Reading a compensated Rx?

[CCGREEN]

Just looking to find out what others do in this situation.
We hand the patient a Rx written in normal 0.25 steps. Pt takes Rx somewhere else to have it filled and for what ever reason be it a high wrap frame or the use of some digital lens or what ever lens design is chosen it get calculated using a compensated Rx.
Now pt has difficulty with new Rx and comes back to the Dr's office for a recheck. Glasses get thrown into a manual or auto lensometer and of course a wild off the wall Rx is found due to compensation.
Question is......how does the Dr's office know if the Rx was filled correctly since they are looking at a computer generated compensated Rx? All that's left for us to do is refract again and send them back to where ever they had the Rx filled and hope it works for them. The pt really wants an answer from US. After all we are the "DR"S" office. The know it all place. But with the way things are we are really just flying by the seat of our pants.
Any input here would be greatly appreciated.

Thanks

[WFruit]

I'd start by calling where ever they had the glasses made and get the compensated Rx.

There are a number of Rx "calculators" that can be found online which will give you a compensated Rx based on patient's Rx, frame measurements, and POW measurements.

The best would probably be to find out what design lens the patient has and run it through that company's software. Any lab that runs the same designer's lenses can help you with that.

In theory, the place where the glasses were purchased should have checked the glasses against the compensated Rx, and in theory found them to be good if they dispensed them.

[rbaker]

Overrefract and write the correction is about the only thing that you can do. Aint all this new fangled technology great?

[Sledzinator]

I have found A LOT of places using compensated lenses without providing POW measurements. This can cause exactly the problem you are having. I would call where they had them made and ask for the POW measurements, my guess is that they won't be able to provide them and this is where the problem lies.

[CCGREEN]

I agree with everything that WFruit suggest. But simply put.........sounds like that there is no quick simple accurate way for us to double check the compensated Rx without the compensated print out in front of us. And then we are still at the mercy of whoever keyed the Rx into the computer.....hoping that they did it correct. Simply put I feel that when I see a compensated Rx come through...I'm screwed. There is no real way to know if it was made right.
Rbaker: The technology may be great but we need a simple way to check the glasses made with that technology. Right now I don't see any out there.

[Robert Martellaro]

Just looking to find out what others do in this situation.
We hand the patient a Rx written in normal 0.25 steps. Pt takes Rx somewhere else to have it filled and for what ever reason be it a high wrap frame or the use of some digital lens or what ever lens design is chosen it get calculated using a compensated Rx.
Now pt has difficulty with new Rx and comes back to the Dr's office for a recheck. Glasses get thrown into a manual or auto lensometer and of course a wild off the wall Rx is found due to compensation.
Question is......how does the Dr's office know if the Rx was filled correctly since they are looking at a computer generated compensated Rx? All that's left for us to do is refract again and send them back to where ever they had the Rx filled and hope it works for them. The pt really wants an answer from US. After all we are the "DR"S" office. The know it all place. But with the way things are we are really just flying by the seat of our pants.
Any input here would be greatly appreciated.

Thanks

The client should have consulted with the ophthalmic dispenser first. They should do the troubleshooting. If they see enough evidence to suspect the refraction, they should send your client back to you for a recheck. Once the Rx is confirmed or tweaked, send the client back to the dispenser for resolution.

[EyeCare Rich]

I agree Robert. First troubleshooting should be at the office that dispenses. I find it interesting that the glasses check out all that much different than what was written on the rx. Compensated Rx is usually within about .12 diffent from the written Rx, unless there is a strange parameter for the fit, such as a huge amount of Vertex. Autolensometer usually reads out the same as what the written rx is, if you have it set to .25 increments, not .12. If it reads that much diffent, and the frame fits about average, I think I would call the office that made them and ask for their compensated grind.

[Paul Smith LDO]

Just looking to find out what others do in this situation.
We hand the patient a Rx written in normal 0.25 steps. Pt takes Rx somewhere else to have it filled and for what ever reason be it a high wrap frame or the use of some digital lens or what ever lens design is chosen it get calculated using a compensated Rx.
Now pt has difficulty with new Rx and comes back to the Dr's office for a recheck. Glasses get thrown into a manual or auto lensometer and of course a wild off the wall Rx is found due to compensation.
Question is......how does the Dr's office know if the Rx was filled correctly since they are looking at a computer generated compensated Rx? All that's left for us to do is refract again and send them back to where ever they had the Rx filled and hope it works for them. The pt really wants an answer from US. After all we are the "DR"S" office. The know it all place. But with the way things are we are really just flying by the seat of our pants.
Any input here would be greatly appreciated.

