HELP me solve this puzzle- CURVES?

**misstara007** · 04-17-2009, 12:19 PM

Hey Optiboarders- Any help would be greatly appreciated!

Here's the scoop:

Dr. precribes New Pt. 1st time PAL
Old frame: 2.5 degress of wrap
Old SV Rx: -2.75+1.50x10
-1.75+1.00x 178

PAL Style: Hoyalux ID Life style 1.67 w/ SHV
New frame 5 degress of wrap
New Rx: -3.00 +1.75 x 12
-1.75+1.00x180
+1.50Add

When dispensing the PAL, pt. puts them on and becomes VERY disoriented and unhappy- blurry distance, and a swimmng sensation. After checking the measurements and(we had time in the schedule for the OD to even recheck the RX) everything checks out.

I advised him to take them home and try them out. He did. I get a phone call in about 10 days with complaints of non-adaption.

So we move him into SV.

He came in to pick those up today and I thought foir sure he'd be a happy camper and we'd call it a day- but he puts the new pair on and says everything is blurry and he cannot read. He puts his old glasses on and says I can see great in the distance and read fine. Which leads me to think that its the curve. Which also makes me wonder if he didnt like the PAL's because of this issue as well.

He wore them in the office for a while, with no change. But I advised him to try them out to see if he can get used to the curvature. And if he doesnt, we will scrap the whole deal and Reframe style (something very close to his current frame)and match basecureves- the whole she-bang.

Its frustrating because #1-We have to incur more costs to make him happy. #2 He has to go outta his way. #3 I still dont know if even THAT will work.

What to do, What to do???

Any help guys? Thanks in advance. Long story, I know. Thanks for taking the time to read it!

**obxeyeguy** · 04-17-2009, 12:38 PM

What was the material on his 1st pair of SV? I'm thinking the 1.67 is the problem, and a tad overkill for that rx. JMHO

**misstara007** · 04-17-2009, 12:40 PM

Not sure. New patient. Probably Poly.

**optical24/7** · 04-17-2009, 01:22 PM

Consider checking the differences between old and new pair:

B.C.'s
Panto
vertex
PD and vertical placement.

I'd also consider switching to 1.60

**misstara007** · 04-17-2009, 01:27 PM

B.C.'s
Panto
vertex
PD and vertical placement.

I'd also consider switching to 1.60

These are all things that I will do if it comes to re frame styling him.

**Dave Nelson** · 04-17-2009, 01:34 PM

In addition to all the previous parameters to double check, pay very close attention to the curvature of the frame front, often referred to as "wrap," compared to the old frames. An increase in index combined with less frame front curvature is virtually guaranteed to cause adaption problems.

**AdmiralKnight** · 04-17-2009, 01:44 PM

Wait, I'm confused... why would you restyle him instead of fixing the problem with the lenses? The frame would be the bottom of the list of things causing his problem. If you check these differences, you'll have a better idea of what's wrong, and possibly be able to fix the issue!

**misstara007** · 04-17-2009, 01:46 PM

Yes- there was a significant difference in"frame wrap" between the old and new - And the high index combination- You're saying that's the problem? -Well I guess I should reframe style him then- because there's no changing the wrap of the frame he chose.

**misstara007** · 04-17-2009, 01:55 PM

Becuase the frame has so much wrap- I would have to reframe style him to achieve flatter lenses- RIGHT? if in fact curvature is the issue here.

**Refractingoptician.com** · 04-17-2009, 02:13 PM

Originally Posted by misstara007

Becuase the frame has so much wrap- I would have to reframe style him to achieve flatter lenses- RIGHT? if in fact curvature is the issue here.

I would like to suggest that you do not include your real name and the name of your business in a forum that is open to public viewing .

If you include your name and address consider doing it in the Eye Care Professionals Only forum

**AdmiralKnight** · 04-17-2009, 02:56 PM

Originally Posted by misstara007

Becuase the frame has so much wrap- I would have to reframe style him to achieve flatter lenses- RIGHT? if in fact curvature is the issue here.

That's the thing Tara, it's hard to know what the issue is without knowing what differences there are between the old and new. Sure, it could be the curvature, but you should try to get all the info before deciding what to do.

**Dave Nelson** · 04-17-2009, 03:41 PM

There are a number of possible causes for adaptation problems, most of them mentioned here on this thread. Changes in frame curve and panto are the first things to try, not because they are the most likely, but because they are the easiest things to eliminate before moving on to changing lenses or frames.

**libellule** · 04-17-2009, 04:12 PM

One question I would have is how did you measure the 'frame wrap' of the old and new frames? If you measured the old glasses with a lens clock you are measuring the front base curve of the lenses...not the frame. You would have to remove the lenses from the frame to accurately measure the amount of wrap of the frame alone....

The frame base will be effected by the front BC of the lenses, when mounted. So its important to compare the old and new with an eye to detail...

And I agree that 1.67 is overkill in this RX..the ID Lifestyle is available in Trivex...would have been better to start there. What material did you use for the SV? I like 1.6 ...seems to be going out of style these days but is a good option.

