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Ophthalmology & Optometry/Need CliffNotes for the Eye Chart


Dear Dr Dovie,
I am very nearsighted, with a pretty severe astigmatism L eye. I have worn glasses since age 10 and am now 58. #2 Diabetes but very well controlled with HA1c of 7.2. No retinopathy.
My first pair of progressives were OK but not great, but my newest are terrible. The midrange (up to 5-6 ft) is good, but at any distance is blurry. I cannot read the TV menu at 8 feet away, driving in unfamiliar places is scary, as I can't read the signs until I am right on (and passing) them. I can't read cans and boxes on the grocery shelf without picking them up. Can't read the names of stores when cruising a strip mall. On a recent trip, I found my chin resting on my chest and my eyes squinting up through the top of my glasses, which I tried to push closer to my eyes. As a bird watcher, looking up or up to the side I have had double vision on occasion - with items as small as a bird and as large as the rising moon. At the BMV, I could only read the 2 letters in the center of the line on either side. and the edges were totally blurry...they passed me out of kindness.  
My fear is that I am flunking the eye chart. At some point, I can't tell a difference between the options given. My distance vision is always less than I wish for, but has never been as bad as this. Shopping, driving and birdwatching has become quite frustrating, and gives me headaches/nausea. Can you give me some tips about reading the eye chart? And give me the proper words to address this with the Doctor? I have an appt next week and a second eye exam in a year is hurting the budget - I can't afford to get it wrong this time.
I'm told the prescription is on the stem: mine reads 2152  352  58 17   140 on the left stem-with a small square between 58/17. If that is helpful...They were made at Lenscrafter.

This sounds frustrating.  My first comment is that if you're having trouble with your glasses, regardless of blood sugar (which, yours is good), a simple Rx check should be complimentary and at no charge.  Any doctor is responsible for the vision out of the glasses being optimal, and if you think they are bad/worse than they were, then go back to the original doctor and have them recheck.  Again, this should be no charge.
If you don't have confidence in the doctor, a second opinion is not a bad idea, but you're right, the costs will add up.  
Another note is that if the Rx changes and needs a remake, this should also be free of charge, if within a reasonable time (normally 2-3 months).
My comments on getting the presrciption 'right' would be the following.
1. Start by telling the doctor specifically what the current problem is, don't leave out details.
2. Let them know you have a slight anxiety about answering the questions and want to get it right, so suggest them to take their time.
3. Take your time, don't feel rushed.  BUT in general, go with your gut.  If you're not sure if it's better 1 or 2, tell them so.  Remember, it doesn't have to be perfect--the excercise is about bracketing the Rx, and narrowing it down.  In the beginning it's not unusual to be fairly blurred, etc.  As the process moves along it should get better.  When you're 'done' you should be able to see clearly and comfortably.
4. Have him/her show you your final Rx in a trial frame. Walk around with it on, look down the hall, etc.  Test it out.  If you can't see well, tell them and ask them why.  It's possibly your vision is limited because of cataracts or other aging / health issues.
5. Make the doctor accountable.
6. The Rx is not on the glasses themselves.  The measurements printed on the glasses are about the frames themselves.  Manufacturer, color codes, sizing, etc.

Good Luck!

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John M. Dovie, OD, FAAO


As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.


Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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