What is up with my glasses?
August 24, 2021 12:36 PM   Subscribe

A new optician has had two tries to get my glasses prescription right and failed both times - have you any idea what is going wrong?

I'm middle aged and extremely myopic - one eye more than the other. I have (1) contact lenses and (2) an old pair of glasses which work both for being out and about and for reading and work at the computer screen. The old glasses are just getting a tiny bit weak for the screen (more comfortable to enlarge some fonts). They are not bifocals or varifocals of any kind. I wanted a new pair for cosmetic reasons and to see if a small improvement could be made but two visits to the optician have resulted in disaster. First they gave me distance glasses by mistake (90% of what I do is reading). Then they said they understood my prescription - one eye did the reading and the other was better for distance and made me new specs. They were awful. Much worse than my old glasses for reading and the print on my computer screen was no longer sharp - they felt weird when worn outside too. My contact lenses are identical for each eye yet work for all these tasks. Has anyone any idea what is going wrong? I'm going to go to another optician but having some idea of why this was a disaster might be useful. I had planned on mostly replacing the contacts with wearing glasses because of dry eye problems in one eye.
posted by Flitcraft to Health & Fitness (14 answers total) 19 users marked this as a favorite
Not an optician or any sort of medical professional, but...

In what way are the new ones awful? Do they focus in the wrong spots?

I found out, the hard way, that my eyes have two focal points... If I open my eyes wide, vs. leave my lids at "half-mast". If I open my eyes wide I get a second unfocused image in the "back" as if I'm watching some cheap hologram. And what do they do at an optometrist? Turn off the lights and asks you to open your eyes wide!

It takes conscious effort to leave my eyes half-mast so I can get my glasses to "fit" properly.
posted by kschang at 1:08 PM on August 24, 2021

It is worth asking an optician to measure what the prescription in your new glasses actually is, in case they have been made differently from your prescription you should have been given. The other basic thing to check is whether they have been made with the right pupillary distance.
posted by plonkee at 1:31 PM on August 24, 2021 [2 favorites]

If you have had two pairs and they both are bad, the prescription is probably wrong. Go get a new prescription from an actual eye doctor—an ophthalmologist, not an optometrist.
posted by kindall at 2:06 PM on August 24, 2021 [4 favorites]

Best answer: Are you perhaps in your 40s or maybe 50s? If so, what is happening to you is almost certainly presbyopia. This is the gradual loss of the ability of your eyes to focus.

In the end your eyes will completely lose their ability to focus between near and far and become completely fixed in one focus position. But for now it is likely that you still have some focus ability but it is just gradually, month by month and year by year becoming more limited.

So, your current pair of glasses just by good luck are at the exact point where you can see the computer screen kind of OK and distant things kind of OK, too. So your fixed (or limited range) focus area is somewhere in between computer screen distance and infinity.

But if the optician tweaks your prescription to work a bit better for distance viewing, then suddenly you can't see close-in things (like the computer screen) very well at all. And if it is tweaked a bit in the opposite direction to see the computer screen better, then you won't be able to see distant things well.

I'm sorry about this, especially because it should be something every human knows about and plans/prepares for. But someone forgot to tell like 99% of the human race this is going to happen to them.

Anyway, a good short term solution (and also long-term - it's one of the ways I deal with the situation) is to get a pair of glasses exactly calibrated to computer screen distance and a different pair exactly calibrated to distant/outside viewing.

I also have a third pair for reading - ie books, newspapers, etc - with the focus point set even closer than the computer pair.

And I have a fourth pair that is graduated or bifocal lenses that "does it all" - meaning I can see near, middle, and far, but honestly all of those are "ok" but no better than that. The distant glasses are better at distant viewing, the computer glasses are far better at computer viewing, and the reading glasses are far, far better for reading. But for going on a walk or to the grocery store or a restaurant, bowling, etc the graduated or bifocal lenses "do it all" well enough to get along and are a lot easier than carrying 3 separate pair.

By the way, I am on a slight rampage about presbyopia, the fact that most people don't even know what it is, and also the fact that the vast majority of the population goes around the last half of their lives half-blind for no reason at all except that "I don't want to wear GLASSES!!1!!1!!!" plus nobody has ever explained the solutions that really work so that you can see everything - at ALL distances - at 100% again.

(Hint: Older people don't need larger fonts on computer or paper. But they DO need glasses that will allow them to focus properly when reading a computer screen or piece of paper.)

