Carrie wrote:
I have very very nearsighted eyes, and I have worn contact lenses for a long, long time.
My Optometrist told me that there is no other option but to wear a toric lens in my right eye. I agreed to wear a trial lens, but I’m finding that my vision is blurry, close up and farther away.  I went back and he ordered me another toric lens with a -10 something-or other.  (The lenses are taken out of the packaging before given to me, so I really have no idea what the fine details are, I just remember something about him saying something about -10)  So THAT lens is HORRIBLE, and I refuse to wear it.
Now I know I have very bad eyesight, but I’m convinced I see better with regular lenses, BUT the Optometrist insists I get toric lenses.
Really, what should I do?

ANSWER

Dear Carrie:
Toric lenses are prescribed/fitted when a patient has astigmatism and regular spherical lenses do not adequately correct the patient’s vision. Fitting toric lenses to someone who is “very very nearsighted” is clinically challenging and it is not unusual for the fitting process to require several “trial” pair before a final lens design is achieved. That being said, the ultimate goal of contact lens fitting is to provide you with lenses that give you the best vision and ocular health.  In my own experience, I have found that in some instances, the patient felt they saw better with their spherical lenses than with the toric lenses that I had painstakingly fitted. In those cases, if the spherical lenses were a good option for the health of the eyes, I usually deferred to the patient’s visual preference.
You should have a candid conversation with your optometrist to express your concerns about the clarity of your vision with your trial toric contact lenses. It may well be that you need to try some alternative toric lens designs, but if none of those provide you with clearer vision, spherical lenses may be a practical option.
Thank you for your question.
Dr. Smit

Monica wrote:
Hello,

I’m from Brazil and I already have a prescription for lenses, I have astigmatism… I use glasses, but I would like to try contact lenses….
I would like to know if, with my prescription from Brazil, I can buy lenses here in Canada or should I book an appointment with an optometrist?
My mother tried use lenses and she couldn’t. It’s possible it will happen to me too?
Thanks

ANSWER

Dear Monica

This is a very interesting point you brought up here. First thing to say is that you NEVER should try/buy contact lenses without the recommendation and an appropriate follow-up from an optometrist or an ophthalmologist. These are medical devices that can cause harm to your eyes if they are not fitted well and not cleaned well. Internet purchase increases the risk to develop severe infections 5 times because the lack of professional recommendations and follow up.

Astigmatism is easily fitted nowadays in contact lenses. It should not be a problem for you to be fitted by a competent eye care practitioner.

If the first pair is not working, there are always others that can be considered.

Select an optometrist or an ophthalmologist that is experienced with contact lenses and follow his recommendations.

Good luck,

Dr. Langis Michaud, OD, MSc, FAAO (Dipl)
Associate Professor
Université de Montréal

Tait wrote:
Dear Dr.,
I’m an 44 year old father of four.  Born with Nystagmus, Lazy eye and a strong astigmatism (dilated right +3.00/-4.75×180: left+2.00/-2.75×180).  In March of 2008 I was considered a great candidate for Lasik eye surgery and that I would be able to participate in everyday life without glasses.  I have had four Lasik surgeries and the results are mind blowing.  It appears that my eyes want to now fuse together binocularly and this fusion process has created for me blurred vision, double vision, spinning of the room and vertigo type feelings.  I have had resent strabismus surgery to correct the double vision its slowing coming along.  My ignorance is that I was under the impression my vision problems were caused by the high asygmatism.  As you can image our lives have been more than a challenge but I need this question answered so I can move on local Dr’s seem too reluctant to directly comment.
My question to you is; would you have considered me to be a good candidate for laser surgery and could the binocular vision problem not have been predictable.

Gratefully Yours,
Tait

ANSWER

Hello Tait,
I am sorry to hear what you are going through.  It must be very physically and emotionally difficult.  Unfortunately, not knowing your exact ocular history and exam results it’s difficult to say for sure, but in my experience, patients who suffer from a “lazy eye” are generally not great candidates for laser vision correction.  This is because of the risk involved with doing surgery on the “good eye”.  Imagine if there were complications with the better-seeing eye and all you were left with is the vision in the poorer-seeing eye.
The problems that you are describing with the binocular issues following your laser correction are truly unfortunate, but atypical.  I do not think that this could have been a predictable outcome.
Best of luck to you,
Dr. Donati

Caitlin wrote:
I wear contacts 95% of the time and I recently had my yearly check up. I found my vision less clear lately with my contacts, but my prescription hadn’t changed (-1.50 in both eyes). However, now when wearing my contacts, the left one is clearly not as sharp as the right. I’ve tried putting a new contact in, switching the contact, but nothing seems to help. It’s so annoying that I eventually give up after an hour and have to put my glasses on. What could be causing this? The obvious answer is that my left eye needs a stronger prescription, but my check up was only a month ago, and there was no change.

