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Posted on 10-01-2013

The Importance of Prescribing Lenses: More Than Meets the Eye - The Sequel

Originally posted on August 6th, 2013

Last time I took up the idea that lenses can do much more than just make things look clear or make someone’s eyes look less crossed. I also discussed how most doctors are satisfied simply tending to these basic issues, but remain uninterested in investigating the bigger picture - those visual issues that cause many people to need glasses for clarity in the first place. Also ignored is the possibility of using lenses (and vision therapy) to promote improvement instead of expecting (and unfortunately aiding) deterioration of the visual process. I feel that any doctor who isn’t providing more comprehensive vision care should at least assess patients for these problems and then refer them to someone who is experienced in understanding and providing treatment for these kinds of visual issues.

It's not what a lens does, but what a person does with a lens that matters.

I explained in Part One that lenses create very predictable effects on light passing through them, but that people wearing lenses can have quite varied responses to viewing through any lens. Similarly, the visual stress resulting from the kind of persistent close work so widespread in our modern culture is fairly consistent for all humans, but the ability to handle that visual stress differs wildly across the human species. While one person might never knowingly experience symptoms related to this stress on the visual system, another may inadvertently develop any number of visual habits to manage the stress, and another may become symptomatic, exhibiting headaches, eye fatigue and/or discomfort, dry eyes, double vision, words moving on a page and many other symptoms alone or in combination.

Unfortunately, only behavioral optometrists tend to connect the necessary dots that will lead to a comprehensive resolution. Most optometrists and ophthalmologists untrained and/or uninterested in delving into the important visual issues many people bring, knowingly or otherwise, to their offices. Therefore many people are told "there is nothing wrong with your eyes," which is technically true. However, it is not the eyes that tell the tale and the eyes themselves are not the issue in these cases. It is the brain's inability to properly direct the action of the eyes that causes so many of the problems discussed here.

Most eye doctors assume the interaction between a person and their lenses is a passive one. This is rarely if ever true and either way is not a very productive way to look at things. While lens wearers notice that things (hopefully) look clearer with the lenses on (or in) this is not merely something the lenses do. The brain behind the lenses must actively enable the lenses to have some effect. In reality, the lenses do not so much make things clear as they perceptually move the world to where the person can see clearly without the lenses. It is, after all, the brain that really sees; it creates a representation of the world around us, which we then use to think and move.

I have a new patient who was recently seen by another optometrist. This 24 year old man has worn glasses for nearsightedness since an early age. His prescription started out small and is now quite a bit stronger so he wears his glasses all the time. He was measured as 20/20 by the previous doctor and yet still prescribed even stronger lenses. This is pretty much standard operating procedure in the eye care community. Most doctors expect nearsighted people to become more nearsighted. And most doctors are either unaware of or indifferent to the fact that they are directly contributing to the problem by doing nothing more than writing stronger prescriptions.

Next time: The Importance of Prescribing Lenses: More Than Meets the Eye - Part 3: Too Close For Comfort

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