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Thread: PAL w/ Crisp Vision D & N - No Interm.

  1. #1
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    PAL w/ Crisp Vision D & N - No Interm.

    Cannot find a reasonable solution to Patients intermediate issue. Advice from optical co-horts appreciated.

    Background:
    New Patient, presented with OTC. States she has experience wearing PALS in past. Does not have prior glasses & cannot recall prescribing Dr.or optical shop she received her last PAL from-less than two years ago.

    frame is round, very small A = 42mm, B = 40
    Patient insists wearing frame with VD of 18.
    V/P/W custom measurements taken to compensate VD issue
    Has minimal distance & astig correction
    OD +.050 sph
    OS +0.50 -0.25 113
    ADD +2.25
    UNITY PLXTRA PAL

    Issue:
    Patient complains that although distance and reading vision is clear - no Rx problems - she cannot achieve good interm vision. Feels she is dropping from good distance straight into good near with no usable interm. area.

    Interim complaint makes sense due to high near+Shape of lens+V.D. I was just hoping that someone might have a suggestion that I am overlooking. Considered all the obvious options.

    Patient does not want NVF/refuses VD & frame adjustment/& will not consider an alternate frame.

  2. #2
    My Brain Hurts jpways's Avatar
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    Looking at the VSP website I see the lens comes in 5 corridor lengths, do you know which one is in the lens?

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    The patient will never be happy if they insist on wearing progressives that far away from the eye. To demonstarate have them hold their 2 index fingers up close to one eye forming 2 "posts". Ask how much of the room they see. Now have them move them away and tell them to notice how much more restricted the view becomes. That's the problem.

    It's also graphically illustrated showing increased add powers as well below (From Opticampus: Progressive Lens Design.)
    Last edited by Uncle Fester; 12-06-2016 at 04:36 PM. Reason: just noticing old thread...

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    20 mm seg height

    plxtra 18
    Last edited by STURNER; 12-06-2016 at 07:04 PM.

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    Appreciate the diagram. Been through this with Patient to no avail. They hear what they want to hear at times. Sometimes actually seeing a demonstration is helpful. We shall see.

  6. #6
    What's up? drk's Avatar
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    There's no way to solve that problem.

    The intermediate zone is small even at a 14 mm vertex. Dragging it out farther is not helpful.

    At best, you could stretch the corridor out a little longer in that frame, but it's still not going to be good enough.

    Consider if she can tolerate +0.25 over her distance Rx. That's pretty helpful at midrange.

  7. #7
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    Can you get a Seiko Surmount WS? It has a barrel shape as opposed to a hour-glass or T shape. Alternate would be a Definity or Hoya iD, from what I understand are more of a + shape.

    cs

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    A follow up on this post would be great.

    I'd love to know if you were able to get the pt. to reduce vert, if you dropped seg, or changed style.

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    I counseled Pt. as to proper spec wearing, fitting, lens design and the options we had to address her midrange issues. Patient left. Unhappy. Went to get a second opinion from other Opticians. It seems Patient's Mother was an optician of some sort 20 years ago, so of course that makes the Patient an expert on all-things-optical. She felt she would find the answer elsewhere.
    She returned 2 weeks later, humbler, but refusing to work with myself any longer, and went to the trainee for a 'redo'. Again, explanations were made with same options addressed as before. She then moved on to the manager, whom she asked a refund from.
    Seems this Patient is one of those that will not be happy no matter what you do, will not listen to anything you are saying, and refuses to work with you in any way to achieve a satisfactory result.
    You all know the type, we have all seen them far too many times.
    So in the short of it, no resolution was came to for intermediate issues as presented. Never given a chance to remedy or improve by an unhappy-no-matter-what, uncooperative Patient.
    Too bad because I find the puzzle of troubleshooting to be the most exciting in the optical field.
    Thanks for your interest and support to all who replied. Optiboard peeps are great!

  10. #10
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Quote Originally Posted by STURNER View Post
    I counseled Pt. as to proper spec wearing, fitting, lens design and the options we had to address her midrange issues. Patient left. Unhappy. Went to get a second opinion from other Opticians. It seems Patient's Mother was an optician of some sort 20 years ago, so of course that makes the Patient an expert on all-things-optical. She felt she would find the answer elsewhere.
    She returned 2 weeks later, humbler, but refusing to work with myself any longer, and went to the trainee for a 'redo'. Again, explanations were made with same options addressed as before. She then moved on to the manager, whom she asked a refund from.
    Seems this Patient is one of those that will not be happy no matter what you do, will not listen to anything you are saying, and refuses to work with you in any way to achieve a satisfactory result.
    You all know the type, we have all seen them far too many times.
    So in the short of it, no resolution was came to for intermediate issues as presented. Never given a chance to remedy or improve by an unhappy-no-matter-what, uncooperative Patient.
    Too bad because I find the puzzle of troubleshooting to be the most exciting in the optical field.
    Thanks for your interest and support to all who replied. Optiboard peeps are great!
    I think a solid 10% of the population that we learn to deal with are this type. Most of them don't reach this extreme level of frustration thankfully!

    I hope any refund comes with a polite request that your relationship is over!

    Thanks for a final word. Too often we're left wondering if it had a happy ending.

    This time alas, it twas not.
    Last edited by Uncle Fester; 01-19-2017 at 04:57 PM. Reason: clarify...

  11. #11
    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by STURNER View Post
    She returned 2 weeks later, humbler, but refusing to work with myself any longer, and went to the trainee for a 'redo'. Again, explanations were made with same options addressed as before. She then moved on to the manager, whom she asked a refund from.
    Seems this Patient is one of those that will not be happy no matter what you do, will not listen to anything you are saying, and refuses to work with you in any way to achieve a satisfactory result.
    You all know the type, we have all seen them far too many times.
    Tuesday morning I had one patient who refused to work with me and another who would only work with me, both in the office at the same time. It is what it is.
    I'm Andrew Hamm and I approve this message.

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    Master OptiBoarder OptiBoard Gold Supporter
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    Im more and more putting these patients into a "workplace" type lens. Its really been succesaful

  13. #13
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    Redhot Jumper This time alas, it twas not....................................

    Quote Originally Posted by Uncle Fester View Post

    I hope any refund comes with a polite request that your relationship is over!

    Thanks for a final word. Too often we're left wondering if it had a happy ending.

    This time alas, it twas not.


    Essilor gave courses some 55 years ago in Europe for opticians, to learn how not to sell Varilux lenses, and why, with high additions to older people.

    What was then, seems to be of no value in modern times.

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