I had a pt the other day whoes refn was -0.75DSph /-0.75D Cyl @10 in Od and -0.50D Sph / -0.50D Cyl @170 in Os. the best corrected vision is 20/20. the pt doesnt want to wear glass he wants only contacts. my question is whether to give toric or conventional soft lens . the pt is not comfortable without any rxregarding quality of vision
Sunsign
A contientious practioner would put spherical trial lenses on pat. Then check acuity. Then check with cross cyl or at last expected cylinder over
CL and see if this gives patient a noticeable improvement of acuity.
Most practioners would just give them a spherical equilvant and hope the patient doesn't realise or find out from some one later how much better it could be.
Had one doctor (who thinks she is a competent expert and therefore specifies the contact she thinks the patient should have) Rx a spherical equilivant for a -1.75 +175 patient last week. Dumb brawd didn't even notice patient was wearing torics (which we had found years ago to be needed) at the time of Rx and cylinder had actually doubled from last exam.
Back in the early days of soft contact I had one of my practioner friends tell me the ideal CL patient was a spectacle patient that came in with about 20/50 or less so that when he saw 20/30 he would think it was so much better.
Chip
And you fellas wonder why I have gotten so bitter over the years.
Yes to torics.
You'd be correcting 50% of the error, otherwise.
Astigmatism is astigmatism, regardless of spherical error.
Re: correcting 1/2 D cylinder OS with a toric in this case:
It's better to be slightly undercorrected at 80 (OR pl-0.25x080)
with -0.25-0.75x170 CL...
...than it is to be more undercorrected at 170 (OR pl-0.50x170) with -0.50 DS CL.
Plus, there would be balance in the lens type OD and OS.
And most important, I make much, much, much more money with toric lenses! Ha ha, Chip! You wish you were me!
Gotta go...my personal assistant has bluetoothed me that my boat is waiting.
Go toric on the right eye. Go aspheric or spherical equivalent on the left.
Be sensitive to oblique and against the rule (axis 90) patients, they will always benefit from a toric lens to correct cyl. You have alittle more room for with the rule patients.
OHPNTZ, you are a quack! What kind of recommendation is that? :shiner:
Always keep in mind that
a: The stronger the correction the more likely the patient will be happy with contacts..
b: The more nearly the patient is to be controled by hormones (past puberty a least), the more likely the patient is to be happy with contact lenses.
Translation: Patient's with wimpy little Rx's under a diopter or under three for that matter are far more likely to end up in spectacles in the long run.
With patient's with very strong corrections, it's very difficult to get them to wear spectacles at all once they find out how they can see with contacts.
Chip
First fit with a Spherical RGP to control the myopia make sure to charge the patient full price!
... then Over-refract and sell the patient for Toric RGPs for the reisdual lenticular astigmatism.
Make sure to sell the patient a backup pair in case he/she ever is in a dire situation where one may get lost and they need to apply for the Indian airforce.
...And before they leave make sure to schedule the Ortho-K treatments.
Or
Correct him to 20/25+ and 20/20 with sphericals (20/20 OU) and ask him if it's satisfatory before having everyone else assume what's best.
Quack Dr K???Originally Posted by drk
Care to explain???
Just joshin'...:cheers:
start from Asp shperical equivalent BE.. RGP or Ortho-K will be the best option.
Yeap
Yeap:
Get serious the percentage of patients that will still be wearing rigid contacts with that Rx after six-weeks would be close to five, if that.
The less the Rx the wimpier the patient.
Chip
Does he wear eyeglasses now with that cyl? Or does he wear nothing.
If he wears nothing , spheres will be an improvement. If he wears his Eyeglasses all the time, he may need a more accurate rx.
Also, you need to look at k readings. If much of the cyl is corneal, a firmer soft lens ( also aspheric) may correct a good deal of the cyl
If the cyl is lenticular, torics may be needed, but I would start with a thicker soft sphere.
the pt is currently not using any form of correction even though he knows he has refractive error.
the kerato reading is not revealing much of corneal astig in either eye .
the pt is currently being given soft contacts as he finds it difficult to maintain???? on trial basis. if he successfully completes the trial period without any events then planning to put him on torics.
sunsign
Why in the H would you put a patient in trial spheres when he has a toric correction. Even toric disposable trials are free. You will learn nothing about the position or even the patient's happiness with the correction with trial spheres.
Chip
I would try toric on the right, and sphere on the left, assuming he is right eye dominant. If a sherical equivilent is used, I would be astounded if the patients binoular V/A showed any difference at all using a toric in the left.
The pt wants to use contacts but reluctant to take care. says it is too tedious???!!!. hence for the pt to get a hang on contcts we are giving office trial (he had visited only twice so far ) so that he can handle the lens . explained to the pt about the toric free trial.
am i wasting my time with this pt or should i try to motivate him ?
More often than not you are wasting your time on patient's with very low correction.
Might be worthwhile if you concider collecting a fee as success. Probably not if you concider keeping the patient happy and in CL's for many years or decates as successs.
Chip
Personally.....
Would agree with above, toric R sph L. Would go with a daily disposable as your px sounds ideal for that (won't wear glasses, CBA with cleaning regime).
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