I don't get the impression that the OP just got out of school. Sounds to me like they have been dispensing for awhile.Originally Posted by Craig
I don't get the impression that the OP just got out of school. Sounds to me like they have been dispensing for awhile.
I would think that the hyperope would also like to see what's closer than a mile away, yet further than what is in front of their bumpers as well! There will be a no mans land without correction from up close to where the hyperope can actually see clearly. Just fill the Rx.
You are thinking that because hyperopia is also called farsighted, than someone with hyperopia had good far vision. But while their near vision is worse than their far vision, many many hyperopes need correction in distance.
I'm really glad you came here and asked. Hey, we were all new opticians at one point!
What makes you so sure that spex911 is a new optician? Other than a false conclusion reached, I see indications in the text of the post that spex911 is not all that new.
I can see how the confusion can arise, because for hyperopes up until age 40 or so, they typically have SV lenses just for reading, which are far too strong for distance, so they become accustomed to driving without any corrective lens even though they might benefit from them.
IMO, patients with hyperopia are generally treated very poorly overall by the optical profession, even by some experienced opticians, OD's, and MD's. I assume that the main reason for that is the relative scarcity of patients with hyperopia.
The eyeglasses are in essence correcting the deficiency in the distance function. Accommodation allows the eyes to compensate for this deficiency. They need eyeglasses for near because, due to age, the accommodation is insufficient to compensate for both distance and near.
http://www.aoa.org/documents/optometrists/CPG-16.pdf
I believe hyperopia is more common than myopia worldwide, and is dependent on age and ethnicity. European descent are about even, east asians are more myopic. The prevalence of myopia decreases with age, hyperopia increases with age (hyperopic shift).I assume that the main reason for that is the relative scarcity of patients with hyperopia.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
Most young hyperopes are given SV lenses (at least for me they were) and are either not optimal for distance or not optimal for reading. In that situation a hypoerope with SV lenses for reading may become accustomed to driving without lenses until they absolutely need progressives. This is because it is easier for them to accommodate for distance, than to accommodate for reading. But a lot of this depends on how they are refracted by an OD or MD, which can be all over the place for a hyperope, and depends on how severe the condition is.
Information I found suggests that hyperopia is between 5-10% of Americans (not including presbyopes). Incidence in the far east is probably even less."It [hyperopia] affects about 5 to 10 percent of Americans."
http://www.nei.nih.gov/health/errors/hyperopia.asp
Last edited by m0002a; 06-04-2014 at 11:05 AM.
MakeOptics is correct and makes it very clear. spex911 if you are a -2.00, make yourself up a pair of -4.00 to replicate your patients -2.00 excess. Wear that around for a day and see how comfortable that is.
And as Uncle Fester said, with +2.00 add these are not young eyes so they will not be able to overcome that -2.00 excess anymore. At this add they have maybe 2D max accomodation left, and probably only at most 1D comfortable accommodation. This patient might get away with just +1.00 DV and accommodate the rest, but they absolutely would benefit from DVO.
Actually, since your eyes are young and have plenty accommodation left, make yourself a -5.00 or -6.00 to better replicate your patient's difficulties.
Dear Friend,
You made it so simple and easy. and that is right answer.
A 20/40 brain cannot see 20/20 at times. (the usual hyperope? and **insert other applicable type of patient**)
right on brother!!!originally posted by spex911let's say this is the example rx:
+2.00
+2.00
add: 2.00
this patient is saying they want just the driving single vision rx, and i am trying to tell them that they do not need correction for distance. (you are wrong) the patient says no that is incorrect, i need the +2.00 sv rx to drive.(patient is correct) but in all my studies (basic beginner abo studies), this would be considered a patient with hyperopia and presbyopia, and they do not need any correction for distance right? (no, the rx specifically shows +2.00 for distance and +2.00 more for near making a total of +4.00 for near)
does the +2.00 sv distance rx really correct for the distance focal length? (yes) does their hyperopia create a "barrier" that blurs the distance? (yes)
i guess i can use my own experience with my distance correction. When i read a book (i have no add power, just strictly a normal -2.00 ou sph) and that kind of feels like it makes the letters sharper when i read a book.... But... I don't need reading correction.... ??? How does this work? (no, you cannot use your experience, it has nothing to do with the question you asked, in fact it's the exact opposite of the question posted. Get that example out of your head, you're confusing yourself.)
you have 3 options...
1. Ask for a refund.
2. Fire the teacher and switch to another.
3.re-read your notes.
Bryan Finley, Florida Board Certified Licensed Dispensing Optician
To everyone: Thanks for the advice. I guess I just need to grasp the concept of the accommodating hyperope.
And yes, even though I have been an optician for 8+ years and am ABO certified, I still consider myself a newbie. But I guess that goes to show you that American standards for opticianry are quite low, you can thank retail chains for that... All you need is a pulse and the ability to speak English to be an optician in America-- All you guys seem to know that already though.
