explaining presbyopia to a mild-moderate myope

**pknsbeans** · 08-30-2017, 06:38 PM

Should I call the CDC? I just had a -3.50 presbyope that couldn't read with their DVO glasses on, but could read just fine with them off. They acted like they were patient zero.

I've tried numerous ways to explain this "phenomenon" to these people but still get something to the effect of: "with my glasses off, I can read just fine. I just can't see far. But with them on, everything far is good, just can't see up close."

It goes something like this:
Me: Your eyes just can't focus like they could previously, so you can either continue taking your glasses off to read or get a bifocal.
Them: But, when I take them off I can see just fine to read.
M: Correct. You are near-sighted. Your eyes' focal point is about that distance. But when you put them on, the focal point is way far away, and your eye can no longer adjust to bring the closer stuff in focus.
Them: But I can't see far with them off.
M: Yes. You need them more to see far. And if you would like to keep your glasses on all the time instead of taking them off to read, you can get a bifocal.
T: But I can see fine up close with them off.
M: Yes, you can continue taking them off to read. It's entirely up to you, but your eyes no longer have the ability to adjust focus with them on.
T: Why would I take them off to read when I can see far just fine with them on. Will my insurance cover this?
M:

**Tallboy** · 08-30-2017, 07:48 PM

Explain refractive area from Myopia as the result of their lens not projecting the image on their retina "movie screen" on their eye correctly. The glasses fix this. Also explain our eyes lens is flexible and is flexed by muscles to focus on things closer or more far away, similar to how a camera's lens focuses. Then explain that the lens hardens as you get older so it can not change focus anymore.

Then just give up and tell them they need a new kind of medicine in their lenses and just make them.

**lensmanmd** · 08-30-2017, 10:26 PM

Thanks. I needed this. Today has been a stupid pill day.

One example
Why is this on call back?
+6 is the max power for this FF PAL. You ordered a +6.25 with a +3 add
But you made this pair 6 months ago
Yes, that should not have been made, but it got by our staff and made it to your clinic. My apologies for this. You say the patient has had trouble with it since day one (6 months now). This will need to be remade in a molded PAL or this other FF design.
Well the RX is +6.25 -2.00 so the total power would be +4.25 and should be in range
Facepalm........

And there were more moments. I had to stop answering emails and spent time in production working on specialty products the rest of the day.

**jpways** · 08-31-2017, 07:21 AM

I just tell these people that they were luckily enough to be in the small ground of people that get to have the 1 benefit of getting old

**EyeManDan** · 08-31-2017, 07:55 AM

This is when a Benny Hill style head tap is necessary

**jasons** · 09-01-2017, 03:59 PM

Originally Posted by pknsbeans

Should I call the CDC? I just had a -3.50 presbyope that couldn't read with their DVO glasses on, but could read just fine with them off. They acted like they were patient zero.

I've tried numerous ways to explain this "phenomenon" to these people but still get something to the effect of: "with my glasses off, I can read just fine. I just can't see far. But with them on, everything far is good, just can't see up close."

It goes something like this:
Me: Your eyes just can't focus like they could previously, so you can either continue taking your glasses off to read or get a bifocal.
Them: But, when I take them off I can see just fine to read.
M: Correct. You are near-sighted. Your eyes' focal point is about that distance. But when you put them on, the focal point is way far away, and your eye can no longer adjust to bring the closer stuff in focus.
Them: But I can't see far with them off.
M: Yes. You need them more to see far. And if you would like to keep your glasses on all the time instead of taking them off to read, you can get a bifocal.
T: But I can see fine up close with them off.
M: Yes, you can continue taking them off to read. It's entirely up to you, but your eyes no longer have the ability to adjust focus with them on.
T: Why would I take them off to read when I can see far just fine with them on. Will my insurance cover this?
M:

I explain to patients that their eyes are like a camera. It needs to change focus to see up close. As our eyes get older they do not change focus as well. In your case, your eyes, without a prescription, focus up close. But when your distance vision is corrected, they no longer have the power to change focus to see close as well.

**drk** · 09-03-2017, 06:36 PM

Maybe this will help:

"You are NEAR-sighted. That means you have SUPER-GOOD near vision.

But when you put on your glasses, you lose your special 'near-sighted' abilities, like Clark Kent loses his Superman powers. Then you're merely a mild-mannered 48 year-old who needs bifocals to read. You have to take them off, again, to get back your super near-vision.

But if you want the convenience of not having to take off your glasses all the time, we can put a bifocal in there. Your choice, of course."

**jasons** · 09-05-2017, 09:17 AM

drk I love that explanation.

**Happylady** · 09-05-2017, 02:19 PM

I tell them the reason they can see well up close without their glasses is only because they are nearsighted. If they correct their myopia, than they have the same issues everyone else over 45 has.

And I NEVER say that if they want to see both at the same time they need bifocals! People don't want lines in their glasses. Many people don't realize that they can have lenses made that allow vision at all distances without lines. I tell them we can make them glasses that allow them to see all distances and briefly explain progressives. I often mention we can also make them with a line but no one seems to want that!

**Pete Hanlin** · 09-05-2017, 02:59 PM

+1 for drk's line... I will definitely be stealing this one in the future!

**optical24/7** · 09-05-2017, 03:18 PM

Just point them to Wikipedia and tell them to look up the meaning of Presbyopia: "The term is from Greek πρέσβυς presbys meaning "old man" and ὤψ ōps meaning "sight" (GEN ὠπός ōpos)"....Then, duck for cover....

**Uncle Fester** · 09-06-2017, 12:39 PM

"Let me try to explain it this way-
When you look through a microscope do you expect to see things far away clearly?
When you look through a telescope can you see things very close clearly?
Because of the lenses the focus is made to see different.
Every-ones eyes are kind of similar. You have "microscope eyes" that naturally see close objects fine. You make great jewelers and watchmakers!"

drk still wins for best presbyope explanation though!

**Hayde** · 09-06-2017, 01:15 PM

Great posts!

(Mine's only mildly amusing...probably only to me.)

"Think of your vision like arms. Since your eyes have 'short arms,' they need that handle extender to reach across the room.

But you don't need the extender to grab your fork at the kitchen table. When you want to 'reach' what's in front of you, you put down the extender and use your own natural arms again."