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Thread: How would you handle this?

  1. #1
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    How would you handle this?

    Patient does not care for the peripheral distortion.
    OD -5.25
    OS -5.00

    1.67 with premium AR coating. I do not recall exact measurements off hand but a narrow plastic frame and perhaps 1mm of decentration per eye. After numerous visits with other "opticians" and then the obligatory trip to the doctor where the script gets reduced by .25 and the lenses have been remade I finally get involved. "Can you see clearly when you look straight ahead" says I. "Yes, but if I'm not looking straight ahead I just don't like it. I can't use these glasses." The frame was pretty flat so I increased face-form a bit and talked with the patient about distortion, the "sweet spot" and the fact that the most distortion will occur on the edge of the lenses. After the adjustment the reply was, "I can see better, but I just don't think I can handle these".

    The only thing I can think of is to put her in cr-39, which will not go over well because this customer does not want thick lenses. I could try 1.60 but I just don't think she will ever be satisfied. She also goes back and forth between contacts and glasses. The contacts were .25 weaker than the spectacle rx.

    She does have an old pair of glasses that apparently worked in the past so I told her to bring them in today and I will do a full-blown lens analysis and see what exactly is different.

    Any advice?

  2. #2
    Doh! braheem24's Avatar
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    Did you try explaining they're not contacts?

  3. #3
    OptiWizard
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    I think a material with a higher Abbe. You also might consider a digital lens I have had a lot of patients liking this combo.

  4. #4
    Master OptiBoarder pseudonym's Avatar
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    Quote Originally Posted by braheem24 View Post
    Did you try explaining they're not contacts?
    LOL. That's how I sell the premium AR everyday. "You wear contacts most of the time, so you're going to be especially bothered by unwanted reflections from your glasses."

  5. #5
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    Quote Originally Posted by braheem24 View Post
    Did you try explaining they're not contacts?
    Haha. Some people just think they should be able to switch back and forth without any change in vision whatsoever.

  6. #6
    Master OptiBoarder kat's Avatar
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    +1, go digital
    I came, I saw, I left

  7. #7
    Master OptiBoarder pseudonym's Avatar
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    Quote Originally Posted by Quantrill View Post
    Haha. Some people just think they should be able to switch back and forth without any change in vision whatsoever.
    And doncha just love it when they come in to pick up their glasses while wearing their contacts. Then they act as if you've detained them when you ask them to remove the contacts and wait a half hour for their eye to equilibrate before letting them put their glasses on to eval;uate their vision.

  8. #8
    Rising Star
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    I dealt with a very similar situation not too long ago. The patient I worked with had the same complaints and the RX was very close to what you are working with with this patient. In our situation, I put her in a 1.67 digital with premium AR. I also did a lot of educating regarding the differences between her vision in the contacts and her vision in glasses so she understood what to expect. The combination of the digital lens with premium AR and the education did the trick in our situation and she is quite happy with her glasses now.

  9. #9
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    Quote Originally Posted by pseudonym View Post
    And doncha just love it when they come in to pick up their glasses while wearing their contacts. Then they act as if you've detained them when you ask them to remove the contacts and wait a half hour for their eye to equilibrate before letting them put their glasses on to eval;uate their vision.
    It's always 'the best' when they forget to tell you they're wearing their contacts, and are confused when the glasses feel 'too strong'...

    EDIT: To the OP, is the Px wearing spheric or aspheric?

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    Quote Originally Posted by cjdavis View Post
    To the OP, is the Px wearing spheric or aspheric?
    1.67 SOMO aspheric ultra clear AR with ITO.

  11. #11
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    Quote Originally Posted by Quantrill View Post
    aspheric
    Perhaps this is my poor poor brain not working, is it possible she has previously been fitted with spherical 1.67s, and doesn't like the 'new' peripheral distortion?

  12. #12
    Master OptiBoarder RIMLESS's Avatar
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    I agree with the other posters. I would drop to trivex for the abbe with a digital design which would give you essentially a double aspheric lens. At the same time I would try to go to a smaller frame size to help reduce peripheral issues as well as any apparent edge thickness discrepencies from the 1.67
    90% of everything is crap...except for crap, because crap is 100% crap

  13. #13
    Doh! braheem24's Avatar
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    What's the old spectacle Rx? PD? OC, BC and material?

    Rx May be right, Just not right for this patient.

  14. #14
    Master OptiBoarder OptiBoard Silver Supporter rdcoach5's Avatar
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    Quote Originally Posted by Quantrill View Post
    Patient does not care for the peripheral distortion.
    OD -5.25
    OS -5.00

    1.67 with premium AR coating. I do not recall exact measurements off hand but a narrow plastic frame and perhaps 1mm of decentration per eye. After numerous visits with other "opticians" and then the obligatory trip to the doctor where the script gets reduced by .25 and the lenses have been remade I finally get involved. "Can you see clearly when you look straight ahead" says I. "Yes, but if I'm not looking straight ahead I just don't like it. I can't use these glasses." The frame was pretty flat so I increased face-form a bit and talked with the patient about distortion, the "sweet spot" and the fact that the most distortion will occur on the edge of the lenses. After the adjustment the reply was, "I can see better, but I just don't think I can handle these".

    The only thing I can think of is to put her in cr-39, which will not go over well because this customer does not want thick lenses. I could try 1.60 but I just don't think she will ever be satisfied. She also goes back and forth between contacts and glasses. The contacts were .25 weaker than the spectacle rx.

    She does have an old pair of glasses that apparently worked in the past so I told her to bring them in today and I will do a full-blown lens analysis and see what exactly is different.

