What type of frame would you use for a high hyperope (+12)?

[ilanh]

We recently had a patient with a +12 prescription. She was fitted with high index lenses (PAL) which were put in a metal frame. The lenses were constantly slipping out of the frame and we have already had 2 redo's by the lab. The lenses are still slipping out and we no longer do business with the original lab that did the job. I now need to send this job out to another lab (at our expense) but I want to make sure that they will stop falling out of the frame. What type of frame would be most reliable? What other precautions would you take to insure that this doesn't keep happening? Thanks,

[uncut]

Frame: The distance OC and the geometric OC of the lens shape must coincide. Stay away from rectangles, and use frame materials to create size, not lens size/area. Use frames with temporal extensions for width. Default to the smallest possible size of lens, since anything over 30 mm is not going to be used visually, not even for peripheral. Frame must be adjustable, with nosepads, or several bridge sizes in order to achieve MED. A deep groove depth is desirable, and a metal that holds it's adjustment(stiff) is preferable. Stability is required/desired.

Lens:
I would suggest that you default to a visible bif.seg for two reasons. 1.) The read power in a PAL is too far away from distance OC to be useful in any meaningful way, and the patient is using the intermediate anyway. 2.) The thickness of your lens would be requested to be KET in 4 quadrants, due to it now based on the distance power rather than the thickness of combining the add and the distance(in PAL).

A skilled lab, and a skilled edger operator, will produce a beautiful fitting product, which should be edged slightly big, since a KET lens will lose some edge due to compaction.

[Barry Santini]

+12?

Two ways to approach this, IMHO:

1. Strict MED fitting. I'd favor CR39 index
2. Modified MED, with a blended carrier filling out from the bowl to the frame bevel.

In both cases, the lens bevel curve must be close (within 1.5D) of the frame's bevel curve. The lab who made the original job is incompetent. Period.

B

[LENNY]

Don't polish edges.:)

[MikeAurelius]

Round shape or modified P4. Agreed on not polishing the edges. Try to match frame size to patient PD with little or no decentration.

[Pogu]

As Barry said the lenses are coming out because the company that does your work did it poorly. A competent finish tech should be able to mount a lens securely within any reasonable frame selection. I would add that preforming your own finish work would allow you to control the end product, but that's not what you asked about so I won't push it.

[jefe]

We recently had a patient with a +12 prescription. She was fitted with high index lenses (PAL) which were put in a metal frame. The lenses were constantly slipping out of the frame and we have already had 2 redo's by the lab. The lenses are still slipping out and we no longer do business with the original lab that did the job. I now need to send this job out to another lab (at our expense) but I want to make sure that they will stop falling out of the frame. What type of frame would be most reliable? What other precautions would you take to insure that this doesn't keep happening? Thanks,

The ideal frame would be one which is perfectly round and with no decentration. Remember that and try to find something as close to that ideal as possible.

[braheem24]

[ilanh]

Thanks for all the tips. Much appreciated.

[AngeHamm]

Gant Rugger Boerum. John Varvatos V111.

[sharpstick777]

Frame selection is far more important in high plus powers, I would not blame the lab for the quality of the job in a frame that is not compatible with the RX.

We recently had a patient with a +12 prescription. She was fitted with high index lenses (PAL) which were put in a metal frame. The lenses were constantly slipping out of the frame and we have already had 2 redo's by the lab. The lenses are still slipping out and we no longer do business with the original lab that did the job. I now need to send this job out to another lab (at our expense) but I want to make sure that they will stop falling out of the frame. What type of frame would be most reliable? What other precautions would you take to insure that this doesn't keep happening? Thanks,

[sharpstick777]

I work in a lab and see poorly choosen frames for plus patients all the time. There are simply some frame and RX combinations that should never be done, and cannot be made satisfactorly by any lab.

As Barry said the lenses are coming out because the company that does your work did it poorly. A competent finish tech should be able to mount a lens securely within any reasonable frame selection. I would add that preforming your own finish work would allow you to control the end product, but that's not what you asked about so I won't push it.

[sharpstick777]

ilanh, I will repeat the great content offered here another way. Round and Centered is key for the frame. The problem with plus is that frame selection will determine both edge and center thickness, unlike minus where edge thickness is your only concern.

To reduce both edge and center thickness in plus powers, place the frame on the patient and dot the pupil. Measure the distance from the pupil to the outside farthest edge of the frame. That distance and material will determine center thickness because that will be the required radius of the blank.

Secondly, determine the shortest distance between the pupil and the edge of the frame. That will the the thickest point of the lens. As well, if you subtract the Longest radius from the shortest, and there is a difference of more than 30%, your outcome both cosmetically and fit is likely to be poor. You can estimate the thickness using the calculator from Opticampus. Often the case of decentered rectangles. For example, if the longest and shortest radius are identical, no matter the material, you will have a very thin edges (the center will be thick though, and the lens heavy). Its rare you can get it perfect, but the closer the longest and shortest radius are, the better the fit and cosmetics will be.

Strangely, if it centers the eye better, a larger frame can actually work better (but it can increase weight too).

[manoj_verma]

A Frame ,which requires Least Decentration or No Decentration.
A Frame ,Which is Round or atleast Similar to Round .
A Frame ,Which has a bit thik Rims unlike metal Frames.

Hope It Works !

[Speed]

We recently had a patient with a +12 prescription. She was fitted with high index lenses (PAL) which were put in a metal frame. The lenses were constantly slipping out of the frame and we have already had 2 redo's by the lab. The lenses are still slipping out and we no longer do business with the original lab that did the job. I now need to send this job out to another lab (at our expense) but I want to make sure that they will stop falling out of the frame. What type of frame would be most reliable? What other precautions would you take to insure that this doesn't keep happening? Thanks,

Round shape with frame pd as equal to patients. Super modular lens, if you can find. The shallow B frames that are so popular today would make a think looking lens.

[AngeHamm]

Hopefully you can convince the patient to listen to your recommendations. There's nothing like a patient with an extreme prescription who insists on a frame undesirable for their lenses and the complains when they come out aesthetically displeasing. :-/