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Thread: Can people get used to wrong cylinder axis?

  1. #1
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    Can people get used to wrong cylinder axis?

    I ordered a new pair of glasses for a friend and he had a slight change in cylinder axis.

    Old RX
    +3.75 / -1.00 x 170
    +7.00 / -5.00 x 10

    New RX
    +3.75 / -1.00 x 170
    +7.00 / -5.00 x 7

    He clearly had better vision with the new RX but still I only changed the axis to 9° in order not to change too much and I know he's rather sensitive to changes.

    New pair arrived today, he says everything looks slightly distorted. He keeps tilting it to the old axis and tells me he sees better that way, even though I know he doesn't.

    Checked the power and it's 100% what I ordered.

    Is it possible he just got used to the wrong axis or am I going crazy here?

  2. #2
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Q: What exactly is the “wrong” axis?

    Discussion.

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    Master OptiBoarder CCGREEN's Avatar
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    Quote Originally Posted by Barry Santini View Post
    Q: What exactly is the “wrong” axis?

    Discussion.
    Great question Barry. IMHO I feel the "wrong axis" is something other then what the Rx called for.
    Now that being said the axis is determined between the patient and the Dr. that is a conversation I am not involved in so its not for me to make a call on. My job is to fill the Rx according to the written Rx. If I see a need to do otherwise then that is a conversation I need to have with the Dr and come to a mutual understanding.
    Yes sometimes for some patients when you have a history on them it may very well be better to give them only half of what the Rx calls for and work them up to the rx that was called for to start with. BUT DO NOT DO THAT WITH OUT A NEW RX FROM THE DR! It could turn on you and you would be in the wrong. Also document your conversation with pt and dr. The eye and the brain are amazing parts of the body. They can adapt to a lot of stuff but that does not mean that it is the right Rx. With a little bit of help it can do better.
    Last edited by CCGREEN; 01-31-2020 at 10:43 AM.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    My retired Doc had a great expression for patients like this:

    "There is the chair world and the real world".

    Sounds like this guy is perfectly happy in the real world with his old axis and the rx should be adjusted accordingly.

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    Eyes eastward... Uilleann's Avatar
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    20/20 vs 20/Happy. Old as time...

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    Who knows when the phoropter was calibrated on the latest exam. Fodder for thought

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    Quote Originally Posted by Airegin View Post
    I ordered a new pair of glasses for a friend and he had a slight change in cylinder axis.

    Old RX
    +3.75 / -1.00 x 170
    +7.00 / -5.00 x 10

    New RX
    +3.75 / -1.00 x 170
    +7.00 / -5.00 x 7

    He clearly had better vision with the new RX but still I only changed the axis to 9° in order not to change too much and I know he's rather sensitive to changes.

    New pair arrived today, he says everything looks slightly distorted. He keeps tilting it to the old axis and tells me he sees better that way, even though I know he doesn't.

    Checked the power and it's 100% what I ordered.

    Is it possible he just got used to the wrong axis or am I going crazy here?
    Nope, you are not headed to the rubber room!

    Many forms of corneal astigmatism can create the axis to be half 7 and half 10 in position. Then add the other variables like pantoscopic angle, base curve and wrap into the mix.........

    If you have access to corneal topographic maps, you will see exactly why your friend has a preference position. My opinion only.
    Eyes wide open

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    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by Uilleann View Post
    20/20 vs 20/Happy. Old as time...
    +1
    I'm Andrew Hamm and I approve this message.

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by CCGREEN View Post
    Great question Barry. IMHO I feel the "wrong axis" is something other then what the Rx called for.
    Now that being said the axis is determined between the patient and the Dr. that is a conversation I am not involved in so its not for me to make a call on. My job is to fill the Rx according to the written Rx. If I see a need to do otherwise then that is a conversation I need to have with the Dr and come to a mutual understanding.
    Yes sometimes for some patients when you have a history on them it may very well be better to give them only half of what the Rx calls for and work them up to the rx that was called for to start with. BUT DO NOT DO THAT WITH OUT A NEW RX FROM THE DR! It could turn on you and you would be in the wrong. Also document your conversation with pt and dr. The eye and the brain are amazing parts of the body. They can adapt to a lot of stuff but that does not mean that it is the right Rx. With a little bit of help it can do better.
    Two words:Pupil sampling

  10. #10
    What's up? drk's Avatar
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    Quote Originally Posted by Barry Santini View Post
    Q: What exactly is the “wrong” axis?

