What would you do?

[jpways]

I have a patient asking me for something and I'm not coming up with a solution that sound good to me so I want to know if anyone has any other solutions

The patient is a 36 year old female who doesn't currently wear glasses, but has a previous subjective refraction (in 2009) of
-0.25 -0.25 x 120
-0.50 -0.25 x 75

New RX
Pl -0.50 x 90
Pl -0.50 x 70

UCVA R: 20/20- L: 20/20
BCVA R: 20/20 L: 20/20 Binoc: 20/15

PD's
D: 30.0 30.0
N: 28.0 28.0

Frame
52-17 with a O.C. height +1 from mechanical center

She complains of eye strain at the end of the day and suffers from dry eye syndrome

She works on a computer for most of the day, however her desk is placed diagonally in her cubicle so that she is her back and the front of her computer display is diagonal to a window as shown in the drawing.

Unfortunately, the easiest solution getting a blind for the window that can be lowered when the sun is causing issues is not an option.

But to make it easier she does not have to be able to look at both her computer and a customer at the same time.

So I have 2 possible solutions that I'm considering, and I'll include my current thoughts on each one.

1. Polarized Gray A with AR (I believe this is only comes in 1.50 Plastic). The polarization will eliminate most of the glare from the excess light, while giving a light enough tint that she can still see when it's not sunny. However, while the monitor is a newer LCD if the display is not set at an axis to allow for use with polarizing filters she won't be able to see her screen.

2. Gradient grey tint with AR (material will either be 1.50, Polycarbonate, or Trivex). While this eliminated the issues associated with polarization I'm not sure how dark to make this tint I'm right now thinking 50->0 but I'm worried that it could either be too dark or too light, if it's an overcast or fully cloudy day 50% is way too dark and I'd be worried about causing next strain from her having to lift her neck to see through the lighter portion of the lens or eye strain from her taking them off on those day. But, at the same time I don't want to make it so light that on full sun days the tint is insufficient.

I'm right now leaning to option 2 because it has less total fail issues then option 1.

So, is there a third option I'm not seeing or has someone used one of my two solutions with success (and if option 2 want kind of tint to you use)

[Robert Martellaro]

If she can't make physical changes to the layout of the desk and monitor, and isn't allowed to occlude the window, even partially with a poster or some such device, then I'd say a tint is in order, but to alleviate your concerns about light level variations, put the tint in a Chemistrie Clip with a backside AR.

Ask the doc about an Rx for intermediate use, again, probably with a Chemistrie Clip. Treat the dry eyes.

Hope this helps,

[drk]

You don't know why she has strain. There are a lot of differentials. At least talk to the doctor to help find the most likely cause before treating.

[jpways]

You don't know why she has strain. There are a lot of differentials. At least talk to the doctor to help find the most likely cause before treating.

Dr. suspects that the glare from the sun is the primary cause of the eye strain, there was nothing in the exam, aside from the necessary correction, that seemed to be contributing to the eye strain.

[ak47]

i would consider transitions xtractive with a blue light filtering AR in a wrap frame (to help with excessive dryness from forced air blowing in the eyes as is common in office settings). don't overlook the dry eyes, hopefully individual is able to take a few minutes off of the screen each hour

[drk]

She really needs to get some sort of partition behind her. I don't think you'll be able to block the reflections off her screen, nor can you block the reflections off her glasses. Plus they're not wrapped.

How about: http://i00.i.aliimg.com/wsphoto/v0/1...ng-curtain.jpg

[ak47]

i love the sewage swimming pool just outside the window in the link above!

[drk]

Raw reflections and whatnot.

[Robert Martellaro]

China

[obxeyeguy]

Ask the doc about an Rx for intermediate use, again, probably with a Chemistrie Clip. Treat the dry eyes.

Hope this helps,

I'm with this. A 36 YO does not need that Rx for the computer, or to see someone across the room. Dry corneas = erratic Rx's. Leave glasses off for a couple days, symptoms remain, there's your answer. Symptoms go away, it's the simple minus Rx in a 36 Yo, she doesn't need them!

I wouldn't go swinging for the fence on a complicated solution to this, until I tried a few simple things.

[uncut]

@jpways: You indicate that she has not worn Rx previously. I would create the new Rx in a simple product first....just to evaluate the impact of the Rx, which should help with accuracy of night vision. as well as prolonged computer work. I would only use a light tint of 15%, or if budget warrants, in a photochromic, with AR. This would show the impact of Rx use, and work for night time driving accuracy.

[erichwmack]

Based on the info I'm also leaning towards not going to complex with this. The correction probably doesn't factor much into this. The dry eye could easily be caused forced air ventilation, allergies, asthenopia, or something else. Figure that out first. Maybe all she needs to do is take an extra break from the computer during these episodes. Anyway, there are computer screen attachable filters that can eliminate sun glare and HE blue. This would be cheaper that concocting a pair of specialized glasses and possibly more effective.

[Robert Martellaro]

Well then, how 'bout trying a pair of sunglasses from the car wash?

[CCGREEN]

The dry eye could easily be caused forced air ventilation, allergies,......... Maybe all she needs to do is take an extra break from the computer during these episodes.

This is the closest to what I am going to suggest.
The good lord did not design us to sit and stare at a screen all day, we did that to ourselves. When doing that we do not blink the 180 or so times a minute as we should. So if she sits under a A/C vent those corneas are drying out. Redirect the vent. Second suggestion. Put on a hat/visor of some type. Any of you hold your hand over your eyes and shield them from the glare of those overhead florescent lights. You will immediately feel the comfort. So look cool and not mess your hair or put on a hat/visor and be more comfortable at your work station.

[D_Zab]

When doing that we do not blink the 180 or so times a minute as we should.

I had no idea we were supposed to blink 3 times per second... ;)

[fjpod]

Was about to say what obexguy said. This Rx would not benefit a 36 year old at a desk...maybe for night driving, but absolutely no value indoors