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Thread: Finicky patient. Prism. New Rx. Comfort out of range. Help!!

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    Master OptiBoarder OptiBoard Silver Supporter ak47's Avatar
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    Finicky patient. Prism. New Rx. Comfort out of range. Help!!

    Would appreciate any advice (including pick up a 6 pack and call me in the morning). Have a very finicky patient with 7 diopters vertical prism who has only been happy with Vx Comfort. Add has increased from 350 to 375 and Comfort is now out of range. Distance power very minimal. Suggestions?

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    Master OptiBoarder OptiBoard Gold Supporter
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    Comfort enhanced / W3 might come in that power

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    I'm told the Comfort W2, Physio W3 only go up to 3.50 add, but the new X goes up to a 4.00. (Haven't dispensed it personally yet.) For this patient, I get the feeling going up to a high-grade freeform is risky, but if she insists on a single-pair solution she may no longer have a choice. Good luck Ak.

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    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by ak47 View Post
    Would appreciate any advice (including pick up a 6 pack and call me in the morning). Have a very finicky patient with 7 diopters vertical prism who has only been happy with Vx Comfort. Add has increased from 350 to 375 and Comfort is now out of range. Distance power very minimal. Suggestions?
    The Hoya ECP comes is available in 1.60 and Trivex, but the corridor length might be too long, unless a separate pair (recommended) is used for near. Ask the prescriber to stay at +3.50 because of the above, with bumping the distance +.12 to +.25 as a workaround.

    Hope this helps.

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Master OptiBoarder OptiBoard Silver Supporter ak47's Avatar
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    Unfortunately bumping the distance is out of the question, and none of the Comfort variations appear to be available past 350 add....I think I have a solution.....but it is only available in liquid form!

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    Master Jedi King of the Lab's Avatar
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    Quote Originally Posted by ak47 View Post
    Unfortunately bumping the distance is out of the question, and none of the Comfort variations appear to be available past 350 add....I think I have a solution.....but it is only available in liquid form!
    Drink three IPA's and eat 1/2 lb of bacon. Stick the patient in a traditional backside PAL, call it a day.
    Erik Zuniga, ABOC.

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    What's up? drk's Avatar
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    Talk to the doctor.

    I marvel at prescribers and their crazy add powers.

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    Master OptiBoarder OptiBoard Gold Supporter
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    Quote Originally Posted by King of the Lab View Post
    Drink three IPA's and eat 1/2 lb of bacon. Stick the patient in a traditional backside PAL, call it a day.
    Its amazing what can be accomplished with a well brewed beer, well cooked bacon, and a well fit progressive whose design is tried and true. I have a couple "comfortable" backside house designs gbat I keep in my back pocket at a times because I love to use them, but I don't post specific house designs on the public board.

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    Master OptiBoarder rbaker's Avatar
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    Just what is so important about increasing the Add a quarter of a Diopter.

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    Quote Originally Posted by rbaker View Post
    Just what is so important about increasing the Add a quarter of a Diopter.
    Absolutely nothing. Get a second pair of less expensive glasses if you have eyes like that and a hobby that requires such an RX. It sucks to shop in the Big and Tall section also, but we are all adults here and make due with the cirumstances of our own lives.

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    Quote Originally Posted by Tallboy View Post
    Absolutely nothing. Get a second pair of less expensive glasses if you have eyes like that and a hobby that requires such an RX. It sucks to shop in the Big and Tall section also, but we are all adults here and make due with the cirumstances of our own lives.
    +1

    If they HAVE to wear a specific style because that is the only thing that works for them, I would do exactly this.

    I feel like I have had a rash of people lately that want the impossible- usually for computer.
    "I can't see my computer screen with my progressives."
    Where is your monitor?
    "Above my head."
    You need a separate pair for your computer for the best vision.
    "I don't want to have to have multiple pairs. Can't you just adjust my progressives?"
    You will need a second pair for distance if I do that.

    Whoever invents a lens or this scenario will be RICH!
    Have I told you today how much I hate poly?

