I have a patient who has been with us for about 5 years now. So I have been trying to work with her on her current progressive situation.
Patient came in for her annual exam in Jan 2006.
Her rx last year was:
+1.25 DS
+1.00 DS
+2.75 Add with a seg of 20 (gradal top in plastic)
She expressed preference in Jan this year for :
+1.50
+1.25
+2.25 Add (Dr. did try the 2.75 and 2.50 three times during exam and patient expressed that 2.25 was better each time.)
Patient wanted smaller frame, had a seg of 17. Went with Brevity.
Patient tries glasses for 3 weeks, comes back in saying she was having trouble with everything but reading.
Dr. refracted her again, came up with:
+1.25
+1.00
+2.50 Add (bumped it to keep reading power same since she was satisfied with this)
Dr also requested we drop seg by 1mm to 16.
Patient comes back a few days after dispense still saying everything is blurred. She says if she raises her glasses, then the distance comes in more clear. (so she is adding back in the power she had us take away!)
Reading isn't as good as prior. If I place a +.25 lens in front of the glasses, they still aren't clear.. and neither is her old pair. But her old pair is better than the new pair.
The distance isn't as wide as previous either (I thought the Brevity was supposed to have the same or at least similar distance properties)
Talking with her more in depth, the computer she uses is actually sitting at eye level (she sees the majority of the monitor at a direct gaze.) I talked with her about seeing if she can lower the monitor, since her chair is raised as high as it will go.
We discussed computer specific glasses, but she doesn't want to make the investment in something since she will be changing job duties in less than a month, yet her current glasses do not work for what she wants, nor does her old pair! Also when talking about tuffing it out for the 3-4 weeks, she says her regular job comprises of computer work as well. But she thinks that it won't be as visually demanding as her temp position that she now says she only has to cover this other area for an hour or two a day.
I explained to her numerous times that no progessive design will give her the ability to drive and see her computer while looking straight ahead. That I can either give her one or the other. She refuses to accept this, and insists that one pair can do it all.
At this point, any remakes are on us(half cost..but still money). So I want to make sure I cover all bases at once. My fear is that part of the issue is the placement of the computer screen, and that even if I get her in a larger frame, and switch mats (though she has been in poly before but it was 3 years ago), that she won't get the computer vision she wants.. Not to mention the contridictory information she gives on reading/distance vision anyway. If we increase her add by another .25 she will be back at her current script which she says doesn't work. The doctor has spent 30mins to an hour on 3 occasions now going over the refraction issues.
Any other suggestions?
Cassandra
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