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Thread: We're all stumped.

  1. #1
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    We're all stumped.

    We have a patient who is having issues with his new glasses when he looks through glass surfaces, i.e. his car windshield and glass doors. He says his vision gets blurry. He has an old pair of glasses that work, so we matched material, curves, everything...and he is still having this issue. There isn't a big change in his RX from his old pair to the new pair. He has a high plus RX, and is wearing a lined bifocal. The pair that works for him is 1.67, no AR.

    Has anyone had any experience troubleshooting a problem like this? Our office and lab are baffled as to what to do to help this patient!

  2. #2
    Optimentor Diane's Avatar
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    Does he like the frame?

    Diane
    Anything worth doing is worth doing well.

  3. #3
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    Yes-it looks very similar to his old one. He hasn't said anything about the frame.

  4. #4
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by Vortwein View Post
    We have a patient who is having issues with his new glasses when he looks through glass surfaces, i.e. his car windshield and glass doors. He says his vision gets blurry. He has an old pair of glasses that work, so we matched material, curves, everything...and he is still having this issue. There isn't a big change in his RX from his old pair to the new pair. He has a high plus RX, and is wearing a lined bifocal. The pair that works for him is 1.67, no AR.

    Has anyone had any experience troubleshooting a problem like this? Our office and lab are baffled as to what to do to help this patient!
    Could be the Rx. The glass surfaces (dirty/scracthed?) might be triggering accommodation, blurring distance objects.
    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.



  5. #5
    Doh! braheem24's Avatar
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    Are his new lenses vantage? Are they too tight in the frame? Was he given more plus?

    Little more info on old vs dispensed would help it we could keep asking you uneducated questions.

  6. #6
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    Quote Originally Posted by Vortwein View Post
    We have a patient who is having issues with his new glasses when he looks through glass surfaces, i.e. his car windshield and glass doors. He says his vision gets blurry. He has an old pair of glasses that work, so we matched material, curves, everything...and he is still having this issue. There isn't a big change in his RX from his old pair to the new pair. He has a high plus RX, and is wearing a lined bifocal. The pair that works for him is 1.67, no AR.

    Has anyone had any experience troubleshooting a problem like this? Our office and lab are baffled as to what to do to help this patient!
    My first question: is this guy an engineer?

    Remake them to the old Rx and no AR, just like he had previously. If that fails to satisfy him, there is a nugget of truth and non-optical related factors at play that he's not sharing with you.

    I went through this with a lady a couple of years ago. After 4 remakes, hours wasted and no solution, I was in the hole huge on this job and told her I would refund her money and she could go elsewhere.

    Then the truth came out, she loved the frame when she ordered it, but her friend hated it and said they were hideous (which wasn't the case at all) and blamed poor vision as the culprit. After the steam from my ears subsided and my blood pressure returned to normal, I upgraded her lenses and charged her additional for it in a new frame she picked out (with her friend).

    Problem solved and she actually referred more clients over to us.

  7. #7
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    New lenses are the same material, 1.67, lined bifocal, no AR. They are not too tight. His RX had a minor increase in plus in each eye. At dispense, we adjusted the new pair to sit like the pair that works. There is not much difference between the old vs new pair anymore. The differences are the RX, the frame (even though it's very similar in size and shape), and his old pair has the edges polished.

    I don't think he is an engineer! He has had a pair made in between the working pair and the latest, and according to him, they never worked either...yet he wore them a whole year until he came back to tell us that. So. I'm starting to wonder about what ACTUALLY is going on with him...maybe he knows your lady friend :)
    Last edited by Vortwein; 03-31-2015 at 08:27 AM.

  8. #8
    What's up? drk's Avatar
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    I think this is a head case.

    Let's put it this way: I've been doing this almost as long as some of you, and I've never heard anything close to that. What's more, I can't even begin to come up with an explanation (unless these are polarized like braheem said).

