Afraid to increase eyeglass power, but need to!

I need to increase my distance glasses’ power, as the pair I’m using are too weak and not giving enough stimulus. Thing is, I’ve been way undercorrected for over 10 years, never wearing full power, and rarely wearing something close to it. I’m looking to slowly work up to a full normalized power. The glasses I’m currently wearing are roughly 1D below a full correction, for perspective. So, normalized is likely in that ballpark, which is quite a ways from what I’m using now.

I’m planning to increase in single 0.25 increments. I messed around with the next higher correction, and things look pretty good…there is some slight blur, mostly in low light, but a good amount of (subtle) multiple images, etc…which I understand is totally normal.

The problem is, I’m afraid to look through stronger glasses. I know I need them, but I’m afraid of making myself more nearsighted, especially when I look at things within a couple of feet from me. Is this fear justified? Do I really have to take them off or switch to a differential everytime I look at something nearby? Or is this just me being worried? I mean, I think I can see a little bit of hyperopic defocus when I look near…even though the glasses are still quite a bit away from a full normalized. Due to weaker glasses, I’m more used to stuff focusing better on the peripheral retina, rather than the center, or foveal area.

Also, even though my intermediate-to-near vision is by no means perfect, near is still substantially better with no glasses than with a differential or normalized, or any glasses. I just have to get real close. The quality of the image with glasses has never been as good as without them…there is always some slight blur at near…possibly a combination of hyperopic and myopic blur. But my ophthalmologist once said to me “You have very little astigmatism…actually, you really don’t have any. Your eyes reject it every time it’s put into the phoropter.”

Also, I’m the type of person who measures way high on autorefractor readings. I had one about a year ago, and it said -5.75! That is craziness, and is about 2D over a crisp 20/20 correction for me.

And a second question: I was thinking of giving it the traditional 6-8 weeks, or possibly longer, to get used to each power increase. Sometimes, I feel like I might need even more time than that. Any advice on this?

I did throw some numbers in here in this post, but they’re strictly for perspective…I’m not looking for diopter-specific advice, and I know it’s not allowed…I don’t want anyone getting the wrong impression!

Thank you in advance!

Thanks!

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As someone who has stepped up training glasses, I can recommend it. Went up to -3, which for my right eye was the strongest I’ve ever worn, and then went down to -2.75 again. Worked great for all I can tell. The same optometrist office lowered my right eye’s full prescription from -3.5 to -3 as I was transitioning back down.

There’s little reason to be afraid of focusing near for short periods. If that were a problem, every normal human who looks at some close stuff every now and then would become super nearsighted. Similarly, there’s little reason to be afraid of using minimally undercorrected distance glasses; if that were a problem, everyone with full correction would have rapidly progressing myopia.

This sounds unusual, unless you have presbyopia… could it be that you’ve been undercorrected for so long, your visual system has forgotten how to accommodate properly?

I can almost plant my face on the screen, even with distance glasses on, and still see a very sharp image. For me, more lens power usually means a crisper image, or at least the quality stays at the same, high level while I’m in accommodation range. The peripheral hyperopic defocus from strong glasses is there, but even with -3 glasses, I didn’t intuitively notice it while in accommodation range.

This also sounds like a problem with accommodation, but in the opposite direction. I’ve done a number of autorefractor measurements, and some were off quite a bit, but never by more than a diopter.

This is a total shot in the dark, but maybe try to train your accommodation and see if you can cause any change in how you are focusing. The ciliary muscle can be consciously controlled, so there’s a chance that something in your control is off and needs some stimulus to hit the mark again. I don’t know much about this, but IIRC there are a lot of ideas about this in behavioral optometry. Again, I’m just guessing wildly, but who knows, maybe it applies to you.

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@Varakari, thanks for the reply. Regarding accommodation, I wasn’t going to delve into this in this depth, but will now to address what you wrote. I almost definitely have always had accommodative issues…most likely convergence insufficiency…which ironically, can be protective against myopia if someone is only looking near for short periods of time…the problem arises when the person (usually a kid) doesn’t accommodate enough during extended close work, and then those nasty hyperopic defocus signals get sent to the visual cortex, and we all know what happens after that.

I think some of these tendencies run in families (the so-called genetic basis of myopia). My mom always had discomfort with her distance glasses at near, as well, from a young age.

