What's wrong?

[NUECoptical]

Okay, so we had a patient that we made a pair of lined bifocals for in September. She came back in November saying that her lenses would get blurry during the day and she couldn't see through them, but when she took them off she could see fine. She elaborated by saying that when she was driving she couldn't see the signs until she was really close to them, the problem was worse after she had worked in her salon during the day, and the glasses gave her a headache. We had her come in for an RX check just to make sure everything was right on (which it was) and that the measurements (seg height, PD, etc.) were right...they were. We remade the lenses thinking that maybe something was wrong with the A/R coating even though I couldn't see any distortions in the lens. She's had the new pair since mid-December and is calling to say the new pair isn't any better. I've wondered if this was just a ploy to get a new frame, but she said that she loves the frame and doesn't want to change it. She doesn't have cataracts going on or any other serious condition. She said she didn't have any problems with her old lenses. Listed below are the attributes of each pair of lenses:

Old Pair:
OD: +1.00 sph +2.25 ADD
OS: +0.0+0.50x125 +2.50 ADD
ST28 Plastic Transitions Brown
Crizal Alize
Base: 6.21

New Pair:
OD: +1.00 sph +2.50 ADD
OS: +0.0+0.50x125 +2.50 ADD
ST28 Plastic (pt. didn't want Transitions because she got a frame with a sunglass clip)
Crizal Alize
Base 6.20

What is wrong? Would not doing Transitions, or having the same ADD instead of different ones in each lens really make such a difference to the patient. Oh, and when the doc rechecked the RX, the patient did like the equal ADD power instead of different ones. I was wondering if it was possibly dryness? Thoughts???

[Java99]

A couple things come to mind here - if she has a salon, she may be working at intermediate distance all day long, for which she has no correct correction in her flat tops, which could be causing some issues. Is she overplussed for distance - have heard similar complaints when that's the culprit. Is she diabetic? Has she had her thyroid checked?

[Wes]

+1 on the diabetic question. +2 on the slight accomodation all day. Excessive accommodation can result in eyestrain.
Also, this seems too obvious for you to miss, but you said she has a salon, as in hair salon? Could her glasses be fogged up by hairspray or some other product?

[Varangian]

A couple things come to mind here - if she has a salon, she may be working at intermediate distance all day long, for which she has no correct correction in her flat tops, which could be causing some issues.

I think you are on to something there. Does she use the near segment when cutting hair, or does she use the distance part? If she has the customer at, say, 20", then an add of 2.50 is a bit too much. It wouldn't cause the distance blur but it would more likely make her hunch over. If she checks her customers in a mirror, it might be about 4-5 feet away (real viewing distance becomes twice that), which might cause a slight accommodation and thus distance blur. She might need a pair for work, with lower add and an intermediate power in the distance part (but not as to cause too much distance blur inside the salon).

[Chris Ryser]

She might need a pair for work, with lower add and an intermediate power in the distance part (but not as to cause too much distance blur inside the salon).

Interesting and makes sense................., with an add of +2.50 she must be a senior and the Rx was made for reading distance which would be too close for work.

[Diane]

Eyestrain. I agree that with a +2.50 add, she must be advanced in age or have some other accommodative issue. How tall is she and how far away are her clients at work? What is her standard working distance at work? Her comment that the glasses get blurry during the day is a clue. They don't start out that way, and the glasses are not changing unless they are getting coated or dirty. Her vision is changing...could be glucose shifts in either direction. Hair dressers are notorious for not properly hydrating themselves and standing too long and not eating at regular times.

Just guessing here, but is she switching to her old glasses? If so, does the problem remain? With the exception of adds the Rx is the same, unless I read it incorrectly. Did the old pair have some residual tint (even if it is ever so slight) remaining that may have helped slightly with overhead lighting? We have gone back in the last several years to NO tints indoors, and some people still like a little indoor tint.

Check the EXACT panto/wrap on both. check the EXACT segment placement. However, I think +2.50 Add is too much for her working distance if she is a hairdresser . That's why I would be curious about everything relating to her old pair.

I'm going to think of more and post later...since I need to get back to work.

Diane

[Robert Martellaro]

...is she switching to her old glasses? If so, does the problem remain?
Diane

That's the first thing I would do- revert to the old eyeglasses for a week or so. If the symptoms subside, you can probably rule out diabetes, but maybe not accommodative and vergence dysfunction.

Dissimilar Add powers wouldn't be my first choice for the older eye, but if it works...and she refuses to wear separates, you might have no choice, although I would explore cutting the Add in both eyes. Good luck.

[NUECoptical]

Patient, 71 years old, has no history of diabetes, but she is getting some blood work done today actually to see if there is anything going on. She has had high blood pressure, but no diabetes. She does keep her glasses very clean and when she came in, the lenses have been spotless of all residue that might occur during the day at a salon.

Her old pair broke, so she can't revert back to them, or use them to see if it's just a problem with this pair. She just remembers that she never had this problem with her old pair before they broke. That being the case is what has me so confused. Because the RX is pretty much just the same, she should have been noticing the slight accommodation during the day with her old pair as well. Maybe she was just so used to the accommodation with her old pair, that she didn't notice it. And then when she had to go a while without glasses while we made her a new pair maybe it kind of hit a "reset" button in her brain if that makes any sense. So now she is more aware of just how much strain she was putting her eyes through during the day. As I read through these posts the whole excessive accommodation theory makes the most sense to me. I'll keep you posted as I talk to the patient and doc.

Thanks again for all the great input!

[SeaU2020]

I agree with everyone else. She needs intermediate for her job.
I do NOT have diabetes and I'm not that old, but I wear progressives with a plano/1.50 add which works fine. After a long day of work and reading I can hardly read the tv screen program guide and that's when I know it's time to shut my eyes and SLEEP.
I recently made a pair with the kodak monitorview lens for the office and I LOVE it! The whole center is intermediate with a wee bit of distance at the top( they say it's good for up to 10 feet) and a wee bit of reading at the bottom. Much easier to take seg heights without showing off my nose hair, haha.
Good luck with your patient.

[Ejmaxie]

Interesting and makes sense................., with an add of +2.50 she must be a senior and the Rx was made for reading distance which would be too close for work.

I have a +2.50 add and wouldn't consider my self a senior LOL

[Uilleann]

What *type* of salon? Nail salons are a different working distance and lighting than hair in many cases. As silly as it sounds, if you can get her to demonstrate to you in person her position and posture when she's working, and also get her to be as specific as possible about working environment, lighting, chemicals etc... It's a good place to start! :)

[uncut]

Assumption.....hair salon.

Actual cutting distance preferred.......probably 10 to 12 inches, +0.25 more add than for reading distance............... if a trifocal is used.(person in chair, elevated) and likely high in the lense above seg, if set in a standard height(suitable for driving).
Equipment, roller tray at 24 to 36 inches............intermediate power required...non-existent in eyeglasses worn.

Eyewear answer .....my first choice is a multifocal contact lens, or a high set(above mid pupil) 28 or 35 trifocal, overplussed in add. This would also work in a nail salon. Seperate set with lower seg for street use, revert to bifocal, standard add.

[NUECoptical]

What *type* of salon? Nail salons are a different working distance and lighting than hair in many cases. As silly as it sounds, if you can get her to demonstrate to you in person her position and posture when she's working, and also get her to be as specific as possible about working environment, lighting, chemicals etc... It's a good place to start! :)

The salon is indeed a hair salon. I've been trying to get her to come in so we can go over things with her glasses but she keeps putting it off. If it's not bothering her enough to come in as soon as possible, then I guess I'll just make time whenever she decides she's ready. :Shrug: