02 Common Eye Problems - a podcast by The InBound Podcasting Network

Have questions about an eye condition or vision problem?  Douglas W. Stephey, O.D., M.S. explains the differences between hyperopia, myopia, astigmatism and presbyopia. You will also learn how many of these conditions can be treated with lenses, prisms and vision therapy.

Douglas W. Stephey, O.D., M.S.

208 West Badillo St. Covina, CA 91723

Phone: 626-332-4510

Website: http://bit.ly/DouglasWStepheyWebsite

Videos: http://bit.ly/DrStepheyOptometryVideos

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If interested in producing a podcast of your own, like the Move Look & Listen Podcast, contact Tim Edwards at tim@InBoundPodcasting.com or visit www.InBoundPodcasting.com

Transcription Below:

Tim Edwards: Welcome to episode two of the Move Look & Listen podcast with Dr. Doug Stephey. I'm Tim Edwards with the Inbound Podcasting Network and a client of Dr. Stephey's over the past couple of years. In our last episode, we got a chance to meet Dr. Stephey and get to know him personally and professionally and to learn a little bit more about some of Dr. Stephey's unconventional methods that he practices at his optometry practice. And when we say unconventional methods, we mean when you visit Dr. Stephey, you're going to experience a session unlike you've had with any other optometrists. I can almost guarantee that. Can you back that guarantee up with me Dr. Stephey? I think that's pretty true. 

Dr. Stephey: Tim, I think that is true. I do practice all the kinds of regular optometry that most people can eventually know. But I do things that go back in optometry to the 1930s and 1940s. So what's interesting about a lot of this stuff is it's not really new. It's just that the profession in expanding its scope has moved away from some of the tenants that has made this kind of optometry so unique and yet at times in the field of neuro rehabilitation, especially with traumatic brain injury and concussions, the rehab community understands the value of this kind of optometry better than regular optometry itself in some cases, and certainly that's true that the neuro rehab community understands this better than the educational community or the medical community as it relates to how this kind of optometry practice can affect the quality of somebody's life. Whether they get migraines or motion sickness or headaches or have a history of dyslexia or a learning disability or ADHD or autism. This kind of optometry cuts across a lot of different disciplines and a lot of different diagnoses. 

Tim Edwards: And as you mentioned in our last episode, we are going to dive deep into each of those elements that you just described and how through vision therapy and through some of the modalities that you use at your practice can be relieved, hopefully, maybe and sometimes eliminated. 

Dr. Stephey: I think that's true. 

Tim Edwards: And today what we're going to do, we're going to bring it down to the elementary school level. For people like me, if you don't mind Dr. Stephey, and we're going to talk about common eye problems. So I think it would be important for those that are binge listening to this podcast, much like people do on Netflix, right? You find a show you like and you'll watch every episode, the same type of consumer habits occur with podcast listening, so let's give some basic common eye issues that you would deal with that we are all dealing with. 

Dr. Stephey: So the most common things that people know are nearsightedness, farsightedness, astigmatism and reading glasses. 

Tim Edwards: That's pretty much the scope, no pun intended, of my knowledge or something like this. 

Dr. Stephey: And the idea that seeing 20/20 is the holy grail of going to the eye doctor. I'm here to suggest that seeing 20/20 is a small, albeit an important piece of the puzzle, but it's just a tiny piece of the puzzle. So for example, the expression 20/20 conventionally means that you can read a letter just slightly smaller than nine millimeters at 20 feet. That's it. 

Tim Edwards: That's where the 20 comes in. 

Dr. Stephey: That's where 20/20 comes in. That's all it means. It doesn't say anything about the way you use your two eyes together, whether you see fast, how you integrate vision and auditory or vision and motor or visual and processing speed or vision and attention or vision and movement skills. It just means you can read a tiny letter at 20 feet. 

Tim Edwards: And why did they choose that? Whomever created this chart, right? And the distance. Why at 20 feet. 

Dr. Stephey: Honestly I have no idea. 

Tim Edwards: Because that's the size of the room when they put this whole thing together and they say well.. 

