lens material question

[Jstanfast]

So I am looking for recommendations and a little bit of advice on this job.

OD--1.75-0.75x090
OS--3.75-4.75x041
Add 2.00

Eyemed schedule 3 Pal. 16.5 seg
tier 3 ARC.
Silhouette drill mount frame. shape 5225

Correct for the aniseikonia?
balance the lens thicknesses for cosmetics?

What would you do?

[Browman]

So I am looking for recommendations and a little bit of advice on this job.

OD--1.75-0.75x090
OS--3.75-4.75x041
Add 2.00

Eyemed schedule 3 Pal. 16.5 seg
tier 3 ARC.
Silhouette drill mount frame. shape 5225

Correct for the aniseikonia?
balance the lens thicknesses for cosmetics?

What would you do?

Trivex, appropriate Hoya product, if you're a provider. Haven't got my formulary in front of me; go-to would be CD iQ.

[Don Gilman]

slab off

[Paul Smith LDO]

Any issues with diplopia or suppression? RVA? I would keep the eye centered, so try to match FPD with patients IPD. Trivex might prove to be more difficult, due to edge thickness, that leaves polycarb and HI -1.67. What material are they currently wearing.

[Jstanfast]

Currently wearing Poly. Hates vision but that is also probably attributed to ovation PAL. Coming from a Pair where FPD and IPD were not even close. Lens thickness is an issue she wants to go thinner. I explained that I would expect some minor adjustment period from changing materials but would be better in the long run. On this new pair FPD is centered nicely over the IPD. No apparent issues with Double vision or suppression, patient said no to me and doctor did not bring it up... Thickness is roughly 3.8 and 6.0 mm respectively. Any benefits in going through the math to lower the magnification difference between the eyes and figuring out the best mixed materials and thicknesses?

I have never used much slab off. benefits?

[Paul Smith LDO]

Currently wearing Poly. Hates vision but that is also probably attributed to ovation PAL. Coming from a Pair where FPD and IPD were not even close. Lens thickness is an issue she wants to go thinner. I explained that I would expect some minor adjustment period from changing materials but would be better in the long run. On this new pair FPD is centered nicely over the IPD. No apparent issues with Double vision or suppression, patient said no to me and doctor did not bring it up... Thickness is roughly 3.8 and 6.0 mm respectively. Any benefits in going through the math to lower the magnification difference between the eyes and figuring out the best mixed materials and thicknesses?

I have never used much slab off. benefits?

If diplopia is not an issue slab off would be unnecessary. If you are going with a smaller A, it might be worthwhile to have the lab calculate ET in trivex; if you want to enhance her visual experience. It will perhaps compromise her desire for a thinner aesthetically appealing lens.

[Robert_S]

I'd use 1.6 or Tribrid.

[Robert Martellaro]

Hates vision but that is also probably attributed to ovation PAL.

More likely due to the nature of the Rx.

Coming from a Pair where FPD and IPD were not even close. Lens thickness is an issue she wants to go thinner. I explained that I would expect some minor adjustment period from changing materials but would be better in the long run. On this new pair FPD is centered nicely over the IPD.

1.74 is the thinnest. There will be no adaptation issues if you change from polycarbonate to another material.

No apparent issues with Double vision or suppression, patient said no to me and doctor did not bring it up

It's good that you've communicated with the prescriber.

Any benefits in going through the math to lower the magnification difference between the eyes and figuring out the best mixed materials and thicknesses?

Short answer, no. You should trial frame if the degree of anisometropia has increased substantially, and possibly take an entirely different approach overall if there is any significant change in Rx, pathology, or VA.

I have never used much slab off. benefits?

It reduces or eliminates asthenopia and/or diplopia when using multifocals in the presence of Vertical Imbalance at near. Our vertical fusional reserves are in the two to three diopters range, so one would expect that your client would be displaying symptoms because the VI with PALs is about 5∆. In general, I would recommend telling your client that it may be beneficial if they wear SVNO eyeglasses for frequent and extended near tasks.

[Paul Smith LDO]

I'd use 1.6 or Tribrid.

Perhaps I am mistaken, things can change quickly but from what I have been able to gather, Tribrid, is only available in SV in the US. This is someone's cue to slap me upside my head and tell me otherwise.

[fjpod]

Is the patient binocular? With roughly equal acuities od and os? If not, slab-off, while technically correct, is probably not necessary. What Rx have they worn before?

[Jstanfast]

Presenting RX was
-1.50-0.50x089
-2.50-4.75x046
1.75 Add.

POLY ovation Pal with standard corridor but 17mm seg so bad fit/lense choice, partial near zone cut off.

Also, I second that Tribrid question. I was told it is still in testing phase and I can't get it yet?

[mshimp]

1.70... Tribrid if available. Add un poquito thickness to right eye. 3 base curve right. 2 base curve left.

[mshimp]

Slab line would never be perfectly straight with that oblique axis. Though it could potential be helpful in reducing thickness on the left eye (just thinking). And I agree with fjpod that its not necessary for the slab and probable wouldn't make any difference. OK I'm talking to myself... NO SLAB.

[Boldt]

I agree with Browman, Trivex or 1.60. Even with the cyl the thickness would be almost identical to poly with trivex and you can have them make it thinner due to it's durability, and they get better optics. 1.60 would be along the same, only it's not as durable.
I've had good luck with the spectrum sv with rx's like this.