HELP! Diagnosing mystery problems...

[OptiChick21]

We have a patient who bought two pairs of SV glasses from us a couple months ago. One clear pair and one sunglass pair. The clear pair were plastic and suns were poly polarized. Her original Rx the doctor here wrote for her was:

-1.75 -0.50 x015
-1.50 -0.50 x150

She complained after having them one day they made her feel sea sick as soon as she puts them on and she needed to see the doc asap. So she came in that very day and the doctor realized she has had her old pair for 8 yrs, so she had the original eye doctor in NY fax us her original Rx and we remade both pairs in that exact Rx:

-1.50 -0.50 x167
-1.50 -0.50 x179

This doesnt look like much to me, but the doctor thought maybe she was really sensitive to the axis change. After remaking BOTH pairs for her, the doctor and her decided she would try and build up her wearing time slowly to get used to the new frames, etc... Well that was almost 3 wks ago and she is still complaining of eye strain, headaches and says she cannot even wear the suns because they make the clear pair seem worse!! But she is fine with her old glasses!

We have rechecked her and the glasses vs her old pair several times and there seems to be nothing wrong with the Rx...

What is going on? Even if there is no answer as to the cause, how would you handle these types of situations?? Would you just refund?

[DragonLensmanWV]

This is why every dispensary needs a huge vat of acid for those problem patients....

A couple of things:
Are the base curves the same? Probably are but needs checking.
Is the wrap and panto the same as her old pair? Try to match her old one as close as possible.
PDs the same?
If all else fails tell her that most people will retrain their brain to adapt to those in a week or two. Then tell her that these pairs will be the ones she can see better out of than whatever her next new pairs are.

[wolfman]

The question is, she really building up the wear time and wearing them like she is supposed to or at the first sign of trouble (after 15 min) she is putting her old ones on and wearing those for 15 hours a day thereby never getting used to them.

We get the patients who tell us they are doing everything we tell them, but then they get in with the doctor or we prod some more and they fess up to not wearing them at all.

[braheem24]

Try the drawer remake technique along with a few adjustments before the dispense.

It always humors me when I get these patients that tell me they're going to be problem patients because thier last OMD/OD or optician used to send the glasses back to thier lab 3 or 4 times till they were perfect and would wait for months before they were dispensed.

I always smirk and ask them why didnt they just pay the extra $5.00 and send it to a reputable lab in the first place:hammer:

[opticianbart]

Try the drawer remake technique along with a few adjustments before the dispense.

It always humors me when I get these patients that tell me they're going to be problem patients because thier last OMD/OD or optician used to send the glasses back to thier lab 3 or 4 times till they were perfect and would wait for months before they were dispensed.

I always smirk and ask them why didnt they just pay the extra $5.00 and send it to a reputable lab in the first place:hammer:

just remember, a properly made pair of glasses for a trouble patient always invovles "ageing" after this process the patient can then see properly ;)

[OptiChick21]

This is why every dispensary needs a huge vat of acid for those problem patients....

A couple of things:
Are the base curves the same? Probably are but needs checking.
Is the wrap and panto the same as her old pair? Try to match her old one as close as possible.
PDs the same?
If all else fails tell her that most people will retrain their brain to adapt to those in a week or two. Then tell her that these pairs will be the ones she can see better out of than whatever her next new pairs are.

We checked BCs and they were almost exactly the same.

The wrap isnt noticably different and as for panto, I dont remember!

The funny thing about her old glasses is they were obviously bent up at one point in the last 8 yrs because one lens is slightly bent upwards at a weird angle, and this is how she wears them!! We have checked the Rx with this odd angle already incorporated. I am just wondering if she got used to the wrong thing and now the right thing seems weird...

[obxeyeguy]

We checked BCs and they were almost exactly the same.

The wrap isnt noticably different and as for panto, I dont remember!

The funny thing about her old glasses is they were obviously bent up at one point in the last 8 yrs because one lens is slightly bent upwards at a weird angle, and this is how she wears them!! We have checked the Rx with this odd angle already incorporated. I am just wondering if she got used to the wrong thing and now the right thing seems weird...

Two questions. If you re-did these in the written origional Rx, and the "one lens is slightly bent upwards at a weird angle", what's the axis difference? (written and actual flat plane axis of glasses).

Two, why poly in the suns? In my mind, no good reason for it in that Rx. JMHO

[OptiChick21]

Honestly I didnt write down the weird angle axis, but when we checked it, it was closer to the Rx she got the first time from us.

For the sunglasses being in poly, we have a package price for our sun lenses which includes polarization, poly and backside AR. Also she picked out a trendy, large zyl frame and I figured this would help keep the weight down too. Didnt think in this day and age poly makes a noticable difference anymore... I think it's somethin else.

[Uncle Fester]

Hate to say it but I think you're dealing with a neurotic patient who will test all your people skills and patience before either accepting that these aren't the old pair or refunding their money.

