Picky PAL gal `

[Rockstargazer]

Hello all- i have a patient who has history of sensitivity to any minor changes in glasses, I fit her in Zeiss Individual 2 years ago and although took some effort and determination was able to adapt to lenses. She can tell when her lenses aren't a 6 base believe it or not. Anyway long short she went elsewhere for new glasses a month ago and is having a hard time with things looking "wonky" or going downhill on her. Her new PAL is Varilux Physio DRX in Trivex material.

OLD RX:
OD +1.00 +0.50 180 +2.25 ADD
OS +0.50 +0.75 10 +2.25
32.5/32.0
POLY AR PURECOAT
ZEISS INDIVIDUAL
SHE LIKES HER SEGS ON THE HIGH SIDE (1MM ABOVE OC)

NEW RX:
+1.25 +0.50 180 +2.25
+0.75 +1.00 180 +2.25
31.0/32.5
VARILUX PHYSIO DRX TRIVEX

I checked new glasses thoroughly and they are spot on to specs-

I'm thinking the problem is different PAL design from Zeiss to Varilux and refitting with the oc 1mm higher. Any other clues I've missed?


Thanks as always guys.

Marcie Patten

[DanLiv]

Any difference in design is going to alter the curvature of field and produce the "wonky" effects, and as we all know some patients are impossibly hypersensitive to these changes. The Rx change will do it, but so will progressive design change and material change. This patient has all three compounded. Plus, the Individual is pretty customized, of course with fit values but also in custom corridor length. DRx has neither of those customizations (merely Rx optimization).

I have patients with those histories too, and I've learned not to try and fight it. I do have one long time patient to whom I had to give a little grief counseling when her beloved Panamic was discontinued, but other than that I keep them in what they like. For some people the psychological self-priming of "this is the only thing that works for me" is far more powerful than any explanatory or persuasive power on our part. I wherever she went can't put her back into what she was in, you have great opportunity to recapture her (assuming you want to).

[NCspecs]

.....For some people the psychological self-priming of "this is the only thing that works for me" is far more powerful than any explanatory or persuasive power on our part. I wherever she went can't put her back into what she was in, you have great opportunity to recapture her (assuming you want to)....

Man, this on so many levels. I would add that if she decided to get a new pair with you to verbally prep her regarding the Rx change. You can eliminate some of the other issues like changing the PAL but she is going to have to be mentally prepared to "get used to" that slight Rx change. To 99% of the population, that slight change doesn't mean a thing but to her it might mean the world, we have no idea.

[Robert Martellaro]

Look for differences in prism thinning first. Then POW, primarily the panto tilt. BCs should be about +5.00 ±.50 D

Do not fit high- change the PAL design, brand, or supply task eyeglasses if there is excessive posturing and/or visual problems.

[Rockstargazer]

DanLiv, NcSpecs and Robert M- thank you for taking time to weigh in- Sometimes you just need another opinion to help you feel convicted what you are doing is the right thing!! Have a wonderful weekend.

Marcie aka rockstargazer

[sharpstick777]

Hello all- i have a patient who has history of sensitivity to any minor changes in glasses, I fit her in Zeiss Individual 2 years ago .....

Anyway long short she went elsewhere for new glasses a month ago and is having a hard time with things looking "wonky" or going downhill on her.

Anyone who doesn't have the sense to go back to a good Optician, esp after being so picky, is nuts. Kudo's to you, but I would have sent her back to where she got them from... without regret.

[waynegilpin]

"I keep them in what they like."

Truer words were never spoken. Sometimes we just outsmart ourselves and introduce unnecessary problems.

If you change 15 variables, you'll never identify the one (or more) that is causing the problem. Don't try to fix what ain't broken.

[Uncle Fester]

All of these posts are right on! Optiboarders RULE!!!

I good-naturedly scold them when this happens and ask why they left me.

Then I tell them to go back and see if they'll re do it "in the more expensive lens". This lets the other optical at least try to recover some of the re do costs. I'll also advise that she needs to be aware that there is an rx change involved so it could take a few weeks to get used to the re do. If they do return to me for future work I try to- how should I put it- adjust my future price accordingly.

I'd also send her with a card with my suggestions more specifically the PD I used but from the sounds of it the wonkyness is coming from a sensitive patient picking up the minimal prism thinning and design change as touched on earlier.

I've found this straightforward professional honesty rewards me far more often than it harms me.

[ThatOneGuy]

Zeiss Individual was a disaster for me with Hyperopes. Individual 2 has been great and eats physio for lunch every day of the week. Double check PD/Seg on the new pair to see that it is right. Check POW. Ultimately though, if you do fix the other optical's glasses, you have vindicated the patient in their decision to leave you if the glasses work great. I would explain every step of the way what you are doing and why you are doing it, and explaining that these are things you (the competent Optician) do that others don't pay attention to despite their critical importance.

You never want to make someone feel bad about their glasses rather they are old, new, or elsewhere's. Instead, sell yourself to the patient on how your skills can make a product work as intended.