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    Master OptiBoarder OptiBoard Gold Supporter
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    Quote Originally Posted by Quince View Post

    I feel like I have had a rash of people lately that want the impossible- usually for computer.
    "I can't see my computer screen with my progressives."
    Where is your monitor?
    "Above my head."
    You need a separate pair for your computer for the best vision.
    "I don't want to have to have multiple pairs. Can't you just adjust my progressives?"
    You will need a second pair for distance if I do that.

    Whoever invents a lens or this scenario will be RICH!
    Whip out some Double Ds and offer them as a solution. Watch them reel in horror lol

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    Quote Originally Posted by Quince View Post
    +1

    If they HAVE to wear a specific style because that is the only thing that works for them, I would do exactly this.

    I feel like I have had a rash of people lately that want the impossible- usually for computer.
    "I can't see my computer screen with my progressives."
    Where is your monitor?
    "Above my head."
    You need a separate pair for your computer for the best vision.
    "I don't want to have to have multiple pairs. Can't you just adjust my progressives?"
    You will need a second pair for distance if I do that.

    Whoever invents a lens or this scenario will be RICH!
    Chemistrie and put the progressive upside down. One pair solution with a clip.

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    "Whip out some Double Ds and offer them as a solution. Watch them reel in horror lol"

    Right?! I do ​make those so it would be an easy scare tactic to produce!
    Last edited by Quince; 09-20-2017 at 12:46 PM. Reason: no quote...
    Have I told you today how much I hate poly?

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    Quote Originally Posted by lensmanmd View Post
    Chemistrie and put the progressive upside down. One pair solution with a clip.
    Actually I could utilize the Chemistries... that is something I forgot about. Suggesting a clip instead of a second pair might be a good option to explore. Thanks!
    Have I told you today how much I hate poly?

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    lololol

    Quote Originally Posted by King of the Lab View Post
    Drink three IPA's and eat 1/2 lb of bacon. Stick the patient in a traditional backside PAL, call it a day.
    this is hilarious

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Quote Originally Posted by ak47 View Post
    Would appreciate any advice (including pick up a 6 pack and call me in the morning). Have a very finicky patient with 7 diopters vertical prism who has only been happy with Vx Comfort. Add has increased from 350 to 375 and Comfort is now out of range. Distance power very minimal. Suggestions?
    So what did you do?

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    Master OptiBoarder OptiBoard Silver Supporter ak47's Avatar
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    Talked to doc - did not want to change. Ordered IOT in the 3.75 add. Not dispensed yet, fingers crossed

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    Quote Originally Posted by ak47 View Post
    Talked to doc - did not want to change. Ordered IOT in the 3.75 add. Not dispensed yet, fingers crossed
    It's worked for me before, good juju you way!

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    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by drk View Post
    Talk to the doctor.
    Yup. I would tell them that this degree of prism and add power, combined with the use of a PAL, will not provide optimal results, likely resulting in poorer vision compared to the old eyeglasses!

    I marvel at prescribers and their crazy add powers.
    Pretty common for low vision. I see plenty of adds up to six or more diopters, benefiting from relative size magnification, hands free. Usually trifocals with the higher adds.

    Quote Originally Posted by rbaker View Post
    Just what is so important about increasing the Add a quarter of a Diopter.
    2cm closer work distance. Can be an improvement from J1 -3 to J1.

    Quote Originally Posted by ak47 View Post
    Talked to doc - did not want to change. Ordered IOT in the 3.75 add. Not dispensed yet, fingers crossed
    Keep your head down- the wearer will prefer their old eyeglasses.

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Master OptiBoarder OptiBoard Silver Supporter ak47's Avatar
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    Update: dispensed these a few weeks ago, patient seemed happy with new specs! Saw patient today for unrelated reason, he is still very happy with them! Great success!

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    Quote Originally Posted by rbaker View Post
    Just what is so important about increasing the Add a quarter of a Diopter.
    That's what I want to know.

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