Low rx issues and PAL

[charan]

Here's the rx first

New:

OD balance
OS +1.50 -1.00 x166
add 2.50
Seg 25
pd 31/32


Old rx

OD balance
OS +1.00 -0.50 x 172
add 2.50
Seg 23
pd 31/32


Here's the issue, the patient is 80 yrs old male with right eye balance, old rx is 5 yrs old and he's wearing essilor natural lens. We matched the lens and the new frame is lager than what he's wearing. He doesn't seem to like his Distance rx, dr says no change, have checked for prisms and he's tried for over a week, what seems to be the issue here? This is such a simple rx, do u guys think it's better if he goes back to original rx ? Or any other alternatives?

[Wes]

I've noticed that peoples' acceptance of change has an inverse relationship to their age.

[Java99]

I've noticed that peoples' acceptance of change has an inverse relationship to their age.

+1

[RIMLESS]

Go back to the original. Make sure you explain it to him that sometimes people don't adapt to an rx change. That's the key line and what he want's to hear.
You should be fine. We all bump into similar pts. Sometimes they see 20/20 with the new script 20/30-40 with the old. I use to split the difference but got tired of making glasses for a sport. I read a study that was done yrs ago where they found that less than 5% of people over 40 were willing to switch catsup or mustard brands. I agree with Wes's observation. Older patients strongly equate any change with things getting worse and often simply refuse to accept it.

[uncut]

My 2 cents.....soon to be obsolete as a coin, so my nickle.................

The key to comfort here is that the patient is monocular.....by increasing the cyl. you have restricted his peripheral vision, and this is an adjustment in behavior. The 1/2 diopter more plus could be an improvement for near, but might create a complaint about far distance. I would query his discomfort, is it peripheral, far, or accuracy of vision at all distances. If the refractionist is unwilling to budge, or compromise, change back to the old rx, but first confirm that the new is inaccurate.

[chip anderson]

Is the "ballance" eye non-seeing or just semidisfunctional. If it has some vision although not comprable to the seeing eye you could have an issue here. Especially if the best va is near something or other in power and you used a plano for ballance.

[sharpstick777]

That is a lot of cyl change for an 80 year old. I would do training lenses and split the difference.

Most 80 year olds have a very hard time adjusting to anything more that .25 D or 2 Degree Cyl change.

I call this "Petropia"

[braheem24]

People with one eye are much more sensitive to axis Imperfections.

[davidxuonline]

If I were you, I'll use the old RX

[Java99]

Ran into this yesterday with a pt in her 60's. Low rx, OS amblyopic 20/70. Old gls worn for 10 years. New rx removed her OD .-50 of cyl. Doc had to do a recheck and put it back in.

[sharpstick777]

People with one eye are much more sensitive to axis Imperfections.

Yes

[CCGREEN]

Excellent point Chip. "Balance" does not mean throw anything in front of that eye. You best "duplicate" whatever "balance" the pt is wearing.
At some time we try not to rock the boat to much for the patient. Make the patient 20/happy even if it means no change in Rx. It's hard enought to get them to accept a new frame just because their grand daughter wants them to have one.
20/happy will save you tons of headache and possibly a few dollars. And you have helped make someones final years more comfortable for them.

Is the "ballance" eye non-seeing or just semidisfunctional. If it has some vision although not comprable to the seeing eye you could have an issue here. Especially if the best va is near something or other in power and you used a plano for ballance.

[sharpstick777]

If I were you, I'll use the old RX

It depends on the DVA gain. If the patient's RX continues to progress along the same lines the pair they are wearing will decrease in DVA over time. Since many older people don't change their lenses every year, or every 2, or every 3, you could be sentancing this person to low VA for the next 4 years. Comfort is a factor, but just one. Its not worth a high RX change for a low gain in VA, but its worth discomfort for a large gain.