Need help trouble shooting this, please!

**VHB** · 06-08-2010, 12:28 PM

New Rx:
-5.50 -.75 x90
-5.50 -.25 x105.
She's been to the prescribing optometrist before and has always liked the Rxs, but his optical shop always messed up on the lenses, so she came to me.

Her old glasses are a 3 piece mounting with broken lenses, glued together crookedly. As best I can tell, the old Rx was
-5.75 -.25 x50
-5.25 -.25 x 78

I couldn't tell what material her old lenses were, and she doesn't remember where they were from, so I used poly (my favorite material) with Carat AR.

The pd on the old glasses seems to match mine pretty closely: 31.5/29 was my measurement. Her old lenses appear to be 30/30, but since they're broken, it's hard to be precise.

She got a zyl frame, size 51/15, which had her eyes centered vertically.

The old lenses clocked at OD +1 BC and OS +2.00. I ordered +2 base curve, but in the frame, they clock at +2.75.

She gets dull aching behind her eyes. She returned to the doctor who rechecked her vision and verified that the lenses were made correctly. He suggested remaking the lenses with the optical centers lower.

I did that (moved them down 3 mm, so the optical centers are below her pupils). She says it's better, but she still gets these headaches.

I would gladly remake them in some other material, but I don't know what she was wearing.

And I've never (in over 35 years) had anyone bothered by getting a steeper base curve.

Do you think it could be the change in axes? Especially the OD since it moved 40 degrees and increased by .50D? Also, she's been wearing her old Rx crooked because of the broken, glued lenses. I didn't think to measure the axes as she's been wearing them, but they had only .25 cyl anyway.

She doesn't want a different frame or a refund. She says the vision is sharp and clear. She's been very pleasant through all this & even brought her husband to me for glasses.

I'm usually so good at trouble shooting, but I'm stumped here and would appreciate any help.

**Mactire** · 06-08-2010, 12:43 PM

I'd say the axis can make a difference.

Even if the Rx is right.

[storymode]
I once had a man with a 8 year old pair of glasses.
Came with a prescription from the ophthalmologist which we rechecked and made a new pair according to that presription.
There were no mayor power changes, just the axis by about 45 to 50 degrees (can't remember exactly).
Het wore the glasses for about two weeks and came back complaining about headaches at the end of the day.

So, rechecked the Rx, wich came out fine. Put the Rx in a trial frame, wich seemed fine.
But I let him wear the trial frame during the following conversation about what we should do next.
Then the following happend: He got a headache!
I changed the axis back to the old axis and in the following minutes the headache went away.

After checking the Rx once more I concluded that the visius was higher with the new axis. But we remade the glasses with the old axis.
Problem solved.
[/storymode]

So it's just a suggestion. But you can try letting the patient wear the trial frame for about 10-15 minutes and see what happens.

**VHB** · 06-08-2010, 12:55 PM

I'm an independent optician and don't have a doctor, and therefore no trial frame. But I think you may be right that it is the axis.

**Ivan Hoe** · 06-08-2010, 01:11 PM

Hi VHB,

Since the old lenses were broken, therefore i can assume that the are not poly material.
Polycarbonate material can cause the kind of discomfort you are describing, and in serious cases, can even cause eye pain and tearing.
The best materials i would suggest are,1.6 or 1.67 plastic lenses.

You also say that you, "ordered +2 base curve, but in the frame, they clock at +2.75".
That sounds to me like the lenses are warped by the frame. If you ordered +2 it should also be +2 after mounting.
I believe that the problem is excessive frame pressure on the poly material which is soft.

I hope that I have helped.

**OHPNTZ** · 06-08-2010, 01:20 PM

Maybe it's not optically related. You need to find out associated signs and symptoms. I had a patient who had similar complaint, the optician tried to trobleshoot...in the end it was dry eye.

**Mactire** · 06-08-2010, 01:26 PM

Woah, that's true, poly doesn't break. That's why they are in safetyglasses right?

And since it's softer it may warp more easely.
Do you have a tensionmeter? If so, you can see the warping and get that confirmed. But the difference in basecurve is also a confirmation.

I was so focussed on the axis I assumed that that was the problem.

I also have a question, does the warping have simmilar consequences on the vision and nausia in materials like 1.6 plastic?

**Uncle Fester** · 06-08-2010, 01:40 PM

I'd take a simple frame and put a pair of stock sv lenses into it with the old rx and have her try them.

Or make a right eye only as a temp to try.

