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Thread: What Am I Missing?

  1. #1
    OptiBoard Professional Jamelina's Avatar
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    Confused What Am I Missing?

    Hi guys. I have a patient who picked up a pair of glasses today and feels like his reading area is much more narrow and not as clear as his last pair. He is in the same frame as his previous order, same progressive, material, measurements, etc, and his prescription is basically the same (only one step difference per eye for distance). I double checked all measurements and adjustments, everything checks out fine....could this minor of a change in his rx really have this much of an impact on his reading area? That's the only thing I can come up with.

    Thanks for your help!

  2. #2
    Master OptiBoarder TLG's Avatar
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    Re-mark the lenses at the laser engravings, lay on top of a straight line and make sure ALL dots hit the line. If there isn't a ton of cylinder, sometimes I'll rotate the lens so the nasal engraving falls just below the line; that will sort of 'push' the reading add out slightly to widen it. An easy fix that has worked well countless times for me, worth a try if you think you've got everything else right. Good luck!!

  3. #3
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Did you check vertex distance and face form (wrap)?

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    If it is a digital progressive, it may be due to a flatter base curve.

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    OptiBoard Professional Jamelina's Avatar
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    Thanks for the suggestions! Did check face form, not vertex. Base curve did change between the two orders, but due to the style of progressive I can't match the old pair (the computer decides it). When he comes in I'm going to try TLG's suggestion. I really appreciate your help!

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    Lens thickness?

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    OptiBoard Professional Jamelina's Avatar
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    Edge thickness is identical...

  8. #8
    OptiBoard Professional Jamelina's Avatar
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    Center thickness is also the same.

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    ABOM Wes's Avatar
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    The patient's perception of corridor width varies significantly with the vertex distance. The closer the lens is to the eye, the wider the corridor is perceived to be. Also, as the add goes up, the corridor narrows. However, I'm betting on vertex distance.
    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

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    Manuf. Lens Surface Treatments
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    Blue Jumper areas of distortions get larger and more notixable...................................

    With every pair of progressive lens change, due to age of the patient, whater the design, make or manufacturer or material or price..................the areas of distortions get larger and more noticable, the progressive area changes to smaller and narrower and the reading area gets smaller through re increase in power.

    Progressive lenses have originally been brought on the market to hide the age indications of wearing bifocals and selling for a lot more money. They have been around for some 50+ years and made a lot of money to some corporations as well as opticians ................not because they are better optically.

    They have been renamed and repackaged a few dozen time over a period of time to make them a new novelty but nobody has been able to produce them without majour distortions and smaller reading areas as patients get more and more wrinkles, ...............because the laws of physics do not allow it.

    A local courier driver ( on the mid 50s) in the optical that comes by every day, changed from a $ 400.00 par of progressives he had the last 3 years to a new pair of regular straight tops including frame, purchased on line for $ 45.00 +$ 10.00 shipping. He claims to have much better vision with them. This person has become an active promoter for the on line business, not only because of price, but because he is more confortable in his vision without the progressives.

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    When we get down to it, progessive have two purposes:
    1: To allow persons over 40 to read and appear that they are not over 40.
    2: To eliminate "jump" when looking down.
    Why does a person over 50 or 60 need #1? They are not gonna pass for 35 or under no matter what.
    Does the seeing clearly at closer distances outweigh the inconvienence of "jump."
    As Opticians we should ask ourselves, and the patient, and possibly the prescriber these questions before we fill any prescription. Of course some of us in each group answer all of the above wiith another question: "What can I make the most money out of the patient/Rx?

    Chip

    Awaiting contrary opinions.

  12. #12
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Gee, Chip, I'm wearing a SightStar365 and see just fine. I read my Kindle comfortably, sew, read music, drive, work on my computer and my iPad. If my vision is compromised, I sure don't notice it.

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    Judy: Make yourself a pair of 7/28's or Bifocals if you are under 54 in the same frame at the same power, PD's etc. As I have done in the past. Compare the vision. Also see how long it takes you to adjust to "the lines" when you switch from one to the other.
    In my own case it takes less than 30 seconds to adjust to "the lines" and I find that vision at near, and vision peripherally is much better in the 7/28's. Don't think one can really evaluate this any other way. The things we hear at CEC "courses" and from sales "technical" information are obviously squewed. Of course your results may be different, but give it a shot.

    Chip

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    [QUOTE=chip anderson;432220]Judy: Make yourself a pair of 7/28's or Bifocals if you are under 54 in the same frame at the same power, PD's etc. As I have done in the past. Compare the vision. Also see how long it takes you to adjust to "the lines" when you switch from one to the other.
    In my own case it takes less than 30 seconds to adjust to "the lines" and I find that vision at near, and vision peripherally is much better in the 7/28's. Don't think one can really evaluate this any other way. The things we hear at CEC "courses" and from sales "technical" information are obviously squewed. Of course your results may be different, but give it a shot.