If I do too much near work (especially with fine detail or computer screens, or lack of breaks), I seem to develop transient myopia that can last days if I don’t do something about it. Plus-lens fogging with +3.25 glasses can eliminate it for me, which I found out accidentally about a year ago. Basically I put them on, look into the distance for about a minute, and then focus back forth between something nearer and something distant a few times, but not too quickly or abruptly. The whole process takes less than 5 minutes. Sometimes, the distance vision improves so much that it seems to even overshoot the original condition when I remove them…occasionally, I’ve gotten a slightly veiled 20/80 or so after doing this. That’s why I estimate that my true refractive state is around or a bit below -3. I mean, 20/80 is what you’d expect from someone who is under -3 as opposed to over -3…actually, drastically under, in most cases.

I’ve started learning to do it without the plus, too, as you suggest. Not easy, but it does work to a degree.

So, I do feel I have a degree of accommodative/vergence dysfunction…over accommodation coupled with under-convergence. I would like to eventually go to a good behavioral optometrist, but it’s not in the plan at the moment. I want to do as much as I can on my own, first. The right glasses do seem to help recalibrate the system to some degree, which is a good thing.

May I ask you if you’ve ever experienced temporarily increased ciliary spasm/myopia after viewing at an intermediate or semi-near distance for more than a few minutes when you were wearing the “strong normalized”?

I fully expect I may have to eventually go beyond -3 with my normalized, for a short time. The way you did it is actually the way I was planning to do it…step it up until it hits the right threshold, and then step it back down again when appropriate.

Did you stick to 2-3 months per lens change?

Wow! You’re more brave than I am…I would never want to try something that extreme!

Another question for anyone here…

I have this idea in my head that it’s bad to wear normalized once your eyes get fatigued (ciliary spasm/loss of contrast sensitivity) from too much screen use.

I don’t know if there’s anything solid to back this up…it’s just how I feel, intuitively, because my vision is lowered afterward. I figure putting on distance glasses at that point can’t be a good thing, so avoid it. But maybe I’m just overreacting again?

This one issue is probably my biggest obstacle to getting back on the road to consistent normalized lens use…possibly even bigger than the fear of looking at near objects through them. So, every time I do a lot of screen use and get fatigued after, I avoid distance glasses for a day or several afterward. I also revert back to lower diopters. Obviously, if I keep doing this, I will never be able to wear them and can’t improve properly! I think it was the fact that I read a lot of stuff by the Bates-teacher crowd when I was first starting out, and these fears came from that stuff, I believe. A lot of those people used drastic undercorrections, or promoted it, because they felt all glasses were varying degrees of bad. Obviously, we know better than that! Please help me get past this one, too!

I know logically that it shouldn’t hurt to use normalized on fatigued eyes, right? But I still want to hear feedback from others and see how it went.

Hey, I had the same fears as you actually. I spent the last 7 years probably about -1.25 diopters of undercorrection as my “normalized” in practice, but really didn’t use it that much. Like you I would think glasses were the reason my eyes were getting tired.

I just spent the last 6 weeks or so with a full prescription! The longest ever in my entire life actually, I’ve always used glasses as a temporary crutch, which meant that a big chunk of my life was just blurry and not very fun from a visual perspective.

To give you an idea of what I’ve been doing, I use -1.75 undercorrection from my full prescription and it lets me sit about 70cm from the screen at work. Otherwise, I use the full prescription for distances beyond the computer only, and limit my close up time with full prescription within a computer distance to less than 10 seconds at a time, always resting my eyes somewhere farther.

The result is that my cm went from 27cm when I started to 37cm. My eyes don’t hurt with the full prescription, actually, in part because I convinced my optometrist to lower it to a comfortable 20/20. It has since improved to 20/15, and is mildly uncomfortable to wear now after 6 weeks. But this is a sign that I experienced very fast reduction of up to -1 diopters within the first 3 months (I’m -0.75 down from my full prescription if I go by cm).

The key is that when you’ve spent a lot of time in blur, you’re very likely experiencing blur adaptation. Wearing a strong pair of glasses is actually beneficial in this case to overcome the blur adaptation and to reset your mind’s image of the world to full clarity. Doing this has resulted in more clear flashes in the morning actually, and sometimes I’ll flash all the way to 20/20 with my naked eye for a good 10 seconds. More realistically though, the biggest change is that my eyes do not hurt anymore.

