Just a Little Stronger, Doc

One of the funnier things about this profession is how simple a lot of people (patients & primary care doctors alike) think it is. I'm sure a lot of professions are like this...harder/more complicated than you'd think. Just about every patient who thinks they have blurry vision assumes they need "stronger". You have to admit that's kind of comical: that a profession that needs a doctorate to perform could be boiled down to the absolute simplest of solutions..."stronger!" So many things to talk about here. Firstly, "stronger" only works when your refractive error has increased. Sometimes "weaker" is the answer. Sometimes a change in astigmatism orientation is it. Sometimes it's corneal edema, or retinopathy, or excess mucous production, or cataracts, or dry eye, or literally dozens (hundreds?) of other things. One of the things I talk about with patients is expectation. A spherical (no astigmatism) myope sees *awesome* up close, and many of them judge their vision at all other distances by that standard, expecting to see exactly that well at all other distances & through every material in glasses, contacts, etc, which is unrealistic. Another thing I frequently discuss is perception. Patients get hung up on acuity...20/20 being their standard, when really vision is very subjective. What is "blurry" and what is "clear" is a lot like asking patients what is painful and what is not. On a scale of 1-10 how much does a fire ant bite hurt? Well it depends on who you ask. My daughter would say at least a "7". Vision is a lot like that. PLENTY of people who see normally, have 20/20 acuity & don't even need glasses tell us that their vision is "so blurry". Ok what do we do with that? Usually nothing. I certainly don't prescribe them "stronger". This is kind of a 'how blue is the sky' kind of issue. I've blogged about this before: VISION IS SUBJECTIVE In the end, medicine is somewhat limited in what we can do for people who see blurry. If it's refractive error, we account for it. If it's eye disease, we treat it the best we can. But if it's perception/expectation, there's not a lot we can do. I spend a lot of my day explaining why 'stronger glasses' won't help a person with cataracts or macular degeneration see better, and why 'stronger contacts' won't stop a young myope from having headaches when they read. It just doesn't work that way...some of these vision issues are more complicated than a lot of patients assume. Which is fine...that's why they're at the optometrist's office!


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