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.

My Optometry Turn-ons

When I first graduated from optometry school, I assumed that as I practiced I would find an aspect of optometry that particularly interested me and could turn into somewhat of a specialty.  Now that I’m a few years removed from optometry school, here are a few things I’ve realized I’m passionate about:

1) Communication.  I feel strongly that every patient leaving my office should understand the current state of their eyes and their options for correcting any problems with their eyes.  I try to be very clear about all this during the exam, and if anyone sends me an email after their exam asking questions, I typically send a pretty detailed reply to make sure nothing is left unsaid or under-explained.

2) Good prescriptions.  Whether for glasses or contacts, I want things spot-on.  I was extremely picky about my vision growing up – probably to a fault – and I am picky about my patients’ vision.  This is why if you come in saying you recently got a glasses prescription somewhere else and only want contacts from me, I’ll still remeasure your glasses prescription to make sure things are as exact as I want them (we use the glasses Rx to determine the contact lens Rx).  And yes, I am aware of the fine line between a thorough exam and causing my patients a nervous breakdown from having to answer “1 or 2” too many times 🙂

3) Having options.  My prescribing philosophy is to offer each of my patients any and all options that I would consider for myself if I had their eyes.  If I’m offering you a separate pair of glasses specifically for the computer, it’s because if I had your prescription, I would probably want those glasses.  If I think you would benefit from part-time or full-time contact lenses, or from LASIK, I try hard always to bring up these options and how they could help enrich your life.  Before I had LASIK, I had prescription glasses, prescription sunglasses, and daily disposable contacts for part-time wear.  I had options for whatever came my way.

4) Technology.  I love my optomap because I think it gives me a better view of the back of the eye and a more perfect comparison from year to year to check for change.  I love my computerized refraction system because it makes the process of checking glasses prescriptions more efficient and more precise.  I truly believe the exam I can give you with my technology is better than the tradition exam with all manual equipment and dilating drops in your eyes (which isn’t to say there is never a reason to use dilating drops, just fyi).

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.

Ordering glasses online: proceed at your own risk!

Image via Wikipedia

I recently read an article in the journal of the American Optometric Association discussing the upswing in glasses being ordered from online vendors.  The idea behind the article was to explore whether patients using these supply avenues were receiving glasses that would both fulfill their visual requirements and provide them with adequate safety.

In the interest of both time and my desire to avoid regurgitating the monotonous details of a scientific survey, let me skip to the results:

With a sample size of more than 150 pairs of glasses, nearly one half failed to meet the nationally accepted standards for vision and/or safety!  One point from the study that I find significant is how these failures in vision and safety were independent of lens price, meaning that you are apparently just as likely to get a crummy pair of expensive online glasses as you are to get a crummy pair of cheap online glasses.  Yikes!

Bottom line?  If you choose to order glasses online, proceed at your own risk.  There is currently no defined body to regulate these types of orders, and there appears to be a 25-50% chance that your vision and/or safety will be compromised.  Obviously you will also be on your own regarding having the glasses adjusted to fit your face correctly.  And don’t get me started on ordering bifocals or progressive lenses online – the measurements required to ensure these lenses will work appropriately make the very idea of ordering them online completely unfathomable to me!

If you’re looking to save a few bucks on your glasses, I recommend Costco Optical.  They have been ranked #1 by Consumer Reports for overall patient satisfaction, and I have been extremely impressed since taking over the office here at the Thornton Costco.

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• Warby Parker Raises Money to Sell Prescription Glasses Online (bits.blogs.nytimes.com)