Hi Everyone,
I'm seeking some advice.
For the last 4 years I've been relying on the eye tests given by the Optometrist dept at my local hospital. The last high street eye test was back in 2003 when Specsavers detected the KC and referred me to my GP.
I've recently been into a local independent optician to have my frames repaired and was very impressed by their knowledge of KC and learnt they were amongst a handful of opticians in the area that have their own Typography machine. They also said they had the means to photograph the back of the eye. I was under the impression that any optician would simply wipe their hands of me the moment they spotted KC - in the same way Specsavers did.
The local optician said that hospitals rarely conduct accurate tests for glasses. However, this puzzled me a little bit since the last prescription I had to make up the lenses I'm wearing now were issued by the hospital.
The eye test at the hospital last year was purely made by shining a light into my eyes and changing lenses whilst starring at the chart. At the time I thought it was a bit basic - but did not know any better. Is this practice normal? Could an eye test involving more technical gizmos produce a better result? Or was the optom I saw then just naturally gifted?
When I got my glasses made up at Boots last year the guy their said that they treat a Hospital prescription as being very accurate. Yet the optician today said otherwise.
When ever I go back to hospital for a contact lens checkup or refit, they get me to read out a few lines from the Snellen chart and swap a few lenses around on the testing-frames but I'm never given any prescription.
My question to you, is whether you think it is worth paying for an independent eye-test? I'm thinking it would be good to get a second opinion but are unsure whether I'll be able to make any sense of it. Also whether it would just be worthless.
What do you think?
Eye Test Advice
Moderators: Anne Klepacz, John Smith, Sweet
-
Rich Moore
- Contributor
- Posts: 39
- Joined: Tue 23 May 2006 6:43 pm
Eye Test Advice
Last edited by Rich Moore on Tue 24 Jul 2007 8:24 am, edited 2 times in total.
-
Lynn White
- Optometrist
- Posts: 1398
- Joined: Sat 12 Mar 2005 8:00 pm
- Location: Leighton Buzzard
Rich
As an optom I reckon its my call here!
You have a lot of confusing info here so let me wade through it.
Hospital Departments can vary a lot depending on size and location. However, I would definitely say, if a hospital optometrist does your refraction, I would take that as being accurate as they tend to be experts at what they are doing.
The test at hospital where it is "purely made by shining a light into my eyes and changing lenses" is called retinoscopy and is the way we optometrists can determine what your correction is without actually asking you anything. The optometrist would take that info, compare it to what you have had before and make a clinical decision what your prescription should be.
This is entirely normal for hospital optometry because they are there to get your prescription and thats it. If there are other considerations, you will get passed onto other clinics such as orthoptics. In High Street practice, one is starting from scratch at each visit and the optom has to do a whole range of tests to make sure all contingencies of eye disease, muscle balance, reading ability and so are covered. This is why such an examination may look more comprehensive than a hospital one.
In keratoconus actually, the standard gizmos such as autorefractors and so on are actually confused by the distortions caused by the condition. Therefore you are not likely to get a better result, refraction wise.
What you CAN get in community optometry is more time to discuss your case and more convenience for consultations, if you find someone who knows keratoconus, as you obviously have.
As to whether you should get a second opinion.. well, for a start, without access to your past records, an informed opinion would be difficult. I am wondering if there is any particular reason you are dissatisfied or whether you are just confused by conflicting advice?
Lynn
As an optom I reckon its my call here!
You have a lot of confusing info here so let me wade through it.
Hospital Departments can vary a lot depending on size and location. However, I would definitely say, if a hospital optometrist does your refraction, I would take that as being accurate as they tend to be experts at what they are doing.
The test at hospital where it is "purely made by shining a light into my eyes and changing lenses" is called retinoscopy and is the way we optometrists can determine what your correction is without actually asking you anything. The optometrist would take that info, compare it to what you have had before and make a clinical decision what your prescription should be.
This is entirely normal for hospital optometry because they are there to get your prescription and thats it. If there are other considerations, you will get passed onto other clinics such as orthoptics. In High Street practice, one is starting from scratch at each visit and the optom has to do a whole range of tests to make sure all contingencies of eye disease, muscle balance, reading ability and so are covered. This is why such an examination may look more comprehensive than a hospital one.
In keratoconus actually, the standard gizmos such as autorefractors and so on are actually confused by the distortions caused by the condition. Therefore you are not likely to get a better result, refraction wise.
What you CAN get in community optometry is more time to discuss your case and more convenience for consultations, if you find someone who knows keratoconus, as you obviously have.
As to whether you should get a second opinion.. well, for a start, without access to your past records, an informed opinion would be difficult. I am wondering if there is any particular reason you are dissatisfied or whether you are just confused by conflicting advice?