    Any advice?
    change to a different brand of 1.67 and make sure it's aspheric

  15. #15
    Master OptiBoarder OptiBoard Silver Supporter Java99's Avatar
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    Quote Originally Posted by acoakley View Post
    I dealt with a very similar situation not too long ago. The patient I worked with had the same complaints and the RX was very close to what you are working with with this patient. In our situation, I put her in a 1.67 digital with premium AR. I also did a lot of educating regarding the differences between her vision in the contacts and her vision in glasses so she understood what to expect. The combination of the digital lens with premium AR and the education did the trick in our situation and she is quite happy with her glasses now.
    Do this. The right products + the right expectation.

  16. #16
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by Quantrill View Post
    Patient does not care for the peripheral distortion.
    OD -5.25
    OS -5.00
    If you mean barrel distortion, all you can do to reduce this is to fit the lenses as close as possible the eyes. If the problem is peripheral blur, again fit close, use a material with a higher Abbe value, and supply a very high quality optimized lens to reduce on and off-axis aberrations.

    She does have an old pair of glasses that apparently worked in the past so I told her to bring them in today and I will do a full-blown lens analysis and see what exactly is different.
    Post your findings, please.
    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.



  17. #17
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    I really appreciate everyone's replies. Pretty much what I was thinking, but the frame was not too large for her face. Come to find out, she had a fairly small frame before with cr-39 lenses. Also the old frame was very round and in addition to being wider the new one is more of a rectangle. We are looking at a smaller frame and hopefully digital lenses. I am thinking that no matter what I do, I will regret this whole situation. I'm sure it's my mediocre skills as an optician, but I don't know if this gal will ever be happy.

    Here are my findings: Old pair - OD -5.25 OS -5.00
    far p.d. 31OD 30OS
    OC 11
    2.75 Base, CR-39 w/ polish
    frame measurements: 45A 23B 20DBL 46ED oval design, metal frame

    new pair: -5.25 -5.00
    30.5 30
    OC 17
    4 Base, the aforementioned 1.67 w/AR
    51A 25B 16DBL 53ED rectangle design, plastic frame

  18. #18
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    Quote Originally Posted by cjdavis View Post
    It's always 'the best' when they forget to tell you they're wearing their contacts, and are confused when the glasses feel 'too strong'...
    That's why I always look at the Rx before handing the glasses over. If it's more than -2.50 or so, I just get out a contact lens case for them. Sometimes I get fooled, but not often.

  19. #19
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by Quantrill View Post
    I really appreciate everyone's replies. Pretty much what I was thinking, but the frame was not too large for her face. Come to find out, she had a fairly small frame before with cr-39 lenses. Also the old frame was very round and in addition to being wider the new one is more of a rectangle. We are looking at a smaller frame and hopefully digital lenses. I am thinking that no matter what I do, I will regret this whole situation. I'm sure it's my mediocre skills as an optician, but I don't know if this gal will ever be happy.

    Here are my findings: Old pair - OD -5.25 OS -5.00
    far p.d. 31OD 30OS
    OC 11
    2.75 Base, CR-39 w/ polish
    frame measurements: 45A 23B 20DBL 46ED oval design, metal frame

    new pair: -5.25 -5.00
    30.5 30
    OC 17
    4 Base, the aforementioned 1.67 w/AR
    51A 25B 16DBL 53ED rectangle design, plastic frame
    Here are the red flags as I see them.


    • Somo says a finished aspheric 1.67 should have a +2 BC. http://somoptical.com/pdfs/finished/167ASP.pdf
    • The vertical centers seem unusually high (4.5mm above center). Old are essentially on center. Review the OC position relative to the pupil and pantoscopic angle.
    • Old lenses have the highest Abbe value lens material possible, new lenses have almost the lowest Abbe available.


    Hope this helps,
    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.



  20. #20
    Master OptiBoarder AngeHamm's Avatar
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    That's a substantial BC difference...
    I'm Andrew Hamm and I approve this message.

  21. #21
    Master OptiBoarder mdeimler's Avatar
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    Why are the 167's on a 4 BC ? That's kinda high.

  22. #22
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by mdeimler View Post
    Why are the 167's on a 4 BC ? That's kinda high.
    Hopefully they're spherical semi-finished (best form would be about +4). If they're aspheric on a +4 BC, the off-axis optics would be, depending on the p-value, somewhere between bad and dreadful.
    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.



  23. #23
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    This doesn't look like a substantial BC diff. to me.
    Old pair 2.75 BC (call it a 3.00)
    New pair 4.00 BC

  24. #24
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    The old specs have the "old shoe effect." She's probably had them for a good while & she is completely use to whatever the distortion she has been getting from the CR 39 in that smaller 45 eye size. It's ok to go back to larger eye sizes, but I think we should warn that this creates added weight, added thickness & more lens peripherally to add to the distortion. There are so many trade-offs in our industry & customers are generally fine if we forewarn them & given them realistic expectations. I'd take her back down in the eye size to what she's accustom to. Regardless, she will get use to them if she'd just put them on & wear them for a week or 2. But she sounds possibly to winey to even try to go there. lol Contact lens patients take longer to adjust generally.
    Last edited by eyechick1969; 05-10-2012 at 10:33 AM. Reason: spelling, sometimes just can't spell,lol

  25. #25
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by eyechick1969 View Post
    This doesn't look like a substantial BC diff. to me.
    Old pair 2.75 BC (call it a 3.00)
    New pair 4.00 BC
    It's not the difference between the old and new, it's concern regarding the correctness of the new BC used on the new lenses. If a +4 aspheric was used, and the manufacturer's charts call for a +2 BC, there would be symptoms similar to waht was reported by the OP's client.
    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.



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