -0.50 +0.5 x165 or 0.00 -0.50 x75 > Prescription D: > > -0.50 -1.00 x90 > -0.50 -0.75 x55 > your comments welcome ... This reflects my experience. Starting a refraction with no historical information (present eyeglasses or prescription) is blind flying for some, if not most, phoroptrists. I wanted Mike Wallace to do an investigative piece with that ruse ("I've lost my glasses, doctor") but unfortunately he retired before I could get to him. My advice -- takes Leuko's advice and get a trial pair of $19 Zenni's. Check and refine with successive pairs as I outlined in http://groups.google.com/groups?selm=k9Tlg.4024$V55.3037@trndny01 -- Dicky No MD no OD. Had good General Science course in 8th grade. Once stayed at a Holiday Inn Express. > > Prescription A: > [quoted text clipped - 7 lines] > you eventual personal frames will. Your personal frames may not hold the > lenses as flat to your face as the mock-up ones. IIRC, vertex distance should be a virtual non-factor at that low prescription. Dr. Leukoma (IMO) IS exactly right: average ... or toss a coin. Dicky > No MD no OD. Had good General Science course in 8th grade. Once stayed at a Holiday Inn Express Otis> Cute! I like that by-line and you Zenni recommendation. Otis> And the NEXT THING you will recommend is that the person obtain the basic OD tools, Snellen and Trial-lens kit, and make her OWN MEASUREMENTS just to triple-check all the others. Otis> In fact in one "measurement" she is almost "plano" -- and if she checked her Snellen, she might be passing the DMV level test. Best, Otis What you are really saying is you are not willing to make a decision but are happy to spray the optical profession. You have had 4 subjective refractions. Subjective means that we go by7 what you say, thus 4 results means you can't make up your mind. FWIW, I would be starting with less cyl if any and lower minus, enough to make you happy (after all anything is better than the nothing you have been wearing). dr grant > your comments welcome, Well Andy, when you have a refraction the Optometrist prescribes by placing lenses in front of you and asking, is this better or worse, puts another lenses and asks, is this better or worse. And so on. With four different presciptions it sounds like the problem is subjective, that is your responses have been different to each exam. Possibly you don't pay attention.  SignatureCharles I just had gotten a new prescription when I received an offer of a free exam from another practitioner in the mail, so I went to that as well. I don't have the prescriptions with me, but they weren't really very close. In either the diameter or base curve measurements, they were almost opposites. In the vision, one had a -5.25 while another had -6.00. I have new contacts in from the last prescriptiion, and I no longer can read anything within 5 feet or so without reading glasses. When I mentioned that I didn't require reading glasses before, the doctor said that due to the fact that I'm 50 years old, this is as it should be. He said my old prescription was too weak for me, and that was why I could see up close so well with them. Funny, I never noticed any great loss in distance vision either, although I do see sharper at long distances with this new prescription. So, if I follow the doctor's advise, I'll never be able to read anything in close proximity again (this computer screen is blurry). > To all people who know more about Optometry than 1: > [quoted text clipped - 121 lines] > > Andy Dear Keven, Sounds like you are seriously over-prescribed. But, as they say -- you'll get used to it. Best, Otis But then, to most people, it sounds as though I am SERIOUSLY over-medicated, so what can one do? > Dear Keven, Dear Kevin, Please disregard Otis's postings. He is not in the medical profession and not in any position to give medical advice. Thank you! Allen Dear Privacy, According to Al Lieberman you are seriously under/over prescribed -- what that -1 D, ...no, make that -1.25 D, ... no, make that -0.74 D astig -0.75 at 75, -- well just take the average. Who ever said that optometry was and exact science anyway. Just get used to it. Best, Otis > > Dear Keven, > [quoted text clipped - 6 lines] > > Allen I'm sorry, Privacy. I've had a bit of an "episode" the last few weeks. Please forgive me and try to ignore my posts. I just had gotten a new prescription when I received an offer of a free exam