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Posted on 11-15-2016
Adventures in Lenses
I would like to share the stories of two women with whom I am currently working. Both are attorneys and long past the age where common wisdom accepts there is any way to reduce a prescription for myopia. Common wisdom only recently decided it was possible to stop or reverse myopia at all, but still has not looked very closely at prevention. One of the women is currently in a vision therapy program in my office. The other drove seven hours for an evaluation and will not be able to engage in the typical one-visit-per-week vision therapy program in my office. Both had very exciting changes immediately.
I refer to practicing law as working in a “high-risk visual environment.” The reason I put it that way is that being a lawyer requires hour after hour, day after day of sitting at a desk and gazing into a computer screen and/or books and papers on the desk. All of this is extremely stressful on the visual system (eyes, brain and body) and is a leading factor in the onset and progression of myopia in people of all ages. Obviously many other work environments fall into this category.
Jane contacted me because she wanted to “take better care of her vision” as she had just turned 60. She was experiencing discomfort at the computer and stopped wearing contact lenses several months before our first meeting. I will spare you the details of her visual evaluation other than to say that there was nothing particularly out of the ordinary other than her very strong prescription lenses. Jane first began wearing compensating lenses at age 7. The need for compensating lenses at such an early age is generally not a good sign for trying to reduce myopia in adulthood.
A brief aside about compensating lenses: As I have written about from time to time, the lenses I refer to as compensating are typically called “corrective” lenses. I do not think the term corrective accurately reflects what is going on with these lenses. Yes they seem to ‘correct’ the inability to see clearly at distance, so when the doctor finds the lenses that address this singular issue they believe they have corrected the problem. What I am saying is that, a) the problem is much more complex than just reduced clarity in most cases and, b) simply masking the symptom of reduced clarity does not correct anything.
Jane’s prescription was approximately -12.00 with astigmatism in both eyes. We decided to go with -10.00 and slightly less astigmatism compensation as a starting point for vision therapy. Within the first month Jane started wearing -9.50 contact lenses (with no astigmatism compensation). Her visual acuity was better with these contacts than it had been with her much stronger prescription. Two weeks later the prescription was -9.00, and three months later -8.50 (this is essentially a 30-40% reduction) with the same acuity (almost 20/20) she had with her original prescription. Common wisdom says this is impossible.
“Those who say it cannot be done should not interrupt the person doing it.”
Anne, 57, came from a pretty good distance for an evaluation after having tried one of the many “do-it-yourself” get rid of your myopia websites/programs to no effect. Anne’s complaints were discomfort at the computer, some eye fatigue late in the day and getting drowsy when reading at night. She was also not happy with the progressive lenses she had been wearing for nine months. Anne first began wearing compensating lenses at age 9. Besides being an attorney Anne skis and plays ice hockey – for which she prefers to wear contact lenses. She has not been able to get good acuity with contact lenses so far. Anne’s prescription was -4.25 with twice the amount of astigmatism as Jane (discussed above). This type of prescription is believed by most eye care professionals to be immovable…with the exception of worsening; that is something they all but assume with happen. Weekly vision therapy sessions are clearly not an option since Anne is so far away. Our plan was to start with -3.50 lenses (glasses and contacts), which is what we decided upon together by the end of the evaluation, and to keep in touch. The prescription we came up with would have been unthinkable to the vast majority of doctors, and would never have been tried yet Anne’s acuity with the new lenses is close to 20/20. Anne plans to make time to try my intensive vision therapy program for out-of-towners in the near future. She was very pleased with how the new prescription was working as soon as she began using it. My experience tells me that it will only get better with time and she will probably be in an even weaker prescription before long. Common wisdom says this is even more impossible than what is happening with Jane.
These are not exactly common examples, but I have had quite a few that rise to this level over the years. The bottom line is that unless there is some thinking outside the box, there is very little opportunity for discovery.
"It is by logic that we prove, but by intuition that we discover."
There is much more to the visual process than seeing clearly, but these other aspects are rarely addressed during standard eye exams, or by the many website/programs designed to attract people into trying to fix the “problem” themselves. Certainly standard symptom-relief-based eye exams and the lenses people wear as a result are helpful in many cases – this does not mean that a more thorough cause-based evaluation would not do even more for these same people. I will also admit that the do-it-yourself programs available to the public can lead to improved eyesight for some people – this does not mean that an actual evaluation performed by a trained professional would not do even more for these same people. The do-it-yourself programs can only do so much and most doctors will not be interested in being more thorough or more innovative. There are doctors out there who have a much broader and more creative approach to dealing with myopia. Most of them can be found at the Optometric Extension Program Foundation.
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