suggestions???

**foureyes** · 02-27-2007, 02:52 PM

i work for an OD's office. we have a woman we have been dealing with for several years with the same problems. i need some suggestions. she is a PAL wearer, Rx -2.75 OD -3.00 OS with a +2.00 add. Her only complaint is headaches, headaches, headaches. We have changed the Rx, lens brands, adjusted until we thought our hands would fall off. Both are lightweight metal frames similar size, same nosepads.

Her old glasses do not give her headaches, and they are a similar Rx, lower add though, with Cr39 Varilux Comfort. (The new lenses are also Cr)

She is a very sweet woman and is almost in tears with her frustration. I don't know who is more frustrated.

Suggestions!?

**Barry Santini** · 02-27-2007, 03:15 PM

If the new Rx is somewhat more to the plus (+; overplussed?), then she might have headches

If the new Rx changed her binocular balance compared with her old pair...ditto

She may need some (unprescribed) prism with the new add??

Face form angle, or (to a lesser degree) panto?

Just some thoughts...

Barry

**Fezz** · 02-27-2007, 03:23 PM

I am sure you have checked all the optical things like base curve, etc.

Maybe you should pry elsewhere.

Is she suffering from caffeine withdrawl, stress, diet triggers, etc that may be giving her these headaches. Blood pressure may be an issue also. Hopefully one of our talented Optoms could chime in soon.

**foureyes** · 02-27-2007, 03:31 PM

have checked base curve, panto, face form, etc. seg height same, no major change in distance. it seems like she's just nuts, but i really don't think so.

the thing about a medical issue is she doesn't get headaches with her old ones. still, i'd love to hear from an OD.

**Dave Nelson** · 02-27-2007, 03:36 PM

Ongoing headaches without a known cause is absolutely an indication for referral to an M.D. It may be just coincidence that she feels she is not having headaches with her old glasses. Better to err on the side of caution.

**Fezz** · 02-27-2007, 03:39 PM

Originally Posted by Dave Nelson

Better to err on the side of caution.

Amen Brother!

:cheers:

**foureyes** · 02-27-2007, 03:47 PM

i'll mention that to my doctor. she suffers from migraines and is being treated for them. however, when she wears the new glasses for an extended period of time, she develops a terrible headache. i know it could still be just coincidence, i'm just wondering if anyone knows anything else i should consider before assuming this. also because when our doctor talks with her about this possibility, she is insistent on the fact that it is the glasses.

**chip anderson** · 02-27-2007, 03:49 PM

Put de lime in de coconut, call me in de mornin.

**drk** · 02-27-2007, 06:02 PM

Headaches are virtually impossible to pin down.

Check everything reasonable, including the refraction, and see what happens.

Otherwise, punt.

**DocInChina** · 02-27-2007, 07:30 PM

Originally Posted by foureyes

have checked base curve, panto, face form, etc. seg height same, no major change in distance. it seems like she's just nuts, but i really don't think so.
the thing about a medical issue is she doesn't get headaches with her old ones. still, i'd love to hear from an OD.

When does she get the headaches; specifically what is she doing (watching TV, computer, reading)? Once you pin down the task she is doing you then may want to check her habitual posture with the old Rx and then with the new. This evaluation can provide a lot of information. Also I would be interested to know the following: her full refraction, what was Rx'ed, her old Rx and how many years has she been wearing the old Rx.

Doc

**foureyes** · 02-27-2007, 08:19 PM

thanks for your suggestions. i will talk more specifically with her about when this happens with the glasses. and tomorrow, when i get in, i'll let you know more details, old rx, etc. just to give you an idea, this has been going on since i began working there. that's almost 4 years. and the old glasses are much older than that. i feel like we've tried virutually everything with her.

**Joann Raytar** · 02-27-2007, 09:53 PM

Excessive Visual Strain: Excessive visual strain at emmetropia, myopic overcorrected spectacles or contact lenses, and astigmatism or hyperopia under-corrected causes Migraines

Visual Strain and Low illumination: It causes Migraine by pupil dilation that raises the intraocular pressure. At older times, this occurred with photographers in dark rooms and with needlewomen in deficient illumination. Nowadays this visual effort occurs with children and teenagers seeing TV, computer and electronic games in a scarcely illuminated room
http://library.med.utah.edu/NOVEL/co...2049%20cat.doc

Maybe the above link can offer some clues???

**harry888** · 02-27-2007, 09:58 PM

foureyes,

What exactly is the old rx that doesn't give headaches?

Harry

**foureyes** · 02-28-2007, 03:22 PM

rx without headaches is
OD -2.75 -0.50 x 82
OS -3.25 -0.25 x 75

+1.75 add

as far as the cylinder, last refracted at

-2.50 -0.25 x 100
-2.75 -0.25 x 80
+2.00 add

rerefracted yesterday w/ the rx in my first post.

**DocInChina** · 02-28-2007, 03:40 PM

I just PM'ed you. I don't think prescribing advice should be posted in the open forum. You can reply to me there.

Doc

**harry888** · 02-28-2007, 07:56 PM

I kind of agree on not giving on-line prescribing advice, but really think the headaches are from too much reduction in minus. Power is very addictive you know.

Harry

**Happylady** · 03-01-2007, 09:24 AM

Can she see better with the new glasses?

**CCGREEN** · 03-01-2007, 10:08 AM

I do not recall anyone saying anything about lens material. What material is the old pair made of? Match it if you can. Vision can be much better out of some the the older material, as in glass or plastic. Newer material is good at making nice thin lenses but due to the density of the material the light can pass through the lens slower thus sacrificing visual acuity and can create chromatic aberrations which could be, not just the cause but a contributing factor along with other factors to her problem.

**foureyes** · 03-01-2007, 01:07 PM

she can see better with the new Rx. She loves it! (At first....)

material, i have already remade them with cr39, the old material.

**Chris Ryser** · 03-01-2007, 01:15 PM

Put her into some single vision CR39 for a couple of days (no big cost factor). She can read without glasses.

If she has no problems that way your culprit is the progressive lens you gave her.

**Excel-Lentes** · 03-01-2007, 02:48 PM

Had a patient one time complain about headaches after getting new glasses (V.Comfort Cr-39) after wearing them for about an hour. Rx had very slight change/ Vision was very good w/new rx.

After checking all parameters I found that his old varilux lenses were made without prism thinning. The new ones had 1.5 BD Ou. I remade the glasses w/o prism thinning and everything was back to normal.

Maybe worth checking?

**Barry Santini** · 03-01-2007, 03:53 PM

Originally Posted by foureyes

rx without headaches is
OD -2.75 -0.50 x 82
OS -3.25 -0.25 x 75

+1.75 add

as far as the cylinder, last refracted at

-2.50 -0.25 x 100
-2.75 -0.25 x 80
+2.00 add

rerefracted yesterday w/ the rx in my first post.

Posted below is my first response:

If the new Rx is somewhat more to the plus (+; overplussed?), then she might have headches

If the new Rx changed her binocular balance compared with her old pair...ditto

She may need some (unprescribed) prism with the new add??

Face form angle, or (to a lesser degree) panto?

Just some thoughts...

Barry