Weird problem....need help ASAP!

**DC Optix** · 05-08-2015, 08:27 AM

Hola, friends!

I have a patient who is experiencing a problem that I cannot figure out how to solve, and I'm hoping I can pick some of your brains to find something I'm not thinking of! Any help or suggestions you can provide is welcome!

The patient purchased new glasses recently and complains of "peripheral glare on the lenses". Now, he is wearing a HUGE frame, but he has worn the exact same thing for YEARS.

Habitual Rx: -1.75 + 0.50 x 105
Plano + 0.75 x 155 +3.00 add

PD: 32/34 Seg Ht: 33/33
Kodak Unique Poly Trans Grey w/ Avance'
A:59 B:51 DBL: 18 ED:65

New Rx: -1.75 + 0.50 x 105
Plano + 0.75 x 160

PD: 32/34 Seg Ht: 33/33
Shamir Auto II Trivex Trans Grey w/ Avance'
A:59 B:51 DBL:18 ED:65

Pt returned approx. 3 weeks after picking up new pair with complaint mentioned above. All adjustments on the frame were virtually identical to original pair. Pt claims never experienced in old pair. After a long while of troubleshooting, with really no answers, I decided to go ahead and remake the lenses into all the same original lens options, so we put him back in the Unique Poly Trans w/ AR. All measurements IDENTICAL. Pt picked up about 5 weeks ago, and still consistently has the same glare problem on the periphery!

I'm truly at a loss...the only thing I haven't been able to do, which I would like to do, is put the patient's original lenses back in to make sure that he absolutely is not experiencing the problem, but he threw the lenses away after he picked up the new pair

Does anybody have any thoughts on this? The patient has pretty good vision, corrected to 20/20-1 OD and 20/25 OS. IOL OD, slight Cat OS, but have spoken with Doc and she sees no reason why that would be causing any of this, plus patient is saying the problem is the same OU, so I really don't think it's related to the IOL or the Cat.

HELP PLEASE! If you need any other information, please let me know! Thanks in advance for all your feedback!

DC

**Uncle Fester** · 05-08-2015, 08:36 AM

Bummer no old lenses.

How old were the old lenses?
BC?
Polished edges?
Indian test?

**drk** · 05-08-2015, 09:07 AM

I was thinking "Indian test" too, but I will call it "Much Honored Native American Test", since I'm more culturally sensitive than Fester. If the guy cups his hands around the sides or makes a visor, does it go away?

(Fester used to call it "The-Only-Good-Redskin-is-a-Dead-Redskin" test, so we have to give him some credit for evolving.)

**idispense** · 05-08-2015, 09:11 AM

If the glare is still there after the cup test, what is your solution?

**Robert Martellaro** · 05-08-2015, 09:42 AM

The reflections disappear when the eyeglasses are removed? We want to make sure this isn't from intraocular glare.

A flatter base curve might make reflections more noticeable, and might also shift the reflections from one area of the lens to another area, making them more noticeable. When the Kodak lens came out, the BCs tended to run on the steep side. The Shamir product tends to be slightly flatter. It's possible that the lab might have squeezed the new Rx on a flatter BC, maybe about +5, and the old were about +7.00, which would explain why using the same PAL design didn't solve the problem. See if you can dig up the specs on the old lenses from the fabricator of the old lenses.

A smaller lens would help- that's a lot of surface to collect and reflect light.

OT, but does the client really need/want a 13" work distance? If not, back off the add a quarter.

**Uncle Fester** · 05-08-2015, 10:12 AM

I'm thinking the new lenses are too clear compared to the old scuffed and scratched ones. What I call the old pair of shoes syndrome (apologies to any offended old shoes).

I like to say that "nothing fits and feels as comfortable as an old pair of shoe". It implies in a nice and relate-able way that the patient is dealing with something new and needs more patience to let them "break in".

Of course it could be one like I've told in the past where a patient insisted the inside reflection on the sun lens was definitely not on the old lenses. When I surreptitiously* slipped the old lenses into the frame...wait for it..."Yeah-it's right there. It's really noticeable!".

When told of the ruse his sheepish look was priceless!!!

*WARNING- To be done on only selective patients (preferably after being assured they're not carrying).

iD · 05-08-2015, 11:28 AM

Originally Posted by Uncle Fester

I'm thinking the new lenses are too clear compared to the old scuffed and scratched ones. What I call the old pair of shoes syndrome (apologies to any offended old shoes).

I like to say that "nothing fits and feels as comfortable as an old pair of shoe". It implies in a nice and relate-able way that the patient is dealing with something new and needs more patience to let them "break in".

Of course it could be one like I've told in the past where a patient insisted the inside reflection on the sun lens was definitely not on the old lenses. When I surreptitiously* slipped the old lenses into the frame...wait for it..."Yeah-it's right there. It's really noticeable!".

