Curly progressive question

**Bok** · 11-13-2011, 07:33 PM

Hi folks got another curly one for you all to think about. pt comes and see's me Rx of, hasnt worn glasses in 20 years as finds vision better without. R:-0.75/-3.50x53 L:-0.75/-3.75x143 wearing Hoya GP Wide PD: 31.0/31.5 Height 18mm complaining at blurred vision in distance and reading checked the Rx client complained that rx blurred and worse than specs but was the same rx? specs better and can get them into focus by adjusting her head to the left around 8 degrees, both rx's the same in specs and trial frame. will double check rx again see if there is some changes that need to be made. however when wearing the specs she can get them into focus so dotted the lenses where the pupils sitting getting a different PD and height (PD 34.5/32 height 20mm) decided to get the pt to take a walk around the shop and then make her way back to me to double check these measurements got different again (PD 27.5/29.5) Checked on a pupilometer and different again (PD 32.5/31.0) which PD should i be using and how can i get a stable PD not changing every 5 minutes, and what would explain the Rx in trial frame being blurred but Rx in specs clearer.. going to raise the height to 20 as this will suit the lens better but still unsure on PD and Rx outcome.

**chip anderson** · 11-13-2011, 08:38 PM

You sure someone hasn't moved the near far dial on the pupilometer. And when in doubt of a pupilometer, re-check with a ruler.

Chip

**Bok** · 11-13-2011, 09:28 PM

Originally Posted by chip anderson

You sure someone hasn't moved the near far dial on the pupilometer. And when in doubt of a pupilometer, re-check with a ruler.

Chip

In doubt, checked with ruler and dotting the lens for pupil center. Still in doubt, is there any reason for different PD measurements when done three different ways and get getting consistent measurements when repeating each way.

**MIOPE** · 11-13-2011, 09:37 PM

Are you sure the patient was looking to a far object and not to you when measuring with the rule?

**Bok** · 11-13-2011, 10:18 PM

Originally Posted by MIOPE

Are you sure the patient was looking to a far object and not to you when measuring with the rule?

Positive

**marktheeyeguy** · 11-13-2011, 10:35 PM

MATCH THE PD ON THE OLD GLASSES THE PATIENT HAS BEEN WEARING. JUST BECAUSE YOU MEASURE FOR A NEW PD AND IT IS CORRECT DOESNT MEAN ITS RIGHT FOR THE PATIENT. Old glasses are always the map to the treasure chest.

**Robert Martellaro** · 11-14-2011, 01:01 PM

Bok,

I'm having some trouble following the details, but it seems that your client hasn't worn glasses for twenty years. Has you client ever worn glasses?

Regarding the PD, calibrate the pupilometer, and use a centration chart http://www.thelensguru.com/charts/gpwide.pdf to verify the lens markings (dots or lines). Eliminate errors due to parallax.

The visual problems are probably related to the Rx, complicated by the use of a PAL. Consult with the doctor to find something that's workable, starting with trial lenses or Rx single vision lenses. The cylinder power may need to be reduced, and the axis may need tweaking (less oblique). Once you've found a refraction that's wearable, you could consider PALs to correct the presbyopia, but it would be best if you used one of Hoya's more advanced lenses, or Zeiss's Individual. A segmented multifocal should be on the table as well. Hoya's IQ FT 28 would be ideal due to the Atoric grind.