You Pick Your Prescription

Most people are unaware of this basic tenet of the Optical Industry…You choose your own prescription!

I know it, it sounds preposterous to think this could be, but at it’s most basic that’s what’s happening.  Think about it.  You are asked to choose which you like better (1 or 2, A or B).

But even more important than this, your personal state at the time of the exam can have a significant impact on what prescription you choose for yourself.

Hard Day at Work?

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If you’ve just spent 6 or 8 hours staring at a computer screen, your eyes are tired and you have trouble focusing up close.  This means, during the exam, you will “choose” a prescription that is stronger for up close correction.  Even the amount of sleep you had the night before can have an impact.   Make sure you go into your exam with typical amounts of stress, sleep, and computer use to get a prescription most accurate for yourself.

Blood Sugar Feel Off?

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If you are diabetic and have had difficulty controlling your glucose levels, or worse yet, don’t manage it with diet or medication, then your vision is constantly fluctuating with the peaks and valleys of your blood sugar levels.  The higher your sugar levels, the generally more nearsighted you are.  So if you’re spiking when you have your exam, you will choose a stronger “distance” correction.

In addition, poor diabetes control can lead to Diabetic Retinopathy.  This is a condition which causes small, “dark patches” in your vision which will not go away.  This is an irreversible condition and should managed and monitored very closely to prevent it’s development and growth.

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Take Away

Remember, your exam is a “snapshot” of your life.  Your entire life and daily routine comes into play when finding your prescription.  Keep all of this in mind when coming in for your exam, or even when considering what day or time you want to schedule that appointment.

And remember, if you have any struggles with your prescription after picking up your new glasses, maybe it’s not the fault of the Doctor, maybe it had to do with how stressful your day was when you had that exam.

A Little Explanation on Progressive Lenses

There is a common misconception amongst patients which I’ve come across many many times.

The vast majority of patients are under the impression that there is only one progressive lens.  This has been in great part due to a failure amongst all eye care professionals to explain the choices for fit.  At this time there are several hundred progressive lenses.  There are laser etchings on the lenses which help the eye care professional to identify which of the several hundred lens designs you are currently wearing.

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All progressive lenses are not created equal.  The example I like to use with my patients, is that saying ‘progressive’ is like saying ‘car.’  There are different manufacturers (i.e. Toyota, BMW, Ford, etc.).  And each manufacturer has several models, each designed to suit a different budget, or function (i.e. Prius, Camry, Highlander).  One of the most critical jobs for an optician is to have the conversation with the patient to help identify which progressive lens is best suited to the patient’s needs.

Be Careful when Price Shopping

This diverse market of lens options can make price shopping for progressives very challenging.  Understand that not all shops and locations even offer all the options available.  Most offices work most closely with one manufacturer or another.  For example, some “big box” retailers will only work with one design, and it’s a much older technology with the necessary pitfalls associated with less advanced manufacturing.

How Progressives Work

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A progressive lens was developed to eliminate the hard “line” of a traditional bifocal, as well as to provide a large, comfortable intermediate vision zone.  Essentially, in a progressive lens, you can see clearly and in focus through a distinct “hourglass” channel.  Outside of this hourglass, generally in the lower periphery of the lens, vision is not as clear.

I find the best way to describe this for the layperson to understand, is to imagine a bifocal lens made out of clay.  If you wanted to eliminate the physical “lip” of the reading zone, you would put your thumbs down into the middle of the lens and “squeeze” the clay out towards the periphery to smooth out that lip.  In essence, this is what is happening with a progressive lens.  This means instead of having a blurry line in the middle of your vision, your have a blurry edge to the lens.  There are various different lens technologies amongst the larger family of progressive lenses to try and handle these inherent issues for no-line lenses.

A Word on the Technologies

OK, I’m just going to be straight up here.  Some of the technologies involved in manufacturing progressive lenses (or PALs in the parlance of the industry) are not easy to explain in layman’s terms.  To put it as simply as possible, older lens tech used to generate PALs involves molding the prescription into the backside of the lens only.  This is a less expensive method, and has the drawbacks you might suspect.  When you put all the power on one side of the lens, it means the “channel” for your best vision is necessarily smaller than when the power is shared across the front and the back of the lens.

Newer lens technologies digitally surface the power (using lasers to cut lens) on both the front and the back of the lens.  When the power is “shared” across the front and the back of the lens, it opens the channel of your vision up.  Giving more space for clear focus, and pushing the “distortion” further off to the sides, and out of your field of view.

