Please help w/ Non-Adapt!

[s-man-optiker]

Hi,
I haven't posted too much here but I really need some advice.
I've got a customer who I've remade 4 times now and still haven't got it right. I had the doc do a re-exam early on and now I'm just frustrated and thinking maybe the cust is just crazy. The problem is that the cust always has clarity issues with one eye - this problems alternates each time between R and L. The frame measurements shouldn't be an issue, it's a small lens A=47, B=28, but I checked the cust's previous frame and it's even smaller. One big thing here is that the rx has differing signs (one is +, one is -). I've tried every adjustment and different prg designs, varilux comfort and panamic, the seg is 17mm. Now that I"m reading this I realize that I'm not really expecting anyone to be able to help but I do feel better by venting here. Thanks for allowing me the opportunity. : )

[chip anderson]

One needs to know at least how much + and how much minus, then I am sure we can give you a lot of hints. Surely your office can't be so skert to let the Rx out that you wouldn't post it here.

Chip

[s-man-optiker]

Sorry, I didn't think to post it before. The rx is as follows:
OD -0.75 -0.75
OS +0.25 -1.00
The add is +1.75
Just a little more info, I made sure to order the cust CR39, in order to minimize distortion and narrowing of the corridor. I usually don't have problems with -1.00 cyl's in poly but with this cust I didn't want to take any chances.

[optigrrl]

Hi,
I haven't posted too much here but I really need some advice.
I've got a customer who I've remade 4 times now and still haven't got it right. I had the doc do a re-exam early on and now I'm just frustrated and thinking maybe the cust is just crazy. The problem is that the cust always has clarity issues with one eye - this problems alternates each time between R and L.

Are there alternating problems after each new rx check? If not, and you truly feel that the issue may be psychosematic - then try "pretending" you changed the glasses and see if the issue remains the same. If the patient has a different complaint in the same glasses then you have eliminated your question about the patient's sanity.

The frame measurements shouldn't be an issue, it's a small lens A=47, B=28, but I checked the cust's previous frame and it's even smaller. One big thing here is that the rx has differing signs (one is +, one is -). I've tried every adjustment and different prg designs, varilux comfort and panamic, the seg is 17mm. Now that I"m reading this I realize that I'm not really expecting anyone to be able to help but I do feel better by venting here. Thanks for allowing me the opportunity. : )

If the problems are related to clarity of vision, why are you changing PAL styles? Is it a head position that helps with the clarity? How is the VA with both eyes open? I discourage patients from looking through one eye and then another when trying out a new rx. Can you test the VA with this patient with both eyes open?

Also - the Ovation is made to accomodate a minimum height of 17, while the Comfort and Panamic are 18 min. Is the problem in the distance, near, or all over?

[chip anderson]

Make up a pair of ST lenses for he frame, Insert and see if the problem exists.

[Robert Wagner]

Just a thought, Place a leap pad at the full power of the add and have the patient look through it, you may have to trim or cut the top of the leap pad so the distance in not hampered and see if he/she is more comfortable with the reading? :bbg:

Robert
;)

[FVCCHRIS]

I have to agree with her on the suggestion to do what we here refer to as a "bench job". Let them sit in the back room for a few days and call him back to try the same lenses. Many times we have been completely successful with the "new lenses" and thanked profusely by the patient for "fixing" the problem. Chris..:bbg:

If when he comes back the blurriness has changed to the other eye, well then I guess we know what we're up against, huh?

[Chris Ryser]

New pair of glasses with probable higher addition. Fussy difficult customer who relizes the progressive area has become smaller and he now sees the distorted parts of the lens.

Will probably never like them. Follow Chips advise.

[Ed]

When it a problem with a patients perception and the doc has checked him a couple of times, then this is where the fun begins.

First: Take his old glasses and, if they are progressives, dot them up. Measure what the old monocular PD's were. (you can do this even if the old glasses are single vision)Are they what you are getting and are they about what you have on the new lenses? Next, go to the prism point. See if there is any prism in the old lenses ... it is much easier getting used to induced prism than it is trying to take it away. If there is prism in the old lenses, then you may have to try to match that prism or slowly "walk him out of" that prism by halving it now and in 60 days, do a Dr. Rx Change and reduce it further or try to eliminate it. Also, if the old lenses were single vision and there is a large difference between the monocular measurements of each eye i.e. 34/30 and his single vision glasses were done binocularly (64)- - (32/32) then there may be more time needed to get used to the difference. (That's why I never measure single vision binocularly). Next, look at the base curve of the old lenses ... especially the concave curve on the back of the lens where patients get used to and compare it to the new lenses. If they are within 1 diopter, then, continue on. Put the old glasses on the patient, look at the panascopic tilt ... compare it to the new glasses ... try to adjust the new glasses to his old ones. Then look at the face form of the old glasses and try to match the new ones to that.

Next, look at the lenses you are using. You said that you fitted him at a 17 seg ht. Both of those lenses have a minimum fitting height of 18, so, by using them, you are cutting about half of his bifocal off ... not good at all for reading. At a seg ht of 17, I would seriously consider using the Varilux Ellipse (min fitting ht of 14). That way he will get a very good use of the bifocal.

Now ... EDUCATE HIM. Tell him that glasses are meant to be utilized with BOTH eyes. Look at the visual accuity that the doc has recorded using the new Rx. Is one eye different from the other? If it is, then he won't see as well with one eye than he will with the other. You may also have doc explain to him about how Optomotrists use "balance" when giving Rx's ... i.e. .. The Subjective Rx may or may not be the same as the Final Rx. Have doc do this because then he will believe him more than he believes an optician.

If you have done all the above and touched all the bases, the chances of success will be increased.

There is one other thing you can do. If this is his first time coming to you, find out where he went before and give the optician there a call. Chances are they have had the same problem with him (and maybe are glad to see him go) ;) . Ask them if they had the same problems and if they did, what they did to correct it. Of course, if this is his first progressive, and you have done all of the above steps and he has worn them continually for 2 weeks and is still having problems ... then, he may be a true non-adapt.

[EyeFitWell]

Just FYI, although I agree I would NEVER fit a comfort at 17, my chart from essilor says the minimum IS 17. Not 18. I try to stay at 19 or above.

[Bobie]

I agree with EyeFitWell in this case , and may be Physio or DEFINITY or any free form PALs will be much better.

For Panamic , we can forget it because Anisometropia 1.00D will be kick out the equalize function of Panamic. Please check about base curve of Comfort and Panamic in this case that same base curve for R & L or not.

[Trevor D]

Hey Bobie, do you mind elaborating about the "equalize function" of a Panamic?

Trev

[Bobie]

Panamic is good if Rx R/L about the same , because perfect power equalisation between corresponding points of right and left lenses will give more vision field and less distortion , but in case of anisometropia this function will be off and in some case it can be reduce the vision field and induce more distortion.

For some case , Panamic can be better than Ipseo or Comfort or Physio or even Physio 360 , but in some case Panamic can be very bad if compare with Hoyalux GP Wide , Comfort , AO Pro , Sola Percepta , Genesis , AO Compact , Kodak Concise.

In some case Panamic is still good choice if you understand how to handle it.

Then , my conclusion is " Put the Panamic to the right patient " if you are not sure , try another PALs. :bbg: