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Thread: tough rx, need suggestions

  1. #1
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    tough rx, need suggestions

    My co-worker asked me about this, but when I saw the rx, I thought I'd reach out to the Barry's lol of the forum for lens input.

    Pt is 10 years old.

    -6.25/ -0.50 / 175 +3.00
    +3.25 / -2.00 / 180 no add

    frame is 50-15-135 A 50.0 B 29.0 ED 50.0

    So we need a BF in the OD and a sv in the other... what are the thoughts for this poor young girl?

  2. #2
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    May I ask the reason for the lack of add in the left?

    What are the visual acuities?

  3. #3
    What's up? drk's Avatar
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    That's just wrong.

    How about a contact lens. Seriously.

    This is a pediatric pseudophake. The eye is probably amblyopic. There's no chance for fusion with that spectacle Rx whatsoever (almost a 10 diopter aniso!) (assuming the eye isn't eso or exotropic).

    Don't fill it. Call the ophthalmologist and tell them you think it's not going to work.

    I can't believe someone would do that.
    Last edited by drk; 04-02-2015 at 09:42 PM.

  4. #4
    What's up? drk's Avatar
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    To standarduck: I agree that if you're going to do an add in one eye, do one in the other.

    Also, why the +3.00? That's just going to screw with the size of the PAL zone. Do a bilateral PAL at +2.50. Get a contact lens OD (about a -6.50).

  5. #5
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    Quote Originally Posted by drk View Post
    To standardduck: I agree that if you're going to do an add in one eye, do one in the other.

    Also, why the +3.00? That's just going to screw with the size of the PAL zone. Do a bilateral PAL. Get a contact lens OD (about a -7.50).
    The simplicity of a CL in one eye is unbeatable.

    The bunny knows what's up. ^

  6. #6
    What's up? drk's Avatar
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    And I'm wwwwascally! Huhhuhuhuhuhuh.


    We really need more info before we cast stones, but hey, it's the internet.

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    Agreed DRK, on the dont fill it... as soon as I saw it it I was like UHM no...

    Ok so, it looks like this rx was an outside rx...So I dont know why or the VA's...

    in 2010 when we saw her, Doc had...

    -1.00 / -1.25 / 170
    +1.25 / sph

    VA at that time was
    20/150
    20/125

  8. #8
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    Having the dad bring in her gls to read whats current... past that our Doc wants a quick refract as his notes had her no better than the 125-150 VA even with more power...

  9. #9
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    That kid needs some help.

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    Master OptiBoarder rbaker's Avatar
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    Quote Originally Posted by drk View Post
    We really need more info before we cast stones, but hey, it's the internet.
    Yes, we do need complete medical records to come to a valid conclusion and that being the situation the web and OptiBoard are not the place to go. A consult with whoever wrote the script is in order - hopefully a Pediatric Ophthalmologist. All this guesswork does little for the patients welfare.

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    yup, now that I know more, its beyond anything easy... Our doc said she had cataracts too.. :(

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    OptiBoard Moron newguyaroundhere's Avatar
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    Quote Originally Posted by Slim View Post
    yup, now that I know more, its beyond anything easy... Our doc said she had cataracts too.. :(
    Had cataracts, as in had them before and already had surgery done or has them currently? Either way, I would try to get this patient set up with a pediatric specialist.
    Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity

  13. #13
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    pretty sure it was HAD...

  14. #14
    OptiBoard Moron newguyaroundhere's Avatar
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    I had one situation years ago in Detroit. Had a kid that came through the clinic we were doing. I was performing auto refractor on him. Got a reading of +14.00 in his right eye and couldn't get a reading at all on his left eye. One of the doctors found out that he had cataracts as a baby and the implants they did on him ended up no longer viable for him to use. We had to refer him to a local specialist to help him with his needs. Wonder if this is a similar situation.
    Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity

  15. #15
    What's up? drk's Avatar
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    Quote Originally Posted by rbaker View Post
    Yes, we do need complete medical records to come to a valid conclusion and that being the situation the web and OptiBoard are not the place to go. A consult with whoever wrote the script is in order - hopefully a Pediatric Ophthalmologist. All this guesswork does little for the patients welfare.
    I see what you did, there.

    OK for you.

    BTW, he probably already went to a pediatric ophthalmologist.

    I'll bet you a dollar.

  16. #16
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    ok so, I just read the current pair that dad had dropped off last night....

    -6.25 / sph / +2.75 add
    -2.75 / -2.00 / 003

    Wish I was here so I could have talked to him.

  17. #17
    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by drk View Post
    The eye is probably amblyopic....

    .
    If he's not, he will be if he wears that Rx!

  18. #18
    Master OptiBoarder Mizikal's Avatar
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    I fill scripts like this on a regular bases. The patient have generally been seeing the same DR that did the surgery. I would call and verify the new RX though. The change from a -2.75 to a +3.25 is a red flag. Other then that I would fill the RX. Just be mindfull when it comes to frames selection.

  19. #19
    What's up? drk's Avatar
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    Well at least the kid is adapted somewhat to a unilateral seg OD.

    Binocular vision is impossible with this. She's probably some kind of amblyope/esotrope with congenital cataracts OD and a normal-ish OS. Some major change in Rx OS, and it didn't "just happen". Either they're measuring it "better" because she's older, or they put an implant in OS (where's the add, though) or they were trying a "blur lens" OS to penalize it for amblyopia therapy OD or something screwy.

    But regardless, that's an Rx that says "we don't care about one of those two eyes".

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