High Minus, large head!!!!

**xmaslightman** · 05-06-2010, 11:25 AM

OK so I think I finially have met my macth with rx fit to frame. I recently had a pt with a minus 13.50 RX OU. He came in very unhappy with his current pair he was wearing from a large optical retailer. I agree with him they are the worst thickness ive ever seen in lenses.

Here is my problem. The pt has a large head ,which makes me have to put him into larger eyesize frames. Well To make his lens thickness go down I was thinking smaller and rounder, which will not work due to the size of his head. I am going to use a SV hi index 1.74 lens which will help but ultimalty I need a good frame to get the job done any sugestions?

**j.maran** · 05-06-2010, 12:51 PM

I've had luck w/ the xxl modified rect. from A&A. Made for a large head, softer edges for a rounder look, and temples that come out so the eye size doesn't have to be that large.

**DragonLensmanWV** · 05-06-2010, 01:14 PM

Of course you have to ask him- which do you want more- clearer vision or thinner lenses. Pick one. Can't have both. 1.74 has the same poor ABBE value as 1.67, and as a former -15.00, I can tell you that at that size and Rx, there will be issues with the ABBE. So, since the difference in thickness between 1.70 and 1.74 is very small, you can drop the 1.74 and go with the 1.70 and he will experience far better off-axis vision than with the 1.74. It's often too easy to just jump to the highest index, but until you've experienced the visual problems at high Rx and low ABBE, you just can't fully understand the difference.
So, to sum up:

1.70 index
XXL frames from A&A= thumbs up!

**ohioeyeguy** · 05-06-2010, 01:25 PM

clearvision has a line of frames made for people with larger heads... and they look somewhat modern... my office manager is a -15.50 and i just put her in the 1.74 autograph II free form lens and she loves it. they look decent for being a -15.50 and she gets good optics out of the lens. just a suggestion for what its worth.

**DragonLensmanWV** · 05-06-2010, 01:56 PM

Believe me she would be surprised at how much better the off-axis view would be with 1.70. Most people don't notice any poor performance of the lens until they try one with better performance. I had a pair of perfectly good, but perfectly useless 1.67 Gradal Top lenses that had only a very small area of clear vision through the center of the lens. I could not turn my eyes very far, had to turn my head and everything had a sort of glinty cast to it. Then Hoya came up with the 1.70 and I never got anything else. Until after cataract surgery.Then it's Trivex, baby.

have her try the Hoya ID LIfestyle in 1.70, she'll throw away those 1.74s.

**Strab** · 05-06-2010, 02:45 PM

What would be the benefit and downside to having his Rx made as a Myodisc as well as the 1.70?

**Wes** · 05-06-2010, 03:20 PM

Meniscus? Do you mean myodisc?

**kcount** · 05-06-2010, 03:24 PM

I think he means bi-concave.

**kcount** · 05-06-2010, 03:26 PM

or throw a note over to allen (awtech on optiboard) and ask him to work out a lens for you. Maybe a Myodisc that feathers back down to a thinner edge? He's doing some interesting stuff with high minus rx's and his freeform machines..

**Wes** · 05-06-2010, 03:38 PM

The off axis optics on a biconcave are terrible.

**kcount** · 05-06-2010, 03:50 PM

Originally Posted by wss2020

The off axis optics on a biconcave are terrible.

Agreed.

**Strab** · 05-06-2010, 05:04 PM

Originally Posted by wss2020

Meniscus? Do you mean myodisc?

LOL oops! Too funny I was absolutely talking earlier with a pt. about the meniscus in his knees. Yes I did mean myodisc. Thanks for the correction:)

If the off axis optics are terrible at what point would a myodisc become a good choice? I have used a myodisc only on one pt. before and he was a -15.00 with no complaints but that was 5 years ago or more. He had no complaints but again he may not have known what he was missing and apparently neither did I.

**ScottV** · 05-06-2010, 05:24 PM

Why not a customized silhouette TMA?

**DragonLensmanWV** · 05-06-2010, 06:44 PM

Originally Posted by Strab

LOL oops! Too funny I was absolutely talking earlier with a pt. about the meniscus in his knees. Yes I did mean myodisc. Thanks for the correction:)

If the off axis optics are terrible at what point would a myodisc become a good choice? I have used a myodisc only on one pt. before and he was a -15.00 with no complaints but that was 5 years ago or more. He had no complaints but again he may not have known what he was missing and apparently neither did I.

I wouldn't go to a myodisk at that power. Granted it would be a a rather large myodisk at that power. Much simpler to go to 1.70 index.

**Wes** · 05-06-2010, 07:01 PM

Listen to the dragon. He's been there.

**Reylynn** · 05-07-2010, 12:42 AM

Originally Posted by xmaslightman

OK so I think I finially have met my macth with rx fit to frame. I recently had a pt with a minus 13.50 RX OU.

I am going to use a SV hi index 1.74 lens which will help but ultimalty I need a good frame to get the job done any sugestions?

[QUOTE=DragonLensmanWV;344056

have her try the Hoya ID LIfestyle in 1.70, she'll throw away those 1.74s.[/QUOTE]

Why let her try Hoya ID Lifestyle? This is multifocal lens as far as I know and xmaslightman is talking about single vision lens only. Maybe you mean Eyry 1.70.

**DragonLensmanWV** · 05-07-2010, 06:15 AM

Originally Posted by Reylynn

Why let her try Hoya ID Lifestyle? This is multifocal lens as far as I know and xmaslightman is talking about single vision lens only. Maybe you mean Eyry 1.70.

I was referring to post #4. The 1.74 index Autograph II. I've worn both and I liked the ID LIfestyle better.

**scriptfiller** · 05-07-2010, 09:35 AM

I will second kcount. I just sent a -17.50-7.00X90/-17.00-5.00X90 to Allen's(AWTECH) lab, Ice Tech, FF is the way to go with an RX frame situation like you have.

I'd go with a 1.70 for acuity reasons.

**uncut** · 05-07-2010, 10:08 AM

I agree with ScottV....go with a custom shape in a Silhouette minimal Art. Choose a bridge based on P.D. and use the M.E.D. method of size and shape control,

Do an edge polish and if your client is adventurous......tattoo design on the edge of lens, using the thickness to his advantage.

uncut

**WFruit** · 05-07-2010, 10:49 AM

Originally Posted by DragonLensmanWV

I was referring to post #4. The 1.74 index Autograph II. I've worn both and I liked the ID LIfestyle better.

I think they meant the 1.74 Autograph II Single Vision....

I would say, no matter what material, that a Free Form Single vision is the best bet for visual acuity, whether it Shamir's or ICE-TECH, or whosever.