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Thread: High-Add round seg Bifocals, or the lack thereof!

  1. #1
    Bad address email on file RetroRat's Avatar
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    High-Add round seg Bifocals, or the lack thereof!

    ey guys,

    Bit of a chewy case here for a patient, we're getting pretty desperate as well so any advise/offers would be much appreciated!

    Px is 35, but has reduced acuity (~20/100OU best corrected) and her Rx measured up as

    OD +3.25/-3.00 x 25
    OS +4.25/-3.00 x 165
    //+7.00D Near addition.

    PD 62/57

    Easy, right? Not quite. The reduced acuity is a result of congenital oculocutaneous albinism and for as long as the px has been in glasses she'd been in a round seg. Before I saw her she was fit with a D28 (the only option available) and hated it, presumably due to the prism jump.

    Ideally what we are looking for is a 6 base round seg with the +7.00 add, ideally in high index resin, frame has been pre-selected and measurements are

    Frame size: 52-19
    ED : 53
    B: 28

    Only other thing worthy of note is the frame has a magnetic clip on that sits about 4mm from the front of the demo lenses in the frame.

    Any ideas (radical or otherwise) is very much appreciated, or anyone willing to have a crack at such a beast please let me know!!

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    Master OptiBoarder LENNY's Avatar
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    Flat base for clip to fit
    FreeForm Round seg in any material

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    Underemployed Genius Jacqui's Avatar
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    Ditto what Lenny said

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    Bad address email on file RetroRat's Avatar
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    Quote Originally Posted by LENNY View Post
    Flat base for clip to fit
    Would probably not prefer a biconvex to try and avoid any aberrations that would affect her already poor vision

    FreeForm Round seg in any material
    However, you make it sound like I've been stressing for nothing! The local labs are unable (unwilling?) to produce *any* round seg, so I'd be interested in contacting someone who is happy to have a crack at this job for me.
    Last edited by RetroRat; 09-07-2011 at 08:32 PM. Reason: Extra thought

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    Franklin

    Why not make a Franklin and you can add are eliminate prism any way you want.
    It won't be round, but it'll work

    Jacqui: I'm supprised you din't suggest this.

    Chip

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    I think you can get that. Try Airelite. I can't find the #. Look in the lens book.

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    Quote Originally Posted by chip anderson View Post
    Why not make a Franklin and you can add are eliminate prism any way you want.
    It won't be round, but it'll work

    Jacqui: I'm supprised you din't suggest this.

    Chip
    Chip,

    I am surprised that you didn't suggest contacts?

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    Bad address email on file RetroRat's Avatar
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    Quote Originally Posted by Diopterman View Post
    Chip,

    I am surprised that you didn't suggest contacts?
    I too was expecting that! Due to the patients albinism, there is remarkable nystagmus. However I was just reading up on it and it seems like there is research to indicate that the use of contacts (soft or rigid) can retard the oscillopsia and eye movement, any comment on that Chip? What do we think? Our patient has a good attitude towards managing her vision so I do not think she would be entirely resistant to the idea if we could achieve the same sort of acuity with contacts.

    If worst comes to worst, I am happy to design her a franklin, but I'd rather exhaust all other options before it came to needing to do that.

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    Master OptiBoarder optical24/7's Avatar
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    I pity the patient that will have a 5 1/2 inch focal length with that add. I'm not at work so I can't tell you if 3 Rivers can produce a +7.00 in FF, but another option would be to split the add with the clip. (i.e. +3.50 add RD seg in frame, plano w/+3.50 add in clip.) Also keep in mind that you will need to adjust the near PD to approx. 52mm ( with a 62 DPD and a +7.00 add.)

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    Retro:

    Many years ago we used to try pinhole contacts on nystagmic albinos with favourable results about half the time.
    These were rigid contacts. Haven't a clue where you would get same today.
    I've also read that the Dow-Corning 5.50 series of spectacle filters help sometimes. This would be possible in a Franklin but probably prohibitively expensive.

    Chip

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    Objection! OptiBoard Gold Supporter shanbaum's Avatar
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    Aire-o-lite does make 6.25 base 7.00 add SF blanks. http://www.aire-o-lite-optical.com/

    Freeform probably isn't possible - you'd have to have a convex seg on the backside in the midst of the concave surface; the only way to manufacture it would be with a huge blend zone, where you'd want a seam, and you'd have massive spherical abberation & marginal astigmatism in such a seg.

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    Quote Originally Posted by shanbaum View Post
    Aire-o-lite does make 6.25 base 7.00 add SF blanks. http://www.aire-o-lite-optical.com/

    Freeform probably isn't possible - you'd have to have a convex seg on the backside in the midst of the concave surface; the only way to manufacture it would be with a huge blend zone, where you'd want a seam, and you'd have massive spherical abberation & marginal astigmatism in such a seg.
    True, even with the airelite blank, there is gonna be a heck of an image jump. Also that is not a job I would just put in a tray with a work ticket and put in the lab. Extra, extra care needed here.

