Vitreous Enhanced (Induced?) Presbyopia, Lens Type Aggravated?

Discussion in 'Optometry Archives' started by Dick DeadEye, Sep 3, 2005.

  1. Dick DeadEye

    Dick DeadEye Guest

    To begin with, my eyes have always been subpar.
    I've worn glasses since whenever I can remember, for myopia with a
    strong astigmatism and had surgery to correct amblyopia (not sure which
    eye) when I was about 6 or 7.
    Then back in the fall of '79, when I was 13, I awoke with floaters in my
    left eye, which becane inflamed with a rip roarin' case of
    chorioretinitis (at the time they suspected it was caused by
    toxoplasmosis), with the vision deteriorating to less than 20/200.
    The inflammation cleared up and, while technically my vision returned to
    20/20, the field was reduced by scarring around the edges and the
    vitreous was--at least partly--detached.
    Fast forward to Jan.'89 when, one morning, I suddenly noticed a couple
    of small, pure black spots in the near center vision of my right eye.
    It turned out to be a "cold sore" on my optic nerve! Like my left eye,
    10 years earlier (which they now believe may have also been caused by a
    herpes infection, not toxo), the right eye became inflamed, started to
    recover, then reinflamed, this time totally cooking it, to be followed
    in a few months by a trauma induced cataract! P=(
    So now I am totally blind in one eye and half blind in the other (in the
    sense of the field is reduced and the detached vitreous has greatly
    reduced the quality of the remaining vision in that eye: It takes
    longer for the eye to adjust to darkness {and, even then, it's only
    about half--or even less--sensitive than my [previously] "good" eye},
    there is a mild reduction in overall "brightness contrast" {a slight
    "film" caused by the vitreous?}--though, since that is the only eye I
    see out of, I don't notice it--and there is a mostly transparent {except
    when I squint, when it looks "bubbley/sudsy"} wrinkly wad of "raw
    pie/cake dough" {i.e., when you stir or kneed the dough, it holds
    together but "wrinkles"} swishing around in my vision, which sometimes
    looks--albeit, usually faintly and out of focus--like either a fishing
    net sprawling around in water or a dim puff of smoke).
    In the past few years, I've had a few--what I believe are--"vitreous
    events", where, when I shifted my vision, I'd notice a litte spot (or
    strand?) that visually seemed to slightly flap or pull--it didn't look
    like the retina, but maybe a piece of loose but tethered vitreous (at
    least one of them looked like a small air bubble under a transparent
    sticker stuck to a window). After a couple of weeks or so, it would
    seem to have just about disappeared when, suddenly, (at the
    correspondingly opposite side of my vision field?) I'd notice a real
    vivid, small patch or strand of floaters that was tethered/anchored to
    that one area. After 2-3 weeks that tethered patch/strand would start
    to "weather" and fade into the background, never completely disappearing
    (other than the accompanying floaters), just adding to the vitreal
    artifacts.
    A couple of years ago, I had a couple of similar episodes, though these
    times the eye fluid (vitreous?) became not blurry, hazy or
    cloudy--suggesting inflammation--but a bit "gooey", yet certain things I
    could see off in the distance, relatively clear, while at the same time
    the facial features of someone standing 20-30 feet away may be a
    blur--it actually looked like if you squinted to *almost* a blur. As it
    cleared up, the (vitreous?) fluid had a slight, but definite, greasy,
    shiny slick to it. It was after those episodes cleared up that I started
    noticing that real small print--like the newspaper stock market
    results--started to become difficult (albeit, just slightly) to read.
    Then, last Feb ('04), another episode started, this time to the point of
    causing (besides the "gooiness") some mild inflammation: The distant
    "wall chart" vision remained relatively close to 20/20, but I needed a
    magnifying glass to be able to read even regular newspaper size print!
    Even a couple of months after the inflammation cleared up, it was
    apparent I now needed reading glasses/bifocals: Do I need reading
    glasses because of the event, or was the vitreous event caused by my eye
    (focus) muscles changing?
    The recent eyeglass history for my left eye is so:

