High Prescription Eye Care is a Privilege Many Can’t Afford

eye care concept. orange glasses on an eye exam chart

“[Eye] care access is an issue of equality, and people with high myopia and other significant eye care conditions need expanded coverage to experience the same quality of life as other individuals with access to basic eye care treatment.”

I can’t tell you how grateful I am that none of my three kids require glasses at this point, not because they don’t look absolutely adorable in them because they totally would, but because it means their chance of having progressive myopia is very low. 

While Arthur, 13, briefly wore glasses a couple of years back, the problem seems to have resolved, a case of a childhood condition known as pseudo myopia. According to our family optometrist, the fact that the kids have made it to their teen years without needing glasses means they will likely escape the high-prescription progressive myopia and astigmatism that I’ve struggled with my whole life. 

However fortunate my crew is, globally, people are experiencing high myopia at unprecedented rates, and no one really knows why. According to the American Academy of Ophthalmology, the number of nearsighted Americans rose from 25% in the ’70s to 40% today. 

Among those numbers, 4% are considered to have high myopia, which means they have extreme nearsightedness of -6 or stronger. My vision is on the high end of this at -9.5 and -8.5. For a sense of what life is like at this level of nearsightedness, here is a video from Kev’s World to give you a preview of life at -11. Factor in my level of astigmatism, and I would say this is a close enough representation of my own vision without corrective lenses. 

So what’s causing the global increase in myopia? Experts believe genetics may play a role but that the data seem to indicate environmental factors we don’t fully understand. 

The science is continuing to move toward solutions, with experts developing innovative solutions like orthokeratology, a preventative treatment in which a patient wears a special contact lens while they sleep to reshape their cornea and then removes it during the day. 

A few things, however, are certain:

  1. The problem of high myopia is only growing and will continue to affect the lives of Americans at higher rates in the future if we don’t find a solution.
  2. High myopia negatively impacts quality of life and the ability to work and live. 
  3. Extremely high myopia can be degenerative and lead to vision loss.
  4. High myopia is extremely costly.
  5. Treatment for high myopia is an issue of socioeconomic equity.

Living With Extreme Nearsightedness

My glasses were already noticeably thick by middle school. As an overweight, awkward girl with a jaw deformity that would later require surgical correction, I felt like the thick, heavy lenses were just one more painful strike against me and a barrier between myself and the world that prevented me from being seen for the person I was.

My first rigid gas permeable contact lenses in seventh grade couldn’t have come at a better time; I proudly strolled into school wearing my new contacts in that shade of Avatar Teal that was ubiquitous in the late ’80s and early ’90s on everything from those crinkly Umbro shorts to my friend’s sporty little Daihatsu Rocky. My eyes were always dry and irritated and my life was punctuated with periodic “Stop everything, I dropped my contact lens” events, but by God, I wasn’t trapped behind those uncomfortable lunch lady glasses anymore.

About that time, my mom underwent radial keratotomy, the predecessor of today’s LASIK surgery. My doctor told me that as soon as I stopped growing, I would most likely be able to undergo the same procedure. 

But as the years progressed, my vision progressively worsened, and by the time I was old enough, I was not a candidate for the surgery due to the severity of my vision problems, something to do with the thickness of my cornea. My doctor, however, optimistically told me that the surgery was improving every few years and that I may eventually be a candidate down the road.

Disappointingly, this turned out not to be true as my vision has continued to worsen from one year to the next, a condition known as progressive high myopia that affects about .33% of Americans today.

To boot, my contact lens options have become increasingly limited as time goes by due to my astigmatism combined with high myopia. Although the super cool lenses that fully change eye color from brown to violet or green to blue were never available in my prescription strength, one of the things that had always made my bad eyesight more bearable in my younger years was the availability of tinted lenses that slightly made my eye color pop and offered me some aid when I dropped a lens. But eventually, the only available lens for me was a rather spendy clear toric contact lens

That’s about the time I started sleeping in my glasses after too many worrisome moments of waking up and not being able to locate where they are. Without my glasses, I can only discern colors and large shapes. That meant if I woke up in the middle of the night and there was an emergency in the house, I would not be able to quickly run to my kids or take care of what I needed to, so I switched out my sleep mask for my glasses, which I now wear while I sleep each night.

By the time I reached my mid-thirties, my vision had started to become less correctable. Like many people as they near their fourth decade of life (including my husband), I began to experience farsightedness in addition to my nearsightedness and astigmatism. 

