updated views on PALs

[cdavis6632]

Well, the other day I tried a little experiment - I put into my left eye a RGP toric contact lens from before my cataract surgery (+.25 -2.00 x169) and I had no problems! I could barely feel it and I wore it all day. So I wore it for a couple of days and then decided to put the soft contact lens I had from just after surgery (0 -.25 x163) into my right eye. This combination works just great! For reading, I put on my husband's plano readers with +2.00 and I could read just fine. No more vertical imbalance or pupil distance problems! I will see a new optometrist to check the fit and give me new prescriptions. I will obtain a good quality pair of readers.

What I will not do is listen to the optician or doctor anymore (I have no vision insurance, I pay out of pocket, and I don't mind paying for a doctor that will take the time to do it right). I have been refused remakes, been told the problem is my frame and I need to buy new, smaller ones, been refused refunds, and been told there is nothing more that they can do and I don't really need the vision in my left (or right) eye anyway. I am only 53 years and my performance at work has suffered greatly in the past two years and I have not been able to see far enough ahead on the road to drive on the freeway since 1995. By 2003 I could not see far enough ahead to go more than 25 miles an hour. Now I can do both.

The problem as I see it, is that nobody will take the time to fit, measure, and grind PALS properly. My far pupil distance is 32.5/31.5 but I have never had my reading PD measured. I have had the reading add measured for each eye (with my glasses on) and they are different. But to make it easier they change the distance prescription and base curve each time so that the add power can be the same. In the past 4 years, I have had 3 new frames and 4 new sets of lenses, all the same size and in PALS. Lens width, height, bridge width and height off my nose, and segment height of 22. In the first pair, I ordered CR-39, no edge polish, an add of +2.25 and no AR coating and seemed to be fine except the left eye was blurred up more than when I had bifocals or monofocals. These are Essilor Panamic. Since this was the first time that I had had a PAL without a slab-off on the right side, the doctor said not to worry about it. I have some amblyopia in the left eye and my best corrected vision has never been better than 20/35 and still is now. Now the best uncorrected vision in my right eye is 20/10, the best corrected vision is 20/20 and always has been. After that the doctor insisted that I needed polycarbonate, a higher add, and AR. Since he is the doctor, I took his word for it but I insisted on no edge polish. The second pair of lenses are Varilux comfort and they blur up my right eye and the doctor said I needed an add of +3.5 but it can't be done. All of these lenses have a B measurement of 39. The next pair of lenses are Essilor Panamic in polycarbonate with a top-of-the-line Hoya AR with 1 base down in the right and an add of +2.25. These are OK for distance in both eyes but blurry for everything else. The most recent pair of lenses, the doctor insisted on the Gradal Top, polycarbonate, AR, and edge polish. He changed the base curve on the left to 4.25, add of +3.0, and left the segment height at 22. In the right eye, he left the base curve at 5.25, changed the add to +2.5, prism 2 base down, and seg height 24. The vision in my right eye is very blurry at all distances. He will not do a remake or refund. Don't forget that this is the town where the MD sends you to the OD and the OD sends you to the optician and if you make the least noise about the prescription or fit, even if you have tried to be very clear (having needed glasses all my life) about the exact nature of the problem and what you want in the way of adjustment or prescription change. I can live without driving on the freeway or having my left eye corrected to 20/20. I don't think that the rest is too much to ask.

I am not asking for a diagnosis as the MD says that my eyes are healthy except for some very early AMD in the left eye. But these contact lenses and readers work very well and that is what I will stick with for now. If I ever buy another pair of glasses, I will get CR-39, no AR (every pair I have with AR reflects light that is coming from behind me directly into my eyes), no edge polish, and trifocals. I will use one of my current pairs of frames even though two of them have been previously broken by opticians "adjusting" them and then having them suggest I order a backup pair while waiting the 6 weeks it will take to repair them. I go in for exams once a year because I take my sight seriously. BUT I don't think I need 2 or 3 new pair of glasses every year not even to mention the new prescription pair of sunglasses! And you wonder why people turn to the internet after having spent many years trying to be loyal to local "professionals". I'm pretty sure now that I didn't even need cataract surgery in my left eye, he just wanted to get paid for another one. There is no proof that I had one, except for his word, and now the evidence is gone.

[Andrew Weiss]

I am sorry you had such bad experiences.

Internet purchasing is no substitute for competent professionals in the opthalmic field. There are many such competent professionals out there.

[cdavis6632]

I am sorry you had such bad experiences.

Internet purchasing is no substitute for competent professionals in the opthalmic field. There are many such competent professionals out there.

I'm sure that there are but as I said, my driving has become more limited although I was referred to the Stanford Eye Clinic and I had someone drive me to the Bay Area. The run-around was just the same but with more specialists to be passed off to, especially when they find out I have seen other MD's and OD's. Maybe I am just crazy but I still have money to spend. I have spent upwards of $20,000.00 in the past 4 years and would just like to have 1 or 2 pair of glasses that can reproduce the sight these contact lenses give. And as I also said I will have the fit checked. I just meant that I will order frames or new (prescribed) contact lenses online to cut down on some of the costs.
Thank you for reading my long post and replying!

