Balance lenses

[ASoule]

Hello :)

I wanted to see what everyone's opinion is when it comes to patients with balanced lenses.
currently 2 out of 3 opticians I work with automatically put patients in trivex or poly lens. and one optician is not on the same page as the rest of us.

I believe strongly in protecting the 'good' eye and always put them in trivex.

what is the policy in your practice? your opinion?

[mervinek]

I agree with Trivex or Poly to protect the good eye, however sometimes that isn't an option (think high add low vision patients). When Trivex or Poly is not available, I will have the lab grind the lenses to safety thickness to add protection.

[Chris Ryser]

A balance lens is a lens looking close to the good lens and its power should be somewhere in the area of the other lens for cosmetic reasons.

If specific laws as in the USA require safety features, they have to be observed.

[Tallboy]

Merv hit it on the head 100%, otherwise it is always impact resistance, and any patient/client who feels otherwise can get their glasses somewhere else. I am not going to be the one involved in you losing your only good eye, even if it is only a .005% chance.

[eyedude]

I recommend you make the same rx as previous balance lens. We think patient has no vision, and feel uncomfortable with something different.

[Tallboy]

I recommend you make the same rx as previous balance lens. We think patient has no vision, and feel uncomfortable with something different.

These are wise words, I often ask doctors "Are they really a balance lens" because I've had too many where I did a progressive in one eye and spherical in the other and the person complains about seeing "shadows" or something out of the eye with "no vision".

[jpways]

I feel like this thread is going in the direction of exceeding the scope of practice of opticianry (depending on your state). To use an example I had to deal with Pt. was a -6.00/2.00, Balance, however the patient's balance lens in their old glasses was SV Plano. For something like this I feel that I would be unable to order a lens that is that different in prescription from the lens I need to balance without the prescribing Dr's express permission.

[Tallboy]

I feel like this thread is going in the direction of exceeding the scope of practice of opticianry (depending on your state). To use an example I had to deal with Pt. was a -6.00/2.00, Balance, however the patient's balance lens in their old glasses was SV Plano. For something like this I feel that I would be unable to order a lens that is that different in prescription from the lens I need to balance without the prescribing Dr's express permission.

How so? A true "balance" lens is one that is a certain thickness/power to balance the frame for comfort/cosmetics. I could put anything I want in there that is my decision.

What happens often though is Dr.s RX a "balance" when in reality the patient "sees" enough in there that they feel odd if the RX isn't within a certain range, or even a multifocal like I said in my last post. I don't think this goes beyond my scope. In a true balance lens there is absolutely no reason to cut a progressive in both eyes, except to charge your client more money for nothing.

[jpways]

That would be my point, the definition is trying to balance the lens cosmetically, in my case I have a 6D difference between the prescribed lens and the balance lens. I would almost never balance a progressive lens with a progressive lens (with the exception being match what the patient is used to). But instead of ordering -6.00/2.00 progressive, SV balance, I am now specifying -6.00/2.00 progressive, Plano SV, at this point I feel like I just became the prescriber for the left lens since I feel that the difference of the prescriptions between the 2 lenses exceeds what a casual observer would consider a cosmetic balance.

[Tallboy]

That would be my point, the definition is trying to balance the lens cosmetically, in my case I have a 6D difference between the prescribed lens and the balance lens. I would almost never balance a progressive lens with a progressive lens (with the exception being match what the patient is used to). But instead of ordering -6.00/2.00 progressive, SV balance, I am now specifying -6.00/2.00 progressive, Plano SV, at this point I feel like I just became the prescriber for the left lens since I feel that the difference of the prescriptions between the 2 lenses exceeds what a casual observer would consider a cosmetic balance.

Hmm, what about a situation where a patient has one eye that droops or is underdeveloped and small. Do you consider cutting prism or plus into the "balance" to achieve a cosmetic benefit to the patient prescribing? (Raising the image of the eye in the lens, or magnifying an eye that looks much smaller than the other?

[jpways]

Hmm, what about a situation where a patient has one eye that droops or is underdeveloped and small. Do you consider cutting prism or plus into the "balance" to achieve a cosmetic benefit to the patient prescribing? (Raising the image of the eye in the lens, or magnifying an eye that looks much smaller than the other?

