Incorrect near pd is what patient wants?

**Rich R** · 10-10-2005, 08:30 PM

Had a patient pick her flattop 28 last week and brought them back in yesterday, said they make her dizzy. Powers +1.00 sph with 2.25 add ou.
Here is what she feels is her problem, p.d is 55 near, previous glasses near p.d was 61, she is used to having a small amount of dist power at nasal between frame and edge of bifocal, about 4mm each eye, I rechecked p.ds and 55 near is correct but leaves no space at nasal, she gets dizzy looking at that area now, previously distance power now bifocal power.
She wishes to have them remade with same p.d. as previous pair, 61.
What to do?
Rich R.

**Lewy** · 10-11-2005, 02:39 AM

Rich,

Initially try taking the lenses out of the mount and hold them in front of her eyes at a pd of 61 or as near as physically possible. If you get a favourable response then either remake with the pd set at 61, or better still somewhere in between where she is still comfortable but getting closer to 55. If you don't want to do a remake, insist the lenses are correct (they are aren't they?) and tell her the problem will go away after a time, having explained why she is having the problem. This is why it is a good idea to check old specs before dispensing new ones.

Lewy

**rbaker** · 10-11-2005, 02:53 AM

"This is why it is a good idea to check old specs before dispensing new ones."

This is why it is a good idea to check the old specs before ordering new ones.

**Chris Ryser** · 10-11-2005, 03:19 AM

Originally Posted by rbaker

"This is why it is a good idea to check old specs before dispensing new ones."

This is why it is a good idea to check the old specs before ordering new ones.

Makes a lot of sense........................

Often when an off PD has been worn by patients, they have problems re-adapting to the correct one. Specially higher minus cases one has to watch for, they get used to the prismatic effect and hate to have done the right way.

**Chairtime** · 10-11-2005, 08:13 AM

I would try to insist she adapts. Assuming distance PD is 60, and she wants a near of 61, that may be difficult to order. Simply explain that the last place she went to made a mistake and you are not going to copy that mistake.

**Chris Ryser** · 10-11-2005, 08:33 AM

Originally Posted by Chairtime

I would try to insist she adapts. Assuming distance PD is 60, and she wants a near of 61, that may be difficult to order. Simply explain that the last place she went to made a mistake and you are not going to copy that mistake.

Obviously you must be of the younger generation who never run into a similar poblem. We are not talking of just 1mm, I have seen cases of 4 to 6mm off PD.

If somebody that has worn glasses with an off PD for several years, in many cases they will not accept your perfectly made glasses. These people have gotten used to the prismatic effect and do not like to look through your perfectly adjusted lenses.

This is not only a visiual but also psychological problem. You could try to go hald way between what's right and what they had been wearing.

But insisting that they get used to the perfect fit in such cases, will make your patient hate you and end up going somewhere else.

**mama'slittlehelper** · 10-11-2005, 04:33 PM

I think Chris is right. Remake them. It's not like she wants a new progressive in high index. The lab should be able to share the cost with you. Mine would.
Mark

**fvc2020** · 10-11-2005, 06:15 PM

hello

Actually my doc and I came up with another solution. I had heard this suggestions at my abo advance review class. We give the corret pd and give the prism as prescripted and it has worked fabulously.

We should not be adding to problems by giving something wrong over and over again. Find other ways to solve problems...

Christina

**harry888** · 10-11-2005, 06:37 PM

Had a similar problem last week, patient was a -10.00 and pd of 58. New glasses gave headache and were thicker than old ones (I'd used 1.67). Checked old specs, pd was 65 right in the optical center of the frame. She called previous optician who said he'd "adjusted the glasses to make them thin as possible".

Bottom line is that we explained the situation to the patient and remade them as a 63 pd. We also put a note on her copy of the Rx that she was used to a 65 Pd.

My suggestion to the original postee is to go between where she should be and what she is wearing for PD. AND MAKE SURE HER COPY OF RX SAYS "prefers xx pd".

Harry

**optowalt** · 10-11-2005, 08:39 PM

Bet you switched from plactic to poly.

**Rich R** · 10-11-2005, 11:17 PM

Thanks for all the replies everyone.
Patient problem is not prismatic effect, she is used to looking at the space between the bifocal and nasal edge of frame about 4 to 5 mm of distance power, which is now near power, I could probably do a ft 25 instead of ft 28, and would only have to fudge p.d. slightly to create the same effect.
Rich R.

**DocInChina** · 10-12-2005, 04:47 AM

Its interesting to see the range of advice found here. I especially liked the comment " Simply explain that the last place she went to made a mistake and you are not going to copy that mistake."

Likely the last place inherited the wearing PD. In anycase if you are not the "last place" the glasses were made then you certainly do not know the dynamics of why that PD was given. The advice given by rbaker was excellent advice...check wearing PD's before ordering lenses.

IMHO, I don't think giving the right PD but then giving prism is the solution. Whatever solution allows the patient to have comfortable vision is the right solution. Certainly in this case giving the same PD and the same bifocal type they had worn previously would be the ideal. You can also try to move the patient into a progressive lens which would have the correct PD and offer the patient a greater range of clarity.

Doc