**Chris Ryser** · 06-08-2010, 01:43 PM

The axis of a 025 and a 075 can take quite some tolerance.

The original lenses were probably CR39 (they broke). Easy to find out tapp them on a table top and you can differentiate between that sound the hard clack of poly against the much softer of CR9.
CR39 is the closest to glass which is the best media for lenses.

**VHB** · 06-08-2010, 02:47 PM

Well, I've had poly break! A customer had glued her broken zyl frame together and got super glue on the lenses. "No problem!" said I, and proceeded to swab the lens with acetone. I'd just started using poly and no one had told me not to use acetone on them! The lens snapped in half. So poly can break, yes.

And I can't tap them on the table to hear how they sound because they're glued together, so the sound is dulled.

**Speed** · 06-08-2010, 02:56 PM

Poly is the problem.

**Uncle Fester** · 06-08-2010, 03:44 PM

Originally Posted by VHB

And I can't tap them on the table to hear how they sound because they're glued together, so the sound is dulled.

Touch it to the hand wheel- Any swarf?

**Judy Canty** · 06-08-2010, 04:12 PM

This may be a stupid question, but did you verify the old rx with the prescriber? There are a few too many ECP's out there who think that a big change in axis on a fairly low cyl power won't make a difference. We all know better.

**VHB** · 06-08-2010, 04:35 PM

Thanks, Judy. I think my next step is to call her optometrist and have a chat.

And, Speed, I'll concede that poly might be the problem in this case, but it will be a first for me. I've never had a problem switching people to poly from whatever they were wearing. When I switch someone, I tell them what I'm doing and why. And I tell them that if they're not happy with the poly lenses, I'll remake it in their previous material, for just the difference in price. I have never had anyone take me up on the offer.

Given its light weight and its safety, I think it's one of the best materials on the market. And it's the only material that I will wear.

**Mactire** · 06-08-2010, 04:45 PM

VHB said:
"No problem!" said I, and proceeded to swab the lens with acetone. I'd just started using poly and no one had told me not to use acetone on them!

That's an instant classic I had a quite similar experience. I in my first few weeks working in an opticianry and made a magnifing clipon from reading glasses.
After carefull drilling and screwing I removed my markings with spirit (is that what you call it?) my collegue said: you'd break the lenses sraying that on. I just looked at him wondering if he made fun of me when I heard the chipping of the lens. That was funny ^_^

Back on topic: Reading back the entire post I don't think poly is the problem. It's the pressure on the poly. Considering the difference in base curve.

**Uilleann** · 06-08-2010, 06:53 PM

Disagree. I wouldn't point the finger of blame solely on poly as the demon material many here tout it to be in this case - far too many other variables to consider. With that said, poly wouldn't be my first lens of choice in this particular Rx. And I have also seen a poly lens break - it takes a LOT mind you, but it is not "shatter-proof".

1.74, 1.71, 1.70, or 1.67 would each be a more viable solution I would think. Keep in mind the axis orientation will act much like a hinge in this Rx, and with a 51 eye you're just asking for flex in the lens. Especially when you're talking a wide zyl frame here - can you check the C sizing and make sure the lenses weren't cut a hair large or long?

Do you have any information on what the patient presented with to the doctor initially? Were headaches a complaint in the first place? Sometimes, a new correct Rx will shed light on other potential problems a patient may not have been aware of as acutely before. I can remember a case about two years back in which a patient actually preferred their old computer Rx to their new because they preferred the screen slightly blurred. The new lenses were said to make things "too sharp" and caused headaches where none were noticed before. "Clear" many not always be perceived as "better" to a given individual, and sometimes sharpening an image will also sharpen other symptoms like headaches etc. Rare, and certainly not the rule, sometimes cases like that can be confusing and will serve to strain what we know and are taught about how to properly manage a particular patient's case.

At any rate, please post back with your results - and here's to hoping that all works our perfectly for your patient and you!

**drk** · 06-08-2010, 07:02 PM

The complaint has one million, six-hundred and forty-five different causes.

To suspect that it's the glasses is dubious, but it must be ruled out.

Remake the lens in a less flexible polymer, like 1.6 or Trivex.

After that, it's on the patient to adapt. Two weeks, minimum.

If the symptoms don't go away, I'd send her for a medical work up.

**Fezz** · 06-08-2010, 07:06 PM

*****REFUND*****

In aisle "No Win" please!

Thank you!

**Bill West** · 06-08-2010, 08:58 PM

Originally Posted by drk

the complaint has one million, six-hundred and forty-five different causes.

