help! about Aniseikonia

[modeho]

HI everyone,
I am current having a Px with OD+0.75 OS+3.00 and this is her first pair of eyeglasses.
She complain having a foggy vision on her OS and I know it might correct this issue by changing the base curve of the lenses.
Is there any other way to correct this issue? thank you and it is urgent.

[Dr. Bill Stacy]

HI everyone,
I am current having a Px with OD+0.75 OS+3.00 and this is her first pair of eyeglasses.
She complain having a foggy vision on her OS and I know it might correct this issue by changing the base curve of the lenses.
Is there any other way to correct this issue? thank you and it is urgent.

Depending on her age, this new Rx may take a few hours or days to adjust to. But no matter what, with that Rx if she compares R and L eye vision with the Rx on the left eye will be foggy by itself until her brain adjusts to controlling its focus better. That may take weeks or months. And she may NEVER see as well with L as with R. With both eyes open, she should rapidly adapt, esp. if she is a kid. The younger the quicker.

Changing the BC will have no effect on this complaint. This is not a symptom of aniseikonia. Tell her NOT to compare her 2 eyes more than 1x per day max. Of course all this depends on the Rx being correct. And of course she should wear these all the time.

[Robert Martellaro]

HI everyone,
I am current having a Px with OD+0.75 OS+3.00 and this is her first pair of eyeglasses.
She complain having a foggy vision on her OS and I know it might correct this issue by changing the base curve of the lenses.
Is there any other way to correct this issue? thank you and it is urgent.

More correctly, anisometropia. We can't assume aniseikonia just by looking at the Rx. It would be prudent to use an aspheric design for the left eye, and a slightly thicker right lens. Regardless, the left eye will look larger behind this Rx, and is normal.

The foggy vision could be due to amblyopia. If true, changing the base curve would not improve the acuity in the left eye. Make sure the optical centers are coincident with the pupil heights, minimizing vertical prismatic imbalance. Wear the eyeglasses full-time for a minimum of ten days and evaluate. Consult with the prescriber if there any questions, especially if the client is a child.

[modeho]

More correctly, anisometropia. We can't assume aniseikonia just by looking at the Rx. It would be prudent to use an aspheric design for the left eye, and a slightly thicker right lens. Regardless, the left eye will look larger behind this Rx, and is normal.

The foggy vision could be due to amblyopia. If true, changing the base curve would not improve the acuity in the left eye. Make sure the optical centers are coincident with the pupil heights, minimizing vertical prismatic imbalance. Wear the eyeglasses full-time for a minimum of ten days and evaluate. Consult with the prescriber if there any questions, especially if the client is a child.

Thank you Robert & Dr.Bill, let me try

[Paul Smith LDO]

More correctly, anisometropia. We can't assume aniseikonia just by looking at the Rx. It would be prudent to use an aspheric design for the left eye, and a slightly thicker right lens. Regardless, the left eye will look larger behind this Rx, and is normal.

The foggy vision could be due to amblyopia. If true, changing the base curve would not improve the acuity in the left eye. Make sure the optical centers are coincident with the pupil heights, minimizing vertical prismatic imbalance. Wear the eyeglasses full-time for a minimum of ten days and evaluate. Consult with the prescriber if there any questions, especially if the client is a child.

+1, with Robert. If first time EG wearer I would put my effort on achieving good central vision, that is not to say that they will not have good peripheral vision.

[Dr. Bill Stacy]

Thank you Robert & Dr.Bill, let me try

What is her age?

[modeho]

What is her age?

she is in her mid 20.
I did use 1.56index and it come out OD base 4, CT 1.75 & OS 4.5 base CT 3

she just visit and she is having a same foggy vision on both trial lens and eyeglasses on OS, but she feel way better when I switch the OS to +2 & +2.50, it also might be the error of RX, isn't it?

[Paul Smith LDO]

she is in her mid 20.
I did use 1.56index and it come out OD base 4, CT 1.75 & OS 4.5 base CT 3

she just visit and she is having a same foggy vision on both trial lens and eyeglasses on OS, but she feel way better when I switch the OS to +2 & +2.50, it also might be the error of RX, isn't it?

I wouldn't go as far as calling the refractive correction an error. True, it is some what subjective in nature but if the patient felt more comfortable with an OS + 3.00 in the chair we can't rule it out as not being correct. It sounds more like an adaptation issue and should be treated as such. The patient may feel more comfortable with it being reduced but she may require an increase down the road.
If you can, I would have her wear the Trial Frame for about 15 min. while both reading and viewing in the distance.

[CCGREEN]

This pts rx brings me to a question I have always tried to wrap my head around.
When a pt like this with such a extreme power difference in the Rx and is a first time wearer, OR take a pt who has a HUGE jump in power O.U. increase or decrease, just why is the Dr always so willing to throw all of it at one time onto the pt and expect them to be ok with it. Depending on the amount of change and the age of the pt personally to me I find it to be better to give it to them gradually in two or three visits.
This reminds me of back in my college days a fellow student had his first pair made and he had a bit of hyperopia and a fair amount of astigmatism along with some prism and his first add. If I recall correctly it was his first pair of glasses. Doc threw it all on him at once and I will never forget him grumping about that Rx. Still do not know what became of him or the Rx.

[optilady1]

These are the types of situations that it would be nice if the doctor fully explained what they may experience during the first few days of wear. On the other hand if the rx clearly stated Left eye not correctable, amblyopia, etc...then it falls on the optician to give them an idea of what can be expected at first. Either way, if you weren't in the examining room with the pt it's hard to know what was said to them.

[modeho]

These are the types of situations that it would be nice if the doctor fully explained what they may experience during the first few days of wear. On the other hand if the rx clearly stated Left eye not correctable, amblyopia, etc...then it falls on the optician to give them an idea of what can be expected at first. Either way, if you weren't in the examining room with the pt it's hard to know what was said to them.

agree of you, I did expect a follow up and gave my PX an idea what will happen.

[smallworld]

My rx growing up was plano os and +3.25 od. I'm amblyopic in my right eye, so the vision is never "clear" no matter how much or little prescription. Rules of thumb are to put lenses as close to the face as possible (plastic frames). Use 1.67 if you can. And I would suggest a digital sv lense. For myself the best vision and adaptation I ever had wearing glasses was a Hoya ID SV. Before I had an IOL my axial lengths were measured and I had a 7 diopter difference between the two eyes. Contact lenses obviously are the best choice. I started wearing a contact in my right eye age 7. For me the glasses didn't make my vision foggy, but I experienced severe headaches, nausea, eye pain for at least a week if I went without glasses to wearing them again. It's a long adaptation. Maybe she's trying to explain what amblyopic people experience. We never see as clear in our "bad" eye as we do in our good eye. The only way I can describe it is I feel like I'm looking through a plastic bag. It's just distorted. Even with correction.

[Paul Smith LDO]

These are the types of situations that it would be nice if the doctor fully explained what they may experience during the first few days of wear. On the other hand if the rx clearly stated Left eye not correctable, amblyopia, etc...then it falls on the optician to give them an idea of what can be expected at first. Either way, if you weren't in the examining room with the pt it's hard to know what was said to them.

BINGO, begging the question; which is more important on the Rx the PD or the best CVA.

[modeho]

My rx growing up was plano os and +3.25 od. I'm amblyopic in my right eye, so the vision is never "clear" no matter how much or little prescription. Rules of thumb are to put lenses as close to the face as possible (plastic frames). Use 1.67 if you can. And I would suggest a digital sv lense. For myself the best vision and adaptation I ever had wearing glasses was a Hoya ID SV. Before I had an IOL my axial lengths were measured and I had a 7 diopter difference between the two eyes. Contact lenses obviously are the best choice. I started wearing a contact in my right eye age 7. For me the glasses didn't make my vision foggy, but I experienced severe headaches, nausea, eye pain for at least a week if I went without glasses to wearing them again. It's a long adaptation. Maybe she's trying to explain what amblyopic people experience. We never see as clear in our "bad" eye as we do in our good eye. The only way I can describe it is I feel like I'm looking through a plastic bag. It's just distorted. Even with correction.

good to have a real case here, thank you for your suggestion :)
but I am not able to put the frame to close to her face since she has a very long eye lashes....:(

[Dr. Bill Stacy]

Wow. Interesting case. Are we sure it's her first Rx at age 20 something? What are the unaided and best acuities, or are you filling an outside Rx? Classical theory is to give full Rx which I almost always do because the accommodative function is yoked (we are not chameleons). In the case like this, depending on her desires and symptoms, I can be talked out of full correction on the bad eye, but it rubs me the wrong way. She of course is a prime candidate for CL fitting, but my SRx lens of choice here would be Trivex for sure for at least 8 reasons. If she's fairly asymptomatic without Rx, I'd back them both down equally, say to R plano, L +2.25 to get her eyes working together. If she wants to improve any existing amblyopia, add patching the o.d. for an hour or 2 a day with glasses on. All this is predicated on an ACCURATE refraction, and if you're not sure, do a cyclo.

