Test Driving a Cataract

Gratefully, I have not yet reached the point of requiring or even thinking about requiring cataract surgery. Most of us (human beings) will need to have the cataract conversation with our optometrist sometime in our early to mid seventies; and, well, let’s just say I still have an 8-month-old baby at home. Recently, however, I had an experience that gave me a brief and unsettling glimpse at what may lay ahead for me in a few decades.

With my family out of town, I decided to head up to the mountains for some late-season skiing. Although recent snows made for a great day on the slopes, they also contributed to some slushy driving on the way up.

Unfortunately, I did not check that my windshield wiper fluid was up to an adequate level; and with all the muck being thrown onto my windshield from fellow cars, I soon found that my wiper fluid ran out completely. I did my best to wipe the windshield immediately, while the muddy water was still wet; but I was soon left with a frighteningly opaque film that made it difficult to navigate the road, especially when hit with glare from the sun.

As soon as I could, I pulled over in a safe area to grab some snow that I could use to wipe off the mud. Although this got me back down to ground zero, within minutes of returning to the road I was back in the same predicament, and I knew there would be no stopping until I got to the next town. Obviously I’m here to tell the tale, so all’s well that ends well, but I can tell you it was not a comfortable experience at the time.

By now you’re probably asking yourself what in the world this has to do with cataracts. Well, on pretty much a daily basis, I use the analogy of a dirty windshield to describe cataracts. If that windshield is dirty, it doesn’t matter how good your prescription is – you can’t see as well as you should. Glare definitely becomes an issue. And because that windshield (cataract) gets worse bit by bit, sometimes it seems like you’re doing fine, and all of a sudden you realize you’re in trouble.

I didn’t realize just how apt this windshield analogy was until I lived through it myself. If you or a loved one has ever been told they have cataracts, an annual comprehensive eye exam is vitally important to ensure that vision hasn’t gotten worse than you think!

 

Why the Vision Exam is so Confusing

I’ve always said I feel like I should have a mental health professional stationed outside my office to help repair my patients’ damaged psyches following the vision test.  I say this not because of any self-professed deficiency in my exam technique, but rather due to the nature of the exam itself: it is at times frustrating, confusing, or both.

The reason for vision-test-related frustration is mostly two-fold.  First, the best way to refine and pinpoint a glasses prescription is to rule out all of the power options that DON’T work.  For example, to arrive at a prescription of -1.00D (D stands for diopters, but that’s another conversation), I would want to confirm that neither -0.75 nor -1.25 looks as good.  That’s already two different sets of “Which is better, 1 or 2?” right there.  And sometimes – especially for younger patients whose focusing muscles can mask their prescription somewhat – both choices look pretty identical, so we go back and forth a few times and have tough decisions to make.

The second cause of eye exam stress is that certain parts of the test are confusing and/or counterintuitive – I’m looking at you, astigmatism test!  To test for astigmatism, we introduce a lens called the Jackson Cross Cylinder (JCC).  Without getting into too much gory detail (too late?), as we use the JCC to test astigmatism, the goal is actually to EQUALIZE the BLUR between the two choices.  We don’t even care of either/both choices look clear; we just want them to look the same.  I try to prepare my patients beforehand that both choices may look blurry, but inevitably I’ll get patients who uneasily state “they both look pretty bad.”  Yup, they do.  Once I’ve gotten the measurements I need – again, trying to bracket by finding what DOESN’T look better – I remove the JCC and the image is magically a lot clearer.  Hopefully I can get to that point before my patient has a heart attack.

Most patients who have been through this crazy dance before take it in stride and accept that, in the end, they can expect to see well; but I don’t blame anyone who doesn’t look forward to the vision test.  It’s like what people say about most standardized tests, except even more true – you can’t study for it.

Help me help you

Every so often, a patient returns to my office within just a few months of their comprehensive eye exam, complaining of blurry or uncomfortable vision with their new glasses.  Of course I am happy to double check my measurements and see if some change is in order, but I often find that the situation could have been prevented a couple of different ways.

First and foremost, whenever you have an eye exam, bring as much information as possible regarding your current and/or preferred vision correction.  As an optometrist, my goal is not only to give you the clearest vision possible, but also to make it as easy as possible for you to adapt to your new glasses.  If I have no idea what correction you’ve been using, I also have no idea if I’m making a big enough change to give you a headache.  I have known people who almost seem to hold back information – because they don’t want to feel like the doctor is simply copying a previous prescription – but that sort of thinking can come back to bite you in the end.

If you do ever find yourself in the 2-4% of patients who have problems with their new glasses, my recommendation is first to stop by the optical department before ever seeing the doctor.  I would venture to say that at least 50% of glasses re-checks I see involve problems that could have been solved by the optical department through measuring or adjusting the glasses.  Especially if you are wearing a bifocal or progressive lens, stop by the optical first.

At the end of the day, prescriptions are variable, and mistakes can be made.  If your eyes were quite dry or irritated the day of your exam, your vision may change once your eyes are feeling better.  If your doctor saw 20 other people for exams the same day as you, statistics would suggest that at least one number on one person’s prescription was slightly off.  I definitely subscribe to the theory of “measure twice, cut once,” but no one is perfect.  If you can’t wear your new glasses that you paid good money for, please come in and let us help you!  The last thing we want is for those beautiful glasses to go in a desk drawer until next year.

Back to School eye exams

As a Minnesota native, I still have a tough time accepting that school starts before Labor Day here in Colorado; but believe it or not, we are in bona fide back to school season!

For many of my patients, back to school means back to the optometrist, and I totally agree with this mindset! In my experience, young patients aren’t generally given to complaining about their vision, especially if those complaints may land them in the exam chair with the possibility of glasses or (gasp!) eye drops looming. Lest you think you can rely solely on school vision screenings, studies have shown that roughly one third of kids who should be sent for a comprehensive eye exam are missed during screening exams.

To ensure that young people are performing their best in school and are not hampered by uncorrected vision problems, schedule their yearly eye exam! Back to school season is a great time for their exam, firstly because it’s easy to remember each year, and second because it ensures their prescription should stay up to date for the duration of the school year.

For our more vanity or sports oriented young people, back to school exams are also a great time to pick out a fabulous new frame or get fitted for contacts. I remember during my school days, it was always great to feel like I was starting the year off with a fresh new look!

So, whether your kids wear glasses, contacts, or no vision correction; schedule their back to school eye exam to ensure they’re performing their best and feeling prepared to face another year in the trenches 🙂