Often your eyes may be tired from undercorrection because you’re inadvertently squinting, and your visual cortex is working overtime to figure out what it’s seeing. Too much undercorrection, from my experience, just makes the eyes sting and become dry, and is not that helpful in the long run.

Anyways, long story short: it’s worth it to wear the strong glasses to help you reset to clarity. You want to expect clarity – this is how you can harness blur to your advantage, by using a mental image of clarity as your reference. Don’t be afraid of them. Check yourself against a Snellen and you should be able to make your own decisions regarding a proper normalized.

EDIT: I also wanted to address fatigued eyes. I had really badly stinging and dry eyes all the time using only 1 pair of glasses. What worked for me to avoid fatigue was to use a differential that lets me sit 50cm with full clarity from the screen, and take frequent breaks (every 20 minutes, take a 5 minute break). Otherwise, I used my stronger pair (full). A couple days of this helped eliminate the strain, and after 3 weeks of this, my eyes are no longer chronically fatigued. Going to reduce very soon down from the full prescription.

I also combined using the proper glasses with occasional hot towel masks on my eyes to unclog my meibomian glands. You can find microwaveable eye masks in drug stores, but I just run a small hand towel through hot water and put it on my eyes for 10 minutes as needed for dry eyes. I was doing it a lot for 2 weeks and now I only do it every few days.

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@hellothere, thank you so much for the reply! I tried to like it more than once, but obviously that doesn’t work!

This basically reassured me that I’m doing the right thing…because it worked for you, I feel more confident doing it now. It sounds like we had almost the same situation with undercorrection.

The similarities don’t end there. I have meibomian gland issues, too. A lot of people have it and don’t understand why their eyes are dry, burning, stinging, etc. It’s so common. I have to use warm compresses at least twice a day. If I don’t do that, combined with a shower, I feel lousy. Been doing it for many years now, and it stays under control if I do that. Today, I didn’t have to be anywhere and was busy on the computer, so I didn’t shower and do the compresses until late. All day, skin oil was probably dripping into my eyes, making it worse. My dad has the same issues and handles it in the same way, with warm soaks. One of my old college roommates had it, too, but didn’t handle it that way. He occasionally used packaged lid wipes. He had issues with it because of that. And his dad was a medical doctor. He was also highly myopic at -8 and looked through full correction for fine detail close work for hours on end, but that’s another story.

I got off on a tangent. But thank you so much for the reply! I’m going to do it slowly, because when I’ve tried in the past, I did not take well to full correction all at once. I’m going to go up 0.25 at a time. I’m not sure how long I’m going to stay with each strength…but I’ll measure my far point regularly and log it to make sure I’m going the right direction. It should increase from around 29/30 cm where I am now, as I go up in lens power…I totally agree with the theory behind that, and your experience illustrates that it does indeed work that way…you have to get the light to focus at the central retina to get good, comfortable vision.

Edit: this is going to be a long road…it’s going to take me months just to get to a full normalized. I’m not sure how high I’ll end up going…but if I have to, I’ll go all the way up to whatever my refractive state indicates I need from my centimeter measurements. I doubt this will be -4, but it may be close to that. I already have all the glasses I’m going to need, with some on order as of a few days ago. I was actually thinking of going all the way up to -3.75, -3.5 a few weeks before my eye doctor appointment, and then walk in there with those and hopefully get 20/20 with them during the screening part of the exam and have them use them as the starting point for the subjective refraction. We will see, though…it’s impossible to plan ahead the numbers with total confidence. If I really need to go one stronger before the exam, I can always order one more pair that’s -4, -3.75 when I get to that point. I doubt I’ll need to, though…my last correction from that particular doctor was -4.25, -3.75, so I shouldn’t need to go quite up to -4, -3.75 (remember, I dropped another 0.25D of my anisometropia over the years). And I didn’t go to them for quite a while, so I can tell them that a previous exam at another office (which is technically true) was responsible for what I walk in wearing.

Ok, I have one more fear…

At the eye exam itself, when I get to that point…I have this fear that I will perform worse on the autorefraction and subjective tests if I wear my distance glasses immediately before taking the tests.

Can anyone comment on this one? It’s enough to cause me physical anxiety when I sit in the chair!