    (Sph = "Sphere", Cyl = "Cylinder", Axs = "Axis";
    Adj.Sph, Adj.Cyl = Adjusted Sph, Cyl = Sph/Cyl + Add)

    Year Sph Cyl Axs
    ==== ===== ===== ===
    *** 1976? -1.50 +3.25 80 (Right eye = -1.25 +3.75 105)
    1988? -0.25 +2.75 80
    1990 -3.00 +4.00 85 Add Adj.Sph Adj.Cyl
    2002 -2.00 +3.00 80 ===== ==============
    2004 -2.00 +3.00 85 +1.25 -0.75 +4.25
    2005 -2.00 +3.00 85 +1.75 -0.25 +4.75

    The vision didn't really change between 1988-90, it was just that, until
    the right eye went down the tubes, I had used my eyes complementarily:
    My (then) "bad" (left) eye was used for close-up vision and the (then)
    "good" (right) eye was used for distance.
    Once the right eye became useless, the left eye was re-evaluated.
    A couple of other characteristics/properties that may be contributing
    factor(s):

    --- The left eye pressure is relatively low (7-13--whereas the right eye
    is usually 1 or less!)--so don't even THINK of suggesting anything
    surgical (vitrectomy, LASIK, etc.)! P=/
    --- The left eye also has a slight "reverse sided" cataract (whereas a
    "normal" cataract develops on the outside of the lens, this one, caused
    by the inflammation and scarring, is on the *inside* of the lens).

    With all that said, here is the $50 question: Is there such a thing as
    "dual focus"?
    In other words, could my distance vision be both -2.00/+3.00 *AND* about
    -0.25/+2.75 Sph, with perhaps some tweaking of the Cyl and/or Axs?
    It was during the time I had my order in for my first pair of bifocals
    last summer, that I tried on all of my old glasses and found that my
    "1988" pair seemed perfect for reading--and not half bad for distance!
    Over the past year, since I got the bifocals, I've checked my distance
    vision through the bifocal and it seems less and less clear: When I
    first looked though the "1988" glasses and the bifocals, the distance
    didn't really look blurry, everything just had a slight "ghosting" to it
    (like looking though binoculars or a telescope that is out of focus:
    When you adjust the focus of the binoculars/telescope, are you changing
    the Sph, Cyl, both or neither?); recently, though, I've found that
    looking in the distance through the new bifocals (and "1988" glasses)
    does introduce a definite blurriness, besides the "ghosting" (which my
    oculist said was going to start happening as the "Add" increased, even
    at mid-distance, thus requiring either trifocals or progressives--which
    I *have* considered).
    Even more "perverse", if I turn my glasses backwards so that the outside
    face of the glasses is "facing my face" with the (normally positioned)
    left eyeglass in front of my left eye and the (normally positioned)
    right eyeglass hanging off to the left of my head: If I rest the top
    edge of my left eyeglass against my left eyebrow, tilt the bottom of the
    resting eyeglass out/up slightly (15°-30°--The Sph and/or Cyl
    component/action?)) and turn the tilted glass slightly counterclockwise
    (5°-15°--The Cyl and/or Axs component/action?), (albeit, everything
    looks a little smaller) looking through the upper part of the bifocal
    section, the distance looks almost as clear as through the regular
    distance part of the lens! The kicker is that when I turn my attention
    to up close (intended "bifocal") vision, holding the glasses in the same
    position, at the same angle, looking out through the same area of the
    bifocal, I can still read up close, perfectly clear (maybe even
    *slightly* better than via the prescribed way!), whereas the non-bifocal
    part is just as fuzzy as the other way!!