But back to my main overall qualm: The reason I started this thread was to ask you guys how to bolster myself with a good argument when a hyperop tells me "I SEE DISTNACE PERFECTLY FINE" -- But all of you are telling me "NO THEY DO NOT SEE DISTANCE PERFECTLY FINE"
....So..... How do you win this argument?
To everyone: Thanks for the advice. I guess I just need to grasp the concept of the accommodating hyperope.
And yes, even though I have been an optician for 8+ years and am ABO certified, I still consider myself a newbie. But I guess that goes to show you that American standards for opticianry are quite low
But back to my main overall qualm: The reason I started this thread was to ask you guys how to bolster myself with a good argument when a hyperop tells me "I SEE DISTNACE PERFECTLY FINE" -- But all of you are telling me "NO THEY DO NOT SEE DISTANCE PERFECTLY FINE"
....So..... How do you win this argument?
And now that I am reading this again.... I guess I would tell the above patient "Sir/mam, this is because you are accommodating" ... Then the patient tells me, "Accommodating? What's that?" ... Then I tell them "That is where your crystalline lens is working hard to focus and make the distance clear... Kind of the like the 'key hole focusing' effect"
.... Am I getting there!!???
But that wasn't your original question, which was why an age 50 or so, mild hyperopic client, would ask for a distance correction and subsequently eyeglasses. The answers given above cover both questions.
If there is something from the above that you don't understand, ask away, and we'll do the best we can to explain it.
Additional reading here...
http://books.google.com/books?id=uEm...acuity&f=false
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
Yes, I know that wasn't the EXACT word-for-word initial question, but the gist of my inquiry came from me having trouble understanding why hyperopes tell me they see fine for distance and all of you are telling me they can.
Doesn't myopia generally decrease with age due to cataract? I find it somewhat funny when people above the age of 50 come in and say their vision has 'gotten better', say from -3 to -2. Sure it could be caused by something else, but only thing on my mind at a moment like that is cataract, cataract, cataract.
Hyperopes need correction when the required amount of accommodation exceeds 1/2 or 2/3 of their maximum ability to accommodate, depending on their age. http://en.wikipedia.org/wiki/Amplitude_of_accommodation
Last edited by revein; 06-26-2014 at 02:36 PM.
Some can, some can't. The reason 'why' is what you should be pursuing. Read the link I posted. It's all there.
A hyperopic shift is more common with hyperopes, emmetropes, and in my experience low myopes. It's due to changes in the refractive or gradient index of the lens, and is generally independent of cataracts. Myopes, especially moderate to high myopes, tend to be stable, maybe due to changes in axial length overcoming changes in the lens. A myopic shift is almost always due to nuclear cataracts.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
I tell these patients that they dont need them just as much as they dont need shoes or a car. Bare feet work but your feet get sore. Walking instead of driving still gets you there. Distance glasses for this type of Rx will help eliminate the strain and can even help you to enjoy reading and computers.To everyone: Thanks for the advice. I guess I just need to grasp the concept of the accommodating hyperope.
And yes, even though I have been an optician for 8+ years and am ABO certified, I still consider myself a newbie. But I guess that goes to show you that American standards for opticianry are quite low
But back to my main overall qualm: The reason I started this thread was to ask you guys how to bolster myself with a good argument when a hyperop tells me "I SEE DISTNACE PERFECTLY FINE" -- But all of you are telling me "NO THEY DO NOT SEE DISTANCE PERFECTLY FINE"
....So..... How do you win this argument?
Its ultimately up to the patient and this is usually a case where I like to sweeten the deal. Package price something at a reasonable price and throw it out there. Mr Jones for a hundo, I'll upgrade your view on life to HD. Try these on tell me you dont look good.
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As a rule of thumb I wouldn't argue with the customer what they need.
HD? Give me a break. When I hear people talking like that to me (in any business) the first thing I do is reach around my backside and make sure my wallet is still there, and then run out of the store.
It is not we the posters who are telling you this particular hyperope does not see perfectly fine to drive in the distance. It is the patient telling you he wants driving specs. It is the RX written for distance correction. It's really just that simple. Not all hyperopes need NVO specs, some need/want DVO, bifocals, trifocals or PALs. Why is it an argument to be won?
So in your Experio when you do a 360 Optimization in a Customized optical shop that pops in High Definition decor you must WAVE a Saphire ringed finger on your Digitally Compensated hand as you Avance away!!!
I do find that lower powered hyperopes often see better distance than myopes with the same amount of correction. For example with my husband's distance correction of +1.25- 50 he can see 20/20 or 20/25 with no correction, glasses correct him to 20/15. He's totally lost up close, his add is +2.50.
My distance correction of -1.00 -75 means I need glasses to drive, I find it noticeably blurry even across the room. But I see alright up close even though my add is +2.50.
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