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Thread: Help, baffled why patient is having trouble...

  1. #1
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    Confused Help, baffled why patient is having trouble...

    OK, I have a patient who came in and got some clear, trivex flat top 28's.
    Seg ht is 13.
    Rx is as follows:

    OD: balance
    OS: +1.75 - 0.75 x 73

    Add: +2.25

    She is having trouble seeing her computer screen through the bifocal section, (which she insists is how she is used to using them, even though it strains her neck abit), she feels like she has to get up too close to the screen for comfort.
    She had an almost identical pair made at another practice that works great.
    She brought me the Rx those were supposedly made in:
    OD: balance
    OS: +1.75 -0.75 x 78
    Add: +2.25
    The other office told me they were FT28 plastic, seg ht 13, clear, nothing special ordered.

    I checked and both BC's measure about the same.
    The funny thing is, on her old pair I read more of a +2.50 add. so wouldnt that cause her to sit closer not farther away??
    What could be causing her to see the computer screen from further away with the old pair but feel she has to move in much closer with the new ones?
    The small 0.25 cyl difference???

    Please help!
    Doctor is out and often isnt willing to budge on his Rx's anyway...

    Thanks.

  2. #2
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    as an optician you can make the call *usually* to change to an intermediate add instead of a full add (this is something we do frequently in our office, judging what the patient need is and filling the bi-focal for lifestyle) . i would have the patient measure the distance she would like to have to sit away from the computer at home and then calculate the add accordingly. also, try having her raise her chair to reduce neck strain. i had a patient the other day who we had to do a D/I bi-focal for, and then fill her a set of "reading only" for her 3rd distance since she couldnt do progressives or tri-focals.

    or tell her she's off her freakin rocker. that always makes for a good reaction
    "what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy

  3. #3
    OptiWizard
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    Had an answer, but I spoke to soon - I take it back.
    Last edited by Jason H; 05-22-2013 at 11:08 AM.

  4. #4
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    LoL yeah the doctor already told me last week he thought she was off her rocker! But I am not about to tell that to her face! He also mentioned he already backed down the reading power so she could use at a computer, plus she *claims* she can see the computer fine with the old pair of the "same" add... so this is why I'm so confused. Just trying to figure out if there is some other variable here at play....

  5. #5
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    Optigal, have you ever used the "magic drawer"? Sometimes if you hold onto the glasses for a week or so while "inspecting" them, the patient will come back and the problem will be mysteriously fixed. A magic drawer can be found in any office and can come in other forms (cabinet, tray, bin etc). The old OD I worked for taught me that skill for similar patients.

  6. #6
    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by Optigal28 View Post
    OK, I have a patient who came in and got some clear, trivex flat top 28's.
    Seg ht is 13.
    Rx is as follows:

    OD: balance
    OS: +1.75 - 0.75 x 73

    Add: +2.25

    She is having trouble seeing her computer screen through the bifocal section, (which she insists is how she is used to using them, even though it strains her neck abit), she feels like she has to get up too close to the screen for comfort.
    She had an almost identical pair made at another practice that works great.
    She brought me the Rx those were supposedly made in:
    OD: balance
    OS: +1.75 -0.75 x 78
    Add: +2.25
    The other office told me they were FT28 plastic, seg ht 13, clear, nothing special ordered.

    I checked and both BC's measure about the same.
    The funny thing is, on her old pair I read more of a +2.50 add. so wouldnt that cause her to sit closer not farther away??
    Yes, but are you measuring the front vertex power? The add power will read too high if you use the back vertex measurement on plus powers, although the power here isn't that high/thick. I wouldn't go by the old Rx- measure the old distance to be sure you have good data. Maybe they fudged the distance grind and made +1.25 -.75 x 78!

    What could be causing her to see the computer screen from further away with the old pair but feel she has to move in much closer with the new ones?
    The small 0.25 cyl difference???
    What difference?!

    Please help!
    Doctor is out and often isnt willing to budge on his Rx's anyway...

    Thanks.
    Cut the add .25, but make sure she understands what this will do to J1, especially in poor light. I'd strongly recommend two pair for this monocular client.

    Hope this helps,
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

  7. #7
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    +.25/-.25 flippers are your best friend. I am sure you have a set, every optician should.
    Beer is proof that God loves us and wants us to be happy ~Benjamin Franklin

  8. #8
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    Sounds like buyer's remorse manifesting in other ways to me-

  9. #9
    Master OptiBoarder opty4062's Avatar
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    I agree with Kittyeyes about the buyer's remorse possibility. But I will also share this: recently had a pt in the office complaining of trouble with focusing on computer. After many questions we determined she had recently changed the lighting around her computer in her home office. She added a lamp to her desk and adjusted the brightness on her monitor a bit and all was back to normal. Sometimes it's the little things. Hang in there!

  10. #10
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    Quote Originally Posted by RichR View Post
    Optigal, have you ever used the "magic drawer"? Sometimes if you hold onto the glasses for a week or so while "inspecting" them, the patient will come back and the problem will be mysteriously fixed. A magic drawer can be found in any office and can come in other forms (cabinet, tray, bin etc). The old OD I worked for taught me that skill for similar patients.
    This would be the "easy" way out. I feel the "magic drawer" should be used with care, cause over-use of it's powers will weaken it's strength. It should never be overcrowded with tasks, nor should everyone have access to it. Optigal28 may have to wait till she is Optigal48 before the drawer's powers might be bestowed upon her.....just sayin'.

