Can I see clearly now?
February 16, 2012 6:26 AM   Subscribe

My annual eye exam is coming up.  I've had a years-long string of not-quite-right corrective lenses.   What can I do to get an accurate prescription this time?

I'm super nearsighted (~-7.50 in contacts, coke-bottle in glasses), and I've had about five years of awful luck in contact and glasses prescriptions.  Regularly, about once a year, I've gone to the doctor, given my best answers on the eye test, and received a slightly different prescription from last time's, only to find out, when I get the lenses and settle in a bit, that it's not *quite* clear-- fine for daily life, but with a little residual blurriness that makes me squint a lot without realizing it and give myself frown lines and headaches.  

Since I have no money and no time, I've just lived with whatever slightly-off eye apparatus I just bought, but the result is that I've been cycling daily between two pairs of glasses and a set of contact lenses that are all slightly different, slightly wrong prescriptions.  Which means I don't at present have a really good conscious sense of what perfectly clear vision would even look like.   Meaning I can't honestly tell whether A or B is clearer in the next eye exam... and cue vicious cycle. 

I'm wondering whether there are best practices for receiving eye examinations that might help me find my way out of this blurry existence.  I thought maybe That Machine (name escapes me) that automatically measures vision might help, but my last Pearle Vision exam incorporated the Machine, and the resulting prescription was just as bad as the rest of them.  Would it help, possibly, to go to an actual doctor's office instead of a mall place?  Anything else I can do? 
posted by yersinia to Health & Fitness (24 answers total) 5 users marked this as a favorite
Skip the mall place and the automatic machine and find a good optometrist. If you have a local university with an optometry school, this could be a great place to start - the exam will take forever, but it will be more than comprehensive in my experience.

I've also heard they have a method for correcting young children which does not require the A-B testing and takes the natural compensation for "almost right" out of the process.

One final comment, I've found in the past that the time of day when I go to the exam can make a big difference. End of the day with tired eyes never worked out well...
posted by NoDef at 6:33 AM on February 16, 2012

I've had this problem too. One thing that comes to mind: do you have cataracts? When I had them, no glasses Rx gave me clear vision.
posted by cp311 at 6:33 AM on February 16, 2012

From what my eye doctor has told me:
-contacts will almost never be as accurate as glasses, because they are available only in larger increments (i.e. 7.5, 7.25, 7.0, whereas glasses I guess can be made in smaller increments?). This is even more accentuated if you have astigmatism.

-your eyes need to acclimate to one prescription. Switching between contacts and glasses regularly will lessen the effectiveness of both. I was advised to either wear my glasses full time and sparingly wear contacts (I only wear them when running and to special events like weddings). OR wear my contacts full time and just wear my glasses for the first 20 mins when I wake up or right before bed (not even allowed to wear them on weekends or for full days).

Also seconding getting an eye doctor in private practice, not at one of the big-name places. Explain to them your past issues in detail, and ask if they have advice. I used to always get nervous that they were trying to trick me ("Better with 1 or 2?" "One?" "Ha HA! The correct answer was 2! You're faking! Get out."). Then I got over it and had an honest patient to doctor discussion and got decent lenses.
posted by melissasaurus at 6:39 AM on February 16, 2012 [2 favorites]

Go during the time of day that you're usually busy. That way your doctor is looking at your "normal" eyes. Also, you will be more alert and best able to decide which lenses provide the clearest vision.
posted by anaelith at 6:40 AM on February 16, 2012

What I've found is most helpful is really taking your time with the lens-thingy. In the past, I'd let them flip between the different lenses too quickly. That's fine for the big jumps, but when they're doing the fine tuning, don't be afraid to ask to go back to a prior lens and to give you an extra second to register the new lens.
posted by smirkette at 6:43 AM on February 16, 2012

As for where to go, I've had good success with America's Best. They're understanding about my issues, answer my questions well, and all for a good price. Can't say how they compare to anyone else though.
posted by DoubleLune at 6:56 AM on February 16, 2012

Yeah, like smirkette, I seemed to get better results when I spoke up and said, "can I see 'a' again?" as needed.
posted by Jahaza at 7:00 AM on February 16, 2012

A few years ago, I saw an optometrist who, when flipping the lenses and asking, "Which is better, A or B?", would ask me, "which feels more comfortable?" instead of "which is clearer?" She said it is possible to actually over-correct if you focus too much on the clearest once. No optomestrist since then has asked me that, but if I'm having trouble choosing between two lenses, I keep that in mind.

You may have better luck at a free-standing clinic than a mall place.

