Category: Optometry

Specs: Do I Really Need…

When it comes to buying glasses, there are a TON of options.  Whether you’re new to buying specs, or an old pro, it can be difficult to determine what you really need.  Sometimes your doctor or the optician will may make suggestions, but what if they don’t?
In this post, I’ll dive into some common glasses options and try to provide some doctoral advice on what you do (and don’t) need.  Let’s get started!

Transitions

I pretty vividly remember a speaker coming in during optometry school and lecturing on the benefits of transitions and why we need to promote them to every patient.  At the end, as with all such lectures, we were polled on our likelihood to suggest these lenses at the end of an exam.  My vote? Not at all likely.
Why?
I don’t believe in promoting products that I personally will not wear.
But, for the sake of discussion in a spirit of fairness, here are the pros and cons:
  • Pro: You’ve got built in sunglasses, which are supposed to protect the eyes.  Hello 2 for 1?
  • Con: They’re getting better, but they struggle in the cold (#OhioWintersSuck), often don’t change in vehicles, and are an up-charge.
The story?  Some patients love them (ie my mom, who has worn transistions as long as I can remember).  Some patients hate them (ie me, who put transitions in a pair of glasses during optometry school and wore them literally once – I couldn’t stand looking like a backwards 90s kid).
Takeaway?  If you want to try them, great! If you don’t, great! Don’t feel like you have to, but I am obligated to inform you that a good pair of sunglasses promotes better ocular health.

Anti-Reflective Coating

As an OD, I, once again, have first hand experience with the difference that AR-Coating makes.  My primary pair of specs (aka the pair without transitions) doesn’t have AR-Coating.  I don’t notice it 100% of the time (mainly because I typically wear them for maybe 10 minutes/day), but the reflections are miserable.
Though I rarely wear the other pair which has one of the best AR-coatings, I never notice reflections with these.
Takeaway: 10/10 would recommend.

High Index Lenses

The need for high index lenses is entirely dependent on your prescription.  If you’re less than a +/-4.00 and have minimal astigmatism, don’t spend the extra.  If your prescription is higher and you wear your glasses frequently/all the time, go high-index.  The difference in weight will be noticeable.
Takeaway: For high prescriptions, use high index.

Blue Blockers

In theory, blue-blockers have not been definitively proven to have an effect on vision/eyestrain/etc, especially considering that natural light produces significantly more blue light than screens.
However, I personally am a huge fan of blue-blockers.  Regardless of study results, I generally appreciate reduced eyestrain when using blue-blocking lenses, and I know many others that report the same improvement.
From there, blue-blocking lenses are definitely not a necessity, however, I would be inclined to suggest them (as well as improved ocular habits) for patients with ocular complaints secondary to excessive screen-time.

Progressive Lenses

Progressive lenses, or no-line bifocals, could really be a post of their own (and probably will at some point.) For now though, let’s stick with the basics.  These line-free lenses aim to provide clear vision at all distances – far, intermediate, and near, with a transition zone that adds progressively more power as needed.
  • Pro: They’re bifocals, but without the line!
  • Pro: Clear vision at (theoretically) all distances.
  • Con: Putting variable powers into one lens makes for a lot of “peripheral distortions” – or blurry/unusable vision when you’re not looking through the center.
  • Con: Some people have a really hard time adjusting to them (normally those who are more likely to move their eyes than their head for tasks).  I normally tell patients to give a new pair of progressives 2 weeks for adjustment, but this isn’t always enough.
Takeaway: Progressives are not a requirement.  It never hurts to give them a try, but they’re definitely not for everyone.  If you try them and can’t adjust, don’t be afraid to go back and ask for something different.  I know plenty of patients who are perfectly happy in a lined bifocal (or trifocal…)  The key? Find what works for you.

