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Thread: NV cyl power different for DV cyl power???

  1. #1
    Master OptiBoarder Joann Raytar's Avatar
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    Question NV cyl power different for DV cyl power???

    Does anyone have a clue why someone would be given the following Rx's? Does this make any sense to you folks?

    DVO
    plano -1.25 X080
    -0.50 -1.75 X110

    NVO
    +4.25 -2.25 X080
    +3.75 -1.75 X110

    She has had cataract surgery but had some complications. What those complications were we cannot find out. We tried verifying the Rx but couldn't get past the woman at the Dr's front desk. All she would say was that was what the Dr. wrote so that is what he wants. We apparently are not able to speak to the Dr. himself.

    Why would someone require such a dramatic increase in cylinder power in their near Rx?

  2. #2
    Forever Liz's Dad Steve Machol's Avatar
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    I'd be willing to bet this is a simple typo and that if you ever got a chance to check with the Doctor he'd agree. Unless of course he's the kind of person that does not like to admit fault. In which case you'll do the Rx, the patient will complain, the Dr' will say it was a lab error, and then issue a slightly revised prescription since it has to be 'remade anyway'.


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  3. #3
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    Call the Doctor's office tell them it's Jesus and you want to talk to God. Many receptionist today seem to think that M.D. Means
    Medical Deity and only other Medical Deity's should be able to communicate directly with them. This seems to be more of a growning tendancy with with the newer generations of doctors.

    In the past this was not the case and unless the doctor had both hands in the patient's eye the help would put us mear technicians right through. Now it's "He's with a patient can I have him call you back." If you're lucky you hear this, If you are even luckier he calls you back. But you never seem to be lucky enough for the Doctor to call you as soon as he finishes with the current patient. The end of the day, maybe. Several day's later when you don't even remember which problem you asked him about, maybe.

    They don't even seem to be educated in how to communicate with us when it's to their benefit. It's been a very long time since one of them sent me a drawing of an ulcer or abrasion so that I would know what to correct for in a contact lens fit after he had succesfully treated same.

    Chip

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    registeredoptician Refractingoptician.com's Avatar
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    Last edited by Refractingoptician.com; 02-15-2007 at 09:34 PM.

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    Master OptiBoarder Joann Raytar's Avatar
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    I neutralized her old NVO from last year and she was wearing a -1.50 cyl. I think you guys are correct; this one requires a direct conversation with the doctor.

    Normally, we have no problem with the area Doctors, even those with their own dispensaries. So far all of them seem more eager to help the patient see well than get them back into their dispensaries. Often if we find a solution to a problem that we are working through with an outside doctor we call that doctor back and let them know what had to be done to troubleshoot the patients problems.

    This one may turn into one of those don't make my doctor call your doctor moments.

  6. #6
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Why not trial frame her and see for yourself?

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    Jo,
    As has already been pointed out here, I also beleive that this is a typo. However, if it's not a typo, how do you intend to do this lens? can you make the cylinder vary by 1D along the corridor? This seems to me, as a task for 1st class lens designer, and then requires the use of a special lathing machine. Am I wrong?

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    Rannan: Can easily be done in a Franklin (split two piece lens) bifocal. Rather inexpensivlely I might add. But suspect the problem is a lazy doctor too eat up with his self importance to check and see if he made a mistake.

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    Thanks Chip. This makes sence only if the other lens is also bifocal. Anyway, I guess the type of lens (bifocal, PAL, etc..) should be indicated in the prescription.
    I must admit I liked your characterization of the doctor.

  10. #10
    Manuf. Lens Surface Treatments
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    Re: NV cyl power different for DV cyl power???

    Jo said:
    Does anyone have a clue why someone would be given the following Rx's? Does this make any sense to you folks?

    DVO
    plano -1.25 X080
    -0.50 -1.75 X110

    NVO
    +4.25 -2.25 X080
    +3.75 -1.75 X110

    She has had cataract surgery but had some complications. What those complications were we cannot find out. We tried verifying the Rx but couldn't get past the woman at the Dr's front desk. All she would say was that was what the Dr. wrote so that is what he wants. We apparently are not able to speak to the Dr. himself.

    Why would someone require such a dramatic increase in cylinder power in their near Rx?

    Copy the RX on a Fax form, address it to the Dr as personal and mark with big marking pen "PLEASE CONFIRM AND FAX BACK", fax it to him, that should do the trick.

