Thrifty Client With Off-Axis Astigmatism - Aspheric The Best/Only Option?

[Lelarep]

The client wants to keep his spending to an absolute minimum, buy says he has a major problem with off-axis astigmatism. The issue seems to only be in the OD eye +3.50 -4.50 x76. The OS script is very minor. Lens thickness doesn't seem to be too much of an issue, client wears those large, chunky acetate frame that seems to be popular these days. I was thinking that an aspheric lens would probably be the best option. I think he'd do better with an ashpheric front side and an atoric back, but I don't think he'll go for the cost. Any other options I can give him that will probably keep his budget reasonable while also helping with this issue?

[Lab Insight]

The client wants to keep his spending to an absolute minimum, buy says he has a major problem with off-axis astigmatism. The issue seems to only be in the OD eye +3.50 -4.50 x76. The OS script is very minor. Lens thickness doesn't seem to be too much of an issue, client wears those large, chunky acetate frame that seems to be popular these days. I was thinking that an aspheric lens would probably be the best option. I think he'd do better with an ashpheric front side and an atoric back, but I don't think he'll go for the cost. Any other options I can give him that will probably keep his budget reasonable while also helping with this issue?

A patient with major visual issues who is cheap and wants to call the shots on price? He needs to give his head a shake. He will be the type of patient you will make no money on, have a few remakes and most likely bad mouth to others every positive attempt you make to keep him satisfied. Not to mention, will most likely make a ruccus in your store in front of other customers during each visit.

IMHO, cut him loose and send him online where he can then re-evaluate the value of a licensed optical professional that provides quality products and service in person.

[optical24/7]

House brand digitals aren't radically more expensive than traditional grinders. Most all utilize asphericity/atoricity in their software. You don't need an aspheric front. If he wants bare bones give him CR with only a hard coat (but explain the benefits of adding AR at least.)

[Tallboy]

Yeah there are some great basic digital designs out there, you just have to know the labs that use the good ones. With that RX thickness most likely can be avoided by smart frame fit. CR39 and a hard coat like optical 24/7 says.

[DanLiv]

I think more of his problems, both visual and financial, will be solved by a smaller eye size than any upgraded optics. And if he doesn't go for that, as Lab Insight said you can give him half a dozen options to improve his experience but if he shoots them all down he's hopeless. Let someone else make him disappointing eyewear.

[Tallboy]

I can be pretty jaded sometimes guys but sheesh - you know there are people out there who don't have a lot of money but do have crazy RXs. Sometimes they want an expert fit and well made lens but dont't have the money for high end materials and designs. They are welcome in my shop and I will do my best to accomadate them. I guess until any one of us (other than Lela of course) actually met the gentleman we can't get a feeling for the situation but I have done plenty of fittings for fast food workers etc. who appreciate non-walmart eyecare but can't afford Zeiss 1.74 individual SV.

[Robert Martellaro]

The client wants to keep his spending to an absolute minimum, buy says he has a major problem with off-axis astigmatism.

Symptoms? Fatigue, blur (on or off-axis), intermittent diplopia, etc.

The issue seems to only be in the OD eye +3.50 -4.50 x76. The OS script is very minor. Lens thickness doesn't seem to be too much of an issue, client wears those large, chunky acetate frame that seems to be popular these days.

There will be VI (vertical imbalance) if there is a difference in power in the vertical meridian, and if the OCs are not aligned with the primary, (straight ahead) gaze, and is binocular. Assuming a plano sph left, and a pupil height 7mm above center (typical for bigger deeper zyl frames), the VI will be about 2 prism diopters base up left, likely symptomatic considering the high astigmatism, especially if the VI has increased in value compared to his habitual eyeglasses.

I was thinking that an aspheric lens would probably be the best option. I think he'd do better with an ashpheric front side and an atoric back, but I don't think he'll go for the cost. Any other options I can give him that will probably keep his budget reasonable while also helping with this issue?

CR39 in a moderate size frame, a "text book" bridge fit that positions the 180 line as close as possible to the pupil height, decentering the lens to eliminate VI, will be cost effective and functional, if his nose can take a zyl bridge w/o pads and tolerate the weight. Don't forget to charge for your expertise.

Hope this helps,

Robert Martellaro

[Paul Smith LDO]

I sell FFSV CR-39 for 109.00 to 149.00 depending upon the frame material and how much time I spend during the interview process. I charge for my time, as knowledge and experience has to be factored in with time spent. One should also calculate for the post interview alcohol absorption rate.

[Lelarep]

His major complaint was off-axis blur. He's an eye-mover (rather than a head-turner) so once he gazes outside of the center, he says the blur is bad enough with this current lenses (appear to be spherical trivex) that he can't make out anything useful. His OS is -1.50 -0.50 x118, so he's technically anisometropic. Complains of depth perception issues, but says he's had it all his life and doesn't feel that it can be solved, and he doesn't want to discuss it if it will increase the price of anything (whatever...).

Thanks for the insight, everyone, looks like good options that won't break the bank.

I'd dump him as a client, but he's a family friend, so, unfortunately, that's not an option... (I'm sure there are more than a few of you that are all too familiar with this)

[Uilleann]

Contacts.

[Lelarep]

Contacts.

Tried that, not interested.

[Lelarep]

In the end, I was able to get him into a digital aspheric 1.6 MR-8, with a basic AR, total cost to him 118.00. He considered that acceptable. I am crossing my fingers he is happy.

[drk]

Slam dunk.

[CCGREEN]

Hope you put him in a round frame. That way you can rotate that lens to whatever axis he accepts. Yes you ground the lens to the prescribed Rx.

Some things you dont want to do for family or friends. And if it involves money any issues are compounded because feelings get involved.

[Lelarep]

No such luck on the round frame. he brought the frame with him, Ray Ban 5277 54-17, couldn't possibly be more rectangular...

[Robert Martellaro]

His major complaint was off-axis blur. He's an eye-mover (rather than a head-turner) so once he gazes outside of the center, he says the blur is bad enough with this current lenses (appear to be spherical trivex) that he can't make out anything useful. His OS is -1.50 -0.50 x118, so he's technically anisometropic.

I wonder if he's describing diplopia instead of blur. If the lenses are mispositioned, he might be able to sustain fusion on the primary gaze, but not on the eccentric gaze. I don't see how there can be noticeable blur on the horizontal axis due to oblique astigmatism or power error unless the base curve is whacky (plano) or a warped lens.

Complains of depth perception issues, but says he's had it all his life and doesn't feel that it can be solved, and he doesn't want to discuss it if it will increase the price of anything (whatever...).

Fit close, and position the OC center pupil. That means no Zeiss or any other lens that places the PRP 4mm or more below the pupil height.

I'd dump him as a client, but he's a family friend, so, unfortunately, that's not an option... (I'm sure there are more than a few of you that are all too familiar with this).

But if you help him see better, he'll send his friends to you (except for your "crazy uncle"), and maybe tells his doctor about your skills.

In the end, I was able to get him into a digital aspheric 1.6 MR-8, with a basic AR, total cost to him 118.00. He considered that acceptable. I am crossing my fingers he is happy.

Atoric is a nice touch, and he might notice the difference if the right eye BCVA is 20/20 or better, but generally inconsequential if the lenses are not positioned optimally.

Hope this helps,

Robert Martellaro