Progressive, issus fitting a pt with vision only in one eye.

**highline** · 01-16-2013, 04:10 PM

My Pt. only has vision in his OD, and is currently in an Augen progressive lens (he is used to it and it works well for him). I fit him in to a physio thinking it would at least be a little better. He is having issues, RX doesn't seem to be the problem, pd and segs are perfect, when he looks through the lens the reading corridor doesn't see to be in the right place or wide enough for him, he has no peripheral near vision to the right in his good vision eye but does have a wider range to the left. No adjustments, even shifting the frame to move the pd, seem to help (Pd in his old pair is defiantly different that the new glasses, also tried to mimic that and it didn't help). Both his current and new frame (larger round frames) has a very similar vertex distance and panto, the new frame has a little larger lens. Any suggestions or hints on what I should do would be of great help. Thanx, Highline

**Randle Tibbs, ABOM** · 01-16-2013, 04:27 PM

Remember, he only has sight in one eye so he is probably not converging much if any at near. did you fit him with the original pair?
did his add power increase, if so that will narrow the intermediate zone and reading zone. did his entire Rx change?
without more information, it's hard to give any definitive answers.

**CCGREEN** · 01-16-2013, 04:33 PM

Would be nice to have the old Rx and the new Rx to compare to.
Old lens material and new lens material would be nice to know.
Old PD vs New PD
In other words we just need more information to work with.

**uncut** · 01-16-2013, 08:22 PM

Welcome to Optiboard, highline.......this forum is the "Rockies" of the optical forums.

The intention you had was a good one. I think that if you view the topograpy maps of the previous brand of lens, and the newest, you will find that the corridors are different widths, insets, and the newer one has more of an s curve to the corridor. That's all fine, if you have binocular vision.

In this case...........use the same brand previously worn, if possible. Use the same index of refraction. Use the same near decentration, as opposed to distance OC.......and check to see if someone rotated the lens nasal down, which moves the useful area, peripherally. That is something you could try to salvage the fit of the Physio, BTW.

Good luck.........and post back with your progress and final result! Remember that any increase in add usually will result in a width(useful) of intermediate and near area, reduction.

**Yeap** · 01-17-2013, 04:23 AM

give a try on monocularly for his reading on trial frame. if the Rx no issue then probably is the fitting issue.
well acoomodation and convergence maybe another issue if you able to do a further asessment about it.

**highline** · 01-19-2013, 12:09 PM

His old RX: OD -2.75+2.75X015 ADD+2.25
(2007) OS -2.75+2.50X175 ADD+2.25

His new RX: OD -2.25+2.75X180 ADD+2.25
(2012) OS -2.75+2.00X175 ADD+2.25

I know the placement of his PD (in old glasses) for OD. In regards to his pupil, seg height was placed directly to the outer right edge of his pupil before the limbus and directly down before you hit the bottom edge of the lower limbus. Pd on new pair was at perfect centration and height. Also, what is the correct way to calculate the near pd for someone like this, I know Randel Tibbs posted that in a situation like this the Pt. may have little to no convergence? Highline
P.S. if anyone knows off the top of their head were I can find an Augen progressive lens that would be great.

**uncut** · 01-19-2013, 02:41 PM

Originally Posted by highline

His old RX: OD -2.75+2.75X015 ADD+2.25
(2007) OS -2.75+2.50X175 ADD+2.25

His new RX: OD -2.25+2.75X180 ADD+2.25
(2012) OS -2.75+2.00X175 ADD+2.25

I know the placement of his PD (in old glasses) for OD. In regards to his pupil, seg height was placed directly to the outer right edge of his pupil before the limbus and directly down before you hit the bottom edge of the lower limbus. Pd on new pair was at perfect centration and height. Also, what is the correct way to calculate the near pd for someone like this, I know Randel Tibbs posted that in a situation like this the Pt. may have little to no convergence? Highline
P.S. if anyone knows off the top of their head were I can find an Augen progressive lens that would be great.

"Saturday........Saturday........Saturday...."(those lyrics are in my head) LOL

I think you mean iris, not limbus, because the limbus is about 1 mm wide and is the transition zone way out, occasionally further out than the iris edge, that transitions the cornea into the conjunctiva and sclera. You may want to edit your location described!

Best source of near IPD is(wait for it).....................to...............measure.............. ..it! Also, observe if patient is OD or OS-handed. This creates a habitual positioning of near activity.

**marktheeyeguy** · 01-19-2013, 03:52 PM

New base curve is way to flat. Ok, first. Base curve clock old lenses. Match old base curve, 15 degrees panto tilt, trivex only, match face form, use pd on old glasses and I don't care what it is, match it. Seg height match old lenses nomatter how high or low, match it. Measure base down prism on old glasses and match it exact on new. If you follow these instructions, he I guaranteed to see. The Eye Guy ;)

**marktheeyeguy** · 01-19-2013, 04:16 PM

Don't over calculate or troubleshoot. Stick to what I outlined. Forget Augen. Order free form trivex. You pick, it doesn't really matter. Any freeform will be better than Augen. Trivex, trivex, trivex. It will work!!! Must match all measurements off old glasses and I don't care how they look. What's correct isn't always right for the patient. When its right is when he can see. ;)

**Robert Martellaro** · 01-21-2013, 05:35 PM

Originally Posted by highline

Also, what is the correct way to calculate the near pd for someone like this, I know Randel Tibbs posted that in a situation like this the Pt. may have little to no convergence? Highline

Search Optiboard for "mirror method" or "mirror trick". One clue is if he places the reading card right under his right eye!

**highline** · 01-23-2013, 04:56 PM

Thank you everyone for the advice, I will let you know what the out come is. Highline

**sharpstick777** · 02-21-2013, 12:16 PM

He has a ton of cyl, and in sphere is rx is offsetting which means his sphere power offsets his add, which means he may not be using his eyewear full time like he should. Both factors will be improved with true Free-form. Autograph could do wonders for your patient.

You will probably have to explain to your patient that wearing eyewear full time will give him the best VA in the long run. And taking his glasses off for reading his eyes are not adapting to his glasses.

Welocome to Optiboard highline.

Originally Posted by highline

His old RX: OD -2.75+2.75X015 ADD+2.25
(2007) OS -2.75+2.50X175 ADD+2.25

His new RX: OD -2.25+2.75X180 ADD+2.25
(2012) OS -2.75+2.00X175 ADD+2.25

I know the placement of his PD (in old glasses) for OD. In regards to his pupil, seg height was placed directly to the outer right edge of his pupil before the limbus and directly down before you hit the bottom edge of the lower limbus. Pd on new pair was at perfect centration and height. Also, what is the correct way to calculate the near pd for someone like this, I know Randel Tibbs posted that in a situation like this the Pt. may have little to no convergence? Highline
P.S. if anyone knows off the top of their head were I can find an Augen progressive lens that would be great.