A Puzzle

Printable View

03-12-2019, 08:40 PM
Trina

A Puzzle

I have a patient whose prescription is:

-8.00 -0.50 x 073
-6.50 -0.25 x 097
ADD +1.50

She is in a Nikon Emblematic 1.74 for her ophthalmic and an Emblematic 1.67 polar for her suns. She says the sunglasses are perfect but she can't see out of the ophthalmic. To complicate things, she has a pair of glasses from 2015 with the following prescription:

-8.25 -0.25 x 092
-6.75 -0.25 x 103
ADD +1.50

This lens is the Nikon Master AP in index 1.74. She says she can see perfectly well out of these also.

I've checked base curve, panto, wrap, tilt, vertex distance, etc and have found that the glasses from 2015 were made on a different base curve than the two newest pairs, but her new glasses were both on the same base curve with the same panto, wrap, tilt AND vertex distance. The heights are correct on everything.

What's going on? I'm inclined to believe that she just doesn't care for her ophthalmic frame because I can't seem to make sense out of why she can't see out of them. To make matters worse, the glasses (and sunglasses) are 9 months old. She had a prescription re-check two weeks ago and the prescription is correct.

Let me know if there's something I've missed! I'm stumped!
03-12-2019, 09:30 PM
Tyler Underwood

You mentioned the seg heights are correct.. are they the same as each other in the two newest pairs? We’ll often put them lower in sunglasses than ophthalmics. It makes the design feel different, especially in a higher prescription.

A 1.74 has a lot more colour fringing than a 1.67 due to the Abbe value of material. When she’s wearing the sunglasses outside her pupils will be smaller and she’ll be less likely to notice any blur.
03-12-2019, 10:12 PM
Alex Camblor

What does the patient mean by they "cant see"? Have you checked VA with the new pair? Is the distance blurry/near/ or both? Is one eye blurrier than the other?
03-12-2019, 10:40 PM
lensmanmd

Quote:

Originally Posted by Trina

I'm inclined to believe that she just doesn't care for her ophthalmic frame because I can't seem to make sense out of why she can't see out of them. To make matters worse, the glasses (and sunglasses) are 9 months old. She had a prescription re-check two weeks ago and the prescription is correct!

Bingo
03-13-2019, 03:59 AM
Robert_S

If she's saying she 'can't see' then she is just being ridiculous
03-13-2019, 09:55 AM
AngeHamm

Nine months later is about six months too late for a patient to make a reasonable request for an RX change.
03-13-2019, 10:29 AM
Trina

Quote:

Originally Posted by Robert_S

If she's saying she 'can't see' then she is just being ridiculous

Very dramatic! Raising them doesn’t help. Lowering them doesn’t help. Moving them in and out doesn’t help. She can’t see at any distance. Yet every other pair, with all the differences listed above, are just fine. Thanks everyone! I just wanted to make sure I wasn’t missing something!
03-13-2019, 10:40 AM
Robert_S

Just offer to send them to Nikon for analysis
03-14-2019, 03:14 PM
Happylady

Quote:

Originally Posted by Tyler Underwood

You mentioned the seg heights are correct.. are they the same as each other in the two newest pairs? We’ll often put them lower in sunglasses than ophthalmics

I used to work with an optician that always dropped the fitting height in sunglasses. Why? I can do everything perfectly well including driving in my clear progressives so why lower the fitting height in sunglasses? I did a pair for myself lower years ago and hated it! I had to raise my chin slightly to read comfortably.
03-14-2019, 03:52 PM
bta89

Sounds to me like she is just trying to get something free. At first thought I noticed the axis OD did change quite a bit. Why did you end up doing a 1.67 and a 1.74. I think it would of made more sense to do the same index in both pair. What is B measurement, just curious? Does she have some sort of scratch warranty? Did she get an AR coating? If she has a warranty on the lens, offer to remake the lens. Maybe there is a defect in the lens that you can't see. Most high end AR's have two year warranties on them.
03-15-2019, 08:32 AM
mervinek

Quote:

Originally Posted by Happylady

I used to work with an optician that always dropped the fitting height in sunglasses. Why? I can do everything perfectly well including driving in my clear progressives so why lower the fitting height in sunglasses? I did a pair for myself lower years ago and hated it! I had to raise my chin slightly to read comfortably.

I like mine dropped just a hair. I'm a shorty and always end up raising my head to avoid the sun that comes just under the visors.
03-15-2019, 09:31 AM
Oscar

Quote:

Originally Posted by bta89

Sounds to me like she is just trying to get something free. At first thought I noticed the axis OD did change quite a bit. Why did you end up doing a 1.67 and a 1.74. I think it would of made more sense to do the same index in both pair. What is B measurement, just curious? Does she have some sort of scratch warranty? Did she get an AR coating? If she has a warranty on the lens, offer to remake the lens. Maybe there is a defect in the lens that you can't see. Most high end AR's have two year warranties on them.

1.74 doesn't hold tint and not many labs have a 1.74 polarized option so in most cases splitting the index is the only option. So why not 1.67 for the clear as well? people are more fussy about the thickness of their clear lenses so they opt for the thinnest.
03-15-2019, 11:08 AM
bta89

Oscar thanks for the clarification. Whenever it comes to 1.74 I never know. We don't even really offer 1.74 in our office. I've only ever done 1 pair of 1.74 because the patient requested it. She was like a -16 OU. I guess it makes sense that it doesn't come with tons of options so 1.67 would be easier as far as availability.
03-15-2019, 04:44 PM
Trina

Quote:

Originally Posted by bta89

Sounds to me like she is just trying to get something free. At first thought I noticed the axis OD did change quite a bit. Why did you end up doing a 1.67 and a 1.74. I think it would of made more sense to do the same index in both pair. What is B measurement, just curious? Does she have some sort of scratch warranty? Did she get an AR coating? If she has a warranty on the lens, offer to remake the lens. Maybe there is a defect in the lens that you can't see. Most high end AR's have two year warranties on them.

She has always worn a 1.74 index and this is her first pair of sunglasses. She wants the lightest and thinnest. The B in the ophthalmic is 41 and 39 in the suns.

She came back today for me to look over all of her glasses, including the ones from 2015. Insisted up and down that she could see just fine out of the 2015 pair but as soon as I said she could wear those while I sent the new pair to the lab for inspection, she changed her story and admitted that they were too strong. She also talked a lot about not liking the frame. She's been exaggerating too "I couldn't even see the top line at the ophthalmologist!" Yet she's been wearing them for 9 months. I'm still convinced that she is only trying to get something for nothing. As a last ditch effort, the OD I work for asked me to call the lab and see if they had any suggestions. Not sure what to tell her other than to offer her a discount on a new pair and watch the same lens magically work!