Pt. says vision not crisp...changed rx added prism, changed material.. HELP!!!!!!!!!

[Barry Santini]

I have to agree and disagree here:

1. multi-redos do NOT engender loss of patient confidence - The way I approach it, they feel I have their best interests at heart, and am tryinh to solve the problems.
2. It's not uncommon for me to make over eyewear 3-6 times, if I feel it necessary to solve the complaint, or discover what *won't* work.
3. I learn from each and every difficult client something new.
4. I too suspect the refraction - and would not have done polyu - perhaps trivex or 1.6 index.
5. Auto II or Individual would be my go-to lens with whatever Rx we ended up with.

FWIW

Barry

[Happylady]

Was this patient happy with the Adapter progressive? I don't see that mentioned anywhere. I used to use that lens a lot with good results. I haven't used it in ages but if the patient was happy with it then maybe go back to it.

[Robert Martellaro]

This patient is high plus progressive, was in an adaptar...
Current RX
OD +4.75 -5.75 x 022
OS +4.75 -5.00 x 170
Add +2.50
We started with poly, varilux comfort 360, then after wearing them a couple weeks, said VA wasn't clear, added prism, because had unwanted in old pair from another office, that she acclimate too.
Wore them a couple of weeks, and still complaining not crisp....last glasses were plastic so we changed her poly lenses to plastic, has worn them 12 days, and still saying VA not clear....doc and I both are stumped....any suggestions?

She this 50 year old patient came in today, she added a new piece to the puzzle....she said comparatively speaking, when she puts on the glasses we made her, things look farther away not as crisp...first time she mentioned this.

OLD RX

+4.50 -5.75 x022
+4.50 -5.25 x171
Add +2.50 ( Adaptar in plastic )

NEW RX

+4.75 -5.75 x 022
+4.75 -5.00 x 170
Add +2.50 ( Varilux Physio 360 in Poly, with Crizal Avance' )

So as you can see....axis shouldn't be a problem....will double check PD in old pr. and doc may have to see her for another refraction.
Thanks for all of your input...

I assume you mean that the acuity is soft (text not crisp) at all distances. If so, I'd look at the cyl axis first.

Start all over again at the refraction. One degree off and boom!

Compare the axis of the old lenses. Turn these to that , if you can , just to see if that helps.

Make sure that you're comparing the axis of the lenses not the Rx. In other words, compare the axis of the old and new lenses, not the old and new Rxs. Do the same for the lens power.

If only the distance vision is involved, espeically with road signs, then I'd look at the change in sphere equivalant power. Try -.25 over the new glasses and +.25 over the old glasses, at both room distances and infinity. Both power and axis tweaks may be necessary.

Changes in perspective "things look farther away" may be due to the steeper BC of the Adapter design (I believe it's spherical) and the flatter aspheric BC of the Physio. Changes in prism thinning as well as vertex distance may also upset the perspective for some. This can usually be ignored due to adaptation, but maybe not for hyper sensitive individuals. These folks might even need to stay with a harder design like the Adapter, especially wwith high astigmats.

[bigeyejim]

You know, this reminds me of two patients whom we took out of "old school" Adaptars and updated them into the an AOEasy, and the other into a GT2.. BOTH, with minimal RX change, ultimately were most happy non-adapting back to their Adaptars. Silly but true. That might be the pearl you're looking for.

Another funny one is that we have several engineer types who have been wearing the Percepta for a thousand years. Try getting them out of those. UGH.

[autumneyes]

she is still in plastic....

[autumneyes]

Yes she seemed to be happy with the adaptar.....maybe I should go back to it....we don't use it here either...but its an idea.

[scriptfiller]

I've got a pat. now who we changed only a .25 from a Natural to a Physio360, the first thing he commented on was some loss of intermediate.

[Uilleann]

An increase of add power (even just +0.25) will narrow the corridor in most all progressive lenses - regardless of manufacturer. Some patients (and some lens designs) will be more sensitive to this than others.