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

[Linnaea]

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?

[For-Life]

A few questions:

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

[optical24/7]

Is she going back and forth between her '06 and '08 Rx's? A 5 degree change in a -2 cyl is substantial. (OD)

[Happylady]

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.

[HarryChiling]

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.

[Barry Santini]

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!

[Linnaea]

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.

Is she going back and forth between her '06 and '08 Rx's? A 5 degree change in a -2 cyl is substantial. (OD)

[Linnaea]

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.

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.

[Linnaea]

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:

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.

[Linnaea]

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

A few questions:

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

[Linnaea]

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!

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!

[Robert Martellaro]

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.

[For-Life]

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.

[Happylady]

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.

[icu2gel58]

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....