Can I go back to an optician and get a prescription for a different kind of lenses without another exam?

June 21, 2009 7:47 PM

Yet another optician question. I got a prescription for reading/computer glasses, but I really need progressives (I think) because I can't see anything closeup without the glasses on. But I don't trust my optician.

I went to an optician at the beginning of the year and got reading/computer glasses that are great. The issue is, however, that I've finally come to terms that I cannot see ANYTHING close up without the glasses. Even cooking, eating dinner, is more pleasurable with the glasses on because I can actually SEE with clarity.

My distance vision is still fine. The exam confirmed that. And we talked about progressives but I didn't know enough to ask the right questions and I realize that I basically don't trust anyone who is covered by my vision plan (they tried to forcefully push this extended exam on me, and swore it was covered by insurance, and then never called me back to confirm - and when I called myself to confirm I got a runaround, and finally cancelled the exam).

So the question is, can I go back to him and get a prescription for progressives without another exam? I do not trust them to tell me the right thing, and since I have to pay for another exam out of pocket, I would try to find a decent/reputable optometrist in NYC who isn't going to try to sell me the farm. If I have to pay for another exam I will definitely go elsewhere, but if he can get a prescription together with the results of my last exam then I'll go back there, simply because money doesn't grow on trees. He told me, specifically, "If these don't work for you, come back and we'll get you something that does," since the glasses I had gotten the previous year were worthless and I'd gone back to using the previous prescription, and I'd told him that. But, again, he might say "I can't do that" and I need to know if that's true or not.

posted by micawber to health & fitness (10 answers total)

I'm not sure if I understand. You got a prescription for reading/computer glasses and now you find that when you wear the glasses for other close-up work, they make things clearer? If the same glasses are working for all your near-middle vision needs, then just wear them when you need them. Progressives are good when your eyes can't make the adjustment from distance to near vision. For example, i wore glasses since I was young to improve my distance vision. That worked fine, my eyes easily adjusted to see things up close when I had my glasses on. Then, after I turned 40, my eyes became less flexible and my near vision needs help. With progressives, the top part has my distance vision and the lower part is not as strong to help out my near vision.
posted by metahawk at 7:56 PM on June 21, 2009

I think what the poster is looking for is a on all the time pair of glasses that has no correction in the distance area, but does in the close up area.

It would be beneficial to know what your insurance covers before going into a doctors office. They [are supposed to] know their medicine, and aren't responsible for knowing the peculiarities of your insurance.

Vision is very different from person to person, that's why you get the "this one or that one" questions. The doctor said to come back if it's wrong, that implies that you and he had an understanding that it doesn't always work on the first shot.

You might also research your state laws- I believe there are laws about glasses that cover these types of situations. Something like a forced guarantee- they have to fix the glasses if they don't solve the problem you complained about.
posted by gjc at 8:35 PM on June 21, 2009

Also, isn't there a difference between an optician and an optometrist? Which did you see? I could be wrong, but I think an optician is restricted in what they can do versus an optometrist.
posted by gjc at 8:36 PM on June 21, 2009

Since your distance vision is okay, you don't need progressives. What you need are half-frame reading glasses. These allow you to look over the tops of them for your distance vision and look down and through them for your close up vision. It is like having just the lower half of bi-focal glasses.

You have in your hand the prescription for the close up lens. You just need to go to any eyeglass shop and have them make you half-frames with that prescription instead of full frames.
posted by JackFlash at 8:56 PM on June 21, 2009

I'm really confused by what you've written.

If you had a complete eye exam, you should have received a prescription that looks something like this, although it should also include P.D. (pupil distance) if you're getting glasses instead of contacts. If it doesn't include P.D., you can measure it yourself or any optician ready to make you glasses can measure it. In most parts of that world, that prescription is considered good for 2 years and you can take it anywhere you like to get the glasses you want. You don't need a separate exam or prescription for progressives if you have that complete prescription in your possession.

Another point of confusion: if your current glasses are reading/computer, that suggests they're good for reading print as well as the screen. What kind of close-up vision isn't working for you if reading glasses aren't doing it for you? If you're used to extremely sharp close vision, the sad truth is that while the nearsighted can generally see fine detail very well without correction for a long time, those of you who aren't nearsighted find that your close vision degrades pretty badly and quickly in comparison. You may simply need higher magnification to do things like read the fine print on an aspirin bottle. This should be something a good optician can get from your current complete prescription.

HOWEVER -- if you so strongly distrust your current practitioner to get things right, or if you can't get a free re-examination and/or new glasses, then yeah, you will have to pay to go elsewhere reputable for another exam and glasses.
posted by maudlin at 9:05 PM on June 21, 2009

gjc has a very good point, you need to see an optometrist. Opticians mainly deal with selling and fitting you with glasses, whereas a optometrist is an actual Medical Doctor who will properly diagnose your problems and figure out what corrective lens curvature (or whatever) you actually need. You then take that prescription and go to an optician (or really, you can get cheaper frames online), who then gets you what product you need.