Lynn
-
John Smith
- Moderator
- Posts: 1942
- Joined: Thu 08 Jan 2004 12:48 am
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and spectacles
- Location: Sidcup, Kent
Hi Lynn,
Thanks for answering this one.
However, something that Dan Erhlich (I think) said at the conference was along the lines of the "perfect" prescription not making one jot of difference to the quality of a KCer's vision, yet a slightly off-perfect prescription can work wonders.
I know that sounds really confusing, and I hope I've made myself clear.
So, if a prescription is taken without asking the patient any questions, could it be that a more conventional snellen-scale refraction would produce a better result for the keratoconic patient? And if so, do the hospitals need educating that the retinoscopy they are performing may not yield a useful prescription (even if it is "perfect")?
Thanks for answering this one.
However, something that Dan Erhlich (I think) said at the conference was along the lines of the "perfect" prescription not making one jot of difference to the quality of a KCer's vision, yet a slightly off-perfect prescription can work wonders.
I know that sounds really confusing, and I hope I've made myself clear.
So, if a prescription is taken without asking the patient any questions, could it be that a more conventional snellen-scale refraction would produce a better result for the keratoconic patient? And if so, do the hospitals need educating that the retinoscopy they are performing may not yield a useful prescription (even if it is "perfect")?
John
-
Lynn White
- Optometrist
- Posts: 1398
- Joined: Sat 12 Mar 2005 8:00 pm
- Location: Leighton Buzzard
I see where you are coming from John!
The thing is here, one cannot extrapolate from what one person perceives at one clinic visit. Its more than third hand, in reality!
I didn't want to get into specifics but I think the optom in Rich's case was just checking if the prescription had changed by using retinoscopy. If I personally was refracting any patient for the purpose of actually supplying spectacles, I would definitely do Snellen (ie ask the patient what they can see) This is different from checking whether things have changed, which I suspect is what the optom was doing in Rich's case. Also, looking at the retinoscopy reflex (the light that comes back from the retina through the lens and cornea) tells us a lot in KC.
To be honest, for any KC person who is wearing RGP's, then when you swap into glasses, the prescription starts to change with time anyway, as the compression from the RGP wears off. So getting an "accurate" prescription is difficult.
As for a "not quite perfect" prescription, any optom who is used to KC is adept at trying things out to see what works. As a patient you may not even be aware of what they are doing. What also needs to be remembered, is that we are dealing with aberrated (ie distorted) optics here which can't be matched by conventional lenses. So what we find as optoms, is sometimes several prescriptions "work" at the same time. This happens with moderately advanced cataracts as well. This is because different values of conventional lenses will correct different aspects of the distortions present.
If this all sounds like a bit of a nightmare, then yes it is!! This is why contacts are a much better option optically!
Technology is advancing nowadays on the wavefront technology front and attempts are being made to match topography and aberrometry readings to individually made spectacles lenses. So far I have heard of this being done for normal eyes - not sure how this would work for KC. Besides which there is the thorny problem of what then happens if you look through such a lens off axis.
Hope this helps! Its an intersting subject actually!
The thing is here, one cannot extrapolate from what one person perceives at one clinic visit. Its more than third hand, in reality!
I didn't want to get into specifics but I think the optom in Rich's case was just checking if the prescription had changed by using retinoscopy. If I personally was refracting any patient for the purpose of actually supplying spectacles, I would definitely do Snellen (ie ask the patient what they can see) This is different from checking whether things have changed, which I suspect is what the optom was doing in Rich's case. Also, looking at the retinoscopy reflex (the light that comes back from the retina through the lens and cornea) tells us a lot in KC.
To be honest, for any KC person who is wearing RGP's, then when you swap into glasses, the prescription starts to change with time anyway, as the compression from the RGP wears off. So getting an "accurate" prescription is difficult.
As for a "not quite perfect" prescription, any optom who is used to KC is adept at trying things out to see what works. As a patient you may not even be aware of what they are doing. What also needs to be remembered, is that we are dealing with aberrated (ie distorted) optics here which can't be matched by conventional lenses. So what we find as optoms, is sometimes several prescriptions "work" at the same time. This happens with moderately advanced cataracts as well. This is because different values of conventional lenses will correct different aspects of the distortions present.
If this all sounds like a bit of a nightmare, then yes it is!! This is why contacts are a much better option optically!
Technology is advancing nowadays on the wavefront technology front and attempts are being made to match topography and aberrometry readings to individually made spectacles lenses. So far I have heard of this being done for normal eyes - not sure how this would work for KC. Besides which there is the thorny problem of what then happens if you look through such a lens off axis.
Hope this helps! Its an intersting subject actually!
-
Rich Moore
- Contributor
- Posts: 39
- Joined: Tue 23 May 2006 6:43 pm
Thanks everyone, especially Lynn for your very comprehensive replies.
