+3.75 ADD, Transitions PAL, what to use?!?!

[dammy05]

RX OU -5.00 -.25 x 180 +3.75add. This patients neuro-ophthalmologist just cut her back from a +4.00 add and I'm having a hard time finding any Poly Transition PAL lenses to use here, any suggestions out there? Thanks in advance!

[RT]

HOYA Summit ECP 1.67 Transitions VI Gray is available in 3.75 and 4.00 adds.

[dammy05]

Thanks, unfortunately the lab we work with doesn't offer Hoya lenses.... :/

[sharpstick777]

I would suggest the Seiko Supercede for your patient, its great for high myopes. But I would also consider 3 pairs, I know its a nightmare but with that high of an add, there is no way your patient will ever be served well with only one pair of glasses. I would suggest a distance progressive with a +3.00 Add for everyday around town, a computer pair in ST-28, half the add on top, and a reading pair.

At least if you tell her up front about the 3 pairs, if she is disappointed in one, she won't blame you.

Also, is this Add new to her? Or has she worn it for some time.

[dammy05]

Thanks, I'll look into that. Yes this is a new add for her, her last pair of glasses (6 years ago) were a 1.75ADD, same distance rx. She tells me she see's great with them, however this new DR thinks this is the way to go.... We had her in a Physio DRX with a +4.00 add and the patient was having a hard time with it, so the remake rx came back at +3.75. I've pretty much decided in my head that it's not going to work, however I want to give this DR the benefit of the doubt and see if she can prove me wrong.

[sharpstick777]

Danger will Robinson, danger.
1) 6 years of not having any RX change will give you fits no matter what she chooses, I call it Petropia, where a patient just gets used to one pair and even a new pair in the same power causes eye strain. No matter what solution you end up with, you will do well to advise her at dispense that adaptation could be 2 weeks to one month, and that she may have a lot of eyestrain until she's adapted. I always advise patients to change lenses every 3 years even if they don't have an RX change.

2) Is there a pathology involved, like Age Related Macular Degeneration?

3) That is a huge jump in power for someone who says they are seeing well. Is this an outside RX? Or your OD? If its an outside RX I would trial frame you patient for SV reading and see how close she has to hold reading material. There is a chance the Add was written incorrectly. If she doesn't trial frame well, or she doesn't have an pathology, then you may want to verify the RX with the perscriber.

Thanks, I'll look into that. Yes this is a new add for her, her last pair of glasses (6 years ago) were a 1.75ADD, same distance rx. She tells me she see's great with them, however this new DR thinks this is the way to go.... We had her in a Physio DRX with a +4.00 add and the patient was having a hard time with it, so the remake rx came back at +3.75. I've pretty much decided in my head that it's not going to work, however I want to give this DR the benefit of the doubt and see if she can prove me wrong.

[NCspecs]

Danger will Robinson, danger.
1) 6 years of not having any RX change will give you fits no matter what she chooses, I call it Petropia, where a patient just gets used to one pair and even a new pair in the same power causes eye strain. No matter what solution you end up with, you will do well to advise her at dispense that adaptation could be 2 weeks to one month, and that she may have a lot of eyestrain until she's adapted. I always advise patients to change lenses every 3 years even if they don't have an RX change.

2) Is there a pathology involved, like Age Related Macular Degeneration?

3) That is a huge jump in power for someone who says they are seeing well. Is this an outside RX? Or your OD? If its an outside RX I would trial frame you patient for SV reading and see how close she has to hold reading material. There is a chance the Add was written incorrectly. If she doesn't trial frame well, or she doesn't have an pathology, then you may want to verify the RX with the perscriber.

+1 This. All of this.

[Robert Martellaro]

Thanks, unfortunately the lab we work with doesn't offer Hoya lenses.... :/

Then you have three choices: Get the Hoya lens from another lab, convince the neuro-ophthalmologist to authorize a +3.50 add (plenty of PAL choices), or use a mid to low refractive index segmented multifocal from X-Cel (both) or Younger (cr39 only).