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Thread: Update and question re; PAL sunglasses--problem for patient

  1. #1
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    Confused Update and question re; PAL sunglasses--problem for patient

    I had sent this with my original post, but I'm not sure if anyone read it. So I'll send it now:


    Need help with PAL Rx/sunglasses--pt. problem
    Okay, so the woman I talked about in my original post picked up her sunglasses today. She decided to go with the Kate Spade "Jacqueline" zyl frame. She liked them, at least the way they fit and looked on her.
    She went with a Comfort Airwear polarized gray poly carb.

    However, she called at the end of the day and left a message. She said that after wearing them awhile, she really noticed an eye strain, almost like they might be too strong, to the point of wanting to take them off--now. She expected them to feel different when she first put them on--but this seemed to worsen as she wore them. It's not a progressive-thing, she said. She's entirely used to that. She's worn Varilux for 14 years. Her everyday glasses are a short corrider (Ellipse.) Loves them.

    She said that the everything is where it should be re; distance, close-up, mid. It's just that they seem to strain her eyes. And, when she changes into her Ellipses her eyes have an adjustment period. I can see that.

    It doesn't seem like the Rx has changed that much. Here is the new Rx and the one from 2 years ago under it. Can just that amount alter the way she sees out of them? Oh she had us put a slight pano tilt which she says always seems to help with distance vision, ever so slightly though.


    New Rx 2008

    sphere cyl axis
    OD -4.25 -2.25 20
    OS -5.00 -1.25 170

    ADD +2.50

    R--Seg Ht. 21
    L--Seg Ht. 22

    MonStd
    R 27.5
    L 27.5
    ************************
    Rx 2006

    OD -4.25 -2.00 015
    OS -4.75 -1.50 170
    ADD +2.50

    Her old sunglasses were made in 1999. She's worn them almost everyday since then. The recently broke (metal) She found that old Rx. Strange, but her ADD was +3.25!

    Rx 1999

    R sphere -4.75 cyl -2.00 axis 10
    L -4.50 1.50 axis 176 ADD +3.25

    So what do you think is happening? She's not having any of the typical PAL adjustment as I mentioned. Just this feeling of the lenses being too strong...or something! Her eyes feel very tired and achy she said. Worried that it won't go away. Any advice?

  2. #2
    One of the worst people here
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    A few questions:

    - What colour are the lenses?
    - Is there a backside AR?
    - What are the base curve comparisons?

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    Master OptiBoarder OptiBoard Silver Supporter optical24/7's Avatar
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    Is she going back and forth between her '06 and '08 Rx's? A 5 degree change in a -2 cyl is substantial. (OD)

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    Has she worn polarized sunglasses before? Has she worn poly before? Is this frame a lot larger then any she has worn recently?

    Have her come in with all her eyeglasses. Even though she says everything is where it should be, you need to remark all her eyeglasses and compare the where the fitting crosses are. Compare the fit of the eyeglasses, too. Double check the prescription and make sure the polarized axis is correct.

    If everything checks out she might need a recheck from the doctor.

    Good luck and let us know what happens.

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    ATO Member OptiBoard Bronze Supporter HarryChiling's Avatar
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    Some possible explanations:

    1. Cylinder, 5 degrees in this case is the equivalent of 0.40D difference which I would say is significant.
    2. Lens Design, your saying she wears a short corridor Ellipse compared to a comfort the desing will be different
    3. Poly and Sunglasses, the size of her pupils will be enlarged behind a sun lens which would allow her to get a larger bundle of rays at one time. This could mean that the aberrations would be increased.
    4. Lens Size, an Ellipse is probably fit into a small frame edgeign away all the distortion the sunglass I am guessing is in a larger frame so it's all there and more exagerated in the periphery.

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    She is absolutely, positively out of binocular (accomodative) balance with her 2008 RX. Look at the old vs. new binocularity comparison.

    Try putting +0.25 over her new 2008 OS, both eyes open.

    Do the opposite, -0.25D over her 2006 OD, both eyes open.

    Tell me what she says.

    Barry

    PS I'll further bet she compains of pressure in her temples wfter wearing the 2008 RX. Ask her!

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    Yes, she is. Her regular glasses are still in good condition. Can't afford new ones quite yet. This was the first time she made use of her new VSP plan and can't get new glasses for 2 years.

    Quote Originally Posted by optical24/7 View Post
    Is she going back and forth between her '06 and '08 Rx's? A 5 degree change in a -2 cyl is substantial. (OD)

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    Arrow

    No on the polarized. Yes on the poly. Her eyeglasses are very small with the Ellipse. Her old sunglasses are smaller than the new ones. Non-polarized and I think, CR-39. Very thick, she told me. Metal. She didn't bring them in since the temple had broken. 9 years old. '99 Rx on those.

