Is it possible to get an accurate eyeglass rx when you have dry eyes?

[achyeyes]

I saw an opthamologist a few weeks ago & was called about the follow-up today. He told me that as I'd be the one saying whether "1 or 2, here or here" was better or worse for my eyes that I was the one entirely responsible for coming up w/ my eyeglass rx. On top of that he said that a person w/ dry eyes really couldn't get a true/accurate rx at all. I asked if I had any recourse if I had the script that he'll write up made into glasses if they don't work. He said there would be no recourse as I would subjectively come up with my own rx and he'd only be the one to write it out.

So, is it possible to get an accurate eyeglass rx when you have dry eyes?

[Súil Eile]

That's a tough one! The only thing you can really do is go through the eye test as accurately as possible on any given day. Even if you didn't need Rx glasses, your vision would still vary on a daily basis. I have a standing arrangement with my optician whereby I can ring up for a last minute appointment. It means that if I'm having a good eye day he'll fit me in as soon as possible to get a good base reading for my Rx.

But I don't think tiny adjustments either way would make too much of a difference. If you woke up in the morning and your eyesight was particularly bad, I would avoid getting an eye test done that day as it may end up being too strong and strain your eyes. But slight variations are inevitable. Getting it as close as possible is the best you can do

[indrep]

achy
It can be very difficult from the astigmatism part of the rx. Corneas of patients with dry eyes are always in some state of "swelling" to get tears on the ocular surface. This creates an irregular corneal surface. I have seen patients whose Rx changed by more than 1.50 diopters weekly.

[poppy]

Really really hard to get accurate prescription for severe dry eyes. Good optometrists have told me not to buy glasses until I get my dry eye under control (HA! impossible) but they do have a point - telling me that vision can improve once dry eye is treated well. I struggle with my vision though it isn't that bad when measured by eye charts particularly with both eyes open. This is frustrating, as doctors cannot understand how someone with vision of about 20/25 (with both eyes open) can have such problems with day to day life. I recently had contact lenses prescribed to trial as a bandage solution. The doc said my vision wasn't bad enough that he would ever recommend I use contacts just for vision correction, but checked my prescription as I might as well have better vision if I am using them for medical purposes anyway. The contact lenses make absolutely NO difference to my vision and if anything seems to make it worse, I think due to build up of debris and gels made worse due to contacts. My personal opinion is that if your prescription is mild like mine you probably won't get much benefit from glasses much less contacts. I also have found that when I have really bad corneal issues it causes halos and starbursts and glasses (even anti-glare ones) don't help with this. Only improving the corneal inflammation helps with these kinds of issues. Night time ointments also seem to worsen starbursts and blurred vision issues as the residue effect continues to affect me the next morning.

[achyeyes]

You all make some excellent points, things I hadn't even thought of checking.

Here's my sticky wicket...I have to get new glasses and get an a o.k. from the eye dr. in order to get back to driving, hopefully (b/c of a non-vision-related health condition I voluntarily gave up driving for 3 months...it's been almost a year now, I hesitate to tell the story. It's an endless series of unknown hoops to jump through b/c I'd be driving the family's car. I've had a clear MRI, EEG and EMG and have twice been cleared by the pcp and have been cleared by an eminent neurologist.) I really need to be able to drive soon.

I made the mistake of being open and honest and mentioned the halos and starbursts to both the rheumy and the family. They've gotten a lot better, but the family says no driving if you're seeing these things. (From poppy's post--thanks, poppy --it sounds like these are things that may get better or worse, but w/ dry eye they're pretty much part and parcel.)

My glasses are 8 yrs old, so, having a lot of co-morbid autoimmunes (incl. lupus, ra, sjogren's--all are bad and aren't medically mediated just now,) I thought I'd go to an ophthalmologist--they were supposed to be a great place--hoping he'd do a full exam. It's turned out to be an expensive mistake. In part, he never checked the astigmatism, never checked the progressive portion of my glasses and never noticed my tear ducts being cauterized.

So now I'm thinking maybe I'll have to go to an in-plan dr. just to have him refer me to another cornea specialist (I saw one steady about 2 years ago where I had my tear ducts cauterized. At least it helped with the eye pain.) Maybe that and possibly going to some place like eyemasters to have my eyeglass rx written. And it looks like it'll be about a month before I can get in to the new rheumatologist (and it's only after the second or third appointment before the dr. will start a course of treatment, incl. something for the inflammation besides tylenol.)

I know I need new glasses, but since the severe dry eye came on it's been all but impossible to get them. About 4 years ago I tried getting glasses--they were made 3 times and they made everything look so distorted that everything looked like a fun house hall of wavy mirrors. (Is that a dry eye thing, too?) My current eyeglass rx is for pretty bad vision and the changes have made it somewhat worse...And the not-so-good ophthalmologist has me putting in drops 6 times/day (which makes me think I really do need to get back to a cornea guy. I truly believed that if I had my ducts cauterized that I could go back to life as normal, not so, I guess.) And I'm having trouble seeing at all distances--all to a different degree--and it's hard to switch vision between something near to something far, that sort of thing. And I concur about the nighttime or thicker eye drops. For me, they never seem to absorb into the eye, instead just sitting atop them and making things blurry (also, my eyes didn't hurt until I started back with the drops again. So I don't know what that's all about, either.) Also, eye-wise, the lupus makes sunlight extremely painful and inflames my eyes, too. So all the eye mischief has been going on for at least the last 5 years and I'm just trying to get some glasses and sunglasses.

Who do you think might do the best job writing the rx:

A cornea specialist?
Another ophthalmologist?
An eyeglass chain?

Súil Eile--I'm taking your advice about seeing if someone will test on a good day. It might take finding a really understanding dr, but hopefully there's one out there

Indrep, is it possible to get fairly accurate lenses for someone with bad dry eye? (If so, is there anything I can do to make my eyes the best they can possibly be?)

And besides putting in drops several time/day, an suggestions for making my eyes their best b4 the eye exam?

(p.s. Poppy, is your eye dr. considering duct plugs or cautery next in order to give you some relief?)

Thank you guys so much. I was feeling kind of alone with all these strange effects, but it really means a lot to know I'm not alone and, in a sense, this is a new normal

[eye_allergy-kids]

My glasses are 8 yrs old, so, having a lot of co-morbid autoimmunes (incl. lupus, ra, sjogren's--all are bad and aren't medically mediated just now,) I thought I'd go to an ophthalmologist--they were supposed to be a great place--hoping he'd do a full exam. It's turned out to be an expensive mistake. In part, he never checked the astigmatism, never checked the progressive portion of my glasses and never noticed my tear ducts being cauterized.

I feel you have to get something done to your internal organs because of your autoimmunes. For this natural is good

[farmgirl]

I have Sjogren's and extreme dry eye. With my last Schirmer test after 5 min the strips stuck to my eyeballs and bruised them when she pulled them off (I think it took a hunk of hide). My TBUT time was 2 and 3 sec respectively. That was at the corneal specialist who declared my corneas perfect and healthy. I credit the autologous eye serum that I use daily. Having said all that I have to say I see perfectly (always have) with correction - farsighted with astigmatism - and have never had starbursts nor halos even in the days when my corneas showed damage. There are many times when i am driving if I have just added drops that everything is a bit blurry but not to the point that i feel dangerous. My eyes check out normally and my glasses, with perhaps just a bit of normal minor tweaking always give me perfect vision.

I highly recommend getting trial plugs before you get the ducts cauterized as that is pretty permanent. I now have cauterized uppers and plugged lowers and it helps a lot. If I have even one duct not plugged my eyes start to scream right away. Not just the affected one, but both and for the life of me I don't know why both??? I use restatsis, eye serum, goggle glasses, drops as needed and plugs plus oniyx goggles at night and with all this I have healthy corneas and 80% less discomfort than when it all started 2 years ago.

Keep trying achyeyes until you find what combination works for you. Go in on a good day and pretend there is nothing wrong with you and I hope you will be behind that wheel again soon...cheers...F/G

[indrep]

achy eyes,
The spherical refraction (the first number in the Rx) can be fairly stable for dry eyes. The astigmatism (the second number in the Rx) can be much more difficult to pin down. The astigmatism number is also what affects your "real world" vision. In a doctors office with black letters on a white surface the refraction might say your best corrected vision is 20/30. When outside (dawn, dusk, an overcast, rainy, etc) in any condition other than optimum light your vision will decrease rapidly due to light scatter inside the eye from the astigmatism.