Published: 23 February 2025

Eye doctors typically pride themselves on being able to improve someone’s vision through glasses or contact lens prescriptions. Whether it’s a first-time glasses wearer, or someone having either a small or large change in their prescription, we like to aim for that goal of 20/20 vision. Despite our best efforts, however, correcting vision to 20/20 is not always a positive outcome for the patient. Whether someone will be able to tolerate their new prescription is based on something called neuroplasticity, which is what allows our brains to adapt to changes in our vision. You or someone you know may have had this happen: Your vision was blurry, so you went to the eye doctor. The doctor gave you a new prescription, but after you received your new glasses, things seem “off.” Common complaints are that the prescription feels too strong (or even too clear!) or that the wearer feels dizzy or faint. This is especially true with older patients who have had large changes in their prescriptions, since neuroplasticity decreases with age. It is also more likely to happen when the new prescription has a change in the strength or the angle of astigmatism correction. Conversely, this happens less often in children, since their brains have a high amount of plasticity. Quite often, giving the brain enough time to adapt to the new vision will decrease these symptoms. Whenever a patient has a large change in prescription, I tell them that they should wear the glasses full time for at least one week. This is true for both large changes in prescription strength, as well as changing lens modality, e.g., single vision to progressives. Despite the patient’s best efforts, though, sometimes allowing time to adapt to the new vision isn’t enough, and the prescription needs to be adjusted. Even when someone sees 20/20 on the eye chart with their new glasses, if they are uncomfortable in them even after trying to adjust for a week then we sometimes have to make a compromise and move the script back closer to their previous script so that there is less change and they can more easily adapt. In conclusion, adapting to a new prescription can sometimes be frustrating. It does not mean there is anything wrong with you if you have difficulty adjusting to large changes in a prescription. With a little patience and understanding about how your brain adapts to these kinds of changes, your likelihood of success will be that much higher. Article contributed by Dr. Jonathan Gerard

Published: 09 February 2025

Age-related macular degeneration, often called ARMD or AMD, is the leading cause of vision loss among Americans 65 and older. AMD causes damage to the macula, which is the central portion of the retina responsible for sharp central vision. AMD doesn't lead to complete blindness because peripheral vision is still intact, but the loss of central vision can interfere with simple everyday activities such as reading and driving, and it can be debilitating. Types of Macular Degeneration There are two types of macular degeneration: Dry AMD and Wet AMD. Dry (non-exudative) macular degeneration constitutes approximately 85-90% of all cases of AMD. Dry AMD results from thinning of the macula or the deposition of yellow pigment known as drusen in the macula. There may be gradual loss of central vision with dry AMD, but it is usually not as severe as wet AMD vision loss. However, dry AMD can slowly progress to late-stage geographic atrophy, which can cause severe vision loss. Wet (exudative) macular degeneration makes up the remaining 10-15% of cases. Exudative or neovascular refers to the growth of new blood vessels in the macula, where they are not normally present. The wet form usually leads to more serious vision loss than the dry form. AMD Risk factors Age is the biggest risk factor. Risk increases with age. Smoking. Research shows that smoking increases your risk. Family history. People with a family history of AMD are at higher risk. Race. AMD is more common in Caucasians than other races, but it exists in every ethnicity. Light eyes. Blue and hazel eyes are more prone to AMD than brown eyes. Gender. AMD is more common in women than men. High blood pressure. Diet high in saturated fat. Detection of AMD There are several tests that are used to detect AMD. A dilated eye exam can detect AMD. Once the eyes are dilated, the macula can be viewed by the ophthalmologist or optometrist. The presence of drusen and pigmentary changes can then be detected. An Amsler Grid test uses pattern of straight lines that resemble a checkerboard. It can be used to monitor changes in vision. The onset of AMD can cause the lines on the grid to disappear or appear wavy and distorted. Fluorescein Angiogram is a test performed in the office. A fluorescent dye is injected into the arm and then a series of pictures are taken as the dye passes through the circulatory system in the back of the eye. Optical coherence tomography (OCT) is a test based on ultrasound. It is a painless study where high-resolution pictures are taken of the retina. Article contributed by Jane Pan M.D.