Help!, Problem Patient with High Cyl

[s-man-optiker]

I have a customer who I've now reframed 3 times. She has -3.00 and some change cyl in each eye. I covered my bases as far as measuring OC height and mono PD. I've got her in a 1.67 w/Crizal lens. Here's a list of her complaints:
-When she squints it seems to feel like there's less strain on her eyes
-Artificial light feels too bright, like at the grocery store.
-Also in artifical light she sees some blurry patches when trying to read near and far.
Since I've made the 3rd pair with measured OC height and mono PD, she says that she can see much better, but she's still experiencing the above mentioned problems. Please if anyone knows what could be causing this please let me know. Thanks for your time.

Austin Raths, ABOC

[DragonLensmanWV]

I have a customer who I've now reframed 3 times. She has -3.00 and some change cyl in each eye. I covered my bases as far as measuring OC height and mono PD. I've got her in a 1.67 w/Crizal lens. Here's a list of her complaints:
-When she squints it seems to feel like there's less strain on her eyes
-Artificial light feels too bright, like at the grocery store.
-Also in artifical light she sees some blurry patches when trying to read near and far.
Since I've made the 3rd pair with measured OC height and mono PD, she says that she can see much better, but she's still experiencing the above mentioned problems. Please if anyone knows what could be causing this please let me know. Thanks for your time.

Austin Raths, ABOC

Problem 1 - have you checked for vertex distance differences?

Problem 2 - and 3 - Low ABBE bothers some people. Try a 1.60 with better ABBE or Hoya's 1.70 - that has good ABBE.

[braheem24]

A few things that may help....

Old Rx
New RX
VAs
Medical history, Cataracts, AMD, etc
AR also in old rx?
Any tint in old RX?


Significant improvement in vision can also make things seem too bright ;)

[Uncle Fester]

When she squints and feels less strain it's probably due to a reduced pupil apeture. You can demonstrate this on myopes by having them take their glasses off and pinch their left index finger and thumb together, then hold the right index finger to the other finger and thumb so you create a very small "pinhole". Now have her close one eye and hold her hands up very close to the open eye and look through the hole. She'll say she sees much better. This is due to the small ammount of light focusing on the fovea. Of course her peripheral vision is shot to H..E.. double toothpicks:)

[Andrew Weiss]

Probably it's materials-related -- I second the suggestion of backing off to a 1.6 for better ABBE value -- but just in case I'd check these things:

-- Base curve: have you matched the old lenses?
-- Vertical OC: is the placement relative to the pupil the same on the new lenses as on the old ones?

Just about all the high-cyl patients I've dealt with prefer the base curve and OC horizontal and vertical placement to stay the same.

[MTAMERIUS]

What Brand Of 1.67 Are You Using. Is It Aspheric. If So What Is The Aspheric Value. The Vertex Distance And The Panoscopic Tilt Are Also Possible Causes.

Many Of The 1.67 Products On The Market Are Not Well Suited For Strong Cylinder Corrections. The Abbe Value And Base Curve Selections Limit It's Effective Uses.

One More Possible Problem Is With The Ar Coating. The Processes Of Applying Ar Coatings Is So Aggressive That It Is All But Impossible To Not Damage The Hard Coating ( Orange Peel ) On Many Lenses. It Is Very Difficult To See, But Most Ar Lenses Have Surface Damage.

[Fezz]

Welcome to Optiboard! Jump on in, the water is fine.


:cheers::cheers::cheers::cheers:

[dweinstein]

How about adding a light tint or even ordering the lenses in a polarized neutral gray or neutral brown for indoors? You can get them from KBCo (www.kbco.net).

[Diane]

How old is she and???What is her exact Rx? What is the difference in her current Rx and her old Rx? What is the base curves of old and new Rx as well as ocular curves of both? What is the tilt/wrap difference if any? What material was her previous pair? Did she like her old Rx. How long since her previous Rx change? How long does she routinely go between Rx changes, and has she experienced problems previously?

Verify that she actually "likes" her new frame as well.

What are her old and new corrected visual acuities?

Diane

[s-man-optiker]

Thanks for all your replies. One thing I think I might try is reordering the lenses with maybe 20% tint. She just picked up her sunglasses the other day and says she can see everything near and far much clearer with them. As far as the frame, I finally put her in a Flexon - my favorite - because she was having a lot of problems if the frame moved at all (lenses shifting). I checked the frame fit yesterday, and it was still good after 3 weeks. She has seen the doc 3 times about the problem, but only came back with a change in axis of 3 degrees. Yes, I reordered the lenses, the axis is dead on and she's still having the same problem. So, I think there may be something to this tint.

Austin

[wasan]

I think for position of the glasses same? till , pantoscopic ? . If you adjust the frame i think better :)

[Uncle Fester]

I've been around long enough to know sometimes the problem is not in the glasses but between the patients ears and you'll never get them happy:hammer:

[Robert Martellaro]

Austin,

You need to provide this information...

http://www.optiboard.com/forums/showpost.php?p=191494&postcount=3

http://www.optiboard.com/forums/showpost.php?p=191509&postcount=9

Regards,

[braheem24]

Any tint in old RX?


Significant improvement in vision can also make things seem too bright ;)

She just picked up her sunglasses the other day and says she can see everything near and far much clearer with them.

So, I think there may be something to this tint.

Austin

If she is a myope, she is over corrected, the blurry patches are probably the same effect you and I would notice if someone flashed a bright light in our eyes.

She is not used to having that much light focused so perfectly on her eyes. If she is a myope reduce the correction as well as adding the tint.

[Chris Ryser]

I would just about bet that she had CR39 lenses prior to the new RX. High index have flatter curves and many people specially the myopic ones are fussy characters.

Put her back were to what she was used to and ............a haaaaaaaaaaappppppppppy customer will grin at you. :)

[gemstone]

Austin,

You need to provide this information...

http://www.optiboard.com/forums/showpost.php?p=191494&postcount=3

http://www.optiboard.com/forums/showpost.php?p=191509&postcount=9

Regards,
Here! Here! Questions of this nature should not be allowed with out the basic info. So many questions are ask like, "oh crap I don't know what to do. My customer can't see with the glasses I made. " Then we get the question game. What they wearin'. What they been wearin'. We probably solve from there. My guess this "doctor" changed the axix 5 degrees on a high cyl.

[s-man-optiker]

I don't recall saying "Oh, crap". Maybe you feel you're somehow above my situation. No hard feelings though.... how could you possibly know how great I am at what I do? It's all good.

Austin

[Andrew Weiss]

Austin,

I'm sure you've been on Optiboard long enough not to take any of this stuff personally . . . :)

I think most of us prefer as much information as we can get about what the patient's been happy wearing, so we can help you figure out why she's unhappy with the new glasses. As far as I can tell, that's what Robert and Gemstone were asking you to provide us with.

I'll be interested to hear what happens with the tint, although I tend to think Chris is on the right track here.

Good luck!

[gemstone]

I don't recall saying "Oh, crap". Maybe you feel you're somehow above my situation. No hard feelings though.... how could you possibly know how great I am at what I do? It's all good.

Austin
not above. Sorry. Not meant to offend. Please just forget what I said. :(