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Medical Forum / General / Vision / October 2006

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Ive heard of people wearing readers over contact lenses but what about distance glasses?

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Ace - 27 Oct 2006 04:17 GMT
Howcome few people think about it? It seems that optometrists and their
patients place too much emphasis on distance vision but if that person
spends most of his time reading or on the computer, wouldnt it be a
better choice to undercorrect with contact lenses to avoid readers and
instead wear distance over them for stuff like driving or watching
movies? Marcia is one person that can really benefit from that
unconventional method. She spends 90% of her time reading! Yet she
wants to wear reading glasses 90% of the time when she could
undercorrect and wear distance glasses 10% of the time! If someone is
going to be in glasses almost full time, then this defeats the purpose
of contact lenses(OrthoK, Intacs, Lasik, etc) and its best to just
stick to bifocals/progressives.

I have undercorrected both eyes with contacts and I actually like it. I
retain the ability to see clearly from near without much of an impact
on distance vision. You can always move a little closer to see
something in the distance but your arms arent long enough to read!
When/if I get orthoK(less risky than Intacs but also less convinent) or
Intacs(a big IF but still have much to research on the pros and cons
and risks) I will be undercorrected(a full correction isnt possible nor
do I want one) then I will be free of glasses except for driving and
movies in which a thin pair will suffice just fine. I will be able to
do anything near without glasses and most distance tasks without
correction for the matter as the blur will be very slight, my brother
and most of my friends I know just forgo correction with -1 to -2
refractive states. Almost all presbyopic people would much rather be a
little myopic than plano except for those that hate reading and have no
clue how to use a computer.
marcia_jay - 27 Oct 2006 13:59 GMT
"She spends 90% of her time reading! Yet she
>wants to wear reading glasses 90% of the time when she could
>undercorrect and wear distance glasses 10% of the time!?"

Where did you get these figures from?  And I never send I "want" to spend 90%
of my time wearing reading glasses.

Ace, you have said your piece, and I have told you that I am not interested
in your help.  So please do not take up my "cause" at this board.  Please do
not refer to me or speak for me or post to me or name me again on this board.

>Howcome few people think about it? It seems that optometrists and their
>patients place too much emphasis on distance vision but if that person
[quoted text clipped - 24 lines]
>little myopic than plano except for those that hate reading and have no
>clue how to use a computer.
The Real Bev - 27 Oct 2006 17:20 GMT
> Ace, you have said your piece, and I have told you that I am not interested
> in your help.  So please do not take up my "cause" at this board.  Please do
> not refer to me or speak for me or post to me or name me again on this board.

Lighten up, kid, usenet doesn't work like that.

Signature

Cheers, Bev
===================================
New sig on order, watch this space.

Ace - 28 Oct 2006 08:34 GMT
> "She spends 90% of her time reading! Yet she
> >wants to wear reading glasses 90% of the time when she could
[quoted text clipped - 6 lines]
> in your help.  So please do not take up my "cause" at this board.  Please do
> not refer to me or speak for me or post to me or name me again on this board.

Very well, I shall back off as you wish. If you ever need any help all
you have to do is ask. You do know we respect everyone and want the
best for them and are just trying to be helpful. I wish you luck in
however method you chose to deal with your dilemna.

The Real Bev wrote:

> I look at it from a safety standpoint.  I'm astigmatic and can see
> NOTHING clearly without help.  My contacts correct for distance for
[quoted text clipped - 14 lines]
>
> (3) Binoculars work better if you don't wear glasses.

If your toric contacts go higher, its possible to overcorrect you into
myopia. However I guess myopia is a strange concept for a hyperope just
like hyperopia is strange for me. If you break glasses all the time(be
more careful!) then I guess its better to break cheapo readers than
expensive prescription glasses. However if you have to wear reading
glasses most of the time, might as well get progressive glasses in your
prescription and wear contacts for distance only. Makes no sense to
wear both glasses and contacts when glasses alone does the job.

Dan Abel wrote:

> > Howcome few people think about it?
>
> Some people have thought about it, and decided that it didn't make much
> sense for most people.

Dont knock it till you try it. If it works, good!

> Most people value both distance and close vision.  Many people find that
> it is easier to wear reading glasses, and have their "no glasses" vision
> set for distance.  I was given a choice, and chose distance vision (I
> have IOLs in both eyes, and the doctor can put any strength in).

Look up presbyopia and youll see your falacy in that. Monovision is a
crude compromise and it still sounds crazy to me but some people swear
by it. Multifocal contacts didnt seem to make much of a difference for
me and my mom. As for IOLs, what if you ended up a bit overcorrected?
Can they be removed and the correct ones put in(more risks incurred im
sure) or would you just have to wear bifocals full time? I know a lady
who ended slightly overcorrected with IOLs and now needs bifocals or
she cant see clear at *any* distance! With an undercorrection, you are
in focus *somewhere* so its risky at best asking to be plano.