**Dave Nelson** · 04-17-2009, 05:32 PM

Putting a lens clock on an empty frame to measure frame wrap is a trick I'd like to see. Frame wrap is usually just eyeballed to see if there is any noticable difference, although you can often use a ruler placed on the backside of the frame and see how far off the nasal part of the frame is from the ruler. You are not really looking for the "frame base" as you call it, but rather, the overall curve of the frame and lenses as a whole, which means the bridge can be used to add or subtract some wrap.
Bevel placement can also be used to give the eyewire some wrap with a very low BC, as well as remove some with lenses that have a higher BC.

**libellule** · 04-17-2009, 06:53 PM

"Putting a lens clock on an empty frame to measure frame wrap is a trick I'd like to see. Frame wrap is usually just eyeballed to see if there is any noticable difference, although you can often use a ruler placed on the backside of the frame and see how far off the nasal part of the frame is from the ruler. You are not really looking for the "frame base" as you call it, but rather, the overall curve of the frame and lenses as a whole, which means the bridge can be used to add or subtract some wrap."

Dave....I think this is one of those times when you really need to read the context...do you really imagine that I was suggesting she put a lens clock on a frame? Give a girl a little credit, please...and I call it 'frame base' because that is how you will find it listed in the manufacturer's catalogs and I was actually trying to point out just what you said....it is the overall curvature of finished frame and lenses that the person asking the question should be comparing between the old and new glasses.

But you do make a good point about using the bridge to add or subtract a bit of curve.

**sharpstick777** · 04-17-2009, 07:56 PM

Originally Posted by optical24/7

Consider checking the differences between old and new pair:

B.C.'s
Panto
vertex
PD and vertical placement.

I'd also consider switching to 1.60

I have had a lot of patients non-adapt to 1.67., I would switch to Trivex too. The Lifestyle ID is a very good lens (wearing one now).

**Uncle Fester** · 04-17-2009, 10:03 PM

Originally Posted by libellule

"Putting a lens clock on an empty frame to measure frame wrap is a trick I'd like to see. Frame wrap is usually just eyeballed to see if there is any noticable difference, although you can often use a ruler placed on the backside of the frame and see how far off the nasal part of the frame is from the ruler.

Can someone provide a link to I believe Darryl's printable "wrap" chart?

libellule-You're right it doesn't involve a lens clock!

Hope this helps to be more accurate--To determine wrap place one lens of the frame flush to the 180 line. The wrap in degrees is shown by the other lens.

**optical24/7** · 04-18-2009, 08:40 AM

I use a simple protractor to determine the degree of wrap.

**YrahG** · 04-18-2009, 01:04 PM

Originally Posted by misstara007

Yes- there was a significant difference in"frame wrap" between the old and new - And the high index combination- You're saying that's the problem? -Well I guess I should reframe style him then- because there's no changing the wrap of the frame he chose.

Hi, I'm new here but I don't think a 2.5 degree change is going to be that noticeable in this prescription. Maybe it's the lens design, try a free form lens. Material may not be a probelm either if the patient used to wearing poly, the prescription too low for problems with material. Base curve maybe, patients get used to base curve sthat they wear even if it's not the right base curve. We say match base curve but what we really mean is match same error.

**obxeyeguy** · 04-18-2009, 04:33 PM

PAL Style: Hoyalux ID Life style 1.67 w/ SHV
New frame 5 degress of wrap
New Rx: -3.00 +1.75 x 12
-1.75+1.00x180
+1.50Add

Ist post.;)

**Fezz** · 04-18-2009, 04:40 PM

Isn't Curves an exercise joint?

http://www.curves.com/

:cheers::cheers::cheers::cheers::D

**chip anderson** · 04-18-2009, 11:40 PM

Bend frame out to same wrap as origional, bend temples in to keep it on his head and see if he is happy. Then look for a more cosmetic way to adjust frame to same if it solves his problem. Frames an be bent you know.

Chip

**braheem24** · 04-19-2009, 01:05 AM

Originally Posted by Fezz

Isn't Curves an exercise joint?

http://www.curves.com/

:cheers::cheers::cheers::cheers::D

Joints... beer... you tryinn' to get us all pinched? :D

PS, Anyone tried a trial frame? most myopes dont like face form and most high astigmats dont like low abbe lenses. You can confirm both with a trial frame before you restyle. good luck and make sure FEZZ dont get u drunk and high before you log-off.

**Chris Ryser** · 04-19-2009, 02:49 AM

Originally Posted by braheem24

PS, Anyone tried a trial frame? most myopes dont like face form and most high astigmats dont like low abbe lenses. You can confirm both with a trial frame before you restyle.

Originally Posted by chip anderson

Bend frame out to same wrap as origional, bend temples in to keep it on his head and see if he is happy. Then look for a more cosmetic way to adjust frame to same if it solves his problem. Frames an be bent you know.
Chip

The most logical solutions listed right above.