Another mystery...

[kaypaula]

Man, I get some strange ones. Okay, this patient I do know personally and he's not a quack. He may be a bit "sensitive" to changes etc so here's the scenario and maybe one of you has an idea of what could be going on that I haven't thought of.

RX OD -4.75 +1.00 X 040 OS -6.00 +0.75 X 145 +2.00ADD

His habitual was SO AWFUL, I don't see how he could see anything out of them. He's a judge AND on the side a pilot. I don't have his habitual RX as it was an outside RX to begin with and he never got glasses from me before so I don't have a record of it. I do remember it was reduced in minus, and the ADD was also lower, but I think only by 0.25. He was wearing POLY, very scratched (almost like a brillo pad was taken to it scratched), rimless, NO AR, very thick. The frame was so far out of adjustment, it not only had Xing going on, but the bridge was very skewed therefore one lens was lower than the other.

New glasses: Nice new full rimmed frame, 52 eye, High Index, Super Hi vision AR, Hoya Lifestyle ID progressive.

Complaint: Can see much clearer EXCEPT at dusk or dawn or in low lighting conditions he has to resort to putting on those old glasses. He states he can actually see better in the old scratched, distorted, no AR, rimless poly's in low light conditions. Especially when he is flying.

I have no answers for him. I wanted him to see his doc but he's put it off so long (and he's not one of our doc's patients), I don't think he will go bc of his busy schedule. The ONLY thing I can think of is some pathology that I am not privvy to bc he is not one of our patients. Is there any pathology that would allow someone to actually see better in a situation like this? Any thoughts?

Thanks
P

[optilady1]

ugh those are my thoughts. Good luck with that. Sounds more like a psychology problem.

[COMEINPEACE]

is he seeing better in the new spex?(check va w/ old and new on a chart to demonstrate to him), OR is he one of those 'hi minus people" that sees "more comfortably"when the va is less accute?
sometimes when they say they see 'better' they mean more comfortable

[coupe]

Pilots are like engineers and photographers. They relate directly to their avaition needs. That is why he is only discussing his problems in a flying mode terms and not his everyday conditions. Best solution is to convince him to stop using his flying comparison and start relating to his everyday vison. Is he blinded when he drives to work in the morning....coming home at night....sitting on his porch at 6:00pm for cocktails....playing golf at the end of the day or early moring.

Get him out of his flying mode comparison and you will remove the problem. But like engineers and photographres.....GOOD LUCK

[ThatOneGuy]

Does he have really big pupils? Perhaps the scratched lenses are reducing the amount of light that is being distorted by corneal imperfections?

Try a contrast clip over his new gls and see if that helps.

[optical24/7]

Night Myopia.

[Robert Martellaro]

I don't have his habitual RX as it was an outside RX to begin with and he never got glasses from me before so I don't have a record of it. I do remember it was reduced in minus,

Are you saying that the new Rx has less sphere equivalent minus, or that the old was less minus? If the former, give the eyes a few days for the accommodation to relax. If the latter, he may be over-minused somewhat. Remember to neutralize all outside RXs.

[Uncle Fester]

Try a contrast clip over his new gls and see if that helps.

This is my dart at the wall thought too.

Maybe a fitover pair with yellow lenses.

Do let us know how it turns out!!!

[Hayde]

Impressive darts on this thread.

This one is much lamer...but just to say we asked: did we edge polish the new lenses?

(Dx: X63.20 - Persnikitiness, not otherwise specified.)

[EyeManDan]

Impressive darts on this thread.

This one is much lamer...but just to say we asked: did we edge polish the new lenses?

(Dx: X63.20 - Persnikitiness, not otherwise specified.)

That was the first thing I though of, or maybe a frame adjustment change the angle of the way light hits it.

[kaypaula]

Actually, he has really small eyes. Not sure of the pupil size, but they always seem so small. Narrow PD too. His frames is an Aspex so he has the polorized Mag clip, of course being a pilot we know they can't use polorized with the instrument panels but he can certainly use it outside. I will try the contrast as a test, and check his VA next time I see him .... which will be way too long if I wait for him to come back into optical. I think I will drag it all out to his house and invite myself over for coffee. What I think, is he should have went back for a Dr. Recheck exam, but his exam was probably over a year ago, he waited a good deal of time before he ordered glasses.

[kaypaula]

That was the first thing I though of, or maybe a frame adjustment change the angle of the way light hits it.

No, no edge polish.

[kaypaula]

Are you saying that the new Rx has less sphere equivalent minus, or that the old was less minus? If the former, give the eyes a few days for the accommodation to relax. If the latter, he may be over-minused somewhat. Remember to neutralize all outside RXs.

He was overminused, the doc brought it down some. About a diopter if I recall.

[Robert Martellaro]

He was overminused, the doc brought it down some. About a diopter if I recall.

