Help!!!

[harrisholdbrook]

I Have a Patient that is from Africa, maybe 80+ yrs of age. She had cataract surgery and never had a lens put back in. so she has like a +.50/-1.00 in her right eye and a +12.00/ 2.25 in the left(not to sure about the cyl). I never fit one with this script before, and not to forget she is in a bifocal. I work in a retail chain and I know she would be better off at a private practice but I wanna get this right. If anybody could offer any advice as far as frame type and lens I would greatly apprecite it.

[chip anderson]

You got two choices:
(Best)Fit a contact in the aphakic eye.
(What we did before contacts) Frost the lens on the eye with least corrected acuity.

Chip

[harrisholdbrook]

That would be good but she speaks no english and don't forget she is a little of 80 and is only visiting. so I have to come up with the best solution for her.

[kcount]

Frost the aphakic eye and call it a day.

[harrisholdbrook]

Just a question why would I want to frost her lens, she does has vision but its best corrected at 20/60 or 40 I believe.

[RetroRat]

Has this patient worn bifocals with such differing powers after her cataract surgery before? If not;

You might want to consider two single vision pairs if you are going to attempt to fit this lady. The smaller the frames, the better.
Take special care measuring her monocular PD's as well.

For her reading pair, think frames like these - very small, round and low b-measurement (distance between top and bottom of frame)

Good luck with it!

[chip anderson]

Anyone who tries to fit this much imballance with spectacles skipped a few lessons in optics.
Also one doesn't frost "the aphakic eye" unless it has vision a lot better than the phakic eye. You haven't mentioned the comparative acuities. If the aphakic eye has a conciderably better corrected acuity, frost the unoperated eye. If acuity is nearly the same or only slightly better or worse than the aphakic eye frost the aphakic eye.
But for God's sake if the phakic eye sees 20/100 and the aphakic eye sees 20/40 or better let her see with the one that can see.

Chip

But as I said contact for operated eye, and glasses for non-operated eye and reading OU, is best. There isn't any rule book (except amoung practioners that don't want to fool with this type case) that 80 year olds can't wear a contact.

Chip

[kcount]

If you have a patient with +0.50 OD and +12.00 in the right you probably have a fusion issue. By frosting the OS (+12.00) you'll actually help her. This is actually a great time for the gel filled product they were delivering in Kenya a year ago. (can't remember the name.)

Good luck with this. worst case, Make two regular lenses, cover the OS with Scotch Tape(frosts the lens) have patient try. If family (who I assume are translating for her ) report discomfort, remove tape and have her try that. Your out .002 Cents in tape and you look like a genius!

Please excuse typo's I'm typing faster than my vodka filled mind thinks.

[Judy Canty]

That is my solution as well...the tape, not the vodka. I prefer Scotch.

[braheem24]

anyone considered she may noy want to fuse the 2 images?

how long has she been aphakic?

[chip anderson]

Braheem: What do you think I have been talking about? There will be 20% difference in image size in spectacles, about 4 with a contact. The aphakic eye in spectacles will have a ring scotoma, doorways and other rectangular objects to the point that the patient will think she won't fit through doorways. All vision will drop off terribly beyond 25 to 30 degrees from center in spectacles. There are other defects in spectacle vision for aphakes which can only be tolerated if the two eyes are ballanced or nearly so. Hense the recommendation for a contact, or monocular vision used eye with best visual acuity.

Chip

[optical24/7]

Read everything Chip wrote. This is how we did it "back in the day".

[braheem24]

Braheem: What do you think I have been talking about?

Chip

Brother, Sometimes I ask myself the same question. I'll rephrase it in the form of a question.....


Has she been aphakic most of her life? If so, she's probably not interested in fusion.


Secondly,

I work in a retail chain

Any advice out of his scope of practice is for educational purposes only.

[Chris Ryser]

Chip is right all the way...............believe him..............that was how it was done before the days of implants.

[Robert Martellaro]

Any advice out of his scope of practice is for educational purposes only.

Right. The OP should refer this to an experienced optician.

[Fezz]

Right. The OP should refer this to an experienced optician.

+1!!!!

[CCGREEN]

Chip is spot on here. Going back to my days before implants. Which ever eye will give her the best V/A let her use it and frost the other lens. But both eyes together is not going to work with glasses unless you put a contact on the aphakic eye. The other question you need to know the answer to, is she going to be having surgery any time soon the the other eye? Knowing that will help you chose which path you will take. Consult the Dr that wrote the Rx and advice of those who have been down that road back in the day.

But if you are in a big box store and in Georgia this pt/family came looking for a "low price" and what the chain lets you offer is VERY limited. Without experience and resources to draw from odd's are against your getting this right and pt./family being happy. I could be way off base here. But none the less best of luck and the experience you gain will be priceless and you will always carry with you as you grow in the business.

[chip anderson]

Now in case the big box doesn't know what to do to come up with a frosted lens. Just sand the backside only with very fine sandpaper, something in the 200 grit range or finer. Or you can ousource it, but it's gonna cost a lot more and take longer than a piece of sandpaper. Sand until you see nothing "shining back at you' from this surface.


Chip

[CCGREEN]

And be sure NOT to go get that sand paper from the hardware section of the store eather. Loss prevention will be on you like stink on doo-doo.