BCVA decrease

I have anisometropic amblyopia due to astigmatism; cylinder left eye -1.5, right eye -4.0 with some spherical correction (.50 OU) and an add of 3.00 in lined trifocals, +3.25 in reading glasses.  Age 39, health care professional.  Wear glasses full time while working and reading, while driving, and whenever I get the urge!  Use contacts socially, but they honestly don't give me the sharpest vision.  BCVA at exam 1.5 years ago was 20/20 left eye and 20/30 right eye as it has been most of my life.  At most recent exam, BCVA was 20/30 left eye and only 20/50 right eye.  Eyes check out totally healthy in all other respects.  In past year I've been working longer and harder than ever, and my job is very detail oriented and most taxing on my vision!  My concern is why my BCVA dropped off in my lazy eye, and I did not really walk out of my exam with too many answers.  Maybe someone here can help!  By not wearing my glasses ALL the time, am I suppressing my right eye vision to a point where it's starting to weaken even more?  Would absolute full-time wear perhaps reverse things?  Admittedly I've always (since age 4!!) been one who takes my glasses off and on, self consciously, vainly, whatever and never really resigned myself to full time wear!  I currently have near vision glasses, distance glasses, and lined trifocals.  I need my vision to be as good as possible, so if full time is the answer,  please say so!  Additionally, my own doc has never mentioned this but others that I've spoken to in conversation seem to stress that I should not wear contacts ever and should be in glasses with protective lenses at all tlimes.  The reason for that was that I need to be protecting my 'better' eye at all times and glasses are the only way to be doing that.  Agree?  In closing, I will note that since my exam a couple of days ago I've been trying to wear the much more and now find that when I remove them, my uncorrected vision is more irritating than usual. I suspect it's that 'dependency' factor, where I'm finding the clearer vision to be more comfortable than the not so clear?  I suppose the answer to this is simple, but I just need to hear it!  But again, my biggest concern is what's happening with my BCVA.  Thanks so much for any suggestions.  

[John C Hagan III, MD, FACS, FAAO]

Because of your age you are going to experience very large changes in both eyes due to presbyopia and being far-sighted. Your vision without glasses in both eyes will get much worse, more in the left eye than in the right. This is age related and not affected by how much you wear your glasses.

I would be concerned because you have lost two lines of best corrected visual acuity (BCVA) in BOTH eyes. That needs an explanation.

Do you see an ophthalmologist Eye MD? If not then you need to see one. If so you need to discuss with your Eye MD the explanation for losing two line of visual acuity. Normally this is not something that is not something you live sliding.

It would be appropriate to see another Eye MD for a second opinion about the reduced visual acuity. you may need special tests such as a visual field, color vision, amsler grid and corneal topography. If this doesn't turn up an answer and subsequent refractions don't improve the vision you may need to see a neuro-ophthalmologist.

At some point down the road when the cause of the problem has been identified or it has been determined that there is no problem you might want to see a refractive/corneal surgeon to discuss refractive surgeon options on one or at least the amblyopic eye to reduce the hyperopia and astigmatism.

JCH III MD