Can see distance and near, can't see intermediate?

[Xiatian123]

I had a patient came back for complaint last week, she got a pair of essilor Ds one progressive lens, her prescription is plus based for her two eyes. Her add is +2.50.
she was complainting about intermediate, she said she can see distance and near well, but she can't see the computer, I was trying to ask her to move her head to see if she can see any spot for computer clearly.she was angry since she had been waiting for a long time to be served. She felt stupid for what I requested.

Any idea for this case? Should I upgrade her lenses if she come back or suggest her to get a pair of office lens for computer?

Thanks for help!

[drk]

With a +2.50, my poor eyes LOVE my computer glasses.

[Klean]

The most likely problem, monocular P.D. slighly off.

[Tallboy]

Check her pd, check seg, make sure she doesn't wear them too far from standard Position Of Wear, and if so order it as such. The corridor shrinks very quickly when people look through a longer vertex.

As for what Doc said, any hyperopic patient with a legitimate 250 add should be in an office lens if they are a cubicle warrior. Construction workers buy steel toed boots.

[Xiatian123]

So I guess, I need to suggest her office lens when she come back.

[Xiatian123]

I will double check that if she comes back.
Thank you.

[Xiatian123]

The frame was non-Asian fit. I will definitely take this suggestion. Thank you.

[Xiatian123]

It's me again.

It's me again, so I had a patient come back for a new pair glasses. Her prescription didnt change compare to last year, it was roughly -6.00 and -7.00 on both eyes with slightly astigmatism. She had a prescription paper from doctor, the PD is 59, on our file,her PD was 59. Today I double check, the PD is 28/29.5. My coworker who double check for me, it's the same number. I check the dot for seg height, two sides are not balanced. She got her glass from last year in our place, the PD was 59, 29.5/29.5. Should I use the PD that I double check, or keep the old one?
Thanks!

[Tallboy]

If it was me Xiatian, I would do 28.5 and 29.5.

If you are confident in your measurements the patient is not getting the best use of their PAL corridor in the right eye because it is off. If her ADD has increased she will notice the PD being off more this time than last, but moving it too much at once may cause issues. I probably wouldn't move it all the way to 28 this year, save that for next time.


Someone can wear a +1.00 add easily if the seg PD is off a bit, but as that ADD increases to 1.50, 1.75, 2.00 or even 2.50 the corridor gets smaller and smaller and must be situated more and more precisely. Ease her back into her true PD, split the difference.

[Xiatian123]

The add is the same, it's 1.50 for both eyes.

[Xiatian123]

Will she notice that a lot if pd change by 1. Since only pd on right eye changed. And her prescription is exactly the same as last year.

[Tallboy]

Will she notice that a lot if pd change by 1. Since only pd on right eye changed. And her prescription is exactly the same as last year.

The issues in the distance most likely won't bother her, you could probably just move it the whole 1.5mm, to be safe I might only move it 1mm towards your measured pd in the right eye.

And yes in a reasonably high add she will definitely feel like the reading and intermediate are smaller. I took a great class with Essilor's own Pete Hanlin a few years ago on trouble shooting progressives and he had a chart with amount the PD was off/power of the add and the resulting % of the corridor that would be cut out of the patients vision. I had yet to that point thought much about PD affecting PAL performance and always was Seg Height first when trouble shoooting, thinking about PD only as affecting peripheral vision when it was too narrow.

Basically if you are confident in your PD measurement you are doing her a disservice by not correcting the PD. Also if her ADD has increased, what wasn't a problem for her in a weaker ADD with the the old incorrect 59 pd may become your problem because her reading all of a sudden feels small.

[Happylady]

I'm late to this thread but I wanted to weigh in. I also wear a +2.50 add, though my distance is minus. I would love to hear the outcome for this woman when you redid her lenses. Correct PD and heights are very important.

As for changing her to an office type lens- that would be great for computer and close but will make her distance blurry. Some patients are ok with this but it's really just changing one problem for another. In many cases I think an office/computer pair should be an additional pair. This is especially true if they are already wearing a progressive and are used to a clear distance.

Another thing to look at is the height of the computer monitor. Unfortunately most are not adjustable but they just don't work if well if people have to look straight at them since that is the distance area in a progressive. The eyes looking straight ahead should ideally look just over the top of the moniter. A properly fit progressive will work then.

[Racheal]

Hi guys. So i have a patient who collected her glasses (progressives) four days ago. She wore it for two days and went back to the old glasses (4 year old RX). She visited my office and reported that she can see very clearly to read. But her intermediate (computer screen for work and phone screen for pics) appears double. Her distance is fairly ok.
Old rx - OD: +0.25/-1.25 x 065 VA: 20/40 OS: +0.25/-2.25 x 080 VA: 20/70 Add: +1.50 Progs, Transitions, Anti-reflective coating (scratched)
Frame: rectangular shape
New rx - OD: +0.50/-1.75 x 067 VA: 20/20 OS: +0.25/-2.25 x 091 VA: 20/50 Add: +2.00
Frame: slightly rounded

When she visited, I rechecked the heights and asked her to demonstrate how she was using the frame. I explained about the change in RX and adaptation, as well as the change in the shape of the frame. I adjusted the temples as well, however, she said she was experiencing the same issues. I advised her to stop using the old pair and to use the new pair and to try to adjust to the changes.

What else can I do to help my patient?

[Tallboy]

check face form, panto and vertex distance. PAL design and PDs. I'm interested that a quarter difference cyl and sph in the OD took her from 20/40 to 20/20, its perfectly possible though