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Thread: Slab off lens question? Please advise.

  1. #1
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    Confused Slab off lens question? Please advise.

    Hi Optiboarders,

    Patient came in today with a modified rx redo and dr. noted "advise slab off". Rx is as follows:
    OD -3.00 -0.50 x 094
    OS -0.25 -1.75 x 105 +2.50 ADD OU

    Wearing a GT2 3D progressive 1.67 Transition with AR coat.

    She is hesitant to try the slab off because of cost, and since she has seen 3 doctors in the last 3 months and every rx is different she is afraid she will get the new lenses and will have to change glasses again in 3 months.

    Would you recommend a slab off based on this scrip? Or think it will even make a difference?
    I appreciate any help.
    Thanks.

  2. #2
    Master OptiBoarder snowmonster's Avatar
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    I haven't done the actual math on this, but that doesn't look like a big enough difference between OD and OS in the vertical meridian to warrant it.

    Does your patient even complain of diplopia in downgaze/reading? That's the reason to use slab off.

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    Could go either way on need for slab off. Many don't feel it's needed until 4 diopter imbalance is present. Others much sooner. Patient sensitivity varies. But then you all ready got som uch cost involved with 167 (totally un needed O.S. and 150 or so would be enough O.S. unless eyesize is huge, transition with AR is high ticket, so what's another $85 bucks for slab?
    Really 167 on a -0.25 -1.75 @ 105? and -3.00 -0.50 x 094? Sure you're not in Sales?
    If the doctor thinks this is 3mo or so temporary CR-39 with scratch coat only and a pair of clip ons should suffice.
    But, socket to 'em bro.

    Chip

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    Master OptiBoarder snowmonster's Avatar
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    So I wasn't the only one who thought the 1.67 was a bit much...

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    The 1.67 was not due to my sales but that this patient is extremenly sensitive to weight. Wearing a 47 eyesize. The rx is not meant to be temporary but this patient acts as though she cannot see no matter what rx is given so it is in her head that she will need a new rx in another 3 months because it changes every time she visits OD.

    Basically, newest rx given by Dr. (Kaiser) says on recommendations, Advise using slab off.

    And trust me, I wouldn't have sold her 1.67 either, but she insisted. And still feels they are too heavy.

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    Quote Originally Posted by CaliOptician View Post
    Hi Optiboarders,

    Patient came in today with a modified rx redo and dr. noted "advise slab off". Rx is as follows:
    OD -3.00 -0.50 x 094
    OS -0.25 -1.75 x 105 +2.50 ADD OU

    Wearing a GT2 3D progressive 1.67 Transition with AR coat.

    She is hesitant to try the slab off because of cost, and since she has seen 3 doctors in the last 3 months and every rx is different she is afraid she will get the new lenses and will have to change glasses again in 3 months.

    Would you recommend a slab off based on this scrip? Or think it will even make a difference?
    I appreciate any help.
    Thanks.
    Always try the no slab first. Espicially on a progressive. Really, where are you going to calc to match the prism, 5, 8, 15 below? You can only match at one point. Therefore you render the intermiediant zones of useless. I will tell you, there are millions of people reading with one eye and liking it. Worse (unlikely) thing can happen, she has a problem and you got to tell her , well we tried, now we got to do the bicentric. That case, you may need to go to a flat top.

  7. #7
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    Quote Originally Posted by CaliOptician View Post
    Would you recommend a slab off based on this scrip? Or think it will even make a difference?
    I appreciate any help.
    Thanks.
    If you're doing it to improve the distance, NO.
    If she's always had a big refractive variance between the 2 eyes, NO.

    If you're doing it to improve the near, maybe.
    If this is recent anisomatropia, maybe.

    You may also consider using an iseikonic fit to improve the distance.

    Ideal fit would be a -2.00 contact lens OD and over-refract with eyeglasses.


    Good luck.

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    Master OptiBoarder mshimp's Avatar
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    The specific gravity of 1.67 is about 1.35 making it one of the heavier plastic materials. Wrong choice for this RX. Good comunication with the patient in regards to what might be improved. As braheem24 and snowmonster mentioned, the slab will do nothing for the distance. It "might" help in the reading. With an imbalance of approximately 2.62 this meets my threshold to have it done. Make sure the slab line is measured to where a conventional line bifocal would go, as you dont want it to interfere with the intermidiate. Trivex material would be my choice. It is the lightest weight of all materials , and due to the small eye size would just about be the same thickness as the 1.67. Add the fact of the higher abbe value for good optics. Again good communication is key. Has she worn progressives for awhile with the difference in her eyes successfully? Did she recently have cataract surgery, or cataracts developing? Is she diabetic? Loss of visual accuity in any of her eyes? And many more questions.

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    If she needs light you should consider Trivex, it's the lightest material.

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    If your going to put her in contacts at all, why not put her in bilateral bifocal contacts and eliminate the glasses and the an the anisimetropia entirely?

    Chip

  11. #11
    Doh! braheem24's Avatar
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    Because anyone who complains about vision every 3 months is not a good candidate for a typical cl bifocal fit.

  12. #12
    Master OptiBoarder OptiBoard Gold Supporter DragonLensmanWV's Avatar
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    She sounds like an overwrought patient, I agree with Braheem24.
    DragonlensmanWV N.A.O.L.
    "There is nothing patriotic about hating your government or pretending you can hate your government but love your country."

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    I would try the RX as written without slab. Though slab is possibly needed, the Drs recommendation is not based on her refraction, its just based on the fact that any time there are more than 2 diopters difference there is an increased chanced the patient can't merge the images. He is right, but its only a chance.

    If she does manage to merge, then you are great. If she merges but gets diplopia when she is tired, she may need reading glasses too. The other option is (with the Drs permission) to fudge the RX a tad (make one eye slightly stronger, the other slightly weaker) or use differing adds. I have used both to keep a patient out of slab. If she can't use the reading after a week, then slab is warranted.

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