    *** Now, just a few days ago, I found a few more pairs of even older
    glasses (maybe even my first two pairs???--I don't even think the lenses
    are even an inch high and the bulky black --> grayish-white framed
    {i.e., classic "geek" glasses} earpieces only go back to about .5-.75
    way to my ears!), and one of the more recent of them (I suspect from
    about 1976, well before my left eye became afflicted: They actually
    half fit!)--I kid you not--provides ALMOST PERFECT vision, both for
    distance AND close-up!!!
    The distance looks almost as good as through my current distance
    lens--and a lot better than the bifocals/"1988" pairs--while the near
    and far intermediate distances seem about right (whereas both the
    distance and bifocal parts of my current glasses appear a bit fuzzy) and
    the close-up is also mildly to moderately fuzzy (as compared to major to
    severe fuzziness with my distance lens--almost like I'm not wearing
    glasses!), *BUT* there *is* the classic urge to move away whatever it is
    I am looking at (and it *does* lessen the fuzziness a bit), unlike with
    the distance lens, where the fuzziness appears constant, even as you
    move it away! And, like with the "1988" pair, if you turn the "1976"
    pair backwards and tilt them a certain way, it seems to improve the
    vision (at all distances) slightly (as well as by looking out the
    extreme edge, where the frame seems to modulate it slightly, like when
    you look through pinholes).

    Thus the main question: Is it possible to have two (or more) equally
    valid focal values, at least for distance?
    One difference I notice is that, looking through the regular distance
    lens, the "vitreous wad" is more like a "puff of smoke" and out of
    focus, whereas, through the bifocal, everything looks "watery" (at
    times, anyways, even a little greasy?), like I am looking through a
    clear piece of "Saran Wrap" that is spread out but anchored underwater
    (i.e., I am looking *through* the vitreal fluid--at least more--in focus?).
    Another, related analogy is fresh vs. salt water: A "normal" eye sees
    things through fresh, clear pond water, whereas I'm looking through
    relatively clear, but still slightly hazy, salty seawater.
    Could the "ghosting"/slight double imaging (at least partly) be the
    image reflecting (refracting?) off of the vitreous, like looking through
    a double paned window, thus what may be my "natural" 20/20 vision with
    -0.25/+2.75 is "ghosted" by the "double pane" effect of the vitreous,
    which is cancelled out with the -2.00/+3.00 values--and now that it is
    starting to present itself, presbyopia isn't compatible with the
    -2.00/+3.00 values???
    Can the Cyl and Axs have two different values for bifocals or does the
    bifocal and rest of the glass have to have the same values?
    Another possible culprit/"irritant" I've wondered about is the lens type.
    These newly found ("1976") glasses--I believe--have pure glass lenses,
    while the "1988" pair have simple plastic lenses. All the more recent
    pairs, however, are "UV coated" (polycarbonate?--that option isn't
    circled on the prescription: But isn't all "UV coated" lens
    polycarbonate?) plastic, which seems prone to fogging/greasing up in the
    upper inside corner of the lens (by the nose), and which the optician
    advises should be cleaned with a wet (not dry) cloth/tissue.
    It *could* just be my imagination, but it seems that the bifocal in my
    current glasses gives a slightly hazier view than the "1988" pair (and
    they both work out to a Sph of -0.25, though there is a 2.00 difference
    in Cyl), with, maybe, even slightly lesser haziness with the "1976" pure
    glass lens.
    Given the compexities of my situation, would it be advisable to consider
    finding an optometrist (who may be up on all of the obscure optic tricks
    of optometry) rather than have my regular opthamologist do it--or is
    an opthamologist just as advancedly versed as an optometrist, in terms
    of lens and glasses (I'm thinking like, while a general opthamologist
    may be *qualified* to treat my retinal problems, at the onset of my
    right eye's event, I was referred to a retinologist, with all of the
    special equipment, etc.)?
    After finding the "1976" pair and having the prescription evaluated, it
    *is* between my current distant and close-up vision--though a lot closer
    to the distant value, and there seems to be a lot less fuzziness
    close-up (and even intermediate) than with my current distance lens,
    given that there is only a 0.50 Sph and 0.25 Cyl difference between the
    two, the fuzziness difference between the two doesn't right!?!--so
    considering trifocals or even progressives does seem a lot more
    palatable now.
    Trifocals
    _______________ _______________ _______________
    | \ | \ | \
    | | |________________| |_______________|
    | ___________| | | | |
    | |___________| | | | |
    | | | |----------------| | +----------|
    | | / | / | | /
    | | / | / | | /
    \_____\_______/ \_____________/ \_____\______/
    Traditional Other Variations?

