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Thread: Need advice ... astigmatism and accomodation

  1. #1
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    Question Need advice ... astigmatism and accomodation

    Someone over at visioncareforums.com suggested I post my question here.

    I'll try to make this as brief as possible. I have some strange stuff going on with my eyes, and really, REALLY want to get back into contacts.

    I was far-sighted in elementary school, and diagnosed with an accomodation paresis (I was tested at 20/15 but couldn't read the textbook on my desk). I was told that my eyesight would change rather drastically until I was about 20, then the variances would slow down, and I'd be left with my "standard" vision problems, and experience "normal" degradation from there.

    I wore bi-focals in high school, then in my Junior year, my eyesight changed drastically and I ended up with a slight near-sighted problem. At this point I started wearing contacts, because I've always hated my glasses. I've always gotten headaches without correction, so contacts are a better option for me.

    At one point an OD told me I wasn't a good lens candidate because I didn't require enough correction. (I was in a .25 and .5 correction at the time) I told him that regardless, I got headaches if I didn't wear correction, and that I'd been wearing contacts with that correction for years. I found another OD who fit me.

    This year when I went in, my correction dropped from .75 and 1.25 to about .5 - the OD couldn't explain it other than to say that the OD who fitted me the year before must have messed up. He tried to talk me out of contacts, and I insisted. I couldn't see decently with the new lenses, and was frustrated with the OD who insisted I should wear the same correction in both eyes, despite a .25 variance and I've NEVER gotten my lenses confused, I'm VERY careful. Visual acuity is of the highest importance to me.

    I'm a computer geek by trade, so I spend LONG hours at a computer. I ended up earlier in the year having eyestrain so bad that I had to call in sick for 2 days. I went to see my fiance's OD, because he really liked him and said he was very thorough. He was very nice, but told me I'm a poor CL candidate because of my low correction, and the fact that I have an astigmatism. I told him about the accomodation problem (every other OD had ignored me when I told them) and he did some testing and agreed that I do have a fairly significant accomodation problem, and need to use reading glasses. He said my distance vision hardly needs correction, other than the astigmatism. At that point, preventing eyestrain was the most critical, so I've gone with his suggestions. He said that the distance glasses I had were fit wrong, (they're about 1.00 and 1.25 and he has me at .25 and .50) but that I can keep wearing them if they work.

    I've been trying to use the glasses for about 4 months now, and they do fix the eyestrain problem, WHEN I remember to keep them with me. However, I am coming to despise my glasses again, and will frequently find myself with a serious headache because I hate the pressure on my face, the acne on my nose, and the reduction in my field of vision. Nineteen years in contacts has spoiled me rotten.

    Now. I have read information on the MacroLens, and it sounds absolutely ideal, but all of the people I can find who use them are post-refractive surgery. They don't seem to have a lot of clients who aren't, and I don't understand why. (Incidentally, I also have a problem with enormous pupils, and require the largest diameter of soft contacts my OD's have had in stock... so the diameter of the MacroLens doesn't concern me.)

    I spoke with an OD about the MacroLens, and he said it's not really a good idea because of the large diameter and the price, unless you have irregular astigmatism. I'm not sure what irregular astigmatism is vs. whatever kind of astigmatism I have.

    I am more than willing to track down an OD that can fit the MacroLens and pay whatever it costs (as long as we're not talking about more than about $600 a year) ... or do whatever it takes to get my clear vision back. I'm frustrated and tired of playing musical OD's. I know my condition is kinda strange, and it's very odd that I see better with corrections that I'm being told are way too strong for me.

    My latest prescription:
    Sph. Cyl. Axis
    OD: -050 -050 60
    OS: -025 -075 147

    I'm not sure what any of that means, perhaps someone can help out?

    Also, can the accomodation problem be causing distance problems that vary from day to day so I'm testing differently in the office than I do otherwise?

    Is there a contact out there that can help, or am I really stuck in these awful glasses with the headaches & all forever? If there is a contact out there, how do I find someone who can help? I'm in the Dallas, TX area and would love any and all suggestions.