When told of the ruse his sheepish look was priceless!!!

*WARNING- To be done on only selective patients (preferably after being assured they're not carrying).

did that patient come back?

**scriptfiller** · 05-08-2015, 11:37 AM

Did the pat. go from a matte finish frame to a shiny/glossy finished frame?

**optilady1** · 05-08-2015, 11:52 AM

Is it a full frame? Did he maybe have a ton of opti snot built up in the bevel and now with clean lenses he is seeing reflections from the edge of the lens?

**drk** · 05-08-2015, 12:34 PM

I shudder to think of your solution if that is indeed the problem, annie.

**Uncle Fester** · 05-08-2015, 12:51 PM

Originally Posted by iD

did that patient come back?

Yes! He still chuckles about it.

It's rare that I do this and if in any doubt how it will go over I feign surprise when I realize my mistake ;) . Really no different than the magic shelf. It's just we usually have other than the exact same everything involved.

**DC Optix** · 05-08-2015, 02:06 PM

Thanks for everyone's replies! I'll try my best to answer all of them here:

1. Lenses were from 2011, and in VERY good condition. Unsure of the base curve because he tossed the lenses, but now that I've read all these responses, I'm going to track the info down from the lab in just a few minutes. No polish. And Indian test got rid of the issue.

2. Yes, this is only happening WITH the glasses. Not an IOL glare issue. I agree on the smaller lens, but the patient REALLY doesn't want to go there. Have tried to get him to switch for years. Great ideas on the base curves...I failed to consider that a small change in BC might move the glare to another spot and make it more noticeable. Thanks!

3. Don't think it's the Old Pair of Shoes Syndrome. Although I don't have the old lenses to compare, they were in GREAT shape. Believe me, I would LOVE to do the ole' "Oops, those are your OLD lenses" trick with him to prove him wrong, but alas, no old lenses!

4. Did not switch frames...first one shiny, second one shiny.

5. Again, keeps them in GREAT shape, so no stanky nose build up of any kind! LOL

Thanks again for all your feedback and questions! I'm about to go track down the base curve info. The only thing that makes me think that's not it is that we remade it back to Unique and, my guess is, the BC's will be the same between the old pair and the remade pair. I do believe the Auto II's were flatter, and that was part of my reason for switching back.

I'll let y'all know what I find out!

DC

**Uncle Fester** · 05-08-2015, 02:16 PM

Here's another thought that I sometimes try- Put them on! Do you see it?

Sometimes we overlook the obvious and I must admit I've sometimes dismissed the issue as a problem twix the ears only to put them on and see it myself!

Do you dare to put a ton of wrap to the front?

**Robert Martellaro** · 05-08-2015, 02:52 PM

Originally Posted by Uncle Fester

Here's another thought that I sometimes try- Put them on! Do you see it?

Sometimes we overlook the obvious and I must admit I've sometimes dismissed the issue as a problem twix the ears only to put them on and see it myself!

We certainly need to inspect the lens and coating for flaws. A defective coating could cause the symptoms described above. Twice in a row seems unlikely, but I would definitely talk to the lab manager to get their input.

**optilady1** · 05-08-2015, 04:41 PM

Ok, another thought, does your lab use 'heavy' non slip coating on their hydrophobic ar coats? I just got one in the other day that I would have bet money on was crazed, but it turned out it was just still covered in that stuff, whatever it is, and I had to use a little extra muscle and a lot of alcohol to remove it, and they were fine afterwards.

**DC Optix** · 07-07-2015, 03:19 PM

Sorry I disappeared on y'all! Ended up going out on medical leave for a while, but I'm back in action now. Still dealing with this problem! I feel like it almost HAS to be a base curve issue at this point, but I have no way to verify the base curve of the previous pair. I have tried everything...it was so old that the lab cannot pull that info.

Does anyone know, off hand, if anything changed with the design of the Kodak Unique (relating to the selection of base curves) between 2011 and 2015?

**MakeOptics** · 07-07-2015, 05:13 PM

Originally Posted by DC Optix

Sorry I disappeared on y'all! Ended up going out on medical leave for a while, but I'm back in action now. Still dealing with this problem! I feel like it almost HAS to be a base curve issue at this point, but I have no way to verify the base curve of the previous pair. I have tried everything...it was so old that the lab cannot pull that info.

Does anyone know, off hand, if anything changed with the design of the Kodak Unique (relating to the selection of base curves) between 2011 and 2015?

The powers in your previous post are problematic for ghost images, particularly when light travels through the front, bounces off the back surface, then bounces off the front surface, and into the eye. This is commonly referred to as Ghost Image 1 and is the most problematic in nature, presents in low powers and is independent of the curvature of the lenses. You could try a higher index material to reduce transmission, tint (yuk), or some sort of filtered lens.