[shellrob]

You may think you will be saving money by purchasing your glasses online, but more than likely not. What happens when the glasses don't work? They're not going to take them back and then where will you be? Going back to the doctor to have the glasses checked(which some charge for) and possibly a new rx? Then going back online and purchasing another cheap pair? This could go on and on and then you've spent more than you would have if you went to a reputable Optician in the first place. I think you may have had a bad experience somewhere and now have a bad taste for doctors and opticians. Don't let those people stop you from finding a good doctor and optician. They are out there, believe me. Buying online is a bad idea for several reasons. You obviously have some special circumstances with your eyes and deserve better than any internet site can offer. I also cannot speak for other Opticians and Od's, but we will also work with a patients budget to find a great pair of glasses, not every pair of glasses is hundreds of dollars. I think you just need to search a little bit more before you ban all of us.

[Cindy K]

And you wonder why people turn to the internet after having spent many years trying to be loyal to local "professionals".

Good heavens, whatever makes you think you'll have any better success with an internet retailer???? Because you believe YOU can TELL them exactly what YOU want, and how to do it?

And who is going to measure your NPD for your readers? Reading your post, you state you've had your DPD measured but never had your NPD measured. Who, pray tell, is going to do this for you if you order your readers over the internet? What if you're one of the few folks with an inequal convergence left and right? (BTW- any of your prior opticians check for this when you've had trouble with your progressives?) And where are you going to take your glasses you've purchased online to have them fitted, or adjusted if you have a mishap? Or repaired if necessary? What if a lens comes out? Are you planning on ordering contacts via the internet also? If so, where are you planning on having your fit evaluations performed? What if a lens suddenly becomes less comfortable, or less clear, who ya gonna call?

[Andrew Weiss]

cdavis6332, with all due respect, it isn't fair or reasonable to go to an eyeglasss shop or ECP's office and expect them to measure, adjust, repair, etc., when you purchase your glasses online. Most places do not charge for these services; they anticipate doing them for their patients and roll the cost into their fees.

I reiterate my original advice: seek out a competent ECP in your area. Even with the limitations you report, you can most likely still manage it.

[akeroptical]

I this patient sure seems to be well educated and seems to have had a lot of evaluation done to his eyes. I just like how he claims no one has done proper measurements and then goes on to describe in detail base curve changes, assymetric add powers and all combined with some prism.

I also liked the "I have SOME amblyopia" and uncorrected vision was 20/10 and corrected was 20/20. hmmmmmmmmm.

I don't doubt you are having a frustrating time with your vision but I also think we are not getting the full story (not that we want it). I've been in this field for 15+ years and the only patients I know of that have been refered to multiple doctors are ones with eye health problems. My guess is that the vision issues are not all refractive error but some lie in pathology.

I don't mean to sound negative but hopefully you are not walking into these places with the same chip on your shoulder that you brought here. I also agree with an earlier reply that if you have had these issues with multiple proffesionals what on earth makes you think cyberspace will be any better.

I am raising the B.S. flag on this one, something doesn't seem right.

[feel_love217]

hello cadavis6632,



i would like to mention that u should never have problem when wearing contact lenses and to add to your great knowledge that contact lenses gives u 1 magnification and brain can easily fuse them. i can help you with best progressive u need but i m bit confused with your actual priscription.

it will be great if you can write ur full rx given by optometrist. i would like to say that these people are experienced and trust me they would have worked out your prescription correctly and also any related pathology. what i can understand is, things go wrong when supplying you with spex.



you had ODD add( ie diff reading rx between two eyes) because of less accomodation in particular eye. due to this problem, your PPL'S(progressive lenses) will have diff prism thinning.



please mention your complete rx for both eyes with visual acuity, before and after cataract operation done.



you have a gr8 knowledge of this and i haven’t seen any1 like yourself in my 6 years of professional life. It will be a pleasure giving you advice on PPL’S.



Amit jain.

[HarryChiling]

He changed the base curve on the left to 4.25, add of +3.0, and left the segment height at 22. In the right eye, he left the base curve at 5.25, changed the add to +2.5, prism 2 base down, and seg height 24.

This statement coupled with the slight bit of amblyopia to me seems like it could be anisometropia, wich would explain the changes in base curves. This is called isekonic lenses wich is the designing of lenses to help eliminate the difference in the magnification between the left and right eye, which could also explain the reason why contacts would be more clear. The lack of vertex distance in contact lenses leads to a more equal magnification even with differing powers. Just from what you described it seems as though you have been seeing competant professionals and should continue to search out and see a competant professional. As for purchasing online, by all means do it. I will not stop you from making a foolish mistake, but beware the optician that is going to get stuck with you after you have the bad experience with the online place should not have to deal with your frustration with your online shopping experience. Good Luck. SEE AN ECP.