  2. #2
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    Based on what you are describing, I would suggest that you seek someone who can fully evaluate your retina, optic nerve and other neuroregions of your eye. Not trying to create worry, however, the accomodation issue vs. your desired refraction could be an indication of something deeper that has been overlooked. A full medical history would be needed to help establish any potential scenario. I am sure that I speak for others here that giving you a diagnosis or even a suggestion for contacts is a touchy subject as there are too many questions that need to be answered and without seeing your eyes, it is impossible to diagnos, treat, and prescribe.

    :cheers:

    Cowboy

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    Thanks for the advice. Are you suggesting an opthamologist as opposed to an optometrist? If so, where would I get informtion on finding a good one? I'm really tired of the doctor-go-round on this issue.

  4. #4
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    Look in the yellow pages under physicians ophthalmology, Dallas and Houston probably have more per square mile than anywhere on earth. There are probably even some good ones there that practice medicine as opposed to selling surgery.

    Chip

    Seriously, your local independent optician can probably send you in the right direction.

    Chip

  5. #5
    Master OptiBoarder LENNY's Avatar
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    I am not shure about your state but in NY you can see an Optometrist for a full dilated fundus exam. Than he or she can reffer you to any Ophthalmological specialist if you need one.

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    Master OptiBoarder BobV's Avatar
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    A question for you, Tigger...

    Realizing that you are more "comfortable" in contacts, you already had 3 or 4 optoms tell you that you are not a good candidate for contacts.

    Have you not been fitted properly for glasses, where ever you have gone? Is it the style you are in that bothers you?

    Has anyone checked vertex distance to see if that would help with accomodation?

    Just wondering.

    Bob V.

  7. #7
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    Yes, I've had 3 OD's tell me I'm not a good candidate. But what none of them can tell me is why I wore contacts with very clear vision for 18 years prior. When I went in last year for my annual exam, I was seeing fine in the contacts I had, but the OD said my correction was wrong. He didn't want to put me in contacts, but wouldn't give me specifics. The contacts he gave me, I couldn't see with.

    If I'd never had clear vision with contacts, I'd just assume that I'm stuck in glasses and deal with it. But I wore contacts up until the day the OD I saw told me they were wrong, and I could see fine. There was a very slight loss of clarity vs. glasses because I didn't want to go into torics and the astigmatism wasn't enough to bother me much. The reasons I don't like the glasses are that I get acne breakouts under the nose pads which are very uncomfortable, I also have serious allergy issues and even with my very lightweight glasses, the weight on my face is uncomfortable when I'm having sinus problems. In addition, now that I have reading glasses, I have to carry 3 pairs of glasses with me: prescription sunglasses, regular glasses, and my reading glasses.

    To make it worse, I'm suspicious that the only reason I can see with my current glasses is because they're with my old prescription. I'm afraid that if I had my new prescription made up, I'd be unable to see with that either. My new OD is very nice and is trying to be helpful, but I'm not happy with the solutions, and if there's a chance there's more going on here, then I really think I need to seek help elsewhere. My OD's haven't thought that I needed to see anyone else.

    I don't know what vertex is, I don't think I've had anything done called that.

    Thanks for all the replies. One of my co-workers is married to an optician, and I'm going to ask him for a referral to a good opthamologist.

  8. #8

    Re: A question for you, Tigger...

    BobV said:
    Has anyone checked vertex distance to see if that would help with accomodation?
    Bob V,
    vertex isn't an issue at her power.

    Trigger1969,
    Usually people who can't wear contacts because their eyes become too dry as they age, or their eye health isn't good in contacts... ie lack of oxygen, allergy, infection etc etc etc.

    I'm not even going to suggest a diagnosis given what you have written, and you have come to the wrong place for a diagnosis. However I do have one suggestion. Perhaps someone on optiboard can suggest an optometry school in your area. Usually universities have top of the line docs that know everything. On top of that you will be evaluated in much more painstaking detail adnausium at a school, with evey expert in the book on the faculty.

    You should have someone explain to you to your satisfaction the answers you want.

    Keep trying, the answer is out there.

