Need fast help!

**oxmoon** · 08-17-2011, 11:31 AM

This PT is 62 year old guy who came in with Panamic Poly with script of:

OD +1.75 -.75 X 107
OS +2.25 -1.25 X 087
Add 2.00

New script:

OD no change
OS +2/25 -1.00 X 89
Add no change

Since I have read here that poly is no good for script over 2.00 I recommended a 1.60 Hoya Summit ECP. This was made up in Silhouette rimless lens size 49, same as the Panamics,. He picked them up last Friday and is back today saying he tried since Friday to tolerate them but cannot because his left eye feels like it is being "pushed out of focus by the lens", and indicates the direction of the "push" being toward his nose. Glasses are made correctly to script. What do you suggest I do about this? Is the problem the minor script change, the change from poly to 1.60, or the change from Panamic to Summit?

Barbara

**optilady1** · 08-17-2011, 11:33 AM

It's the panamic- It's optical crack!!!! I've had such a hard time in the past getting patients out of that stupid design. My only luck was going with the ovation. good luck.

**blinkvelo** · 08-17-2011, 12:34 PM

What was the previous RX?

**oxmoon** · 08-17-2011, 01:55 PM

Originally Posted by blinkvelo

What was the previous RX?

It's in the original message. Need some new glasses?

**Judy Canty** · 08-17-2011, 02:26 PM

I agree that it's probably the change in design rather than the material, though I have used poly in a variety of powers over the last 35 years or so with few if any problems. I would suggest checking the frame fit with regard to vertex distance, wrap and tilt. I'd also explain to the patient that it was necessary to change the design because the Panamic has been discontinued and that there will be some adaptation issues regardless of design. Ask your patient to be patient and work with you.

**oxmoon** · 08-17-2011, 02:57 PM

CuriousCat, thanks for your reply. When he came in initially I told him about the Panamic being discontinued and the need to select something else and adapt to it. He was complaining about the new glasses when he first picked them up, and now feels that he has done his best but is still unhappy. And I've tried all the fitting techniques I know. At this point I'm thinking we just need to change something, and my question is what should that change be.

**optilady1** · 08-17-2011, 03:02 PM

Try the ovation. From what I understand (and I think the understanding comes from a bunch of good old lab rats from here), it's a generic version of the panamic. I've had to switch patients who had been in a panamic, then I put them into a digital and hated it, into an ovation and they were fine. I don't know if it's becuase it was so soft of a design, but people really get used to it and have a hard time adapting to other designs. In the future I would give patients the heads up about it. I do this every so often since the frequence of patients coming in with them has decreased for me recently.

And of course, on the flip side to this, patients typically don't have trouble going from an ovation to another design, which is good since it's been the LC's go to lens now for about the last 5 or so years.

**Robert Martellaro** · 08-17-2011, 03:17 PM

I assume the lenses are properly positioned, free of waves and warpage, similar prism thinning, and an appropriate amount of usable seg height. Lens material and Rx change should be inconsequential.

Here are my concerns-

The ECP has a slighty longer corridor than the Panamic.

The Add power at age 62 is usually at least +2.25.

The above might be enough to cause symptoms if there are frequent near and intermediate tasks. If true, change the PAL design to one that has a slightly shorter corridor, and recheck the Rx Add power. Consider task specific eyeglasses as needed.

**oxmoon** · 08-17-2011, 03:34 PM

Thanks, Robert. I'm not in a position to question what the doc says is the script. But I suspect the add is not too low because he is saying the feeling of have his eye being pushed comes from the distance part of the lens., and his old glasses are fine and have the same add. Would the Summit CD be an appropriate change for a shorter corridor?

**CalCal** · 08-17-2011, 05:37 PM

I think is the RX change. But I would suggest using the GT2/GT2 Short to replaced the Panamic.

**uncut** · 08-17-2011, 08:01 PM

@oxmoon:

Give him back his -1.25 cyl......the change given may interfere with his distance acuity/comfort, and only horizontally!

**rdcoach5** · 08-18-2011, 07:42 AM

The PD's are different. Re-check both pair and match the old.

**Robert Martellaro** · 08-18-2011, 11:21 AM

Originally Posted by oxmoon

Thanks, Robert. I'm not in a position to question what the doc says is the script.

Sure you are. Nothing wrong with a few professional observations, questions, and feedback. I would always red flag that Add power for a 62 year old, if the reading distance is 40cm.

