Explaining DVA to hyperop

[spex911]

This has been a concept I've been trying grasp for a while:

Let'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. The patient says NO THAT IS INCORRECT, I need the +2.00 SV Rx to drive. 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?

Does the +2.00 SV Distance Rx really correct for the distance focal length? Does their hyperopia create a "barrier" that blurs the distance?


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?

[Uncle Fester]

Short n sweet---

http://en.wikipedia.org/wiki/Hyperopia

Note in youth we can usually accommodate +2.00. With a +2.00 add they are no longer young.

[MakeOptics]

This has been a concept I've been trying grasp for a while:

Let'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. The patient says NO THAT IS INCORRECT, I need the +2.00 SV Rx to drive. 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?

Does the +2.00 SV Distance Rx really correct for the distance focal length? Does their hyperopia create a "barrier" that blurs the distance?


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?

The distance Rx is +2.00, that means the patients eyes have an excess of -2.00. A younger hyperope maybe able to accommodate that +2.00, sometimes it manifests as asthenopia (aka headaches). At a +2.00 add this person definitely would need a +2.00, even at a lower add or no add that is the distance correction, they may choose not to use it, but that is their distance correction.

[EyeSore]

This has been a concept I've been trying grasp for a while:

Let'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. The patient says NO THAT IS INCORRECT, I need the +2.00 SV Rx to drive. 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?

Does the +2.00 SV Distance Rx really correct for the distance focal length? Does their hyperopia create a "barrier" that blurs the distance?


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?

Based on the Rx . I think you'll find the patient would prefer driving with the correction than without.

[spex911]

The distance Rx is +2.00, that means the patients eyes have an excess of -2.00.....

hmmm... this sounds like it's going in the right direction of what I'm looking for...




Basically: What would be taught in a beginners optician class is that looking at an Rx like:

+2.00 sph
+2.00 sph

No ADD needed. SV only

The teacher would say "This patient John Doe has hyperopia. This means that John Doe needs correction ONLY for reading. John Doe is 20/20 DVA. John Doe sees PERFECTLY fine for distance"

BUT, John Doe says to his optician "I can't even drive without my glasses!!! I need them to drive!!!"

I say "well sir, you have hyperopia ONLY. And you do not need correction for distance"

What is John Doe trying to articulate? How do I explain to him that he is WRONG and he does was not diagnosed with any myopia, and it's hard to debate them since they are the ones with that Rx!!

( keep in mind, this only happens with very few of my hyperop's ... All the others say "yup! you're right, I only need them for reading! you're correct, I drive perfectly fine without glasses )

[m0002a]

As a hyperope myself, I can concur with the responses above by others:

• At a young age, a +2.00 hyperope can probably accommodate for distance vision
• By the time a hyperope needs progressives, they cannot accommodate, or cannot completely accommodate
• If they wear progressives with a +2.00 sphere and +2.00 add, and they want a distance only lens, it should be +2.00

[spex911]

As a hyperope myself, I can concur with the responses above by others:

• At a young age, a +2.00 hyperope can probably accommodate for distance vision
• By the time a hyperope needs progressives, they cannot accommodate, or cannot completely accommodate
• If they wear progressives with a +2.00 sphere and +2.00 add, and they want a distance only lens, it should be +2.00

Good answer, the rest of you are also using the word" accommodate", so it seems like I'm getting close....

What is the definition of "accommodation" for the optical field? I know the standard English definition which is: To compromise or settle ....

[edKENdance]

I had a similar rx years ago. I could drive without my glasses but I didn't really feel comfortable doing so because I had issues with reading the speedometer. There was no texting at that time either. Perhaps he considers this to be part of the driving experience.

[merrymaker]

What is the definition of "accommodation" for the optical field? I know the standard English definition which is: To compromise or settle ....

http://en.wikipedia.org/wiki/Accomod...ergence_reflex

[Robert Martellaro]

This has been a concept I've been trying grasp for a while:

Let'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. The patient says NO THAT IS INCORRECT, I need the +2.00 SV Rx to drive. 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?

Does the +2.00 SV Distance Rx really correct for the distance focal length? Does their hyperopia create a "barrier" that blurs the distance?


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?

It depends on their amplitude of accommodation, pupil diameter, if they have been wearing the correction full-time, etc. I'd guess at this age (early to mid fifties) their VA might be from 20/20 to 20/50 uncorrected. Most should and will wear them for driving, especially at night. And as MakeOptics said, asthenopia may be an issue regardless of acuity.

[m0002a]

Good answer, the rest of you are also using the word" accommodate", so it seems like I'm getting close....

What is the definition of "accommodation" for the optical field? I know the standard English definition which is: To compromise or settle ....

A younger person can accommodate for an eye that does not focus properly, either because it is too long (myopia), or too short (hyperopia) because:

• The cornea (lens) is more flexible in younger people, and more easily manipulated by the muscles around the eye.
• The muscles in the eye are stronger and more easily able to bend the cornea to focus correctly and compensate for the misshapen eye.

[m0002a]

It depends on their ... pupil diameter ...

Sure. I am +5.00 with 2.25 add (+7.25 in reading area) but if I take off my glasses and squint really hard, I can read everything on this webpage.

[spex911]

Sure. I am +5.00 with 2.25 add (+7.25 in reading area) but if I take off my glasses and squint really hard, I can read everything on this webpage.

Reminds me of the key hole trick. Huffington Post posted an article a few weeks ago where they explained how to read if you lose your glasses. They said you can poke a small needle head sized hole in a piece of paper and look through it to make reading letters easier if you are in a pinch.

