New Optometrist Gives New Insight
Posted , 6 users are following.
I found an unusual optometrist who schedules refractions to take a full hour and in my case spent an hour-and-a-half! My usual OD last year said she could not get me to 20-20 any more and it would soon be time for cataract surgery. I'm not fussy about distance acuity, but I am about computer distance, and it was getting to be problematic. So I asked this new O.D. to concentrate on the best possible prescription for 28 inches.
I have huge astigmatism in the right eye (-8.25 cyl according to last refraction). I asked the new OD, might the astigmatism prescription be different for distance vs intermediate? The answer was the new insight referenced in the title of this post: He said the axis is different, near vs far, but eye docs almost never bother to consider that. The eyes rotate as they converge for near, but the eyeglass lens does not, he said. Therefore, the axis for near is different than for far. With my high cylinder power, that few degrees of axis error can make a significant difference.
He did complete refractons for distance and 28 inches and came up with two different prescriptions: Axis of 89 degrees for distance and 93 degrees for 28 inches. My previous prescription was 87 degrees for all distances. He also backed off on the cylinder power a full diopter, from 8.25 to 7.25. With that, I was able to achieve 20 -20 at both distances, albeit a slow 20-20 with errors. The reduction in cylinder was interesting, because 7 cyl is what the fancy machines came up with (at the corneal plane) in my cataract evaluations and I wondered about the discrepancy between that and my subjective refractions.
I have decided to put off cataract surgery until my vision is significantly worse. I'm hopeful this new prescription and this new OD will help me postpone surgery more years.
He charged $200 and does not take insurance. Future appointments will be $180.
I found him by looking for someone in my area who does the Zeiss Iscription system (Google it if curious). Ironically, in the end he said I wasn't a good candidate for Iscription because I need prism in my lenses and he has found Iscription with prism does not work well.
4 likes, 12 replies
soks jimluck
Posted
thanks for sharing. i am a big fan of pin point refraction. however 89 and 93 is just 4 degrees. for me that is negligible for my 0.75 cylinder.
the diopter change in distance and far is probably expected. i would think the -8 is for far and -7 is for near. the residual astigmatism helps on the near side?
if u can manage putting off is a good idea. good luck to you.
jimluck soks
Posted
The reduction in cylinder power is for both near and far.
judith93585 jimluck
Edited
Thanks Jim. Your post displayed just as I was wondering how to find an optometrist who does full refractions. In my case, I would like this service to help in choosing the IOL power for my second cataract surgery. I have Googled as you suggested and will follow up on Monday. That said, is the optometrist who helped you affiliated with a chain of opticians or independent? I have never had a refraction scheduled for anywhere close to an hour so wonder how to find such a practice.
RonAKA judith93585
Edited
If you are just wanting to know a ballpark number as to where you ended up, you could ask your optical dispenser for an autorefraction. It only takes a few minutes. It is not accurate enough to prescribe glasses with but does give you a ballpark number. Optometrists often use the autorefraction numbers as a starting point for the full phoropter test. They may be willing to give you the results verbally for you to write down. This assumes your optical dispenser has the equipment. It is the machine that you look at a hot air balloon or house on the horizon and it does everything automatically with no input from you.
judith93585 RonAKA
Posted
Is the full phoropter test the same as full refraction? The only thing I can remember from visits to the optometrist is looking at the Snellen chart and selecting 1 OR 2. Is there more to it than that for the purposes of knowing where your first eye settled?
Many thanks!
RonAKA judith93585
Edited
The full phoropter is typically called full refraction. It is the one where you look at the Snellen chart and pick which is better? 1 or 2. The value of a full refraction is that the surgeon can determine where your eye ended up compared to where his formula estimated it to be. A responsible ophthalmologist will adjust the formula if there is a significant difference between estimated and actual. My surgeon told me "I always learn something from the first eye that I can use on the second eye".
trilemma judith93585
Edited
Note when getting refracted, I will often concentrate more on one letter. If the difference is not substantial, I will look at a different letter, and say "again". Occasionally I have a third try.
jimluck judith93585
Edited
This optometrist comes maybe once a week to this optician shop. He's independent of the shop; just has some kind of deal with them. The shop is Eye Look Optical. I don't know if they are a chain. I think the hook would be to find an optician who does the Zeiss Iscription razz-ma-taz.
His degree of engagement and willingness to lavish time on the process was exceptional.
RonAKA jimluck
Posted
IOLs should solve the issue of cylinder changing angle with distance. IOLs other than the experimental ones that are really not here yet, have no accommodation and do not change shape at all as you focus near or far. Cylinder correction should hold bot both near and far with a toric IOL.
jimluck RonAKA
Posted
Yes. No issue of axis change from near to far with an IOL, nor with contacts. Only with eyeglasses.
trilemma jimluck
Edited
Interesting story. Unique resource I think.
How many people have had cataract IOLs installed and said they wish they would have waited.... Yes, it could happen if some improved technology came out, but I really think the extra years of good vision that you will get with one suitable toric makes sense to me. And somebody else who will agree with you is your insurance... they will not want to pay while they know that you are correctable to 20/20 or even 20/40.
Your right lens is heavy, even with high-index.
jimluck trilemma
Edited
I don't anticipate any difficulty with getting insurance to pay its share whenever I decide to do it -- unless the surgery is outside the country (which it probably will be on the right eye). The medicare guidelines make clear that testing 20/20 doesn't mean surgery is not medically necessary and testing 20/50 or 20/100 does not mean it is. I quote from the medicare coverage database:
"The Snellen chart is frequently used as a screening tool to measure visual acuity. However, testing using high contrast letters viewed in dark room conditions, can underestimate the functional impairments caused by some cataracts in common real-life situations (e.g., glare conditions, poor contrast environments, reading, halos and starbursts at night, and impaired optical quality causing monocular diplopia and ghosting). An evaluation of visual acuity alone can neither rule in nor rule out the need for surgery. Visual acuity should be recorded and considered in the context of the patient’s visual impairment and other ocular findings."
I've consulted two different surgeons. Both were eager to schedule me for surgery as soon as possible. Neither expressed any reservations about establishing medical necessity if I said it was time.
Source:
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34413#:~:text=Cataract%20causing%20symptomatic%20(i.e.%2C%20causing,restrictions%20including%2C%20but%20not%20limited