Help me troubleshoot, please

[MarcE]

Here are the specifics:

75yo lady, long time PAL wearer, comes in wearing:
Rt: +1.37 -0.37 x 87
Lf: +1.67 -0.75 x 70
PD (taken from lens): 30.0/29.5
Ovation Poly w/ a 2.50 add. Fit at 16mm high so it's reading a +2.25. She is happy w/ vision overall, but wanted new specs and a larger reading area. Specs are 2 yrs old.

New Rx:
Rt: +1.25 -0.75 x 090
Lf: +1.75 -1.00 x 080
2.50 add.
PD (measured multiple times):29.5/31.5
Fit with an Accolade poly @ 20mm high, full 2.50 add present and Rx is spot on except left reads an axis of 078.

Cataract (not ready for removal) OD, pseudoaphakic OS. Good refractionist (ours), Rx already rechecked.

Subjective: Can't see clearly OU, OS worse than OD. Binocular worse than OD. Seems to have trouble w/ every part of the lens, and can't find a clear spot. Worse with reading.

I don't see any warpage in the lens.

She is very picky, visually. She really likes us and so does her whole family. I don't think she is mental. She is willling to work through this, even though we have remade them twice. These are the first specs ordered from us. She doesn't have buyers remorse - that's not the issue. She tells it like it is, so I don't think there is an unspoken agenda.

So the left PD is too wide, right? But we measured it many times with different pupilometers and by doting lenses. All readings were between 32.0 and 31.0.

Does she like the BI prism induced by the previous PD that is too narrow?

I just don't like remaking a lens when I don't know what the issue is.

[kelmobud]

Hi,
Cpuld be she has PCO OS. If she is pseudophakic OS the cloudy vision could be from PCO. Have her see her Ophthamologist to evel. for YAG Laser os.
Good Luck,
Kelley

[Refractingoptician.com]

..

[Robert Martellaro]

Here are the specifics:

75yo lady, long time PAL wearer, comes in wearing:
Rt: +1.37 -0.37 x 87
Lf: +1.67 -0.75 x 70
PD (taken from lens): 30.0/29.5
Ovation Poly w/ a 2.50 add. Fit at 16mm high so it's reading a +2.25. She is happy w/ vision overall, but wanted new specs and a larger reading area. Specs are 2 yrs old.

I wouldn't concentrate too much on her request for a larger reading area. If you shorten the corridor and use a wider near design (piccolo, XS,etc.) you'll lose most of the intermediate, which might not be an issue, and potentially compromise the quality of vision on the distance gaze, which is an issue. Give some thought to readers or segmented multifocals if there are extended periods of close tasks. Check her reading distance- due to habit or phyiscal size, some folks will hold the book at 14", others at 19". Tweak the Add as needed.

New Rx:
Rt: +1.25 -0.75 x 090
Lf: +1.75 -1.00 x 080
2.50 add.
PD (measured multiple times):29.5/31.5
Fit with an Accolade poly @ 20mm high, full 2.50 add present and Rx is spot on except left reads an axis of 078.

Cataract (not ready for removal) OD, pseudoaphakic OS. Good refractionist (ours), Rx already rechecked.

Is that a nuclear cataract? The less plus/more minus change can upset the intermediate vision even though the distance is improved. She might be picking up on the decreased clarity at intermediate distances. Point out that this is normal, a trade-off so to speak. It's usually a grin and bear it type situation, although if she dosen't drive, then some compromise on the Rx might be the best bet.

Subjective: Can't see clearly OU, OS worse than OD. Binocular worse than OD. Seems to have trouble w/ every part of the lens, and can't find a clear spot. Worse with reading.

I'd need to know the BCVA of each eye. The better vision in the right might be normal. Her expectations might be too high in the operated eye. 20/20 would be nice, but 20/25 is typical.

She is very picky, visually. She really likes us and so does her whole family. I don't think she is mental. She is willling to work through this, even though we have remade them twice. These are the first specs ordered from us. She doesn't have buyers remorse - that's not the issue. She tells it like it is, so I don't think there is an unspoken agenda.

Ok. But make sure she realizes that she's not going to see as well as she did twenty years ago. Drive it home, even if it hurts.

However, she should certainly see as well as the old glasses, probably better considering the seg height was 16mm. What were they thinking?

So the left PD is too wide, right? But we measured it many times with different pupilometers and by doting lenses. All readings were between 32.0 and 31.0.

Trust your skills. Put the fitting cross center pupil. Don't compromise.

Does she like the BI prism induced by the previous PD that is too narrow?

Extremely unlikely due to the miniscule amount of induced prism. Look elsewhere.

I just don't like remaking a lens when I don't know what the issue is.

No kidding. When there's pathology, you need to factor in patient expectations along with providing optimum optical performance when determing if you've done all you can do. It's a tough call sometimes, that's for sure.