from another practitioner in the mail, so I went to that as well. I don't have the prescriptions with me, but they weren't really very close. In either the diameter or base curve measurements, they were almost opposites. In the vision, one had a -5.25 while another had -6.00. I have new contacts in from the last prescriptiion, and I no longer can read anything within 5 feet or so without reading glasses. When I mentioned that I didn't require reading glasses before, the doctor said that due to the fact that I'm 50 years old, this is as it should be. He said my old prescription was too weak for me, and that was why I could see up close so well with them. Funny, I never noticed any great loss in distance vision either, although I do see sharper at long distances with this new prescription. So, if I follow the doctor's advise, I'll never be able to read anything in close proximity again (this computer screen is blurry). > To all people who know more about Optometry than 1: > [quoted text clipped - 121 lines] > > Andy Dear Andy, Subject: Doing your own checking. You might have "variable accommodation", or even pseudo-myopia. Perhaps, to "clear the air" you could read your own Snellen. A nifty chart is on my site as EyeChart #2. (Linked). Since you seem to be getting various "measurements" -- you might find you can read the 20/50 to 20/40 line. (Reading 1/2 the letters "passes" the line.) It never hurts to check. Best, Otis Andy, the web site is: www.myopiafree.com Enjoy, Otis >Andy, the web site is: > >www.myopiafree.com Wear your hip waders. The BS runs pret-ty deep in there.... > Dear Andy, > > Subject: Doing your own checking. Dear Andy, Please disregard Otis's postings. He is not in the medical profession nor in any position to give medical advice. Thank you! Allen Guys, All I want to know is: Since Prescriptions A and C gave powers of 0.00, and -0.75, I need to pick between Prescriptions B and D, -0.25, and -0.50. The slightly weaker prescription -0.25 (which implies on the day my vision was better?), or the slightly stronger power -0.50 (which is closer to my 10 year old prescription of -1.75). Even if I 'preferred' the -0.50, this could just mean my eyes 'prefer more minus' as someone said. Therefore I should go for the weaker -.0.25, which would help improve my eyesight because they may be slightly underpowered. Which would be a better choice for this 41 year old, for driving and movies? Given their similarity, should i go for -0.25, or -0.50? Andy You could go for option E and F too. Or maybe X, Y or Z? Pick one optom and get them to sort it out. If you came into my office and started reeling off other peoples scripts, I would show you the door. WTF do you want? If you want the right glasses then ask me for help and I will sort it out. If you want to compare scripts, then go elsewhere. The problem sounds like you are an active accommodator (you can read this as anal retentive with some patients) and want to accommodate and don't want to relax your focus. Thus all the scripts are correct at the time of each test and you need help. Like I said, pick one guy and let him work it out, it is his job after all. dr grant > Like I said, pick one guy and let him work it out, it is his job after > all. > > dr grant Cool. Which one? Andy Which ever one you like. Generally the one you feel most comfortable with. dr grant > Guys, > [quoted text clipped - 16 lines] > > Andy Get the -0.50 - better for distance vision, especially at night. Getting the -0.25 will not help improve your eyesight. Dom > > Guys, > > [quoted text clipped - 22 lines] > > Dom Thanks. I suppose even if prescriptions with more minus than necessary DO 'weaken' the eye, wearing glasses only for driving and movies, would negate that effect anyway. Andy >I suppose even if prescriptions with more minus than necessary DO >'weaken' the eye, wearing glasses only for driving and movies, would >negate that effect anyway. The only studies that showed the increased myopia due to use of a minus lens: 1) Were with ONE SPECIES of monkey (it didn't do it with others); 2) Were with monkeys who didn't NEED the lens; 3) Were sutured on the eye and remained there 24/7 In all other studies, even a period break--say an hour or two--negated even these effects. Other studies have shown that UNDER-correction of myopia hastens its progression.
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