    Thanks for the advice, Happylady. I'll give her a call and do what you suggested. I did talk to her today and she said they felt a little better, so maybe she needs to acclimate? I'm going to go ahead and have her come in, though. I'll let you know how it goes. I will say, she's a very nice lady and easy to work with. Not all of them are.

    Quote Originally Posted by Happylady View Post
    Has she worn polarized sunglasses before? Has she worn poly before? Is this frame a lot larger then any she has worn recently?

    Have her come in with all her eyeglasses. Even though she says everything is where it should be, you need to remark all her eyeglasses and compare the where the fitting crosses are. Compare the fit of the eyeglasses, too. Double check the prescription and make sure the polarized axis is correct.

    If everything checks out she might need a recheck from the doctor.

    Good luck and let us know what happens.

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    Thanks so much for these explanations, Harry. I'm printing this and will call her to come in so we can check all of your points out. See my comments below next to yours:


    Quote Originally Posted by HarryChiling View Post
    Some possible explanations:

    1. Cylinder, 5 degrees in this case is the equivalent of 0.40D difference which I would say is significant. Should she have kept her Rx the same as her 2 year old eyeglass Rx? She sees well out of those (she said.) Sometimes I wonder just how exact these Rx are anyway. I know it can be confusing trying to choose the letters that look the "most clear". Even myself, I sometimes doubt my own answers at times. :o
    2. Lens Design, your saying she wears a short corridor Ellipse compared to a comfort the desing will be different. Yes, this is true. But she wants larger sunglasses and smaller eyeglasses. Whatchagonnado.
    3. Poly and Sunglasses, the size of her pupils will be enlarged behind a sun lens which would allow her to get a larger bundle of rays at one time. This could mean that the aberrations would be increased. How can we remedy this?
    4. Lens Size, an Ellipse is probably fit into a small frame edgeign away all the distortion the sunglass I am guessing is in a larger frame so it's all there and more exagerated in the periphery. Excellent point. Definitely more lens there in those sunglass frames. She did mention that she sees more distortion on the sides, needing to turn her head more. But she said she can get used to that. Her old eyeglasses (before the short corridors) were larger, so she's accustomed to distortion.

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    Lens color is dark gray. No AR at all. Not sure about the base curve comparisons. Will check. Thanks, For-Life.

    Quote Originally Posted by For-Life View Post
    A few questions:

    - What colour are the lenses?
    - Is there a backside AR?
    - What are the base curve comparisons?

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    Thanks for the suggestions, Barry. Will do that. I'll also ask her about the temples, although she didn't complain about that with her initial call. I don't think she wore them long enough to tell. I'll let you know!


    Quote Originally Posted by Barry Santini View Post
    She is absolutely, positively out of binocular (accomodative) balance with her 2008 RX. Look at the old vs. new binocularity comparison.

    Try putting +0.25 over her new 2008 OS, both eyes open.

    Do the opposite, -0.25D over her 2006 OD, both eyes open.

    Tell me what she says.

    Barry

    PS I'll further bet she compains of pressure in her temples wfter wearing the 2008 RX. Ask her!

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    Always learning OptiBoard Bronze Supporter
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    Quote Originally Posted by Linnaea View Post
    So what do you think is happening? She's not having any of the typical PAL adjustment as I mentioned. Just this feeling of the lenses being too strong...or something! Her eyes feel very tired and achy she said. Worried that it won't go away. Any advice?
    The trend toward more minus suggests a nuclear cataract in the left eye, and the old +3.25 Add suggests some type of pathology, possibly cataracts.

    You mentioned that her old lenses might not have been polarized. If true, they may have been dyed plastic, and considering their age (nine years) have probably faded and turned red.

    It's possible that the new sunglasses are to dark, causing discomfort and diminished vision. The solution might be as simple as changing the tint to a Brown C polarized, increasing the perceived contrast and brightness.
    Robert Martellaro
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    www.roberts-optical.com
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    Quote Originally Posted by Linnaea View Post
    Lens color is dark gray. No AR at all. Not sure about the base curve comparisons. Will check. Thanks, For-Life.
    Wondering if the poly mix and no backside AR are making her strain through the lenses. Additionally, with the gray, there is no protection for blue light, so it could just add to the problem.

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    Quote Originally Posted by Linnaea View Post
    Can't afford new ones quite yet. This was the first time she made use of her new VSP plan and can't get new glasses for 2 years.

    I did talk to her today and she said they felt a little better, so maybe she needs to acclimate?

    I always hate it when patients say they can't get new glasses for 2 years because of their insurance. Yes, they can get new glasses, they just have to pay for them themselves. :)

    Maybe she does just need more time to adjust to them. The 5 degree difference on the cylinder might be a problem for some people but not all people. You could try covering up each eye and see if one lens seems to be bothering her more then the other one.

