21st Century Optometry & Eyeglasses?

August 14, 2011 7:34 PM

Is there a 21st century hi-tech optometry system that will give me both more accurate eyeglass prescription and more precise corrective lenses?

My current optometrist uses the same standard, steampunky trial-and-error equipment that has been used for at least a generation: flipping lenses from eye to eye, saying "Does this look better than the last one?" It's the 21st century and there has to be a better, more accurate method of measuring my increasingly poor vision. Is there any such newfangled equipment and, if so, how would I locate an optometrist who uses it?

Of course, such a system would be useless without a company that can take these amazingly precise measurements of my eyes and use them to create a...(ahem) spectacular pair of lenses which will give me optimum vision. Is there such a place or am I confined to Lenscrafter hell?

posted by Jamesonian to health & fitness (6 answers total)

I use an ophthalmologist rather than an optometrist and his equipment does it all. I wish I could tell you the brand, etc but I do not know that.
posted by JayRwv at 7:58 PM on August 14, 2011

I am most certainly not a doctor, and this is most definitely not medical advice.

The old-school device you're describing is called a phoropter. (I never thought of it as being steampunk-y, but you're right — that Wikipedia photo looks surprisingly bad-ass!)

The more modern version of a phoropter is, I believe, generally called an autorefractor. It is indeed very quick, though my eye doctor never used any kind of "cycloplegic agent" (sounds like a muscle relaxant for the eye), which Wikipedia describes — I always just use the device directly, without any preparation. My doctor likes to use the autorefractor in conjunction with the phoropter — he'll start with the first, then use that as the baseline to double-check it with the second. (For me, usually the numbers are identical or close to it.) Again, I'm no eye doctor myself, but I'd guess that's probably a best practice. Personally, I'd feel that a doctor who only used the autorefractor was being lazy, but perhaps medical professionals would tell me that's ridiculous. Anyhow, I like that my guy uses both.

One other thing you can ask about is whether the doctor uses a retinal scanner like the Optomap. This takes the place of those annoying tests where they put those pupil-dilating drops in your eyes that ruin half your day. They're also great because they take photographs of the back of your eyes, and your doctor can compare them over time to see if there are any changes.
posted by Conrad Cornelius o'Donald o'Dell at 8:58 PM on August 14, 2011 [1 favorite]

Part of the problem is that different people like different prescriptions. So a good clinician should really always go through the trial and error period.

Secondly, they do use a technique for dialing in the correction. They use the retinoscope to shine a light through your eye and by looking at the projected image in the back of the retina, they can dial in the prescription to "pretty close" and then the trial and error to determine preference.

According to the wikipedia article on the autorefractor, it seems to say that they aren't quite good enough yet. Perhaps there are newer models that can do a better job. Or maybe those things are "good enough for government work" but not preferred by the family doc type of person.

The last possibility is that the state of art in correction isn't up to what can be measured. A "perfect" correction probably can only work if your eyes are focused exactly the same way they were when measured, and that's hard to do with a hunk of plastic .

As for the eye drops, I have no idea why they are still used. My eye doc, a pretty simple practice without all kinds of fancy equipment, has a microscope looking thing that he uses to view the back of the eye. My pupils get dilated because he just turns the lights off and tells me to focus on the back wall.
posted by gjc at 9:21 PM on August 14, 2011

This might also be because a large part of how vision works is to do with the brain resolving and processing images and not the eye itself.

I have one eye is much more myopic than the other. If I was to wear glasses that had the "correct" presecription for both eyes, my brain would not be able to resolve the images from each eye into one image because they would be too different. (and yes, I've tried this in the optometrist's chair and it was literally nauseating). The phoropter allows the optometrist to adjust the "bad" eye's prescription until it is comfortable for me. My level of comfort is likely to be different to other peoples.

This problem is less present with contact lenses, because they are not changing the resolution of the image before it hits the lense of the eye, they are in effect an extension of the lense of the eye. For this reason, my contact lense prescription is the "correct" prescription for my eyes. So it would posisble be ok to move away from the phoropter for contact lense prescriptions, but not for glasses.
posted by girlgenius at 12:31 AM on August 15, 2011

I get my eyes checked at a university school of optometry. They have all the gizmos but the scrips they write for me are invariably developed and double-checked with the phoroptor, interactively and with my specific feedback taken into account. With my freaky eyes that can take half an hour or more. I take the prescription paper and get eyewear made by a company in Hong Kong that specializes in freaky prescriptions. I can see quite well.
posted by seanmpuckett at 5:29 AM on August 15, 2011

Oh yes -- it's not just the optical measurements of your eyes themselves that are important if having spectacles made, you also need your IPD inter-pupillary distances. You need two numbers, measured from the bridge of the nose, not just one... unless your nose is perfectly centred between your eyes.
posted by seanmpuckett at 5:33 AM on August 15, 2011