Dr. Stephey: There's probably some logic behind why they chose the 20 feet, but I honestly do..If I ever learned that in the past, I don't remember it. 

Tim Edwards: So that it's not that relevant anyway. It's just a, a baseline form of measurement. 

Dr. Stephey: So and as an extension of that thinking, people are nearsighted. Maybe they read the big E on the eye chart and that big E is referred to as a 2,400 letter. And what that means is that the "normally sighted person who could read that size letter at 400 feet, a nearsighted, a person has to walk up closer and closer and closer until they're 20 feet away from the letter. And then they can finally read the big E." 

Tim Edwards: I got it. 

Dr. Stephey: That's where that fraction comes from. Common misunderstanding is when people refer to themselves as being legally blind. Well the definition of legal blindness has to do with the best corrected vision in your better seeing eye. 

Dr. Stephey: So when we go back to that standard eye chart, it's called a Snellen chart. And if somebody has best corrected vision in their better seeing eye,no better than 20/80, that would meet one of the standards of, of truly meeting the definition of being legally blind. Because your best corrected vision is worse than 20/70 in your better seeing eye. Well if you don't have glasses on and you can't see the 2400 letter, that is not the standard of being legally blind. You could, you couldn't see two inches in front of your face without glasses on. But if you put glasses on and you can see 20/20, you're not legally blind. So that's a really common misunderstanding that patients have about their uncorrected vision versus their best corrected vision. And just for completeness sake, someone who's nearsighted, you think about what that word is saying, you have sight at near. 

Dr. Stephey: So the implication is that you're blurry far away. And so that is true. If you're nearsighted and you don't have correction on you have distance blur. And the more nearsighted, the more blur you have at distance. Interestingly enough though, you can continue to see well up close if you're nearsighted and don't have glasses on. And that particularly is advantageous when you get to be 40 to 45, that's the most common window when you develop a condition called Presbyopia, which I looked up a few months ago and essentially it means old man eyes. 

Tim Edwards: And I had been suffering from that for quite some time. 

Dr. Stephey: But presbyopia is a gentler way of saying the same thing or at least it's a more confounding way. And patients don't really know that. I'm telling them that they're getting old, they just think that they're getting presbyopic. 

Tim Edwards: Sounds a little nicer. a little bit, but if you. 

Dr. Stephey: But if you're near sighted and presbyopic, you might be able to avoid reading glasses or a bifocal. You just take your glasses off and then you can see for for quite a long time, depending on the level of your nearsightedness. Farsightedness or hyperopia. That's more confounding because again, farsightedness means you have site at far, so there are limits though about what we can tolerate with faraway vision when we're farsighted and not wearing the glasses correction. So many people that are farsighted, their primary complaint is they have trouble seeing up close. That's not age related and so we might prescribe farsighted glasses that are primarily used for near vision or we might give you farsighted glasses that you wear full time. There is a term called accommodative esotropia. Accommodation, meaning eye focusing and esotropia meaning your one or both eyes turns in towards your nose. 

Dr. Stephey: So the term accommodative esotropia means that without glasses on, you have one or both eyes. That turned way inward whether you're looking at far away objects or even up close objects. 

Tim Edwards: Is that just a muscle issue in the eye? 

Dr. Stephey: Well, it's a muscle issue in the sense that it's related to, and I'm having a lot of farsightedness, but nobody's figured that out yet. So someone who's an accommodative esotrope, you see that they have crossed eyes. What you don't know is that without crossing their eyes, the retina registers a fair amount of blur and the brain is experiencing that blur and his thinking to itself, this is not good. I don't want to see blurry. And the only way to make it clearer is that the brain has got to make the eye focusing inside. The brain has got to make the eye focusing system in the eye work harder and the eye focusing and the eye taming systems are neurologically tied to each other. 

