Please help me with my glasses
April 23, 2009 3:04 PM   Subscribe

Please help me with my glasses. Farsighted, astigmatism, presbyopia. Glasses provide only a very small field of sharpness. Details within.

I'm a lifelong wearer of glasses. Over the past 10 or 15 years, I’ve been increasingly dissatisfied with the glasses that I’ve owned. I’m wondering if it is just the way it is, or if I can do better. Sorry for the length of this question. I think I’ve read most of the threads here about glasses.

First some specifics. I’m farsighted, with astigmatism. My prescription is something like +5.50 sphere, -1.5 cylinder. I also have presbyopia, and use +2.25 progressive addition to the lenses. I may well increase this amount with my next glasses. My prescription is basically stable aside from increasing presbyopia. I’m in my 50’s. Optometrists tell me I’m not a good candidate for laser surgery due to the strength of my prescription.

I’ve purchased my glasses at chain stores: Lenscrafters, Pearl, etc. The current pair came from Walmart. I’ve seen the threads here about purchasing glasses online and am intrigued, but haven’t tried them out yet.

The problem I am having is with radial blur anywhere away from what I would call the optical center of the lens. This was bad enough a decade ago, but adding the progressive part of the lens seems to have made things worse and the current glasses are by far the worst of all. In fact, my current lenses seem to have only a very narrow channel of real sharpness. Anything to the left or right of this channel is blurred. These are Zeiss Premium 1.67 Hi-Index lenses and were supposedly the highest quality lenses available at the time from Walmart. I need to find something with a much wider field of sharpness and less of the radial/off-center blur. At their center, the sharpness is fine, so I think the prescription is correct. It’s just such a very small spot that is sharp.

Reading, computer use, SLR photography, etc. are all becoming increasingly difficult. I’m a software engineer so I spend most of my time with the computer and books/pencil/paper. I don't think it's an eye problem. My corrected vision has always been 20/15.

So my questions are:

- Am I stuck with this situation?

- Would I be better off with some non-chain store solution or more expensive/exotic lenses? Glass lenses? Some other lens material or manufacturer?

- Should I Look for a better quality optician than might be found in a chain store? Is there likely to be a significant difference? How would I find someone good?

- Should I try lined bifocal/trifocal glasses? Is the radial blurring problem made worse by the progressives? Or perhaps separate glasses for different situations?

- I’m intrigued by hard contact lenses. I gave them a short trial in the early 90s, but had a very hard time getting them in and out of my eyes. Not sure if I’d have better luck now. I’d like the freedom from glasses and the wide field of view, if I can adapt to wearing them. I’d probably still need reading glasses to go with them. Is this a reasonable thing to try?

Also, if anyone has any suggestions for scratch resistance, I’d be interested. It seems that the anti-scratch coatings have become worthless over the past decade.

Thank you for reading this and any suggestions or comments you have are appreciated. Anyone who provides a real answer for me will have their own shrine in my house that I will bow to daily.
posted by DarkForest to Health & Fitness (23 answers total) 1 user marked this as a favorite
Try an ophthalmologist; an MD is likely to be able to help with the issues related to your actual vision, and will hopefully have the knowledge to help you figure out the equipment problem.
posted by chesty_a_arthur at 3:09 PM on April 23, 2009

Have you considered radial keratotomy, instead of laser surgery?
posted by Blazecock Pileon at 3:10 PM on April 23, 2009

Talk to your optometrist, not us. If he/she doesn't take your concerns seriously, find someone who will. There's too many factors going on here for anyone but the guy actually looking at your eye to tell you what's going on. An optometrist can dial your prescription into his machine (made with high quality lenses), which should give you an idea whether your lenses or your eyes are the issue here.
posted by zachlipton at 3:13 PM on April 23, 2009

What size of lens are your frames for? I have thrice the sphere value that you do, and have found that only by buying frames with really small lenses, can I get a consistent level of clarity.
posted by nomisxid at 3:28 PM on April 23, 2009

Response by poster: What size of lens are your frames for?

I always get frames that take small lenses. Otherwise the added thickness causes annoying extra weight in the lenses.
posted by DarkForest at 3:35 PM on April 23, 2009

I probably have a very similar prescription to yours. I've been generally happy using the more expensive optical shops (Eyes on Fremont in Seattle), they keep informed on the most up-to-date technologies and materials. I stopped using chain/mall stores many years ago due to not trusting the quality.
posted by matildaben at 3:46 PM on April 23, 2009

My whole family has bad eyesight, but my little sisters' has to be the worst of all, terrible astigmatism and like a +7 something-or-other... BUT she was in luck, they have contacts she can wear! I think contacts have come a long way in the last decade or so, you should really give them a try.

