Optician, Optometrist & Opthalmologist

My last prescription was written 2½ years ago by my ophthalmologist
who had done a cataract surgery on my right eye. He added the "add"
part of my glasses (+2.75, +1.75 for my computer glasses which I use
most of the time indoors) by a standard formula, not by testing my
near vision. An optician filled the prescription as written.

My eyes are not "standard". My left eye (the "good eye") is more or
less normal, with mild/moderate myopia, astigmatism and presbyopia
and a slight cataract due to age. My vitreous in that eye is
completely detached with no problems. OTOH, My left eye has had a
macular hole, followed by a retinal detachment (vitrectomy, scleral
buckle, laser and pryopexy, which resulted in a thick cataract).
Luckily, all my surgery have been successful with no more
complications so far, although I have lost some vision in my R eye
with best corrected acuity of 20/40 and some deficiency in central
vision. There is a difference of approximately 1D between the eyes.

Reading has become more and more difficult. It seems that it's easier
without glasses sometimes, but it's never comfortable or effortless.
My eyes get tired of reading and sore very quickly. Actually, I can
hardly read at all thru my bad eye with glasses, but can without
glasses. Usually computer reading is easier than a book, perhaps
because the print is sharper. My conclusion is that I need a new Rx.

Well, my optician can only follow the instructions of the
ophthalmologist, and they are not in the same office. I suggested to
get tested by the optometrist at his office and obtain a prescription
from him, which will enable a more direct communication between the
two, but the optician said that since I am under the care of an
ophthalmologist I must get the Rx from him.

Is there such a rule or law? Or is it just customary?

My next scheduled appointment with the ophthalmologist is in 3 days.
Will it be reasonable for me to ask for a near vision test instead of
the formula? Could it be that I might need a different "add" for each
eye?

>"Ms.Brainy" <(E-Mail Removed)> wrote in message
>news:07c88d4a-b73e-4ff5-8dc7-(E-Mail Removed)...
> but the optician said that since I am under the care of an ophthalmologist
> I must get the Rx from him.
>
> Is there such a rule or law? Or is it just customary?

Probably part professional courtesy and part fear of liability when
prescribing a lens for someone with a serious eye condition under the care
of an MD.

In article
<07c88d4a-b73e-4ff5-8dc7-(E-Mail Removed)>,
"Ms.Brainy" <(E-Mail Removed)> wrote:

> My last prescription was written 2½ years ago by my ophthalmologist
> who had done a cataract surgery on my right eye.

> Well, my optician can only follow the instructions of the
> ophthalmologist, and they are not in the same office. I suggested to
> get tested by the optometrist at his office and obtain a prescription
> from him, which will enable a more direct communication between the
> two, but the optician said that since I am under the care of an
> ophthalmologist I must get the Rx from him.
>
> Is there such a rule or law? Or is it just customary?

Interesting. I belong to an HMO. The MDs pretty much won't do
refractions. I have had cataract surgery in both eyes, five years
apart. In both cases, after the amount of time per the MD, I was
refracted by an optometrist, and then went to the waiting room while the
MD reviewed the results. I then saw the MD to have my eye examined.

> My next scheduled appointment with the ophthalmologist is in 3 days.
> Will it be reasonable for me to ask for a near vision test instead of
> the formula? Could it be that I might need a different "add" for each
> eye?

It won't hurt to ask, especially since you are having problems. I asked
my OD to check my near vision. I'm glad I did, but still, even though
he found that they were different, he averaged them and recommended I
buy reading glasses at the drugstore. He said that if I had any
problems, come back and see him. He would be happy to sell me some
prescription reading glasses if they would work any better. I was
wearing contacts for distance. My distance prescription was plano for
the right eye, and -10D for the left. The reading glasses measured at
1.75D for one eye and 2.25D for the other, over the contacts, so he
recommended 2D OTC glasses.

Bear in mind that some people want monovision for reading glasses, so
they can use one eye better for close reading, and the other for the
computer or tv. Some people don't, though.

