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    Lopsided

    Good morning all:

    Px first time PAL wearer in Zeiss SL 3. (Poly photochromic gray w/ best AR)

    +2.25 -1.75 091
    +1.75 -1.25 101
    Add: +2.25

    Px came back day after dispense reporting an asymmetric field of view favoring the right side. Everything left of directly-forward in OS was noticeably blurrier than the right. I'm satisfied with PD measurements, monocular PD stick check corroborates pupilometer results.

    Ordinarilly I'd shoo him away and insist he continue trialing for a week, but the severe asymmetry was too odd to ignore.

    Thanks for any insights you care to share!

    #2
    Sunken left orbit?

    Comment


      #3
      Whats up, doc?

      There was a prior trauma affecting comfortable range of postures--nothing so severe as any noticeable difference in ocular orbits. Nose slopes and so frame fit may vary from pupilometer, but I checked it--weird thing is the nose slopes in the opposite direction to have explained the PAL channel asymmetry. Unless the pupilometer was sitting far lower than I think--but still the PD stick above eye level would have caught that...

      Comment


        #4
        Weird head turn?

        Comment


          #5
          Originally posted by drk View Post
          Weird head turn?
          Maybe not so weird. When self-testing with their hands, I've noticed that most folks turn their heads in the direction of the eye that's occluded, maybe less so with the dominant eye.

          I always measure the IPD using a fitted frame in situ to adjust for head turns and other irregularities in facial anatomy.

          Best regards,

          Robert Martellaro
          Science is a way of trying not to fool yourself. - Richard P. Feynman

          Experience is the hardest teacher. She gives the test before the lesson.


          Comment


            #6
            Heaven spare us from people doing their own monocular acuity checks at dispense.

            I haven't latched onto your "artificial head turn inducing a look through the nasal portion of the lens because of a shoulder turn to raise a hand to be occlusive" theory but it's very true, after thinking about it. At least they should use a standard occluder if you wanted to let them do it (and I surely don't).

            Comment


              #7
              To me it sounds as if the lens was surfaced incorrectly with the reading bit turned outward. I've seen this before.

              Comment


                #8
                Originally posted by drk View Post
                Heaven spare us from people doing their own monocular acuity checks at dispense.

                I haven't latched onto your "artificial head turn inducing a look through the nasal portion of the lens because of a shoulder turn to raise a hand to be occlusive" theory but it's very true, after thinking about it. At least they should use a standard occluder if you wanted to let them do it (and I surely don't).
                This is one of the things I hate the most. Lately, out of nowhere, multiple people have done this during the dispense. Completely unprompted, trying to read my sample reading card with progressives while closing one eye at a time and then acting shocked when it isn't crystal clear. I have to explain why they shouldn't do that and they look at me with suspicion. Also, someone recently tried holding the reading card off to the side of their head to "test their peripheral vision." Mercury is in retrograde or something.
                :spin:Krystle:spin:

                Comment


                  #9
                  Originally posted by KrystleClear View Post
                  This is one of the things I hate the most. Lately, out of nowhere, multiple people have done this during the dispense. Completely unprompted, trying to read my sample reading card with progressives while closing one eye at a time and then acting shocked when it isn't crystal clear. I have to explain why they shouldn't do that and they look at me with suspicion. Also, someone recently tried holding the reading card off to the side of their head to "test their peripheral vision." Mercury is in retrograde or something.
                  if i had a dollar for the amount of times a patient will come in to say "x eye is fuzzy when i close x eye" and ill say "and with both eyes open?" could buy me the world

                  Comment


                    #10
                    Realize, too, that monocular acuity is always worse than binocular acuity, regardless of convergence/exophoria, etc.

                    It's just not a valid test in most cases.

                    Comment


                      #11
                      Originally posted by drk View Post
                      Weird head turn?
                      If anything he turns his head as little as possible.

                      Originally posted by Prentice Pro 9000 View Post
                      To me it sounds as if the lens was surfaced incorrectly with the reading bit turned outward. I've seen this before.
                      If so, it'd be my second such occurance this year. [The first one the Px threw the glasses off her face at dispense--after troubleshooting we discovered it worked at a 15 degree tilt. Remade with a hard data input of the standard tilt default value--came back roses.]