And be sure to tell the optometrist this right up front. I had my eyes checked week before last, and I told the optometrist that I am always nervous about whether I'm giving the right answers and will get the right prescription, and he ended up explaining to me how the combination of the automatic machine and the lens tester thing work, and was very reassuring.
posted by not that girl at 7:12 AM on February 16, 2012

I got an awesome prescription by looking for an independent practice that uses the latest technology (automatic refractor, retinal tomography and imaging, etc.). Their website also had articles on a ton of topics including everyday things like floaters. That indicated someone there really cared, and one of the docs turned out to be the eye doc for all the local sports teams. Really nice guy.

Two things:
- When you hold an eyelid closed for a bit, it deforms the eye, which lasts for a little while even after opening it. That can throw off the hole lens bit. Give it 15 seconds and blink a lot. Make a joke, etc. Or ask them to give you something to hold in front of the closed eye so you don't need to close it.
- My contacts prescription is scarily accurate, far better than any glasses I've had. I wanted them for diving (long story) so he really took time with them.
posted by jwells at 7:12 AM on February 16, 2012 [1 favorite]

My right eye has always been bad, even when supposedly corrected to 20/20. I went in for a Lasik evaluation this year and discovered that the surface of my cornea is irregular - the thickness is supposed to be uniform but mine is more like, as the doctor said, "a funhouse mirror," and can never really be corrected to perfect vision as a result. I asked why no optometrist had ever told me this before (because I have asked, many times, what's up with my right eye), and she said that most eye doctors don't have the equipment in-house to measure corneal thickness patterns because it's expensive and not really that important for your average prescription.

So anyway, who knows if that's what's going on with you (and even if it is, I don't think it can be corrected) but I was relieved to have an answer to a lifelong question of why I can't see worth a damn out of my right eye.
posted by something something at 7:17 AM on February 16, 2012

Nthing the suggestions to acclimate to one pair of glasses (rather than constant switching) and to be willing to double/triple/quadruple-check the "Which is better?" decision. My optometrist is also perfectly OK with an answer of "about the same" or more detailed info like, "A is kind of blurry vertically, while B is kind of blurry horizontally."

The other important thing I discovered just a few years ago concerns pupillary distance, which is part of the optician fitting you with frames. So far every optician I've ever been to has had a sort of binocular-looking device (unsurprisingly called a pupilometer) that they hold up to your face to determine this measurement. You really want to think about how your glasses sit on your face and make sure the pupilometer rests there when they take that measurement. In the past I had a tendency to press the device right up against my face (like binoculars) and had some not-so-great glasses. Once I began making sure the pupilometer rested on the bridge of my nose like my glasses do, I've had much better results.
posted by soundguy99 at 7:38 AM on February 16, 2012

Find a good optomitrist, and when you get your Rx, don't order a big batch of lenses at once. My optomitrist will let me take home a few lenses and test a prescription out if I ask, and if it's not right I will go back. My Rx is not that terrible (-3.75) so they usually have them in stock.

I used to order all my lenses through them too (they were about the price of ordering online), and they would always exchange them (sealed of course) if the Rx was not right, or even if my Rx changed before I finished my remaining lenses, so a place like that might be more willing to work with you.

Have you gone back after getting a pair of glasses or contacts to explain they weren't right or that you were getting headaches? I was under the impression that you would not have to pay if they did not give you the correct perscription for you.
posted by inertia at 7:40 AM on February 16, 2012

Nthing the suggestion to go to an experienced optometrist with the most current equipment. My eye exam takes about three to four different machines, and my doctor is very thorough in the examination. I also think it's a good sign when it's someone who likes to explain everything to you; you can see he pays attention to the smallest things.
posted by Ender's Friend at 7:42 AM on February 16, 2012

I feel your pain! I have bad, bad vision (-16.5) and it is always difficult to get things right. Please do go to an independent optometrist or ophthalmologist, they tend to be less rushed and have better equipment than mall optometrists.

Also, this might sound weird, but I have had good luck going to doctors who serve a large population of elderly patients. They are usually very helpful when it comes to taking time to make sure that I am seeing the right thing. And please mention to the optometrist that you've had this problem--they will take extra time with you.

If you have vision insurance, your provider may allow for the doctors to remake lenses (both contacts and glasses) if you can't see correctly out of them at no charge to you. Take your time and insist on getting it right if they don't work for you initially. It's really hard on your eyes if you have to switch between prescriptions all the time.
posted by zoetrope at 7:51 AM on February 16, 2012 [1 favorite]

I'll nth the advice to go to a private practice (preferably one with a good recommendation from friends) rather than LensCrafters or something. I'd been going to a quite nice LensCrafters with all the latest equipment but my vision was never quite what I felt it should be. I wrote it off as a fact of life — I just wasn't going to have the vision I felt like I should.

Well, this year I decided to go to a boutiquey place that had glowing recommendations. Low and behold, they gave me a different prescription than I've had for the last couple years and the difference was immediate and amazing! It's always taken me a day or so to get used to a new pair of glasses, but these felt right in an hour.