BUT (a big but) it's hard to wear contacts when you're at the computer or reading, you don't blink as much (apparently) and my eyes get so very tired when wearing them for that purpose. You will still need to get glasses. My little sister's glasses would be coke bottle lenses if it weren't for the ultrathin ones the optician recommended, which the optician indeed said gave a better range of vision too, and avoided that problem you were mentioning. She went with the wide vision, thick armed glasses that are all the rage now, which hides the thickness of the lenses at the side (still some thickness in the lenses at the far side).
posted by lizbunny at 4:04 PM on April 23, 2009

I see an ophthalmologist for my eye exam, but get my prescription filled elsewhere. Then, I take my glasses back to my doc's office and the tech checks my lenses quickly and for free. I started doing this after I wore glasses made with a completely wrong prescription for about 2 years. It was kind of like I had to hold my head exactly the right angle to see anything. The tech says that people are always coming in from the chain stores with off-lenses. I've had to get another pair fixed since. That's something to check if you haven't already, but I have no idea if that's your problem.
posted by classa at 4:04 PM on April 23, 2009

Oh, and my mother has bifocals, but she's got a third pair of glasses just for wearing at the computer, so the optimum focal length is right at arm's reach where the computer monitor sits. You may want to give that a try too.
posted by lizbunny at 4:07 PM on April 23, 2009

Yuck, the pain of strong glasses. I'm -5.5 which is the same problem but the other way.

High index (thin) lenses have higher chromatic abberation (ABBE). This is the effect that makes only the very center of the lens clear. What you need, in my opinion, is plain old CR39 plastic. The optical clarity of this material is nearly as good as crown glass. It is also the cheapest material you can have your glasses made out of. It, unfortunately, is also the thickest. The optical clarity and thinness are a tradeoff you must make. I choose the clarity (CR39) and you chose, probably unwittingly and based on the advice of an uninformed salesperson at walmart, the thinness. You can help the excessive thickness a lot by choosing small round frames. Luckily these are currently in style.

When they say these lenses are "the best", they probably mean "the thinnest" and possibly also "the most expensive we sell". It is naive to think there is a "best" lens material and you should not trust anyone who tells you such a simpleminded thing. There are many many materials to choose from BECAUSE of the tradeoffs involved.

The progressives also add to this kind of distortion. If you have not tried plain old plastic CR39 lenses in traditional bifocals (or trifocals?), you should try those I suspect. I have been very unhappy with some of the opticians that have helped me. I do my own research because of so many bad experiences. It seems they just don't understand the issues that we have with our strong prescriptions. A google search for ABBE will tell you a lot about the materials and tradeoffs available to you.
posted by fritley at 4:08 PM on April 23, 2009 [2 favorites]

We all just bought glasses in the last 6 months from a higher end store, fwiw. My sister's lenses were the top of their line, also new-ish to the store.
posted by lizbunny at 4:12 PM on April 23, 2009

Should I Look for a better quality optician than might be found in a chain store? Is there likely to be a significant difference?

In my experience there's a HUGE difference. The high end optometrist has longer appointments (which, in my case, were actually cheaper), knows so much more about current technology, does a much more thorough examination of my eyes, and really took the time to work out what combination of lenses and contact solution and frames and whatever would work for me (I wear contacts or glasses, depending on my mood). Plus several follow up visits including trialling two different types of contacts to make sure I'm happy. I get really personalised service rather than just slotted into a box like the chain-store guys do and the whole process isn't over until my vision is acceptable to both of us. This is the level of service you should be getting.

Personally I found an optometrist who had done post-grad work as well as the basic optometry degree and who mentions on her website that she specifically aims to keep up with and understand the technology side (lens types etc). She also doesn't sell very many types of glasses in her store, that's not where she makes money. I think this is a good sign and is also true of my previous excellent optometrist. Chain stores aren't there for making you see, they're fashion stores for glasses with lots of pretty frames.

