new glasses rx

[lisa10400]

I will try to be brief!!  Previous Rx OD -1.00, -4.75, x10;  OS -1.00, -1.50 x65  add 3.00 .  Age 30, and have been wearing glasses/contacts for at least 17 years.  Have always had two pair, one for distance and one for near as I didn't want to be wearing bifocals as a pre-teen!  Also, I've alway been a put them on/take them off kind of person, never wanting to be a full time wearer....for a couple of reasons.....vanity (I know, stupid!!!) and I've never had a pair of glasses that gave me truly good vision or let me merge images together.  I always felt like I had to really FOCUS in on things to get my eyes to work together, noted this at every eye visit, but never was able to remedy it.  Wore contacts occasionally, but never regularly.  I had been having a lot more problems of late (as a dentist, my work is all up close!) both near AND distance, found I was trying to wear my glasses much more, and tried a new doctor.  Rx given is
OD -.25, -3.75, x180, 2PD BU;  OS  +75, -1.25, x63   add 2.00.  I had a pair made with a lined bifocal but without the prism, to see if new RX worked as it was so different from previous ones.  They're fabulous, but kind of unattractive as it gives me one magnified eye and one minified/stretched horizontally eye!  And I find that when I take them off now that my uncorrected vision seems worse.  So, I'll find I wear them more, and as I do, when I take them off, my uncorrected vision is even MORE uncomfortable.  Is that normal?  And, I worry because  the doctor noted that once I have them made up with the prism, and this new rx, I won't be able to do my 'put them on/take them off ' thing any more as the prism dictates I'll actually come to NEED to wear them, not just want to.  The prism she prescribed is the starting point as she believes I would benefit from more but throwing all these changes at me at once might be too much!  Oh, and no more contacts!!  So, I suppose I'm asking does this all make sense, am I now a full time glasses wearer? If I am doing full time correction can I get some type of contact?  Why is my uncorrected vision so bad now, and how will the lens with the prism look once it's added in there; the lenses are unusually unbalanced enough, making my eyes noticably different sizes.  How will this affect things?  I thank you so very much for your insight.  Added note; I am very happy with the new doctor; she was thorough and patient yet I didn't want to sound silly asking if I REALLY was going to be wearing glasses all the time!  

[John C Hagan III, MD, FACS, FAAO]

This is the deal about prism glasses. You don't want to prescribe them unless there is a signficiant problem and nothing else is helping. Once you get in to prism glasses your eyes let the prism to the work so they are more clear and comfortable. However when you take the glasses off the eye muscles are not willing to work as hard (think you working 100 hours/week. If you get a new employee and now you work 40 hours week you likely will not be willing to go back to 100 hr week).

You so your experieince WITHOUT glasses is typcial. the important thing is HOW DO THEY FEEL and SEE WITH THE Prism glasses.

JCHMD

[lisa10400]

Thank you for your response.  As per your suggetsion, I got another opinion/exam and it did seem to reveal that I could use a prism addition in my glasses.  I had glasses made, with prism, with the bifocal, and one that is for near only.  I have been seeing the same optometrist for many years, and now two opthalmologists have determined that prism is needed, though I've never had it before.  I venture to guess that if I had it previously I may not have struggled so much with my vision over the years?  Nonetheless, when I first tried the glasses they felt strange, in that things were very clear and vibrant.  When I would take them off, things shifted vertically as they always do with my regular glasses. Unlike before, when I tried to take my glasses off whenever they weren't absolutely neccessary I am finding these to be making an impressive difference, and my eyes seems less strained, too.  BUT, as I tend to keep them on longer, I find that when I take them off now, I cannot focus properly at all.  For example, before I would put my old glasses  on to read clearly, but upon removal, could still read but not easily.  Seems now I take them off and am faced with a terrible blur, and holding things further away doesn't help.  Likewise with the distance vision/bifocal pair; when they come off, things don't come back into focus.  Is this a result of the prism, and if so, exactly what is it doing that is making this happen?  I wasn't ready to jump to full time wear yet, but was told it would be a certainty, especially when I need more prism.  I know you can't answer everything since you did not treat me but........will the prism increase, and why does it?   Were my headaches, tired eyes and problems bringing things into focus indications that prism was needed all along?  And, according to your previous response, contacts aren't going to be an option, nor part time wear either, so for as long as I've avoided it, I'm now jumping head first into full time wear?  Again, I thank you for your response.  

[John C Hagan III, MD, FACS, FAAO]

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[JodieJ]

Dr. Hagan is right--you should get another opinion from a strabismus specialist.  I have another suggestion for you:  Get your glasses made with aspheric lenses.  These lenses cost a little more, but they will reduce the magnification/minification effect, making your glasses more attractive to wear.  (Maybe a higher index material for the lenses would help, too.)  You would really benefit from the advice of an experienced optician.  (I'm not an eye care professional, but I'm wondering whether a combination of contacts and glasses would be the best way to correct your vision.)

[John C Hagan III, MD, FACS, FAAO]

Once you go into prism glasses the eye muscles get lazy and you often cannot go without them nor get glasses without them and contacts which cannot have prism ground into them often no longer work.

Since you are wearing bifocals at age 30 you either have accommodative esotrophia or you have  large amount of latent hyperopia.

Either way, especially the latter, as you get older your uncorrected vision is going to get a lot worse and in your late 30's and 40's your uncorrected vision is going to be much worse.

I suggest you see a Eye MD strabismus specialist (called a pediatric ophthalmologist often) to find eye:   1. do you have an eye muscle problem? 2. do you need prism glasses?

Find one near you at www.aao.org

JCH MD