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    ODs: Rulers of the Land of Presbyopia


    We adjust them. We mark them up and adjust them again. We clean them. We show the patient how to read with them, how to drop her eyes, how to point with her nose. She says she does not want to point with her nose, and we explain she must to do this to avoid the distortion on the edges. Then she spends 20 minutes complaining about the distortion on the edges. We spend 10 minutes explaining why the small amount of distortion is negligible when she looks through the lenses properly.

    Related: How to better fit progressive spectacle lenses

    She leaves. The optician lays his head on the table and thanks the Lord. Any patients in the dispensary with a sense of humor clap, and close friends of the staff will give high fives.

    The patient returns with her progressives 10 days later and says she can’t wear them at the computer. After drawing several pictures of a channel, we attempt to explain intermediate vision. We discuss computer glasses, including single vision, office lenses, and modified bifocals. We educate the patient on lens coating and the evils of blue light. She leaves without computer glasses, but with a cranky disposition.

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    Moving to surgery

    Years later, she proceeds with cataract surgery. We are well informed of the options at her disposal because we spend 20 minutes explaining standard, “government issue” surgery, toric, and presbyopic options.

    She return to the office the next day after surgery. And she is happy with her 20/25 vision.

    Me: “How are you doing?”

    Patient: “Pretty good”


    At one month, she returns, reporting she can drive without glasses. Her visual acuities are 20/25 OU at distance, and she is wearing over-the-counter (OTC) readers. She has two pairs, one for reading and one for the computer. She finally got computer glasses.

    I offer refraction because how can anyone be happy with OTC readers? Her eyes are not balanced. The prism induced by the line of sight not traveling through the lens center causes asthenopia. Her lenses do not have anti-reflection coating. She has severe lens aberrations, so everything looks distorted.

    Related: Troubleshooting optical complaints

    You can’t walk in these lenses, and distance is horribly blurry. The glasses can’t be found because they are left in the car/bedroom/living room/desk/by the pool/in a coat pocket. The right lens keeps falling out. The frames never stay adjusted, and after two adjustments, they break. But the patient reports, “They are fine.”

    Where was this attitude when the same patient got progressives?

    Tracy Schroeder Swartz, OD, MS, FAAO
    Tracy Schroeder Swartz currently practices at Madison Eye Care Center in Madison, Alabama. She serves as Education Chair for the ...

    1 Comment

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    • [email protected]
      I always thought how can the same optics in MF's CL's work so poorly yet when incorporated in an IOL they are perfect. SMH.

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