Focusing strategies for a maturing pathologist

July 7, 2007 2:40 PM

Presbyopiafilter... My lovely wife has started to lose her powers of ocular accomodation. No biggie, but...

...she's a pathologist, and must constantly look back and forth from the microscope to the computer screen and the patient record (piece of paper). It's starting to be more of a strain.

Is there some combination of reading glasses, contacts, lighting and/or focusing strategy on the 'scope that might help? (N.B., she's also nearsighted to the tune of 10 or so diopters in each eye and normally wears contacts.)

posted by Calibandage to health (12 comments total)

That's why God (or Ben Franklin) gave us bifocals.

It's normal as you age for you to lose your ability to change focus, and there's nothing that can be done about it. The lens in the eye stiffens up and the muscles that control it lose the ability to change its shape.
posted by Steven C. Den Beste at 2:52 PM on July 7, 2007

A combination of her normal contacts and a pair of half-lens reading glasses (that she can peer over when they're not needed) would probably work.
posted by amyms at 2:53 PM on July 7, 2007

Heh. I was going to say that this is precisely the situation bifocals were invented for. SCDB beat me to it.
posted by Cool Papa Bell at 2:53 PM on July 7, 2007

There is a medical group in Ohio- I think called AceVision- they are developing a surgical approach to correcting presbyopia and one of their eye doctors is an expert on aging and the eye. You might check them out.
posted by mistsandrain at 2:54 PM on July 7, 2007

SCDB and CPB, she's considered the bifocals but she doesn't get the same overall acuity with glasses as she does with her contacts, due to the high correction, I suppose. [Speaking personally, I just got my own bifocals (actually progressives), and they haven't really helped me in the way that I want either.]
posted by Calibandage at 3:25 PM on July 7, 2007

Unfortunately, some problems do not have perfect solutions.
posted by Steven C. Den Beste at 3:42 PM on July 7, 2007

she's considered the bifocals but she doesn't get the same overall acuity with glasses as she does with her contacts, due to the high correction, I suppose.

That's why she should consider a pair of half-lens reading glasses to wear with her normal contacts. They will be task-specific to the work-related needs you described.
posted by amyms at 3:44 PM on July 7, 2007

In my case, the contacts+reading glasses and the progressive bifocals and the lined bifocals have all sucked. Sorry. If someone has an actual good solution for this, I'd sure like to hear it. I still have 20/15 eyes when properly corrected, but all my everyday glasses/contact solutions have sucked since presbyopia hit.
posted by DarkForest at 5:22 PM on July 7, 2007

Can the microscope eyepiece be diopter-adjusted like an SLR or binocular eyepiece? If so, then get a special pair of mono-vision glasses set for a distance appropriate for reading and computer (or a middle ground between) then adjust the diopter of the microscope eyepiece to match. Those eyeglasses will be just for these tasks; she'll need another pair for regular walking around life. I don't know if most microscopes have this adjustment though.
posted by DarkForest at 5:29 PM on July 7, 2007

"I don't know if most microscopes have this adjustment though."

Maybe they don't need it though, as it might be a function of just the regular focus control. But I think the key is not to be looking through the eyepiece with progressive lenses. At least in my case, looking through a viewfinder with progressives doesn't work well. Ignore me, I'm just blathering on...
posted by DarkForest at 5:33 PM on July 7, 2007

I have mono-vision = one eye corrected for reading, one for distance. Works fine for me.
posted by A189Nut at 12:58 AM on July 8, 2007 [1 favorite]

The microscope can be focused to accommodate any amount of near/far-sighted-ness. So the problem is almost certainly that she likes to look through the microscope without glasses, because the visual field (and perhaps acuity) is better. Yet with the presbyopia, she needs reading glasses to see the paper. So the difficulty is, glasses on/off/on/off all day long.

Second difficulty is that the computer screen is a different distance than the paper--thus requiring a different strength of reading glasses.

That suggests some things to try:

1. Different eyepieces will give a different field size and eye relief (distance between eyepiece & eye). With the right eyepiece and eyecup you might be able to find something that works. You might talk to co-workers who use glasses while microscoping (typically because of astigmatism). Some eyepiece designs are very persnickety about having the eye in an exact spot--if you're not there you see only a portion of the field, or the kidney bean effect, or nothing at all. With glasses it becomes harder to find that exact spot so you might look for the eyepiece design that is more forgiving.

2. You might be able to find a reading glasses strength that is midway between the computer screen distance and the sheet-of-paper distance and so (if your wife's eyes can accommodate at all--some can't) might work for both. Got to a drugstore and experiment with their different strength reading glasses to find one that works.

3. Putting #1 & #2 together you might be able to find one full-sized set of reading glasses (not the half-moon) that would work for all tasks at the desk--microscope, printed paper, and computer.

4. Move your computer screen closer (and adjust font size as necessary, etc.) so that there is not so much difference in reading distance between the screen and the paper. This makes it much easier to find one pair of reading glasses that will work for both computer and paper.

5. Increase overall/ambient lighting in the office. This reduces pupil size and increase depth-of-field of your vision (very much like increasing the f-stop on your camera will greatly increase the depth-of-field of the photograph). Low light levels create a depth-of-field that is razor thin. Increasing the lighting may cause problems with glare with the microscope eyepieces, or adjusting to the different light level while looking in the microscope--but worth experimenting with.

6. Others have mentioned laser surgery where one eye is corrected for near vision and one for far vision. The same effect can be obtained with contact lenses of different strength for the two different eyes. This works for some people and drives others crazy. With contacts you could experiment easily to find out whether this could work for your wife. But taking it to the extreme, something like this could work quite well:

a. Contact for one set for paper/print reading distance.

b. Contact for other eye set for computer screen reading distance.

c. Assuming your wife uses a binocular microscope, there should be an individual focusing adjustment for one side, designed to accommodate just this type of visual difference. It will (probably) adjust enough to allow sharp binocular vision in the microscope.

d. You then have glasses made that you put on (over the contacts) when you need distance vision.

If you spend the majority of your time working with the near & medium distances, and need best acuity there, this solution makes a lot of sense. Instead of putting on "reading glasses" when you need to do these medium/near tasks, you put on "distance glasses" when you need to drive or do other "far" tasks.

7. Most bi-focals are set up for distance/close vision. Trifocal are distant/medium/close. Instead of either of these, consider having bifocals made for medium/close work. The medium (larger) part of the glasses is used for reading the computer screen, the close (lower) section is for reading papers and print. Again, the idea is that you would put these glasses on when sitting down at the desk, and only need to take them off when getting up to do activities that require distant vision.

Probably more important than any of these specifically is finding an optometrist who is open to experimenting with different solutions like this and finding something that really works for your given situation.

Example: My optometrist had a patient who plays tuba in a military band. When marching they use those little flip music holders that hang off the tuba and it came in at the top of his visual field. So normal bifocals didn't work at all. The solution? Put the "near vision" area of the bifocal at the TOP of the bifocal rather than at the bottom.

Worked like a charm . . .

Also, many musicians use the "two-eye" solution, with one eye set to medium distance (for reading music on the music stand) and the other for distant (to see the conductor, fellow musicians, etc.) For close-up work like reading they add reading glasses.
posted by flug at 1:13 PM on July 8, 2007