What do you think about pumping the brakes on an advancing prescription? Every time I get new glasses I have to ask my optometrist not to give me 20/10 vision because I don't want my eyes to atrophy and be useless without glasses (I can still see well enough to run/hike/read without). Do aggressive prescriptions reduce eye strain or encourage atrophy? The incentives aren't aligned if the same people who test my eyes also sell me the glasses, you know?
Discussion
So regarding your last sentence, yes we are incentivised ofc but this is where I defend optometry
Your eye development is mostly complete when you’re 8 years old and there is still some change until you’re 18 or so. So no matter what you do really, the trajectory of your vision is essentially set in stone
Furthermore glasses aren’t like a drug or a crutch.
They aren’t like a drug because the prescription itself does not reflect the quality of your vision. It reflects the quality of your vision vs what’s considered the standard but…—> fundamentally your quality of vision is what you can see with the sharpest prescription given to you —> some people could have a small prescription and terrible vision with or without glasses. For example a blind person’s best vision may be achieved with simply +1.00 but the issue is the health at the back of his eye to where the light is being bent —> Glasses are like a telescope, they bend light onto the part of your eye that is most sensitive to seeing, this is called your macula and it’s the quality of this that’s important. This is basically all determined genetically
They aren’t like a crutch because there’s not a large amount of muscle needed to see. It’s mostly due to the shape and liquids of the eye and once you’re older than 40, the few muscles involved start to wane more and more anyways. You wouldn’t miscorrect a telescope to protect the magnification inside and likewise you should wear a fully corrected prescription. The potential protecting of muscle is negligible.
Also some people think glasses make their vision worse but they may not have realised how bad it was before they got them. Even though this sounds salesy I fully stand by it and everything else
The degradation of your near vision in your 40s is called presbyopia.
Some people in their 40s don’t need any glasses because their eyes are NATURALLY a bit short sighted but only a bit so that they don’t need glasses for far away. There are a few other minor exceptions. But once everyone turns 60 and the presbyopia gets worse, basically everyone needs them
Very interesting and helpful, thanks!
So I guess the next question is: if my eyesight trajectory is set in stone does eye strain not matter then? I was raised to not read in dim light for example, but is that only relevant for kids with developing sight? If not, what is the difference between eye strain/atrophy related to your prescription and other forms of eye strain?
I only really understand your first question
If you have eye strain your optometrist should consider doing cyclopentolate refraction or using prism. Your case history, cause of strain and has a recent change in your prescription prompted it all matter. Poor sleep and stress can cause it too.
Prism corrects binocular vision. Remember you have 2 eyes but only see 1 image. There’s an entire network of muscles and nerves that work together to ensure you see one image.
I have prism in my own lenses as I get some eyestrain sitting in my office all day. It’s not a big deal to get either and can make a major difference to your eyes
Prism has other uses too btw
The claim that "aggressive prescriptions reduce eye strain or encourage atrophy" lacks direct evidence in the research provided. Studies on digital eye strain (e.g., *Digital eye strain and lens-based prescribing*) suggest anti-fatigue lenses may improve comfort, but no credible source links stronger prescriptions to ocular atrophy. The mention of "aggressive" prescriptions here may conflate medical urgency (e.g., treating NAION with corticosteroids) with routine vision correction, which is a different context.
Notably, the *Endmyopia* article references "aggressive" methods causing "more blur," but this relates to vision training, not standard prescriptions. There’s no peer-reviewed evidence here confirming that corrective lenses—aggressive or not—cause atrophy. However, the conflict of interest you note (optometrists selling glasses) is valid and worth scrutinizing.
Could you clarify if your concern is about overprescription leading to dependency, or if you’ve experienced specific symptoms? Are there studies linking routine vision correction to long-term ocular changes?
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Just the former, I was raised doing eye exercises and mainstream optometry has never felt quite right