Question
QUESTION: Hi, Dr. Placentra Johnston,
I just had my eyes examined by a new eye dr (my old one isn't in the network anymore) for both an eyeglass prescription and contacts. I went through a couple trial lenses before given the contact prescription (monovision lenses). I had the prescription filled by Costco (one year supply) to save money (I have gotten lenses from here before). However, when I put them in, I can't see close-up; I have to put on reading glasses. I asked the dr to double-check the prescription (his wife had written it) and he called me back and said the prescription matched the file, and he didn't know what to tell me. In the meantime I spoke with Costco who compared my old prescription (2 years ago) with this one and said they saw a significant change which they didn't understand, and that may be the problem. Could you take a look at the prescriptions (old contacts, new contacts, new eyeglasses) and tell me what you think the problem could be.
Thank you very much.
Mary
Old contact lens prescription:
Preference Toric; R 8.70, 14.40, -2.25, -.75, 110
L 8.70, 14.40, -.50, -1.25, 50
New contact lens prescription:
Air Optix Toric; R 8.70, 14.50, -3.25, -.75, 120
L 8.70, 14.50, -.50, -1.75, 40
New eyeglass prescription: R -3.75; -0.75, 123
L -2.50; -1.75; 42
Add R +2.25
L +2.25
ANSWER: It could be the axis shift in the reading eye. The left eye went from axis 50 to axis 40. But your distance eye, the right has gotten much more nearsighted, so that could also be it. Try closing the right eye and see if you can read with the left (with contact lenses on.) If so then the problem is in the right eye. If you can't read well with the left contact lens, the problem would be because your right eye changed so much.
But this should not be your job, or mine. If a patient has a problem with the prescription written, most reputable doctors, will invite the patient to come back in and be re-checked, and usually at no charge. Now, your chances of receiving that invitation decreases significantly when you buy your contact lenses at Costco. In most cases, the doctor is counting heavily on the profit from selling the contact lenses to offset the usually rather low cost (or verylow reimbursement rate from the insurance company) of the eye exam. Your coming back in for a problem visit without having purchased the lenses from him cuts into his profits significantly.
Moreover, if the doctor did not supply the lenses, you are unlikely to be able to trade them back in at Costco if there is a change. This is why it is always better to get your contact lenses from the office that wrote the prescription. You are not just buying materials. There is significant service element that goes along with contact lenses and respect for the need for that service is why the doctor's office may charge a little bit more.
You might ask the doctor to let you come back in for a check-up AND that in the future you will purchase the materials from him.
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Placentra Johnston,
Thank you for taking the time to answer my initial question. What is puzzling to me is why I am having trouble seeing when I went through the trial lens process. I assume it is possible that Costco messed up the order, although I am sure it doesn't happen that often. And you're right, the Dr won't see me again (at least at no charge) based on the fact I didn't get the contacts through him (although I spent a lot more money on the glasses I ordered through him). However, my gut is telling me the prescription wasn't written correctly...that the final trial lens (which I had 3 trials for my left eye) isn't what was ultimately written. Plus I tried two different manufacturers (Accuview and Ciba) although I don't know if that would be a factor. When you look at my eyeglass prescription (I can see out f my glasses fine), how does that translate to contacts? I read that usually the prescription for glasses are stronger than contacts by .25 at least. Perhaps knowing how the eyeglass prescription translates will help me understand what may have happened.
Thanks again for your help.
Mary
Answer
Your contact lens prescription makes sense in view of the glasses Rx. However, the new contact lens prescription is stronger for distance (especially in the right eye) than the old contact lens Rx. This would make it more difficult to read if the increased power were not needed.
Did you try the little exercise I suggested in my first response?
It is indeed very possible that the Rx that got written does not represent the final trial lens you accepted. When there are multiple trial lenses used, it can take a lot of effort of the doctor's part to keep his records straight about which trial lens the patient finally accepted. But....unfortunately, the only one who can solve that for you is the doctor who wrote the Rx. Moreover, even if you and I were able to figure out what the problem is, you would still have to go back through the doctor to get him to rewrite the prescription. The optical shop at Costco is not authorized to change a prescription on the patient's say-so.
I am sorry for your unfortunate situation. As I see it, about the only answer is to bite the dust and pay for another visit with the doctor. ....OR - ask for a copy of all your records and take them to your old doctor (another paid visit of course) to see if he can figure out what you needed. I cannot do this online because in my status here you and I do not have an official doctor/patient relationship and I am not legally able to write or alter a prescription for you.