Dr. Stephey: So if you focus harder, your eye's going to turn in. So somebody who's an accommodative esotrope, they're really farsighted but nobody's figured that out. And when you finally do figure it out and you put glasses on them and the brain says, oh, I got the glasses to do all this extra work for me and I don't have to do that. Great. I'll turn the eyes back out to a straight ahead posture and get them to work together as a team. So that's what it means to be an accommodative esotrope. 

Tim Edwards: So is that different than a lazy eye? 

Dr. Stephey: Yes, yes. The simple answer to that is yes. So Lazy. I the common term that people know. Amblyopia is the fancier term. And most of the things that we talk about, there's always exceptions to the rule. So typically somebody who has a lazy eye, "can see 20/20 in one eye and less than 20/20 in the other eye."

Dr. Stephey: Maybe it's 20/25, maybe it's 20/30, maybe it's 2100, maybe it's 2,400. But you don't really know why they have that poor vision until you do a comprehensive exam and begin to figure out why these things are true. So in an accommodative esotrope, if there's an asymmetry in prescription between the two eyes, one eye has got little to no prescription and the other one's got quite a bit of farsightedness. The far sighted eye that has not been wearing a correction is going to see blurry because the brain will take the path of least resistance. It will do whatever work it has to, but not anymore than it has to. So if you can see 20/20 with one eye and it takes very little effort, the brain says, well I'm not going to work that other eye because I'm seeing 20/20. That was my ultimate goal. 

Dr. Stephey: I don't have to work the other eye harder so I'm just going to let it be blurry. Well, the longer that other eye stays blurry, the cells in the visual cortex or the occipital lobe or the back of the brain where visual input is sent to, those cells never get stimulated with clear vision. They constantly see blurry. So those brain cells that receive visual input don't know how to see clear. And so when you go to measure clarity of vision, like on the standard eye chart, they can't get to 20/20 because they've never seen 20/20. So in that context, oftentimes in every case is different. But oftentimes when you put glasses on, someone who's like that, and maybe give them four or five or six weeks just to put glasses on, wear them full time. Let clear images be on both retinas. Let both retinas send that information back to the brain to be stimulated. 

Dr. Stephey: And perhaps we do a follow up exam in four to six or seven weeks and recheck the snellen chart again in the lazier eye and see how much better it's getting. If it's getting better on its own, maybe just more time is all that's necessary to get the eye back to 20/20 or close to it. And facilitate the brain's ability to begin to learn how to use the two eyes together. And if time alone and the prescription alone is not sufficient, then we come up with a vision therapy plan about how are we going to intervene to teach the brain how to keep both eyes on and see clearly at the same time. Because and historically, if you get diagnosed with a lazy eye, and this is still true to some degree in some circles, the classic example is that you patch the good eye, right? 

Dr. Stephey: You cover up the good idea, have forced the brain to see through the blurry eye and sometimes even in 2018, that is still the conventional approach with a lot of eye doctors. And I'm going to tell you that is woefully inadequate because it is true that when you patch the good eye, the brain will look through the other eye because it has no choice. Once you take the patch back off, the brain goes back to look through the "good eye" and turns the lazy eye back off. 

Tim Edwards: So this has never worked then. 

Dr. Stephey: I wouldn't say it's never worked, but it has limited value because the ultimate goal and what's really necessary is the brain has to learn how to use the two eyes together as a team and you can't do that if you patch one of them. So the extension beyond patching, if patching is even necessary at all, is that you have to develop a vision therapy program where the brain is aware of what both eyes are doing, but that the brain is also aware that the two eyes are seeing different colors or different colored objects or that the objects at the right eye and the left are seeing are polarized. 

Dr. Stephey: So the right eye sees one polarized target. The left eye sees a different polarized target so that if the brain doesn't keep both eyes on, one of the one of the targets is going to disappear. Well, when you can see that happen and your brain says, Hey, what the heck happened to that other object? Well, the brain's now got immediate real time feedback to turn that eye back on, and that's the coup de gras in this whole thing. The brain's got to be aware that it has two channels and that it is supposed to learn how to use the two eyes together as an integrated team. That's why patching has limited value. And I got an email several days ago from a colleague of mine that this is crazy when I tell you this. It is a practice that has been done within the discipline of ophthalmology who's big on patching..

