need a little help

[snv]

Hi all,

I have a first time progressive wearer. She is natural monovision with

OD pl - 0.75 x 165
OS -1.50 ADD 1.75

She's currently wears two different pairs of glasses. Once for Distance and one for Near and she have no problems at all. However, now, she wants to get a first pr. of progressive lens.

We put her in a silhouette with 19 seg and varilux comfort poly lenses and AR. Everything is fit perfectly. This is what she experienced with this new glasses

when both eyes open, everything is blurry up close. she only able to see 20/30. When she close her left eye with the glass. Her right eye see 20/20 and when she close her right eye, her left eye only see 20/30. She said if she really pay attention to it, it would be clear.

Her distance Rx has been the same for two years with good binocular balance. I don't think this has anything to do with aneisokonia since the difference is too minimal and she's doing fine with her two separate pairs.

What could this be? She tried out this glasses for two weeks already.

Thanks for your input.

[QDO1]

have the lenses checked very carefully.... I had this, and the lab switched the left and right lens over on surfacing, so the RX looked right, but the segs were switched round.


is there a pile of surfaced vertical prisim in the job?

[drk]

Sounds like the left eye is overminused, somehow. Check for equal distance acuities, recheck the refraction. Is she 20/30 OS at near in a trial frame? If so, maybe there is uncorrected cylinder. Pathology? Rarely, rarely, she may need more add in the left eye due to some neurological issue, like Adie's Tonic Pupil. Consider unequal adds.

[chip anderson]

Remember that little word that some are trying to find other things to describe in another post. "Distortion" "Aberration" in progressives. "Chromatic Aberration in Poly". Not everyone is a good patient for progressives or poly.Ya, think this just might be the problem?

Chip

[Chairtime]

When you put 2 and 2 together it sounds to me like progressive non-adapt.

You said she's natural monovision, which means good vision without glasses. She has very little incentive to get used to all the normal distortion in a progressive. Anytime someone switches from low-power single vision to progressive this problem will present itself.

[snv]

Her VA is 20/20 monocularly and binocularly at distance and near with her distance glasses and near glasses. She has been a patient of mine for the past 3 years. Her rx has not changed at distance except for the near add changed from 1.50 to 1.75. I re-refracted her immediately after she notice this problem and it is not overminus on the left eye. No ocular or systemic pathology.

Both of her single vision glasses and progressive glasses are made by us. and they are all poly. I'm begin to think it is progressive non adapt than anything else.

[Judy Canty]

Remake the lenses in a frame or lens shape that will accomodate a 21 seg ht. That's where Comfort was originally designed to be used. Otherwise, use their Panamic design.

[snv]

Judy,

We fit many patients with comfort at 18 seg height with no problems at all. Do you think this is the seg height problems?

[Judy Canty]

Could be. I don't fit Comfort at less than 21 and haven't since Panamic was introduced. Troubleshoot by raising the frame and checking her reading comfort. If it's better higher, change either the lens or frame design.

[SpecialT]

My brain is racked . It sort of sounds like a convergence issue! I just wanted to add that I too was under the impression that the comfort was supposed to be a 21mm seg height.

[ASenior]

Hi all,

I have a first time progressive wearer. She is natural monovision with

OD pl - 0.75 x 165
OS -1.50 ADD 1.75

She's currently wears two different pairs of glasses. Once for Distance and one for Near and she have no problems at all.

She was wearing
+1.75 -.75 x165
+0.25 SPH
For near? with 20/20 VA? Has she had Silhouette Titan frame before?

Then there is a RX problem or fitting problem for sure. There is a solution to the problem somewhere, there always is. Non-adapts are for those who dont like the "feel" of Pal's in my opinion.

I can count the times on one hand a patient has complained about a PAL, when it was atually the fact that they didnt like the frame or color or something totally differant than the function of the lens.... but that was all they thought they could complain about to ultimatly get something done about it.

Just for "Just".... ask her if she likes the frame or would like to change it?

[shellrob]

I tend to agree with Asenior...I have very very few non-adapts. I believe most of the time it's something they don't like because they're not used to it, or it's not fitted right, or the glasses just aren't doing for them what they want them to be doing. Not eveyone can comfortably wear a progressive and if the patient isn't given realistic expectations of what the glasses can realistically do for them, they will not be happy. The fact is progressives can and will not do everything for everyone. Listening and investigating a patients true needs are key to a successful fit of any pair of glasses. Your patient may be one of those patients that their needs demand more than one pair of glasses.