teenager with nystagmus and PAL's

**karen** · 07-21-2005, 09:22 AM

Hello all! Looking for opinions/experiences. I have a Doc with a 13 year old patient with nystagmus (she describes it a pendular as opposed to short jerky movement) If she gives him about a diopter and a half of plus at the near it really helps. Bifocals are the obvious choice but she wants to avoid the line, he gets a hard enough time at school as it is. She asked me about a PAL, my concern was the intermediate area throwing him off. My friend Pete thinks a blended would work, as do I but I wondered what you all thought. Any of you ever had this scenario???

**chip anderson** · 07-21-2005, 09:30 AM

Any optician dumb enough to use a pal on a patient with nystagmus deserves to have trouble.
While your friend Pete is a lot smarter than I, he's wrong, use a line and tell the patient: "This is what you need to see with your condition, get used to it."

**drk** · 07-21-2005, 09:51 AM

This may work against you, Karen (you're a wholesale lab gal, right?) but try Three Rivers' new TR-O seg, which is Transitions V poly round-22,25,28. Or maybe you can order it uncut from them?

This lens is now my lens of choice for kids with multifocal needs.

**karen** · 07-21-2005, 08:33 PM

Originally Posted by drk

This may work against you, Karen (you're a wholesale lab gal, right?) but try Three Rivers' new TR-O seg, which is Transitions V poly round-22,25,28. Or maybe you can order it uncut from them?

This lens is now my lens of choice for kids with multifocal needs.

So you like it so far?? I am BEYOND irritated that we can't get it and don't really want to refer existing accounts to them to try it as they might try to get the rest of their work ( I sure would! :bbg: ) rumor is that Trans FT 28 poly is closer than we think so we will see....

**karen** · 07-21-2005, 08:36 PM

Originally Posted by chip anderson

Any optician dumb enough to use a pal on a patient with nystagmus deserves to have trouble.
While your friend Pete is a lot smarter than I, he's wrong, use a line and tell the patient: "This is what you need to see with your condition, get used to it."

Chip- she's the Doc, not an optician which is why she asked my advice-so let's give her a break honey! I think we would all agree that the line would be the best choice but if we are eliminating the line the second best choice would be a blended, right?? Have you ever had this happen and what did you fit??

**eyegirl** · 07-21-2005, 08:56 PM

A lot of times these patients have particular head postures or gaze preferences that will give them their best vision. I say, if it's JUST for reading only, then do SV readers! Unless, I misread the OP and this person requires FT Rx wear.

**Jacqui** · 07-21-2005, 09:40 PM

I've used blended bi's in a couple of cases like this, no problems.

**SarahMP584** · 07-22-2005, 12:58 AM

Yeah I would definatley try the round bifocal...Hardly as noticeable as a ft but not as risky as using a PAL.

**Pete Hanlin** · 07-22-2005, 11:25 AM

The round seg would be a great alternative to a blended (although I can't believe there is that much demand for a round seg Transitions).

As to the lined bifocal option- sure, this would be ideal (especially in Executive, which avoids some of the image jump problem by placing the optical center at the seg line). As I recall, in this case we are trying to keep a teenager from looking totally uncool in his glasses. Having to wear bifocals at that age is tough enough, if we can come up with an option that is functional but removes the additional stygma of the line, I'm sure the patient would be most appreciative.

**drk** · 07-22-2005, 01:07 PM

My first response to that round seg was "sure, like I'll need that", but it is really ideal for:
1.) juveniles
2.) progressive non-adapts

Who the heck wants a line?

Why is Three Rivers the only lab that has that? Who makes it? Is it PPG?

**Pete Hanlin** · 07-22-2005, 01:14 PM

I believe they are using a FreeForm process to grind the round seg on a SV lens. DAC has been demonstrating freeforming of round segs at event like OLA for a while now, but I don't really know what equipment they are using.

I honestly don't see much of a market for the product, but you have to hand out kudos on a clever marketing idea- they're the only ones offering a unique product.

**drk** · 07-22-2005, 03:18 PM

Pete, you are probably right. Three Rivers is doing the Gradal Individual as well.

**karen** · 07-22-2005, 07:38 PM

Originally Posted by drk

Pete, you are probably right. Three Rivers is doing the Gradal Individual as well.

In house with their own equipment? If so, perhaps that is how they are doing the round seg as well. We can get the Individual, just have to order it from Virginia.

**Pete Hanlin** · 07-23-2005, 02:07 PM

It is my understanding that Three Rivers does indeed have some sort of FreeForm capability in their laboratory. Whether they are using DAC, Schneider, or some other manufacturer's equipment, I do not know.

**chip anderson** · 07-24-2005, 02:59 PM

Second best aternative if "the poor little darling would be socially destroyed with a line" would be two pairs of glasses. Patient's with nystagmus need all the help they can get from visual aids. Not lenses with inherent difficulties that most of the non-visually impaired (and not all of them) can overcome.

No lines and aspherics are sort of a controlled distortion with inherent optical defects. No need to add to the problem.

Chip

**Kirsten** · 07-25-2005, 10:13 PM

Hello,

I was wondering if someone could refer me to a website or provide a name of a sales rep. for Three Rivers Optical (I am on the west coast, if it matters). The retail chain I work for is interested in finding a source for Round Bifocals in polycarbonate, and have thus far come up empty-handed on a source in the United States.

Thanks for the information
~Kirsten