[modeho]

Wow. Interesting case. Are we sure it's her first Rx at age 20 something? What are the unaided and best acuities, or are you filling an outside Rx? Classical theory is to give full Rx which I almost always do because the accommodative function is yoked (we are not chameleons). In the case like this, depending on her desires and symptoms, I can be talked out of full correction on the bad eye, but it rubs me the wrong way. She of course is a prime candidate for CL fitting, but my SRx lens of choice here would be Trivex for sure for at least 8 reasons. If she's fairly asymptomatic without Rx, I'd back them both down equally, say to R plano, L +2.25 to get her eyes working together. If she wants to improve any existing amblyopia, add patching the o.d. for an hour or 2 a day with glasses on. All this is predicated on an ACCURATE refraction, and if you're not sure, do a cyclo.

Yes, this is her first RX and it is from an optometry. I did tried to dispense her CL(as I know its the best solution) but she refuse to do that.
Why is Trivex is the best lenses for her? cause of the abbe value?
I might change her OS to +2.50 since she feel way better after wearing a trail lens for 10 minutes.

[Dr. Bill Stacy]

Yes, this is her first RX and it is from an optometry. I did tried to dispense her CL(as I know its the best solution) but she refuse to do that.
Why is Trivex is the best lenses for her? cause of the abbe value?
I might change her OS to +2.50 since she feel way better after wearing a trail lens for 10 minutes.

Abbe is way better, thin and light, shatterproof, scratch resistant, uv protected, and can be ground thinner than most materials.

I'd sure like to know what her acuities are with and without Rx. But for sure, have her try them at home watching TV for a couple of hours and note how they work after that. If you must cut powers on one eye, cut it the by the same amount on the other.

[braheem24]

At mid 20's she has accommodation available to use for distance viewing and apparently she is not using much of it since she has made it this far without a +3.00 for 20+ years.

If she can't see in the left eye while OD is occluded she is over corrected, Latent hyperopia or wrong Rx either way she can't afford to revisit this situation at 38 when she needs progressive.

If you have any say so in the Rx, Give her a +2.00 and stop punishing her. If she wants another diopter she'll give it to herself, retest in 6 months and give her more if she can tolerate it.

@1.25D imbalance she should not have trouble tolerating the anisometropia but plan ahead and fit her in a small frame to reduce off axis gaze prism should you need to go back to the +3.00 in 6 months.

[Dr. Bill Stacy]

At mid 20's she has accommodation available to use for distance viewing and apparently she is not using much of it since she has made it this far without a +3.00 for 20+ years.

If she can't see in the left eye while OD is occluded she is over corrected, Latent hyperopia or wrong Rx either way she can't afford to revisit this situation at 38 when she needs progressive.

If you have any say so in the Rx, Give her a +2.00 and stop punishing her. If she wants another diopter she'll give it to herself, retest in 6 months and give her more if she can tolerate it.

@1.25D imbalance she should not have trouble tolerating the anisometropia but plan ahead and fit her in a small frame to reduce off axis gaze prism should you need to go back to the +3.00 in 6 months.

I disagree. Purposely putting that left eye 1 D. out of focus under binocular conditions is pretty close to her not wearing glasses at all. The brain will continue to ignore a 1 D. blurred image from that eye for the same reason it's been ignoring a 2.25 D. out of focus image from that eye for 20 some years. The glasses are made and they should be tried full time for at least one day. Her brain will take a while to adjust to having two clear images coming to it, but it will adapt. The only exception to this that I can think of, interestingly enough, is the possibility of aniseikonia, or discomfort from unequal image sizes. If that happens, contact lenses are the best answer. But I've never encountered that in this type and amount of anisometropia. If she tries them for 3 days full time and still has symptoms other than when she closes her right eye, it's time to recheck that refraction with full cycloplegia. She might even need more plus on that left eye. Undercorrecting it might be more distracting to her than not correcting it at all.

[drk]

This pts rx brings me to a question I have always tried to wrap my head around.
When a pt like this with such a extreme power difference in the Rx and is a first time wearer, OR take a pt who has a HUGE jump in power O.U. increase or decrease, just why is the Dr always so willing to throw all of it at one time onto the pt and expect them to be ok with it. Depending on the amount of change and the age of the pt personally to me I find it to be better to give it to them gradually in two or three visits.
This reminds me of back in my college days a fellow student had his first pair made and he had a bit of hyperopia and a fair amount of astigmatism along with some prism and his first add. If I recall correctly it was his first pair of glasses. Doc threw it all on him at once and I will never forget him grumping about that Rx. Still do not know what became of him or the Rx.

Good point, but for all we know she's a +6.00. Nevertheless...

[smallworld]

good to have a real case here, thank you for your suggestion :)
but I am not able to put the frame to close to her face since she has a very long eye lashes....:(

I use eyelash curler. It's hard not to get eyelash touching when you are a high plus.

[drk]

I do too.