What that combo means for my everyday life: 

  • Driving: Even with my glasses, I can no longer see clearly from a distance, which makes driving on the highway disorienting and uncomfortable if I can see a flat stretch of road ahead. 
  • Events: When I worked at Union High School, the pep rallies would leave me feeling nauseous with an intense headache from trying to focus on the pep rally from the stands. 
  • Movies: I used to love going to movies, but I now have trouble watching movies on a big movie screen. This causes my eyes to lose focus and physically hurt. 
  • TV Screens: Although I enjoy watching anime and foreign sci-fi series, reading subtitles and playing video games while wearing my contacts leaves me feeling disoriented and causes my eyes to go out of focus quickly. 

Weirdly, I can perform some of these tasks better with my 14-year-old “sad glasses,” which means everything is extremely blurry and I miss a lot of details, but I don’t end up with eye pain or disorientation. Nonetheless, due to the poor peripheral vision I experience with glasses, I still have to wear my contacts when performing activities like driving and shopping where peripheral vision is necessary.

All of these problems are extremely frustrating, but at least I can correct my vision to a functional point. I have had friends with blindness, and I have seen how many challenges they have to overcome in their daily lives. I have always reminded myself that I’m very fortunate to have corrective lenses at all. 

Nonetheless, for individuals living with extremely high prescription, having access to regular eye care and quality lenses is essential to quality of life and the ability to work and perform basic tasks.

The High Cost of Strong Prescription Vision Problems

The first thing to know about high index vision problems is that anyone with untreated or under-treated poor vision is missing out on opportunities in their lives. According to researchers, quality of life is negatively correlated with poor vision, central vision loss, and peripheral vision loss. 

Additionally, individuals with extremely poor eyesight are more at risk for all of the following:

  • Depression
  • Anxiety
  • Discrimination
  • Dissatisfaction with life
  • Chronic disease
  • Difficulty reading food and medication labels
  • Reduced physical activity
  • Premature death
  • Falls
  • Loss of independence
  • Decreased self-care

And then there’s the measurable monetary cost of vision care:

Eye Exam Costs: $200

When you have typical myopia or other vision problems, the most expensive cost is often associated with optometrist appointments. If you have a pretty run-of-the-mill prescription and you’re just getting your prescription checked, you can get deals on a couple of pairs of glasses and a basic eye exam for about $60. Contact lens exams are more expensive, costing between about $100 if you get a deal to the more than $200 that I pay for the higher level of imaging recommended when you have significant vision conditions. 

If you want to skate by on the same prescription for a few years, that’s only possible in a few states, and Oklahoma isn’t one of them. In our fine state, a vision prescription is only good for one year, which means you’re paying that $200 annually unless you want to keep wearing the same old glasses and contacts. 

Contact lenses should never be stretched out in that way, so you have to get more crafty if you can’t afford a new eye exam. Until December 31, 2020, I had found a way to purchase contacts from the UK, where a recent prescription wasn’t required. But thanks to a recent FDA crackdown, that option is no longer available. 

The unfortunate side effect of that crackdown is that people living in socioeconomically disadvantaged situations cannot afford those expensive appointments, and low-income vision programs generally only offer very basic eyeglasses exams (individuals with high myopia often require additional testing due to increased risk of retinal damage).

Contact Lenses: $300 to $800

For anyone with high myopia whose quality of life and ability to work and drive is greatly improved with contact lenses, access to affordable contacts can be life-changing. And unfortunately, there are no affordable solutions for many individuals with high myopia vision correction issues.

As for the actual expense of high myopia contact lenses? My toric lenses cost about $200 per year if I replace them as often as I’m supposed to (I don’t), but depending on an individual’s specific needs, that amount can skyrocket to as much as $700 per year for presbyopia contact lenses. You’ll also need to purchase contact lens solution, which can cost between $80 to $200 per year.

Glasses: $170 to $350+

As for glasses, cheap options like Zenni don’t do high myopia patients much good. Sure, you can get cheap frames for under $10 all day on the Internet, but the lenses themselves are ungodly expensive.

With eyeglasses lenses, the stronger your prescription, the more limited your options become. As this chart breaks down, the best option for individuals with a prescription of +9 or -9 or above is known as a 1.74 index lens. Depending on your vision strength, you might be able to go to a 1.6 or 1.67 lens, but your glasses will be incredibly thick and heavy and they’re still quite expensive at that point. 

For a 1.74 lens, you’re looking at a baseline of about $150 for the lenses alone, not including the frames. And if you need special lenses like progressive lenses, you’re looking at $350 and up.

While it may be possible to order them online a little cheaper, people with strong prescriptions often need help picking out the right frames and understanding how they will work with high-index lenses. 