[m0002a]

Reminds me of the key hole trick. Huffington Post posted an article a few weeks ago where they explained how to read if you lose your glasses. They said you can poke a small needle head sized hole in a piece of paper and look through it to make reading letters easier if you are in a pinch.

Same way a camera works. The aperture controls the amount of light that reaches the film/sensor, but the smaller the aperture, the deeper the depth of field. If the aperture is wide open, then only parts of the picture will be in focus (unless the camera is focused at infinity).

There was a Jeopardy question very recently about Group f/64 founded in the 1930's. It was a group of photographers that preferred to use the smallest possible aperture on their camera lenses to keep everything in focus, contrary to the previous photographic styles with a background that is usually out of focus. Early members included Ansel Adams and Edward Weston (and others).

[Trip]

• The cornea (lens) is more flexible in younger people, and more easily manipulated by the muscles around the eye.
• The muscles in the eye are stronger and more easily able to bend the cornea to focus correctly and compensate for the misshapen eye.

Crystalline lens vs cornea, .... yah?

[opty4062]

If the pt didn't need the +2.00 for distance the RX would be plano +2.00 add. Don't over-think it. It's hard for some people to go from reading only glasses to multifocals as their eyes age. Especially if they were able to drive easily without them before. But in this case, the rx has it and the pt requests it, what's the issue with selling/dispensing it?

[m0002a]

Crystalline lens vs cornea, .... yah?

Yes, it is the crystalline lens not cornea. Here is better explanation:

Accommodation

The lens is flexible and its curvature is controlled by ciliary muscles through the zonules. By changing the curvature of the lens, one can focus the eye on objects at different distances from it. This process is called accommodation. At short focal distance the ciliary muscle contracts, zonule fibers loosen, and the lens thickens, resulting in a rounder shape and thus high refractive power. Changing focus to an object at a greater distance requires the relaxation of the ciliary muscle, which in turn increases the tension on the zonules, flattening the lens and thus increasing the focal distance.
http://en.wikipedia.org/wiki/Lens_%28anatomy%29

As noted earlier, as one ages, the lens is less flexible and the ciliary muscles less able to change the curvature of the lens to focus properly.

[m0002a]

It's hard for some people to go from reading only glasses to multifocals as their eyes age. Especially if they were able to drive easily without them before.

Is that vanity, or a real problem for them?

[mshimp]

If the pt didn't need the +2.00 for distance the RX would be plano +2.00 add. Don't over-think it. It's hard for some people to go from reading only glasses to multifocals as their eyes age. Especially if they were able to drive easily without them before. But in this case, the rx has it and the pt requests it, what's the issue with selling/dispensing it?

dittos.

[mshimp]

The distance Rx is +2.00, that means the patients eyes have an excess of -2.00. A younger hyperope maybe able to accommodate that +2.00, sometimes it manifests as asthenopia (aka headaches). At a +2.00 add this person definitely would need a +2.00, even at a lower add or no add that is the distance correction, they may choose not to use it, but that is their distance correction.

Nice insight to explaining why a hyperopic patient would be able to see at a distance without the need to be corrected with lens!

[m0002a]

Nice insight to explaining why a hyperopic patient would be able to see at a distance without the need to be corrected with lens!

Most younger people that are far-sighted (hyperopia) can see at least OK at a distance even without correction, mostly because of accommodation as discussed above. That does not mean they won't see better with correction, especially if they are older and can not accommodate as easily, and especially if the correction is customized for their distance vision.

One problem with hyperopes still wearing SV lenses is that the Rx is usually optimized for reading, and are too strong for distance or driving, so they don't like to drive with them. But by the time the have progressives, and there are two different powers (one for distance and one for reading) then the distance Rx is customized for them to be used comfortably for driving. I am not an OD, but speaking as a hyperope (the most abused optical patients out there).

In a sense, hyperopes are presbyopes at birth, even though they typically wear SV lenses until they reach their 40's.

[obxeyeguy]

The teacher would say "This patient John Doe has hyperopia. This means that John Doe needs correction ONLY for reading. John Doe is 20/20 DVA. John Doe sees PERFECTLY fine for distance"

BUT, John Doe says to his optician "I can't even drive without my glasses!!! I need them to drive!!!"

I say "well sir, you have hyperopia ONLY. And you do not need correction for distance"

What is John Doe trying to articulate? How do I explain to him that he is WRONG and he does was not diagnosed with any myopia, and it's hard to debate them since they are the ones with that Rx!!

( keep in mind, this only happens with very few of my hyperop's ... All the others say "yup! you're right, I only need them for reading! you're correct, I drive perfectly fine without glasses )

How many wrong statements can we get in one post? 20/20 with a +2.00 distance correction? I doubt it.

[m0002a]

How many wrong statements can we get in one post?

How many times have consumers come on this forum asking questions about their specific Rx, lenses, etc, and we tell them that we are not allowed to provide advice to consumers, and that they should rely on their local eye care professional. It a tough world out there for consumers of optical products.

( keep in mind, this only happens with very few of my hyperop's ... All the others say "yup! you're right, I only need them for reading! you're correct, I drive perfectly fine without glasses )

Yeah, but anyone who is wearing a progressive, even if they can drive without their glasses, would see better with their distance correction per Rx while driving, unless their distance vision were plano without any cylinder. Just think of all those other patients driving around without the best distance correction. It would probably would make a personal injury lawyer start foaming at the mouth.

[braheem24]

Let'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.

[Craig]

You have 3 options...

1. Ask for a refund.
2. Fire the teacher and switch to another.
3.Re-read your notes.

The truth is told!