Dr. Stephey: Not so much the binocular vision piece, but big on patching. And if you're a kid who sees good in one eye and really poorly out of the other and someone puts a patch on your good seeing eye, are you going to want to wear that patch? No. The answer is no. So you're going to take it off. Well, believe it or not, I've seen cases where an eye surgeon has actually sutured a patch onto somebody's face. 

Tim Edwards: Sutured? Sutured, so they cannot take it off no matter what. 

Dr. Stephey: They have stitched it into their skin. That seems really egregious. And the second one that's close to that is that they put elbows splints on the kids so they can't bend their arms. 

Tim Edwards: Oh my goodness. Wow. That's like the cone that you put over a dog's head so it doesn't lick its wounds. Right. 

Dr. Stephey: When when I read that email, I thought the exact same thing. 

Tim Edwards: That's terrible. That's archaic. 

Dr. Stephey: Yeah, well it seems pretty extreme. I don't know. I'd have to go back and read more about it and make my peace with whether or not it's ever necessary and maybe it is. But those are two pretty extreme examples of what it means to patch. 

Tim Edwards: So we're going to take a short break Dr. Stephey and when we come back on the other side, give us a little insight as to what we can expect. 

Dr. Stephey: When we come back on the other side of this, I'm going to talk a little bit about astigmatism. I'll talk a little bit more about presbyopia and I'll talk a little bit about myopia control. Because myopia is an out of control epidemic worldwide and there's lots of research and lots of discussion being done about how do we control this. 

Tim Edwards: And why don't we also give some solutions as well too, that they can find at your optometry practice. 

Dr. Stephey: Sounds great. 

Tim Edwards: Welcome back to the Move Look & Listen podcast with Dr. Stephey. I'm Tim Edwards with the Inbound Podcasting Network. And today we're talking about common eye problems. Getting a nice education on when you hear that somebody has astigmatism, which we're about to talk about. Or presbyopia. Did I say it right? 

Dr. Stephey: Presbyopia. Yeah. 

Tim Edwards: And what's the other one? 

Dr. Stephey: There's hyperopia, myopia, astigmatism and presbyopia. 

Tim Edwards: I'll never be able to do that without it written down in front of me, unfortunately. After I listen to this number two, I will. So why don't we pick up where we left off? 

Dr. Stephey: Well, let's talk about astigmatism because that's a common component of a lot of people's prescriptions. And I think there's some confusion about what it really means. So if you think about the shape of the basketball, it's got one radius of curvature and that's typical of whether you're nearsighted or farsighted. Meaning that when light focuses in front of or behind your retina to induce that blur, it's only got one focal point of blur, and that's to be implied by the shape of the basketball, only having one curve. In contrast, to a football which has one radius of curvature from the long end to the other long end, and it's got a steeper radius of curvature around the center. 

Dr. Stephey: Those two major curvatures are 90 degrees apart from each other and each one has a different focal point. So with astigmatism, you've got two different blur points around your retina instead of the single blur point. So with myopia, you're primarily blurry at distance and have sight up close. With hyperopia, you're primarily blurry at close and have good vision far away unless you're really farsighted then you have blur everywhere. And astigmatism because you've got to blur points. You're blurry everywhere as well. So that's what astigmatism is. There's two different blur points and we have to correct both of those blur points to give you clear vision. 

Tim Edwards: I've heard astigmatism my entire life. Never knew that. You're talking about different blur points within each eyeball. 

Dr. Stephey: Yes, that's right. And furthermore there is something called the astigmatism axis. So if you think back to high school math class and you ever had to pull out a protractor, it's got degrees on it, right from zero to 180 degrees. And those degrees on that protractor make up part of your astigmatism prescription. 