Specs: When the Price is Right

First things first: let it be known that I am not a good salesman (or saleswoman).
During my time as a student at OSU Optometry, one of my most frustrating classes was our business class.  Though I understood its necessity, considering the high percentage of most graduating classes that go on to join or form private practices, a business mindset never came naturally to me.  So, while the professor was lecturing on how to create our frame-board, set our prices, and push products for maximum sales, I was fighting the urge to run out of the classroom screaming.
Naturally then, I was overjoyed when I had the opportunity to work with several medically based optometrists who, rather than pushing products, would provide the prescription and say, “you can fill this at any optical.”

Honest optometry.
As I look the potential of a career in private practice in the face, however, the questions posed in the hours of business classes come back to haunt me.

Frame and lens sales are often the primary income of general optometry practices, compensating for the meager returns from insurance payments.
How do I do what’s best for my patients while making enough income to pay off debts and keep the business open?

When it comes to specs, when is the price right?

 Optometry Practices

Some optometrists that I have worked with who have an in-house optical push their patients to get glasses from their optical.  Like I said before, the thought of pushing someone to do anything for my profit sickens me. But, there are some definite benefits to buying local.
  • It supports local businesses.  As I already mentioned, many practices earn their living by optical sales – not eye exams.  I’m a firm believer in showing appreciation by action. If you’re a fan of the doc and the staff, consider buying products from their practice to help  them continue to provide quality care.
  • Better customer service.  This isn’t always the case, but in most of the private practices I’ve worked with, the staff genuinely care about you as a patient.  Your kid broke his glasses and you don’t have a back-up? They’ll be the ones to jerry-rig them back together with spare parts until the new one comes in.  Broke a nosepad? They’ll replace it, sometimes even for free.
  • Experience. In the best opticals, the staff are trained as opticians.  They know what the best products are for your needs, and they know what modifications to make to best suit you. They’ve tried the products (I rarely know an optician with less than 6 pairs of glasses) and can give you the inside scoop.

Online Retailers

In most aspects of life, I’m a huge bargain shopper.  Why buy one thing for twice the cost if you can get it for half the price somewhere else? (Especially when you’re living on a resident salary and trying to pay off school loans beside.) For this reason, it can be super tempting to buy online from retailers such as Zenni Optical.  Sometimes that’s okay. Others? Best stay away.
  • (Maybe) Buy Online: Simple prescriptions. If you’ve got one set of numbers on your prescription pad (just a relatively low near-sighted or far-sighted prescription, without any astigmatism, add, or prism) you’re probably okay to try buying online.  I can’t guarantee the quality of the material, but if you need a simple no-frills pair, you won’t be out much giving it a shot.
  • (Maybe) Buy Online: Back-up glasses.  Little Johnny has broken his third frame in 6 months. You’re past the warranty.  Your benefits have been used, and you frankly don’t have the money to go out and buy yet another pair full-priced pair.  Try online.  Again, it may not be perfect, but it’s at least something to hold him through til you’re in a better spot.
  • (Maybe) Buy Online: Frequently changing prescriptions.  This may be a near-sighted child who seems to need a new pair of lenses every 6 months.  Or maybe you’re a diabetic and the doctor has said that your prescription isn’t stable secondary to blood sugar fluctuations, but you’re not legal to drive with your current visual status. Try online.  You already know that your vision is going to change, but getting something fast and cheap while waiting for things to fluctuate is better than having nothing at all.
  • Don’t Buy Online: Difficult prescriptions. This is pretty much the opposite of my first point above.  If you have lots of numbers, or anything that sounds out of the ordinary, don’t waste your money on the online up-charges and end up with a pair of glasses that don’t work at all.  Spend the money and make sure it gets done right the first time.

Retail Opticals

From my experience, retail opticals (ie Walmart Optical, Costco Optical, etc, etc, etc) can be super hit or miss.  Some of them are awesome, and my patients rave about the specs they’ve gotten.  Others of them are crap, and I’ve sent 3 patients back for remakes within the course of a few hours.  For this reason, my advice regarding retail optometry stores is identical to that of online retailers.

