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Thread: Nauseous Myope in PAL??

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    Confused Nauseous Myope in PAL??

    Hello all...I need help with this one...any comments/suggestions would be much appreciated.

    OK, here it goes...I have a high minus OD -12.00sph OS -12.00 -1.00 x 135 ADD +2.50. Wears contacts the majority of the time, however doc is recommending this pt wear their glasses more than they have been. I ordered a 1.70 PAL, pt came in to pick up and literally started sweating and became nauseous while trying them on, and wouldn't leave them on for any real length of time......I'm not sure what to do?? Pt says it feels like looking through a tunnel....reading was great, only issue seems to be with the distance. The pt wanted to take them home (pt picked up on Sat) and try them over the weekend, today I am going to touch base and see how it went, but based on Sat, I truly doubt that it went much better at home. Anyway, the bottom line is...this is a first for me...never had anyone with such and adverse reaction to a PAL..so, any info anyone can give me will be helpful!:)

    Thanks!
    Heather

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    Any patient at this high of an Rx and even lower who habitually wears contacts may and probably will experience this. Is this the first PAL? If so even worse. The doc may have to back down on the Rx. What were the patien's old glasses? What differences can you find between the old accepted glasses and the new ones? Trying as much as possible to replicate the old frame fit helps. Back in the chair for this one and a little trouble shooting by the optician with vertex distance etc. What is the contact lens power?

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    Thanks for your response...As far as a PAL...this is the 2nd, had trouble with the first as well (from another dispensary)...so of course, I had a red flag to begin with...but, since the pt didn't have a pair of old glasses to reference, I went with what the doc prescribed for vertex distance..9mm. I'm not sure of contact RX, I will get more info from doc about that. One thing that I did, was a roll & polish...would that make it unbearable to wear?

    Again, thanks for the information!

    Heather

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Wow! No previous pair of glasses to reference? How long has he been in contacts only?

    Yes- The polish can create more problems but I don't think that's the main issue here. What PAL do you have him in?

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    Hello, UncleFester...

    Yeah, I know no previous pair...makes ya wonder, huh??:drop:
    I used a 1.70 Tokai (not sure of spelling on this one, sorry!)..got any thoughts??

    Thanks
    Heather

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    I'm thinking to walk before you run as this as you know is expensive experimentation.;)

    Any chance you could talk him into simple distance 1.6 in a small round or oval that if vision is good can be tinted to suns (at no additional charge!).

    If that works then it's not the rx but the progressive. I suspect however the poor guy is being whacked with way too many distortions. A lined bifocal may be the best solution. For what it's worth I'd go with a Three rivers Optical round seg 1.6 as higher indexes create more and more problems IMHO, for someone who's not in them all the time. They also look almost like a blended as TRO does very nice work on these kinds of strong powers.

    I'm not familiar with this RSE Optics lens but as I said I think this is optical overload for someone who has a natural focus right where all the progressive distortion are.

    If the CL's are gas perms we also have corneal changes that create even more problems.:shiner:
    Good luck.
    Last edited by Uncle Fester; 05-13-2008 at 02:53 PM. Reason: compliment to TRO...

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    Remember the patient (in rigid contacts) see with almost no distortion on eye excersions. With a -12.00 spectacle patient will have about 25 degrees with no distortion after that things go to it in an handbasket fast. Next you will have about 14-17% reduction in size of everything in spectacles. All of this is increased by the higher index, flatter curve lenses. So now you want to add a progressive, which is kind of a controlled abberattion in itself.
    Your situation would be improved if the patient had soft contacts on not only from the lack of corneal distortion (which shouldn't be present in a properly fitted rigid lens anyway) but the patient will used to not haveing his cylinder corrected and a certian amount of distortion from the bending of the soft contact. This would make it easier for him to adapt to distortions in spectacles.
    When any myope over about six diopters takes their contacts off and puts spectacles on, amoung other things table tops look curved. Think of what it's like for a 12 diopter myope.
    You got a heep 'o trouble hear babe.

    Chip

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Chip- I'm speculating he's in RGP's. Good info!

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    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    I agree with Fester about the higher index lens materials. They introduce more off-axis distortion and decrease light transmission, even with AR. And, as much as I figure I can solve any puzzle :hammer:, if a patient comes to me who's had problems with progressives before and has an Rx like that, I'd talk long and hard with my OD about whether (s)he would consider recommending a bifocal instead.

