Help Needed

[tolchinz]

Good Morning,

I had a new patient come in today. Only glasses he has worn are magnifiers for reading. Pt. has distance Rx and doc wants him in PALs. He is a truck driver and could use intermediate of the PAL. The issue he presented me with is when he was young he had an accident and he has double vision when he moves his eyes up or down. My question is: are PALs a good option for him? Would it cause more double vision when he is looking up or down? Would a 7x28 trifocal be better? Thanks for any help in this and if I need more information to give please let me know.

[Robert Martellaro]

Good Morning,

I had a new patient come in today. Only glasses he has worn are magnifiers for reading. Pt. has distance Rx and doc wants him in PALs. He is a truck driver and could use intermediate of the PAL. The issue he presented me with is when he was young he had an accident and he has double vision when he moves his eyes up or down. My question is: are PALs a good option for him? Would it cause more double vision when he is looking up or down? Would a 7x28 trifocal be better? Thanks for any help in this and if I need more information to give please let me know.

What's the distance Rx (and add for near), and can he see his gauges adequately w/o correction presently? Get a clearer understanding of the diplopia (consult with the prescribing doctor). If any amount of inferior (down) gaze causes diplopia, you can probably nix the multifocals.

[tolchinz]

Robert,

his rx is +0.00 -0.75 x 180 od -0.25 -0.75 x 180 os and add power of 1.50. He is struggling to see gauges is what he told me. I will check with doc about the diplopia issue. Thanks

[Robert Martellaro]

Robert,

his rx is +0.00 -0.75 x 180 od -0.25 -0.75 x 180 os and add power of 1.50. He is struggling to see gauges is what he told me. I will check with doc about the diplopia issue. Thanks

He'll probably appreciate the improved, mostly night vision, but if the add is for 16", I would think that he would have enough accommodation, even with the minus distance correction in place, to see adequately at 25" to 30". It's possible that the gauges will be clearer with the distance Rx- problem solved.

OTOH, if the Rx add is for the gauge cluster distance (likely if he's over age 50, and should have been written on the Rx, but you never know), then you'll want a ST28 set as high as possible (but about 1 to 2mm lower than normal because semi-truck drivers sit high) without interfering with his distance vision, or a ST7x28 with the full add.

Most of the unknowns can be cleared up by using a trial frame, with the client measuring the distance to the gauges. If N/A, use his OTCs to get a feel for how much vertical latitude there is on the downgaze before he breaks fusion. Remember, he doesn't have to sustain fusion, he's just glancing at the gauges. Reading the manifests or for pleasure might be different matter though.

Diplopia or not, I would strongly encourage separates or segmented multifocals for first-time Rx eyeglass wearers who are full-time drivers.

[becc971]

For a patient similar to this (without the diplopia issue) full time truck driver i recently did a pair of D/I FT-28's and they worked out perfectly for what he needed, then for up close he just did OTC readers. I would hesitate to put most full time truck drivers in a PAL for the peripheral vision issues, and also because of the need for the intermediate unless they were willing to shell out the big money for some crazy lenses.

[shannon]

I agree, I am not a fan of putting someone who drives something with 18 wheels (assuming that is what he drives) into a PAL. The peripheral will be less than stellar and I would really like him to see me if he's trying to come into my lane. Also, I would prefer he has easy access to his guages without having to find a sweet spot. There are some lenses out there where this may not pose much of an issue, but is he willing to purchase those?

[bigeyejim]

We have been successful both ways. But I would almost err to the BF/TF as stated. Most drivers will look out of the corner of their eyes to "check their mirrors" which is done constantly. You don't want them to run into any peripheral issues at all. Funny fact, I drove a school bus back in the day during undergrad days...Mirror checking is almost a constant/unconscious activity that is very important to the driver. Sometimes you can gauge whether or not the patient will be successful in a PAL, and if there is ANY question or concern, again err to the BF.

Then you have the guys who never have worn anything until they turn 52, and can't take any correction without freaking out...

[sharpstick777]

Tri-focals would be terrible for this patient.

Good Morning,

I had a new patient come in today. Only glasses he has worn are magnifiers for reading. Pt. has distance Rx and doc wants him in PALs. He is a truck driver and could use intermediate of the PAL. The issue he presented me with is when he was young he had an accident and he has double vision when he moves his eyes up or down. My question is: are PALs a good option for him? Would it cause more double vision when he is looking up or down? Would a 7x28 trifocal be better? Thanks for any help in this and if I need more information to give please let me know.

[sharpstick777]

Although I am a huge fan of progressives, tractor operators, farmers, and truck drivers often do better in FT-28
s because they can look down in the corners and see the ground better. Their working postion of being up high and looking down low is unique.