Candidate for Shaw Lenses...

[Uncle Fester]

I've never dealt with a Shaw lens but see this situation seems to qualify so what are your thoughts and experiences:

Forty year old woman with history of amblyopia left eye.

Chief complaints Turner syndrome, strabismus, amblyopia, poor depth perception.

Does not currently wear glasses. Contact lens made her feel dizzy in the distant past.

Medically complex patient per doctor.

New Rx from MD

OD -0.25
OS -6.50
PD 29/29

Well meaning optician from Lenscrafters suggested she see if the doctor might want to prescribe prism for her diplopia.

Ophthalmologist is now prescribing 12^ Base In. Is not optimistic this will improve vision.

I worked with her many years ago until she moved out west and our OD did not think prism would help back then.

Medicaid coverage.

MD's letter has qualified her for a fresnel prism which the doctor does not feel will be successful.

What are your thoughts about Shaw lenses for her?

She may have family that can help pay for them but any ballpark as to how much that costs?

I also believe I need to qualify the office for these lenses which may not be possible but I'd like some offices with more experience to chime in.

Should I recommend she find an established OD to fit her?

[optical24/7]

Can’t help with most of your questions Fes, but here’s a pic of a -1.50 and a -4.25 (sph equivalent)…

https://www.reddit.com/r/optometry/c...h_shaw_lenses/

Your patient may benefit by seeing a pic of them (hers will be thicker..)

there are a few folks on Reddit talking about them. A few have mentioned $450-650 retail.

I would encourage her to try cl’s again, if she refuses, I would recommend see seek a Shaw retailer ( I wouldn’t want that hot mess!)

[Uncle Fester]

Can’t help with most of your questions Fes, but here’s a pic of a -1.50 and a -4.25 (sph equivalent)…

https://www.reddit.com/r/optometry/c...h_shaw_lenses/

Your patient may benefit by seeing a pic of them (hers will be thicker..)

there are a few folks on Reddit talking about them. A few have mentioned $450-650 retail.

I would encourage her to try cl’s again, if she refuses, I would recommend see seek a Shaw retailer ( I wouldn’t want that hot mess!)

I thought they would cost much more.

[drk]

I don't think Shaw Lens is for her. The main advantage I believe is in their PALs.

This is wrong all over the place, but we don't have all the information. But it's a trainwreck and I'd love to hear more before acting hoity-toity. BUT THEN WATCH OUT!

[Uncle Fester]

I don't think Shaw Lens is for her. The main advantage I believe is in their PALs.

This is wrong all over the place, but we don't have all the information. But it's a trainwreck and I'd love to hear more before acting hoity-toity. BUT THEN WATCH OUT!

Always learning here...

So does Shaw shine brightest with presbyopic aniseikonia patients and kids with strabismus?

Anyone else have a thought?

[Uilleann]

What is the claimed benefit of the Shaw fancy schmancy lenses vs standard prescribed prism? Are they able to vary the level of prismatic effect in different physical areas of the lens? What's the drive to use a Shaw design?

[drk]

I seem to remember calling them regarding "gradient" prism (in downgaze) and the person said they did NOT have gradient prism, a la NEUROLENS (whoop de whoop).

I think the advantage is just good aniseikonic design.

In Fester's case, I just don't think that patient can be binocular (the hoity), ergo no aniseikonia possible (the toity).

[drk]

This is subtle, but you can get it if I can explain it right.

If a person has REASONABLE binocular vision, which means that they have at least second degree fusion.....

....We interrupt this discourse for a quick primer on binocular fusion. "First degree fusion" is that there is no suppression from the "bad" eye. "Second degree fusion" means that there is no suppression, but there's too much image disparity on the retina (from size difference or mini-misalignment) to have stereoacuity. "Third degree fusion" is when you have stereoacuity to some extent. IN REALITY IT'S A CONTINUUM, not a three-box world....

......anyway, if there is at least the CHANCE that the patient can see in stereo, then when their stereo gets messed up by unequal image size= boom! Aniseikonia. This is a "normal" binocular vision person with "abnormal" refractive error.

BUT,

If the patient is an "abnormal binocular vision from muscle misalignment" person, then you can make the images exactly equal in size and all, but they still don't hit corresponding retinal points, therefore they would still be perceived as "double vision" and the brain will just suppress, anyways.

So, no, Shaw can't help anisometropic HETEROTROPES.

[drk]

HAVING SAID ALL THAT...

What about the (super rare) cases where the HETEROTROPIA is SECONDARY TO anisometropia? Let's say, a very young kid has -1.00 OD and -5.00 OS and the anisometropia causes aniseikonia that causes weak binocular fusion development. Then that case would benefit from iseikonic design (if pediatric CLs are impossible).

[Uncle Fester]

Thanks drk!

Three box world?

Can an optician (small o) like me do a simple test for first second or especially third stereo-acuity by having them cover one eye then the other? Or is that best addressed in the doctors chair?

I ask so I'm not referring back hopeless causes.


Where's the drop jaw emoji when you want one!!!

[optical24/7]

When you get into this range, (even less) of power discrepancies, even if you could iseikonic the image size difference to nil, you’d still have the power difference inducing a large amount of prism eye to eye off center viewing. Lots of nose pointing to maintain binocularity.

Best case scenario is a cl OS, or possibly surgical, ( lasik, iol.)

[Uncle Fester]

When you get into this range, (even less) of power discrepancies, even if you could iseikonic the image size difference to nil, you’d still have the power difference inducing a large amount of prism eye to eye off center viewing. Lots of nose pointing to maintain binocularity.

Best case scenario is a cl OS, or possibly surgical, ( lasik, iol.)

They are looking at surgery but the MD, she says, is reluctant. Fears are that a terrible situation could become even worse.

[Robert Martellaro]

I don't think Shaw Lens is for her. The main advantage I believe is in their PALs.

This is wrong all over the place, but we don't have all the information. But it's a trainwreck and I'd love to hear more before acting hoity-toity. BUT THEN WATCH OUT!

Yup. Much more data needed for solutions that could out perform...

Does not currently wear glasses.

Best regards,

Robert Martellaro

[drk]

Fester, no, you'd need R-G glasses and a Worth Dot chart/box/flashlight and a stereogram.

Heck 99% of ODs are baffled by this.

[Uncle Fester]

Fester, no, you'd need R-G glasses and a Worth Dot chart/box/flashlight and a stereogram.

Heck 99% of ODs are baffled by this.

I assume that's red - green lenses?

Should I communicate this to the MD's office?

Thanks to all!!!

[drk]

Yes, red-green.
No, stay out of trouble. :)

[McAnerin]

I'm very late to the party, but Zeiss can do Iseikonic designs on request, which is similar to what Shaw lenses achieve, they don't even charge you extra, I've had good results with patients with similar Rx's.