Thanks

Here's what I do, trial frame the individual. I too sell FF/Digital Lenses but tend to be a bit more conservative when it comes to the compensated Rx's. When it comes down to folks with a bit more cyl, I prefer the non compensated lenses especially if they demonstrate more sensitivity to an altered axis that the compensated formulas deliver. As far as any answer is concerned, the truth always works best. If they require more, ask them to go back to the place of purchase and have them explain the lens design and the whys.

[golfnut]

I have found A LOT of places using compensated lenses without providing POW measurements. This can cause exactly the problem you are having. I would call where they had them made and ask for the POW measurements, my guess is that they won't be able to provide them and this is where the problem lies.

That's not necessarily true. If the frame fits close to default values then it will be very close. Maui Jim provides compensated rx's without pows and seem to do very well? Sure in some cases it might be so but definitely not the majority of the time. I do feel alot of times the compensation seems a bit much though?

[ThatOneGuy]

I find 99/100 times that the issue is the frame fit (sometimes I get patients back to see me who had their glasses adjusted when I was not available and so the lens is not positioned properly). If you don't have POW measurements, there are default POW measurements for each lens design. Identify the lens, then make sure the frame fits correctly. Of course, when you show the patient how well they see out of the amazing lenses provided by the other place, then you can say goodbye to that patient unless you can sell yourself as an expert dispenser who ALSO can provide you with the latest and greatest in lens technology.

[AngeHamm]

I agree Robert. First troubleshooting should be at the office that dispenses. I find it interesting that the glasses check out all that much different than what was written on the rx. Compensated Rx is usually within about a 12th diffent from the written Rx, unless there is a strange parameter for the fit, such as a huge amount of Vertex. Autolensometer usually reads out the same as what the written rx is, if you have it set to .25 increments, not .12. If it reads that much diffent, and the frame fits about average, I think I would call the office that made them and ask for their compensated grind.

+1. If your autolensometer is reading a wildly different RX, that smells fishy to me.

[DanLiv]

Some people just don't like their compensated Rxs. Perhaps too long used to the uncompensated and incorrect powers of their old traditional lenses. Also, just cuz it's freeform/digital don't mean it's right, those lenses can be screwed up in just as many ways. I have over the years switched a dozen people out of digital and back to conventional and solved their problems. 5 years ago I myself had 8 base Maui Jim 1.60 freeform made and they were wavy and distorted, had them remade as defective and they were identically poor. Had them remade into conventional 1.60 and they were 100% perfect. If everything is done perfectly freeform can offer superior benefits to conventional. If it's not, all it will do is screw everything up much more precisely.

Too many variables to consider to try troubleshooting other makers' eyewear. I wouldn't even try to explain or figure out why someone else's glasses aren't good, that's the maker's responsibility. If patients don't like someone else's glasses, they can toss them and let me make them instead and I will do everything I can to make it perfect, but I'm not going to try too hard to fix someone else's work.

[Barry Santini]

i agree robert. First troubleshooting should be at the office that dispenses. I find it interesting that the glasses check out all that much different than what was written on the rx. Compensated rx is usually within about a 12th diffent from the written rx, unless there is a strange parameter for the fit, such as a huge amount of vertex. Autolensometer usually reads out the same as what the written rx is, if you have it set to .25 increments, not .12. If it reads that much diffent, and the frame fits about average, i think i would call the office that made them and ask for their compensated grind.

a 12th!!!!!

[Tallboy]

Lol barry can't handle that term.

[leeopt]

Maybe because I use the old fashioned lensometer that it's not a problem. All I ask for is AN EIGHTH!

[jakeller]

Maybe because I use the old fashioned lensometer that it's not a problem. All I ask for is AN EIGHTH!

Thank you. LOL, I'm such a geek. That is one of my pet peeves. Even though I know what people mean, I just can't let it go.

[Jason H]

I'd advise to stand your ground. Freeform lenses work. Digital calculations are overwhelmingly beneficial. The science and mathematics are proven. It's not inconcievable that you might have a digital "non-adapt" but the real problem is usually something more evident. Go through the usual checks - including accurate as-worn measurements - and I'll bet you find a different smoking gun.

[Jason H]

And the point of communications is to get a message across. So if a 12th is an eighth I don't care. So long as were on the same page. You can't claim you don't know what they mean.