Takeaway

Buying the perfect specs, like life, can’t be fit into a binomial. There are times to buy from your local optometrist, and there are times to bargain shop and buy online or at a retail optical. At the end of the day, what matters most is simply finding someone who you trust to keep you seeing and looking your best.

Decoding the Numbers: Myopia

When it comes to optometry, one of the first pictures that comes to people’s minds is of an eye doctor turning dials on that one machine (the phoropter) and asking, “which is better, one or two” in efforts to determine the patient’s glasses prescription.

While I could dive into a lengthy explanation as to how we are trained to do much more than flip knobs and give glasses, that’s not the point of today’s post.  Rather, I’m here today to dive into the numbers and help explain what your prescription means.

Myopia

  • Patients with myopia are commonly referred to as being “near-sighted”.  This is because, even without their glasses, they are able to see clearly when looking at things up close.  Their problem is with looking far away.

What causes myopia?

  • All refractive errors (essentially the reason for needing glasses) are caused by a mismatch of power in the eyes.  In the case of myopia, the power (created by the cornea/clear surface and intraocular lens) is too great for the length of the eye, or, conversely, the length of the eye is too long for the power of the eye.  Either case means that light is focused in front of the retina (back part of the eye), resulting in a blurred image.

Why do we need lenses?

  • Because of the mismatch, minus (concave) lenses are prescribed.  Due to their structure (thinner in the center, thicker on the edges), concave lenses cause light to diverge (spread apart).  This divergence moves the eye’s natural focus point back – putting it right on the retina, and providing a clear image.

Who gets myopia?

  • Refractive errors in general are thought to be inherited.  Myopia is no different.  If you have two parents who are near-sighted, you definitely have a higher likelihood of being near-sighted. (I looked for specific figures on how much this increases your risk, but didn’t find any.)
  • Becoming near-sighted has also been associated with an increase in near work, decreased time outdoors, and a lack of physical activity. 
  • Relatively recent reports suggest a potential connection between myopia and inflammation, specifically in children with inflammatory conditions (ie: diabetes mellitus, uveitis, lupus).
  • Near-sightedness may also be associated with different genetic conditions, such as connective tissue disorders, Stickler’s syndrome, and Down Syndrome.
  • Patients with Retinopathy of Prematurity often are extremely myopic.

When should I suspect myopia?

  • Patients often start becoming near-sighted between 8 and 10 years of age.  However, myopia can occur at any age.
  • Some signs of being myopic are:
    • Squinting when looking far away
    • Holding objects close, or getting really close to objects to see them
    • Complaining of being unable to see the board at school, or difficulty seeing signs

Does myopia get worse?

  • Myopia often progresses, however, the rate at which it progresses is variable.
  • Typically, we expect near-sightedness to worsen from the ages of 8-20, but not everyone follows this pattern.

Are there any complications with being near-sighted?

  • As myopia is associated with a longer eye, near-sighted people are at a higher risk of retinal holes, tears, and detachments due to retinal stretching.
  • Myopia, especially high myopia, that continues to progress rapidly after the normal years may be considered degenerative myopia.  Patients with degenerative myopia are at a higher risk for complications that may significantly impair vision.
  • Near-sighted patients are also at a higher risk for glaucoma.

Can myopia be treated?

  • A ton of research is currently being done regarding myopia progression and potential treatment options to decrease myopic progression.  I’ll talk about that some other day.
  • Most often, patients are prescribed glasses or contacts to improve vision.
  • Special lenses (Ortho-K) may also be worn overnight in some cases to allow people to go without their normal lenses during the day.
  • Refractive surgery can be used to change the power of the eye.  It’s important to remember though that correcting the power of the eye does not change your risk for complications secondary to being near-sighted.
*To read the second part of my series “Decoding the Numbers: Hyperopia” click here!*
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    Optometry vs Ophthalmology

    As a young optometrist, one of the questions I’m most commonly asked is,

    what’s the difference between an optometrist and an ophthalmologist, and who should I see for (insert problem here)?