The background to the hospital prescription this time last year was that for the last three years I had been wearing RGP lenses, with mixed success. She felt that I should just switch to glasses entirely. Hence my request for an up-to-date prescription. I hadn't been wearing my contacts prior to the test so judging by what you say the results are probably accurate. When I went back in December'06 complaining of headaches they checked the lenses and took a quick 'snellen' test and confirmed they were ok. Which I guess reaffirms the accuracy.
This was actually the first time in my life that I had worn glasses 24/7 - up until then I just had a set as a backup to my contacts so never actually used them! I figure that in the world of glasses, I'm still a newbie!
For the last 8 months, I've been in and out, trying to get Kerasoft 2 lenses to fit since I've found glasses have restricted the more active parts of my life - Mountain Biking, Snowboarding, Squash (the opticians always look horrified when I mention the last one!).
I think my reasons for a second opinion were simply that I was curious how a completely new optom, outside of the NHS system would diagnose the condition of my eyes. It was also reassuring to find someone on the high street who knew about KC. The optician also noted the number of prisms in my current glasses and thought that was strange.
I think for now, Im going to wait and see how the next fitting of my Kerasoft2 lens goes and then decide then as to whether to consider a high-street test.
Trying to balance the shear volume of information, view points and cold facts, along with the the different interest of all parties involved with KC is complex to say the least.
Interestingly, the optom yesterday asked me if I knew where KC came from. I refrained from lecturing him about my 4+ years of casual research on the subject but asked for his view - he was under the viewpoint it was from rubbing eyes. He said they diagnose a large number of international students who come over from Africa and are unaware that they have KC. He suspected it was due to the lack of drugs like anti-histamine etc. I had not heard this one before but it might have some merit.
The background to the hospital prescription this time last year was that for the last three years I had been wearing RGP lenses, with mixed success. She felt that I should just switch to glasses entirely. Hence my request for an up-to-date prescription. I hadn't been wearing my contacts prior to the test so judging by what you say the results are probably accurate. When I went back in December'06 complaining of headaches they checked the lenses and took a quick 'snellen' test and confirmed they were ok. Which I guess reaffirms the accuracy.
This was actually the first time in my life that I had worn glasses 24/7 - up until then I just had a set as a backup to my contacts so never actually used them! I figure that in the world of glasses, I'm still a newbie!
For the last 8 months, I've been in and out, trying to get Kerasoft 2 lenses to fit since I've found glasses have restricted the more active parts of my life - Mountain Biking, Snowboarding, Squash (the opticians always look horrified when I mention the last one!).
I think my reasons for a second opinion were simply that I was curious how a completely new optom, outside of the NHS system would diagnose the condition of my eyes. It was also reassuring to find someone on the high street who knew about KC. The optician also noted the number of prisms in my current glasses and thought that was strange.
I think for now, Im going to wait and see how the next fitting of my Kerasoft2 lens goes and then decide then as to whether to consider a high-street test.
Trying to balance the shear volume of information, view points and cold facts, along with the the different interest of all parties involved with KC is complex to say the least.
Interestingly, the optom yesterday asked me if I knew where KC came from. I refrained from lecturing him about my 4+ years of casual research on the subject but asked for his view - he was under the viewpoint it was from rubbing eyes. He said they diagnose a large number of international students who come over from Africa and are unaware that they have KC. He suspected it was due to the lack of drugs like anti-histamine etc. I had not heard this one before but it might have some merit.
-
Matthew_
- Champion
- Posts: 814
- Joined: Thu 13 Jul 2006 3:13 pm
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and contact lenses
- Location: Gallafrey
Rich,
I am a wee bit confused... Are you saying you can get good vision with glasses?
I always thought rgps were most often used when glasses no longer worked. I can no longer use glasses and I miss them terribly. I also do a lot of activities outdoors, so I used titanium memo-flex glasses. They never let me down. I just used soft lenses for diving when glasses could not be used. I really miss that and feel the rgps restrict my active lifestyle. Its interesting that you see it differently. It just goes to show, how our experiences of KC can differ so much.
I am a wee bit confused... Are you saying you can get good vision with glasses?
I always thought rgps were most often used when glasses no longer worked. I can no longer use glasses and I miss them terribly. I also do a lot of activities outdoors, so I used titanium memo-flex glasses. They never let me down. I just used soft lenses for diving when glasses could not be used. I really miss that and feel the rgps restrict my active lifestyle. Its interesting that you see it differently. It just goes to show, how our experiences of KC can differ so much.
Get a life...get a dog!