[jakeller]

And the point of communications is to get a message across. So if a 12th is an eighth I don't care. So long as were on the same page. You can't claim you don't know what they mean.

I do agree with you on that, but unfortunately I have encountered those that don't know the difference between a 12th and an 8th. It's the concept of those numbers that helps us understand the digital Rx and what the compensated powers mean. I didn't mean to come across as nit- picky, but just stating my opinion, and if we are educating someone on this thread, I prefer accuracy. As I stated, it's my issue for liking detail, and wasn't started to slight anyone. That being said, great info on this thread! Thanks.

[CCGREEN]

Far as I am concerned a 8th or a 12th power should not even be reflected by any of our machines until someone finds a way to keep glasses from slipping down which completely voids all your 8th and 12 measurements. Hell even a .25 can hardly be valid.
8th and 12th powers and pow measurements are all grand when glasses are worn in a controlled environment. This is just like the Rx found in the controlled environment of the exam room that is carried out into the real world of use. At times it just is not accurate. To many other factors that are not taken into account make the Rx unusable for the pt beginning with the patients expectations sometimes just are not realistic.

[jakeller]

Far as I am concerned a 8th or a 12th power should not even be reflected by any of our machines until someone finds a way to keep glasses from slipping down which completely voids all your 8th and 12 measurements. Hell even a .25 can hardly be valid.
8th and 12th powers and pow measurements are all grand when glasses are worn in a controlled environment. This is just like the Rx found in the controlled environment of the exam room that is carried out into the real world of use. At times it just is not accurate. To many other factors that are not taken into account make the Rx unusable for the pt beginning with the patients expectations sometimes just are not realistic.

That is a reaaly good point!

[ak47]

Far as I am concerned a 8th or a 12th power should not even be reflected by any of our machines until someone finds a way to keep glasses from slipping down which completely voids all your 8th and 12 measurements. Hell even a .25 can hardly be valid.
8th and 12th powers and pow measurements are all grand when glasses are worn in a controlled environment. This is just like the Rx found in the controlled environment of the exam room that is carried out into the real world of use. At times it just is not accurate. To many other factors that are not taken into account make the Rx unusable for the pt beginning with the patients expectations sometimes just are not realistic.

Exactly why I think pow measurements should only be used in extreme cases such as wrap frames, excessive tilt, and tiny or huge vertex distance. Generally, even if I carefully preadjust a frame before measuring (which some patients are in such a rush they don't really allow for), many, many times the patient will decide at dispense or shortly afterward the glasses are too loose, too tight, or too whatever and that is when they want the real adjustments that would throw the pow compensation out of wack.

Wrap compensation really does seem to help in nearly all cases, however.

[HarryChiling]

The benefits of compensation are far outweighed by the problems created with verification and troubleshooting. I agree with all those that reserve compensation to high wrap and poor fit frames and even then if I can coax a client into a better more appropriate fit ultimately I will. Even when I compensate I comp prescription myself so that I can reverse the procedure and verify factually that the lenses are created to my intent. That does mean that on occasion I am missing out on design compensation however I find the benefits of verification and troubleshooting are a tool I am not willing to give up right now. I assume at a point in time tilt compensations will become standardized like vertex compensations and be part of the ANSI standard like vertex compensation, however that will take more ECPs running into this problem and voicing their opinions. Great thread. Barry get over the 12th thing life gets a whole lot easier when you just learn to accept that this is a common misnomer and move on.

[RT]

I assume at a point in time tilt compensations will become standardized like vertex compensations and be part of the ANSI standard like vertex compensation

I can't find vertex compensation mentioned specifically in ANSI Z80.1 - 2010, so I'm not sure what you're looking to have happen. Section 5.1 does state that if the lenses were produced with compensations to account for as worn correction, that the tolerances apply to the values specified by the manufacturer, and not to the prescribed Rx. That would cover any compensation, including tilt compensation.

[acesrwylde]

I'd advise to stand your ground. Freeform lenses work. Digital calculations are overwhelmingly beneficial. The science and mathematics are proven. It's not inconcievable that you might have a digital "non-adapt" but the real problem is usually something more evident. Go through the usual checks - including accurate as-worn measurements - and I'll bet you find a different smoking gun.

Jason, I have to agree with you here. My office works with freeform lenses all the time, (SV and PAL), When a patient comes in with our prescription, but lenses done elsewhere, we find that it almost always is the measurement. We then fit the patient with the appropriate measurements and send them to the optical that did their lenses. This has worked every time. The issue always seems to be a lack of accuracy and training on the part of the person measuring.