    The larger size can cause problems for some people, too. I would tell her to give it a little more time to see if she adjusts. I wonder what the progressive was in her old sunglasses. It sounds like she was able to comfortably switch between them and her Ellipses.

    If the distortion on the side bothers her a bit more face form might help.

    Thanks for the feedback.

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    re: Kate Spades

    Are they wrap frames..? If so, you may have to re-calculate the Rx. This may include changing the sph/cyl power and possibly adding some base in prism....

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    Thumbs up

    Actually, after she gave it a few days of wearing them for longer periods of time, she's adapted. Hurray! I imagine it was just a matter of her adjusting to a stronger Rx and the fact that this is polarized. Also more side distortion than her Ellipse glasses. Whatever--they seem to be working for her. She did come in and our senior optician tweaked the temples a bit to make them more centered. One temple was a bit closer to her head than the other side. It bother her.Either way, it looks like a happy ending. We did check the Rx and everything was as it should be. So, it's all good! She apologized for over reacting at first, but we just told her "No harm".

    Thanks everyone for your thoughts and tips. Oh and no they really aren't much of a wrap. We taled about that when she was trying on frames.

    Quote Originally Posted by icu2gel58 View Post
    Are they wrap frames..? If so, you may have to re-calculate the Rx. This may include changing the sph/cyl power and possibly adding some base in prism....

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    Just because the insurance company won't provide new glasses except at 2 year intervals. Doesn't mean the patient can't have them. How do we in a socially acceptable (yes, Chip said this) manner explain to the patient that they can still buy glasses out of pocket like they used to before having insurance?
    If it was cold and I didn't have coat, I wouldn't wait for some third party to buy me one. Especially for two years.
    This insurance business and the mentality that seems to befall thier customers is madness.

    chip

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    Quote Originally Posted by chip anderson View Post
    Just because the insurance company won't provide new glasses except at 2 year intervals. Doesn't mean the patient can't have them. How do we in a socially acceptable (yes, Chip said this) manner explain to the patient that they can still buy glasses out of pocket like they used to before having insurance?
    If it was cold and I didn't have coat, I wouldn't wait for some third party to buy me one. Especially for two years.
    This insurance business and the mentality that seems to befall thier customers is madness.

    chip

    I've been trying to figure out the PC way to get this across also. Everything that I have come up with so far makes me sound like (more than usual) a jerk and used car salesman.

    If anyone has any suggestions to get people to buy during the off year, please let's hear them.




    P.S. Glad to see Chip "Socially Acceptable" Anderson growing right before our eyes. Just don't go soft on us now!

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    Quote Originally Posted by Happylady View Post
    I always hate it when patients say they can't get new glasses for 2 years because of their insurance. Yes, they can get new glasses, they just have to pay for them themselves. :)
    Quote Originally Posted by chip anderson View Post
    Just because the insurance company won't provide new glasses except at 2 year intervals. Doesn't mean the patient can't have them. How do we in a socially acceptable (yes, Chip said this) manner explain to the patient that they can still buy glasses out of pocket like they used to before having insurance?
    If it was cold and I didn't have coat, I wouldn't wait for some third party to buy me one. Especially for two years.
    This insurance business and the mentality that seems to befall their customers is madness.

    chip
    Yes, it bugs me when people say that, as I posted above. I would love a good comeback that doesn't sound pushy.

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    Master OptiBoarder rinselberg's Avatar
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    Quote Originally Posted by Happylady View Post
    I always hate it when patients say they can't get new glasses for 2 years because of their insurance. Yes, they can get new glasses, they just have to pay for them themselves..
    Quote Originally Posted by Happylady View Post
    Yes, it bugs me when people say that, as I posted above. I would love a good comeback that doesn't sound pushy.
    How about "They're YOUR eyes.." ..?

    Are you reading more posts and enjoying it less? Make RadioFreeRinsel your next Internet port of call ...

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    She doesn't seem to need new glasses now after adjusting to the new sunglasses. That said, we didn't go into depth about her ability or not to purchase new glasses without insurance IF we felt she needed a new Rx for those, too. She did tell me that this is the FIRST time EVER she's had vision insurance and it really is a big help. Normally her glasses are $600 or so. This time with insurance her sunglasses were $275. So unless she decides to go with the new ones right now, we're not going to pressure her. But I agree with you if someone needs new glasses, it's not mandatory that insurance needs to cover it.


    Quote Originally Posted by chip anderson View Post
    Just because the insurance company won't provide new glasses except at 2 year intervals. Doesn't mean the patient can't have them. How do we in a socially acceptable (yes, Chip said this) manner explain to the patient that they can still buy glasses out of pocket like they used to before having insurance?
    If it was cold and I didn't have coat, I wouldn't wait for some third party to buy me one. Especially for two years.
    This insurance business and the mentality that seems to befall thier customers is madness.

    chip

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