Dr. Stephey: And it's interesting to look at symmetry in the human body because most prescriptions that contain astigmatism are along the 180 degree line plus or minus 10 degrees. So like 170 to maybe 10 degrees somewhere in that range or they're 90 degrees away from that. So now you're at an axis 90 and maybe a common range from 80 to 100. That's pretty common with astigmatism prescriptions. And every once in a while you get an oddball prescription where it's at an oblique axis like 45 degrees or 135 degrees. Not along the 180 or the 90 degree line. And what's also interesting is how sensitive somebody can be to changes in that cylinder axis. So degrees on a protractor change in one degree increments. And if you don't have a lot of astigmatism, maybe you have a tiny amount of astigmatism prescription and your axis could change five to seven degrees and it wouldn't bother you very much. 

Dr. Stephey: But if you have a lot of astigmatism, sometimes you can't even tolerate a one degree change in the axis in your prescription because if you're that sensitive or you have that high of astigmatism power, that one degree change, it doesn't feel right. Like it almost gives you eyestrain or a headache or blur or it throws off your visual perception or it's just not tolerable. I used to have about $4.50 worth of astigmatism. And if you think about prescription changes, we do it in quarter diopter units. Well $4.50 is 18 quarters worth of astigmatism. That's a lot. Before I had Lasik, I couldn't tolerate a one degree change in my astigmatism axis. If I got a pair of glasses made and literally they were one degree off, I have to send them back, I couldn't wear. And some people are really, really sensitive to that. 

Dr. Stephey: If there's one thing I've learned over the years is that every single patient that comes into my practice is unique unto themselves and it doesn't make a difference. Yes, we have had a lot of training. Yes, I've had a lot of experience and yes, most people kind of fall in the bell curve of statistical population outcomes, but that's not you. Everybody's different. And I wouldn't have been sensitive to this probably the first 10 or 12 years that I was in practice. But now I really listened to every single patient that comes to me and what their complaints are and what I think their complaints could be. And nobody's maybe even asking those questions to find out if they have any of the symptoms that I might think you have. For example, there was a gal came into my office recently. She's 48 years old. 

Dr. Stephey: Her two eyes don't work together very well and that's caused her a host of problems. Motion sickness, being clumsy, being ridiculously anxious, and really most of her life feeling like she's got two left feet. And when I started to ask her some of the questions that we're going to talk about in later episodes, she broke down in tears in my exam chair because she said, I've been trying to tell other doctors this most of my adult life. And no one has ever understood what I've been trying to tell them. Well, and they all just think I'm crazy. 

Tim Edwards: Which type of doctors has, she asked? 

Dr. Stephey: She's asked her family doctors this. She's asked neurologist this. She's ultimately been referred to psychology and psychiatry because no one has understood what she's trying to convey. 

Tim Edwards: And you're the first optometrist she's asked? 

Dr. Stephey: No, no, she's 40-years-old. She's been going to see eye doctors since she was a kid. So it's that no one took the time to listen to her and no one took the time to do the kind of testing that would reveal this to know what questions to ask, and so she broke down in tears because she finally felt like she had somebody who understood what she was trying to convey. All this time. It was unbelievable. 

Tim Edwards: That must have been just one of those days like you talked about in the last episode where you just go home smiling because you just found a way to not only listen to this patient of yours, but to fix this patient of yours. 

Dr. Stephey: Well, it's true. Most people probably have heard of the movie, the Matrix with Keanu Reeves. And there's a scene in there that's a red pill, blue pill moment. I love that scene and it's perfect for this kind of optometry because my contention is that when you learn this information, I dare you to go back and not practice this way. I can't do it. I can't unlearn what I know and when I have a chance to talk to parent groups or occupational or physical therapist or I go to maybe a special education conference. I'm going to a conference tomorrow. I'm one of the speakers on the visual aspects of dyslexia. I'm going to talk about that red pill, blue pill moment because once you learn this, you can't go back. 

Tim Edwards: So you're offering them a red pill, blue pill moment as well. 

Dr. Stephey: Yes, that's exactly what I'm going to do tomorrow. 

Tim Edwards: And that is our intent on the Move Look & Listen podcast as well. Dr. Stephey we come to the close of this episode. Can we go over some of the solutions to these ailments that we've talked about for the last 25 minutes or so? 

