65yo male complains that he lately notices his vision is better at distance when he REMOVES his glasses. He always needed glasses to see far away. He finds this odd and troublesome.
When you hear this complaint, check to see if the patient is a hyperope (wears plus lenses for distance). If so, think myopic shift due to cataract progression as one of your main differentials! In extreme cases, it has been noted that some patients can shift 3 or more diopters more minus in only 6 months!