    Discussion.
    Weird question.

    It's the axis when the head is positioned normally at distance gaze, assuming the corresponding vertex distance and position of wear as refracted.

    Yes, high, high amounts of astigmatism are not optimally corrected with head tilt left or right (as if that happens, other than watching TV on the floor propping your head up with your arm).
    Yes, there are some weirdo cases of encyclo/excylotorsion on convergence or when dissociated vs. associated.
    But that's beyond rare.

    I find it aggravating when you go into the epistemological angst regarding refracting. I wish you would lay off: it erodes confidence.
    Last edited by drk; 02-04-2020 at 02:17 PM.

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    What's up? drk's Avatar
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    Quote Originally Posted by Fluegge Optical View Post
    Who knows when the phoropter was calibrated on the latest exam. Fodder for thought
    If you mean calibrate the flip cross for "looseness", I don't think that's even 0.00001% of the cases.

  12. #12
    What's up? drk's Avatar
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    Quote Originally Posted by Barry Santini View Post
    Two words:Pupil sampling
    Normal corneas and normal lenses don't have that issue.

    Keratoconics? Maybe.

    But no, don't worry about such minutiae.

    Unless you're working on the Hubble telescope.
    Last edited by drk; 02-04-2020 at 02:18 PM.

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    Eyes eastward... Uilleann's Avatar
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    Quote Originally Posted by drk View Post
    But no, don't worry about such minutiae.

    Unless you're working on the Hubble telescope.
    Dude, Hubble was so 1990! James Webb is where it's AT my Brotha!! ;) We're way beyond giant astigmatic mirrors these days! (Assuming the basic funding to launch this time doesn't get killed by some bean counter somewhere!)

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    If it's within ANSI tolerance, good luck getting your lab to do a lab remake.

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    The right axis is what the patient is happy with. But in this case tell the patient to wear it for a couple days and see if they get used to it. If you have an Rx like this, or even one not nearly as bad, and have ever sat on your metal frames and put them back on no matter how much you bend them back, it will feel distorted but eventually you'll likely get used to it and be fine. Its the same thing any new frame with or with out an axis change to the rx may feel weird until it becomes the new norm. This is not nearly as objective as many what to believe, it is subjective and also adaptive.

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    oh and Barry never stop being you. I'm fine with Epistemology.

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    Quote Originally Posted by Uncle Fester View Post
    My retired Doc had a great expression for patients like this:

    "There is the chair world and the real world".

    Sounds like this guy is perfectly happy in the real world with his old axis and the rx should be adjusted accordingly.
    I agree. Give the people what they want :)

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    Quote Originally Posted by Uilleann View Post
    20/20 vs 20/Happy. Old as time...
    20/Happy. A Barryism. So apropos.
    I bend light. That is what I do.

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    Quote Originally Posted by Airegin View Post
    I ordered a new pair of glasses for a friend and he had a slight change in cylinder axis.

    Old RX
    +3.75 / -1.00 x 170
    +7.00 / -5.00 x 10

    New RX
    +3.75 / -1.00 x 170
    +7.00 / -5.00 x 7

    He clearly had better vision with the new RX but still I only changed the axis to 9° in order not to change too much and I know he's rather sensitive to changes.

    New pair arrived today, he says everything looks slightly distorted. He keeps tilting it to the old axis and tells me he sees better that way, even though I know he doesn't.

    Checked the power and it's 100% what I ordered.

    Is it possible he just got used to the wrong axis or am I going crazy here?
    If the axis was processed and delivered at 9 deg, there should be no issues.
    Did you check the POL for it’s axis? How different is the new frame? Fit vs old? We are missing some critical info here.
    I bend light. That is what I do.

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