> Many people find that weather conditions are better inside.  One of the
> things I like best about not having glasses for distance is that I don't
> have to deal with fogged or wet glasses.

A slight undercorrection still wont warrant distance glasses for most
things and you still retain much of the ability to see well from close.
I guess it depends on the person but I would want it that way and
simulating the undercorrection with older glasses, this is the way to
go.

> Another factor is that I have a zillion OTC reading glasses, in
> different strengths.  I buy them at Costco at US$18.99 for three pairs.
> They work just great.  If I had gotten my eyes set for close, I would
> have had to pay for prescription glasses for distance.

I have several readers and only use them for magnifying glass and to
simulate different levels of myopia. Yes distance glasses cost more
than readers but if you spend 90% of your time reading, you only need
to wear glasses 10% of the time. This is the case for me which is why I
want good near vision.

> It's mostly a personal preference thing.  Whatever works best for you is
> what you should do.

You wont know till you try it. If it works, good! There are many people
that use their eyes for near more than distance and never think of
undercorrecting themselves to avoid readers! Presbyopia arent a problem
for myopes unless you want to make it be.

> I don't believe that's true.

I can show you proof that when getting IOLs, -1.5 was the refraction
most people chose. Unless you are very active in the outdoors, you will
be *less* dependant on glasses at -1.5 than plano!
Dan Abel - 29 Oct 2006 20:29 GMT
> you have to do is ask. You do know we respect everyone and want the
> best for them and are just trying to be helpful.

What's this "we" stuff?  Do you feel like Dr. Grant respects everybody
here?  How about Otis and his many detractors?  You and I don't appear
to be reading the same newsgroup.

> If your toric contacts go higher, its possible to overcorrect you into
> myopia. However I guess myopia is a strange concept for a hyperope just
> like hyperopia is strange for me.

A presbyopic hyperope will appear to be myopic when trying to look at
things at a distance while forgetting to remove the lenses used for
close vision.

> If you break glasses all the time(be
> more careful!) then I guess its better to break cheapo readers than
> expensive prescription glasses. However if you have to wear reading
> glasses most of the time, might as well get progressive glasses in your
> prescription and wear contacts for distance only. Makes no sense to
> wear both glasses and contacts when glasses alone does the job.

As usual, I don't agree.

> Dan Abel wrote:
>
[quoted text clipped - 4 lines]
>
> Dont knock it till you try it. If it works, good!

I've tried just about everything, it seems.

> > Most people value both distance and close vision.  Many people find that
> > it is easier to wear reading glasses, and have their "no glasses" vision
> > set for distance.  I was given a choice, and chose distance vision (I
> > have IOLs in both eyes, and the doctor can put any strength in).
>
> Look up presbyopia and youll see your falacy in that.

I don't have to look it up.  I've been there and done that.

> Monovision is a
> crude compromise and it still sounds crazy to me but some people swear
> by it.

My wife and I have our own version of "monovision".  We only see out of
one eye.

:-(

> Multifocal contacts didnt seem to make much of a difference for
> me and my mom.

Never tried these and don't want to.

> As for IOLs, what if you ended up a bit overcorrected?
> Can they be removed and the correct ones put in(more risks incurred im
> sure) or would you just have to wear bifocals full time?

There are risks to surgery.  I fully understood going into it that I
might end up wearing glasses full time.  Since I had already worn very
thick glasses for 35 years, the prospect of wearing thin ones didn't
sound too bad.  

> > Many people find that weather conditions are better inside.  One of the
> > things I like best about not having glasses for distance is that I don't
[quoted text clipped - 5 lines]
> simulating the undercorrection with older glasses, this is the way to
> go.

Try IOLs and *THEN* let us know what you think.  There is absolutely
*no* accommodation with them.

> > Another factor is that I have a zillion OTC reading glasses, in
> > different strengths.  I buy them at Costco at US$18.99 for three pairs.
[quoted text clipped - 6 lines]
> to wear glasses 10% of the time. This is the case for me which is why I
> want good near vision.

I doubt that I spend more than four or five hours a day at close work
(reading and computer).  With my reading glasses, I have clear vision at
almost any distance.

> > It's mostly a personal preference thing.  Whatever works best for you is
> > what you should do.
[quoted text clipped - 9 lines]
> most people chose. Unless you are very active in the outdoors, you will
> be *less* dependant on glasses at -1.5 than plano!

