High plus problem in Shamir Autograph II Fixed 18

[Rockstargazer]

Got a patient with the following:

OD +7.75-1.00 x 60
OS +7.75 -1.25 x 95
+2.75 ou

I put her in Shamir Autograph II Fixed 18 1.74 index and she's having problems. Mostly visual acuity related. Said her old pr. is better than new. she has worn them enough to overcome any adaption problems.

My co-worker suggested Physio Enhanced because it is a better lens when you have + on +. Any thoughts or other suggestions?

Thanks fellow Optiboarders-- you rock!

[TLG]

Were the previous lenses 1.74 as well? Which PAL was in previous pair?

[Elvis Is Alive]

1.74 lenses are not as good optically as other thicker materials. If patient has not worn them before, that could be an issue. 1.74 has worse veiling glare and ghost images, although AR will reduce the brightness of them. Abbe value is lower than 1.70 or 1.60 index materials too.

Regarding design, you could always go back to pt's previous design to eliminate it as a cause of acuity problems. Personally, the Autograph II is my favorite PAL, along with Definity. As always, recheck all measurements and compare to measurements in previous lenses. As a last resort, a new refraction may be needed. Good luck.

[rdcoach5]

Hold trial lenses in front of new glasses to see if you can improve vision. If so, it's the Rx. Check base curves of new and see if more panto or faceform helps.

[sharpstick777]

The Shamir Auto II is a terrific lens, but not for high pluses.

Most lens designs are designed for Myopes and they carry the same design over in plus powers. However, Hyperopes converg completely differently than myopes do, so their eyes often don't track down the corridor.

The designs I would look at first are the Seiko Surmount. Its the only US availalbe lens where each corridor is completely optimized base on distance, reading RX and near PD. It has the advantage of being about 18% thinner in plus powers. Another choice would be the Zeiss Individual, they move some of the add back to the front in high pluses (but only in German made versions, allow a month). The Definity also does well in high pluses. The Kodak Unique has some of the same design modifications as the Surmount, but it will be thicker.

[tdj]

My first instinct is the 1.74 being the problem, not the Auto. Has s/he worn 1.74 before?

What was the old rx?

[sharpstick777]

1.74 lenses are not as good optically as other thicker materials. If patient has not worn them before, that could be an issue. 1.74 has worse veiling glare and ghost images, although AR will reduce the brightness of them. Abbe value is lower than 1.70 or 1.60 index materials too.

The 1.74 beats out 1.67, but not 1.70. 1.67 is the most likely previous material given the RX. 1.74 is probably and improvement.

[sharpstick777]

Got a patient with the following:

OD +7.75-1.00 x 60
OS +7.75 -1.25 x 95
+2.75 ou

I put her in Shamir Autograph II Fixed 18 1.74 index and she's having problems. Mostly visual acuity related. Said her old pr. is better than new. she has worn them enough to overcome any adaption problems.
My co-worker suggested Physio Enhanced because it is a better lens when you have + on +. Any thoughts or other suggestions?
Thanks fellow Optiboarders-- you rock!

You don't specify is the accuity loss is in the distance or near, or both. What is her best correct VA with the new pair?
What brand of Progressive was she in before? What material was she in before? These are all needed to properly diagnose the issue.

If her DVA is good its unlikely to be the material. If her reading is OK but there is no intermedate, its a design issue. That high of plus induces tremendous amounts of prism when she gets into the reading area, its inevitable. So if she can't see in both the reading and intermediate, it could be design or RX. To test the RX use +.25/-.25 or +.50/-.50 flippers over both the near and disance. If anything improves its an RX issue.

Usually a material issue will show up with purple or yellow edges, but not always. You can trial frame her to elimate that, if she has good DVA in the trial frame in the same RX then its most likely material.