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Thread: Progressive problem

  1. #1
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    Progressive problem

    Any ideas on this one please?

    Patient has same frame, same prog (Solamax), OCs and heights same but is not happy. Rx was R-4.00 L-3.75/-0.25 x 5 add 2.25, Rx now R-3.50/-0.50 x 110 L-3.25/-0.25 x 95 add 2.25.

    Says:
    Eyes smart as soon puts on.
    After a couple of days gets a low-level headache.
    Momentary difficulty focussing.
    Field of vision more restricted.

    You can tell he's picky!

    Less minus explains more restricted field, but I'm at a loss re the rest. No significant phoria. Presume front curve is the same, haven't checked but doesn't seem to relate to symptoms anyway.

    Any help would be good!

  2. #2
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    Quite an RX Change

    It could be the added cyl in the right eye, but the first thing that comes to my mind is lens material. Poly can cause those symptoms. Did we change from CR39 to Poly, or from 1.60? Verify base curves too.

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    first thing that jumps out at me is the 90 degree shift in axis in Left eye,(albeit just a -.25 cyl) plus a cyl addition to the Right eye that pt. didn't previously have.

  4. #4
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    besides the points made above, could be the change in binocular balance. Look at this as well.

    Fix/demo with trial frame!

    barry

  5. #5
    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by optocarol View Post
    Eyes smart as soon puts on.
    After a couple of days gets a low-level headache.
    Momentary difficulty focussing.
    I would expect this reaction if they were over-minused, and yet he's trending less minus! This change in Rx should feel much better than the old Rx.
    Field of vision more restricted.
    You've ruled out positional errors, so that makes me think there's a problem with the lenses, maybe the wrong base curve, waves or warpage. If everything checks out, I'm afraid you'll need to take another look at the Rx. If there's a remake, it might be a good time to consider a more refined lens like the Sola One.
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



  6. #6
    OptiWizard Yeap's Avatar
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    maybe you can try to check the dominant eye.
    agree with that the axis change may cause discomfort vision..

    just sharing my opinion, i have came across a patient who was overcorrected for 0.75 pass 5 years and once i prescribed the proper correction he has a similar complaint as well.. so a senior told that increase 0.25 at the dominant eye can solve the problem. later for a year follow up then only reduce another 0.25 to the proper correction.

    hope it helps you too..

  7. #7
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    IMHO progressives are more sensitive to RX's being slightly off than SV, expecially in cyl. I would have an RX recheck esp w/ axis. The older the patient the more sensitive they are to axis change.

    What is his VA with the old pair?

    With progressive / rx issues I always occlude one eye and check VA to localize the issue. If one eye is better than the other is probably an RX issue.

    I have also gone back to the chart when a pts RX comes out exactly 90 degrees difference. You won't believe the number of errors that occur from just dropping one digit. I just had an outside RX come in that I requested the chart for based on the new RX being so different than the old. Sure nuff, the 79 should have been 179. I always compare the current glasses on seniors with the RX when its outside the office.

    Please let us know what you find.

    sharpstick

  8. #8
    What's up? drk's Avatar
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    Well, folks, see what you think of this potential explanation:

    Let's presume that the old power (from one or both eyes) was smack dab in the middle of the base curve range to pull, and the new power is at the limit of the base curve range.

    The result? Poorer progressive performance and symptoms.


    My suggestion? Try an individualized progressive design for optimal optics. Sola HDV is the logical choice.

  9. #9
    One eye sees, the other feels OptiBoard Silver Supporter
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    Maybe. BCs for a Spectralite SolaMax are 1.25, 3.00, 5.00, and 6.50. I don't have the charts but I'd guess both Rxs would go on a +3 BC. I don't believe there would be much more oblique astigmatism with a .25 and .50 power change. Less than .125 I would think.

    Those are strong symptoms, even for a hyper sensitive individual. I'm still leaning towards a botched lens.
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



  10. #10
    Master OptiBoarder optical24/7's Avatar
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    I've gotten what I would call botched lenses also. I couldn't find anything wrong with a particular PAL. Rx change low, keeping the Pt in the same design, sometimes same frame, but the pt kept expressing complaints. Many times, a simple remake of the same exact Rx worked. I think it impossible to check every meridian and section of a PAL ( in an avg. dispensary) and can tell if something didn't go wrong during surfacing.

    When I've exhausted every possible factor, I've remaked to the original and had patients say, "Ok, this looks right now."

    fwiw..

  11. #11
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    OK, everyone, hope to address all your points - thanks for the input! Going from memory here as not at work.

    When I first saw him he said red/green was equal with the new Rx, Yesterday he said was in the red O.U. Recheck Rx found R-3.75/0.25 x 110 (probably 0.37) L-3.50 (if I R/G =)/-0.25 x 95, axes definitely correct. VA with old Rx R 6/9-2 L 6/6-2. Also did Mallet, which I don't normally have at work, found 1prism B.I., which subjectively he preferred. Base curves the same both pairs.

    He's L dominant, said he feels somewhat getting acclimatised, so decided to change L to -3.50/-0.25 x 95 1B.I. and hope!

    BTW I always use a trial frame and refract monocularly at first. :)

    If I hear any more, will let you know.

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