Need help with glasses

[smallworld]

My patient (48 years old) wore -5.25 -1.50 x180 /-6.75-1.00x180 with +1.75 rx for two years. She never had success with computer vision, so she wore a reading only lense we made last year. This year she was prescribed -5.00-1.00x176/-6.50-.50x004 with +2.00. The frame is larger b measurement, otherwise progressive type, material, bc, ext are matched. She could see great at work with these, but distance was not clear. She went to an different doctor who gave a new rx of -5.50-1.50x175/-7.00-.50x005 with a +2.25 add. Now she said she can see great distance and near. Was traveling the last week and vision was great. Today she's back at work and she's getting a headache. She says after being on the computer and getting up to walk around she feels dizzy, motion, and seems to have to re-focus. The vision is clear up close though. I used same frame, same lenses, same lab. I called my lab to see if they could see any manufacturing differences and they said there are none. I am stumped. Any ideas?

[drk]

Her distance power needs nailed down.

The first Rx was underminused/cylindered probably, which would explain good intermediate and bad distance. Plus her add was a smooth +1.75. Lower add powers are always more comfortable.

Second Rx is significantly stronger, so she seems to like the distance, but that's why she doesn't like the intermediate. Plus now she has to use a swimmier +2.25 add, and must be tilting her head on the computer. She's aniso, too, which could give her a nice case of eyestrain on downgaze!

After all this remake junk, I would just punt and leave her with the second Rx for general purpose and get her a good pair of computer glasses. Consider re-using the old Rx #1 lenses in a second similar frame (maybe different color). If it's not too late, have your lab add AR. Give her the whole thing at a discount and you're both winners!

[smallworld]

Her distance power needs nailed down.

The first Rx was underminused/cylindered probably, which would explain good intermediate and bad distance. Plus her add was a smooth +1.75. Lower add powers are always more comfortable.

Second Rx is significantly stronger, so she seems to like the distance, but that's why she doesn't like the intermediate. Plus now she has to use a swimmier +2.25 add, and must be tilting her head on the computer. She's aniso, too, which could give her a nice case of eyestrain on downgaze!

After all this remake junk, I would just punt and leave her with the second Rx for general purpose and get her a good pair of computer glasses. Consider re-using the old Rx #1 lenses in a second similar frame (maybe different color). If it's not too late, have your lab add AR. Give her the whole thing at a discount and you're both winners!

I kept the first set of lenses, was thinking of putting them in a duplicate frame for computer only, but will the cyl shift cause issues switching from one to another?

[smallworld]

drk- I have another one I'm stumped on today if you have time. She's post cat they corrected her mono. Over the years the vision has decreased. Now she's uncorrected 20/100 over 20/60 distance. For near uncorrected blissfully 20/20 and doesn't know why she should have to wear glasses at all. So rx is -2.50+1.25x041/-.75+.75x063 with a +2.50 add. She said she can't read with them at all. so I determined she can see without the bifocal enough to drive and see the dashboard. She wanted lenses made with the bifocal area zero or plano which isn't possible. So I called the lab and he said the near rx might be what's throwing her off. To make it worse, previous to surgery she wore round 28 at a seg 11, and like an idiot I ordered blended 28 at 11, which my lab person reminded me cut off most of her add power. So ten hours later (I'm having that kind of day) the patient decided to go distance only for now, and just for driving. But should I have her rx checked for near just in case she wants bifocal again? I tried explaining adaptation to a new script and she almost took my head off. And I don't really want to send her back to the doctor since I ordered the wrong lense. ( ps my OD doesn't check near powers ) pss she also has crocodile shagreen and map dot.

[kaledarkwind]

This year she was prescribed -5.00-1.00x176/-6.50-.50x004 with +2.00. The frame is larger b measurement, otherwise progressive type, material, bc, ext are matched. She could see great at work with these, but distance was not clear.

Are you sure that the glasses are adjusted properly? Is she possibly catching the Intermediate and not full on Distance?

[smallworld]

Yes I was going to try to adjust them higher too. Thanks!

[kaledarkwind]

How did this turn out? Did you get it sorted?

[smallworld]

How did this turn out? Did you get it sorted?

Still working on it.

[Dr. Bill Stacy]

drk- I have another one I'm stumped on today if you have time. She's post cat they corrected her mono. Over the years the vision has decreased. Now she's uncorrected 20/100 over 20/60 distance. For near uncorrected blissfully 20/20 and doesn't know why she should have to wear glasses at all. So rx is -2.50+1.25x041/-.75+.75x063 with a +2.50 add. She said she can't read with them at all. so I determined she can see without the bifocal enough to drive and see the dashboard. She wanted lenses made with the bifocal area zero or plano which isn't possible. So I called the lab and he said the near rx might be what's throwing her off. To make it worse, previous to surgery she wore round 28 at a seg 11, and like an idiot I ordered blended 28 at 11, which my lab person reminded me cut off most of her add power. So ten hours later (I'm having that kind of day) the patient decided to go distance only for now, and just for driving. But should I have her rx checked for near just in case she wants bifocal again? I tried explaining adaptation to a new script and she almost took my head off. And I don't really want to send her back to the doctor since I ordered the wrong lense. ( ps my OD doesn't check near powers ) pss she also has crocodile shagreen and map dot.

She was probably told that with her monovision result, she doesn't "need" glasses at all. We all know better. I think you're right to do single vision distance only, esp. if she can peek under them to see her instruments. Eventually, you might want to do a round bifocal with a 1.75 or 1.50 add to help her see the dash and other stuff. +2.50 is way overkill unless you put her in a trifocal. Not. I agree, never order a blended or digital round. Horrible things.

[smallworld]

She was probably told that with her monovision result, she doesn't "need" glasses at all. We all know better. I think you're right to do single vision distance only, esp. if she can peek under them to see her instruments. Eventually, you might want to do a round bifocal with a 1.75 or 1.50 add to help her see the dash and other stuff. +2.50 is way overkill unless you put her in a trifocal. Not. I agree, never order a blended or digital round. Horrible things.

Thank you for the help. She picked up her distance only and ordered sun distance rx also. She still wants a "0" in the bottom. In the future if she wants bifocal I think I will have her near power checked first. I agree it seems overkill.

[Dr. Bill Stacy]

If she were to wear them full time and did a lot of fine close work, I'd be ok with the strong add. But it sounds like she really only wants to wear them on occasion. When they ask for zero in the bifocal they really mean close to zero. She needs the cyl but doesn't know it yet. Sometimes you just have to go with the flow and do your best. I just had a guy swear he wanted zero at distance instead of the +1.25 someone had Rxed. He was 20/30 without rx, and 20/20 with +.75. I showed him the difference and he was very receptive to get the correct Rx when the 20/20 was demo'd to him.