I actually had headaches adjusting to the stronger glasses in the beginning, but it was interesting. It wasn’t the familiar stinging eyes “wow this is too strong” kind of feeling. It was more like my brain was overloaded with more information than it knew what to do with and I had headaches for that reason.

It lasted about 1 day luckily, I had hit the nail right on the right prescription.

That’s a fine idea to slowly increase if you think that will help you.

As for the autorefractor, I did in fact perform poorly on it, and my first eye appointment was after a long day staring at the computer at work with no breaks (oops!). I was overprescribed about -0.5 and falsely prescribed a light astigmatism. I returned 2 weeks later to fix it and now I’m doing well.

Don’t be too afraid of the result of the eye exam. You need it to check for diseases. Whatever prescription you end up getting, you can safely treat that as an upper bound, and pick something slightly weaker than it as a starter (this is what I did). For reference, my prescription was going to be OD -4.00 OS -3.50 -0.25 060, but I was able to change it to OD -3.5 OS -3.5, which was initially hard on my right eye, but it eventually adjusted and my eyes have equalized. I wouldn’t recommend this in general because Jake has repeated very often not to monkey with lenses and just slowly decrease instead and equalize later.

Anyways, I don’t think you should be too worried about the prescription numbers per se. The biggest thing that has helped me was adjusting my habits and my lifestyle. Making sure to use the differential glasses for close up and normalized for everything else has really helped me regain a lot of control over my life, as I’m no longer stumbling using blur adaptation anymore.

Try to spend more time with distance vision as you can. I aim for at least an hour outside reading signs, and ideally 4 hours or more for a ratio of at least 25% distance vision and 75% close up vision, assuming I’ll be awake for 16 hours.

As Jake often implies or repeats: distance vision improves distance vision. The glasses are a tool to help you get back to 20/20. Address the habits and you’ll find that things will clear up with time, pun intended!

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Interesting story @FMR!

I can’t answer this, since I haven’t done static near work with overly strong glasses for more than a few minutes since last spring or so. I’m quite consistent when it comes to such things; I either stop after a few minutes or fetch weaker glasses. So I’m very consistently either at low accommodation or slight myopic defocus. In other words, I keep undercorrection low, but I don’t overcorrect for a near work task either.

I believe to see some additional myopia after near work, even when using weak glasses, especially when the weak glasses don’t get me to good focus. Feels like something malfunctions when an eye can’t “lock on” to the screen. But this is not a very strong effect, so it’s hard to tell how much is from lighting or fatigue, rather than ciliary muscle spasm.

I used the -3 for training for exactly three months, from the end of May to the end of August. This wasn’t a consistent 100% usage, but rather I jumped up, and then slowly went back to -2.75 on a task-by-task basis, starting with noon sunlight walks and ending with projector use and indoor badminton.

Since mid-October, I’ve been phasing in usage of -2.5, but results are ambiguous so far. I don’t expect to finish this transition in under four months at the current pace. Might be a winter issue, time will tell.

I don’t think there’s any risk involved in doing some focusing experiments for less than a minute. The exposure time is just so low. The eye generally doesn’t seem to care much about short exposure to mere accommodation.

Autorefraction is quite random in my experience. I do regular autorefractor measurements; just did one a few hours ago. Expectations vs results vary quite a bit. That’s an issue with instrument myopia and how the devices work. I just accept it and don’t take the results too seriously until they are repeated a few times.

On the glasses worn as you go to measure, I had the impression that wearing stronger glasses, with minimal undercorrection, gives better results. But the sample size is so low, chances are it’s just random again.

In general, I think we gotta beat this with statistics. With enough improvement and enough measurements, you have to see a trend eventually, or else there’s something wrong.

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Do you mean you didn’t use the -3 for quite everything at distance and still used the -2.75 during that time too? Or rather that you did use the -3 for everything, but then phased in the -2.75 gradually on a task-specific basis? And you still feel that was a good choice, or not?

In any case, I like that idea, and I think I may have to do something similar, even though that’s not the general recommendation for medium myopia (having 3 focal planes for a short period of time). But I think the blur adaptation might be a special case where doing that could be necessary or useful and not detrimental, potentially. We will see, but I’m not surprised you benefitted from it in this case.