--
Dan Abel
Petaluma, California USA
(E-Mail Removed)

On Nov 13, 5:11*pm, "Mike Tyner" <mty...@mindspring.com> wrote:
> How much accommodation do you think you have left?

I believe that I have zero accommodation, obviously in the R eye with
the IOL, and also in the L eye, due to normal aging of the natural
lens. But sometimes I wonder...

> Your eyes may not be "standard" but physics is physics. In the absence of
> accommodation, +2.75 is 14", no matter who measures it.

Of course it doesn't matter who measures it ("physics is physics"),
but my understanding is that the +2.75 is added to my minus Rx,
resulting in a lower D, and the result depends on the D of the Rx,
which is is not the same in both eyes, and furthermore the resulting
acuity is not the same since the bad eye cannot be corrected to
20/20. I think I am missing something, but what?

> If the _distance_ rx
> is right, the reading distance will be the same in each eye.

In other words, you are saying that the "add" must always be the same
for both eyes, correct? And therefore there is no need in testing the
near vision, all that's needed is the standard "add", based on age,
right?
>
> Of course it doesn't mean that one eye will see as well as the other. It
> only means that one eye will be clearest at the same distance as the other.
> That's all we're trying to do.

But I KNOW that I can see better with my bad eye, perhaps not at 14",
but at some closer distance, when I remove my glasses. So it seems to
me that something must be wrong if my glasses produce worse near
vision in my bad eye.

>
> And the optician is ill informed if he says you _have_ to wear what the
> ophthalmologist wrote.

No, he didn't say that I HAVE to wear what the ophthalmologist wrote.
He just made the glasses according to the prescription and wouldn't
refer me to his optometrist, nor would he accept an Rx from anybody
else but my ophthalmologist. I wonder whether it's standard practice
or just his own.

Yesterday I saw my ophthalmologist. He checked my distance vision,
concluding that my Rx is correct. I described to him in detail my
near vision problems and symptoms, and he diagnosed it as dry eye
condition. After a generous application of preservative-free
lubricant it seems that much of the problem is solved. BTW, he was
very impressed with my understanding of the refraction, accommodation
(or lack of), "add" factor etc. -- most of which I have learned from
this Usenet group, and more specifically from people like Mike Tyner,
Dr. Judy, William Stacy and others. Thanks to you all!

On Nov 14, 1:29*am, "Ms.Brainy" <mikabra...@gmail.com> wrote:
> On Nov 13, 5:11*pm, "Mike Tyner" <mty...@mindspring.com> wrote:
>
....
>> In other words, you are saying that the "add" must always be the same
> for both eyes, correct?

It needs to be the same if you want both eyes to focus at the same
distance. I have prescribed unequal adds when the patient was to be
able to see at say 22" and 14 " without using trifocals or
progressives. That means one add at +1.50 and the other at +2,25,


>
> > Of course it doesn't mean that one eye will see as well as the other. It
> > only means that one eye will be clearest at the same distance as the other.
> > That's all we're trying to do.
>
> But I KNOW that I can see better with my bad eye, perhaps not at 14",
> but at some closer distance, when I remove my glasses. So it seems to
> me that something must be wrong if my glasses produce worse near
> vision in my bad eye.


The different distance is the key here. If your bad eye is more
myopic, then you get relative distance magnification by holding things
closer. For example:

Rx
Right: plano add +2.50
Left: -4.00

If you take off the glasses, the left eye has plano at near which is a
+4.00 add. Things will be clear at 25cm or about 10 inches. The
right eye will be clear at 40 cm (about 16 inches). If you used a +4
add for the right eye it would also be clear at 10 inches, but much
clearer than the left.

You could ask for a +4.00 add, but it would mean holding everything
really close and would not be comfortable.

Judy

> Yesterday I saw my ophthalmologist...... *BTW, he was
> very impressed with my understanding of the refraction, accommodation
> (or lack of), "add" factor etc. -- most of which I have learned from
> this Usenet group, and more specifically from people like Mike Tyner,
> Dr. Judy, William Stacy and others. * Thanks to you all!

I too am in awe of the level of knowledge on here. So much more makes
sense after reading some of these posts!!

cheers,
Liz
Indianapolis USA