Questions: Fish Bowl Effect with Progressive Lenses

[LAGUNAEYEDESIGNER]

A patient have been wearing Autograph II fixed 15mm for the last two year and very happy with the lenses.
Old RX:
+1.50 -0.25 x 95
+1.25 -0.25 x 95
Add +1.50

Now we upgraded her lenses to Autograph III fixed 15mm
New RX:
+1.75 -0.75 x 95
+1.50 -0.75 x 95
Add: +1.50

Patient have wore trial frames in the office and happy with the new RX. Then when she wear her new lenses for 3 days then she came back and said: I feel like looking through a fish bowl and feel nauseated.

Then we recheck her RX (correct), recheck PD (correct), recheck Segh. Height (correct), recheck the base curve (same base curve like the old one), the new frame eye size is the same with the old one.

We send back the lenses to the lab and they confirmed that they cut correctly according to what we ordered and NOT HAPPY TO CUT ANOTHER LENSES SINCE THERE IS NO ERROR FROM THE LAB NOR NOTHING NEED TO CHANGE.

My question is:

1. How can the doctor fix the fish bowl effect on the new lenses?
2. How can the lab fix the fish bowl effect on the new lenses?
3. Is it non-adapt to the new autograph III then should we keep her in autograph II instead?

Please please help. I am here to learn from of you. Thank you very much. Happy Holidays.

[EyeCare Rich]

Are the frames adjusted similar to old frame? Did you do any Point of Wear Measurements with new, or old glasses? I suspect without seeing the glasses, that the old frame had just a bit more wrap/faceform in it. The increase in cyl and + may need just a bit more form. Good luck.

[jpways]

I always found 0.25DC change to cause curling for a week or two. With the 0.50DC change in each eye there is going to more noticeable effects. The only things I can suggest are giving this time (assuming you can get the patient to give this at least 1-2 weeks) to see if they can adjust to the new prescription or ask the doctor if they are willing to back off the change now or discuss it with the patient if they patient is unwilling to give this time.

[WFruit]

I agree with Rich. I'd check the face form first. Also, are the new glasses sitting further away from her face? What about the pantoscopic tilt?

You said you rechecked seg height and pd, and they are correct, but are they the same as her old pair?

And yes, if all else fails, go back to the Autograph II.

[Robert Martellaro]

You were really lucky they adapted to a fixed 15 Auto 2 for their first multifocal.

That means they're not sensitive to changes. What's so different here that could cause such a reaction, with the same add power?

Bump in cylinder power

It's possible, but the trial framing was encouraging. Note that the sphere equivalent decreased with the new right eye Rx. It's unusual to see less plus with a hyperopic age 45 early presbyope.

However, it only decreased .125, so I would ignore, even if the direction of change is uncommon.

OTOH, the astigmatism is against-the-rule, which is harder to adapt to.

PAL design change

Maybe. I'm not familiar yet with the Mk3 version, except with a few myopes. I haven't worn it. I only use the Mk2 for myopes like me. The Mk3 is supposed to have a somewhat more relaxed power rate of change, and maybe a tad softer locally at near, maybe globally, just what you want for emmetropes and hyperopes. But using the short corridor version would cancel those advantages, especially with the short 10mm corridor (labeled as 15mm).

New frame fit

Maybe, if the fitting values have changed significantly.

Solutions

Quick fix- realign frame so that the lenses fit closer and lower. There should be immediate improvement.

Use the same PAL design as before.

Use a longer corridor.

Use a more appropriate PAL design for this Rx. If you like Shamir products, try the Creation.

Consult with prescriber- consider modifying the Rx, especially if worn for night driving and reading only.

Hope this helps,

[rdcoach5]

We had a remake due to incorrect panto correction that was resolved with correct panto but You have to have correct POW measurements and correct adjustments.

[Jason H]

Post states that the pd's were correct, but wasn't specific if a near pd was taken seperately from the distance. If there's something unusual there then I'd be more suspicious of the Auto 2 / Auto 3 difference. But for me the astigmatism bump would be more likely.

[Jason H]

Provided adjustments didn't work.

[sharpstick777]

BC on both lens lines is different, and not something you can fix. Auto III blanks are unique to that lens. A combination of power change and BC change can tip the Fish bowl effect.

As well the Auto III is a little harder design, which affects the periphery more (but generaly improves central vision and corridor width) but could exaggerate the effect.

I lean toward a combo of small problems stacked, with BC being the primary one. Regrettably, it means returning to the Auto II.