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Eye doctors typically pride themselves on being able to improve someone’s vision through glasses or contact lens prescriptions. Whether it’s a first-time glasses wearer, or someone having either a small or large change in their prescription, we like to aim for that goal of 20/20 vision.
Despite our best efforts, however, correcting vision to 20/20 is not always a positive outcome for the patient. Whether someone will be able to tolerate their new prescription is based on something called neuroplasticity, which is what allows our brains to adapt to changes in our vision.
You or someone you know may have had this happen: Your vision was blurry, so you went to the eye doctor. The doctor gave you a new prescription, but after you received your new glasses, things seem “off.”
Common complaints are that the prescription feels too strong (or even too clear!) or that the wearer feels dizzy or faint. This is especially true with older patients who have had large changes in their prescriptions, since neuroplasticity decreases with age. It is also more likely to happen when the new prescription has a change in the strength or the angle of astigmatism correction. Conversely, this happens less often in children, since their brains have a high amount of plasticity.
Quite often, giving the brain enough time to adapt to the new vision will decrease these symptoms.
Whenever a patient has a large change in prescription, I tell them that they should wear the glasses full
For over 40 years the standard surgical treatment for glaucoma was a procedure called a trabeculectomy.
In a trabeculectomy, the ophthalmic surgeon would make a hole in the wall of eye to allow fluid from the inside of the eye to flow out of the eye and then get resorbed by the blood vessels in the conjunctiva (the mucous membrane that covers the white part of the eye).
This surgery often resulted in a large decrease in the Intraocular Pressure (IOP). Reducing the IOP is the goal of glaucoma surgery because multiple studies show that if you can reduce the pressure the progression of glaucoma slows.
The problem with trabeculectomy is that although it frequently lowers the pressure, it also has a fairly high complication and/or failure rate. This led to some reluctance to perform the procedure unless the glaucoma was severe, or the pressure was very high. As a result of those issues there has been a search during the last 40 years for something that had a lower complication rate and could be more easily deployed earlier in the disease process.
Enter Minimally Invasive Glaucoma Surgery, or MIGS. There are now several types of surgeries that fit in the MIGS category and many of them are used in conjunction with cataract surgery. They are utilized much earlier in the disease process and when combined with cataract surgery they can be used to not only help control the pressure over the long term but can