    @opOptigal28:

    This patient is monocular in ability, and quality. The change in index of refraction, therefore a slight basecurve change, coupled with the 5* axis change, and a slight shift in near IPD(readable only within seg) may be the acting difference in "closeness", or less forgiving reading area, which IMO at a 13mm height is only 9 mm of useful vertical area. A slightly lower fitting height will also make the lens(es) feel "stronger".
    Eyes wide open

  11. #11
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    Quote Originally Posted by RichR View Post
    Optigal, have you ever used the "magic drawer"? Sometimes if you hold onto the glasses for a week or so while "inspecting" them, the patient will come back and the problem will be mysteriously fixed. A magic drawer can be found in any office and can come in other forms (cabinet, tray, bin etc). The old OD I worked for taught me that skill for similar patients.
    LOL. We must have had similar mentors...only mine called it the WO...Wipe Off. You take the glasses in the back room, heat them up a bit, wipe them off and go put them on the patient while still a little warm. It's amazing how often this makes things better.

    Sorry if we offend some lay people out there, but often there is no logic or scientific reason why things work or don't.

  12. #12
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    Quote Originally Posted by Optigal28 View Post
    OK, I have a patient who came in and got some clear, trivex flat top 28's.
    Seg ht is 13.
    Rx is as follows:

    OD: balance
    OS: +1.75 - 0.75 x 73

    Add: +2.25

    She is having trouble seeing her computer screen through the bifocal section, (which she insists is how she is used to using them, even though it strains her neck abit), she feels like she has to get up too close to the screen for comfort.
    She had an almost identical pair made at another practice that works great.
    She brought me the Rx those were supposedly made in:
    OD: balance
    OS: +1.75 -0.75 x 78
    Add: +2.25
    The other office told me they were FT28 plastic, seg ht 13, clear, nothing special ordered.

    I checked and both BC's measure about the same.
    The funny thing is, on her old pair I read more of a +2.50 add. so wouldnt that cause her to sit closer not farther away??
    What could be causing her to see the computer screen from further away with the old pair but feel she has to move in much closer with the new ones?
    The small 0.25 cyl difference???

    Please help!
    Doctor is out and often isnt willing to budge on his Rx's anyway...

    Thanks.
    This is a longshot, and I realize the patient is monocular in this case, but check the amount of vertical prism in the seg area that the patient uses, relative to the carrier OC. If the two are vastly different, say...more than a diopter, this might be it.

    Or another way to look at it might be to check the belows. If they are not similar, this could be your problem. I once had another mentor who would not fit any frame to a patient unless the below was 4.

  13. #13
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    Quote Originally Posted by RichR View Post
    Optigal, have you ever used the "magic drawer"? Sometimes if you hold onto the glasses for a week or so while "inspecting" them, the patient will come back and the problem will be mysteriously fixed. A magic drawer can be found in any office and can come in other forms (cabinet, tray, bin etc). The old OD I worked for taught me that skill for similar patients.
    I have really begun to notice, especially when a patient comes in for an adjustment (because the frame is sitting crooked, but it really looks fine), that if I just barely make a couple of "moves" on the frame and then when the patient tries it back on I will smile and say, "how does that feel?" with lots of enthusiasm (when I know I did nothing to the frame) and they pretty much always say, "oh yeah that's much better!" it cracks me up. I never thought to use a magic drawer, though... I'm keeping that one in my arsenal :)

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    wow, I am not certified, I have been working in a small office for about a year now and I pretty much am teaching myself most of everything, my boss is wishy-washy (spent about a week training me and just threw me in to it all) and my co-worker is just as green as I am. i have a similar issue to what the OP is dealing with and I thought reading this would help, but it's leaving me with a feeling of, "damn! I have a lot of learning left to do!" I barely understand any of the replies here... I need to start studying!
    Last edited by pl4ceh0lder; 05-25-2013 at 11:55 AM.

  15. #15
    Optical Janitor OptiBoard Silver Supporter peyes's Avatar
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    Change back to cr-39...match base curve...solve issue.
    Last edited by peyes; 05-26-2013 at 05:03 PM. Reason: Error

  16. #16
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    I have a different take.

    I don't see how anyone with even a +2.00 add can see the screen through the add unless their face is planted in it.

    I don't know HOW she was able to do it before, but you certainly can't re-create that miracle.

    Put her in a TF if light use, or better yet get her some intermediate-distance lenses with an add in her old frame.

  17. #17
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Me thinks the problem is not with the glasses but between her ears.

    I call it "new pair of shoes syndrome".
    Nothing fits like an old pair of shoes.

    I do like the possible vertical prism but this smells like a pair of glasses that are best eaten with some salt.

    No easy answer. I do wish you luck.

  18. #18
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    Quote Originally Posted by pl4ceh0lder View Post
    wow, I am not certified, I have been working in a small office for about a year now and I pretty much am teaching myself most of everything, my boss is wishy-washy (spent about a week training me and just threw me in to it all) and my co-worker is just as green as I am. i have a similar issue to what the OP is dealing with and I thought reading this would help, but it's leaving me with a feeling of, "damn! I have a lot of learning left to do!" I barely understand any of the replies here... I need to start studying!

    Yes, start studying, but also stay on Optiboard so you can learn and grow from the experience of others. I've been at this for a decade and I still feel like a "newb" some days. The important thing is to never believe you are "done" learning. Good luck!:)
    "Strictly speaking, there are no enlightened beings; only enlightened activity." -Shunryu Suzuki

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