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Thread: ? for all you experts

  1. #1
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    ? for all you experts



    Okay here is one for you. I had a lady in the office for an eye exam. When the Dr. brought her out, he stated that we were only ordering new lenses for her frame. Her new Rx was:

    OD: +3.50 -1.25x 090 / +2.50

    OS +3.25 -1.00x 180/ +2.50

    Progressive, Varilux Panamic with transition Gray lenses.

    Lenses came in no problem. everything was all set. Patient tries on spec and states. Things seen off to me, but he said with my eyes it might take some adjusting to them. "I will try them". she said and let you know.I planned to call her in four days to check her status, but she beat me to it.

    Three days later she came in still the a problem, only she states she can not find a clear view to focus through. I again remap lenses and recheck everything. I compared her old rx to see what the change was. The only changes were The sphere power increase by +0.25OU, and the add power increased by +0.50OU.

    My question to you is what would you do to figure out what is going on with the new pair of lenses? What do you think the problem was?

    Keep in mind that the frame, lens material, progressive type, PD, and height measurements were the same as two years prior. The only change was the Rx??

  2. #2
    C-10
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    If you have an -0.25 loose lens try to see if that clears up her vision if it does you know that it probably the Rx Now it could also be that with a stronger add you may have to drop the corridor down 1to 2mm. But I would check out the Rx first.

  3. #3
    On the Sunset Tour! Framebender's Avatar
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    Same base curves. . .

    same everything??? Can she see in the distance?? That's a pretty good bump in her add for only 2 years, but if she can't focus in the distance that's a moot point. I give up! Did she take her meds??

  4. #4
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    Something other than the change in Rx is wrong. If the change in Rx was the only problem, the complaint would be primarily in the distance with the possible associated symptom of having to hold things too close to read. Even if there is too much plus, a clear point should be visable at near. I recommend using a manual lensometer to evaluate the lenses and be sure that the mires are clear and not hazy. Also, check to see if the base curve is the same for each pair.

    How is she doing with the old Rx?

  5. #5
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    Just in case. Compare again the prescriptions to make sure that one axis is 180 an the other is 90 on both. Again, just in case.

    "She states she can not find a clear view to focus through."

    Does that means that she can not see clear at any distance?
    How is her monocular vision with old and new lenses?

  6. #6
    OptiBoard Professional eyegirl's Avatar
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    I agree double check that the axis is not supposed to be 180*ou or 90*ou.

    Is distance vision fine just near is blurred?

    Are there any health concerns with this patient?

  7. #7
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    Damn hyperops!! Always an issue with those people.:hammer:

  8. #8
    Banned jewel's Avatar
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    Sounds like she's not given herself enough time to adjust. It takes a good two-three weeks for some to adjust to a progressive lens with a new prescription.

  9. #9
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    Quote Originally Posted by opticalstudent
    it might take some adjusting to them. "I will try them". she said and let you know.I planned to call her in four days to check her status, but she beat me to it.
    If you opticians want to know a dirty little secret, it's this: If they seem bad at first, they are probably bad. Put a simple snellen chart on the wall and have them read the smallest line they can read. If they can read smaller letters with the old Rx than with the new, the RX IS BAD (or the lenses don't match the Rx). Something is wrong. She will NEVER get used to a WRONG Rx.

    NEVER, but NEVER send someone out with an Rx that seems "OFF" to them, unless you first do that simple test, and find that indeed, the new Rx allows them to see smaller print...

    w.stacy, o.d.

  10. #10
    Banned jewel's Avatar
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    Quote Originally Posted by William Stacy O.D.
    If you opticians want to know a dirty little secret, it's this: If they seem bad at first, they are probably bad. Put a simple snellen chart on the wall and have them read the smallest line they can read. If they can read smaller letters with the old Rx than with the new, the RX IS BAD (or the lenses don't match the Rx). Something is wrong. She will NEVER get used to a WRONG Rx.

    NEVER, but NEVER send someone out with an Rx that seems "OFF" to them, unless you first do that simple test, and find that indeed, the new Rx allows them to see smaller print...

    w.stacy, o.d.


    Okay. Will try to get one put up. I will pass that info on to my boss. Sounds like good smart advice. Thanks Doctor.

    But I DO have a question concerning my own RX then. I have not been able to see clearly now since, oh about 1996. Every RX I get I just do not get clear vision. About a year and a half ago my Opthamologist told me that I have slow growing cataracts in both eyes. Could it be that the cataracts were starting in 96 and not caught?
    My family does have a history of slow growing cataracts. Just wondering.
    My RX is R -2.25 -0.75 028
    L -2.25 -1.00 155
    add of +2.00.
    The glasses I have now are one of two pairs that have been 'okay' in the last ten years and I'm in a progressive lens now. But there is still the unclearness there. Pretty frustrating, especially at night.

