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Thread: Strange conundrum...

  1. #1
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    Strange conundrum...

    I dispensed a pair of Physio 360 (Dr recommendation for pt) to a very high myope (-10.00). He came back recently to comment that his vision is actually clearer when looking slightly to his right than straight on. This is true with both eyes simulatneously and each eye individually. Suspecting a PD problem, I dotted them up and observed them on the pt. Perfect. Checked lens power with extreme attn to detail, including at the PRP. Perfect.
    Any ideas besides the PRP to verify that the distance "OC" is truly where the mark-up chart says it is? It reads fine in the lensometer, so I'm not sure why he feels his vision is so much better at an angle almost 10mm to the side of the fitting cross.
    What do you think?

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    Have had this complaint myself. Not able to verify the cause of the problem but I think someone has the "corridor" out of place, inducing slight distortion centrally, patient is finding the 'sweet spot". Other possiblilties, seg too high. Rx strong and he is finding plus or cylinder in the abberation. Remember that the stronger the power the more problems make themselves appearent.

    Just an opinion, suspect that we need Darrel, or Pete for better explaination.

    Chip

  3. #3
    Master OptiBoarder
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    Maybe a surfacing "wave"?

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    Something Wicked This WayComes AngryFish's Avatar
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    How about this for unlikely?

    I would be curious to get him into an exam chair and verify his acuity objectively to "see" if he sees what he claims. Off the top of my head I wonder could he be inducing a little minus at that angle.

  5. #5
    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Hi EyeFitWell,

    One thought: are you mounting these lenses with the fitting cross at center pupil? If so, try moving the lens down so the fitting cross is at lower pupil and see if he has the same complaint.

    Otherwise, I think Chip's suggestion of a corridor abberation makes sense. (On the other hand, Fester and I once had a patient who insisted he could only read properly through the very edge of his progressive's reading area -- no matter how we adjusted his pd (and we redid that job at least 3 times!). As Fester would say, sometimes the problem's between the ears.).
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

  6. #6
    Doh! braheem24's Avatar
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    Eyefitwell, I've read some of your previous posts and know it's not a fitting error, you're very thorough.

    I would read the power throught the 'sweet spot', trial frame it, if the 'sweet spot' power is better then the prescribed then problem solved, it's an rx change.

    If the prescribed rx is better, check to see if the patient also has better VAs looking to the right through the single vision trial lenses. At -10.00 that retina has a lotta eyeball to cover :bbg:

    If neither work, then suspect lens design and all the other theory stuff.

    Always start with your controlled variables, Good luck :cheers:



    Ibrahim

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    I would read the power through the 'sweet spot', trial frame it, if the 'sweet spot' power is better then the prescribed then problem solved, it's an rx change.
    Just a thought on my part.

    At -10.00 be sure to take vertex distance into account and add minus accordingly to the sweet spot.

  8. #8
    Doh! braheem24's Avatar
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    Always listen you your uncle :D

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