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Thread: Lensometry

  1. #1
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    Lensometry

    Im just curious as to how most of you go about verifying the power of PALs. If a patient presents with a complaint of poor vision through new PALs do you always dot the lenses up beforehand?

  2. #2
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    In my store

    Poor vison thru a PAL is *always* the Rx that is to be suspected.

    Barry

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    First thing I do with any px complaining about a problem with their vision is check the Rx. PALs or not. With pals, I dot them up, varify the Rx, then make sure the frame is fitting properly. Depending on wether that makes a difference, I'll check PD's and segs (the ones taken, not if they're to order) and go from there.

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    Master OptiBoarder OptiBoard Gold Supporter DragonLensmanWV's Avatar
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    To check a progressive you will need to first mark it up and check decentration and RX. IMO a Humphrey's will do an exceeding horrible job. Use a manual or semi-automatic lensometer and check several mm above the fitting cross. If they have prism thinning your target will of course not be centered vertically, though it should be centered horizontally. If they have prism thinning, note the amount by reading the strongest powered lens first and them moving to the other lens. The vertical displacement must be the same (within tolerance) when you move to the weaker lens. Though your target won't be centered, you can read the power correctly. I have seen jobs come back from the Dr's office with horrible notes about how off power this job is with excessive cyl and way off axis, etc. only to see their receptionist had stuck them in an autolensometer and even included the dots - halfway down and outside of the corridor. Yeesh!
    DragonlensmanWV N.A.O.L.
    "There is nothing patriotic about hating your government or pretending you can hate your government but love your country."

  5. #5
    OptiBoardaholic Scott R's Avatar
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    I leave the fitting cross on the lens so when I dispense i can make any little adjustments with a visual of the target. Best way I found to troubleshoot new pals is to compair the fit with the old pals. When possible I like to compair the fit of the old lenses the patient was happy with.

  6. #6
    OptiBoard Professional Kyle's Avatar
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    Just a quick, obvious question...

    What do you mean by "poor vision"? How did the "poor vision" manifest?

    It's absolutely the case that you should check for lens accuracy but that may not be the problem at all. More information is needed.

    k

  7. #7
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    Morons rule the world!

    Quote Originally Posted by DragonLensmanWV View Post
    To check a progressive you will need to first mark it up and check decentration and RX. IMO a Humphrey's will do an exceeding horrible job. Use a manual or semi-automatic lensometer and check several mm above the fitting cross. If they have prism thinning your target will of course not be centered vertically, though it should be centered horizontally. If they have prism thinning, note the amount by reading the strongest powered lens first and them moving to the other lens. The vertical displacement must be the same (within tolerance) when you move to the weaker lens. Though your target won't be centered, you can read the power correctly. I have seen jobs come back from the Dr's office with horrible notes about how off power this job is with excessive cyl and way off axis, etc. only to see their receptionist had stuck them in an autolensometer and even included the dots - halfway down and outside of the corridor. Yeesh!
    Throw in about 4 prism out OU and see how bad things get. I know, I just went thru this. The patient said that the Dr.'s and all of his staff read the glasses and how innacurate they were. The note was rather unpleasent as well. I showed the patient how we check progressive(Lensometry 101), she saw how we marked the engravings, etc. She actually understood how the rx was correct and she saw the correct prism too! Then she says, "Well....they said you made them wrong"! I asked if she could read them and see how they were made correctly "Yes". I asked again.."Did I make them wrong?". She thought about and said "Well, they said you made them wrong!"

    Conclusion: Lady, here is your money back, get lost and don't darken my doorway again! Next in line..please step up!

    :shiner::cheers::shiner:

  8. #8
    OptiBoard Professional Kyle's Avatar
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    Quote Originally Posted by DragonLensmanWV View Post
    If they have prism thinning your target will of course not be centered vertically, though it should be centered horizontally... Though your target won't be centered, you can read the power correctly.
    The optical centers will only be "on" pd at the MRP's folks. They will NOT necessarily be centered at the distance reference. This is why we check horizontal/vertical prism at the MRP and NOT the fitting cross.

    As far as your OC's being "too low" or "too high" to read, this is why they make prism rings. :bbg:

    And Fezz, why didn't you just call the Dr's office to find out what they meant by "incorrect"? It sounds like there must have been a clerical error somewhere or someone at the Dr's office just didn't know how to read PAL's. That or they have a different, less informed understanding of their function.

    I offer a free seminar to all surrounding (non-dispensing) MD's on proper lens neutralization as it relates to power and type. If they encounter a problem job I also offer to help them solve the problem for free. I get less #$%@ back that way and it seriously improve my referrals.

  9. #9
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    Quote Originally Posted by Kyle View Post
    And Fezz, why didn't you just call the Dr's office to find out what they meant by "incorrect"? It sounds like there must have been a clerical error somewhere or someone at the Dr's office just didn't know how to read PAL's. That or they have a different, less informed understanding of their function.

