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  • Prentice Pro 9000
    replied
    Originally posted by Hayde View Post


    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...)
    I know this was his first PAL, but did he have an issue with his previous Rx? If he always had this issue somewhat then I'd think it's a "him" problem. If not then it might be the lenses or difference in the axis making everything screwy(there was something in Systems about this I think)?

    I don't know. I had a post cataract pt take a a bifocal in one eye that was like a -0.50 sphere with a +2.50 add and she was freaking out that things seemed "lopsided". That one got me good.

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  • Prentice Pro 9000
    replied
    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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  • Hayde
    replied
    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...

    Leave a comment:


  • NAICITPO
    replied
    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.

    Leave a comment:


  • drk
    replied
    We need the result.

    We deserve to know.

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

    Leave a comment:


  • Hayde
    replied
    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!

    Leave a comment:


  • drk
    replied
    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.

    Leave a comment:


  • dwlk
    replied
    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

    Leave a comment:


  • KrystleClear
    replied
    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.

    Leave a comment:


  • Prentice Pro 9000
    replied
    To me it sounds as if the lens was surfaced incorrectly with the reading bit turned outward. I've seen this before.

    Leave a comment:


  • drk
    replied
    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).

    Leave a comment:


  • Robert Martellaro
    replied
    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

    Leave a comment:


  • drk
    replied
    Weird head turn?

    Leave a comment:


  • Hayde
    replied
    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...

    Leave a comment:


  • drk
    replied
    Sunken left orbit?

    Leave a comment:

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