Near Vision Question ?

**skirk1975** · 03-02-2009, 06:53 PM

Patient has perfect vision. Far and Near. However, at near things blur out very easy when eyes are relaxed. Been like that for a while and now blur out very quick when relaxed at all. In fact, goes to double if looking at near and totally relaxes eyes all together. Can straigten up if need be and read fine. Any thoughts ???

Is this just the general worsening of eyes with age. Patient is only 34. During an exam can acheive 20/20+ or 20/15- over the years. Can read the smallest too, just becomming a little harder. Eyes want to relax and blur.

Looking for any thoughts on this.

Thanks.

**Jacqui** · 03-02-2009, 07:12 PM

Have had the same problem. I put a diopter of base in prism on the read of each eye and it seems to help. Franklin bifocals :D

**chip anderson** · 03-02-2009, 07:49 PM

I'm with Jacqui, I have a similar problem when I am very fatigued. Once when I was working for some OMD's I remarked: "What are those two red lights for at the end of the exam room." The good doctor (and he was a good one) said: "You must have a muscle problem, you are only supposed to see one."
I was still young at the time. If I watch TV into the wee hours I see two screens slightly off-set both vertically and horizontally from each other.
Now when less than give-out fatiqued, I have no problem. Of course this means that my eye muscles are probably in a slight bit of tension until they can't take it any more.

Chip

Despite having many OMD friends, haven't had one volunteer to do an exam in the middle of the night when I am very fatiqued.

**harry888** · 03-02-2009, 08:17 PM

Sounds like binocular problems. Problems with either convergence or divergence.

Harry

**fjpod** · 03-03-2009, 06:00 AM

Definately sounds like a binocular vision disorder. While a lack of convergence is common, you cannot make the assumption that a single remedy will work for everyone that says their eyes get tired when they read.

**Jacqui** · 03-03-2009, 07:38 AM

Originally Posted by fjpod

Definately sounds like a binocular vision disorder. While a lack of convergence is common, you cannot make the assumption that a single remedy will work for everyone that says their eyes get tired when they read.

True, but it is probably a good place to start in this case.

**fjpod** · 03-03-2009, 07:43 AM

Originally Posted by Jacqui

True, but it is probably a good place to start in this case.

Perhaps, but should one be guessing when treating a patient or advising them about their glasses? A diagnostic binocular evaluation should be performed first.

**wmcdonald** · 03-03-2009, 11:04 AM

At near the eyes are not relaxed, but accommodating. At any age, +2.50D is required for us to see at 40cm/16in. This young person is probably a latent hyperope and always accommodating at any range, even at distance. When attempting to further accommodate to achieve the required near point, she experiences difficulty after a few minutes. A question; is the "perfect" vision based on an exam or her stating her vision is "perfect"? If it is based on exam data, then is is almost certainly a binocular disorder.

**chip anderson** · 03-03-2009, 11:13 AM

In fact many hyperopes accomodate for distance (if they are young enough) and fatique sooner than the rest of us.
My own problem (described earlier in this thread) occurs at both distance and near when fatigued. Has been a problem since I was a teenager and doesn't seem to be much better or worse as the years have rolled by. Of course I get fatiqued more easily at 66 than I did at 15. But everything I have gets fatiged more easily now.

Chip

**OHPNTZ** · 03-03-2009, 04:30 PM

This would definately require a binocuclar vision work-up. This patient could have low sustainable accomodation, or low base out or in vergences, be a latent hyperope, etc. A wet refraction would probably be the first step, though...

Chip,

It sounds like you migh be a little hyper...no pun intended. Ever have a maddox rod test at distance and near or a modified thorington card???