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Thread: super myopes and progressive??

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    Master OptiBoarder ziggy's Avatar
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    super myopes and progressive??

    I had a patient this morning rx was -17.50 +.25 135//2.50od
    -12.75 //2.50os
    any one got a good guess what lens I should go with. I told the patient he would be better severed by a ft-28 or 7x28 but he has gotten use to a no line. His rx has gotten a lot worse due to a retinal tear. any sugestions will be welcome.
    Paul:cheers:

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    Quote Originally Posted by ziggy
    I had a patient this morning rx was -17.50 +.25 135//2.50od
    -12.75 //2.50os
    any one got a good guess what lens I should go with. I told the patient he would be better severed by a ft-28 or 7x28 but he has gotten use to a no line. His rx has gotten a lot worse due to a retinal tear. any sugestions will be welcome.
    Another problem with a flat-top is that it will be extremely thick. I would use 1.9 glass or 1.71 plastic (would be perfect if you could get the 1.74 plastic).

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    I would avoid the flat top, if he used a no line he is only going to see the line for the next couple of weeks until he adjusts. most likely you will here about that line every day until the life has been draiined from him for calling and complaining so often. If the 1.71 is available Hoya makes a great progressive, I dont know there rx limitaions but I think that would be your better bet, I would also make sure to add an AR I assume you would do that anyhow but the d-28 thought through me. Let us know what you decide and hope it all works out.

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    ATO Member OPTIDONN's Avatar
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    I agree that I would check Hoya's availability (but that is only because I am used to working with them) Let us know what you use and how it works out. This could be very use full information.:hammer:

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    What's up? drk's Avatar
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    Might want to consider that he's 5D aniso, if he hasn't worn that Rx before.

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    One eye sees, the other feels OptiBoard Silver Supporter
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    Ziggy,

    The near vision will be very poor with a -17.50 +2.50add PAL, and it's unlikely that there will be blanks thick enough unless the frame is extremely small, which would preclude the use of PALs. So, a FT28 1.66 is about your only option.

    Much depends on the corrected visual acuity of the right eye. If the VA is 20/100 or worse, the brain might suppress or ignore the image offered by the right eye, allowing you to use a balance lens in the right. A PAL might then be considered for the left eye, possibly in conjunction with a separate pair of readers. I would still rec. FT28s at this power though.

    However, if the VA is good OU, you will be presented with a plethora of optical concerns due to anisometropia and possibly induced anisokonia. The latter will probably not be an issue (trial frame comes in handy here), as long as you can get the right lens close to the eye, not easy to do with the nasal lens thickness interfering with the nose pad adjustment. Keep this in mind when you select the frame for your client. In addition, consider modifying the bevel placement on the left eye to increase the vertex distance, decreasing the image size disparity.

    Diplopia at near is a real concern due to about 5^ of vertical imbalance at near. I don't know if the right lens can take a slab-off prism due to the steep curve. If not, you might try dropping the distance OCs to the top of the seg, decreasing the VI at near, possibly enough to allow fusion. Set the seg a little higher than normal. Keep in mind that VI will now be induced on the distance gaze, not enough to cause diplopia, but possibly enough to cause general discomfort. It would be wise, client willing, to consider separate pairs for far and near.

    Hope this helps,
    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.



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    Master OptiBoarder ziggy's Avatar
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    Thanks for the replys! I mmentioned the 2 pair Idea to him but he wants to stay with the multifocal, of some type at least. I havent checked to see if sa slab would work with this power, but i will. I will check the Hoya and let you guys know thanks
    Paul:cheers:

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