    They were not only "incorrect", but WRONG and INNACURATE as well. Their note that I mentioned was rather detailed. Basically-everything was wrong. Power off, add wrong(keep in mind-it is engraved=correct), prism was up and down-not out OU like they rx'd, wrong AR coat, you name it...they were WRONG!

    Life is too short to try to educate MORONS.

  10. #10
    OptiBoard Professional Kyle's Avatar
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    Exclamation sorry to elaborate off topic but...

    Fezz, I completely respect your position regarding that note/patient and am only offering the following for other, less experienced Optiboarders as I think your scenario isn't as uncommon as we'd like. I've had plenty of beligerent patients stand on their particular patch of higher ground just because they couldn't reach or even see the mountain that towered over them. People act like sheep sometimes.

    Power off - This is ridiculously easy to do if you don't know how to mark up and correctly read a PAL.

    Add wrong - Also an easy mistake to make for the same reason (and I actually HAVE seen a mismarked lens or two in my day).

    Prism was up and down-not out OU like they rx'd - Lenses may have prism thinning which might skew anticipated results (were there prescribed vertical prism) but as far as horizontal goes, if they didn't know to mark up the lenses and check from the MRP, they would very easily have read the horizontal incorrectly and if there was ANY aniso, they could have picked up a vertical imbalance, depending on where they measured from. Heck, something as simple as not understanding what "O.U." means could have led them to inadvertently misprescribe the rx or misread the lenses.

    Wrong AR - The Dr.'s staff may have a different understanding of what an "anti-glare" coating is. 'Glare' is such an ambiguous term when uttered by a patient. Perhaps the Dr.'s employee expected the lenses to be tinted/UV treated/Transitions or something of the sort.

    In my book, a note like what Fezz received mandates an immediate and potentially stern call to the Dr.'s office. The last thing I want is some newbie hotshot ruining my reputation because of inexperience. That the patient got caught up in believing their doctor over their optician isn't unusual - just not so appropriate, especially in this case.

    Not only that, I'm in the business to help consumers and some wacko like the one who wrote the note seriously needs to either be immediately "de-moronified" or canned. Life might be short, but it's not so short that I can't or won't take time to protect myself or my patients, actual or potential.

    Sorry for the tangential ramble. Just thought it was prudent.

    Just my 2 cents about 4 eyes and 6th sense. I'm not a betting man, but I'm pretty sure I'd pocket the 8 and make at least a Yankee dime.

  11. #11
    Master OptiBoarder
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    You got Gusto Man!

    Hey Kyle.....

    ................I like your style.

    Good post!

  12. #12
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    Manual lensometry reading!!

    Hi,

    I work as an Optometric Technician and i do've to check lenses using Auto lensometer.. But I've had some probs w/ the Prog more than bifocals. Whenever i read a prog.. it comes w/ .25dwn.. Y is that? I'm ok on reading single vision lenses on Manual lensometer but i really need more help in doing the prog,bifocals,trifocals.. Is there a step by step manual for it? :idea:

    Thanks.
    Mary Jacob
    AS, ABO-C, NCLE-C

  13. #13
    Optician Extraordinaire
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    Quote Originally Posted by mjacob View Post
    I'm ok on reading single vision lenses on Manual lensometer but i really need more help in doing the prog,bifocals,trifocals.. Is there a step by step manual for it? :idea:

    Thanks.
    Is there anyone you work with that could teach you?

  14. #14
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    No Offense Mary

    This is why so many patients have problems, Opthalmic tech doing the jobs of Opticians. Doctors will have untrained staff trying to learn on optiboard how to neutralize , fit and dispense eyewear. The manual is in college.

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    Bad address email on file sharonm516's Avatar
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    Quote Originally Posted by Opticianjw View Post
    This is why so many patients have problems, Opthalmic tech doing the jobs of Opticians. Doctors will have untrained staff trying to learn on optiboard how to neutralize , fit and dispense eyewear. The manual is in college.
    Im an ophthalmic technician....and I can read glasses very well. I also am ABOC and NCLEC. Technicians are just as well qualified as an optician when taught. All she needs is to be taught....damn.

  17. #17
    Optician Extraordinaire
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    Quote Originally Posted by sharonm516 View Post
    Im an ophthalmic technician....and I can read glasses very well. I also am ABOC and NCLEC. Technicians are just as well qualified as an optician when taught. All she needs is to be taught....damn.
    Yes, I agree. And Fezz, that's a great link!

  18. #18
    bilateral peripheral scotoma LandLord's Avatar
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    What is the Rx?
    What type of correction was the patient wearing before?
    What are the symptoms?
    Sent from my BlackBerry® wireless device

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