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September 26, 2016
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Seeing Eye to Eye

When I was asked to make my benefits selections for my current job, one of my options was whether or not to select an optical plan. After looking over what I would be paying on a weekly basis, and what I would be receiving, it was obvious that I would be a fool not to sign up, and that I would do much better to select the more expensive plan (it covers antireflective eyeglass coating). After some issues with finding an available slot in my schedule, I went to my local Lenscrafters for a much-overdue eye exam.


Whether to see an optometrist or an ophthalmologist poses an interesting dilemma for those of us with well-controlled type 2 diabetes. Some nonreferral medical plans cover ophthalmologists under their specialist coverage; others refuse to cover ophthalmological care unless there is a definite, diagnosed medical issue other than the usual myopia, hyperopia, presbyopia, and astigmatism. The other horn of that dilemma is, under which type of doctor will we get the better, more-complete examination (and by inference, the better level of care).


I chose to go the optometric route for a couple of reasons. First, the ophthalmologist I've seen on and off for years (who also treats my mother) is in Queens -- meaning two hours' journey each way. Also, it is hard to schedule an appointment months in advance when I don't find out my week's schedule until a day or two before the week begins. The other reason is the examination technology. Because big-box-optical chains (such as VSP and Lenscrafters) have more capital behind each location and a greater variety of revenue streams (i.e., exams, eye glasses, contact lenses, nonprescription eyewear, and accessories for all eyewear), they are able to afford more sophisticated diagnostic equipment than the average ophthalmologist, and can keep their doctors more up-to-date on standards of care and diagnostic techniques.


One of the first things I was presented with upon signing in was a non-covered "upgrade" option to the standard dilated-eye exam. For an additional cost of $39, I could choose to have the practice's OPTOS system photograph my retina without need for dilating drops. Since the dilating drops tend to leave me functionally blind for hours after the exam, and the OPTOS system would also give a better view of my retina (not to mention a permanent record), it was a no-brainer for me. And I got a copy of the images to add to my personal medical record, to boot.


The exam was, in medical terms, "nonremarkable" -- in short, no diabetes- or age-related degeneration other than a slight change in the cylinder and axis of my prescription, and an increase in the magnification of the "reading" portion of my bifocals. However, the doctor suggested I move from bifocals to "progressives", which are supposed to be a kind of multifocal lens that gives variable correction for variable distance. They were described as linearly progressing from reading vision through intermediate/computer vision through to distance vision -- kind of like moving from bifocals to trifocals to tetrifocals, and taking the lines away. Progressive lenses are an important upsell for an optical boutique, as they can add $100 or more to the price of a pair of glasses.


The best thing I can say about progressives is, "it sounded like a good idea at the time".


The honest-to-goodness truth about progressives is, it's like giving your eyes an immediate case of advanced macular degeneration. Rather than linearly progressing, there were tiny blotches of "you're supposed to look here" surrounded by a universe of spherical distortion. There was not a single spot in which both my eyes could focus clearly on a given distance, nor a single distance at which either eye could focus clearly on its own. The peripheral distortion was so bad that it was like trying to see the world through a bowl of jello. The optician insisted the key is to move your head, not your eyes. Well, the way I was taught, the first time anyone says that to you, don't walk -- run in the opposite direction, as fast as you can. The reason we have eye muscles is to use them. We need peripheral vision. We need to be able to see what's coming at us out of the corner of our eyes when we can't turn our heads any further. We need to be able to read more than a letter on a page at a time. We need to be able to read the road signs and see the pedestrians (especially the idiot pedestrians who wear dark clothes after dark and don't look for traffic before darting out into the middle of the street and staying there). And if you can view any peripheral distortion, those lenses should be rejected outright.


It doesn't hurt that when I spent some time trying to learn more about photography, I picked up the habit of viewing the entire lens, not just the center part. I see, will see, and will always reject, lenses with peripheral distortion.


After about an hour of headaches trying to see anything through those godforsaken pieces of upsell garbage called "progressive lenses", I finally got back to see the optometrist again, double-check the prescription, and insist on going back to bifocals for everyday use. (When I get my cycling glasses, they will be for distance only, because they don't come in bifocal. I'll deal with changing flats bare-eyed if I have to.) It will take another week or so until (what will hopefully be) the correct lenses for me come in.

The upsell of the matter? After the insurance coverage, I'll still be paying $99 less for a much superior set of lenses.

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