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In addition, digitally surfaced lenses address the problem of the “blurry” periphery in a very different way as well.  The periphery in a PAL is blurry because it is actually unwanted astigmatism correction.  Astigmatism is correction that has not just power, but also angle.  In an older “analog” lens design that angle of the astigmatism is constantly shifting, which can create a sensation of “swim.”  Essentially, when you move your eyes around, you can feel like you’re riding on an ocean wave.  When a lens is surfaced digitally that unwanted astigmatism is all placed along a similar angle, or axis, so you don’t notice the “swim” as much and they are more comfortable for long term wear.

Take Away

Realize, that when your optician spends a fair bit of time explaining or discussing progressive lenses, it’s not because we’re going for a hard sell.  This is an advanced lens technology which takes time to accurately measure and fit.

If you have questions, you don’t feel were adequately explained here, please feel free to contact me.  Send an audio clip via email and I’ll answer them on my upcoming podcast.

The Doctor isn’t Always Right

Typically, when a patient is handed off to the optician, a conversation has already happened between doctor and patient establishing some detail on what type of visual needs are to be addressed with new glasses (or contacts) and what recommendations the doctor might have for the patient.

The vast majority of the time, this doctor/patient conversation hits the broad strokes of what the patient needs, and what is left for the optician is a conversation to nail down the details (i.e. which progressive lens, does patient need transitions as well).

Sometimes, though, a key component of the patients lifestyle, be it work or hobby, is missed and this is why a good optician often will rehash much of that conversation that already happened with the doctor.

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Sometimes the scenario is Deceiving:

Case in point, I recently helped a patient who is a helicopter pilot.  When I was given this patient from the doctor I was told the recommendation with progressives with anti-reflective.  This is a common enough recommendation for a patient who needs reading help, so I nodded along and prepared myself to ask my usual questions to pinpoint the best progressive design.

But the more I conversed with the patient, and realized he wasn’t just a pilot, but a pilot of helicopters I realized it was critical to get down to where his near vision needs were located.  As we talked through where he needed to look and at what distances, it became crystal clear that a progressive would be a terrible experience for him.  He had a need to see at full distance out of the lower corner of his eyes, where a progressive gives the greatest “distortion” and the clear vision is set at a closer focal length.

So what could have been a very quick session in the dispensary to help him find frames turned into a fairly long and involved conversation to really nail down his specific needs.  While he may have spent quite a bit more time than he intended, I was able to make sure he’ll have a pair of glasses that will function for his lifestyle

Take away Lesson

As a patient, it’s easy to be intimidated and expect that the optician and doctor know what’s best for you.  And for the most part this is quite true, but it’s ABSOLUTELY CRITICAL that you share specifics of your needs.  Even what you may assume is not important or trivial could be the difference between a pair of glasses you LOVE to wear and a pair you’ll LOVE to get rid of.

A lesson on communications 

I helped a patient today who hadn’t been to see an eye doctor in many many years.  She focused on helping her daughter get care, and felt the drugstore readers were getting her by ok.  

She’d had trouble with progressives in the past and also suffers from occasional vertigo. I felt pretty confident I could fit her in a modern progressive which she could wear comfortably, but the reality of her computer workstation was going to cause problems.  

Instead of forcing the issue I considered her comfort and work function as the primary concerns and fit her with a computer progressive. 

For those of you who don’t know, there are hundreds of progressive designs on the market.  Each with their own advantages and disadvantages–partly based on prescription, visual needs, and price.  Computer progressives are a smaller subset which creates the largest visual zone in the midrange, or at arms length. This lens approach can allow not only for the intermediate to be a larger zone, by width, but also for better control of the vertical placement. 

Computer progressives can be incredibly useful for those spending large amounts of time in the midrange but they do not work well when full distance is important to correct, i. e. You can’t drive in them. 

So, your take away here, make sure you have a conversation with your Optician about what visual distance is most critical for you to see clearly. 

Welcome to your Optical Wellspring

Hello and Welcome!

My name is Ric, and I’m here to be your Optical Guru.  Through nearly 30 years of experience as a dispensing optician, I’ve run across continual frustration with the reality that patients are not terribly well informed on what types of lenses fill their visual needs.  So, I’m taking it on myself to try and address this.

My goal here is to write about lens technologies and advancements which could benefit you, the patient.  In addition, I hope to answer your questions about some basic terminology or technologies so you can better understand what exactly it is you need in your daily life.

In conjunction with this blog, I am launching a new podcast to answer these questions and post bi-weekly updates on lens and frame technologies.

While I work in this industry, I do not work for any particular lens or frame company.  I recommend based solely on what fits a patients lifestyle.

I look forward to starting a conversation with you!

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