Another thing to keep in mind is that you can (and should) give more feedback than just "one" or "two" when they're flipping between the different lenses. I had an eye doctor tell me that once, and it's made a big different. For instance, if one is clearer but smaller, say so. If one is sharp but has color halos, say that. The most recent time I went it, we got to the end of the standard tests and it still felt a little fuzzy. I mentioned it, and the doctor started a whole new set of tests. It turns out I have a mild astigmatism that wasn't being corrected, and getting that figured out made all the difference.

I don't personally wear contacts, but my boyfriend does and is going to the same eye doctor I do. After his appointment, they have him a 1-week supply to try out, then ordered the rest after he'd been wearing them for a while and was happy. Tell your doctor that you've been having persistent trouble getting a good prescription, and perhaps they can do something similar for you to make sure you're getting what you need.
posted by duien at 7:54 AM on February 16, 2012 [1 favorite]

My vision is worse than yours and I have an astimgatism that plays up sometimes. With contacts, I found that different brands of contacts at the same prescription gave me very different vision. It actually took until I hit a supposedly "lesser" brand before I could see clearly (the really thin, "breathable" ones just weren't shaped quite right for my eyes. It took until I found a better eye doctor before they could explain why this was, but it worked. Also, hard contacts, while a pain, gave me the best vision I had. They took getting used to, but they were great until I lost one and couldn't afford to get new ones.
posted by katers890 at 7:59 AM on February 16, 2012

I had similar issues to yours until I found an awesome optometrist, and I'll n'th things people have mentioned above:

- ask friends and family for referrals to a good, thorough optometrist - particularly F&F's who have more serious vision problems
- your optometrist should offer to order a trial pair of contacts, retest your vision, and adjust as necessary
- you may have an astigmatism, which is trickier to test for and correct - a good optometrist should be on the lookout for it

After years of never being satisfied with my new prescriptions, I found a doctor who took the time to figure out what would work and make corrections, and it was a revelation! Good luck!

PS: YMMV, but my awesome doctor's practice always has a very calm, slow-business-day vibe - no patients stacked up in the waiting area, no aggressive frame-selling. This kind of vibe might be a helpful clue that you'll get more attention. (It could also be empty-restaurant syndrome, but if you have a solid referral, that should be reassuring.)
posted by snoe at 9:07 AM on February 16, 2012

I had an optometrist I liked in Pennsylvania, and I ordered glasses from their shop. About 6 months in, I realized that one if the lenses just wasn't quite right. (I'm -1.25 in one eye and about -7 in the other, so I tend to just suppress the bad eye. ). Turned out they'd made an error, and they replaced the lens at no charge.
posted by leahwrenn at 9:12 AM on February 16, 2012

Also, there's something to be said for having the ability to have a continuing relationship with the same eye doctor. Especially with reasonably bad eyes and as you're getting older.
posted by leahwrenn at 9:13 AM on February 16, 2012

I used to have inaccurate prescriptions and I believe it's because during my eye exam, I would "squint" to try and figure out which number/letter was clearer. This affected my eye exam.
Once I made a concious effort to remain relaxed and not squint during my eye exam, the prescription was much more accurate.
posted by smitt at 9:40 AM on February 16, 2012

I too wear coke bottle lenses. The guy at the optical shop I go to generally refuses to do eye exams if you've been wearing your contacts for the previous 4 hours. I always chalked it up to a US/Italy cultural difference until last June when my glasses disappeared with my stolen purse and he made an exception for the circumstances; this prescription seems just the slightest bit blurry. YMMV.
posted by romakimmy at 10:33 AM on February 16, 2012

Adding another voice to the "see an OD in private practice" chorus. I think the folks who are affiliated with glasses shops do a fine job with the usual levels of nearsightedness/farsightedness/astigmatisms, but someone who's as much of an outlier as you needs a longer appointment with machines that provide more granular levels of testing, which an OD office will have.

Also, you really have to not wear your contacts for at least four hours (although my ophtalmologist says eight to twelve hours, I think he's overly conservative) before the test, as romakimmy says.

Finally, when you go for your next test, be sure to tell the OD everything you just said here. Some people are harder than others to fit properly, and if the doctor knows that it will help them do the extra testing it sounds like you need.

Good luck!
posted by Sidhedevil at 11:23 AM on February 16, 2012

Has anyone had variances based on frames? Look at Stephen Colbert and his crooked ears. How can all the measurements make any difference if they sit crookedly on the face?
posted by MidSouthern Mouth at 6:45 PM on February 16, 2012

One thing that might be important is to have the optometrist recheck your refraction after dilating your eyes. My prescription isn't nearly as severe as yours, but I had a lazy eye as a child and after much eyestrain and many many eyeglass redo-ings, we figured out that I overcompensate when staring through the refractor. So after my eyes have been dilated, my prescription is a bit different. It still isn't perfect, but at least I have wearable glasses.
posted by monopas at 8:26 PM on February 21, 2012

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