I made this mistake and went undiagnosed with keratoconus for a few years until I saw a proper doctor. Last time I went, they have all sorts of fancy automated gadgetry that will figure out exactly what you need, along with the 'whats better, 1? *click* or 2? *click*' type stuff, with checks for glaucoma and retinal tearing and such. That should all be part of a common eye exam, and every vision plan I've had (VSP, EyeMed) has that pretty well covered, if not fully covered. If someone is giving you the runaround about what is and is not covered, go elsewhere! Run blindly to the hills!
posted by Mach5 at 9:13 PM on June 21, 2009

There are three levels of specialists that deal with eyes (at least in the US). From wikipedia:
1. Ophthalmologist – A medical doctor (MD) who specializes in surgical eye care. In the US, this often requires four years of college, four years of medical school, and four to six more years of residency, internship, and/or fellowship and sub specialty training
2. Optometrist – Diagnoses common eye diseases and disorders as well as refractive vision correction. [Note: this is your first line for experienced eye care - they are qualified to identify and diagnose problems and will refer you to an opthalmologist for treatment if needed]
In the USA, the standard education is four years of college and four years of optometry school at an accredited Doctor of Optometry (OD) program [Note that they are not a fully trained medical doctor, in the same way a psychologist has a doctorate in psychology but a psychiatrist is an MD with additional specialization]
3. Optician – Specializes in the fitting and fabrication of ophthalmic lenses, spectacles, contact lenses, low vision aids and ocular prosthetics. They may also be referred to as an "optical dispenser", "dispensing optician", "ophthalmic dispenser". The prescription for the corrective lenses must be supplied by an ophthalmologist, optometrist or in some countries an orthoptist. This is a regulated profession in most jurisdictions.
posted by metahawk at 9:33 PM on June 21, 2009

you don't have to get half-frames.

you can get reading glasses made, which you will have to take off for distance.

or you can get progressives that blend down from NOTHING in the top portion, to READING RX in the bottom portion. so you'd look out the top (essentially just clear plastic with no correction) for distance. for middle "computer" distance, you'll look thru somewhere in the middle of the blend, and for up close stuff you'll look through the bottom most portion of the lens. this type of lens can take a lot of getting used to, and requires you to teach yourself a new way of moving your head and eyes depending on what you're looking at. lots of people hate these and don't give them a chance, and return them. there can be issues with improper measurements and alignment, so you'll have to be patient. but when done right and given some time they can be great.

if you do get progressives, make sure to get a lens thats taller vertically, because it will give more space for the blending of RX's. too short, and you're going to have a very narrow channel for each distance.
posted by white light at 1:53 AM on June 22, 2009

Go to see an OpTHAMALogist, they are trained and certified in the ability to diagnose FAR more conditions than an optometrist, the difference is subtle, but they can make a world of difference

http://www.medicinenet.com/script/main/art.asp?articlekey=22559 has a comparison of duties, usually optometrists work for places like LensCrafters and Pearl Vision and are really only interested in getting you to buy glasses through them, an opthamalogist will not care if you buy your glasses from them or not.

GET YOUR PRESCRIPTION, if they give you a hard time, its against the law to withhold it, and you should then look for someone else to do your eyecare in the future.
posted by Mesach at 7:11 AM on June 22, 2009

It sounds like you have presbyopia, which reduces near vision as we get older. Everyone eventually gets it, but it can actually improve vision for those who are myopic.

Anyway, there are several options for you that an Optometrist (you don't need an Ophthalmologist) can help you with.

Bi-Focal glasses. These have the line in the middle. For you, it would be plano (no correction) on top for distance and reading on the bottom. Downside is that everything in your lower vision will be blurry when you are walking around. Takes some time to get used to, but not overly problematic. Also, people look older with the line on their lenses.

No-line Bi-Focal glasses. Same as above, but the division between near and far correction is softened, usually to the point that it is unnoticeable.

Progressive glasses. Similar to bi-focals, although the transition from uncorrected to reading is, well, progressive. The benefit to these is that you have correction for everything in between far and reading somewhere along your lens. The downside is that this "sweet spot" can be maddeningly small. You have to get used to moving your head side to side to read - so you can keep the small reading area on the text. Progressive distort side vision in a way that bi-focals don't. Also have the issue with walking a la bi-focals.

Reading glasses. Similar to what you already have. You put them on when you need to see close up and take them off when you don't. Can be a pain in the ass taking on and off. "Half-moon" lenses, or half-height lenses let you look over the top, but you also will look old or like a librarian taking people to task all the time (sorry to those of you who wear them, but it's true).

Multi-focal contact lenses. There are several versions that are geared specifically toward presbyiops. They basically come in three versions:

1. Progressive. Work the same as progressive glasses. As you look down, your pupil moves towards the outer edge of the lens (the lenses float on the eye and have some degree of movement). As you look up, they float back to far vision. This can happen somewhat slower than what you might desire and take some getting used to.

2. Concentric. This is basically a bulls-eye pattern where the center is far vision and then alternates in expanding rings to near, far, near, etc. The way it works is that your brain actually starts to ignore the information that is incorrect for what you are trying to focus on. These definitely take some getting used to. Doesn't work for everyone.

3. Two lenses. This is where you have one eye corrected for reading and the other eye for distance. In your case you likely don't need one for the other eye. Takes some getting used to, but many people find it a livable compromise. The down side is that you no longer have proper depth of field, so it can make some task more difficult.


Personally, I have progressive lenses (two pair) that work fairly well. If you go with progressives, you should consider the tallest lens you are comfortable wearing. The current fashion of narrow frames does not work well with progressives, as the area to go from one extreme to the other is too short.

I also have Multi-focal progressive contacts that work great. I would wear them every day except using contacts is still, for me, a pain in the ass. You have to give yourself 10 minutes in the morning to be sure you can get both in. Sometimes they go right in, sometimes it takes forever. No predicting.
posted by qwip at 3:34 PM on June 22, 2009