Choosing the Right Prescription: Eye Care and Vision Needs

Q: Choosing the Right Prescription: Eye Care and Vision Needs

Hello YM： Based on your refraction data, there is almost no difference before and after dilation, indicating that your prescription is accurate and not influenced by the ciliary muscle. <br>An error of plus or minus 0.25 diopters can be considered negligible. <br>The prescription

What prescription should be used?

Hello Doctor: I am about to get new glasses, and at the optical shop, my measurements were right eye 650 and left eye 575, which are the same as my old glasses from ten years ago.
However, after undergoing cycloplegic refraction at the clinic, the results were right eye 675, left eye 550, with astigmatism of 50.
(I am a bit confused as to why my right eye's cycloplegic measurement is higher.
Is this normal?) My situation is that I usually wear glasses at home and contact lenses when going out, spending most of my time using a computer.
The optical shop suggested that I should get a prescription based on the non-cycloplegic measurements since contact lenses are not perfectly fitted, and glasses should be precise.
However, isn't it commonly said that those who frequently look at close objects should have a reduced prescription? I found various opinions on this matter, including: 1.
Prescribe non-cycloplegic measurements because people typically use their accommodation; it's better to overcorrect than to undercorrect.
2.
Prescribe cycloplegic measurements; otherwise, it may lead to overcorrection, causing dizziness and fatigue.
When I was 13 years old, I was unaware of my pseudomyopia, and if I was overcorrected back then, isn't it usually said that prolonged use of overcorrected glasses can lead to true myopia? Yet, one article stated that clinical studies show overcorrection does not worsen the prescription, only undercorrection does...
Which of these statements is correct? Should I get the cycloplegic prescription of right eye 675 and left eye 550, or should I slightly reduce it to right eye 650 and left eye 525? Additionally, I sometimes experience intermittent strabismus (temporary, it corrects when I focus); is there anything I should pay attention to regarding my prescription? I really want to understand the correct information, and I apologize for the complexity of my questions.
Thank you for your time and response, Doctor.

YM, 20~29 year old female. Ask Date: 2019/08/22

Dr. Gao Pilin reply Ophthalmology

Hello YM: Based on your refraction data, there is almost no difference before and after dilation, indicating that your prescription is accurate and not influenced by the ciliary muscle.
An error of plus or minus 0.25 diopters can be considered negligible.
The prescription for contact lenses needs to be slightly adjusted from the refraction results.
Over-correction can lead to eye strain, and prolonged use of the ciliary muscle can result in irreversible myopia.
Over-correction causes images to form behind the retina, prompting the eye to adapt by elongating the axial length, which is one theory for the increase in myopia.
Under-correction can cause blurred vision, particularly in children whose vision has not fully developed, leading to amblyopia.
Therefore, both over-correction and under-correction are undesirable.
Based on your refractive error, a general prescription for glasses would be right eye -6.50 and left eye -5.50.
For contact lenses, it would be right eye -6.00 and left eye -5.00.
For intermittent strabismus, there are no special considerations needed for glasses.
The ophthalmology department at Puzi Hospital in Taiwan is open Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM, and Wednesday from 2:00 PM to 4:30 PM.
Online responses should only be used as a reference; it is necessary to visit a medical facility for proper care.
I hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2019/08/22

More Info

Choosing the right prescription for your glasses is crucial for maintaining optimal vision, especially considering your lifestyle and specific needs. Your situation involves a few key factors that we should address to help clarify your options.

Firstly, it’s not uncommon to see variations in prescription results between different testing methods, such as regular refraction versus cycloplegic (dilated) refraction. When your eyes are dilated, the muscles that control focusing are temporarily paralyzed, allowing for a more accurate assessment of your refractive error without the influence of accommodation (the eye's ability to focus on near objects). This is why you might see a difference in the prescription, particularly in your right eye, which showed a deeper degree after dilation. This can happen due to several reasons, including the natural progression of your vision or changes in the eye's structure over time.

Regarding your question about whether to use the prescription from the dilated exam or the non-dilated one, it largely depends on your daily activities. Since you spend a significant amount of time using a computer, it’s generally recommended to consider a slight reduction in the prescription to avoid overcorrection, which can lead to discomfort, such as headaches or dizziness. The idea is to balance clarity with comfort, especially for prolonged near work.
1. Overcorrection vs. Undercorrection: The debate about whether overcorrection can lead to worsening vision is ongoing. While some studies suggest that overcorrection does not significantly worsen vision, undercorrection can lead to increased strain and potential progression of myopia. Therefore, it’s often advised to err on the side of slight undercorrection for those who spend a lot of time on near tasks.

2. Choosing the Right Prescription: Given your current prescriptions (675 for the right eye and 550 for the left eye with 50 astigmatism), you might consider going with the non-dilated prescription (650 for the right eye and 525 for the left eye) if you find that it provides adequate clarity without causing discomfort. However, if you feel that the dilated prescription offers better clarity, especially for distance vision, you might opt for that, but keep in mind the potential for discomfort during prolonged near tasks.

3. Addressing Strabismus: You mentioned experiencing occasional strabismus (crossed eyes) when focusing. This can be a sign of eye strain or fatigue, especially if your prescription is not optimal. When getting your glasses, it’s essential to discuss this with your optometrist. They may recommend specific adjustments or even exercises to help manage this condition.
4. Consultation with an Eye Care Professional: Ultimately, the best course of action is to have a thorough discussion with your optometrist or ophthalmologist. They can provide personalized advice based on your specific visual needs, lifestyle, and any other underlying conditions. They may also suggest additional tests to evaluate your eye health and ensure that your prescription is tailored to your unique situation.

In summary, while both the dilated and non-dilated prescriptions have their merits, your choice should reflect your daily activities and comfort level. If you experience discomfort with a particular prescription, it’s crucial to communicate this with your eye care provider, who can help you find the most suitable solution. Regular follow-ups and adjustments are key to maintaining optimal vision and eye health, especially as your visual needs may change over time.

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