Improvement in both near and far vision - is it cause for concern?

[mike2325]

Hi, would like some input on this. Here are my last 3 eye prescriptions

2014
Distance
OD Sphere -1.75, Cylinder -1.50, Axis 170
OS Sphere -2.00, Cylinder -1.00, Axis 20

Reading
OD +0.025 Cylinder -1.50, Axis 165
OS +0.25, Cylinder -1.00, Axis 35


2017 prescription
OD Sphere + 0.25, Cylinder -1.50, axis 165
OS Sphere +0.25, Cylinder -1.00, axis 35

2019 prescription
OD Sphere -1.50, Cylinder -1.00, Axis 160, Add +2.00
OS Sphere -1.25, Cylinder -1.25, Axis 40, Add +2.00

My optometrist says both my near and far vision have improved, he saw no problems in my eyes but was trying to figure out why it had improved. I just started wearing progressives in 2017 and wonder if this may have something to do with it.  Before that I had separate pairs of glasses for far and near. I'm 65 and in good health no existing medical conditions, my optometrist said I look like I'm 40. I read that as you get older your eyes change and a symptom for possible cataract formation was improvement in near vision, hence my concern.  If this is pre-cataract symptoms I'm wondering how long it might take before I do get cataracts.  My optometrist said I might not get cataracts.  Should I have special tests done?

[JohnHaganMD]

Your eyes are not getting better and in a variable number of years you will have to step up to a +2.25 add.  You have 100% chance of having aging changes in you internal lens of your eye. Whether they are bad enough to call cataract is often subjective and varies from doctor to doctor.  If you live to 85 you will have cataracts and probably a 90% chance of needing cataract surgery.   The changes in your distance RX would not be described as 'getting better' only 'different than before" it can be due to aging changes on the lens or cornea.  If you are seeing well you don't need any special tests.

[mike2325]

Hi, Dr.

Thanks for your response.  I didn't include the full 2017 eye prescription which I list below:

2017 prescription
Distance
OD Sphere + 0.25, Cylinder -1.50, axis 165
OS Sphere +0.25, Cylinder -1.00, axis 35

Reading
OD Sphere -1.75, Cylinder -1.50 Axis 165 Add +2.00
OS Sphere -1.75, Cylinder -1.00 Axis 35 Add +2.00

It was in 2017 when I switched to progressives.  The 2019 prescription is combined see below:

2019 prescription
OD Sphere -1.50, Cylinder -1.00, Axis 160, Add +2.00
OS Sphere -1.25, Cylinder -1.25, Axis 40, Add +2.00

I was wondering why he didn't give a separate reading and distance prescription?

I was wondering is +2.25 a severe increase and what is the maximum increase before you are considered blind?

Both of my parents eyes were pretty good and were diagnosed with cataracts in the early to mid-80's.  So if genetics has anything to do with it, I suppose that is what may lie ahead for me (and everyone?) as age increases.

Thanks again for your professional input.

Mike

[JohnHaganMD]

You have not reason to use or consider using the word "Blind" that means you can't see with or without glasses. You have been told you don't have any eye problems except needing glasses.  Glasses change in increments of 0.25 diopters so going from +2.00 to +2.25 is a tiny change.   Generally a glasses RX for a middle age person that needs a reading RX also are only written as one RX. the far away RX is the basic RX and the reading part is just 'added on".   Your  2014 RX but have been given at two different times because the cylinder power and axis should be the same on distance and near glasses.

[mike2325]

Thank you again Dr. for your answer and explanation.

I had one last question.  You said I have a 100% chance of developing cataracts in 20 years when I'm 85.  Is that your evaluation of just me or do you feel everyone will develop cataracts at around 85 years old and have a 90% chance of needing cataract surgery by then.

My mother is 86 and had cataract surgery on both eyes last year.  My father is 94 (people in my family generally live to 100+ years of age) and has cataracts but sees well enough and was considering cataract surgery, but I think he's afraid of it.  He seems to see well enough, reads books, does a lot of text messaging on his phone.  

Do you think genetics has something to do with it, are there exceptions to this or are cataracts like death - sooner or later we will experience it should we live long enough?

As a whole I find this to be an incredible forum especially since it has you to answer/advise patients with such and esteemed background in ophthamology.  People should be grateful to you for your time, patience and caring...I know I am!

Thank you.

[JohnHaganMD]

The problem is age and the way the eye grows with old cells pushed to the center.  You do not have a genetic disposition towards cataracts.  Many people die in their 60's, 70', 80's and 90's without having to have surgery.