  9. #9
    OptiBoardaholic OptiBoard Silver Supporter
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    Hard to say what is going on but high pluses are the trickiest. The panto, wrap, vertex distance becoming increasingly problematic for high pluses so I assume you have matched those to the old frame. A slight increase in power might be enough to make the problems if the frame is out of adjustment to what his is used to. You mentioned the new frame is very similar to the old frame...Is it a bigger eye size at all, even a mm or two? Hopefully not, smaller is better.

    I had a patient with a similar situation and the frame was similar but a mm or two bigger in ED which when coupled with a slight increase in plus RX started to cause a type of chromic aberration. I think Robert M or Chris referred to it as Transverse Chromic Aberration. It causes the color spectrum to separate and blurs vision etc...

    I don't know why just looking through glass door s and windshields would trigger the issue unless it was the polarized effect like Braheem mentioned.

    Sometimes if the patient is older and has a developing cataract the new RX's don't work like the patient expects and they prefer their old glasses. Then time goes on and they try it again with another new RX which of course doesn't because the cataract is further developed. They get more frustrated and fall back on the old trusty glasses that in their mind work best because 3 years ago they did work well. Its viscous cycle that only can be fixed with cataract removal.

  10. #10
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    sometimes the scratch coating (lab issue)accumulates on top of the step of the seg...and then some....especially w/ hi index flatps
    he could be looking out of excess scratch coat
    did you redo the job,different lab?
    look at the power w/ a manual lensometer, not autolens reader and see if you have distortion

  11. #11
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    What do you consider a small change? Half a diopter? A quarter? I've also found face form is far more important to Hyperopes than anyone else. Even the smallest changes can cause weirdness (although it's only ever effected the tilt of things, no whether it's blurry or not)

  12. #12
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    The change in RX is a quarter stronger in one eye. What's so baffling is that he says his distance is sharp...yet when he looks out his sliding glass door, or when driving, his vision isn't as sharp. We do finish edging here, and I use a manual lensometer...one if the first things I looked for was any distortion or wave-nothing!

    erichwmack, we did find out that the pt has cataracts forming in both eyes, but they are not ready to be removed yet. I wonder if the cataracts are the problem here?

  13. #13
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by Vortwein View Post
    The change in RX is a quarter stronger in one eye. What's so baffling is that he says his distance is sharp...yet when he looks out his sliding glass door, or when driving, his vision isn't as sharp. We do finish edging here, and I use a manual lensometer...one if the first things I looked for was any distortion or wave-nothing!

    erichwmack, we did find out that the pt has cataracts forming in both eyes, but they are not ready to be removed yet. I wonder if the cataracts are the problem here?
    It's not helping, with maybe unrealistically high expectations with the new Rx. But the fact that the symptoms disappear with the old eyeglasses would make me look closer, instead of giving up. I had a client the other day with a +2.50 add in one eye and +1.50 in the other; she complained, took them back where she was fitted, but was told they were fine, and wore them for two years.

    How much plus are we talking about? When I hear strong plus, I'm thinking more than 8 diopters. The fact that you haven't posted the old and new Rx, which is the bare minimum for a starting point of a troubleshoot, makes me wonder what else is not quite right here ophthalmic optics-wise. Draw us a more detailed picture of the optics, and we'll try to help. Be very specific.

    Best regards,

    Robert
    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.



  14. #14
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    His old rx, the glasses he likes:
    +5.50 +1.50 x 8
    +7.75 +1.25 x 168
    2.50 add

    Most recent rx:
    +5.75 +1.50 x 10
    +8.00 +.75 x 170
    2.50 add

    If he is having trouble with the rx, why would he only have issue when looking through glass surfaces? I'm nervous to send him back to the doc, because he has said how great his vision is otherwise, like when he watches tv.