                      Having nothing better to go on, this was my tact again--I measured all the POW values which were all within a whisker of the default values in the first place. I decided to push out the PD a smidge. Hopefully something here resolves anything fluky in the digital surfacing.

                      Thanks everybody!

                      Comment


                        #12
                        We need the result.

                        We deserve to know.

                        Don't hold out on us, Hayde...

                        Comment


                          #13
                          Originally posted by KrystleClear View Post
                          This is one of the things I hate the most. Lately, out of nowhere, multiple people have done this during the dispense. Completely unprompted, trying to read my sample reading card with progressives while closing one eye at a time and then acting shocked when it isn't crystal clear. I have to explain why they shouldn't do that and they look at me with suspicion. Also, someone recently tried holding the reading card off to the side of their head to "test their peripheral vision." Mercury is in retrograde or something.
                          Just had a customer the other day try that, went into the doctor's notes and saw that their right eye VA is 20/80 and their left eye VA is 20/100. Look down at the codes and see H25.13, bilateral nuclear cataracts. "Ma'am you aren't going to be anywhere close to comfortable vision until you get your cataracts taken care of!" She was scared to go in for surgery and was hoping that she could put it off, that maybe our doc was wrong about cataracts. I told her the proof is in the pudding, new glasses but you still cannot see. Finally convinced her to go in for JUST a consult.

                          Comment


                            #14
                            Originally posted by drk View Post
                            We need the result.

                            We deserve to know.

                            Don't hold out on us, Hayde...
                            LOL Yessir!

                            Remake dispense was remarkably improved, but patient still reported asymmetrical channel, still compromised in the same direction albeit not as severely. Px willing to trial for a week this time.

                            Pinning down PoWs didn't magically solve it--so I'm no longer inclined to blame the convenient opacity of digital lens chaos theory. The fact he reported improvement after I moved the OS PD out a smidge suggests I'm just fooling myself about the accuracy of the original measurement.

                            I'm wondering if there's an angular variance between his orbitals that takes his OS off the same plane as the OD? Something that shifts his line of sight while obscuring the lateral vector of his pupil on the standard plane of measurement. If I'm thinking that through correctly, that might escape notice of both the pupilometer and my check with the stick? (Still throwing spaghetti at the wall...)

                            Worth mentioning the Px PD is comparable enough to my own--so I'm not parallaxing myself with the PD stick to get a false corroboration of a Px covertly converging with the pupilometer. Neither is his PD so large as to toggle the boundary where 34.5 jumps to 37.0 on the device.

                            Aside:
                            Speaking of Px secretly converging in the pupilometer: I once had a patient with a 79.5 PD who would register 76 in a pupilometer set to infinity. When the PD stick also gave me an apparant "76," I knew something was wrong and threw the flag. Did the parallax math using my own PDs, my reach to Px, Px vertex distance estimates to PD stick, and came up with a 79.5. When the clinic went back and pulled the PD value from the auto-refractor, it backed me up with a 79.0. Got an erroneous prism correction removed from his Rx, and he was the happiest he'd been in years. I'm gonna gloat on that one for the rest of my days, so naturally God has to give me this current case to keep me humble...

                            Comment


                              #15
                              Originally posted by KrystleClear View Post

                              This is one of the things I hate the most. Lately, out of nowhere, multiple people have done this during the dispense. Completely unprompted, trying to read my sample reading card with progressives while closing one eye at a time and then acting shocked when it isn't crystal clear. I have to explain why they shouldn't do that and they look at me with suspicion. Also, someone recently tried holding the reading card off to the side of their head to "test their peripheral vision." Mercury is in retrograde or something.
                              With new PAL wearers I have a trick: I hold the card above their head at 16 inches and tell them to only use their eyes to look upwards at it. I say "doesn't look too great does it?". When they confirm it looks terrible I then start moving the card down until it's at the proper reading angle. Usually they go "oh yeah that looks great". Maybe I should refine this method for seasoned PAL wearers as well.


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