To suspect that it's the glasses is dubious, but it must be ruled out.

Remake the lens in a less flexible polymer, like 1.6 or trivex.

After that, it's on the patient to adapt. Two weeks, minimum.

If the symptoms don't go away, i'd send her for a medical work up.

the only good answer on here. Suggest a brain scan.

**Fezz** · 06-08-2010, 09:07 PM

Originally Posted by Bill West

the only good answer on here. Suggest a brain scan.

Come on Wild Bill!

Where is your Bravado and Gusto?

You could have satisfied this patient, no sweat!

You know, deep down, in your heart, that the only reason this patient is having problems is that they didn't buy their glasses from YOU!!!

Heck, with your 807 years of INDEPENDENT experience, and decades of OD gluteus maximus kicking and superb location picking, this poor dolt of a patient was doomed form the very start because of not choosing your "$49.95 a Day, Everyday and Every Way" pricing structure and entrusting their eyewear needs to you!

You could have gotten this right the first time!

No questions asked!

Maybe a brain scan is in order?

**Johns** · 06-08-2010, 09:41 PM

I think that all your suggestion are a bit over the top, and at the very least, are doing nothing to keep the thread on topic. Let's get serious about this and maybe we can help VHB here.

What I would do is take a digital clock, set it for the day before the patient came in. Next, reverse the poles on a tractor battery, and hook that up to the clock. After 40 minutes, put the clock in the microwave, and put it on the "popcorn" setting. Let it cook for 2 minutes. Take what's left of the clock, and put it in your freezer. If it works the way it should, you have effectively turned back time.

Next, put a sign on your door, "Sorry Closed For Vacation please call..." (Insert your competition's phone number here)

That should solve your dilemma.

**Fezz** · 06-08-2010, 10:09 PM

For all of you folks who think it is the base curve..........................I disagree!

I say SAFE!

Oh wait......was the patient OUT?

Oy vey......................I goofed!

**Mactire** · 06-09-2010, 02:38 AM

Originally Posted by Bill West
the only good answer on here. Suggest a brain scan.

Haha, excellent. That's the best answer to everything!

Client: "I can't get used to my multifocals"
Optician: "Get a brain scan"

Client: "My new glasses give me a headache"
Optician: "Get a brain scan"

Client: "My frame feels a bit loose"
Optician: "Get a brain scan"

Client: "Woah! That's to expensive!"
Optician: "Get a brain scan"

Really, it's the answer to everything!;)

**RetroRat** · 06-09-2010, 04:18 AM

Originally Posted by Mactire

Haha, excellent. That's the best answer to everything!

Client: "I can't get used to my multifocals"
Optician: "Get a brain scan"

Client: "My new glasses give me a headache"
Optician: "Get a brain scan"

Client: "My frame feels a bit loose"
Optician: "Get a brain scan"

Client: "Woah! That's to expensive!"
Optician: "Get a brain scan"

Really, it's the answer to everything!;)

I see one flaw

Client: My pupils aren't dilating
Optician: Get a brain scan!!!
Client: Yeaaaaah, I've heard that one before.
Optician: ...

**mshimp** · 06-09-2010, 07:28 AM

Why would the doc suggest to lower the optical centers? Big NO NO. I do NOT believe it is an axis problem. I would have the doc DO a new refraction. Patient may be having some issues with the added cyl power in the OD. Also base curve does NOT seem to be a problem. I believe the MATERIAL is a real issue to consider. Iwould not use 1.74. Consider using 1.60 or 1.70. Recheck PD. Make sure PD is not too narrow. How old is the pat.? Is this person an emerging presbyope? She might be having strain due to accomodative issues. Just my three cents.

**Optician1960** · 06-09-2010, 07:56 AM

Find out what the last prescribed Rx was. If the axis change is 30 degrees in one eye and 40 in the other, ask the Dr (not techs), why they believe the change is so great. Could be a physical issue with the eye that could in turn be causing some of these issues. Did the Dr explain the terrific change in axis and explain that this might be uncomfortable at 1st, but after adjusting, it will be the best visual correction for Pt. If so, kudos, if not......

Certainly material change and potential warpage mentioned could be challenges also.

With the old frame being broken, adjusting the frame to match panto, faceform, vertex distance... could be tough, but you should see if these changes make imporvements.

Reads like you did a great job of selling a frame that for the customer well optically with the OC dead center, thento have Dr suggest dropping it 3mm is questionable for sure...

Just my 2 cents, good luck...