So I've written quite a bit about this over the years and you and everyone else is welcome to peruse all that to see if it gives you any ideas or solutions:

- Handling microscope/computer screen/paper reading/etc with presbyopia

- What presbyopia is, some ways to cope

- Rather complete explanation of what presbyopia is, how to cope, what eye doctors will typically prescribe and how that works/doesn't work (long but helpful if you can read the whole thing)

Finally, apologies if this isn't your problem. I would say it is likely to be all or at least a part of your problem, but it is possible your problem is something else entirely.
posted by flug at 2:11 PM on August 24, 2021 [209 favorites]

Yeah, presbyopia blew up my comfortable glasses and contacts world as I headed into middle age. I would look into that first. It sounds like, on the second try, your optician was employing one of the anti-presbyopia strategies ("monovision," correcting one eye for one distance, the other for another) and it didn't work, but if your prescription was originally written with that specific purpose, it probably wouldn't. Especially if he didn't check the dominant eye.

Note that another option is progressive contact lenses. Work great for some, not for others. I was happy to get back into them, purely for vanity's sake, when the tech caught up to my wacky prescription (very myopic, very astigmatic), but they are not as good as my progressive glasses lenses and I'm sure they wouldn't be as good as if I were willing to carry around three pair of regular glasses, which I am not. I mean I'm not stumbling around the world, but there's perceptibly a sacrifice for vanity there, mostly in night distance vision. (Which is weird considering I didn't even start wearing contacts until my mid-30s, so my default image of myself is beglassed, but...yeah...look better without 'em.)
posted by praemunire at 2:31 PM on August 24, 2021 [1 favorite]

One optometrist could not get it right for me. Miserable experience. The next one I saw gave me a perfect prescription. See a different optometrist
posted by cotton dress sock at 3:14 PM on August 24, 2021 [2 favorites]

Presbyopia started hitting me about two years ago, at age 46. Fortunately I knew what it was! I got lasik in my 30s, and had been glasses-free for over a decade. It was merely a return to old habits to start wearing some very weak 0.5 diopter computer glasses for the first year or so, and eventually moving to stronger ones later. When I finally started with glasses again, the progression was pretty fast. I think I had been compensating for a long time and when I finally let my poor eye muscles stop struggling, they gave up the ghost. My distance vision remains fine which is good quality of life, I can drive no problem and wear sunglasses when I need to. I just adapted and keep reading glasses at home and work, and a pair of ThinOptics slotted into a case on my phone.
posted by notoriety public at 6:02 AM on August 31, 2021 [1 favorite]

I have standard presbyopia, and a barely noticeable bit of astigmatism.

My collection of glasses are: standard fixed range reading (500mm focus), fixed bifocal reading (500 top, 400 bottom for fine print), limited range varifocal/graduated (450-1000mm), a full range varifocal (450-distant), and a close-up fixed bifocal (400/200) for very fine detail which don't get used much but when they do they are worth every penny.

The limited range varifocal are much easier to use than the full range, and are my favourite for the desktop computer as I don't have to sit at the exact same distance all the time. Varifocal can be VERY fussy, they have to be in just the right relation to the eyes, but when they are they work very well. In particular, the angle the lens makes with the face is critical. This can be fine tuned by adjusting the angle of the arms up or down, and it is surprising just how much difference a few degrees of change can make, everything suddenly slips into sharp focus and alignment.

For my next set of limited range varifocals I will try taking the upper end of the range out to maybe 2000mm, so I can leave them on for most stuff inside the house. Limiting the range on varifocals greatly reduces the issues with them, and if you combine that with a frame that is not full height so you can easily look over the top for distance stuff, it can work very well.

With fixed bifocals the point at which you set the dividing line is important, and can make the difference between okay glasses, and great ones.

The biggest problem I have found with glasses is getting the right frames for your face. Once you have them it is fairly easy sailing from there. But in my experience they are very hard to find. Took me many years to find two frames that were perfect for my face, one a full height, and especially the other about 2/3 height. I have a couple of each and was saving to go back and buy several more pairs of each, which should see me out for life, but then they discontinued them before I could do that. So back to searching for suitable frames. :(

Just behind getting the right frame, the other big problem I have found with glasses is keeping them clean. An endless challenge and chore, especially in hot humid weather. Warm water and mild soap seems best.
posted by Pouteria at 9:00 PM on August 31, 2021 [2 favorites]

I have read about the thickening of lenses leading to farsightedness as we age; as someone who is quite nearsighted, I have been hoping to see some reduction in my prescription but no luck so far.

