Head | Wall. Wall is winning.

[Slim]

Ok Im nearing the end of my rope so I am reaching out to my buds here. Struggling with PT, going on 4th time and want to see what Im missing before I go any further.

Old RX

+2.75/-0.50/080
+2.50/-0.25/090 add of +2.00
Comfort Short- 15 seg.


New RX

+3.50/-0.50/105
+3.25/-0.25/060 add of +2.00 Hi-Index 1.67

Rd 1: Varilux S fit Orig had a seg on this new pair at a 22.3... Some one remeasured her and did a 17. Yeah I know... Some explanation later on that.

Rd: 2 Remade with 17 seg. Still had some complaints.

Rd: 3 Tried a Definity 3 as its supposed to shine with hyperopes. Now her complaint is the only clear vision is in the midrange. Both DX and RX is a lil blurry.
She has been rechecked and the RX is bang on. Even went with the non compensated lens to rule that out. Tried panto and face adjustments. putting on old pair
of varilux comfort and old rx, she can see the peripheral way better.

I need help with rd 4. the only other thing i found is this...

The Lab should have taken the size down, as there is a 2mm. gap in the eye wire. IMO there is a LOT of distortion as they cranked on it. Never saw the color like that.





This is with the screw loose

[Dustin.B]

If you loosen the screw is the vision any better for the patient?

[uncut]

Time for remake #quattro, OP.

The patient should not be in a 1.67 index, IMO. You are handicapping their peripheral vision, especially for the head-turner variety of human. The new rx is 3/4 diopter stronger, and still doesn't warrant a index more than 1.6 in that frame eye size. Just request that the lab make it as thin as possible.

The axis shifts of 25 and 30 degrees is also exacerbating the symptoms and might be warranted, as long as accuracy is improved.

Dustin.B's question is valid, it just adds to the pile of stuff to deal with.

Check out the base curve differences, especially if the index is different than the previous pair. The lenses are probably flatter in the 1.67. Your lens guides from E should help you with specifics.

Is Comfort 360 available for this patient?

[becc971]

I will say comfort patients LOVE the comfort and have a hard time adapting even to the "better" lenses. at least in my experience. Try the W2+

[DanLiv]

I'm no doc, but I think the Rx is just overplussed. Most obvious indicator: sees better with old lower plus Rx. Sure midrange might seem good because at that plus she doesn't even have to tilt back to see the computer since the effective intermediate power is right in front of her eyes, but of course that makes DV blurry. NV is blurry because it's too strong and focal point is too close for natural reading. See if she can read at 10" or closer, if so then everything fits with just a bad Rx.

I don't think material or the distortions you are seeing are the culprits here. 1.67 is fine for that Rx (though I agree unnecessary), I would have even used poly. And the distortions you are seeing are cross polarization artifacts, not distortions that would be visible to the wearer.

[Tallboy]

I don't think material or the distortions you are seeing are the culprits here. 1.67 is fine for that Rx (though I agree unnecessary), I would have even used poly. And the distortions you are seeing are cross polarization artifacts, not distortions that would be visible to the wearer.

I agree that the RX is probably over plussed - however Dan I think you might be a little quick to discount the stress from causing problems. I routinely get jobs in from the dreaded insurance labs with that much stress, when taken down on a hand wheel it relieves issues. Of course millions of large cut lenses are dispensed every year without complaining so you are right that it isn't always an issue.

The "only clear in the midrange" complaint screams over plussed to me here. Too much plus to see in the distance, too much plus in the "reading portion" to read at the arms length she wants to.

[Dr. Bill Stacy]

Assuming the Rx is correct (a big assumption, despite claims of "spot on"), I agree that 1.67 is completely wrong, this Rx cries out loudly for Trivex. Of course the lab finishing method made burnt toast out of what was already toast. I think it's time to throw in the towel and get a 2nd refraction by someone else and yeah, even change the frame to something that can handle a more normal PAL like comfort conventional.

Meanwhile, continue head banging if it helps...

[optical24/7]

Do not discard the extra thickness of the new Rx creating induced magnification. Induced mag is a lot different with a phoropter's thin glass lenses compared to Rx lenses in frames. Induced + Rx increased mag could be why the Rx recheck is "bang on", but the overall plusing effect may be the problem.

[rbaker]

Assuming the Rx is correct (a big assumption, despite claims of "spot on"), I agree that 1.67 is completely wrong, this Rx cries out loudly for Trivex. Of course the lab finishing method made burnt toast out of what was already toast. I think it's time to throw in the towel and get a 2nd refraction by someone else and yeah, even change the frame to something that can handle a more normal PAL like comfort conventional.

Meanwhile, continue head banging if it helps...

That's the question here. At what point do you throw in the towel? How many times before either you or the customer says "enough is enough." Assuming that after the first failure, you, the poor customer, and the refractionist all got together and analyzed the situation. Obviously, are still in the dark and clearly (no pun intended) have no idea where the problem lies.

What next, another guess, another redo?

[Dr. Bill Stacy]

That's the question here. At what point do you throw in the towel? How many times before either you or the customer says "enough is enough." Assuming that after the first failure, you, the poor customer, and the refractionist all got together and analyzed the situation. Obviously, are still in the dark and clearly (no pun intended) have no idea where the problem lies.

What next, another guess, another redo?

After 4 tries, throwing in the towel usually means giving up and moving on. But not always. If the patient is patient enough, I'd try again from start checking and rechecking everything possible down to the monoc. P.D.s. But if I were an optician without an in house refractionist, I'd want that 2nd opinion refraction before throwing good money after bad.

[mshimp]

over plussed . no need for hi 1.67

[Paul Smith LDO]

My .02, trial frame the patient, the material may not be the best choice as some have stated but it should not be the major point of contention.

[pknsbeans]

I agree with trial framing, but would take it a step further. Over-refract the patient with the glasses on in the distance with loose lenses or some minus flippers. Like many others have said, they're probably over-plussed.

[Slim]

Had a lil round table session about this job and like mentioned were gonna take a lil out of the rx. Along with proper fit and maybe one more pg change. Thank you so much for all the input guys. Appreciate it!