Problematic Customer - Trifocal Polarized with a +4.50 add

[optician2601]

A customer placed an order for a trifocal Polarized with a +4.50 add. She is very sensitive to sunlight. Unfortunately, trifocal polarized does not come in +4.50 add. The only availability was Tri-focal CR-39. We told the lab to tint "as dark as possible" solid gray 3, with front & back side sapphire Anti-glare.

After dispensing, The customer is complaining of glare, light sensitivity, and lashes touching the back side of the lens causing smudges. This is happening in patient's own frame!

OMG what to do?? The lab said thats the darkest they can tint.

Please help

[braheem24]

What purpose does a trifocal serve a low vision patient with a +4.50 add?

[Jubilee]

Unfortunately a +4.00 add seems to be the highest you can get in a polarized trifocal.

A mirror coating on the front will help eliminate part of the glare issue, but it still won't be a comfortable as a polarized lens. Definitely better than a just a tint though.

[Robert Martellaro]

A customer placed an order for a trifocal Polarized with a +4.50 add. She is very sensitive to sunlight. Unfortunately, trifocal polarized does not come in +4.50 add. The only availability was Tri-focal CR-39. We told the lab to tint "as dark as possible" solid gray 3, with front & back side sapphire Anti-glare.

After dispensing, The customer is complaining of glare, light sensitivity, and lashes touching the back side of the lens causing smudges. This is happening in patient's own frame!

OMG what to do?? The lab said thats the darkest they can tint.

Please help

Maybe the Corning CPF series. There are trial CPF clips available. Trial a Uvex or Fitover. Brown/amber tints should be evaluated.

What purpose does a trifocal serve a low vision patient with a +4.50 add?

Instrument cluster in the auto, cooking indoors with the the clear Rx (especially with gas stove tops!) are a couple of examples.

[drk]

Probably a low vision patient, and they would benefit from taking a magnifying glass with them in the sunglasses. (I would worry about inset being correct for the BF distance, and then wrong for the TF portion, but what can you do, other than a little fudge factor?)

These uber light-sensitive patients need an edumacation. Sunglasses can't eliminate their photosensitivity, completely. I don't think polarization helps their problem directly, but it is always good indirectly.

You just can't tint a lens to 5% transmittance, and that's what some of these people want. What comes into play is peripheral light coming around the glasses, but how are you going to 1.) wrap a monster Rx 2.) find an acceptable sports wrap frame that looks decent and fits 3.) not totally obscure their peripheral vision with a leather-cupped glacier-glass (Hilco has some plastic frames that block peripheral vision too, if needed) ???

I used to see from Serengetti (with their H20ptics series) the "side window" which I thought was a great compromise. They looked cool, too.

Probably the best thing for these people is to lower expectations and point out that they are the problem--not the sunglasses, do what is humanly possible in a nice pair of sunglasses, and try additive optics with a cool fit-over for those impossible days.

[becc971]

A customer placed an order for a trifocal Polarized with a +4.50 add. She is very sensitive to sunlight. Unfortunately, trifocal polarized does not come in +4.50 add. The only availability was Tri-focal CR-39. We told the lab to tint "as dark as possible" solid gray 3, with front & back side sapphire Anti-glare.

After dispensing, The customer is complaining of glare, light sensitivity, and lashes touching the back side of the lens causing smudges. This is happening in patient's own frame!

OMG what to do?? The lab said thats the darkest they can tint.

Please help

i don't think you can get saphire on trifocals, so they probably used a lower quality AR, which is why the smudges would be occurring (my sapphire is VERY smudge resistent, and i'm mean to my glasses), mirror on the front, a backside AR will help, but as a lot fo people have said frame style and other factors may come into effect. make sure the patient has proper coverage in the suns and make them take them outside to wear them to make sure they are comfortable with the amount of sunlight coming in.

theres always the ever beautiful cocoons ;)

[Java99]

Chemistrie clip + fitovers. Not very elegant, but pretty effective.

[rbaker]

It seems to me that the "problem" was not with the customer but with the person who sold her something that was not available. All of these coatings and tints are not a substitute for polarization.

When you find yourself in a hole, stop digging.

[Judy Canty]

Chemistrie clip + fitovers. Not very elegant, but pretty effective.

Chemistrie Clips are "stackable", so that might be an option as well.

[braheem24]

What purpose does a trifocal serve a low vision patient with a +4.50 add?

Instrument cluster in the auto, cooking indoors with the the clear Rx (especially with gas stove tops!) are a couple of examples.

Does a +4.50 add patient drive? Can they see 26" away with a +2.25 intermediate add? Considering we're talking about polarized lenses these glasses would never be used indoors.

My original question was asked to avoid situations where the patient has no benefit. We're probably going through a lot of effort for no benefits, If anything we're making the situation worse by being forcing the patient to look thorough a low set 28mm bifocal instead of a D35 for a low vision patient most likely with poor field of vision and giving them a gray lens instead of a color which offers better contrast.

My original question still stands, are we doing this patient a service or dis-service by finding a +4.50 add 7x28?

[standarduck]

It seems to me that the "problem" was not with the customer but with the person who sold her something that was not available. All of these coatings and tints are not a substitute for polarization.

When you find yourself in a hole, stop digging.

+1

[mervinek]

I agree... perhaps fitover might be the best option. Not pretty, but effective.

[drk]

My original question still stands, are we doing this patient a service or dis-service by finding a +4.50 add 7x28?

Just depends on how she uses them. You're right, the high add could be superfluous, or not.

[Robert Martellaro]

Does a +4.50 add patient drive? Can they see 26" away with a +2.25 intermediate add? Considering we're talking about polarized lenses these glasses would never be used indoors.

My original question was asked to avoid situations where the patient has no benefit. We're probably going through a lot of effort for no benefits, If anything we're making the situation worse by being forcing the patient to look thorough a low set 28mm bifocal instead of a D35 for a low vision patient most likely with poor field of vision and giving them a gray lens instead of a color which offers better contrast.

My original question still stands, are we doing this patient a service or dis-service by finding a +4.50 add 7x28?

In Wisconsin, 20/100 in one eye, daytime only, maybe with distance restrictions.

I see quite few +5.00 and +6.00 adds, sometimes trifocals, case-by-case. Some will read larger print through the intermediate and use the near for smaller print, minimizing the need for magnifiers. It depends on the degree and/or nature of the vision loss.

The intermediate does take away a little vertical field from the near zone, but it's a necessary tradeoff.

There may be circumstances where a wider seg might be desirable, but I can't remember the last time I used one, probably because most of the higher adds (up to +6.00 cr39 for trifocals and +8 or +9 for FT28s, and +20 for some rounds) are unavailable with wider segs, and that the 28's offer more than adequate field width.

For the OP...

http://www.optometry.co.uk/uploads/a...th20020418.pdf

[sharpstick777]

Java nailed it, but if you don't know Chemistrie does powered SV plus layers clear and in a new Blue light material, that is not only affordable but effective. You can also do Polarized over a tinted base lens (there will be small clear rings around the magnets) that will give you both what you want.

Chemistrie is an enormous problem solver.

She won't need that +4.50 most of the time, and a trifocal is a mess that high as the intermediate is rarely effective. Do a bifocal with a +3.00 add, use a +1.50 Chemistrie layer and you are golden.

Chemistrie clip + fitovers. Not very elegant, but pretty effective.