I started wearing corrective lenses at thirteen and my prescription changed rapidly for five years and then stopped dead. Now, in my mid-fifties, I still have a pair of prescription Ray-Bans I bought the summer I was eighteen. The frames are going to fall apart before the lenses need replacement.
posted by ricochet biscuit at 6:12 AM on September 13, 2021

What works for well for me (age 55, lifelong myopia, typical presbyopia, mild astigmatism) is aspherical contact lenses that are +0.75 diopters weaker than my prescription, monitors 70-80cm from my eyes, and a pair of -0.75 diopter glasses for driving/walking. This is far less intrusive than managing reading glasses.

I'm helped by the fact that I have "hi-res" eyes (my fully corrected vision is a fair bit better than 20/20). This means that so long as I'm using retina / 4k screens, I can be off by up to a diopter in either direction without much impact on productivity apart from feeling a bit stressed at the end of the day.

An unintended side effect of this setup is that my myopia keeps "improving" (not sure whether it's due to what ricochet biscuit mentioned above or a training effect from having a not quite good enough prescription for every distance that's not ~90cm), so I've been having to change my prescription every year or two after it being stable for 30 years.

Also, in general 4k / retina screens make presbyopia much easier to deal with.
posted by lastobelus at 12:30 PM on October 7, 2021

If you are "lucky" enough to get cataracts, by which I mean lucky enough to get a vision condition that insurance will pay to correct, you can get replacement intraocular lenses that put everything in focus from near to far. I don't quite understand how it works, it is some freaky advanced optics, but I had this surgery done last month, and, well, it works as advertised. Everything from about 12" to infinity is in focus.

There is some glare around bright lights especially at night (when pupils are open widest) and you can see interference patterns where the lens is doing its thing. Still much better than the glare of having cataracts.

You can have the same surgery any time, you just have to pay for it all yourself. If you have cataracts, then insurance will pay for the procedure and basic (single-focus) lenses, and you just have to pay the difference between those and the magical multifocal lenses. This alone is about $7K so if you had to pay for eveyrthing else it would be in the $15-20K range, probably.

This is an expensive fix for presbyopia, but it would definitely address it. And if you have thick, heavy, glasses, it would get rid of those, too.

The procedure is inpatient, takes about ten minutes, and does not require general anesthesia. You can see normally in a few days, usually, sometimes a couple weeks. A week after my second eye was done, I was legal to drive. And my vision has improved since then.

One thing that's weird is that when you want to focus past something, you can't anymore. When driving in the rain, for example, it's natural to focus past the rain on the windshield so the traffic is sharp. The rain blurs and you don't really notice it. Now the rain's in focus too. Weird. But I can still drive in the rain fine.

Anyway, this is an (expensive) option to address presbyopia but if cataracts run in your family, you may end up with it eventually anyway.
posted by kindall at 2:14 PM on October 28, 2021 [3 favorites]

Kindall, thanks for that. About three optometrist visits ago (6 years?) I was told to expect to need cataract surgery "soonish" but it hasn't been mentioned since then. I'll keep it in mind as an option! It does seem expensive, but compared to new glasses every couple of years, not so bad.

I have astigmatism and apparently multifocal IOLs will work with that too.
posted by Foosnark at 12:15 PM on November 29, 2021

Foosnark: yeah, it's pricey but I'm finding it to be worth it. I have worn lenses around -10 diopter since is was in kindergarten. I wore contacts for a while but my prescription is so strong, the lenses to correct it are thick and uncomfortable, even the newer ones with increased permeability. So I settled on glasses, which were made tolerable by the newer high-index plastics, but they were still a hassle. Glad to be rid of them.

Indeed they have toric IOLs (the kind of lens you need to correct astigmatism). I actually have one in my left eye. In my right eye, the astigmatism was mild and was corrected by an incision in the cornea during the procedure to flatten it very slightly. My opthamologist is kind of a pioneer in this technique; he has to make an incision anyway, so he makes it in a place that will correct your astigmatism!

After your eyes heal from the cataract surgery, you can get a capsulotomy, which removes (or opens a hole in) the thin membrane behind the eye, which can also get cloudy with age. It doesn't affect vision as much as cataracts, but most people who have cataracts also have clouding in their posterior lens capsule. This is a quick laser procedure and apparently takes the clarity of vision to the next level.

My ophthalmologist also told me that he has a colleague who is researching a technique to reshape IOLs in situ using lasers. That means that if your vision changes, in the future, they will possibly be able to reshape your lenses without taking them out of your eyes!
posted by kindall at 10:05 AM on November 30, 2021

the thin membrane behind the eye
behind the lens, not the eye!
posted by kindall at 1:06 PM on December 7, 2021

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