ANSWER

Caitlin,
Is your vision perfect with your glasses?  I would recommend returning to your optometrist to have them check this problem. Of course I haven’t examined your eyes, so it’s extremely hard to give you an answer, but I’ll give you some possibilities.  It’s possible if your glasses are perfect that you may have a small amount of astigmatism that your contact lenses are not correcting for and your glasses are.  A lot of times if there is a small amount of astigmatism it can be compensated for with regular contacts.  However if the astigmatism gets to a certain point, it will affect the vision and then a contact lens to correct astigmatism, called a toric contact lens may be required.  Astigmatism happens when the very front of your eye, the cornea is not perfectly spherical like a ball, but shaped more like a football. There are two different curvatures that need to be corrected, instead of only one.  Otherwise there could be an issue with your cornea or eyelid causing the problem.  Sometimes inflammation can develop in the cornea or eyelid, which will affect the quality of vision.  The main thing is to go back to your optometrist to make sure there is not an eye health issue which is causing your symptoms.

Dr. Doman

Melanie wrote:
I recently began swimming and want to wear corrective swimming goggles. My prescription is R (-2.75) L (-1.75/-1.50/77). In my city, I have not been able to find a retailer that sells swimming goggles corrected for astigmatism, nor are there any that sell individualized lenses.
My right eye is my dominant eye and a salesperson suggested to me that I just wear goggles that correct for my right eye and forget about the astigmatism in my left. I am thinking of purchasing a pair that is -2.50 (both eyes) because they only sell them in .50 increments. My questions are: 1) Will lack of correction for astigmatism have any adverse effects on my vision in my left eye? 2) Will the stronger correction for myopia in my left eye have any adverse effects?
I tried the goggles on, and I did notice the floor looking clear but slightly distorted and I thought that since the water will be moving anyway, it might not be a problem - I just want to be able to see the clock and not crash into the bulkhead without causing vision problems later.
Thank you.

ANSWER

Melanie,
To the best of my knowledge swimming goggles are not available with astigmatism correction.  The correction you are considering buying would work fine.  To answer your questions, neither the lack of astigmatism correction or stronger correction for myopia will have any adverse effects on your vision.  If you were wearing them for hours you may develop eyestrain or headaches, but there will be no long-term problems.  Of course you will not get perfect vision out of your left eye, but as you said it will give you sufficient vision while swimming.  The vision through the goggles may seem a little funny at first because you are accustomed to having your astigmatism corrected, but this should improve with time.  Happy swimming!

Dr. Doman

Kate wrote:
Hello,
I went to an optometrist yesterday. He was not very talkative; I was asking a lot of questions as he was doing exams and just writing stuff down. He would answer me with one word answers. Then, without explaining why, he put drops in my eyes, I didn’t even have time to ask “why”. Only after he had already put them in he said it was to measure pressure. Also, I know from previous exams that I have astigmatism. To him, however, this was irrelevant as it is not in my prescription! He said my problem was focusing of the eyes, on my prescription there is a number 6 in column “prisme” and it looks like it’s a fraction, but I cannot read it. Should I get another exam? If I bring my prescription from 2 years ago and this one (as my eye sight did not change at all), will I be able to get lenses?

ANSWER

Kate,
I would recommend calling your optometrist’s office.  Optometric assistants are very knowledgeable and would be able to answer your questions about your prescription.  Astigmatism can change throughout your life and it is possible it may have improved.  You will be able to get new glasses with your new prescription.

Dr. Doman

Joyce wrote:
I have always been slightly near sighted, but not enough to wear glasses all the time. As I have aged I have started to use prescription reading glasses, and one optometrist said I had Astigmatism.
My problem is that after watching TV, reading (with glasses) or working on the computer, my vision seems blurry and I can’t seem to refocus my eyes. If I do none of the above, I am fine. Any recommendations?