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    In a similar case we used a photogrey-extra glass lens, with a Brown A(35%) surfcote. I am not sure of the add power in that case, but it became her favorite go-to pair for indoor use. I do recall she had several pair with different adds, though, with weaker adds in the sunglasses. I think she liked the cosmetic effect(backside AR) and a slight mirroring effect the surfcote created for the front of the lens.

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    Underemployed Genius Jacqui's Avatar
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    Quote Originally Posted by chip anderson View Post
    Why not make a Franklin and you can add are eliminate prism any way you want.
    It won't be round, but it'll work

    Jacqui: I'm supprised you din't suggest this.

    Chip
    Make a Franklin with an 8 base read with a +5.00 round seg. It's gonna look kinda funny, but should work. Lenses should be available from X-cel.

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    Why would do that instead of ordering the lenses from Aire-o-lite?

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    Speed: Cost is only that of two pairs of SV lenses. Turnaround time should be only a few days as opposed to months.


    Chip

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    Underemployed Genius Jacqui's Avatar
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    Quote Originally Posted by Speed View Post
    Why would do that instead of ordering the lenses from Aire-o-lite?
    Just another option. Chip mentioned two pairs of SV, what this would take is one pair SV and one pair round seg.

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    Quest Optical Specialty Lab can make it for you in any lens material, any seg diameter you want, visible or blended including 1.71 or 1.74 lens index. questlab@tampabay.rr.com

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    Bad address email on file RetroRat's Avatar
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    Quote Originally Posted by Jacqui View Post
    Just another option. Chip mentioned two pairs of SV, what this would take is one pair SV and one pair round seg.
    Underemployed genius indeed! This is probably going to be the easiest option seeing as I would be outsourcing from american labs otherwise... this will probably end up being the most cost effective option!

    any years ago we used to try pinhole contacts on nystagmic albinos with favourable results about half the time.
    Thanks for the info Chip, very interesting

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    Quote Originally Posted by chip anderson View Post
    Speed: Cost is only that of two pairs of SV lenses. Turnaround time should be only a few days as opposed to months.


    Chip
    I have made some Franklins before. I remember them requiring lots of advanced skills and time. I do not remember the Aire-o-lite lenses taking so long.

    Good thing here is a few options to chose from anyway.

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    I'm a bit surprised at the lack of availability, I can get a R24 with adds up to 15.00 from one of my suppliers

    Can't think of when I'd want that though......

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    Underemployed Genius Jacqui's Avatar
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    Quote Originally Posted by Speed View Post
    I have made some Franklins before. I remember them requiring lots of advanced skills and time. I do not remember the Aire-o-lite lenses taking so long.

    Good thing here is a few options to chose from anyway.
    Franklins are easy, just wait until you hit some of the other multi-piece lenses. When i was running the lab, I did 12 - 15 prs of Franklins per week plus hemianoptic and macular degeneration lenses.

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    Underemployed Genius Jacqui's Avatar
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    Quote Originally Posted by Aberdeen Angus View Post
    I'm a bit surprised at the lack of availability, I can get a R24 with adds up to 15.00 from one of my suppliers

    Can't think of when I'd want that though......
    Who are your suppliers?? I've never seen adds that high on this side of the lake.

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    Bad address email on file RetroRat's Avatar
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    Quote Originally Posted by Speed View Post
    I have made some Franklins before. I remember them requiring lots of advanced skills and time. I do not remember the Aire-o-lite lenses taking so long.

    Good thing here is a few options to chose from anyway.


    Yes, better too many options than not enough options, if the franklin proves problematic then I will definitely be chatting up Aire-o-lite, thanks speed :)

    Quote Originally Posted by Aberdeen Angus View Post
    I'm a bit surprised at the lack of availability, I can get a R24 with adds up to 15.00 from one of my suppliers

    Can't think of when I'd want that though......
    Australia is seemingly dominated by big corporate labs, anything that's not a money-maker isn't worth having anymore apparently. It's only the patient who loses out in the end and who really cares about them anyway right?

    ... right?

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    Quote Originally Posted by Jacqui View Post
    Who are your suppliers?? I've never seen adds that high on this side of the lake.
    An optical company called Norville, they have 5 labs around the UK.

    They are who I go to for anything out of the ordinary. If you want a 20 add you can have that in a R22

    They also do flat tops in high adds, but not as high as the round.

    Don't know if they make them themselves or source them from elsewhere.

    You can view their entire catalogue at www.norville.co.uk prices are not shown though......
    Last edited by Aberdeen Angus; 09-11-2011 at 03:31 AM. Reason: More information added

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