I guess that's the whole point of my argument, it's a slippery slope. It's a decision that each optician has to make. What changes can I make that cause the least harm within the parameters that the prescriber is giving me, without having to bug the prescriber?
So for me personally, in the case of prism, any non-specified changes in prism causes harm. If the patient has cosmetic prism I would match it without asking, because I would always assume that a Dr. would not take away prism. If there is no prism, I would call the prescribing Dr to ask for permission to determine the cosmetic prism. If I get it I would then trial frame it, and then call the Dr. back once I have determined how much I can add, without the patient noticing, so that the office can note it in the patient's record.

For changes in sphere for cosmetic purposes it would be the same thing. If I feel that I have to specify a significantly different prescription (which for cosmetic purposes is generally going to be greater then the 1D that I feel comfortable with not asking permission for) I would call the prescribing Dr. before trial framing. Assuming that don't have an old pair of glasses to work with.

With all this being said, do I think that I am putting myself in too small of a box for the knowledge of optics I have, yes. But I also live and work in a state where the scope of opticiary in not defined by law, so I want to keep it small so I don't annoy someone off who has more legal power than I do.

[mervinek]

So here's a question... I have a doctor who has a lot of patients that are not 20/20. They have some kind of "compromised vision." Often they are cornea transplant patients. This doctor always writes on the Rx, "compromised vision, best optical quality lens." Usually she wants those patients to have CR39 due to the abbe value thinking that their vision will be much better. So my question is this...if the patient has compromised vision, will they see the difference between a trivex and cr39 lens, or for that matter a poly lens? Also, if they are a cornea transplant patient, wouldn't you want to have a durable lens material for safety reasons, to protect what vision they do have?

[jpways]

So here's a question... I have a doctor who has a lot of patients that are not 20/20. They have some kind of "compromised vision." Often they are cornea transplant patients. This doctor always writes on the Rx, "compromised vision, best optical quality lens." Usually she wants those patients to have CR39 due to the abbe value thinking that their vision will be much better. So my question is this...if the patient has compromised vision, will they see the difference between a trivex and cr39 lens, or for that matter a poly lens? Also, if they are a cornea transplant patient, wouldn't you want to have a durable lens material for safety reasons, to protect what vision they do have?

It would be really hard for me to put any fully or pseudo monocular patient in CR 39, if it were me the patient would probably be in poly, trivex or 1.67 anyway: 1. Because I want to protect the vision of the good eye 2. Because I fit more distance glasses in glass than I do CR39; so it would just be a matter of having the same material in both eyes for cosmetics.

[Tallboy]

Wow I can't believe a doctor would not recommend Trivex or Poly if a patient was compromised in one eye like that. Its not like we don't have options in 2018, wow.

[mervinek]

Thanks! This doctor always does weird stuff like that. It's always the fault of the glasses. One patient got his glasses elsewhere and couldn't see well. The doctor had me check the glasses to make sure they were made correctly. They were. They were poly and the patient was a cornea transplant OU patient. Next thing I know, after already 1 Dr Rx change, The doctor had another Rx change (more than 1.5 diopters) and had in the Rx that the lenses must be CR39. I don't think the reason the patient was having a problem with his lenses was because it they were poly. Perhaps it was the huge Rx shifts he had with the 2 remakes? Rx change was
from
OD -0.75 +1.50 x170
OS -0.75 +1.25 x 47
to
OD -2.75 +3.75 x 173
OS -2.25 +2.25 x 23

[tmorse]

50% of the doctors finish in the bottom half of their class.

[mervinek]

50% of the doctors finish in the bottom half of their class.

Someone has to be last right? Even the one that graduates last still graduates.

[Tallboy]

But I also live and work in a state where the scope of opticiary in not defined by law, so I want to keep it small so I don't annoy someone off who has more legal power than I do.

You will 100% chance annoy any OD you call to ask what RX they expect the balance lens to be, and whether they are looking for cosmetic eye size to an observer, thickness or weight or cost in their reason for their decision.

Its fun, sometimes you can even annoy optho techs and MDs with it also. I always call, until they are sick of it and refer their patients to me ;)

[jpways]

You will 100% chance annoy any OD you call to ask what RX they expect the balance lens to be, and whether they are looking for cosmetic eye size to an observer, thickness or weight or cost in their reason for their decision.

Its fun, sometimes you can even annoy optho techs and MDs with it also. I always call, until they are sick of it and refer their patients to me ;)

If that's the only thing I did to annoy OMDs...