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Thread: Suggestions Before I Scream!

  1. #1
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    Suggestions Before I Scream!

    I have a patient who has been with us for about 5 years now. So I have been trying to work with her on her current progressive situation.

    Patient came in for her annual exam in Jan 2006.

    Her rx last year was:
    +1.25 DS
    +1.00 DS
    +2.75 Add with a seg of 20 (gradal top in plastic)

    She expressed preference in Jan this year for :
    +1.50
    +1.25
    +2.25 Add (Dr. did try the 2.75 and 2.50 three times during exam and patient expressed that 2.25 was better each time.)

    Patient wanted smaller frame, had a seg of 17. Went with Brevity.

    Patient tries glasses for 3 weeks, comes back in saying she was having trouble with everything but reading.

    Dr. refracted her again, came up with:
    +1.25
    +1.00
    +2.50 Add (bumped it to keep reading power same since she was satisfied with this)
    Dr also requested we drop seg by 1mm to 16.

    Patient comes back a few days after dispense still saying everything is blurred. She says if she raises her glasses, then the distance comes in more clear. (so she is adding back in the power she had us take away!)

    Reading isn't as good as prior. If I place a +.25 lens in front of the glasses, they still aren't clear.. and neither is her old pair. But her old pair is better than the new pair.

    The distance isn't as wide as previous either (I thought the Brevity was supposed to have the same or at least similar distance properties)

    Talking with her more in depth, the computer she uses is actually sitting at eye level (she sees the majority of the monitor at a direct gaze.) I talked with her about seeing if she can lower the monitor, since her chair is raised as high as it will go.

    We discussed computer specific glasses, but she doesn't want to make the investment in something since she will be changing job duties in less than a month, yet her current glasses do not work for what she wants, nor does her old pair! Also when talking about tuffing it out for the 3-4 weeks, she says her regular job comprises of computer work as well. But she thinks that it won't be as visually demanding as her temp position that she now says she only has to cover this other area for an hour or two a day.

    I explained to her numerous times that no progessive design will give her the ability to drive and see her computer while looking straight ahead. That I can either give her one or the other. She refuses to accept this, and insists that one pair can do it all.

    At this point, any remakes are on us(half cost..but still money). So I want to make sure I cover all bases at once. My fear is that part of the issue is the placement of the computer screen, and that even if I get her in a larger frame, and switch mats (though she has been in poly before but it was 3 years ago), that she won't get the computer vision she wants.. Not to mention the contridictory information she gives on reading/distance vision anyway. If we increase her add by another .25 she will be back at her current script which she says doesn't work. The doctor has spent 30mins to an hour on 3 occasions now going over the refraction issues.

    Any other suggestions?

    Cassandra
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  2. #2
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    Check her sugar. Check her blood pressure.

  3. #3
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    I get patients like that too, makes your blood pressure go up.

    I think her add should be a +2.50 taking in the things you mentioned. I think it may help to have her back in the Gradal Top, that lens has one of the best mid range zones of any progressive out there. If it were me, I would go with the 1.60 index due to it's better light transmittance and better optical clarity than say the polycarb lens. I would inform her that everything in optics has its positives and negatives, and that by moving to a smaller frame and smaller lens there is a real compromise that may or may not work for her. I would then suggest that she reconsider a slightly larger frame that would allow her to wear the Gradal Top. I really like to get a 22 seg on the Gradal Top if possible. I know a lot of people fit it lower but if you can get them into the 22 seg height or more, they get a real nice lower reading area. I really think that would work. Just my thoughts though.


    Don

  4. #4
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Was she unhappy with the old pairs vision?

    If she wasn't you and the doctor fixed what wasn't broken! Now you've sold her a new pair but at what cost relative to re-do and time? Brevities distance and intermediates "unwanted astigmatism zone" for most patients is squeezed versus the top.

    I firmly beleive you should never change progressive types unless there is a complaint in vision! Once they get used to a progessive types drop and visual field you're asking for trouble if you change it unless everyone is onboard as to what to expect.

    Fashion mavens should be made aware of just this potential problem if they insist on a short corridor lens.

    She needs to go back to a top in my humble opinion :cheers:

  5. #5
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    Right now I just need the woman to come back into the shop so we can work on the issue...

    (She no showed yesterday, nor has she come in for the cheap single vision pair for her to try to see the benefit of a computer pair.)

    Looking through her chart, I noticed last time she was in poly, she had some rx issues. So I believe that she is a poly non adapt, and that is certainly not helping the situation.

    What bothers me is the following points:
    For the first remake, we backed off on the distance RX, and the doc lowered the seg (1mm). Now she states that "raising" her glasses helps. This is adding back in the plus!

    When she first complained of distance rx, she stated reading was fine. We did not change the total reading power.. but now she says that the reading isn't there for her.

    She never complained about the Gradal Top, but when I asked her if her old pair worked better, she said that it was "yes and no" That it is still frustrating to use the computer with them, and that she still can't read the fine print with them either.

