When Small Prescriptions Make Big Differences

Optometry is such an interesting profession. One reason is the human element. Some patients can tolerate a lot of blur and be happy while others want everything very sharp. Then there are patients who complain if what they see looks too sharp.

I have found over the years that when a small change in prescription makes a big difference in perceived vision, the patient may have other vision problems. One of these is motion sickness, particularly in the back seat of a car as compared to when the person is actually the driver. Other symptomology may include sensitivity to fluorescent lights or having to hold reading material very closely (even when the patient can see clearly at distance).

Very Sensitive Patient

I examined a patient this morning. Her complaint was blur at night as well as blur reading. What is interesting about the patient is that the prescription that made a difference to her for far away was extremely small. I checked her in all lighting conditions and with sunglasses and the prescription made a very significant improvement in her vision.

I have found over the years that when a small prescription makes a big difference in vision, there are generally some other problems the patient notices. One of which is motion sickness in a car. What's interesting is that the motion sickness is worst when sitting in the back seat, less when a passenger is in the front seat, and least when driving. I have some theories as to why its this way.

Mentoring Students

I got to attend an optometric society meeting last night. In a addition to an interesting continuing education meeting, I got to talk to a few optometry school student who will be graduating this year or next. I'm glad to say they appeared quite passionate about their future profession. I was able to convey to them certain aspects of patient care they hadn't come across.

After 30 years of practicing, I was glad I was able to exhibit my own enthusiasm in sharing different concepts of patient care they hadn't come across yet. Their sincere interest in what I had to say was quite rewarding.

New Office Status

We're getting close to moving into our new office. We should be in there by the second or third week of February. We're just moving across the parking lot within the same center at Baseline and Haven. The office is a lot more spacious and comfortable. I am particularly thankful to my staff for helping in the design of it. Our phone number will still be the same. We're certainly looking forward to the opening.

Metal in the Eye

I have had patients come into the office who are working around metal who have gotten small pieces embedded in the cornea (the front surface). Many times these could be removed fairly easily. Sometimes a rust ring forms around the metal particle and has to be either picked out with a needle of removed with a bur. Generally, as long as the particle doesn't embed in the line of sight, no loss of vision occurs. If however it does embed centrally. A possible scar could result, possibly leading to a disturbance of vision..

If the impact of the metal is high it could possibly penetrate through the front surface. More heroic measures are necessary to remove the particle and a significant loss of vision could occur.

It is so important that when working in any area where paticles could even remotely have a chance of entering the eye, safety glasses must be worn.

Frame Selection and Adjustment

On occasion, a patient will receive their glasses and they will report something isn't right, even if the prescription is the same as the old one. I have seen if the frame is a different size and shape, the patient might have a problem adjusting. This does occur occasionally. Just changing the size of the frame can make a difference to the patient.

The other variable that needs to be looked at is the adjustment of the frame. This is especially true of strong prescriptions. I have learned that how the frame is tilted and wrapped around a patient's head could make a big difference in how a patient sees.

Also if a patient has been wearing contact lenses for a long time and hasn't tried on their glasses for a while, this could cause a problem. This is because glasses magnify or minify what you're seeing more than contact lenses do.

Medications taken could certainly effect one's vision

The general health of a patient as well as medications taken could certainly effect one's vision. There has been several times that patients came in when a sudden change occurred in their vision. In these cases it was undiagnosed diabetes. The vision returned to the patients previous prescription when the condition was treated. Long term diabetes or hypertension could certainly have a dramatic effect on a patient's vision if not treated. Many times the vision worsens and the loss becomes irreversible. Any condition that can affect the body including the heart, liver or kidneys could certainly affect the eyes.