[cdavis6632]

hello cadavis6632,



i would like to mention that u should never have problem when wearing contact lenses and to add to your great knowledge that contact lenses gives u 1 magnification and brain can easily fuse them. i can help you with best progressive u need but i m bit confused with your actual priscription.

it will be great if you can write ur full rx given by optometrist. i would like to say that these people are experienced and trust me they would have worked out your prescription correctly and also any related pathology. what i can understand is, things go wrong when supplying you with spex.



you had ODD add( ie diff reading rx between two eyes) because of less accomodation in particular eye. due to this problem, your PPL'S(progressive lenses) will have diff prism thinning.



please mention your complete rx for both eyes with visual acuity, before and after cataract operation done.



you have a gr8 knowledge of this and i haven’t seen any1 like yourself in my 6 years of professional life. It will be a pleasure giving you advice on PPL’S.



Amit jain.

Thank you so much for responding. I will have to look up all the parameters of each prescription but basicly before surgery:

OD: plano with add of +2.25 and contact lens underneath of -11.5
OS: +.25 -1.75 x169 add +2.25

after surgery and one episode of Nd YAG for "after" cataract in the right eye I have had several prescriptions but only two filled:

OD: -.25 add +2.25
OS: +.25 -1.75 x169 add 2.25
These I only use for the distance and driving

OD: -.37 add +2.75
OS: +.25 -1.75 x169 add +2.75
These are good for the computer and reading in the left eye

I use my glasses from before surgery (without contact lens) for the computer and reading in the right eye which is the eye I prefer to use for these tasks.

As you say, I don't think it is a problem with the actual refraction or prescription but rather the way it has been filled or fitted or adjusted. But since the different doctors keep referring me around and around to each other, no one person will take the responsibility for that aspect. I don't know much about figuring base curves, I've always assumed that the doctors know more than I do. It has only been recently that I just have not been able to figure out how it is that I seem to see well in the doctor's office, everyone assures me that my eyes are in good health, and yet I have a problem after I receive my new glasses or lenses. The prism I talked about before was prescribed prism, not induced prism which I don't know how to find out.

Thank you for any insights you may have.

[cdavis6632]

This statement coupled with the slight bit of amblyopia to me seems like it could be anisometropia, wich would explain the changes in base curves. This is called isekonic lenses wich is the designing of lenses to help eliminate the difference in the magnification between the left and right eye, which could also explain the reason why contacts would be more clear. The lack of vertex distance in contact lenses leads to a more equal magnification even with differing powers. Just from what you described it seems as though you have been seeing competant professionals and should continue to search out and see a competant professional. As for purchasing online, by all means do it. I will not stop you from making a foolish mistake, but beware the optician that is going to get stuck with you after you have the bad experience with the online place should not have to deal with your frustration with your online shopping experience. Good Luck. SEE AN ECP.

Since posting here last, I have seen a new optometrist. This is looking very promising for contact lenses, we can move on to glasses and sunglasses later. Now that you mention it, the word anisometropia has been mentioned before but I'm not exactly sure what it means. It didn't seem to be a problem for me to have such different eyes before I needed bifocals. The correction of nearsightedness in my right eye by cataract surgery has certainly helped a lot. The reason I have been so angry is not because each individual person might not be doing a competant job but because each one seems to feel that he knows better than I do what is providing the best vision or what the best fitting or adjustment is. I'm not talking about his professional expertise but rather, if I say that I seem to get better resolution with CR-39 or I need the right lens moved down and farther out. I don't care what my glasses look like to someone else or if they look crooked, I just want to see as well as I can. I know that with the amblyopia in the left eye I cannot be corrected more than about 20/35 and that's OK.

If I did order glasses online at least they would not be as costly to set aside if they did not provide a viable correction. A viable correction in my view is one that I am not contiually thinking about, squinting, turning my head, putting on a different pair or three, or moving them around on my face. I wouldn't feel too guilty taking online glasses into a local shop for adjustment since I have patronized local shops for 40 years and spent a small fortune following their recommendations only to set their products aside. Maybe it is not worth their time to do a slab-off anymore and that's why they said I needed cataract surgery. I don't know.

Like I said, though, I have high hopes for this new optometrist. She has given me a right, bifocal soft contact lens to try: -0.5 add +1.5

and

left, toric lens: +0.5 -1.75 x170 (no add)

These seem to be working very well and it's been two days now. I can read, see the computer, and drive!

Thank you very much for taking the time to respond and read through all the stuff I was trying to say.

[loncoa]

It's an acknowledged truism that a little knowledge in the wrong hands can be dangerous. Stop buying glasses from people you don't trust, or people you can't see. Find someone you trust, lay out your concerns, and then let them take care of it.

[cdavis6632]

I don't recall saying that I continued to buy glasses from people that had not provided me with an acceptable pair, merely lost money. If I could not see them that was the fault of the glasses. I am certain that I have enough knowledge to know what I can and cannot see.

[Steve Machol]

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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.