Optician Prescription changes and Cataracts

[RosesAndHellebores]

Has anyone else struggled with needing prescriptions altered frequently? Since 2023, my prescription has changed a little three times. About every 15/18 months. I am struggling with work screens and night driving (glare, halos, dazzle and unclear boundaries/edges/shadows).

The optician has been reluctant to refer due to risks of surgery but very keen to prescribe new varifocals, occupational glasses and driving glasses. I sought an ophthalmologist private referral from my GP and pretty much had to beg because opticians know best, and was advised to give up driving at night. I did get the referral after about 15 minutes of arguing my case and saying I'd accept it if an ophthalmologist recommended three pairs of glasses every 12/15 months.

A major issue is that I have -7.5 short sight as well as +2.5 long sight plus astigmatism so a pair of varifocals costs about £800 and the other types of glasses woukd be £4/500 each.

Does anyone have advice or experience. I am seeing the ophthalmologist next Tuesday bit am now doubting my approach, especially if they say nothing is wrong with my eyes.

There is very little risk from cataract surgery, but often they won't refer until the cataracts gets bad, Go private if you ca afford it. My DH had one done and is really keen to get the other one done now but it's not bad enough.

Can you go to a different 'normal' optician for another opinion?

Would you disclose your age?

Eye sight does rapidly change in your 40s/50s.

Have they actually said you have cataracts or that the lenses are slightly yellowing? (Perfectly normal and age related unfortunately).

You don’t need to have a referral to see an ophthalmologist privately. Dazzle and glare are common symptoms in developing cataracts. As cataracts develop they can also cause prescription changes but with all the other symptoms you were getting you should be referred as they are affecting your quality of life

I've had a 2nd opinion, 4 months apart and a different (slightly) prescription. I do have cataracts but still correctable according to opticians, with an altered prescription. I'm 66.

I know I can refer directly, but my inurance requires an optician or GP referral.

@RosesAndHellebores cataract referrals are not based solely on the level of vision you are getting several other cataract related symptoms that would warrant a referral as I mentioned above so I’m not sure why you haven’t been referred via NHS as you have a functional impairment of vision with glare etc. The risks of cataract surgery are higher in myopia but that is something to be discussed with the ophthalmologist

I agree, the opticians have said most people my age have evidence of cataracts but a referral is inappropriate if an altered presceiption can provide 20 20 vision. I'm confused.

Could it be that the rate of the cataracts growth is minimal so they suggest the new glasses over surgery at this point?

Possibly, but they won't be drawn and I would like the facts to help me make a decision.

Referral advice for cataract can be found on the NICE guidelines QS 180 , link here or you can search if you would prefer https://www.nice.org.uk/guidance/qs180
Hope you get things sorted

Can you ask for your optician records? They must record additional information that doesn't appear on a standard report.

Do they both know you have insurance and have they indicated the pace of development of your cataracts?

I had fairly rapidly developing cataracts in my early 40s I need screens to work (and needed to drive, often late). My optician knew me well and simply gave me costs for supplementary aids (for screen/night driving) and advised on likely timeline for surgery for the insurance and the NHS models. He did not recommend varifocals for me due to cost of the lenses and likely closeness of surgery. He referred me back to my GP with a recommendation for particular surgeon (as then the insurers required the referral from the GP, even though he was just forwarding).

I was far enough gone by the time I realised something was wrong with my sight that on I just bought the specialist glasses for screen work with the cheapest suitable frames. This tided me over for the couple of months before surgery for both eyes. I didn’t bother with the anti glare glasses for driving as I thought I could manage without personal night driving for that time period and for work I had other options.

For me the extra temporary cost was worth it but I wouldn’t have spent out on anything more than the basics for extra glasses. After surgery the screen frames were repurposed with new lenses for screen work and lasted me a good few years. It took me a while to adjust to acquiring 20 years of gradual loss of close sight overnight (I had been -7-8). If the timeline to surgery had been more like 12 months I’d have bought the driving glasses as well.

66 is still quite young for cataracts and I was told that on average they develop faster the younger you are. Be prepared for the shock of sudden good long sight and the change in colours!

@C8H10N4O2 thank you. Some of my difficulty is that my optician of 20+ years retored in 2023.

Night driving is a near essential for me. My mother is 89 and 80 miles away and there is nobody else. Also the days are now getting very short.

Being able to drive at night is essential then.

Selfishly, I find one of the hardest things as we age is losing long trusted professionals and tradies who have the nerve to retire :-)

It may be worth asking current optician if they could assess the pace of development if you went in for intermediate appointments privately. If the new optician is operating the same business or requested your records they should have eg your old eye pictures to compare with current (and send them to a new practitioner if you move).

If I’d had to night drive for personal use at the time I’d have paid out for night driving glasses (where were glasses with the anti glare coating) but again, using basic frames as they were temporary.

