Any ideas which lenses will suit?

[Bok]

Hi folks got client wanting to get progressive lenses from me but... her Rx is: -8.50/-0.50x15 -8.50/-6.50x155 near add +2.00 PD: R+L 32 Heights: R+L 26 need to source a photochromatic high index lens frame size Wdt:54 Dpth:38 Dgn:54 Bdg:16 Any lens experts out there got any advice?

[chip anderson]

O.D. Crescent fused. O.S. Bi-Toric Crescent fused., 2nd choice: O.D. Tangent Streak, O.S. Toric Tangent Streak.
Last Choice: O.D. Single vision sperical Soft + reading glassess. O.S. Toric Soft + reading glasses.

Chip

[PhillyEyes]

Pretty big frame. 64 PD? Heavy plastic frame choice? If I would just use a shamir auto II in 1.67 trans. Pretty sure comes upto -6.00 or more total cyl power. Good starter, if no good you don't lose anything with a non-adapt, except time... Then discuss other options :/

[AngeHamm]

Any way of getting that patient in a smaller frame? With that much periphery, even the smoothest progressive in the world is going to have a ton of distortion, not to mention the lens thickness.

[chip anderson]

Also make damn sure that you specify the OC ht. If you don't patient will have outlines in color of everything O.S. Chances are with this much cylinder, especially unilaterally, you gonna have more problems than you can fix already.
The more high tech you go on the lenses, the more likely the problems are to occur.



Chip

[Pogu]

Why on earth does she need a PAL? If vanity is an issue fit a round seg, even at +2.00 it is fairly discreet, especially w/ AR. Does the Rx include visual accuity?

[sharpstick777]

Does she have Keratoconus? or a post-trauma corneal defect? If so, RGP or Scleral Contacts are by far the best option.

What is her Best Correct VA on the right and left? If her best corrected VA on the left is only 20/50 or worse you should just focus on getting the best vision for the OD, (assuming she can get 20/25 or better in the right) which would probably be a Free-form Progressive. If she gets better than 20/40 in the left then a Digital Free-form ST-28 bifocal will give you an edge.

I would guess there is also irregular astigmatism involved. Topography would be helpful in determining wether contacts or glasses would be best. DVA measurements can often indicate the possiblity of irregular astigmatism if topography isn't an option.

If she doesn't have any pathology, is her left eye supressing? Or does she see binocularly through her SV or Bifocals now? If she is surpressing a Free-form lens would be great, but that frame is way to big for her RX. I think the Auto II and Ice-Tech both go that high in 1.74.

A good lens choice will require more information than you have supplied in this case, but in summary:

Corneal Pathology or Irregular Astigmatism: go RGP or Scleral contacts.
Good Accuity OD but NO chance of great accuity OS: Go with Free-form Progressives.
Good Accuity OD, Chance of good Accuity OS: Go with straight top digital/Free-form.

[chip anderson]

Got a real feeling that pathology not present, trying to achieve a "ballance" off center require some sort of kinky slaboff or modification in power to get any sort of ocular unison in spectacles. Fit the woman in contacts. If you don't do this send her to someone who's good at it.

Chip