Dr. Stephey: I would love to do that. The one thing I'm really going to focus on right now is myopia or nearsightedness because it is a worldwide epidemic that is being studied in many countries and people throw in lots and lots of money research wise at myopia control and in part why that's a big deal is that myopia compared to the other kinds of prescription changes that you might need, myopia is associated with higher incidence of glaucoma and higher incidences of retinal tears and retinal detachments. So it's not just that, oh, I need a thicker and thicker pair of glasses to see better. It's that there really are some longterm consequences healthwise and vision wise and blindness wise. So trying to get this figured out is a big deal. Conventionally, the most common way that we handle blur is by prescribing glasses. While prescribing glasses this isn't solving your problem, it's compensating for your problem. And allowing you to see clearly. So what we want to do in myopia control is to see if there's other alternatives that might be better choices for you. And some of the common choices that have been tried and have some modest success and some that have really pretty significant success. A really simple fix would be put somebody in a bifocal, even if you're eight years old, you may benefit from being in a bifocal pair of glasses to slow down your runaway myopia. 

Dr. Stephey: Or alternatively we might put you in a standard hard or gas permeable contact lens to slow down that progression. Or we might put you in a hard contact lens that you wear overnight. Much like you wear a retainer after you've had braces and the hard lens w overnight attempts to flatten your cornea overnight. So it does two things during the daytime. One, the ideal goal is that you don't need glasses or contacts then to see all day and that it's also designed to slow down the progression of the myopia so that over some period of time, even if you stop wearing the overnight lens at night, you will not progress to the same level of myopia you would have, had you never worn that lens to start with. 

Tim Edwards: So it just reshaping the eye a little bit? 

Dr. Stephey: It's reshaping the eye little bit. That's exactly what it's doing. And then there's atropine eyedrops and standard atropine eyedrops dilate the pupil really big and they pharmacologically knock out your eye focusing system so you can't see up close because your eye focusing system doesn't work because it's been pharmacologically paralyzed. Well, I'm here to tell you that in the US there is no one that's going to tolerate full strength atropine eyedrops for those two reasons. They may get by with that in some other countries, but people in the US just aren't going to tolerate that. And they don't really have to because there are diluted atropine eyedrops where they're diluted to a 0.01 percent. So you don't get the pupil dilation, you don't get the eye focusing problems, but you do get a significant myopia reduction control over time. So that's pretty cool. 

Tim Edwards: And this is just drops that you put in your eye? 

Dr. Stephey: Yup. Maybe once a day and off you go. 

Tim Edwards: So it's like a pill. Except a drop for your eye. 

Dr. Stephey: It's sorta like a pill but in drop form. 

Tim Edwards: That's amazing. I've never heard of that before. It's great. 

Dr. Stephey: Yup. And I would say that the diluted atropine drops are relatively new. I don't think they're particularly well known even in the eye care community and that has not been particularly well conveyed into the patient population at large. So I have a handful of patients who are doing the myopia control with the atropine eye drops, but it's not a huge part of our practice at this juncture. But it's an option that's available and you should know about it. Here's a final thought about presbyopia or old man eyes. Rememberit happens between 40 and 45. 

Tim Edwards: Middle-aged man eyes. 

Dr. Stephey: Yes. Yes, that's right. If you've been fortunate enough to have 20/20 vision at distance your whole life, I'm here to tell you, you feel cheated when you turn presbyopic. 

Tim Edwards: Absolutely. 

Dr. Stephey: And it's like, what do you mean I need reading glasses? I've never needed glasses my whole life. 

Tim Edwards: And it grows subtle. I mean, it's not like overnight. You can't see. It just seems to happen over some time and you realize I am not functioning like I used to. It's, it's terrible. It's exhausting, actually. 