I also drew up the rough timeline I was thinking of using, and I realized if I give each lens change 5-6 weeks, it’s going to take a very long time before I can achieve my first decrease…just too long. I’m contemplating just playing it by ear and going by feel…if I feel like I can change lenses in 4 weeks instead of 5 or 6, maybe that’s ok. Last time I tried more like 2 or 3 weeks, and failed…I couldn’t adapt that fast.

Also, it will be interesting to see how I high I end up going. I would not expect to have to use a lens much stronger than what cm far points indicate at that time, but I suppose if I really need to, I could go up to my previous doctor-prescribed power in the less myopic eye (since I’ve done some equalizing since that time).

I’m also planning that my first reduction is going to be an equalization (again…special case, not generally recommended, but I understand what I’m doing at a pretty good level). I only have 0.25D of anisometropia left these days, and have not done any equalization work in years, so I’m due for it again. The downside will be that I won’t be able to use my previous glasses anymore as I step down. The upside will be that it will be easier to equalize when the diopters are higher (because the change will be a smaller fraction of the total power, and also because it will make an easier first reduction if I only reduce one eye’s power). The other downside is that I’d probably have to wear that power for a longer time…there’s no free lunch!

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I can relate to your fear of increasing the diopters.
that said, I am not sure that wearing glasses which gives you exactly 20-20 vision are going to make you myopic so quickly. as long as you are using them for distance visoin, only then you are lowering the risks for making yourself more myopic

@Varakari hi, what do you mean it worked great? do you mean that because the eye had some plateau then you decided to strengthen it?

Well, I didn’t use the -3 for various indoor tasks, and of course not on the computer. But I made them my primary outdoor glasses, and then when my eyes improved, phased in the -2.75 gradually, until I was on a multi-week bike tour with lots of distance vision, where it got so good that I phased out the -3 completely.

My logs show significant improvement during these months, so I still feel it was a good choice. Of course I can’t know for certain, 'cause I don’t have an identical twin to test a different strategy under the same circumstances. (That would be really useful. I wonder how many identical twin scientists there are.)

Maybe. Those were still early days, so my standards for measurement and logging were not as good as they are now. I was under the impression that it wasn’t working too well, and blur adaptation was the elephant in the room. My story is clearly biased, since of course I did this because I believed it might work. But I can say with confidence that it made my eyes better, and improvement at the time was within Jake’s rate, so I’d say the strategy worked great. Even if weaker glasses had worked as well, it would’ve left me with unnecessary blur to live with, so it seems like the choice of going up/back up (one eye had seen this much correction before, the other hadn’t) was good.

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And since then, have you been careful to maintain the same level of clarity with each reduction? Even if you only have had one or two reductions, I feel this is still a very important question.

I tried, but haven’t completed another reduction. The logs look like something went wrong in September, when a slowdown began. I thought that maybe I was using too little blur this time, and tried phasing in -2.5 since mid-October, but if anything, that made it worse. Just today, I finished reverting the changes I did since September.

Winter is probably a factor, but I don’t like the magnitude of the slowdown, and how it looks like the onset was before the equinox. If this goes on, my long-term trend will drop below Jake’s standard rate in about two weeks, and not gently. It seems I made a mistake somewhere.

:thinking:

Looking at the graph, the day I changed my computer setup is super suspicious. The slowdown appeared very soon after that, well within measurement error. So that’s a potential culprit. I reverted that one two days ago.

I read you’re working on a dissertation. So, the effort (stress?), amount of rest, exercise, close-up time, low illumination, diet, possible inconsistent high-lux exposure, etc. could all be factors (which Winter is definitely a part). How much infinity viewing are you getting lately? When I worked indoors in a dim fluorescent-lit interior without windows for a year, my vision worsened. I used to try to walk to where there were windows every 15 min. And I tried to go outside every day at lunch, even in the Winter when it was 30F.

Also, what’s the computer setup? I’m about to phase in a podium setup so I can use it from a distance while standing.

You must’ve misread; I’m not working on any dissertation. (Yet. If I record an axial length reduction, I’ll badger myopia researchers. :stuck_out_tongue: Maybe I was talking about my master’s thesis, but I finished that years ago.) The only “change” in what I do on the computer is that I use this forum a lot – however, this just replaced different places about vision I’ve been browsing before.

What changed most are lighting (winter), time at which I can go outside and get reasonable light (winter again), and my computer geometry.