  9. #9
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    Tigger,

    Regarding carrying three pairs, try this-- A pair of Progressive Bifocal with transitions. The lenses provide distance, reading, and with the correct selection of progressive, an intermediate - for computer or vision requiring a distance of 18"-36". The Transitions, change dark to light and back again. However, get an optician to explain the pros and cons of all.

    :cheers:

    Cowboy

  10. #10
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    Forget Macrolens. It is not the panacea that everyone over at Contact Lens Spectrum thinks it is.

    If you go to an ophthalmologist, chances are you are going to waste a lot of time and money.

    It sounds like your current Dr. is correct with his refraction.

    You are probably chronically overminused. That occurs with type A personalities and Dr.s that aren't as dilligent refracting as they should be. Or, it can occur when a best sphere refraction is obtained for a person with more astigmatism than spherical error. (you). A cycloplegic refraction would rule that out.

    Another outside chance is that you have accommodative spasm. It can occur with people with accommodative insufficiency and high near demand, like computer work. Again, a cycloplegic refraction rules that out.

    You need astigmatism correction with your oblique astigmatism. Try soft toric lenses-don't even think about spheres. If you were my patient, I'd allow you to take up to -0.25D more minus than you really need, to help you adapt, if you've been overminused, but no more. But you'd still need to have near correction for work: possibly a monovision lens or two near contact lenses, just for work. Obviously, readers are simpler, but I can tell that you just aren't going to accept glasses correction.

    Even better, if you can wear RGP's, you should try to wear a low-eccentricity aspheric multifocal (like Aero's or Conforma's ELS or Boston's Multivision) to help with your accommodation problem and your astigmatism. That would be the ideal solution.

    Take these suggestions to your current O.D. He sounds like he knows what he's doing. Don't spend too much time looking around chat rooms for advice. The majority is bad, especially at CL Spectrum. Unlike this forum, it is not moderated, and any self-appointed know-it-all will waste your time and interfere with your Dr.-patient relationship.

  11. #11
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    I agree with alot of what drk said. One other possibility is that you may have a binocular disfunction like a large exophoria(eyes have a tendency to turn out) for distance and or a convergence insufficiency(eyes don't turn in enough up close) for near vision. In this situation patients will use accommodative convergence to keep the eyes alligned and create an over minused prescription which may feel more comfortable to the patient. I know that this probably doesn't make much sense to you but it does to us docs. You can ask yor doc about it. just a thought good luck:cheers:

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    Thanks Dr K and Stopper. You have made a lot of sense. I'll take this to my OD and see what he can do.

    I don't mind so much the reading glasses, as I do spend a lot of time on the computer and I fully realize that it's bad for me and anything I can do to lessen the strain on my eyes is beneficial. When you spend 14 - 18 hours a day in front of a computer screen, you do all sorts of things to make it more comfortable. What I really despise is going back into glasses for regular vision. I can focus on things close up, so I don't have to carry reading glasses to the restaurants or shopping, for instance... it's just when I do a lot of close up work I get a nasty eyestrain.

    With my contacts I had a great deal of freedom, didn't have to change out between sunglasses and regular glasses. I'm extremely light sensitive and I've never been able to get a pair of prescription sunglasses as dark as my RayBans (and the transitions are a joke for darkness in my book). :-) The loss of peripheral vision is annoying as well.

    And just to ease your mind, I used to be a medical professional, and would never look for a diagnosis on the internet. ::grin:: My frustration level with the musical OD's and the fact that one day I could see with contacts and the next I was being told that I wasn't a candidate and the new ones wouldn't work drove me to start looking for other options and possibly some referrals so that I can get to a solution that will work for me. At this point I didn't know if I should be seeing an opthamologist instead of an OD, or what, and the MacroLens is being billed as the miracle of optometry and I wanted to get some feedback before I started another quest for an OD who could help me.

    I hate to be a problem patient, but my OD seems committed to helping me find whatever works... so I guess I'll keep working with him until he gets tired of me. ::grin::

  13. #13
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    No offense to any opthalmologist, but to see one for this kind of problem would be like going to an optometrist for cataract surgery: not the correct specialty.

    PLEASE post the final outcome! We are interested in your story. Best wishes.

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