I'd like to see that, if you have a convenient URL.  My Email address is
good if you don't have a URL but can cut and paste, or attach.  It's too
late for me, but many people eventually get cataracts, so this would be
good for me to know.

Signature

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

Ace - 31 Oct 2006 13:36 GMT
> What's this "we" stuff?  Do you feel like Dr. Grant respects everybody
> here?  How about Otis and his many detractors?  You and I don't appear
> to be reading the same newsgroup.

Otis is a nice guy. Grant lacks manners and curses like a sailor.

> A presbyopic hyperope will appear to be myopic when trying to look at
> things at a distance while forgetting to remove the lenses used for
> close vision.

And an emmetrope will see very blurry from closer range if he forgets
his readers.

> As usual, I don't agree.

Your call. In the far future when I develop cateracts, ill be chosing
about -1.5 undercorrection. The margin of error is typically plus/minus
.5 but can be higher. The last thing I want is to end up hyperopic, if
I do, those IOLs are comming right out and getting exchanged with the
approperate power. I would rather be -3 than have *any* amount of
hyperopia because hyperopes cant see clearly and they see almost
nothing from near(IOLs have zero accomodation) while myopes are in
focus *somewhere* and dont require glasses full time(unless your highly
myopic) unlike hyperopes.

> I've tried just about everything, it seems.

except multifocal contacts ;)

> I don't have to look it up.  I've been there and done that.

I also am familiar with presbyope but mine isnt as bad as yours since
im younger.

> My wife and I have our own version of "monovision".  We only see out of
> one eye.

amblyopia?

> There are risks to surgery.  I fully understood going into it that I
> might end up wearing glasses full time.  Since I had already worn very
> thick glasses for 35 years, the prospect of wearing thin ones didn't
> sound too bad.

Cateract surgury isnt really elective. As soon as my cateracts have any
impact on vision, out they go and whatever IOLs using the latest
technology will be used. If my cateracts is unilateral, ill get that
one removed and if all goes well, have CLE in the other eye because of
a problem called anisekonia which will make glasses impossible to
tolerate without headaches and I cant tolerate contacts even now. Ill
then never have to worry about cateracts, why suffer anisekonia? One
reason I wont touch lasik is this will become wasted once I develop
cateracts, also lasik alters the cornea and makes IOL calculation
tricky because of a strange, distorted oblate cornea.

> Try IOLs and *THEN* let us know what you think.  There is absolutely
> *no* accommodation with them.

Not till I begin to develop cateract(s) Ill have lost all accomodation
before that naturally due to presbyopia. In fact I have a mild degree
of presbyopia right now. I know it depends on the person, some are
happier with distance IOLs, others like me prefer to be in focus at
closer range. I guess being myopic much of my life and taking my
glasses off to read has made me realize how important near vision is.

> I doubt that I spend more than four or five hours a day at close work
> (reading and computer).  With my reading glasses, I have clear vision at
> almost any distance.

I spend about 8 hours doing that. The slight undercorrection will keep
me out of readers(except maybe for really tiny print) and my distance
vision wont be bad enough to need distance glasses most of the time
either so ill be 80-90% free of any kind of glasses compared to you
being about 60-70% free of glasses. Theres a saying you can always step
closer to see something in the distance but your arms arent long enough
to read something nearby! :)

> I'd like to see that, if you have a convenient URL.  My Email address is
> good if you don't have a URL but can cut and paste, or attach.  It's too
> late for me, but many people eventually get cataracts, so this would be
> good for me to know.

I guess perhaps slightly more than 50% choose distance but then many of
those people had good distance vision much of their lives. If you take
a study that compares myopes, most will want to retain clear near
vision. Its different for emmetropes and hyperopes who tend to choose
distance more often.

http://www.facialwizard.yourpower2be.com/cataracteyesurgery.html

Monofocal intraocular lenses are lens that provide a clear vision at
one distance only. Majority of individuals who undergo cataract eye
surgery choose to see well far and correct their near vision with a
pair of eye glasses or contact lenses.

Another site:

Although some doctors use a multifocal or bifocal type of plastic lens
implant, most choose a plastic or silicone implant set for distance
vision. Within certain limits, it's possible to choose the type of
sight you prefer. For example, a very nearsighted person may choose to
be less nearsighted (to see at a distance without glasses)

Two quotes from the OPTHAMOLIC HYPERGUIDE

"If the patient has binocular cataracts, the decision is much easier
because the refractive status of both eyes can be changed. The most
important decision is whether the patient prefers to be myopic and read
without glasses, or near emmetropic and drive without glasses. In some
cases the surgeon and patient may choose the intermediate distance (-1
D) for the best compromise. Targeting for monovision is certainly
acceptable, provided the patient has successfully utilized monovision
in the past. Trying to produce monovision in a patient who has never
experienced this condition may cause intolerable anisometropia and
require further surgery.

