You know, you're right. I'm just grumpy today. (I'd like to find out the solution to this problem though!)Originally Posted by Robert Martellaro
You know, you're right. I'm just grumpy today. (I'd like to find out the solution to this problem though!)
The pt's doc was out of the office all this week, so unfortunately we couldn't discuss anything with him, like the status of his cataracts, etc. I talked with our lab, and he agreed to send us another pair of lenses, because he also didn't understand why the pt wasn't seeing through glass. We had discussed base curves, and other lens material, but nothing would've been as close...so I thought it'd be worth a try while waiting for the doc to come back in the office next Monday.
The pt's complaint was that when he drives, signs and things not as clear with his new glasses as with his old. He also said when he would look through his sliding glass door, he would get the same result. He referred to is as 'blurry' and 'unable to focus'. We tried adjusting where the bifocal line sat, tried adjusting tilt, faceform...nothing helped. We mulled over the idea that he has dirty windows (we've had that issue before with other pt's!), but he would look out our side office windows, which are not always spotless, and he would have the issue looking at cars in the parking lot. Looking around the office and waiting room though, vision was fine.
So-we got our new lenses yesterday, same base curves and material as before. I dropped the seg 1mm, just in case there was coating buildup interfering. The pt picks up, looks outside through our office window, at a car license plate...it's great! WHAT?! Is he crazy, or am I? I was so ready to troubleshoot with all these suggestions! He left the office wearing the new glasses. I'm going to check up on him in a week.
And this is why no matter how scientific we get with glasses, and optics, and being big old nerds, sometimes it just don't make no sense!!! (And why we drink)
There was probably some weird wave in the original lenses or he's suuuuuuper sensitive to the seg ht.
Make sure you tell the patient when you see him that Standarduck is not happy with this outcome, and has, by no means, any sense of closure.
Damn right! Get those old lenses back, find the anomaly, and report your findings to this thread immediately.
Last edited by Robert Martellaro; 04-02-2015 at 12:33 PM.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
You're the crazy one for calling him back looking for problems.
The Doc should have said his old prescription is working fine.
(Shhhh...They can't help themselves from changing it anyway and now it's our problem)
Back less than a day from vaca and here I am... sigh...
(had to stop the jonesing)
Last edited by Uncle Fester; 04-04-2015 at 08:22 PM.
Check the mounted lenses with a polariscope
Loosen right eyewire screw and then tighten a quarter turn. Hand to patient and ask how it is now. Keep adjusting quarter turns until vision is perfect. Repeat for left eyewire screw.
I tried that once.
"Better..."
"Better..."
"Better..."
<CLINK!>
Last edited by drk; 04-06-2015 at 09:30 AM.
I wouldn't expect much on a +8. I'd look for a wave at or above the optical center though.
The OP said the lenses were not too tight.
My recommendation, if you have clients who see better out of their old eyeglasses compared to their new eyeglasses, at infinity, and your skill set leaves you dead-ended with "the client must be crazy", is to refer them to a master optician.
Last edited by Robert Martellaro; 04-06-2015 at 10:20 AM.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
We had a job like this once, and after all the frame adjustments under the sun and rechecks done we put the lenses under a polariscope and found a flat spot from blocking right on optical centre causing the light to disperse in an uneven fashion. obivously the remade job didn't have that flat spot and worked a treat. Who would have guessed to look for a flat spot on the front curve though?
Prism in any direction even yoked can effect the balance of the visual system, and reduce binocular symmetry. His eyes were simply not working together like they should and his reduced vision was probably some form of suppression, he was only seeing with one eye.
Its possible that he had an uncorrected convergence disorder as a child, that just went away. But it didn't. They can re-manifest in strange ways as get older. He got used the prism he had and his muscles could not adjust to even a slight change.
When you changed the OC you adjusted the effective prism.
Just a guess, but I have seen it before.
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