In general, except for the cut plus in the right eye, it looks like the primary difference between old and new is the change in lens brand and design. I would try a nice German lens; ie, GT or Life (now called AT?) and would strongly consider their direct-to-surface free-form designs, and if you do so, Hoya's ID should be on the table along with the above.

Hope this helps,

[Just Optician]

Just switch her back to an ovation lens and she'll be happy. I don't know why but every ovation wearer that I tried to change I ended up eating the job.

good luck

[Robert Martellaro]

Just switch her back to an ovation lens and she'll be happy. I don't know why but every ovation wearer that I tried to change I ended up eating the job.

good luck

Yeah, Essilor impregnates their lenses with an opiate like substance that off-gasses through the wearers eyes, creating a physical dependency to the lens.

I only wear mine on the weekends.:)

[Happylady]

Just switch her back to an ovation lens and she'll be happy. I don't know why but every ovation wearer that I tried to change I ended up eating the job.

good luck

I agree, if you remake again, switch her back.

[Uncle Fester]

Just switch her back to an ovation lens and she'll be happy. I don't know why but every ovation wearer that I tried to change I ended up eating the job.

good luck

Ditto

PS Welcome to the Optiboard Just Optician:cheers::cheers:

[Jubilee]

Yeah, Essilor impregnates their lenses with an opiate like substance that off-gasses through the wearers eyes, creating a physical dependency to the lens.

I only wear mine on the weekends.:)

That would explain so much wouldn't it?!?

The Crack of Optics...

[MarcE]

Just switch her back to an ovation lens and she'll be happy. I don't know why but every ovation wearer that I tried to change I ended up eating the job.

good luck

I've been changing ovation wearers to Accolade consistantly for 4 months. All OK, must more satisfied. Same fitting corridor length, nearly same BCs, same mfg. It's actually the update to the Ovation.

But rest assured, when we remake, it will be an ovation.

I'm sure it's not the cataract causing problems. She can't see as well with new ones as with the old ones.

I also enjoy my essilor lenses only "recreationally":D

[Kyle]

Have you trialed her new OS SRX with the axis changed back to her original? I mean, you changed her axis 10 degrees, increased the Cyl by 33% AND moved the OC out by 2mm. This could create some "swim" for sure, especially if she's sensitive.

Also, when you checked the OC's on the original PAL, did you find and mark them with your lensometer or just measure from the anticipated location of the MRP?

Finally, and forgive me if I'm wrong, do you know whether the old PAL is definitely an Ovation or could it be an Essilor SmallFit, which has practically identical markings? This would make sense considering the fitting height.

Just wondering...

Kyle

[Barry Santini]

Hope this helps,

Really, REALLY EXCELLENT thoughts and reply, Robert!

Barry

[bhess25]

mabye someone mentioned this (i didnt read all of the comments) but it could be as simple as the PD..if she was wearing the old ones at that measured PD she may have just gotten use to that, try going back to that old PD, even in a new lens she should be able to see just fine...its amazing how the body can adapt, and how hard it is to re-adapt.

[Fleming]

ROBERT...

Originally Posted by Robert Martellaro
Yeah, Essilor impregnates their lenses with an opiate like substance that off-gasses through the wearers eyes, creating a physical dependency to the lens.

I only wear mine on the weekends.:)

that was truely beautiful .... I haven't laughed in two days .....Thanks
Fleming

[rdcoach5]

If you have trial lenses, see what taking off 0.25 of cyl does. As a rule of thumb, you never get used to too much cyl. A quick way to see if the left PD is bothering the pt is to take the lenses out of the frame, spot the centers amd hold them in front of her eyes. Some of my recent remakes to great free-form designs like Definity and Identity have been solved by a change of 1mm in PD. Of course ck B.C. and CT and Panto.

[Fleming]

mabye someone mentioned this (i didnt read all of the comments) but it could be as simple as the PD..if she was wearing the old ones at that measured PD she may have just gotten use to that, try going back to that old PD, even in a new lens she should be able to see just fine...its amazing how the body can adapt, and how hard it is to re-adapt.

If you have trial lenses, see what taking off 0.25 of cyl does. As a rule of thumb, you never get used to too much cyl. A quick way to see if the left PD is bothering the pt is to take the lenses out of the frame, spot the centers amd hold them in front of her eyes. Some of my recent remakes to great free-form designs like Definity and Identity have been solved by a change of 1mm in PD. Of course ck B.C. and CT and Panto.

I totally agree, the problem usually lies in the fine details, especially on grooved frames (semi rimless) Some Off site labs seem to get the pd too wide (1 to 2 mm) for some reason. Yes, I have had patients adapt to an incorrect pd (induced prism - and had to wean them back to correct pd over time. Every one have a Great (and a safe) New Year.