For the last three nights, since reverting my computer config, my eyes have been feeling different at night. There’s a kind of stress in the eye socket that I often had during times of improvement. This is another indicator that the computer geometry plays a role.

My computer setup is pretty normal; a 32" monitor facing a room, desk is made of glass with small metal beams and has an elevated portion for the monitor. So peripheral vision can see further into the room, except where the computer’s input/output parts are.

The configuration I tried since September was to use a screen distance in the 50–70 cm range with -1.75 glasses on. The idea was that this would cause slight myopic defocus of the monitor on a broader area on the retina, rather than the strong blur of the background objects. But it may have backfired, either because it makes it harder to look away from the screen, or because it makes it easier to accept a blur level not suitable for print pushing. The -1.75 is a bit weak for my purposes.

The old and now returned setup has my mouse on a right portion of the desk and the glass plates shifted, so that I can increase screen distance to 85–105 cm, with -2.25 dpt glasses now. This setup is what I used during all major improvements. I had problems when first going down to -2.5 on the computer, going back up to -2.75, similar to the distance story. This also worked: the -2.5 that was too weak then is too strong now.

Could be the third time this issue occurs. Maybe I’m just the kind that gets blur adapted really easily, which would befit my history of undercorrection.

If this turns out to be the case, at least my rambling is very relevant to this thread. :sweat_smile:

@Varakari, I assume you determined the distance correction in the standard way (eye chart and/or far point measurements, as well as trial and error)…? I took a quick look at your reddit thread, by the way.

There is at least one positive thing about blur adaptation I’ve noticed…

It makes it easier to active focus on very large details/thicker lines. Being more blurred out means that you’re basically applying a low pass filter to your vision. Big details stay sharp; small ones disappear or tend to blur out, which at least for me, makes it easier to focus on the bigger details (large letters, sides of buildings, basically any large and contrasty edge. I feel like it’s exercising a slightly different skill in the visual cortex that can be used to trigger active focus.

This may be a legit use of plus lenses or going without glasses on occasion.

Also, now that I’ve perfected this skill over many years, I feel like even after I re-accustom my brain to clarity again, I’ll still have this skill.

I measure undercorrected near focus distance much more often than Snellen, but that’s because the former predicts the latter and is more reproducible. I think I’m the biggest measurement nerd on this forum, so I doubt that’s the issue.

What is an issue: I suspect I can’t follow the standard blur levels for Endmyopia. My logs are littered with a sequence of:

  • I change something that increases a blur level somewhere, to a level that still seems very conservative compared to others
  • Usually within a few weeks, some indicators of progress trouble show up. Not always too significant, but these little hints that something could be wrong.
  • I eventually decide that enough is enough and slap on stronger lenses.
  • Progress continues. (Well, I hope this is what’ll happen again this time. It is the longest I waited before reverting, and also the longest bad phase so far.)

So to get back to your question, I don’t determine correction the standard way, because right now I’m going for much higher acuity than is the standard here. This doesn’t need to mean there’s something wrong with Jake’s advice; as he says, things vary by the individual. In my case, it looks like I improved best with distance corrected to maybe even 20/20 monocular in an indirect sunlight Snellen, and when corrected to almost full focus on red/green on the computer. So that’s what I’m going back to now.

Possibly relevant here: the topic of active focus is weird for me. I don’t believe I have any leeway in my ciliary muscle when I try to look far. It looks like anything beyond the usual is either from moisture or directional pull by the extraocular muscles. In other words, either I’m never using active focus, or I’m always using it. The former is unlikely, because my motor control learning is very good. I can desync or defocus my eyes at will, and learned the latter quickly after reading that it’s possible. It would be strange if I’d fail to learn a motor control skill for over half a year, especially when I had no issue learning to do the same skill in the opposite direction.

So maybe active focus is so easy for me that I’m always measuring at about 100% of what my eyes can possibly do. This means that if I go below 20/20, there is no way short of moisture or anisotropic pull to really “clear up” anything. And my ability to read from blur has been trained for a very long time, making the blur level of a Snellen level even worse. So maybe for me, 20/30 is already too much blur?

Just an attempt to explain what’s going on; obviously I’m thinking about this a lot.

In any case, it’s relevant here because if this turns out correct and you happen to be like me, you need a whole lot more lens power to get anywhere.