Have you ever seen AR cause a non-adapt situation?

**Roscoe** · 02-26-2013, 02:53 PM

I have a patient who swears that CR39 is the only material that will work for him. Despite that (thinking that he had never tried Trivex before) one of our opticians tried him in Trivex with Zeiss Purecoat AR. He returned complaining of headaches (as was his complaint in years past when trying poly). During this troubleshoot I checked everything I could think of (including putting his new Rx in a trial frame...through which he saw great), and concluded that perhaps going back to CR39 was the only solution. After wearing the remade lenses in CR39 for 2 weeks he returned again. Same issues. Short of a doctor recheck, would any of you suspect AR as a culprit. I just haven't seen AR negatively affect lenses before, so I'm at a loss until he has his recheck.

Roscoe

**AustinEyewear** · 02-26-2013, 03:26 PM

Originally Posted by Roscoe

I have a patient who swears that CR39 is the only material that will work for him. Despite that (thinking that he had never tried Trivex before) one of our opticians tried him in Trivex with Zeiss Purecoat AR. He returned complaining of headaches (as was his complaint in years past when trying poly). During this troubleshoot I checked everything I could think of (including putting his new Rx in a trial frame...through which he saw great), and concluded that perhaps going back to CR39 was the only solution. After wearing the remade lenses in CR39 for 2 weeks he returned again. Same issues. Short of a doctor recheck, would any of you suspect AR as a culprit. I just haven't seen AR negatively affect lenses before, so I'm at a loss until he has his recheck.

Roscoe

Definitely worth a read and an understanding:

http://www.optiboard.com/forums/show...t=newton+rings

**uncut** · 02-26-2013, 05:08 PM

When you dispense a Anti-reflection coating, there are many advantages to this product.......but remember to inform about the downside, especially with someone who has not participated in the use of the product, previously, or was deemed to be a fail using the product.

Negatives of AR coating:

Increased light transmission compared to lens without, the approximate % is 8-10%, depending on the index of refraction of lens reviously worn, and lens index proposed.

Marks and scratches are more apparent to wearer.....but are not increased in volume(as percieved), but may seem pronounced.

Oils interfere with coating's ability to function.......therefore an oil-free environment is desired for best functionality.

Certain optical characteristics within lens, including optical illusion of material behind lens will be more enhanced.

Infrared transmissibility may also be increased depending on base material of lens.

Life span of AR coating may limit useful life of lenses, reciprocal to quality of coating afforded.

Maybe more later(coffee break)
uncut

**Roscoe** · 02-27-2013, 02:14 PM

Thanks much, Austinwear and uncut!

**Wes** · 02-27-2013, 02:20 PM

A patient will reject an AR coating if it is crazed...

**Roscoe** · 02-27-2013, 02:34 PM

My patient's lenses (with AR) looked great, with no crazing and no newton noise waves (as described in the posts above). So, I'm still stumped after reading the posts (and linked posts) above.

**Wes** · 02-27-2013, 02:39 PM

The increased light transmission mentioned can aggravate "sensitive" patients as everything looks much "brighter". Your patient sounds like a sensitive one. What's the rx, base curve, frame size, wrap/tilt...

**Roscoe** · 02-27-2013, 02:58 PM

OD: -1.25 -0.50 126
OS: -1.00 -0.75 059

Frame: 53-18; B=29 (FPD: 71)
PD's: 34/36 (DPD: 70)
OC: 15
BC: 5
Wrap: 12 deg.
Panto: 5 deg.

**CCGREEN** · 02-27-2013, 03:48 PM

Its great to try and resolve the issue for the patient. It makes them happy and makes you gratified. But at what point do you stop trying to give them something that they already told you they would not like? Just make them 20/happy give them what they want even though you see no reason that they should not be able to wear what you suggested. Then if you want to scratch your head and solve the mystery in your spare time.........enjoy

**jefe** · 02-27-2013, 08:56 PM

I believe there are occasions when the client is determined to be right about these sorts of things. Statements of the sort "I never..." or "I always..." are clues of this type of thinking. Let them be right, and don't go through multiple remakes trying to convince them something else will work.

**uncut** · 02-27-2013, 09:37 PM

Originally Posted by Wes

The increased light transmission mentioned can aggravate "sensitive" patients as everything looks much "brighter". Your patient sounds like a sensitive one. What's the rx, base curve, frame size, wrap/tilt...

I think Wes might have the best explanation, Roscoe.........it the person is sensitive, possibly contends with edema of the cornea due to allergies, medications, or works in an over-lit facility, or outdoors, then increasing the light transmission, when he is unaccustomed to it, would create discomfort.

**Wes** · 02-27-2013, 09:47 PM

Originally Posted by uncut

I think Wes might have the best explanation, Roscoe.........it the person is sensitive, possibly contends with edema of the cornea due to allergies, medications, or works in an over-lit facility, or outdoors, then increasing the light transmission, when he is unaccustomed to it, would create discomfort.

Hey, you mentioned it first! I just elaborated.

**uncut** · 02-27-2013, 09:51 PM

High-five(I can't find that emodicon)

**sharpstick777** · 03-01-2013, 03:15 PM

I have a few patient non-adapt to Trivex. Even a -.50. Rare, but it can happen. BC could also be an issue. CR-39 is a terrific material, the clarity is awesome.

AR should not cause any problems itself, but the hard coat might. Its possible the lab through on a 1.50 or 1.60 hard coat, which should be indexed matched for best results. Order a Stock Lens, and it will eliminate that issue.

Originally Posted by Roscoe

I have a patient who swears that CR39 is the only material that will work for him. Despite that (thinking that he had never tried Trivex before) one of our opticians tried him in Trivex with Zeiss Purecoat AR. He returned complaining of headaches (as was his complaint in years past when trying poly). During this troubleshoot I checked everything I could think of (including putting his new Rx in a trial frame...through which he saw great), and concluded that perhaps going back to CR39 was the only solution. After wearing the remade lenses in CR39 for 2 weeks he returned again. Same issues. Short of a doctor recheck, would any of you suspect AR as a culprit. I just haven't seen AR negatively affect lenses before, so I'm at a loss until he has his recheck.

Roscoe

**sharpstick777** · 03-01-2013, 03:17 PM

Originally Posted by uncut

I think Wes might have the best explanation, Roscoe.........it the person is sensitive, possibly contends with edema of the cornea due to allergies, medications, or works in an over-lit facility, or outdoors, then increasing the light transmission, when he is unaccustomed to it, would create discomfort.

You can test this out with a 10% tint if you like, if the tint brings relief you have found your issue.

**Robert Martellaro** · 03-01-2013, 05:23 PM

Originally Posted by Roscoe

Have you ever seen AR cause a non-adapt situation?

No. Your client's problem lies elsewhere- excessive wrap angle, change in Rx, emerging presbyope, etc.

OTOH, if your client has an irrational belief...

**Tallboy** · 03-05-2013, 05:21 PM

I was gonna mention that wrap angle also, 12 degrees wrap with 5 degrees panto? Thats an odd fit, but I didn't want to make judgments on the gentleman's facial struction.