But I suspect the add is not too low because he is saying the feeling of have his eye being pushed comes from the distance part of the lens., and his old glasses are fine and have the same add.

The old glasses get into the Add power quicker, probably getting about 10% more Add power than the Ecp at intermediate and near. Combine that with an Add power that's 10% too weak...

Would the Summit CD be an appropriate change for a shorter corridor?

You have information that I don't have i.e., useable seg height, near work distances/heights/frequency, etc., so it's hard to say from where I'm sitting. You should at least use a lens that performs in a similar fashion as the Panamic, and that a significant change to a very short corridor PAL needs justification, considering the inherent negatives associated with the shorties.

**oxmoon** · 08-18-2011, 12:01 PM

The patient is coming back this afternoon to see the doc for a retake on script. Asking him wasn't as bad as I thought if would be! Then I'll go for the ovation since you have said it is most like the panamic. PD is accurate and was the same on both pairs. If you see any holes in this plan, please let me know. Many thanks to everyone.

**tsfall** · 08-19-2011, 06:14 AM

I've had a couple of people non-tol to other lenses once they swapped out of Panamics. My mum was one of them actually!! What I ended up putting her in was the AO Pro Easy (it's my mainstay for fixing non-tols). Everyone I know who wore it swore that it was a rip off of the Comfort and the Panamic all blended into one!!

Tom

**robbb1320** · 08-19-2011, 11:05 AM

I would put him in the Seiko Succeed Ws.. One of the cheapest free form prog's out there. GREAT LENS!!! I've NEVER had a problem with this lens. I even tried it on a 76yo male wearing traditional trifocals for 25 plus years, and who had tried Prog's in the past and failed. Let me just tell you he walked out wearing his new lenses praising them!!!! I've even put them up against GT2 and Izon with my dad. Dad said Izon had it beat by a smigin at most..... Can't believe I'm giving my secrets up..lol

**gatorbait** · 08-19-2011, 12:28 PM

Originally Posted by rdcoach5

The PD's are different. Re-check both pair and match the old.

I agree with re checking the old PD and the new PD. Classic issue. Also, I agree its the design. I think a bit of both and I would also recommend the GT2 as a design to change to from Panamic. I have had great success with that change.

Good luck!

**Robert Martellaro** · 08-19-2011, 01:34 PM

Originally Posted by oxmoon

The patient is coming back this afternoon to see the doc for a retake on script. Asking him wasn't as bad as I thought if would be! Then I'll go for the ovation since you have said it is most like the panamic. PD is accurate and was the same on both pairs. If you see any holes in this plan, please let me know. Many thanks to everyone.

The Ovation should work, as well as other similar lenses (gt2, spectrum, outlook, etc.). The Ovation has a variable corridor length- slightly longer for plus, shorter for minus. About 20% more unwanted surface astigmatism though. Some will feel it is slightly less refined compared to the Panamic, although the Panamic had it's own problems- don't get me started!

Don't forget to post the results please.

**rdcoach5** · 08-31-2011, 10:26 AM

And the result was ??? I'm betting cyl change. And I would also recommend GT2

**AshleyVoelzow** · 08-31-2011, 01:54 PM

I have a problem too...
So we had a patient in our office that I'm confused what could be the problem. She has worn progressives in the past but lost them so I couldn't identify which style they were. We put this her in one of our HD lenses and she sees find in the distance and near but after sitting down to read she then cant see clearly out of the distance anymore for a 10 min period of time (give or take). They are made in Trivex and have a Alize coating on them. Rx is a +3.25 -100 in the worse eye. Of course we have checked out the lenses and the doctor has recheck his rx too. Not sure what the problem is and don't really want to remake them and have another problem????

**rdcoach5** · 09-03-2011, 08:24 AM

Originally Posted by AshleyVoelzow

I have a problem too...
So we had a patient in our office that I'm confused what could be the problem. She has worn progressives in the past but lost them so I couldn't identify which style they were. We put this her in one of our HD lenses and she sees find in the distance and near but after sitting down to read she then cant see clearly out of the distance anymore for a 10 min period of time (give or take). They are made in Trivex and have a Alize coating on them. Rx is a +3.25 -100 in the worse eye. Of course we have checked out the lenses and the doctor has recheck his rx too. Not sure what the problem is and don't really want to remake them and have another problem????

Sounds like she needs more plus. Try adding plus trial lenses until her distance starts to blur and then back down to good far. I'll bet you can add at least a 1/4 or more plus until dist starts to blur. Alternative, a 60 plus year old needs at least +2.50 add.