What would you recommend?

[eyeGJ]

Busy morning at work and presented with this patient:

OD -2.00
OS balance
2.00 add OU

Frame 52-15 B=30
Wearing CR39 (scary)
No A/R
ST 35 at 8mm high
Says she only uses bifocal to read her speedometer

Has a 2nd pair in the same frame
Evolution CR 39
18 high
A/R crazing
Says she has never been able to focus anywhere with them (someone sure has been wearing them by the looks of the lenses)


New RX
OD -2.25
OS balance
2.00 add OU

What would you recommend?


TIA (Thanks In Advance)
Ginny

[chip anderson]

How come you skairt o' CR39? It works probably more often than anything else from the patient's point of view.
How ol' is she. If she's retired or a house wife a bifocal may be fine (28 probably wide nough if she only "looks at the speedometer).. If she's working or uses a computer she might need a trifocal or progressive.
See if she's complaining bout glare around lights at night, if not she probably does not need AR. Also remember 99% of the spectacle wearing population lived without AR just fine until recently, the people haven't changed, just the marketing.
Remember this patient is going to be able to read just as well with glasses off. Probably so scratched because they are no worn all the time. Don't expect her to change this any time soon.

[optilady1]

I've never been a big fan of pt's with a balance rx wearing a progressive, but if she wants one, give her one. I would put her in trivex though.

[WFruit]

ST-35, either CR-39 or Trivex (I would go with Trivex because of her only having vision in one eye). Probably no A/R unless she has glare complaints. How old are her "old pairs?"

[DragonLensmanWV]

Just because you didn't have AR 40 years ago is no reason not to use it. Granted, we do a lot of CR-39 lenses without AR, but those are just for the people who want less payout and rapid delivery. That's the bulk of our business. A fair number of people just don't want bottom-end glasses, and that's not just a result of marketing or greediness, as some seem to be stuck on. I'm sure those complainers only sell basic uncoated CR-39 in cheap frames because "they" haven't been corrupted by greediness and marketing and don't need to make a profit. Hey, people lived for a long time without scratch coats, who needs 'em? People lived for a long time without UV filters - who needs that?
We also didn't have titanium frames 40 years ago, should we not use them now just because they're "new-fangled"?
We also didn't have flattop 28s 40 years ago, do they still sell flattop 22s?
Everybody used to wear 12K gold frames - have you priced those lately?

Point is, things change. If you don't change, you get left behind.

Anyway, in this case she might be better off with a flattop. If she always takes 'em off to read, adjust the add power lower for her speedometer.I would agree with those who say to use Trivex for these though - gonna be way lighter weight, and you have her other eye protected as well as you can.

[ThatOneGuy]

Trivex flattop (be sure add is set for speedometer). Get a high quality AR that wont fall apart on her so that they can take abuse from on/off wear, and so that she is getting maximum light transmittance in to her aging eyes. People haven't changed, just the entire way they go about living their lives have.

[eyeGJ]

Thanks for the replies. Patient is doing well with her Definity prog. in Trivex material with Crizal Sapphire.

Ginny

[Happylady]

Thanks for the update. One thing that wasn't clear in the original post is whether she wanted to stay with a ft top or not. I am guessing not. I think the Definity is a great choice for her since she takes them off to read. The Definity has a great distance and intermediate area and the Crizal Sapphire should hold up well and be easy to clean.

[chip anderson]

Dragon: People lived without scratch cote because thier lenses were glass. Anti-reflective cote was available long before plastic lenses but seldom used. Scratch cote came out for plastic because durablility was so sorry on them without it that no one would ever buy a replacement pair of plastic lenses.

Chip