I'm also a bit unsure why you're talking about hard contact lenses. With astigmatism and far-sightedness you should be able to wear soft, possibly with glasses added for the presbyopia. You can also get bifocal or progressive soft lenses these days if that's more appropriate. They're also way more comfy than soft lenses from even three years ago. A good optometrist will be able to tell you pretty quickly what is or isn't an option.
posted by shelleycat at 4:52 PM on April 23, 2009

I'm also a lifelong glasses wearer, and my prescription is +6.25, with a lot of the same problems you have. I'm 30, though, and the presbyopia is only just starting to affect me more negatively. I had been doing the chain store thing, too. But then I went to a fancy optometrist, and shelled out the cash for the good glasses and now I have fantastic, light-weight, thin lenses with a scratch and glare resistant coating and something to correct the sphere, so that my eyes don't look as bug-eyed as they usually do. Totally and completely worth every penny. Go to an optometrist in your area that isn't overworked (as those at a Lenscrafters tend to be) and really talk about what you're looking for.

And on a side note, I wore one soft contact lens and one toric contact lens for a while, but it never really corrects your vision as well as glasses. I think you'll find that if you really get the right pair of frames and lenses, it will make all the difference.
posted by cachondeo45 at 5:02 PM on April 23, 2009

shelleycat: with the -1.5 cylinder, soft (toric) lenses are finicky for many folks because they tend to not stay perfectly upright. If you lay sideways on the sofa and watch TV, forget it -- but that's not the only time they work imperfectly due to this unwanted rotation.

Hard lenses do not conform to the front of the eye, so they correct astigmatism automatically (they fill in behind with tears, and so effectively "replace" the front of the eye with something spherical) and therefore do not have this rotation problem. For me, wearing hard lenses gave me the best vision. There is virtually no distortion anywhere in the field of view. The OP should certainly talk to the eye doctor about them, and not discount them automatically. They are a great option if you can learn to tolerate them.
posted by fritley at 5:03 PM on April 23, 2009

Response by poster: With astigmatism and far-sightedness you should be able to wear soft

I've tried soft lenses, but I can never get them quite sharp enough to read well. The toric soft lenses never seemed to work perfectly. Hard contacts correct the astigmatism and I've heard they work well.
posted by DarkForest at 5:12 PM on April 23, 2009

*shrug* I have about a -1.5 cylinder in one eye and it's not a problem. I'm short sighted though, about -4 in the worst eye I think?

It's not a problem now that is, when I went to a chain store the guy just gave me whatever standard toric lens he gives everyone and yeah, it rotated and I had dry eyes from the computer and it sucked. That's why I went to someone better actually. The good optometrist spent a lot more time talking to me about this and gave me silicone hydrogel lenses (which where brand new at the time) plus better solution so the dry eye is gone despite many hours computer use each day and the lens never rotates incorrectly and I watch TV lying down all the time. This is why DarkForest should go to see someone good, there are lots of options available if you can find someone knowledgeable and willing to work with you.
posted by shelleycat at 5:17 PM on April 23, 2009

One limitation of progressive lenses is that they are aspheric and have that narrow (keyhole-shaped) sweet-spot, with some degree of distortion on either side of it. The chromatic aberration of a high-index plastic can only make that worse. I was once told that Zeiss lenses had the widest sweet-spot available, at least at that time. I'd suggest trying a standard plastic progressive lens in a larger frame. Small frames would require a higher optical gradient (bottom to top) so the lenses have to be mounted more precisely for you to have the proper correction in both eyes simultaneously. The combination of small progressive lenses, a complex prescription, the high index plastic, and an economy supplier, may be too much of a compromise to get the vision you want.

For the computer, a plain computer bifocal works better for me (that's a magic-word any optometrist should know, and means 1/2 of the reading add is added to the distance portion of the lens so your bifocals have a middle distance and a reading portion - no distance lens!). They're spherical lenses so they're good from edge-to-edge laterally, and you won't be nodding up and down, hunting for focus as you read down a large screen. Get a different enough frame that you can easily tell which is which without glasses (or with the wrong ones!) on.
posted by TruncatedTiller at 6:11 PM on April 23, 2009

Also consider having them fit the lenses with the bifocal line ~1/2 mm lower than they think is "right", to keep it out of your vision. You'll use the upper portion 95% of the time.
posted by TruncatedTiller at 6:13 PM on April 23, 2009

I would say that fritley is spot-on.

Other options to consider- different glasses for different tasks. Or contacts for all day use, and add on reading glasses when needed.