Desired Postoperative Refraction
For monofocal lenses, surgeons have traditionally been aiming for
-0.5 D to avoid hyperopic surprise. Some surgeons will target for
monovision in the other eye, thereby attempting to produce a low range
of myopia in the fellow eye of -1.5 to -1.75. Our experience with
multifocal IOLs, such as the Array (Allergan, Irvine, Calif.) lens,
suggests that plano to 0.5 D may be a more desirable target refraction
for this type of IOL because there is less likelihood of unwanted
visual images postoperatively. Some Array surgeons target low myopia in
the fellow eye, such as -0.5, to produce micromonovision, thereby
providing a broader range of intermediate and near vision for the
bilateral Array patient. "
Dan Abel - 31 Oct 2006 17:49 GMT
[Ace snipped his claim, which was:

I can show you proof that when getting IOLs, -1.5 was the refraction
most people chose. Unless you are very active in the outdoors, you will
be *less* dependant on glasses at -1.5 than plano! ]

> > I'd like to see that, if you have a convenient URL.  My Email address is
> > good if you don't have a URL but can cut and paste, or attach.  It's too
[quoted text clipped - 13 lines]
> surgery choose to see well far and correct their near vision with a
> pair of eye glasses or contact lenses.

Although the above site does say that the majority choose distance, I'm
not impressed with the site.  I try not to do spelling and grammar
flames on newsgroups, but when somebody puts up a site, especially one
where I have to look at ads, I expect them to proofread.  For instance,
as a handy way to avoid all the pain and discomfort of cataract surgery,
try their advice:

* The individual who wants to undergo cataract eye surgery must arrive
* at least two hours after the scheduled surgery time.

My HMO made it easy, they just didn't tell you the scheduled surgery
time, just what time to be there.

> Another site:
>
[quoted text clipped - 29 lines]
> providing a broader range of intermediate and near vision for the
> bilateral Array patient. "

Signature

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

The Real Bev - 27 Oct 2006 17:18 GMT
> Howcome few people think about it? It seems that optometrists and their
> patients place too much emphasis on distance vision but if that person
> spends most of his time reading or on the computer, wouldnt it be
> better choice to undercorrect with contact lenses to avoid readers and
> instead wear distance over them for stuff like driving or watching
> movies?

I look at it from a safety standpoint.  I'm astigmatic and can see
NOTHING clearly without help.  My contacts correct for distance for
several reasons:

(1)  My distance settings are +3.5 and +5.5 with 2-2.5 astigmatism
correction.  Trying to add +2 for reading is not within the realm of
possibility.

(2)  If I break my reading glasses at home, no big deal -- I've got
maybe a dozen pair (a buck a pop) in various strengths and everything
will be fine.  If I break distance glasses while I'm driving I probably
wouldn't have backups because you can't get minus lenses for a buck a
pair, and driving under those circumstances would endanger myself and
others.  Plus I'd also need prescription distance sunglasses instead of
my nice yard-sale Oakley M-frames (also a buck a pop), of which I have
several pair.

(3) Binoculars work better if you don't wear glasses.

Signature

Cheers, Bev
===================================
New sig on order, watch this space.

Dan Abel - 27 Oct 2006 18:31 GMT
> Howcome few people think about it?

Some people have thought about it, and decided that it didn't make much
sense for most people.

> It seems that optometrists and their
> patients place too much emphasis on distance vision but if that person
> spends most of his time reading or on the computer, wouldnt it be a
> better choice to undercorrect with contact lenses to avoid readers and
> instead wear distance over them for stuff like driving or watching
> movies?

Most people value both distance and close vision.  Many people find that
it is easier to wear reading glasses, and have their "no glasses" vision
set for distance.  I was given a choice, and chose distance vision (I
have IOLs in both eyes, and the doctor can put any strength in).

Many people find that weather conditions are better inside.  One of the
things I like best about not having glasses for distance is that I don't
have to deal with fogged or wet glasses.  

Another factor is that I have a zillion OTC reading glasses, in
different strengths.  I buy them at Costco at US$18.99 for three pairs.  
They work just great.  If I had gotten my eyes set for close, I would
have had to pay for prescription glasses for distance.

> I have undercorrected both eyes with contacts and I actually like it.

It's mostly a personal preference thing.  Whatever works best for you is
what you should do.

>  Almost all presbyopic people would much rather be a
> little myopic than plano except for those that hate reading and have no
> clue how to use a computer.

I don't believe that's true.

Signature

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


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