    If I ended up making a progressive for this patient and were trouble-shooting this, here are the questions I'd ask myself:

    1) Is there a progressive in a 1.6 that's available in that Rx and that has excellent quality aspheric optics? Even better, does it have a 0mm drop to the corridor, thus minimizing the effective prism when the patient looks through the fitting center?

    2) What is my OD's refractive vertex? What is the frame vertex? Did I compensate the Rx correctly (checking with Darryl's OptiCampus calculator)?

    3) Did I check vertical imbalance at the prism line and was it within 1/2 diopter?

    4) Have I checked panto and face form? Did I experiment with adjusting one/both to see if the patient's vision and comfort improved?

    5) Does the patient have realistic expectations about what a progressive will actually do for him/her and what its limitations are?

    I also agree that roll and polish exacerbates the inevitable abberations as one gets toward the edge of the lens.

    This is a bear. Chip pegged the issues in the first sentence of his post. Maybe a "non-adapt" to a bifocal, like the one Fester mentioned, is the way to go -- unless the patient is really stuck on having a progressive (as the expression goes) "come **** or high water."

    PS: Where in NC are you?
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

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    Oh, my...Thank you all soo much for the feedback! I knew after reading through the posts that this was the BEST place to ask questions!! You all have given me so much great information, I feel like I can really get to the bottom of this and get my pt something great!:cheers:CHEERS to you!!

    The pt is going back to see the doc on Thurs...I talked to her yesterday, she says the reading is no problem, just distance, can't keep them on more than 10 minutes at a time. Bottom line is, she is willing to work with me and the doc to find a solution that fits her needs...THANK-GOODNESS!
    So, although the RX is a little complicated, I am glad that she is willing and agreeable!

    Also, I put in a call to the doc yesterday, I want to talk to him as well, find out some contact lens info...I know that she is in a soft lens...not sure which one or the power...I asked the pt, but, well, she didn't know either...so I'll have to rely on those answers from the doc...

    Well, again thank you all so much for the feedback...I'm sure I'll have more questions before this is all over!:o

    ~Heather

    PS..Andrew, to answer your question, I'm in Fuquay-Varina...opened an optical here a few months ago.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    I also agree that roll and polish exacerbates the inevitable abberations as one gets toward the edge of the lens.
    Consider roll and "satin" polish for enhanced cosmetics of the lenses in profile.

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    ABO-AC, NCLE-AC, LDO-NV bob_f_aboc's Avatar
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    I had a pt several months ago -7.00 -5.25 ish OU with a 2.50 add. Put him in 1.7 and he couldn't stand it. At Dr. suggestion, remade to 1.67, better but not good. Pt brought his old glasses in, Rx within .25 OU to the old ones but CR-39 and in a 5.25 base curve. Finally got him happy with a Trivex PAL in 5.25 base.

    I have no scientific reason for this, but it seemed to work on him. Of course his old glasses were LC 1 hour, probably made with whatever BC was in stock at the time.

    My 2 cents

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    Bob: You didn't say, was patient happy with his old glasses? Could he see well out of them?

    Chip

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    Quote Originally Posted by bob_f_aboc View Post
    I had a pt several months ago -7.00 -5.25 ish OU with a 2.50 add. Put him in 1.7 and he couldn't stand it. At Dr. suggestion, remade to 1.67, better but not good. Pt brought his old glasses in, Rx within .25 OU to the old ones but CR-39 and in a 5.25 base curve. Finally got him happy with a Trivex PAL in 5.25 base.
    I HATE that patients don't bring their current glasses with them when they order new ones. Especially with progressives and stronger prescriptions I really like to see what they were wearing.

    If I make glasses for someone and they have problems for an unknown reason- I always make them bring their old glasses in before I remake them.

    If this patient has another pair of glasses, even if they have problems with them, don't redo the new ones until you see the old ones.

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    HappyLady is right on here.

    I DO NOT make new spectacles for Red Flaggers, high rx's, gas permer's, etc, until I see where they are coming from rx, base curve, material, size, adjustment, etc on old pairs. I get the patient WAY involved in their expectations, needs, wants, etc.

