We have all had 1 or 2 patients who (reported) that they didn't see well through there new Progressives. What are the steps you take to solve the issue?
We have all had 1 or 2 patients who (reported) that they didn't see well through there new Progressives. What are the steps you take to solve the issue?
Are these former progressive wearers? Listen to what they say the problem is.
I think it's important to remark the lenses and check where the fitting cross is sitting on the person. Check their old progressives, also. Is it a different progressive? Of course compare the RXs and make sure they are filled correctly. Make sure the glasses are adjusted correctly.
Make sure the person understands how to use the lenses and what to expect if they are new wearers.
If everything looks good and they aren't new wearers it's possible the RX needs tweaking.
At a minimum, I would want to know their exact Rx, and the exact specifications of the old and new lenses (brand/model/material) and frames (A/B/FH).
On top of that, I would recheck the PD. Ive re-measured pts we haven't seen in a while and gotten .5 to 1mm of difference from the last optician that measured them 2 or three years ago. That messes everything up. Am I right? Are they right? It doesn't matter. The Pt has been wearing the lenses at that PD for 3 years!Originally Posted by Happylady
Did the add change? A stronger add will increase the distortion in the periphery of the lens. That will feel different to the pt. They may notice those feelings and droning on and on about how they feel. Then you can say Bro....I know that feel.
Check the nose pads if the frame has any. You may need to change the camber and facet.
Check the prism of the lens. Did the lab botch it? Anything is possible. Did the PT RX change dramatically? They may like their old RX better then the new RX. Over 10 years ive put bunches of people back into their original RX cause they didn't like the change. To much for them to handle. Honestly, at the end of the day, they have to wear their glasses and be happy.
Your right about the PD, but if the lenses are remarked and checked on the patient, PD issues will be revealed, the fitting cross should sit right on the pupil.
For progressive lenses with moderate to stronger adds, >2.00D; you MUST verify the visual axis subjectively, and not just depend on pupilometer/DCD and a verification protractor.
B
Last edited by Barry Santini; 06-12-2014 at 10:37 AM.
1. Position of wear.
2. Position of wear.
3. Position of wear.
4. Some weird lens defect.
100. My refraction.
I have learned that the most important tool we have as Optician to troubleshoot, is the Trial lens set. After marking up the lenses and checking for fit, the first thing I do is eliminate the progressive issue by simply putting their distance rx only into a trial frame and have them look at the Snellen chart (which is on the wall 20 feet away). If they see according to their accuity on RX then the problem is the progressive. Then compare the accuities from old glasses. This works for me several times a day and also shows the patient that you know your stuff! I just did it 30 minutes ago after lady says she can't see nothing when dispensing her new glasses. Amazing how she left seeing 20/25!
Not only do you have to listen to what the patient is saying. You have to understand what they are trying to say, mean.
Sounds like robotic thinking - we had someone mention patients wearing something different from what is measured. Previous pairs MUST be considered as part of the dispensing process. I wouldn't want to change a PD by a massive amount, in case more problems were created than solved.
On that note, does the Pt know what they mean? It takes some serious forensic science, physics, astrology, and a masters in feng shui to determine what the pt means. Its blurry, its not right, I don't know what it is, the intermediate is fine but its not, I can see but I cant see, you see? ... @#%$&$&(@#!!!
Geez. With progressives, matching PD's to an old pair, when your own (more accurate?) measurements tell you otherwise, is JUST PLAIN WRONG in almost all cases.
Prism, now that's another matter.
B
I think it's too strong to say PLAIN WRONG as a statement of apparent fact. I believe it is important to consider older pairs when dispensing. I've seen some wild errors in my time (>5 mm different PDs from 'correct'). When corrected to 'perfection', adaptation can be (sometimes) problematic.
With some Rx's out there and some hypochondriacs, if I found PD or seg way out of line I would much rather give them only half of what they really should be on this visit and finish my "adjustment" on their next visit. That's better then trying to throw it all at them right now and then beg them to keep trying. Or it creates a remake.
Ahhhhh an executive decision about expenses control has been taken into account.
I'm with CC on this.
I think it's not a great plan to try to steamroll your new measurements into a pair, just because you think you're right.
Is your question Sharpstick a suspicion from labs that we tend to shake our Magic 8 Ball of progressives to change wearers into other designs knowing we can always just send them back for no charge redo's into original less expensive designs worn successfully in the past?
Otherwise like other posters-
Check for obvious errors
Note rx and frame changes
Magic shelf
When all else fails I learned this from a doctor in Haiti-
Come out smoking a big cigar holding a large knife (machete is better) and a live chicken...
You'd be amazed at quickly the troubled patient leaves the office. Problem solved!!!
Last edited by Uncle Fester; 06-12-2014 at 02:09 PM. Reason: tweak...
Perfect is good enough.
Not for progressives, which is Barry's point of reference, considering the thread title!
I used to think the same for non-progressives, easing them in to a zero prism solution. My thinking over the last twenty years or so has been to make the optics spot on, and warn the client that there will be additional adaptation in exchange for increased long term comfort. Exceptions are seg heights (don't forget that the apparent height is also dependent on vertex distance).
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
I agree you should always look at their previous glasses as I said in my original post. Of course, many people don't bring them.
Check prism thinning amount. Check against previous pair.
You guys might find the attached troubleshooting guide handy.
Best regards,
Darryl
Darryl J. Meister, ABOM
Thank you Darryl.
I don't have any suspicion, I KNOW some people use the Magic 8 Ball! lol. Some good points, but I don't see a sense of which order to do them in, and only one person has mentioned verifying visual acuity... no one has mentioned checking for pathology. My own list is a long one of steps, like a Visio flow chart.
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