    The frame is going to be changed for something a little deeper. The original frame has a 17 height. I feel this is pretty respectable. I was told the brevity had the same distance design as the gradal top, so that is why I chose that lens.
    Cassandra
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  6. #6
    What's up? drk's Avatar
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    I think it's impossible for a short corridor to do what a tall and long progressive like Top does, even if it's by Zeiss. Case in point, here.

    I totally agree with everyone's posts. Go back to the Top in a bigger frame with a good fitting height. I'd stay in CrR-39 at this point, for sure, and she will have two of three things covered:

    Super distance optics
    Large intermediate area
    But not large reading area, but she doesn't seem sensitive to this aspect.

    As Mr. Scott said "Ya canna change the laws of physics".

  7. #7
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    Just asking, has she been a PIA in the past?

  8. #8
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    I already plan on switching her back to Cr-39 and with the top. I hate doing CR-39 in a semi-rimless..but I will do it.

    The main concern of mine is spending the money to do this remake, and IT NOT SOLVE the problem of the simple fact she is using the distance portion of her lenses to view a computer screen, which is not designed for a computer specific pair.

    I was told that we will remake this one more time, and that is it. She is an insurance patient, so if she still finds the glasses unsatisfactory at that point in time, she would have to appeal to VSP and they might reissue her the lens benefit again to go to a provider of her choice.

    My concern is how this would affect our reputation. She has been coming here for 5-6 years, and in the past she has only had a couple of issues.

    Since I have one shot, I wanted to have her get refracted again, using her measurements she was supposed to get about computer screen size, distance of monitor, angle, etc. OF course the doctor is now on vacation, (she didn't show up to her recheck yesterday) and then a conference.. so he won't be in the office for two weeks.

    If I remake her glasses right now with CR-39 in a Gradal Top, the rx will be the same as her old pair, with .25 less in the add. I don't see how if she says her current pair is giving her problems, how the rx in its current form will help her. The lenses in her old pair aren't excessively scratched, so I don't think new lenses for the sake of it will be THE solution.

    Cassandra
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  9. #9
    What's up? drk's Avatar
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    Well, what was wrong with her old glasses? Did she provide any clues?

  10. #10
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    Just that her vision isn't crisp. And while they are better than the new ones, they still don't give her the computer vision she wants either.

    Maybe I will have her wear her old ones, and then add / subtract a quarter to see how that affects things....

    I am just frustrated because in the past I have always been able to say we need to change X, Y, and Z and that's it. Problem(s) solved and life goes on.

    I seriously don't think that with her current work situation she will be happy with anything we do unless she addresses the need for a computer pair. I explained the options of single vision intermediate, using a flat top (intermediate with reading, and using an office lens (thinking the RD ) but while this problem is worth a dozen trips to the office, it isn't worth the money to actually fix. Since her old glasses are now basically the same script as now, I suggested that we convert this one to a computer pair..and it wouldn't cost her anything extra.. but she doesn't want that...because the old ones don't work for her either...

    I picked out a pair of +2.00 readers for her to try for computer, to see if it helps and to try hopefully demonstrate enough of an improvement for her to see the difference it might make. But she doesn't have time for this "play" right now.

    So *shrug* hopefully something will please her.

    Cassandra
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  11. #11
    Bad address email on file QDO1's Avatar
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    I recommend a good bottle of Shiraz (for you).. if you still feel stressed, try another

  12. #12
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    Sell her a PC Peeker and let her wear her old glasses with it.

  13. #13
    What's up? drk's Avatar
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    I agree that computer glasses is what she really needs. Go simple: CR39 FT 28 in the new frame she likes so much.

    Option #2: Refund.

  14. #14
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    DRK: A PC Peeker is a drop in that focuses at intermediate (+1.12) leaves near and cylinder as it aready in spectacles. Retails for a whole $25.00. Solves the computer problem.

    Often when I dispense one of these, I see everyone in the patient's office over the age of 45 for more.

    Chip

  15. #15
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    Chip,

    Fill me in on the PC Peeker a bit more. Is it something if I just go into my optician and ask about it, they will know what I am talking about?

    Mark

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    Mark:

    I don't know how many optical shops carry them, any can. Any optical shop can find them on line (pcpeekers.com) but I think they are shipped in boxes of 12. Don't think they can be bought individually except through a retail store.


    But it is a good product, comes with a little styrofoam nose that you can clip to VDT screen case to keep them handy.

    Chip

  17. #17
    What's up? drk's Avatar
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    Thanks, Chip.

  18. #18
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    She wants the impossible. She is being unreasonable.

    We used to have the PC peepers and they didn't sell well. People actually balked at the price and they didn't like the look. They do the job, though and for less then a new pair of glasses.

  19. #19
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    I agree with happylady, she wants the impossible and unfortunatly isn't going to get happy unless she gets it. You're doing what you need to do in my opinion as well. Switching her to a top in cr39 and a little bit larger frame should do it. If she still complains of the computer vision, then her only option is to get some type of office lens. You've done verything you can do.

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