  15. #15
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by Vortwein View Post
    His old rx, the glasses he likes:
    +5.50 +1.50 x 8
    +7.75 +1.25 x 168
    2.50 add

    Most recent rx:
    +5.75 +1.50 x 10
    +8.00 +.75 x 170
    2.50 add

    If he is having trouble with the rx, why would he only have issue when looking through glass surfaces? I'm nervous to send him back to the doc, because he has said how great his vision is otherwise, like when he watches tv.
    That could be due to the distance to the screen, about 10 feet, as opposed to objects at infinity when looking through the car windshield. The greater sphere equivalent (+.25) in the right will improve the vision slightly at shorter distances, but might make infinity a tad soft. Trial -.25 over the right to confirm. Is he amblyopic in the left? That will make him very sensitive to changes in power in the right eye. It's the doctor's call whether to bias the Rx for room distance, or infinity. Consult with the prescriber after you perform this analysis.

    Trial brown/amber sunglasses for daytime use outdoors.

    Measure the distance from the top of the segment to the OC, and from the OC to the corneal reflex on both pair. Eliminate errors due to differences in the client's posture between measurements, and duplicate your position between measurements to eliminate parallax errors. Measure the base curve on both. Post your results.
    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.



  16. #16
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    Are old lenses aspheric?

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    What's up? drk's Avatar
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    Darn me for getting involved in this, but now I have a crazy thought. If he has posterior subcapsular cataracts and his pupils shrink when looking outside (and he oddly relates it to looking through glass) you may have something.

    For cryin' out loud, harvest the poor soul's cataracts as soon as feasible with that high plus power!

  18. #18
    Master OptiBoarder optical24/7's Avatar
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    Moderate to high plus, always check CT differences. Induced mag is a problem for these types of patient. (Weird, sometimes strange complaints...)

  19. #19
    ABOM Wes's Avatar
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    Tell him to wash his car, and see if it doesn't get better.
    Wesley S. Scott, MBA, MIS, ABOM, NCLE-AC, LDO - SC & GA

    “As our circle of knowledge expands, so does the circumference of darkness surrounding it.” -Albert Einstein

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    Quote Originally Posted by Wes View Post
    Tell him to wash his car, and see if it doesn't get better.
    This ++++

    His vision is clear at all time except when looking through glass surfaces..

    why are we sitting here discussing the specs? It's nothing to do with them. Perhaps the sharper vision he gets allows him to be more critical of the imperfections in the glass surfaces.

    Perhaps you could offer to reglaze his car?

  21. #21
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by standarduck View Post
    This ++++

    His vision is clear at all time except when looking through glass surfaces..

    why are we sitting here discussing the specs? It's nothing to do with them. Perhaps the sharper vision he gets allows him to be more critical of the imperfections in the glass surfaces.

    Perhaps you could offer to reglaze his car?
    Because Vortwein says the problem goes away when his client switches to his old eyeglasses. I highlighted this in post #13.

    If you want to be a good troubleshooter, you start by being good listener.
    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.



  22. #22
    What's up? drk's Avatar
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    Yeah, though, like duckie says, maybe he's so dang blurry in the old ones that the effect is the least of his worries.

  23. #23
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by drk View Post
    If he has posterior subcapsular cataracts and his pupils shrink when looking outside (and he oddly relates it to looking through glass) you may have something.
    Similar to what happens when you stop down a camera lens- the foreground becomes clearer. Check the Rx, lens design, and position.
    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.



  24. #24
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    Quote Originally Posted by Robert Martellaro View Post
    If you want to be a good troubleshooter, you start by being good listener.
    That all sounds a little philosophical. The reason we are still discussing it after a whole page of posts is because we don't know much about the problem. I can see you asked some questions about it - I'd like to add my own! (sorry Vortwein)

    Let's have a go then...

    What are the recorded visual acuities with the old pair and the new pair? I assume there must be an improvement in VA, because otherwise change would have been unecessary.
    Is this effect seen with both eyes together? Just the left or right?
    Does moving the head around and using different parts of the main lens make any difference to the effect?
    Does he get the same effect through the windows in the practice (or is it just limited to glass that he owns)?

  25. #25
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    Quote Originally Posted by standarduck View Post
    That all sounds a little philosophical.
    It might sound that way when telemedicine and artificial intelligence becomes the standard of care. Until then, thinking, with top-down/bottom-up logic is my SOP. And for the doctors reading this...please remember to scroll.
    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.



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