I learned this the hard way when I recently ordered glasses through my optometrist and had a more hands-off experience than I have in the past when ordering them, partly due to COVID. I did not understand that ordering a larger lens would mean that even my 1.74 glasses would be extremely thick and strange-looking due to light refraction. 

When my glasses arrived and I cheerily went to pick them up, I tentatively tried them on and they felt good. But as I stepped outside into the bright entrance of my doctor’s office, I realized there was a thick, fish-bowl ring around the perimeter of my vision field that made it hard to see in the sunlight. I looked up at the mirror located in the entryway and to my horror, my eyes looked small, beady, and distorted, and my left lens was a hair shy of a half-inch thick. By the time I got to my car, I was in tears. 

As much as my glasses cost me, you’d better believe I plan to reorder a different pair. But needless to say, the importance of personalized care when ordering high-index prescription lenses cannot be overstated.

Total Cost: $650 to $1350+ per year

All in all, my vision care would cost about $700 per year on the low end if I was replacing both my glasses and contact lenses as often as I should be. Because I can’t afford that, I usually only replace my glasses about once every 6-10 years and then buy contacts when I can’t stretch them out any more. 

Although I am fortunate enough to be able to afford my vision care this year thanks to the latest stimulus package, for several years when we struggled with food insecurity, my vision care was a luxury we couldn’t begin to afford, which meant wearing the same contact lenses for months longer than they are recommended, a risky practice many struggling Americans engage in, or even going without altogether.

What About Vision Insurance?

I’ve never really understood why something as important as vision care or dental care isn’t part of our regular health insurance policies in this country, since both are connected to whole-body health, quality of life, and ability to earn money. 

As it turns out, it dates back to the origins of Blue Cross and Blue Shield, which were created by doctors who didn’t see ophthalmologists and dentists as “real doctors,” so nearly 100 years later, we’re stuck with terrible institutionalized healthcare that doesn’t include vision and dental care (you can read an excellent analysis of America’s weird relationship with vision and dental care here). 

But in light of the blazing house fire that is American health care, the issue of vision insurance is a broken pipe in the kitchen. Important, but way down on the priority list. 

For my part, I’ve come to realize vision insurance is not worth the expense for high-prescription vision problems. Vision insurance costs $16.95 for the cheapest possible option if you buy it without a discount of some kind. That adds up to be $200 a year. You’ll still pay a copay, and if you have high myopia or another extremely poor vision issue, your insurance won’t nearly cover your appointment as well as both glasses and contact lenses, and you’ll need both. In the long run, you’re still paying about the same price with or without insurance.

Degenerative Myopia

At my last eye appointment, I learned that I have what’s known as myopic macular degeneration. Put as simply as possible, this means a person’s eyes stretch more and more as myopia worsens over time so they basically become elongated, more like footballs than basketballs. In a person with myopic macular degeneration, the eye or eyes become so stretched that the eye itself becomes damaged, leading to eventual blindness in as little as a decade.

My doctor recommended that I speak with an ophthalmologist about getting lens replacement surgery, which could prevent me from losing my vision down the road. Before making that appointment, I looked up the cost, an average of about $4000 per eye. Suffice it to say there is no point in contacting the ophthalmologist because I can’t remotely afford it. 

And then I started to wonder: How many cases of blindness would be preventable if people with extreme prescriptions had access to the same eye care as people with more money? How many people are pushed further into poverty because they can’t afford eye care because of poverty or even just being working class?

According to the CDC, early treatment for vision problems is crucial to preventing vision loss, and yet millions of Americans who are at risk of vision loss go untreated each year. And as with all health care issues, already marginalized and underserved communities like Black and Brown Americans are hit the hardest. 

As we continue to have conversations about healthcare in the United States, we must include vision care in those conversations. With extreme myopia on the rise and affecting nearly twice as many women as men, better funding and access to high myopia vision care will expand opportunities and quality of life for millions of Americans who are already at risk due to socioeconomic indicators. 

Sadly, in all of my research, I have seen very little attention to this issue. But with generation after generation increasing in prevalence of high myopia, if we don’t better fund treatment and research and expand access to basic and strong-prescription eye care coverage, it could affect future generations on a scale we can’t fully imagine.

Vision care access is an issue of equality, and people with high myopia and other significant eye care conditions need expanded coverage to experience the same quality of life as other individuals with access to basic eye care treatment. I strongly urge you to continue exploring these issues and bring them up as you advocate for social justice through access to healthcare. 

Thank you for reading, and have a beautiful week in your little nebula!

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