A patient returns for a 2-year exam, and her vision today with glasses is 20/70. Two years ago, she was 20/25- with the same prescription. You performed a pinhole test, which improves her vision to 20/50+. This most likely indicates:

A. The glasses were filled incorrectly.
B. A new refraction should improve her back up to 20/25-.
C. She has dry eye.
D. There is some type of ocular pathology present.

The patient's change in vision despite using the same glasses prescription and the partial improvement with a pinhole test potentially indicates some type of ocular pathology. Age-related stiffness of the lens, or presbyopia, may be a factor but typically does not account for this level of vision change.

Explanation:

Based on the provided information, option d - there is some type of ocular pathology present seems to be the most probable answer. In a typical eye with a 2.00 cm lens-to-retina distance, the power of the eye ranges from 50.0 D (for distant totally relaxed vision) to 54.0 D (for close fully accommodated vision). Ability to accommodate decreases with age, often due to stiffening of the lens. This condition, known as presbyopia (literally, elder eye), results in difficulty seeing close objects clearly. Reading glasses, rated by their power in diopters, are commonly used to correct this condition. The change from a vision of 20/25- to 20/70 with the same glasses prescription over two years and an improvement to 20/50+ with the pinhole test might suggest some kind of ocular pathology, not simply an incorrect prescription or the common age-related presbyopia.

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