I have a pt his Rx is:
+0.25-0.50 60
+0.25 -0.75 105
+2.50 Add
I have him in an Image. He didn't want to spent alot. HE says If he keeps one eye open at a time either eye, intermediate he can see. If he opens both eyes it's blurry. I have used this pal before and have not had a problem. Sght and pd are correct.
Distance and reading are ok.
Any ideas?
how long has he been wearing and actually trying them for?
have you tried lowering or raising the frame by a bit? just because the seg height is "on spec" doesn't mean it's sitting well for that particular patient.
added a bit of panto/wrap?
does he have one eye that sits higher or lower than the other?
has he ever worn a PAL before?
He has had them for a week. The panto is 15. He has worn pals before w/ no issue. I did not do a wrap or tray one b/c it's the same frame. Eyes are at the same height.
what was the rx he had in the frame before? What PAL was he wearing in the old frame and at what seg, and what seg is the Image at currently?
the old was
00.00 -.50 30
00.00 -.50 135
2.00
pd 33/33 sght 24 old pal was a varilux com. old rx was 2002
Image at a 24
why take him out of the Comfort?
He wanted cheap.
well.... you may just have to explain to him that by keeping his old glasses for 10 years he's gotten himself well and truly used to the Comfort and he's going to have to pony up the difference. Either that or he doesn't like the cyl change and is going to have to give it another little while...
He got it!Originally Posted by B101875
Cyls are not strong but they have a significant axis change. This could be it, but if he reports distance and near as ok, probably not.
Never forget to take into account the patient's habits and how he has trained himself to use what he was wearing. That is the most often-missed troubleshoot I see, both in real life, and on Optiboard.
Anyway, You just added a good bit of plus, enough that he had probably trained himself to look too far down the old lenses to see intermediate distances and now when he does it with the new pair, he's at reading distance. He also probably got comfortable with that wide reading area as his intermediate. He either needs to learn to use the new glasses properly (how far down the lens he looks, how much he converges), or if he's now uncomfortable with the much narrower intermediate, you can suggest a pair of "office" type lenses. Second pair sale! Woo hoo!
Wesley S. Scott, MBA, MIS, ABOM, NCLE-AC, LDO - SC & GA
“As our circle of knowledge expands, so does the circumference of darkness surrounding it.” -Albert Einstein
Have you checked for unbalanced vertical prism
He's also gone from a +2.00 add to a +2.50; his reading area just shrunk and my experience with Image (love this lens for certain applications) is that it has a fairly narrow reading area as well. My suspicion is that the corridor width is narrower too - especially compared to his Comforts.
I would also remark the engravings and lay them along a straight edge to make sure all 4 are in line. With a narrow corridor, if the lens gets rotated some it may move it away from the intended position. Be aware of how his head is rotated too when he 'can' see for each eye. You'd be amazed how much you can widen a field of view (or narrow) with a relatively slight rotation of the lens.
And tell him to keep BOTH eyes open for cryin' out loud!! Like this, not like this
- then maybe he can get rid of this
. Sorry, couldn't resist "Fun With Smilies"
-Tony
Agree, most common problem when rx change has more +....patients are never warned/explained about this by their ECP.
WE SEE THINGS NOT AS THEY ARE, BUT AS WE ARE..... Anais Nin
Well I spoke to the good Doc this morning for his input. He thinks it might be a muscle inbalance. So I called him back in for a recheck. We will see how this goes. The Doc was not to happy when I asked if he could bump the cyl a little. He says he hates the Image. I have fitted it for years and found it to be a good low cost pal.
If you're going the imbalance route,
The only real variance in the near was a +0.75 bump in the near which would require the patient to hold the reading material closer which in turn requires the eyes to converge more if BI prism held over his current glasses does not solve the problem it's a non-adapt issue.
The first thing I would check out is if the lab did prism thinning on one lens, but not the other, making vertical prism. Tito elluded to that previously. I also agree with those who said increasing plus on a hyperope typically causes issues, whether the refraction indicates the need for it or not.
The prism in the pal is:
OD: 2 down 1 out OS: 2 down
The 1 out OS is making the convergence to the closer focal length worse.
The patient is at the maximum addition which gives the a narrowest proghressive area. At a 2.50 add most people are in retirement age group. So there are 2 factors,
the smallest and shortest progerssion and reading area, plus the age where adaption is a problem if they are fitted properly. Change the for straight tops.
That 1 D B/Out is enough to move the virtual lens too far out. He is losing binocular symmetry, which is usually manifested in good distance and reading but poor intermediate vision.
Got to love those VSP labs. Thanks Sharpstick.
Without getting into the tricky stuff (PAL horizontal asymmetry, oblique cyl axis, incipient cataracts, etc.), and giving consideration to your client's eyeglass budget, I'd recommend wearing the eyeglasses for ten days to see if the problem resolves, or at least improves and becomes tolerable. And as Wes says, if your client's intermediate needs are greater than occasional glances at teh dashboard and grocery shelves, supply task specific eyeglasses to supplement the general purpose eyeglasses.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
He's and architect and a pain. Just waiting for the good Doc to do his Rx check. We have had a couple of changes b/c of Rx's. I will repost what happens.
If he's an architect, he should understand about how price and quality work. Tell him he's trading in his brick house for a wood one.
Or how he is using T111 instead of Cedar...
I think the combo of more plus in the distance, plus more plus in the near, plus the inbalance in the prism refrence point, plus the change in progressives, is the problem. Do you have any alternative lost cost PAL's that you could switch him to when he gets his rx check? Also, if his rx doesn't change, I would call the lab and get a redo anyways because of the imbalance. You may be able to put him into a Natural. I think they are still making those, and they are very similar to the original Comfort, or you could try the ever popular ovation.
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