Help!?!

[Bok]

Heya

stuck here, need some help

client presenting with rx of;
RE: -3.00/-0.50x22
LE: -3.25/-0.50x172
O.C R29L30.5
Height 2mm Above HCL @ 0 degrees panto tilt
BVD 12mm & tested @12mm also
Panto Tilt 11 Degrees

Wearing a frame with shape depth of 38mm, Single vision 1.5 A/R coated lenses.

Feels needs to raise lenses to a point where eyes are 6mm Below HCL to get clearest vision has been back with the Dr and Rx is fine and stable no issues. Have checked the OC and height seg and all ok and frame fit couldn't be better.

Have considered shifting the height seg to 6mm above HCL to raise ocular center of lens higher in the frame to coincide with the "increase" in vision when frame raised. Does anyone else out there have any bright ideas as I am hesitant to fit this lens 4mm above what the client actually requires.

I measured the height seg to be exactly 6mm above HCL with full 11 degrees of panto tilt applied to frame.

Any ideas or just roll with the 6mm above HCL?

[uncut]

You refer to seg height...........What is the prescribed add power, multifocal type, or are you referring to OC height as measured in a final fit position?

What is the OC height measured/worn in the previous pair, and power of the previous pair?


Hey....Spring must be around the corner in NZ, eh?

[Bok]

You refer to seg height...........What is the prescribed add power, multifocal type, or are you referring to OC height as measured in a final fit position?

What is the OC height measured/worn in the previous pair, and power of the previous pair?


Hey....Spring must be around the corner in NZ, eh?

Hey Uncut! thanks, SUMMER!! is on its way, and looking forward to it!!

Sorry its single vision yes the O.C height not multifocal seg, bad habits die hard...

the current pair is the same frame same rx there has been no change in vision for some time but the client has just persevered with the visual problem for the last year until she has come back on a recall. so current pair is set 2mm above HCL. client doesn't have any other specs to provide. This has been the same frame for the last few years and she cannot provide any history of last dispense. other than what we have done for the last pair and the new pair.

I measured the O.C height to be 6mm above HCL but at the full 11degree panto tilt, so taking into consideration the center of rotation rule I would decrease my 6mm by 5.5mm leaving it with 0.5mm Above HCL which would be lower than the current pair and most likely causing worse issues with having to raise the frame height.

When raising frame height BVD is not being increased or decreased BVD stays the same (not that it would make a huge difference unless massive adjustement to BVD)

[uncut]

You may be experiencing a client that may be perceiving clearer VA but when acuity is checked in an exam setting, attains no accuracy improvement, or is a minus "vacuum". I would suggest a over-refraction, and if results are the same...a refractionist discussion about being over corrected and the discomforts associated with that.

[Bok]

You may be experiencing a client that may be perceiving clearer VA but when acuity is checked in an exam setting, attains no accuracy improvement, or is a minus "vacuum". I would suggest a over-refraction, and if results are the same...a refractionist discussion about being over corrected and the discomforts associated with that.

improvement with V/A is noticed in the testroom however minor.

Visual acuity is noted at 6/5 with specs on, when raised 6/5+2. (no real difference but the client is perceiving the difference.

Can you explain the minus "vacuume" I havn't heard of that term?

[uncut]

The reference is to a myope's ability....at a particular age, to vacuum up, or hoover, or slurp up as much minus as possible. They love to be over corrected, and mildy far-sighted!



"Ive got that summer time, summertime madness......" that song has become a ear-worm!

[Bok]

Oh I see now the reference! So should we over-refract and leave the height as per center of rotation rule?

Can't say I have heard that song either.. Man us in NZ must live in grass huts and wear grass clothing...

[uncut]

Are you sure that the lenses dispensed are not aspheric? That could explain the preference of position. Measure the base curve, carefully, to check for that.

I would not be uncomfortable with re-doing the lenses at the client's expense to fulfill their preference position of wear, they might be a head's down kinda person...........or like to wear their glasses at a lower position than dispensed, or the summer time heat parks them there!

[uncut]

ear-worm: link to Lana Del Rey song: Summertime sadness. Actually a very good summer song. Enjoy

http://www.youtube.com/watch?v=nVjsGKrE6E8

[Bok]

Are you sure that the lenses dispensed are not aspheric? That could explain the preference of position. Measure the base curve, carefully, to check for that.

I would not be uncomfortable with re-doing the lenses at the client's expense to fulfill their preference position of wear, they might be a head's down kinda person...........or like to wear their glasses at a lower position than dispensed, or the summer time heat parks them there!

Pretty sure not aspheric however I dont have any dispensary notes on the current lenses as our practice didn't make them and she cannot provide us with who made them nor with detail of the dispense.

3D Base curve RE
3.5D Base Curve LE

I am uncomfortable with remaking the glasses period..

Client does like to have a lower head position (head tucked into chin) the specs had a tendancy to slip down the nose with the NZ summer heat, but has been adjusted and no longer does that but still the issue is there..