I also had both eyes done within a week (an option because I went under insurance) which reduced my total non driving time. I would not have wanted to drive anywhere between eyes - I had no functioning depth perception.

I'm not as far along the path yet, but am 59, -13 in glasses, -10 in contacts slight astigmatism, and starting cataracts, I wear contacts most of the time plus varifocals for when I'm not wearing them and anti-glare/slight minus top-up glasses for over the contacts for night driving (this allows me to have the contacts slightly under strength amd not need reading glasses) and it is all starting to be a bit of a juggle, I try and only replace one pair of glasses in each insurance year. My optician says loss of night driving ability is key to referral (like you I cannot avoid it, I have to drive home from work cross country and my elderly parents are cross country too). Even without those factors I am NO WAY giving up night driving without trying everything possible it would limit my life in many other ways. I would be really stressing this point.

@C8H10N4O2 I have got my prescriptions from 2022 and have sent to the ophthalmologist today. It's interesting actually because the tweaks are minor (half a diopter here and there) it works for 6-10 months but then I'd say the difficulty is disproportionate to the alteration.

Old optician was in London where we used to live and I went back until 2023. New owners now, v young and edgy. Have been to one large chain here and a much smaller one - I can't find an independent, and don't feel confident enough to go back to them. The last one said there was no astigmatism in one of my eyes, yet there has been for at least 50 years.

It's all a bit perplexing. If the ophthalmologist tells me not to have the op but keep changing various glasses of course I shall and hopefully he can recommend a good independent. I was very shocked that the GP told me to stop driving but resisted the ophthalmology appointment.

The key issue is the driving. Home from work, after 4pm in winter and to get to my mother whose now in the space of "anything could happen".

DH has suddenly needed cataract surgery - he's booked in for both eyes - a week apart - in early October.

we were interested to learn that whilst a standard 'mono' lens is used on the NHS, when having the surgery privately you can upgrade to a 'varifocal' lens - for a cost - which means that you shouldn't have to wear glasses at all.

His surgeon has probably mentioned this but if not, he should do his research and discuss night driving before going for implanted varifocals.

I ended up going for accommodative lenses (small amount of focus) rather than varifocals as I was doing a lot of dark miles and the implanted varifocals at the time tended to cause glare issues at night. With accommodative I still need reading glasses for close complex work but I’ve been impressed at how much focus I’ve retained.

@RosesAndHellebores It's all a bit perplexing. If the ophthalmologist tells me not to have the op but keep changing various glasses of course I shall and hopefully he can recommend a good independent. I was very shocked that the GP told me to stop driving but resisted the ophthalmology appointment

I think some GPs still have a limited understanding of daily life in the real world and the impact of saying “oh just don’t do X". I wonder how hard you would have had to fight for an NHS referral.

FWIW, my opthalmologist said in general he recommends surgery at the point its causing daily life problems rather than waiting for an arbitrary point. He actually preferred to the surgery earlier than later as waiting too long can cause its own issues.

My research has found evidence of this too. If I'm offered surgery, I'll be very happy with monofocals and having reading glasses.

Accommodative lenses are worth a discussion - they are smooth like monos rather than grooved like the varifocals but have a small amount of “squeeze”. I have been impressed by them. They did not remove the need for readers but reduced the need to very closed/detailed work on screens/books.

Of course this is an area where the technology is fast moving and its likely there are new options since mine were done. One of my DC has “insert” lenses sitting in front of the natural lenses which gave them perfect sight with their natural lens (they were borderline VI and could not tolerate contacts). These also have the advantage that they can be swapped out over time and won’t cause issues when/if the family premature cataracts hit. It is very different from the era my DF faced with premature cataracts - they just whipped out the natural lens with no replacement and supplied rigid contacts or bottle glasses!

I had a bad experience with a GP over my eyes about 10 years ago. One eye went slightly red so I called in at the optician, they found very slight corneal ulceration and booked me into the eye hospital. They suggested going to the GP for antibiotics too, so I did, she wrote the prescription, picked up the phone and said "I'm just going to let the DVLA know you are stopping driving". I nearly hit the roof and said "why?!!!" she said well you can't drive with impaired vision. I replied that she hadn't asked me if it was impaired and that it was not and she could put the phone down NOW please. By the next day at the eye hospital the ulceration had cleared and I could have lost my licence over this.

Regards your glasses, i buy mine over the internet for a fraction of the price you pay at the opticians. Zenni Optical is who I and my family use. You need a copy of your prescription and someone (friend or family member with a ruler) to measure the distance between your two pupils. Zenni provide a wide range of frames to choose from - find a style you like at your opticians and then choose the most similar pair from their website. They don’t take long to arrive either.

Thanks @Corneliafunk is that for varifocals with a complex presccription? If there is a tiny measuring error, I assume they wouldn't put it right as they didn't measure. I don't think I'd have the confidence to go that route, particularly with cataracts and prevailing issues to be corrected.