    While the first figure is the traditional trifocal, are there any
    variations (my optician says that there is one that he knows of, known
    as "computer glasses"{?}--but they are real expensive)?

    -"Dick DeadEye"
     
    Dick DeadEye, Sep 3, 2005
    #1
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  2. Dick DeadEye

    Dick DeadEye Guest

    Dick DeadEye, Sep 3, 2005
    #2
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  3. Dick DeadEye

    Dick DeadEye Guest

    Yes, I'm right on the edge (currently 39)! P=)
    Did you see my extended, reworked post (which was my intended one P=/),
    with the older "1976" pair:

    #> (Sph = "Sphere", Cyl = "Cylinder", Axs = "Axis";
    #> Adj.Sph, Adj.Cyl = Adjusted Sph, Cyl = Sph/Cyl + Add)
    #>
    #> Year Sph Cyl Axs
    #> ==== ===== ===== ===
    #> *** 1976? -1.50 +3.25 80 (Right eye = -1.25 +3.75 105)
    #> 1988? -0.25 +2.75 80
    #> 1990 -3.00 +4.00 85 Add Adj.Sph Adj.Cyl
    #> 2002 -2.00 +3.00 80 ===== ==============
    #> 2004 -2.00 +3.00 85 +1.25 -0.75 +4.25
    #> 2005 -2.00 +3.00 85 +1.75 -0.25 +4.75
    What is the actual equation for finding the equivalent spherical?

    -"Dick DeadEye"
     
    Dick DeadEye, Sep 5, 2005
    #3
  4. Dick DeadEye

    Dr Judy Guest

    Sphere plus 1/2 the cyl, respecting signs.

    So your 1976 Rx eqiv sphere is (-1.50 ) + (+3.25/2) = +0.12 which is even
    closer to -0.50. It also is about 0.50 undercorrecting your myopia and thus
    it provides some improvement at near as well.

    Dr Judy
     
    Dr Judy, Sep 7, 2005
    #4
  5. Dick DeadEye

    Dick DeadEye Guest

    Okay, I found a page that seems to give a decent explanation and
    illustration:

    http://www.eyecarecontacts.com/optical_lens_prescriptions.html

    So Cyl is the dioptic spread between meridian boundaries: Sph equals
    the meridian's dioptic value at angle Axs 0° ("Meridian_0°"--or is it
    "Meridian_90°"?), and Sph + Cyl is the other meridian's value at angle
    Axs ("Meridian_Axs°")--why not just express it as "Mer_0,Mer_x"?
    So, based on the "1976" glasses, my left eye's lens may be Meridian_0° =
    -1.50 and Meridian_80° = -1.50 + 3.25 = +1.75 (Meridian_20° may be
    something like -0.65, Meridian_40° may be +0.05 and Meridian_60° may be
    +0.90), whereas my current glasses correct for Meridian_0° = -2.00,
    Meridian_85° = +1.00 (distance) and Meridian_0° = -0.25, Meridian_85° =
    2.75 (close-up).

    I see (no pun intended! P=), it's .5*(Meridian_0° + Meridian_Axs°)
    --though, would it be safe to say that that is just an approximation (it
    is actually the divided difference of a definite integral)?

    -"Dick DeadEye"
     
    Dick DeadEye, Sep 8, 2005
    #5
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