    That's it!!!!!!!! From this day forward I will no longer be selling any progressive lenses. Even when a customer insists I will send them away to my nearest competitor. I have to save these customers and everyone else from all the terrible distortions. Flat-top 35's will be my niche market. lol

    Regards,
    Golfnorth

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    Golf:
    Didn't insinuate that progressives don't have a place but especially when the patient has a visual complaint, other types of lenses should be concidered. If patient has special needs (a watchmaker or an ophthalmic surgeon) for instance one might concider something other than a progressive.

    Chip

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    Hmmm.

    Quote Originally Posted by chip anderson View Post
    When we get down to it, progessive have two purposes:
    1: To allow persons over 40 to read and appear that they are not over 40.
    2: To eliminate "jump" when looking down.
    Why does a person over 50 or 60 need #1? They are not gonna pass for 35 or under no matter what.
    Does the seeing clearly at closer distances outweigh the inconvienence of "jump."
    As Opticians we should ask ourselves, and the patient, and possibly the prescriber these questions before we fill any prescription. Of course some of us in each group answer all of the above wiith another question: "What can I make the most money out of the patient/Rx?

    Chip

    Awaiting contrary opinions.

  17. #17
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    It sounds like a loss of binocular symmetry. Pls double check the PD's on both pairs, old and new, compared to the patients pd. Match the old PDs if nessessary, just 1 mm difference will create narrow zones.

    Is the add power the same? its very unusual there was not an increase in add power. Even a small power change can force someone to look in a different area of the lens to achieve the same visual results.

    if the pds are perfect, try using +.25 / -.25 flippers for the reading area to see it it helps. If it does, you have an RX issue.

    Quote Originally Posted by Jamelina View Post
    Hi guys. I have a patient who picked up a pair of glasses today and feels like his reading area is much more narrow and not as clear as his last pair. He is in the same frame as his previous order, same progressive, material, measurements, etc, and his prescription is basically the same (only one step difference per eye for distance). I double checked all measurements and adjustments, everything checks out fine....could this minor of a change in his rx really have this much of an impact on his reading area? That's the only thing I can come up with.

    Thanks for your help!

  18. #18
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    I am a bit fuzzy, trying to wrap my mind around a change in RX that does not constitute a change in centre, or edge thickness, is it an add power change? in a minus lens?
    Eyes wide open

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    OptiBoard Professional Jamelina's Avatar
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    Quote Originally Posted by uncut View Post
    I am a bit fuzzy, trying to wrap my mind around a change in RX that does not constitute a change in centre, or edge thickness, is it an add power change? in a minus lens?
    Old Rx:
    OD +0.50 sph
    OS +1.25 -1.25 x 153
    ADD +1.75

    New Rx:
    OD +0.75 sph
    OS +1.00 -1.25 x 149
    ADD +1.75

    The bc changed between the two orders, but measurements were all kept the same. They're fitting as they did before. He hasn't been back yet for me to try some of the things suggested. Maybe he adapted? I'm going to call him in a day or two to follow up.

  20. #20
    OptiBoard Professional Jamelina's Avatar
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    You guys are so great with your feedback! I really appreciate it!

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    Quote Originally Posted by Jamelina View Post
    Old Rx:
    OD +0.50 sph
    OS +1.25 -1.25 x 153
    ADD +1.75

    New Rx:
    OD +0.75 sph
    OS +1.00 -1.25 x 149
    ADD +1.75

    The bc changed between the two orders, but measurements were all kept the same. They're fitting as they did before. He hasn't been back yet for me to try some of the things suggested. Maybe he adapted? I'm going to call him in a day or two to follow up.
    Between the change in base curve, and if the person is right eye dominant, the person will notice a decrease in useful field, because of an increase in farsightedness.

    I always warn presbyopes that any change in +, whether it is in the top or bottom of the lens will result in a decreased field of view.


    You are probably right, and he has adapted. Crossing fingers for you.
    Eyes wide open

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    It is, because we are changing the effective reading any time we change the distance in a Progressive or Multifocal, it affects the reading. Any lens with ADD power will do this.

    Quote Originally Posted by uncut View Post
    I am a bit fuzzy, trying to wrap my mind around a change in RX that does not constitute a change in centre, or edge thickness, is it an add power change? in a minus lens?

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    Does adapted mean got used to seeing poorly?

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    Manuf. Lens Surface Treatments
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    Quote Originally Posted by chip anderson View Post

    Does adapted mean got used to seeing poorly?


    Chip, of course, however they never had anything else since they hit 45 years. They just continue to see worse every time the addition increases and they are told that they have to adapt.

    I just love my St35s got lots of them.

  25. #25
    OptiBoard Professional Jamelina's Avatar
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    Quote Originally Posted by chip anderson View Post
    Does adapted mean got used to seeing poorly?
    Perhaps, but I can't imagine suggesting a flat top. He may just go back to his old lenses. He seemed to prefer them over the new rx. If he's happy, I'm happy.

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