-
Rich Moore
- Contributor
- Posts: 39
- Joined: Tue 23 May 2006 6:43 pm
Hi Mathew,
Just to clarify, I get OK vision with specs, good vision using RGPs but had too stop wearing them due to eye fatigue/pain/damage and currently trying to get Kerasoft Lens to fit properly in both eyes.
I consider glasses to really restrict the activities I like to do. Most notably snow boarding, squash and mountain biking. I'm hoping the kerasoft lenses will make a difference and keep persisting to get a good fit.
The KC in my left eye is no way as bad as the right so I do get good vision with glasses in that eye and less so in my right - Although on paper my eye sight is good with glasses, I do find that they sometimes distort the world around me far more than contacts. After 30-40 minutes of reading, I still find myself shutting my right eye to prevent the lines merging into one blur.
One thing that I discussed with the optom during my last hospital visit was how the location of the KC area on the eye affects the quality of vision. Apparently my left eye is worse around the lower edge of the eye, whilst the right is predominantly on the right-side. This is why tilting my head whilst reading or watching TV sometimes helps. I'll also try and sit on the right side of the cinema and so on. Its funny how you adapt to make the best of the situations.
Interesting you mention diving Mathew. I've always been a real keen snorkler and visited places like the Barrier Reef and Cayman Islands and have tried a few Scuba sessions but always thought I'd do it properly 'some time in the future'... now I know I've got KC - I keep thinking I should make the most of what I can see now and stop hesitating...
I find one of the biggest issues with KC is the uncertainty of knowing how far or how quickly it will progress.
Just to clarify, I get OK vision with specs, good vision using RGPs but had too stop wearing them due to eye fatigue/pain/damage and currently trying to get Kerasoft Lens to fit properly in both eyes.
I consider glasses to really restrict the activities I like to do. Most notably snow boarding, squash and mountain biking. I'm hoping the kerasoft lenses will make a difference and keep persisting to get a good fit.
The KC in my left eye is no way as bad as the right so I do get good vision with glasses in that eye and less so in my right - Although on paper my eye sight is good with glasses, I do find that they sometimes distort the world around me far more than contacts. After 30-40 minutes of reading, I still find myself shutting my right eye to prevent the lines merging into one blur.
One thing that I discussed with the optom during my last hospital visit was how the location of the KC area on the eye affects the quality of vision. Apparently my left eye is worse around the lower edge of the eye, whilst the right is predominantly on the right-side. This is why tilting my head whilst reading or watching TV sometimes helps. I'll also try and sit on the right side of the cinema and so on. Its funny how you adapt to make the best of the situations.
Interesting you mention diving Mathew. I've always been a real keen snorkler and visited places like the Barrier Reef and Cayman Islands and have tried a few Scuba sessions but always thought I'd do it properly 'some time in the future'... now I know I've got KC - I keep thinking I should make the most of what I can see now and stop hesitating...
I find one of the biggest issues with KC is the uncertainty of knowing how far or how quickly it will progress.
-
Matthew_
- Champion
- Posts: 814
- Joined: Thu 13 Jul 2006 3:13 pm
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and contact lenses
- Location: Gallafrey
Ah, I see now! I can see how glasses don't work with snow boarding. Unless you could wear them under goggles! But if they are not ideal, its probably a waste of time anyway!
Good luck with the Kerasoft lenses. I hope it all works out for you and you can get back to your sports.
A few threads on diving by the way, if you do a search.
Good luck with the Kerasoft lenses. I hope it all works out for you and you can get back to your sports.
A few threads on diving by the way, if you do a search.
Get a life...get a dog!
-
Lynn White
- Optometrist
- Posts: 1398
- Joined: Sat 12 Mar 2005 8:00 pm
- Location: Leighton Buzzard
Thanks Rich
That does clarify things! Your problems with glasses are really due to the distortions you get and also the prisms sound like they are there to help get your eyes to work together.
The eye-rubbing issue - well the thing is with that is yes, keratoconics do rub their eyes a lot - but which comes first? Lots of people rub their eyes but do not become keratoconic. Also eye rubbing would not explain KC clusters.
There is now evidence that a large element of KC is genetic - and that eye rubbing exacerbates the condition because the cornea is already compromised.
Hope you get on with your Kerasofts and keep us posted!
That does clarify things! Your problems with glasses are really due to the distortions you get and also the prisms sound like they are there to help get your eyes to work together.
The eye-rubbing issue - well the thing is with that is yes, keratoconics do rub their eyes a lot - but which comes first? Lots of people rub their eyes but do not become keratoconic. Also eye rubbing would not explain KC clusters.
There is now evidence that a large element of KC is genetic - and that eye rubbing exacerbates the condition because the cornea is already compromised.
Hope you get on with your Kerasofts and keep us posted!
Return to “General Discussion Forum”
Who is online
Users browsing this forum: No registered users and 24 guests