High add, High myopia

[chip anderson]

Forgive me if I am posting this twice, I think I added a space in the password the first time and am re-posting.

I have a patient that has:

1) Relatively high myopia (about -8.00)
2) A high add (+5.00)
3) And old pair of glasses that she was relatively happy with, which have a posterior round seg.
4) A more recent pair of glasses made our local teaching institution which she was never happy with which have ST Bifocals that are too low and set about 10 degrees counter clockwise O.U.
5) Her doctor specified: Polycarbonate lenses and a plastic frame (neither I or the patient can figure out why?

My thinking at this time is to use:
1) An ST bifocal in the highest (not poly) plastc material I can find.
2) To use a small metal (patient doesn't want a plastic frame or poly). Which centers the P.D verticaly and horizontaly very well.
3) Also concidering: A trifocal if obtainable in this add. Or a clip on for intermediate (computer) distance. I do not think any sort of progressive is a good idea with this sort of subnormal vision even if same is available.

Would appreciate any sort of intelligence you can share for this problem.

Chip

[Jeff Trail]

Chip,

You are right.. putting this lady into a PAL would be a big mistake. Next the person who moved her from a RD seg to a FT was a ninny.. RD segs are always easier on a patient that has a high add.. the OC's are lower in a RD seg, the line in a hard D seg will cause reflections and in some cases the wearer will even pick up an "inverted" image through the top of the seg, especially if sitting down and looking through the lens..
Putting her into a poly would seem to me to be silly, the reason being the OD probably recommended it is for the lighter wght. but probably didn't consider what it would do to the patient swapping them in material as well as seg design .. bad move on the OD's part in my opinion.
You could always try an Ultex design.. I'll have to check my books when I get to the office to make sure it's available in the addition power you are wanting but I think it is...

Jeff "grind'em if ya got'em " Trail

[Rich R]

Hello Chip, no matter what you go with it's not an easy rx to fill, there are not many options in a 5.00 add power, either ft or rnd. I would recommend also a reading only rx. Rich R

[Dave Nelson]

Hi Chip,I'm a bit skeptical about both the trifocal and the ultex. Generally adds this high are prescribed to allow the patient to accomodate at very short distances, and provide "relative distance magnification" ie the closer one brings an object, the larger the retinal image. This may also indicate a need to decenter the segs to aid in convergence. Do you know the patients bcva? What distance does the patient read at with the +5.00 add? If it is very close, an intermediate may not help much, but you're in a better position than I to find out. I would be a bit concerned with an ultex due to the large amount of image jump with an add that high. Progressive is out, if for no other reason than you simply wont find one with that high an add. I disagree with poly, and I dont know why so many ODs are in love with it. I do, however agree with the use of a plastic frame: a well fitted bridge will generally be more comfortable than pads, and help support the weight of these specs. Good luck, and let us know how you make out. David

[stephanie]

Hi Chip! I would have to agree with you using a small metal frame(the smaller and more oval the better). I intensely agree with staying with plastic. You can use high-index plastic...I am sure you can get one with that +5.00 add since I am sure that you being with indep. have more available to you. I can't even believe the dr would suggest poly! If it isn't for safety purposes why take a chance on the abberation it may cause the patient. I think sometimes some drs think they know more about what is better for the patients than we do. Sometimes I feel like saying just write the rx and let me worry about the eyewear. I also agree with Jeff on keeping the pt in round seg. I am one of those if it's not broke don't fix it people. I also don't like to put anyone in a progress. if they have been in fts for awhile or have an incredible rx unless they insist.
Just my 2 cents worth.
Good luck and use your own good judgement. You may even want to call the dr to ask why he suggested this for this patient. I know I would just to know.
Have a great day!
Steph