Are We "Spoiling" Patients?

We read all the time that myopia is a worldwide "epidemic", and I'm not disputing this. Something like 80% of Asians are myopic. But some of this IMO is that people are getting spoiled. We eye docs can and do make people see *awesome*. Literally better than 20/20. So much so that most glasses wearers EXPECT 20/20. Some of them are not even happy with 20/20. I'm serious. They wanted better than that. They complain about having normal acuity. They have seen superhuman 20/10 acuity and now that's what they want all the time, at all distances. I mean we OD's kind of brought this on ourselves to some degree. Gone are the days of only the severely vision impaired wearing glasses. Before about the 1920's we couldn't even make astigmatism glasses! So a whole bunch of people out there were walking around with 20/30 acuity and -1.50 uncorrected cylinder. Let me tell you that almost no one with -1.50 astigmatism goes uncorrected nowadays in the US. Almost all of them are wearing glasses or contacts or getting lasik. So what changed? Are we as a culture really having our eyes deteriorate THAT much more than in years past? Studies say we are, but I bet some of it is that people just won't deal with/accept 20/40 vision anymore. People want better, ESPECIALLY if they have experienced better in glasses. Once they've seen 20/15 they will not go back to 20/40. They DEMAND 20/15. And we sell it to them! That's all fine and good... Good for our pocketbooks, I guess. But there are some problems, like: 1) when elderly people who have seen 20/15 for many, many years start having cataracts, dry macular degeneration and other problems that affect their acuity. I have so many 65+ patients who see ok... 20/25 even... But are very, very upset. They want "sharper" than that. 2) parents who demand their children wear glasses when their acuity is really pretty good and their Rx is low. The parents see 20/15 and when someone tells them the child is "only 20/30" they are very, very upset. But do children need to see 20/15 all the time? I mean I don't know. I'm not saying they don't, but I am saying a case could be made that they don't. 100 years ago a 20/30 child was considered totally fine. 3) presbyopes who have seen 20/15 at all distances for their entire life refuse to accept that having "clear, sharp" vision at all distances SIMULTANEOUSLY is absolute fantasy. It's not possible, and a lot of them are in absolute denial. If you're over 45 you will have to give up clarity at some distance for some visual task, no matter how much money you are willing to spend. It's inevitable and it's a compromise and there is no way around it. You will have to tolerate some blur. I'm rambling here but the point is this: I think it's possible that routinely making patients see INCREDIBLE may be creating a culture that absolutely DEMANDS that. So much so that we have a lot of people who are upset with normal 20/20 vision. It's potentially a problem.


  1. It is interesting... I saw this post prior to my annual exam. I always complained to my old OD that I couldn't see very well out of my Acuvue Oasys lenses... everything was just a tad too blurry. I was basically told to deal with it - I asked to try a toric lens and I was told it wouldn't make a difference. For what it's worth my spectacle script called for half a diopter of cylinder in each eye.

    I went to a new OD this year. Told him my problem. He first tried a different spherical lens to see if it'd make a difference - nope, same issue. He then switched me to a toric lens and WOW, what a difference. Everything is so crisp compared to the spherical lens. I don't know if my old OD was just lazy and didn't want to do the work to fit the toric or what, but I'm so glad I didn't settle and got the second opinion.

    BTW... the lens I'm currently on is the Clariti 1-day Toric. They're expensive as all get out at $34 a box for a 30 day supply, but I've found that they're quite comfortable... and as far as I can tell they're the only toric daily disposable silicone lens on the market. Any thoughts on this product?

  2. I'm sure there are lots of people who go around with 20/80 or worse because they don't like wearing glasses/contacts.


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