The 45 Year old Myope Contact Lens Wearer

We get these all the time. Every week. These folks have been nearsighted for 35 years so they think they know all about vision and glasses and contacts bc they're very "experienced". Here's how it usually goes:
patient: "I'm starting to get blurry vision and a lot of eyestrain when I read my tablet or computer. I think I just need a little more power in my contacts, you know?"
me: "Well you're 45 so it's probably not that you need more powerful lens. You might even need less powerful, and you almost certainly need reading correction, You know - bifocals.
patient: "BIFOCALS!? Aren't those for old people?"
me: "Most people need them by 45. But the easier thing is to just wear over the counter reading glasses over your contacts."
patient: "No I see fine up close. I'M NEARSIGHTED (usually enunciated very slowly and deliberately, to make sure we understand what their condition is, is if we somehow don't understand myopia). I can read a book in bed all night without my contacts on, no problem."
me: "Yes I understand you're nearsighted. But now you have a new and different problem called PRESBYOPIA. It means with your contacts ON you'll need reading correction for up close work like reading or computer."
patient with very skeptical facial expression: "Are you sure? I've never had this problem before."
me: "Very sure, and you've never had this before because you're never been 45 before."
patient: "Can't you just make the contacts a little stronger?"
me: "Stronger won't work. That's going to make the near vision even harder."
patient with even more skeptical facial expression: "Usually I know when I need a new contact lens prescription because everything gets a little blurry and the optometrist just prescribes me a little more power and it clears right up!"
me: "Yes I understand that. But now this new problem is going to have to be treated differently."
patient: So what are my options here? Can I just get LASIK?"
me: "LASIK will not work for this. You could use reading glasses over your contacts as we discussed before..."
patient interrupting: "NO. I don't like glasses."
me: "Well we could make one lens a little weaker so that it sees better up close, then you'd have one eye to see well far away and the other to see well up close."
patient: "Doesn't that mess with your vision!? And give you a headache!? No, I don't think would work for me."
me: " Ok there are multifocal contacts, but the big downside there is that they will actually make you see slightly more blurry far away than traditional contacts."
patient: "OH NO I HAVE TO SEE! I can't have it be blurry far away!"
me: "Well unfortunately you're going to have to make some sacrifice in your vision."
That almost exact conversation happens 2-3x/week in our office (once or twice per doctor). It's a little frustrating because IMO a lot of myopes are "conditioned" to believe that a) stronger is always better and b) since they have always seen well up close uncorrected, they are very confused by a scenario where up close vision would be blurry. In their mind distance vision has always been the big problem for them (which is true) but their 30+ years of experience at the eye doctor hasn't prepared them for a near-vision-blur scenario. They've been to the optometrist 30+ times and this is the first they are hearing of this new problem, and a lot of them become very skeptical as if the doctor doesn't really know what they're doing or there is some kind of scam at play. I'm serious! We are of course very understanding of this scenario, we OD's do have quite a bit of experience with it. We are as patient as we can be and yet a lot of patients end up being a little put off by it anyway. Probably some combo of the aforementioned skepticism and a mild denial scenario in which they don't believe they are old enough for bifocals and reading glasses. Hopefully if you're nearsighted and 45 you'll read this and then you'll know, and knowing is half the battle!


  1. Hi Michael, I am not sure if you are going to see this but I really want your opinion on my GPC. I would come to your clinic however I live in Canada and really am not able to find much information on the topic. A decade ago, my eye doctor diagnosed me with GPC and I have been suffering with red itchy burning eyes ever since. The only thing is, I do not wear/have never worn contact lenses. He said it was from allergies, however my GPC lasts all year round and the patanol/pataday did not help. Please let me know if you can help me.

    1. steroids. Lotemax is what I usually use in these cases

    2. Thank you for your reply! I have been prescribed prednisone FML eye drops in the past however and they helped extremely however I have never been permitted to use them for more than 14 days as I was told they could cause cataracts and once I would finish using them the GPC would come right back. Should I go see my doc for a Lotemax prescription or do they same problems occur?

    3. GPC is chronic. most of those patients need chronic therapy. Lotemax is safter to use long term than any other topical steroid.


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