  11. #11
    Master OptiBoarder Joann Raytar's Avatar
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    Tried to talk with her doctor again today. I was told he would call back this afternoon. I didn't hear from him so I suppose the only way to proceed is to do as Judy suggests and set up our own trial frame or just go ahead and cut the Rx and let things fall where they may.

    My bet is the increase in cyl is going to knock her for a loop. Judy's suggestion is the best because it will save the patient from having to run around between the two offices as much.

  12. #12
    registeredoptician Refractingoptician.com's Avatar
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    ..
    Last edited by Refractingoptician.com; 02-15-2007 at 09:35 PM.

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    Bad address email on file John R's Avatar
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    Wink

    You could always bit the bullet so to speek and make it as you think it should be...At least if it need remaking its your fault..
    Maybe in future you should inform the body on the phone that if it need a remake they will be libel for all costs as it has been quered with them and they are speaking for the doc....Who would not be best pleased that he had not been informed of a mistake.

  14. #14
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    Note: If you set it up in a trial frame and put it on the patient, you could be setting yourself up for a "the unqualified pretenting to be a doctor" hassle. And you already know the doctor (or at least the receptionist) is a .......

    If needed call a friendly doctor and ask him to intercede. The receptionist will put him though.

    Chip

  15. #15
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    This is a little more common for our office. We see a lot of high astigmats. Usually this type of change is with cyls of 2.50D or more. This is done with astigmats, presbyopic or not. High astigmats may present with symptoms of problems at near.

    We also have to bear in mind that sometimes the astigmats cylinder correction may have been cut not to produce symptoms for them for distance.

    The refraction is preformed with both eyes open fusing at near to take in cyclotorision effect that may be induced when focusing. Axis and cyl changes may occur at this point. Usually the cyl is stronger and may fluctuate up to a diopter. We allow the patient to read for a period of time when confirming the RX.

    A great book in my library is The Fine Art of Prescribing Glasses Without Making a Spectacle of Yourself by Benjamin Midler & Melvin L. Rubin. There are several pages devoted to this scenario.[:cheers:

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    I think you may have another problem. (Have you filled this doctor's Rx before?) With a 4.25 reading add I hope this patient is low vision. You may have to add some prism for the patient to fuse. Also I hope someone expained to the pateint how close they will have to hold things.

    Try to talk to the head tech rather then the surgeon. Stress that you want to make sure it is right so that they don't have to return to the doctor. Most good doctors, OD or MD appreciate a good optician that picks up on mistakes.

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    Bad address email on file dfisher's Avatar
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    Regarding Bev's post...
    One of the ODs help me out here. How can the cylinder change by a full diopter or more from distance to near? With a pseudophake I would assume this would be impossible and extremely unlikely in everyone else.

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    Is it possible that the implant is not oriented properly?

  19. #19
    sub specie aeternitatis Pete Hanlin's Avatar
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    I have seen patients who have been prescribed different cyls for near and distance vision (though admitably, not different by a full diopter at the same axis). I would imagine that a note would have accompanied the Rxs if the doctor indeed intended for such an unusual script. Heck, most docs will even circle the "+" and "-" signs when scripting for an anisometrope...

    Go for the trial frame- in the end, that's what it really comes down to anyway (i.e., can the patient actually use the Rx as written)!
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

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    Objection! OptiBoard Gold Supporter shanbaum's Avatar
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    Exclamation

    I think you should send Chip over to beat the **** out of the refractionist.

  21. #21
    One eye sees, the other feels OptiBoard Silver Supporter
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    Jo,

    Either the distance or the near Rx are wrong (Rt eye). If it was meant to be this way (never seen it) the sphere equivalents would be equal and they are not. Unless the add powers are different in each eye. Try to get to get the full refraction ( distance plus the add for near) and due the math yourself. P944t (anyone use their real name around here?) really nailed this one. Talking to the tech is very good advice along with the short 10" focal length concern. Md's love to crank up the add power when there are complaints of poor VA at near. Make sure the client is aware of how close they will have to hold near objects, a 10" reading distance is very uncomfortable for most folks. Also check if a +4.00 add would be ok since over four diopter adds are available in half diopter steps only. I agree that the Doc and the staff will be extremely appreciative that the error was caught before they were dispensed, especially a post-op client with complications.

    Robert

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