ANSWER

Dear Joyce:
If you are not wearing your glasses full time, it is not uncommon to experience blur when your glasses are removed. If you are wearing accurately prescribed and well fitted glasses full time (and based on your description of your eye condition these glasses would have to be multi-focal) it is not normal to experience the blur that you describe.
It is also possible that your symptoms are caused by ocular surface dryness, or “dry eye syndrome”. Symptoms of dry eyes are often more pronounced after periods of watching TV,  reading or using a computer. If this is the case, then you may find that using artificial tear supplements will be beneficial. You may need to see your optometrist to determine what might be the underlying cause of your current symptoms.

Dr. Smit

Regan wrote:
My prescription is -4.5 and -5 with a small degree of astigmatism). As I enter my mid-40s I also find my close vision is slowly getting worse, especially in poor light but it’s only starting to be inconvenient, mostly when I wear my contact lenses. I found the disorientation of bifocals too much for the moment, and they aren’t quite necessary since I can peek over the top of my glasses for the most part.

I tried on pinhole glasses at the store and they corrected my vision quite effectively (while standing there and testing my ability to read fine print at the counter and see the back of the store too - I don’t know how well it would work at my computer or daily life). I’d like to know more about their uses. Having used cameras, I understand how they work in terms of changing the aperture of the eye, but I’d like to know if there are developmental risks or benefits involved, and how they can best be used. I’m not looking for a miracle to replace my glasses and contacts, but I do feel that my lifelong dependence on glasses has worsened my vision, and I can also foresee situation where using pinhole glasses would be less of a strain (like cooking while also reading from a recipe). If they would also slow down or prevent further deterioration that would be an added bonus. Thanks.

ANSWER

Regan,

It is very normal for you, in your mid 40s, to be having problems with close (near) vision, and this is always more evident with contact lenses.  Speak to your Optometrist about a change to your contacts so that you can read.    We often use bifocal contact lenses or a technique called Monovision where one eye sees close up and the other far away.

I would not recommend pinhole glasses for any sustained activity.  The strain of trying to find the little holes would negate any benefits, as well as having to change to your regular glasses in order to walk or move around your office or kitchen.  I am not aware of any scientific studies which purport the use of pinhole glasses. Most often they are used as a novelty, party trick, item.  We have not found a way to stop the changes in near vision, since they are linked to aging.

Dr. Joan Hansen - Optometrist, for CAO

Dominique wrote:
How important is the precision of  the “axe” values in the prescription? These values change each time I go to a different optometrist and the latter do not all provide the same precision for their measurements. Specifically, 7 years ago I got the values R/L 175/170, 1 year ago, 165/178 and this year 170/180. I would like to purchase bi-aspherical lenses, but those are expensive, so I would like to be sure that my prescription is good enough.

ANSWER

Dominique,

The axis value (or axe in French) is an important part of a glasses prescription.  However, this value can vary from visit to visit.  The axis represents the orientation of the power of your astigmatism.  The power of your astigmatism is the second number on your glasses prescription.  If you have a small amount of astigmatism (I would say less than -1.50), it is possible for the axis to vary from visit to visit sometimes by approximately 10-20 degrees.  On the other hand if you have a large amount of astigmatism, this number would likely only vary within 5 degrees.  From looking at your numbers, especially from last year to this year the change in axis is very small.  When you purchase new lenses if you have any problems all optometrists and opticians will work with you to solve the problem.  I would go ahead and get the new prescription filled.

Dr. Carol Doman

Sarah wrote:
I have what I have been told is extreme astigmatism. I am now 32, and have been wearing glasses since I was 8; they get stronger pretty much every visit. My current prescription is (R) -2.00/-6.00/110 and (L) -2.25/-4.75/063. The glasses are working alright for distance, but I am having some difficulty reading, both on paper and the screen. It is almost as if parts of the letters are fading in and out. I had some problem with my old glasses, but not as much. If it doesn’t get better I plan on going back to be rechecked, but new glasses always take me a while to get used to, so I’m going to wait a couple more weeks. My previous prescription was (R) -2.50/-4.75/115 and (L) -2.00/-4.50/059. If the astigmatism correction is so strong, could the difference in axis be causing my problem? Thanks

ANSWER

Dear Sarah:
Yes, you do have a lot of astigmatism, and adapting to a change in prescription, even if it is minor, can be a little difficult. However, in my experience, a new correction is not likely to cause parts of letters to fade in and out as you have described. That symptom is more likely to be caused by changes occurring inside your eye, possibly changes in the macular portion of your retina. I would strongly recommend that you revisit your optometrist, describe your symptoms in detail, and ask to have your retina reassessed.
Best of luck
Dr. Henry Smit