I need help! With a patient that is....

**scottster** · 08-25-2010, 09:30 AM

Greetings and salutations to all!

I've been working with the patient and her sunglasses now for 2 months and I don't know what to do. A little background info:
Rx: OD: +2.25 -.50 x88
OS: +2.75 -.75 x78
Add: +2.25
She purchased a large sunglass frame (Juicy Couture Runway/S model) mostly for reading at the beach. Put her in an Trivex Image with a solid 3 gray tint. And before anybody scolds me, she wasn't my original patient, I would've put her in polarized!
Fitting height @ 29mm. Very good distance and intermediate VA's but she has to lift up the frame off her nose ~2-3mm to read comfortably. With a height of 29mm it seems counter-intuitive to have to do that! Experiencing shadows under text when reading at normal position. Introduced more panto, face form is good, PD is spot on, etc.... Don't know where to go from here now. Any help or suggestions would be greatly appreciated!

Thanks!

**DragonLensmanWV** · 08-25-2010, 12:16 PM

Increasing panto will have the effect of lowering the seg. You want to retro it some to effectively raise the seg.

**TLG** · 08-25-2010, 12:40 PM

I love the Image lens for sunwear. I wear it, and I sell a lot of it, but always with one caveat; I always ask if they'll be doing much reading with them - besides the instrument panel in the car or a quick look at a map or phone etc.
The Image has a nice wide distance zone and the NuPolar polarized lenses are superb, but this is not the greatest lens for reading. The reading area seems very narrow to me so when I hear that reading is a regular activity, I use something else. I would consider switching lenses if I were you. Yes, it will cost you more (another Image plus!), but look how much time you've spent already on this.

Also regarding your comment about the fitting height being 'counter-intuitive' to the problem, keep in mind that fitting a lens at 29 high, when it should be - for example - 32 high, isn't any different than fitting one at 18 that should have been 21. If it's too low, it's too low no matter how high it is. You may want to recheck your fitting height although I have to assume you already have.

**uncut** · 08-25-2010, 05:23 PM

IMO, TLG's post is dead on. At minimum, raise the height, with a caution that distance(walking/hiking/cycling) comfort may be the sacrifice.

**blinkvelo** · 08-25-2010, 08:17 PM

A few other options. Shamir Autograph2 with Attitude (possibly short) with it fit high would give a very large reading area and has much wider everything compared to the image. NuPolar also has a wrap flat top in polarized now. Just ordered one from Pech recently.
Also don't be so sure about polarized for reading. If your patient is using a smart phone/iphone/ipad or Kindle they may have issues with the polarizing fill in the screen. Polarizing is excellent but it is a mistake to think it works every where for everyone.

**edlc168** · 08-25-2010, 10:25 PM

I agree with blinkvelo. I don't think polarized or non-polarized lenses would help with this patient's reading issue. The seg height is probably too low. I like the Physio 360 and Autograph2 (I wear both)...You can order the Shamir lens with more intermediate and reading area as an option.

**scottster** · 08-26-2010, 09:19 AM

You guys rock! Thanks for all the ideas...I was starting to think I couldn't do anything else for this lady. I'm gonna give some these things a try. Wish me luck!