    The simplest answer to this question is as follows:
    Ophthalmologists do surgeries. Optometrists do everything else.
    In all reality though, that’s a bit of an oversimplification. A slightly longer explanation would be:

    Optometrists (at least in the United States) are eye care practitioners (ODs) who have graduated from an accredited optometry school and are licensed to diagnose and treat non-surgical disorders of the eye and optic pathway.  They may further specialize (via residency) to additional experience in working with a specific patient subset. (Note: not all states recognize OD specialization.)

    Ophthalmologists are medical doctors (MDs) who have completed additional training (via residency) to specialize in the diagnosis and treatment (including surgical treatment options) of ocular disease.  These individuals may specialize further (via fellowship) to gain additional expertise in a specific patient subset.
    Okay, great. But, what does that mean practically?  Why are there two different types of eye doctors? Which is better (one or two…)? Do they work together?  Who should I see?
    For me, this is most easily answered with examples. So, let’s run some scenarios,

    I need glasses or contacts.

    • This is generally an optometrist’s job.  Both doctors are capable of writing prescriptions, but optometry as a rule has a greater emphasis on refractive error management.  That said, not all optometrists love spending all day asking, ‘which is better, one or two’ – some of us have further specialized as well, so, before coming to the office, consider asking what all will be included in your exam.

    My eyes are red/watery/itchy/burning/feel like they have something in them.

    • Optometry is generally the best starting place for these complaints.  We are trained to treat ocular surface disease and remove superficial foreign bodies (things that you get in your eye). As the gatekeepers to ophthalmology, we can assess the problem, determine the severity, and refer if needed. 

    My primary care doc says I need a diabetic eye exam.

    • OD’s are again my first choice for diabetic eye exams.  As the early stages of diabetic retinopathy are currently managed by observation only, optometrists are more than able to monitor for disease progression.  If significant changes occur that require further treatment, we will then refer to ophthalmology for intervention and management.

    I have double vision (seeing two things when there should only be one).

    • Double vision is something neither general optometry nor general ophthalmology (from my experience) likes to work with.  So, find a provider on either side of the optometry/ophthalmology wall who specializes in binocular vision or neuro/neuro-rehab.  In ophthalmology, these are often pediatric or neuro-ophthalmologists.  For the optometry side, it can be harder to find specialists (some states don’t allow OD’s to claim specialization), so be sure to call and verify that the doc you’re going to be seeing feels comfortable assessing causes of double vision.

    I have (insert ocular disease here).

    • With a known ocular condition, treatment and management can fall on both sides of the optometry/ophthalmology wall – it really depends on what the disease is and how far it has advanced. Most common ocular diseases (glaucoma, dry macular degeneration, early cataracts, mild/moderate hypertensive and diabetic retinopathy) can be managed by optometry.  Once they progress/if they progress to a point of needing surgical intervention, then management is transferred to ophthalmology.

    I’m sure there are other scenarios that I could pick out, but I think these 5 highlight the main differences between optometry and ophthalmology, and provide a general outline on where to begin your patient care experience.
    To make it even easier, here are my 
                Top 5 OD v MD Tips:
    1. ODs are the primary hub for routine ocular care.
    2. Optometry (optimally) serves as the gatekeeper to ophthalmology.
    3. Both ODs and MDs can diagnose and treat ocular disease. MDs are simply further specialized, and can perform ocular surgeries.
    4. Talk to your eye doctor about your concern to make sure it’s something they’re comfortable with treating.
    5. When the system works right, ODs and MDs work together to provide comprehensive and efficient ocular care through the diagnosis, treatment, and management of ocular disease.


    If you have any questions or comments, please contact me!  If you’ve enjoyed this article, please subscribe, or like my page on Facebook!