(I've needed vision correction since early grade school. My prescription finally settled out at -6.5 in both eyes. Perhaps it's the difference between near and far sightedness, but I find that the quality of vision I get from soft lenses is roughly a million times better than with glasses of the same prescription. Same thing you speak of- the field of vision just isn't good. )
posted by gjc at 6:17 PM on April 23, 2009

Go to an ophthalmology practice that has an optometrist on-staff. Do the refraction and fitting and so on there and get any of your other niggling eyeball-related worries checked out at the same time. Get a good contact lens fitting, too, and grab that scrip.

Next, find the local, non-chain, probably family-owned optical shop in your town that has the nicest elderly woman possible on staff-- she'll often be wearing a little pair of half-glasses on a chain around her neck, that's how you'll know she's the person you want. Give her your scrip, explain your issues, and let her tow you about the store for an hour or so finding something that works for you.

Buy those. Repeat as needed over the next few years, building rapport with your doctors and your optician.

Works for me, and I'm sporting polarized progressive sunglass-tinted -3.00/-10.25 bifocals with a +1.25 adjustment. Lenscrafters, Wal-Mart, and Costco, in my experience, cannot cope with Gonzo Ophthalmology and should not be trusted with your eyeballs or your money-- although you can go to Costco for contact lenses as long as it's just to buy a few boxes, not to let them pretend to fit you.
posted by fairytale of los angeles at 9:01 PM on April 23, 2009

Avoid the chain stores like the plague. I have horrible eyes and even when they got my prescription right (eventually), the glasses just never provided much clarity except right at the center. Went to a local independant business and got glasses which are almost as sharp at the periphery as the center. Cost less, too.
posted by Dr.Enormous at 5:43 AM on April 24, 2009

Hard (actually rigid gas permeable) contacts are da bomb. I have no idea what my prescription is offhand, but my vision is very, very crap (I can focus on something when it's about 2 inches from my eyes, any further is blurry) and I have bad astigmatism. I've worn gas perms for years and years, and they are awesome. With toric soft lenses, I have much fuzzier vision and haloes around lights (which still beats the pants off wearing my glasses)...and switching to them for a year actually made my astigmatism worse; with gas perms everything is crisp and magically visible. It was nice having the sort of backup plan with the softs that if I lost or ripped one, I could just go to next week's box a little early, and replacing a lost gas perm is like a hundred bucks or something, but all things considered, I prefer being able to actually see!

Definitely disagree with the remark that they are hard to deal with at the computer or while reading -- I am a sysadmin and am at a monitor for 12+ hours a day and read all the time, and it's no trouble at all. If your eyes get dry, just put in eye drops.

If you are considering going to get them, though, just be aware that gas perms are not a one-size-fits-all solution like softs. Soft lenses you can pretty much show up and get a pair (well... not so much for astigmatism, but lucky people with decent eyes can) and wear them right away. RGPs you have to go in and get the contours of your eyes measured, then they order you a pair, you wait a week to get them in, you try them, see if they fit, they check the fit, lather rinse repeat until you find the perfect fit. They may also hurt when you first try putting them in (you're putting a chunk of plastic in your eye, after all), but you acclimate pretty quickly if you can get past that initial bump. Get them to give you this tiny little soft rubber suction-cup-on-a-stick thing, in case you want the lens out fast and can't pop it out (sometimes that happens if you get something in your eye and your eye waters, it makes it a bit harder to pop the lens out, so just get the suction cup thingie as backup, it'll make you feel much better to have a Plan B.) There are also different plastics that they are made of, so if you get a pair that you seem to have really dry eyes with, they can order a different kind and see if that makes it better. Also, gas perms last a lot longer if you take care of them; I've gone three years on a pair before and only had to get a new set because my prescription changed.

Hard lenses rule! :)
posted by sldownard at 7:58 AM on April 24, 2009

Response by poster: Thank you all for your great advice. I'll be checking out optometrists in my area and discussing your suggestions with them.

Thanks fritely, for the CR39 info. I've had a very hard time getting anyone at the chain stores to understand the problem I'm having with blurring away from the center. I think I may well have started having this problem when the newer plastics started coming in.

I'll definitely be checking out the hard contacts too. When I tried them before (early 90's), I don't remember them even talking about a custom fitting. Maybe that's why I could never get them to work.

Thanks again. If you have more suggestions, please post.
posted by DarkForest at 8:32 AM on April 24, 2009

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