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  1. Yup, not since Medicare cut their Cat Sx...

    Yup, not since Medicare cut their Cat Sx reimbursement about 25 years ago. Regardless, I'm not comfortable letting the surgeon have total control over the IOL/patient discussion.
  2. But opticians have to try to make the eyeglasses...

    But opticians have to try to make the eyeglasses work, and the client has to try to wear them. Not to mention that this surgeon's solution may require specialized lenses or multiple pairs,...
  3. They missed by 1.50 D, unless they were trying to...

    They missed by 1.50 D, unless they were trying to be cute, not a good thing to pull on an age 70 something.

    Short answer, tough it out, minimizing VI at near and far. Long answer needs more data....
  4. Check your Private Messaging. I'm not well...

    Check your Private Messaging.

    I'm not well versed in the technical details of VSP PAL designs.

    Thanks for the follow-up. Everyone learns when we find solutions that were effective for the...
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    They were reading it off the trial frame, except...

    They were reading it off the trial frame, except they forgot that there's 360˚ in a circle! However, if you wish to use 180 notation, note the eye, base up or down, and the axis. In this example it...
  6. Darryl's ashtray analogy is a very user friendly...

    Darryl's ashtray analogy is a very user friendly visualization of how and why unwanted cylinder is distributed in different ways with PALs.
    ...
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    They stood half a million people on their heads,...

    They stood half a million people on their heads, shifting the earth's axis ever so slightly.

    Here's the full drum solo and outro (audio only).

    https://www.youtube.com/watch?v=7dTH32ClRwI
    ...
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    The mires should be clear and sharp, making sure...

    The mires should be clear and sharp, making sure that the lens is clean and that the instrument is calibrated and focused (I usually didn't have access to a radiuscope, instead using a keratometer)....
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    1) Lowest density, lightest weight, ophthalmic...

    1) Lowest density, lightest weight, ophthalmic lens available.
    2) The only ophthalmic lens that doesn't chip or crack.

    Need more proof?

    Low chromatic aberration, high strength, available in...
  10. The chart above is for HOAs. The way I read it,...

    The chart above is for HOAs. The way I read it, it's only the 2nd and 4th order aberrations that are affected by panto tilt. That's good because spherical aberration is generally not a problem for...
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    Tia, Check medical history. If it happens w/o...

    Tia,

    Check medical history. If it happens w/o eyeglasses see a GP or ENT doc. Otherwise PAL design, probably too hard/fast/strong. Will probably do some or most extended close tasks w/o...
  12. The slightly soft acuities, a somewhat unusual...

    The slightly soft acuities, a somewhat unusual add for their age (unless they have pseudophakic eyes), the .12 distance power cut, and the PAL design change might mean something. Did you get the...
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    The Band - The Weight 1970 Where are the young...

    The Band - The Weight 1970

    Where are the young composers?


    https://www.youtube.com/watch?v=N79OAlMi2nI
  14. Welcome to Optiboard. Thanks for including a...

    Welcome to Optiboard. Thanks for including a fairly thorough history. Including the client age, acuities, and pupil heights would help us tremendously for a proper troubleshoot.

    The red flag that...
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    We can get Zeiss PALs in the US. I looked at...

    We can get Zeiss PALs in the US.

    I looked at Rodenstock frames a few weeks ago. They were contemporary in appearance, and sensibly engineered. I didn't ask if their lens division is re-entering...
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    There are only two ophthalmic lens materials that...

    There are only two ophthalmic lens materials that have an Abbe value in the mid/high 50's, crown glass (59v) and hard resin cr39 (58v). If it is cr39, the refractive index and density should be...
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    No dumb questions, just dumb answers. ...

    No dumb questions, just dumb answers.

    Moreover, you make us think about what else yoked prism can do, bad or good. For example, it changes our perception, enough that we might not want to use it...
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    Jimi Hendrix - Foxy Lady 1968 Aw shucks, foxy...

    Jimi Hendrix - Foxy Lady 1968

    Aw shucks, foxy lady!


    https://www.youtube.com/watch?v=_PVjcIO4MT4
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    Two prism diopters worth, equal to about .6mm of...

    Two prism diopters worth, equal to about .6mm of displacement.

    Frame shape is a different issue, and primarily for variable corridors only. PALs designs might use one, both, or neither...
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    A short eyewear wearing history, resulting in...

    A short eyewear wearing history, resulting in greater sensitivity to magnification and narrowed fields of vision, compared to emmetropes and especially myopes, and less motivation due to good...
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    Most have a very short eyeglasses wearing history...

    Most have a very short eyeglasses wearing history and hate eyeglasses. Watch out for displaced aggression.

    Hone your skills.

    Demonstrate the alternatives (SVDO/SVNO, segmented multifocals,...
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    That might not be aspheric, and it has to be, or...

    That might not be aspheric, and it has to be, or the near and peripheral vision will be poor. Short of CLs, the best spectacle lens for acuity will be the Essilor Super Modular. Keep the decentration...
  23. Keep in mind that the difference in thickness due...

    Keep in mind that the difference in thickness due only to refractive index between 1.60 and 1.67 is only ((1.60 - 1.00) / (1.67 - 1.00) = 0.90) 10% thinner.

    As stated, it's semi-finished, meaning...
  24. About 3% to 5% more (compared to front aspherics)...

    About 3% to 5% more (compared to front aspherics) according to D. Meister's Optical Analysis program. A tad more for high minus (>8 D), without lenticulation.

    Puck, semi-finished, same animal....
  25. The biggest concern I have with this Rx is...

    The biggest concern I have with this Rx is positioning the vertical OCs to minimize vertical prism imbalance due to anisometropia.

    Due to budget constraints that you described, and the above...
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