The true meaning of "Balance" on an Rx

[VHB]

I'll try to be brief. A new customer came in with a pair of Hoya CD lenses that she got elsewhere and said they made her dizzy and sick. I neutralized them and found that the OD read -.75 with a 1.50 add. The OS was -.25 with an add of 1.50, but the lens was cut crooked.

She didn't have her Rx with her, so I couldn't tell if they'd been made to the correct power, but when I told her that the left lens was crooked, she said that didn't matter because she has almost no vision in that eye.

She sent me her Rx today: OD -.50 add 2.50; OS Balance

She was under the impression that she was wearing poly & thinks she asked for it. But the CD was in CR39.

I said I didn't think any decent optician would fill her Rx with something other than poly or Trivex, given that "balance" means (to me at least) that the patient has only one good eye. But I don't know if "balance" legally requires the safest lenses to be used.

What do y'all think about this?

[chip anderson]

Ballance means: Something that looks and weighs similarly to the lens for the fellow (other seeing) eye. Merely this and nothing more.

Chip

[Visionista]

No, balance does not legally require a poly lens, however, many companies, including the one that I work with, do not give the patient any option besides a polycarb lens. To me, that seems like a logical thing to do, after all, if you just have one good seeing eye, wouldn't you want it protected?

[Fezz]

No, balance does not legally require a poly lens, however, many companies, including the one that I work with, do not give the patient any option besides a polycarb lens. To me, that seems like a logical thing to do, after all, if you just have one good seeing eye, wouldn't you want it protected?

Does your company allow Trivex to be used instead of polycarbonate?

[VHB]

I'm surprised that in this litigious society anyone would risk not using poly in this situation. The "duty to warn" about poly's safety is supposed to apply to people with two good eyes. It seems to me that the optician and lab have a serious liability risk here.

[Visionista]

Does your company allow Trivex to be used instead of polycarbonate?

Yes. I suppose what I should have said was, we don't allow balance lenses to use a glass or cr39 lens.

[RT]

Technically, "Duty to Warn" is not a message specifically about selling poly. "Duty to Warn" is a concept by which you should warn people that there are materials with higher impact resistance than other materials. However, it is easy to understand why people in our industry associate Duty to Warn with poly--the Polycarbonate Lens Council was instrumental in popularizing Duty to Warn as a means of promoting poly.

Both Trivex and Polycarbonate can pass the ANSI high impact test. Either could be appropriate materials for this situation.

I'm surprised that the lab supplied the balance lens as a progressive. In many cases, the lab will use SV in the balance eye.

I would place the responsibility for the lens material choice solely on the ECP who ordered it. At some point, the lab has to assume that what you ordered is, um, what you wanted.

[VHB]

The lab, in this case, is part of the chain that dispensed the glasses. I don't want to name names, but you see what I mean? It's all one company.

[Judy Canty]

Virginia or Maryland? In either case, I might be tempted to file a complaint with local cosumer protection offices. If it's a VA office, the customer can file with the State Board for Opticians.

[gemstone]

I said I didn't think any decent optician would fill her Rx ....

Poor choice of words.

[wmcdonald]

We are not certain what was told to this patient, and so we have absolutely no idea other than he said, she said. It is improper to comment about another professional unless you are certain of all the facts. For all we know, this lens that was used (the poorly cut progressive) was a reject for some reason. It is there to balance magnification and weight only. Optician X may have recommended poly, and was turned down. It has happened. A material that meets the high impact standards is the correct recommendation, and it may have been recommended for all we know. Lets don't hang another professional out to dry without all the facts.

[VHB]

She showed me her other three pairs of glasses (all single vision) and they were all poly. She mentioned poly specifically when she told me that she had no vision in her left eye. She was shocked when I told her they were not poly. So I don't think I'm jumping to any conclusions here.

[VHB]

I didn't mention that in addition to the OD being -.25 stronger than ordered, the pd was off by 7mm and was fit about 5mm too low.

[FullCircle]

Optician X may have recommended poly, and was turned down. It has happened.

Yes, I've had newly "balanced" patients, or their family members balk at polycarb. Usually it's an issue of price, granted the difference isn't all that great when you're talking about protection, but often people dont think.

What I've recommended in the past is do the poly lens (no, we don't do Trivex), explain to the patient the reason for suggesting poly then letting them know we will do the poly at the CR39 price this time and for future purchases, they'd have to pay the difference. Make a note in the file to this effect and finish helping the customer. I'd rather we ate a one time price difference for the sake of doing right by the patient.

[Judy Canty]

Warren, I agree in theory, however, given the information from Virginia, her duty is to advise the patient to seek recourse. The patient came to her with a list of problems and (perhaps) misconceptions. We can not just "fix" the problem, we must, in my opinion, "fix" the fitter and the dispenser. The only way to stop some of the foolishness that passes for Opticianry these days is to inform the patient of their rights and responsibilities.

As a side note, the major sticking point for a CE requirement for Opticians in Virginia is a lack of complaints of poor practices from consumers. Changes in Opticianry are going to have to come through consumers.

[Happylady]

I was under the impression that when an AR is added to Trivex that it loses much of it's superior impact resistance. I have read that several places. Since I sell AR to most of my patients I hesitate to use Trivex when I need a more impact resistant lens.

[ziggy]

What was the center thickness of the right lens? I have often fit ballance patients in CR-39, but I will request 3.0mm centers.

"I didn't mention that in addition to the OD being -.25 stronger than ordered, the pd was off by 7mm and was fit about 5mm too low. "

The pd being off by 7mm or being 5mm too low could be the problem -.25 off the power is meaningless.


" We can not just "fix" the problem, we must, in my opinion, "fix" the fitter and the dispenser. The only way to stop some of the foolishness that passes for Opticianry these days is to inform the patient of their rights and responsibilities.
Changes in Opticianry are going to have to come through consumers."

Amen!




'

[chip anderson]

Except for this being sloppy opticianry, the PD being off wouldn't bother a monocular patient much unless the Rx was very strong and this would make things displaced for hand-eye co-ordination.
The fellow eye would be in no danger from whatever material was in the seeing eye lens, howeve cosmetics and frame ballance might be effected.
We often pop the lens out completely and leave a cataract operated eye uncorrected until the doctor feels it's time to correct the operated eye.
I don't feel we are endangering either eye from what might pass through the empty eyewire.

Chip

[NavyChief]

I neutralized them and found that the OD read -.75 with a 1.50 add. The OS was -.25 with an add of 1.50,

She sent me her Rx today: OD -.50 add 2.50; OS Balance

How about the fact the add was a diopter off?

[LENNY]

Except for this being sloppy opticianry, the PD being off wouldn't bother a monocular patient much unless the Rx was very strong and this would make things displaced for hand-eye co-ordination.

Chip

Progressives!?

[VHB]

Thanks for pointing this out, Navy Chief. The add power in the Rx was 1.50, not 2.50.

[chip anderson]

Yes, Lenny evern with a progressive if only one eye is involve one can and will learn to turn the head until he finds a sweet spot. Not good but happens.

[Barry Santini]

"I didn't mention that in addition to the OD being -.25 stronger than ordered, the pd was off by 7mm and was fit about 5mm too low. "

Alternative: re-label the eyewear as "OTCs", and they are perfectly acceptable

" We can not just "fix" the problem, we must, in my opinion, "fix" the fitter and the dispenser.

Changes in Opticianry are going to have to come through consumers."

I respectfully disagree: changes *must* come from corporate management

Amen!

Yes, Amen!

Barry

[Judy Canty]

Corporate management will only react to sales. Change in Opticianry will come through consumers and consumer demands.

[HarryChiling]

I was under the impression that when an AR is added to Trivex that it loses much of it's superior impact resistance. I have read that several places. Since I sell AR to most of my patients I hesitate to use Trivex when I need a more impact resistant lens.

AR does reduce the impact resistance of lenses, so does using lower bases or aspherics.