    Thanks so much,
    jewel

  11. #11
    Master OptiBoarder Cindy Hamlin's Avatar
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    Quote Originally Posted by jewel
    Okay. Will try to get one put up. I will pass that info on to my boss. Sounds like good smart advice. Thanks Doctor.

    But I DO have a question concerning my own RX then. I have not been able to see clearly now since, oh about 1996. Every RX I get I just do not get clear vision. About a year and a half ago my Opthamologist told me that I have slow growing cataracts in both eyes. Could it be that the cataracts were starting in 96 and not caught?
    My family does have a history of slow growing cataracts. Just wondering.
    My RX is R -2.25 -0.75 028
    L -2.25 -1.00 155
    add of +2.00.
    The glasses I have now are one of two pairs that have been 'okay' in the last ten years and I'm in a progressive lens now. But there is still the unclearness there. Pretty frustrating, especially at night.

    Thanks so much,
    jewel
    Jewel,
    You should be asking this question of your OD or OMD and not Dr. Stacy. I am sure Dr. Stacy is more than qualified to give you a supposition as to the cause, but he doesn't know your history or eye related issues. As such it would be inappropriate of him to answer this question for you.
    ~Cindy

    "If you can't be a good example, then you'll just have to be a horrible warning." -Catherine Aird-

  12. #12
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Jewel, I think you just crossed the line from ECP to consumer.

    Consumers are allowed to post on the Board, as long as the posts concern general eyecare related topics. However please be aware that any questions that involve diagnosing specific eyecare and eyewear problems are not appropriate for an online discussion forum. These kinds of questions should be discussed with a qualified eyecare professional who has examined you and is familiar with your situation. Posts asking for diagnostic help will be closed or removed.

  13. #13
    One eye sees, the other feels OptiBoard Silver Supporter
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    Your client will need to hold the book or newspaper about six inches closer than with the old glasses. Show her this. If the shorter focal length is uncomfortable (long arms or just prefers to read at 19") reduce the add to +2.25.

    Regards,
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



  14. #14
    Banned jewel's Avatar
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    Quote Originally Posted by Judy Canty
    Jewel, I think you just crossed the line from ECP to consumer.

    Consumers are allowed to post on the Board, as long as the posts concern general eyecare related topics. However please be aware that any questions that involve diagnosing specific eyecare and eyewear problems are not appropriate for an online discussion forum. These kinds of questions should be discussed with a qualified eyecare professional who has examined you and is familiar with your situation. Posts asking for diagnostic help will be closed or removed.
    Okay. Thanks much...

  15. #15
    Banned jewel's Avatar
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    Quote Originally Posted by Cindy Hamlin
    Jewel,
    You should be asking this question of your OD or OMD and not Dr. Stacy. I am sure Dr. Stacy is more than qualified to give you a supposition as to the cause, but he doesn't know your history or eye related issues. As such it would be inappropriate of him to answer this question for you.
    Very true. Thanks and maybe I should be switching docs.

  16. #16
    OptiBoard Professional Excel-Lentes's Avatar
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    One thing I come across once in a while that causes people to complain:

    Prism Thinning (Equithin):shiner:

    It is important to check the old lenses to see how much prism thinning was used in the old glasses and request the same amount in the new pair of lenses. Check using a lensmeter at the MRP (4 mm below the fitting cross on a varilux lens). It will be Base Down Prism. It is used to equal out the thickness from top to bottom; especially in plus powered lenses.

    Excellent point about using a snellen chart when dispensing glasses. It should be used for every patient picking up new glasses. We put ours about 2 feet above eye level to assure new progressive wearers use the distance portion to see the chart.

  17. #17
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    So what is wrong and how do I fix it?

  18. #18
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    Quote Originally Posted by opticalstudent
    So what is wrong and how do I fix it?

    1) Check the cylinder axis first to confirm that one eye is 90 and the other is 180.

    2) Check the monocular PD's and monocular heights of the old lenses and compare it to the new. The new lenses should have been made as near to the old monoculars.

    3) If the above is confirmed to be OK, I would then check the patient's subjective comfort and vision by placing -0.25 over the new DV portion of the glasses. If their is an improvement (I recommend going outside if possible or have the patient look out a window rather than checking from the examining chair again) you will likely have to redo the Rx.

    4) Have the patient sit down show you their normal reading postion. Do they read at a desk, in a chair, sofa, in bed. Find out where they are having difficulty. Have them hold the reading material at the distance they prefer and then hold loose -0.25 and then -0.50 over the near portion to determine the most comfortable power for them.

    Doc

  19. #19
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Just curious Opticalstudent. Did you find a resolution to this problem you can share with us?

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