You're fortunate or have only been doing this for a few years if this is your first. If you stay around long enough you'll find she won't be your last.

Sending a pm.

[Happylady]

Have you tried the magic shelf?:)

[MarcE]

Optichick to pt who asks for a refund: "I'd love to give you a refund, but there is no money left to refund. We made you three pairs of lenses and checked your eyes twice. I can't resell the frames since they are used. But I promise you this. If you wear the new Rx, you WIlL get used to it and you will see better."

Why poly in suns?? It blocks UV which is very important in suns (although these have polarization). Lighter weight. Impact resistance. There are three good reasons for a poly lenses in this situation.

[obxeyeguy]

Why poly in suns?? It blocks UV which is very important in suns (although these have polarization). Er, help[ me out here, but polorized in cr-39 filters UV, right? Lighter weight. OK, one for you, but signifacantly lighter to make up for the lower abbe and decrease is acuity?. Impact resistance. For the average person, a laminated polorized lens will far excede the need for stopping a bullet with their sunglasses.There are three good reasons for a poly lenses in this situation.

JMHO

[braheem24]

JMHO

MarcE forgot the ;)

[obxeyeguy]

MarcE forgot the ;)

Well, it wasn't there, so.........................

....................

..................

there!!!

[AWTECH]

With todays frames remember that the optical center height is measured much like a PAL to get an accurate placement vertically.

All B measurements should not be fitted at 1/2 the B.

[DragonLensmanWV]

Honestly I didnt write down the weird angle axis, but when we checked it, it was closer to the Rx she got the first time from us.

For the sunglasses being in poly, we have a package price for our sun lenses which includes polarization, poly and backside AR. Also she picked out a trendy, large zyl frame and I figured this would help keep the weight down too. Didnt think in this day and age poly makes a noticable difference anymore... I think it's somethin else.

Aha! Were her old frames big, trendy ones? Sometimes they get some less than satisfactory reviews of their new frames from friends, and then -Poof! they can't see out of the new ones!
Otherwise, she will experience greater distortion near the edges of her frames than she had before, and now, of course she's hyper-critical of them.

[Uncle Fester]

My Favorite is when they come in and tell you "you're the third place I'm trying to get this right".

AAHHHH!!!!!:hammer:

[Jubilee]

I am unsure if Optichick uses the same labs we do.. but with some of the local package pricing it can be CHEAPER FOR US to get poly than CR-39 in a polar.

Pass on to the patient a great package price and the patient gets a higher perceived value (if she wasn't neurotic) and we make more money.

Most places I know of use Poly polar by default anymore. Lighter weight, impact resistance.. and most people don't have any adaptation problems to them. Seems most suns get a beating more so than their clear pairs.

[sandeepgoodbole]

1. Is New frame Supra? If yes, then, the thread may be too tight and lens may be yielding coz of lesser CT. Try making it bit loose. 2. Check poly for stresses. 3. Ask her to close eyes alternatly and discover which one is troubling..If both, then might be R and L lenses are interchanged and getting overlooked. 4. Whats her age ? about 48,,and old frame is smaller than new one ?

[kelanor]

The polarization on the sunglasses could be off.

[OptiChick21]

Everyone is wondering if the poly polarized is a problem, but that doesnt help explain the problem with the clear pair??
One difference btw her old pair and the new clear pair is the old were round shape and the new are more square, slightly larger. Even so, if she just wore it she'd get used to seeing more lens.
And dont think changing shapes would cause headaches everytime she puts them on.
I agree maybe she got a "bad review" and now wont try them long enough to adapt to the changes... (small changes at that)

FYI Jubilee, you were right about the package pricing!

I just dont agree that poly is less clear anymore... maybe a long time ago it was...

[zeke]

Hey-hey from the UK - *long* time lurker, first-time poster!

I think Dragon has probably hit the nail on the head. Chances are (and as we all suspect), there's nothing wrong with the lenses and no reason why there should be problems.

But what about the frames? With a bit of gentle probing I wouldn't be surprised if she's changed her mind after the dispense and is expressing it in the only way she knows how - I can't see out of these!

The other possibility is she's realised she can't actually afford them, and is angling for a refund - what was she like during the dispense? Was she trepedatious at all about purchasing them or putting money down?

[pauly47]

"Hold" onto her old glasses so she can't go back to them.

[hipoptical]

Could be wrong, but I've seen things like this many times before. Every time except one it has been a missed diagnosis. She likely has a very serious condition called B.R.S. and it should be taken care of right away.










(Buyer's Remorse Syndrome);)

[OptiChick21]

I agree 100% she probably has BRS.

The doc talked to her yesterday and she admitted she is doing better with the clear pair, no headaches now, unless she switches from clear pair to sun pair... then HA. Not sure why that would cause a headache??

Probably from thinking of how much she spent on the Coach suns everytime she puts them on.... LoL

We call them MBP's.... (money back patients)... :p