Four clicks weaker? Great. Maybe he's under-minused now. Not a good idea for an active adult, especially a pilot. Anyways, that's the lowest hanging fruit that I see here. A diopter less minus is somewhat unusual for a moderate myope, but it does happen, and might not be a too much of a red flag if his old eyeglasses go back 5+ years.

Is there any pathology that would allow someone to actually see better in a situation like this?

What's his age? Cataracts maybe, considering the hyperopic shift, especially if you fudge the Rx.

[optical24/7]

I'll repeat post # 6. Stargazers, OTR drivers and pilots or folks that spend a lot of time in low light conditions notice this common myopic shift than the rest of us. ( that was a good size drop in minus also).

[Wes]

I'll repeat post # 6. Stargazers, OTR drivers and pilots or folks that spend a lot of time in low light conditions notice this common myopic shift than the rest of us. ( that was a good size drop in minus also).

I'll second that. If he was overminised before, it would have corrected for night myopia. Perhaps a second pair with a half diopter more minus OU for low light activities?

[Robert_S]

Night Myopia.

I agree.

[Robert Martellaro]

He's too old my friends. At the most, a contributor, maybe .25 D. Folks just don't suddenly develop night myopia in their 50's after wearing eyeglasses for 40+ years.

[Craig]

I got one at the insistence of my rep and it was the only free-form lens that I could not see out of. I had a guy who runs a major lab have the same experience and we both love the IOT lenses.

Put him in a decent lens that has accurate powers; mine was to be plano and it was almost +0.20D.
I ended up trowing them in the garbage as they are the only lens I could not wear.

[Robert_S]

Craig you're a pretty smart guy but that is a really dumb thing to say. You sound like a customer who says varifocals are the devil because you tried them once and couldn't get on with them. All your experience tells is is that you aren't suited to the lens, which is fine, some aren't suited to the iot designs either. It doesn't mean there's some inherent flaw in them.

[Robert_S]

He's too old my friends. At the most, a contributor, maybe .25 D. Folks just don't suddenly develop night myopia in their 50's after wearing eyeglasses for 40+ years.

it may have always been there but since the patient was over-minused he wouldn't have been symptomatic. My understanding was we all have night myopia.

[Wes]

it may have always been there but since the patient was over-minused he wouldn't have been symptomatic. My understanding was we all have night myopia.

We do not ALL have night myopia. Only those with accommodation ability left in the lens can have night myopia. However, this guy obviously still has SOME accommodation ability, but not much. Probably about 1.5D total, but you can't use that for long; hence the +2.00 add. All that said, I'm still thinking night myopia.

[optical24/7]

http://www.journalofvision.org/content/12/5/4.full


One study out of Spain found all their test subjects experienced night myopia. But as Wes states, you need accommodative ability.

[Robert Martellaro]

http://www.journalofvision.org/content/12/5/4.full


One study out of Spain found all their test subjects experienced night myopia.

The age of the nineteen subjects in this study was 21.9 ± 4.6 years. Our guy in this thread is in his fifties or sixties.

Consider this...

http://www.ncbi.nlm.nih.gov/pubmed/8944194

It is concluded that high mesopic levels (about 1 cd/m2) of road luminance produced by street and vehicle lighting are normally too great to allow significant refractive shifts to occur, although acuity will be reduced due to light-dependent neural changes. Under these circumstances it appears unlikely that specific night-driving prescriptions will be beneficial: the accurate correction of normal refractive errors is, however, more important during night than day driving due to the greater blur associated with the larger night-time pupil.

My bold.

Night myopia is primarily a concern only for young stargazers and pilots.

http://www.skybrary.aero/index.php/Empty_Field_Myopia

The problem is the Hoya ID lens!! I got one at the insistence of my rep and it was the only free-form lens that I could not see out of.

The 11mm short corridor and my bigger than average pupils made this lens unusable for night driving. The 14mm corridor was adequate, but was/is not my first choice for myopes due to the somewhat soft distance and near vision for some wearers. Could be a contributor though, especially with the unusually large cut in minus power.

kaypaula, throw us a few more bones- client age, new and old PAL design, lens positioning (especially BVD), etc.

[Craig]

Craig you're a pretty smart guy but that is a really dumb thing to say. You sound like a customer who says varifocals are the devil because you tried them once and couldn't get on with them. All your experience tells is is that you aren't suited to the lens, which is fine, some aren't suited to the iot designs either. It doesn't mean there's some inherent flaw in them.

The power in the lens was off due to surfacing by Hoya! I just met with a former Hoya rep who also saoid she did not like the optics in the ID while prefering the older designs. The ID was made for me and a man who runs a lab that does over 2,000 jobs per day while having no issue with wrap IOT or Shamir lenses in the same RX. We also made a sunglass for one of my employees who just tole me he only wears them in the yard as he does not like them either.

I just got in a Camber lens and the reading is great due to more plus below the 180 but not above like the ID. I have no problem with Seiko, Kodak, Zeiss, Shamir (now) or Varilux but for the $ the IOT lenses are my friend and the optics are first class with predictable compensation.