Horrible peripheral in pg, looking for opinions

[Slim]

So this lens is my usual go to lens, and have tons of great feed back, but this pt has terrible off center vision.

Its a shamir intouch 15, poly

+2.00 / -3.25 / 89
________________ +2.25

+1.75 / -3.75 / 78

wrap 12.9
panto -1.4
Vert 15.5

Nike 6060 frame. I spotted up the lenses and also marked the max width of clarity, (the \ / on the lens...)

Seg is 25 so I cant use a variable pg

Any suggestions within Shamir or Varilux line?

[Tallboy]

I would re-check the POW measurements (especially vertex distance). I would go with an Auto II or Auto III - any design that maximizes peripheral above the 180 en lieu of larger reading areas.

Its funny but some of the "specialty" type designs just flat out "break" with high cyl and the right patient. Has definitely happened to me. I usually put them in an IOT T design or one of the autographs and they are fine.

Of course... most importantly... do you know what his last RX was?

[drk]

Nice frame selection for that Rx. Ha ha.

[Robert Martellaro]

Because of the degree of face form, consider the Attitude, probably with the less aggressive add power profile found in the "sport" design, on a +6 BC, fixed 18mm, Trivex, and find some way to get a positive value for the pantoscopic tilt.

Hope this helps,

Robert Martellaro

[Slim]

Yeah I wasnt thrilled with his frame choice....

Thanks robert, I was kinda leaning that way, I just am not super familiar with the attitudes. I will try it just as you suggested.

[jpways]

Just make sure if you're using Autograph III Attitude, you get the Fashion and not the Sport (with Auto II Attitude there is only one design and it's equivalent to the Fashion)

[Robert Martellaro]

Just make sure if you're using Autograph III Attitude, you get the Fashion and not the Sport (with Auto II Attitude there is only one design and it's equivalent to the Fashion)

I can never remember which version does what. Shamir shows...

http://shamir.co.nz/index.php?option...ion&Itemid=249

that the add power ramps up slower with the Sport profile, so I've taken that to mean a more generous distance zone on the vertical distance zone, and assumed that was also true on the horizontal meridian. What's your take on this?

Best regards,

Robert Martellaro

[Slim]

From that link it sounds like he needs the sport. He also plays golf so that might help with that as well.

[Slim]

so I went with Roberts thought, and he was very satisfied! thanks for the input fellas.

[Quince]

Thanks for the follow up. We've been playing with the idea of working with this line more and your situation contributes honest feedback!

[merrymaker]

The Auto 3 Fashion and Sport PAL is incredible. Cant recommend enough. And have yet to find any issues with prior Zeiss, Varilux, etc wearers.

[Uilleann]

"[As opticians we are often] so preoccupied with whether or not we could that they didn't stop to think if we should."

--With apologies to Ian Malcom.

That SRx in that frame (in a PAL no less) never should have happened for any number of reasons. Is everyone just afraid to simply do what's best for a patient and tell them no when its needed?

[Robert Martellaro]

Slim,

Did you use a fixed 18mm as recommended, or continue with the fixed 15mm?

Thanks,

Robert Martellaro

[Slim]

i did the 18 sport in trivex, every thing else stayed the same

[merrymaker]

I'm curious as to how you got 12.9 and 1.4 POW values. An electronic measuring device I imagine?

[AngeHamm]

Is everyone just afraid to simply do what's best for a patient and tell them no when its needed?

Yup. Because patients who hear you say "no" in any context, regardless of how it's presented, are invariably the ones who write an email of complaint to your boss and get you a written reprimand.

[Robert Martellaro]

i did the 18 sport in trivex, every thing else stayed the same

Slim,

I've trialed and/or worn the Autograph 2/3 since 2010- the fixed 18mm (+2.25 add myopic Rx) changes quickly into the near vision zone (100% of add at 13mm, 85% at about 11mm). Using a shorter corridor increases the chances that the client might notice an increase in blur on and off-axis, and general visual discomfort due to the sharper power gradients. I suspect that this may have contributed, maybe significantly, to your client's objection to the original lenses.

It's good to hear your client is doing well with the redesigned lenses for this fairly complex frame/fitting/Rx scenario.

Best regards,

Robert Martellaro

[Uilleann]

Yup. Because patients who hear you say "no" in any context, regardless of how it's presented, are invariably the ones who write an email of complaint to your boss and get you a written reprimand.

Dude - you need a new boss...one who actually CARES about their patient, and further fully trusts you to do the RIGHT thing.

[AngeHamm]

Dude - you need a new boss...one who actually CARES about their patient, and further fully trusts you to do the RIGHT thing.

I've seen this in every private practice I've ever worked for. There's a certain subset of your clientele who, once they've been to see the doc about four or five times, start dropping the "I'm an old patient of Dr. X's, and I'm sure he'll squeeze me in to the full schedule / stay a little late / come in a little early / do one more remake / give an extra discount / etc., etc., etc" when faced with the slightest inconvenience. You can be doing your job exactly as instructed, polite as can be, with the intention of saving the doctor time and money as you have been devoted to do, and .5% of your patients just hear any kind of "no" and report it to the doctor (whose personal email and/or cell phone number they of course have) as how rude you were and how they are considering never returning. One month later, you'll have an office meeting all about how we have to stop squeezing in patients / making the doctor stay late / making the doctor come in early / doing one more remake / giving extra discounts / etc.

Some patients are just bullies, and small business owners are justifiably focused on keeping their returning customers. That said, every place I've ever worked would be much happier and better off divorcing about a dozen repeat clients.

[Uilleann]

I've seen this in every private practice I've ever worked for. There's a certain subset of your clientele who, once they've been to see the doc about four or five times, start dropping the "I'm an old patient of Dr. X's, and I'm sure he'll squeeze me in to the full schedule / stay a little late / come in a little early / do one more remake / give an extra discount / etc., etc., etc" when faced with the slightest inconvenience. You can be doing your job exactly as instructed, polite as can be, with the intention of saving the doctor time and money as you have been devoted to do, and .5% of your patients just hear any kind of "no" and report it to the doctor (whose personal email and/or cell phone number they of course have) as how rude you were and how they are considering never returning.

Some patients are just bullies, and small business owners are justifiably focused on keeping their returning customers. That said, every place I've ever worked would be much happier and better off divorcing about a dozen repeat clients.

Let 'em.

This patient should have been heavily counseled as to why this frame was a very bad idea. Great employers/doctors understand that you know what you're doing, and trust your judgement in cases like this. No amount of letters/silly phone calls should matter.

[AngeHamm]

Let 'em.

This patient should have been heavily counseled as to why this frame was a very bad idea. Great employers/doctors understand that you know what you're doing, and trust your judgement in cases like this. No amount of letters/silly phone calls should matter.

That's much more straightforward in conversation than in reality.