Help with this patient "redo"

**ilanh** · 12-21-2009, 11:08 PM

I've seen this happen a number of times and can never quite explain it. A patient comes in with a pair of spectacles that we just made. They are SV poly with premium AR. The Rx, PD, lens material, base curves, AR and frame style are all identical to his old glasses. Yet the patient hates his new glasses and says that they give him headaches and are fuzzy. The old glasses are "much better". I recheck everything three times over and can't explain it. The only difference that I can see is that the stress patterns look slightly different through my double polarizing tester. Another potential difference is the AR may be different. However, at this point I'm clutching for straws.. I've had this happen 3-4 times over the years and it always confuses me. Any thoughts on what to do when everything is identical!

**Jubilee** · 12-22-2009, 12:47 AM

Out of curiosity.. is the Premium poly aspheric?

I recently had a patient whom I had fitted with poly aspheric with ar in the past. Never had issues with it. Recent update, frame slightly larger, but only a mm in the ED maybe 2.. and he couldn't tolerate them at all. Center was ok.. but anything beyond the central 30% was "wavy"

Called the lab and discovered that the lab was using a different stock. Measuring the amount of tapering towards the edges, the newer pair did seem to have more "asphericity" in the lens compared to the old pair. Barely registered a difference in measuring at various spots in the old, the new pair had a larger variance between center of lens to edges. Remade to non aspheric (since ins lab wouldn't allow me to specify brand of lens..) patient was happy with new set.

I also recall a patient that the OC made a big difference with them in aspherics in the past too..

**optician paul** · 12-22-2009, 02:57 AM

Were they a high minus? I have had several instances where the tilt or face form of a frame made all the difference in the world. It's so simple, but easy to overlook when you are searching for a needle in a haystack. I agree with Jubilee that the slight frame size difference and transition to aspheric can make a difference. Some people are just that sensative to change.

**drk** · 12-22-2009, 09:12 AM

Only "3-4 times over the years"?

<Applause/standing ovation>

**Strab** · 12-22-2009, 09:20 AM

After checking everything and still no differences... My experiance says it's the frame. They regret the frame they purchased but don't want to admit it to you. Of course, be absolutely positive it is not an optical error before bringing up the possibility that it is the frame to the patient and be careful how you word it. Sometimes I am able to use a line like "I have compared everything in the lenses that could be wrong and I'm still not finding an error. Do you (the patient) think that maybe it's the frame?" Of course, also be ready for a remake in a new frame. Another que is to actually listen to the patients words. Did they ever, even one time mention the frame on their own? Good luck these patients are never fun and always time consuming.

**ezrich** · 12-22-2009, 10:45 AM

2nd thing i consider. frame change is so much easier than hr`s spent chasing their inability to admit they hate the frame.

**rbaker** · 12-22-2009, 11:36 AM

Originally Posted by ilanh

everything is identical!

Apparently not.

**Robert Martellaro** · 12-22-2009, 12:11 PM

Originally Posted by ilanh

I've seen this happen a number of times and can never quite explain it. A patient comes in with a pair of spectacles that we just made. They are SV poly with premium AR. The Rx, PD, lens material, base curves, AR and frame style are all identical to his old glasses. Yet the patient hates his new glasses and says that they give him headaches and are fuzzy. The old glasses are "much better". I recheck everything three times over and can't explain it. The only difference that I can see is that the stress patterns look slightly different through my double polarizing tester. Another potential difference is the AR may be different. However, at this point I'm clutching for straws.. I've had this happen 3-4 times over the years and it always confuses me. Any thoughts on what to do when everything is identical!

Might just be one of those mysteries of the universe. For example, why do stars revolve around the center of galaxies at a constant speed over a large range of distances from the center of the galaxy?

Ignoring stresses from the holidays and any full moon effects (if you believe in such things), I would inquire if any or all of these lenses were semi-finished, and if you are asking for a specific base curve. One possibility is that an aspheric design was subbed, without your knowledge, for a spheric surface design or vice versa. You didn't mention vertical OCs, but if the frame was the same and they're single vision I would think they would be on the 180 line. But if aspheric was used, the 180 line might not be the optimum position. I would also look for surface irregularities, especially for those with low powers and/or thin centers.

**Barry Santini** · 12-22-2009, 12:22 PM

Originally Posted by Robert Martellaro

Ignoring stresses from the holidays and any full moon effects (if you believe in such things).

I do. I really do believe in the full moon effect.

Barry

**Robert Martellaro** · 12-22-2009, 01:09 PM

Originally Posted by Barry Santini

I do. I really do believe in the full moon effect.

Barry

I believe also. I almost mooned one of my ex-clients yesterday morning. Bang, zoom, to the moon!

**MarySue** · 12-22-2009, 06:45 PM

:p

Some digitally surfaced lenses have "issues" with softness and precise clarity, it doesn't make sense if you've used same frame, RX and lens design, unless of course the lens is a HOYA ID - then, it makes perfect sense.

I've found the lens to be either brilliant or a bit wishy washy, depending on the day. The design is lovely to wear, but when it comes out wrong, it's really wrong.

The other thing you might want to check for is distortion. You won't see it on a digital focimeter, so get out the old B&L!

**Fezz** · 12-22-2009, 07:44 PM

Please, oh PLEASE let the collective Optiboard group know when you will be walking on water next!

I bet that many of us want to be front and center for the second coming!

;):cheers::cheers::cheers:

**rdcoach5** · 12-22-2009, 08:07 PM

Originally Posted by ilanh

I've seen this happen a number of times and can never quite explain it. A patient comes in with a pair of spectacles that we just made. They are SV poly with premium AR. The Rx, PD, lens material, base curves, AR and frame style are all identical to his old glasses. Yet the patient hates his new glasses and says that they give him headaches and are fuzzy. The old glasses are "much better". I recheck everything three times over and can't explain it. The only difference that I can see is that the stress patterns look slightly different through my double polarizing tester. Another potential difference is the AR may be different. However, at this point I'm clutching for straws.. I've had this happen 3-4 times over the years and it always confuses me. Any thoughts on what to do when everything is identical!

IT'S USUALLY THE PANTO IS DIFFERENT OR THERE ARE WAVES IN THE LENSES.Check the concave side and slide the lens side to side and up and down to see if there are minute waves. I BET YOU WILL.

**nooksak** · 12-23-2009, 09:23 AM

I also to as well thing it may be a "Stun" problem....my guess would be that they are disliking the frame.....

**MarySue** · 12-26-2009, 03:32 PM

Originally Posted by Fezz

Please, oh PLEASE let the collective Optiboard group know when you will be walking on water next!

I bet that many of us want to be front and center for the second coming!

;):cheers::cheers::cheers:

Fezz, I'd never walk on water - I'm useless in many things. I read all of your posts, and others, but only comment when I think I might help. I'll make my new year's resolution to learn a bit of humour.