    An informed patient and dispenser make a much better eyewear development TEAM.

    Life is too short and has enough problems. I try to limit my problems to my own DEMONS-not someone elses!!!!

    :cheers::cheers::cheers::cheers:

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    yep, I agree with all of you with regards to bringing old eyewear ("working" or not!) I knew better than to even start this, without seeing her old specs. I'm going to see my pt today and do what I should have done to start with!...I'll chalk this up to one of my MANY learning experiences :shiner:
    After all, you know what they say...if it don't kill ya, it'll make ya stronger...or was it crazy..can't remember, I think it's the same thing, really! :shiner: + :hammer:=:idea:


    Have a great day!

    Heather

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    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Quote Originally Posted by Fezz View Post

    An informed patient and dispenser make a much better eyewear development TEAM.
    A perfect statement of the perfect dispensing philosophy. Thanks, Fezz. :cheers:
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

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    ABO-AC, NCLE-AC, LDO-NV bob_f_aboc's Avatar
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    Quote Originally Posted by chip anderson View Post
    Bob: You didn't say, was patient happy with his old glasses? Could he see well out of them?

    Chip
    Chip,

    He absolutely loved the vision with the old lenses, but hated the weight and thickness of his lenses. Hence the initial 1.7 recommendation by the doc. (Love it when docs try to do my job for me) Vision was good finally with Trivex and he was marginally happy with the reduction in thickness and weight.

    Bob

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    Master OptiBoarder OptiBoard Gold Supporter DragonLensmanWV's Avatar
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    Quote Originally Posted by Heather A View Post
    Hello, UncleFester...

    Yeah, I know no previous pair...makes ya wonder, huh??:drop:
    I used a 1.70 Tokai (not sure of spelling on this one, sorry!)..got any thoughts??

    Thanks
    Heather
    I'm a slightly higher myope than him, and I use the Tokai progressive and like it just fine. But I've never worn contacts and his vision will not be as good in any lens and frame as it will be in contacts.
    DragonlensmanWV N.A.O.L.
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    Quote Originally Posted by DragonLensmanWV View Post
    I'm a slightly higher myope than him, and I use the Tokai progressive and like it just fine. But I've never worn contacts and his vision will not be as good in any lens and frame as it will be in contacts.
    Yep, I've heard good things about the Tokai...I talked to the doc about this pt yesterday...they are still trying to figure out her RX...seems there is more here than meets the eye (sorry about the pun! :D) turns out, the pts RX has "doubled" within the last yr with no known reason at this point..doc says he has to do some more testing then get back to me with more information.

    Have a great day!
    ___________________________________________

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    Thumbs up This is old, but....

    Hi all, just wanted to give you the update on this one...We ended up putting her in a FT28 1.67 (smaller frame, no edge polish this time) and it worked out very well for her...she was able to keep them on this time (no vomit bag needed!! hee hee! that'll help keep my costs down! :D)

    Thanks again for all of your comments and suggestions, you all were great help! :cheers::cheers::cheers::cheers:

    Have a great day!
    ~ Heather
    ___________________________________________

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    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Hey Heather,

    I'm glad it all worked out. Enjoying the steam-oven we call July?
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Quote Originally Posted by Andrew Weiss View Post
    Hey Heather,

    I'm glad it all worked out. Enjoying the steam-oven we call July?
    I'm glad as well. Too often we don't hear back and I love the feedback. Good, bad or indifferent as it helps my never ending optical education!:cheers:
    Can't resist- Andrew- The front went through last night and our Canadian friends have sent us a cloudless low humidity day in the low eighties! A perfect summer day. Oh wait I'm indoors at work until 7.

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    Thanks, guys..I'm like you, I love feedback...sometimes it "hurts" for a minute, but no matter what kind it is..it gets me thinking! :idea:

    Yes, I am enjoying the steaminess of NC...from my air-conditioned shop of course! :) Although, I have to admit it hasn't seemed quite as hot as in the past..I think it's because of all the storms this past week. OK, now that I've said that, I'm sure I've jinxed it for all of NC...we'll be all hot and steamy again soon..sorry! :hammer:
    ___________________________________________

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    Thanks for letting us know what happened. I'm glad you were able to make some that worked out for her. :)

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