Dr. Stephey: It, you know, that's a good point. It is exhausting. Even when you can see some degree of clarity, your brain has to work so hard to achieve that, that oftentimes those people can read without reading glasses initially, but they have trouble remembering what they're reading because their brain's working so hard to see. And that group is challenging because they typically don't want to wear glasses full time and I certainly understand that. But then they're confronted with these choices. It's like, well doc, how am I going to fix this? Well I can give you a reading glasses? Sounds great, but you're not going to be able to walk around in them. What do you mean? Well they're just for reading, if you try to walk around, you're going to get dizzy and fall over. 

Dr. Stephey: Well yeah, but so what? Wait a minute. What are you, what are you telling me? Are you telling me you're going to use the B word? Yeah, that's the other choice. 

Tim Edwards: That no young man wants to hear. No 45-year-old man wants to hear that. 

Dr. Stephey: Like you're saying, I need a bifocal? And I'm like, well I didn't say that exactly. I implied it but I didn't say it. 

Tim Edwards: Right, but then you know, a lot of men or a lot of people basically they don't want to see that line, you know, but there's a solution to that. That line in their glasses that tells the world I can't see up close without the aid. And so it looks like, I'm guessing there's a stigma attached to that. Sorry. 

Dr. Stephey: And I think that it's, it is an acknowledgement that in fact you are getting older. 

Tim Edwards: It is indeed. Yeah. 

Dr. Stephey: And it's nothing to do with really the wearing of it. It's that it's acknowledgement of your aging. And people are really resistant to that. 

Tim Edwards: Listen, I get it. I was that guy. I was like, I'm 51 now and I just gave up. I just gave up, you know, I need to be able to see and if you don't like the line on my glasses and think I'm an old man then too bad. I have to function. But then again, there are some solutions to that you don't have to have that definitive line. 

Dr. Stephey: That's right. There are bifocals with lines that are obvious. There's bifocals with lines that aren't as obvious. There are round bifocals that technically have a line that are almost invisible and then there's progressive lenses that don't have any lines. 

Dr. Stephey: And of course that has great appeal if you're bothered by the idea of a line and announcing to the world that yes, I'm wearing a bifocal. And I've been wearing a progressive lens for almost 16 years now. I don't think I would go back to wearing a bifocal with a line. But they do have some limits. 

Tim Edwards: Some of the limits I learned this. First of all, it takes some getting used to. It does. There's some, there's some adjustment to that transition. 

Dr. Stephey: Well, there's an adjustment of getting used to anybody bifocal. 

Tim Edwards: Oh that is true. That is true. 

Dr. Stephey: But it is also interesting because when I see patients that have trouble with the way their two eyes work together, if they have tried progressive lenses in the past and failed, it's usually not because they can't wear a progressive lens. 

Dr. Stephey: It's because they can't adapt to the progressive lens because of the binocular vision problem that no one has told them about. So when you get a lot of motion and swim through the no line portion of a progressive, you can't tolerate that. Well then nobody told you why you're getting so much swim because your two eyes aren't working together in a coordinated manner. You just think that progressives aren't for you and you don't know that they're really a viable option. If we address this binocular vision piece. 

Tim Edwards: So there are options. There are options there. And you know what, the only way to know is to get in there and try. And that's what exactly what I did and of course I settled for a great mix of contacts so I could see far away really well and reading glasses. And reading glasses that work while I'm wearing my contacts that you did for me. 

Tim Edwards: It is a perfect combination. Now they're not bifocal glasses. I just put them on when I need to see up close. But this combination works for me. 

Dr. Stephey: Well, Tim, and you make a good point, which is listen to your patients, come up with viable solutions, talk about the viable solutions and put them on the table so that you and the patient then can have a good discussion about their quality of life, what they do vocationally and avocationally and how these lenses are gonna work and how they're not going to work. Because it reminds me that there's also bifocal contact lenses that many people don't know even exist. And there's also instances where we'll fit one eye with the distance contact lens and the other eye with a reading contact lens. And roughly 85 percent of people that try that do really well with it. But again, you have to know it's an option and you have to know it doesn't work for everybody. But that's the point of listening to your patients and working with them and that you really are a collaborative team, which is exactly the kind of practice that I want to have.  

 

 

 

 

 

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