Is Lenticular better for super high plus lenses +15.00 and higher

[Prentice Pro 9000]

I have a patient that had about a +18.00. I did something from Quest that was aspheric and "lenticularized" at the edges, but the patient complained that the vision was not as good as what they saw in the Dr's office. This got me thinking: Maybe I should just try to match the OD lens-kit as closely as possible. I'm assuming then this would call for a lenticular lens.

Does anybody out there have experience with this? Does a more bulbous lens with a smaller diameter end up being better in this situation?

[Robert Martellaro]

At +18 D in cr39 choices are limited to +18 or higher base curve spherical segmented multifocal (Super Modular only goes up to about +16 BC I believe).

Lenticulation will allow a larger frame but make sure the "B" is sufficient to keep the power curve from being edged. Because it's spherical only, the off-axis optics will be poor, but not as bad as it would be with a low Abbe hi-index material or bi-convex I think.

Free-form can clean up the off-axis optics but working on a steep base blank may not be mechanically possible. Full-field will require, depending on the subject's IPD, an "A" of about 38mm to 42mm.

Measure both the refracted and wearing vertex. If N/A you might have to over-refract and remake. Price accordingly.

Hope this helps,

Robert Martellaro

https://aoloptical.com/lens-data/

[Lensman11]

Fitting and dispensing +18 requires a little more effort than just ordering the lens. Did the doc give a vertex distance if so did you match it or compensate for the difference. The patient will need an adaption period you must explain that. Pantoscopic tilt as well as oc height are necessary in fitting theses lenses.

[Prentice Pro 9000]

At +18 D in cr39 choices are limited to +18 or higher base curve spherical segmented multifocal (Super Modular only goes up to about +16 BC I believe).

Lenticulation will allow a larger frame but make sure the "B" is sufficient to keep the power curve from being edged. Because it's spherical only, the off-axis optics will be poor, but not as bad as it would be with a low Abbe hi-index material or bi-convex I think.

Free-form can clean up the off-axis optics but working on a steep base blank may not be mechanically possible. Full-field will require, depending on the subject's IPD, an "A" of about 38mm to 42mm.

Measure both the refracted and wearing vertex. If N/A you might have to over-refract and remake. Price accordingly.

Hope this helps,

Robert Martellaro

https://aoloptical.com/lens-data/

this is quite helpful, but the question remains: Is lenticular going to be better as opposed to full-field? In other words, at those higher powers, will beefing up the base and be more pleasant to look through?

[Prentice Pro 9000]

Fitting and dispensing +18 requires a little more effort than just ordering the lens. Did the doc give a vertex distance if so did you match it or compensate for the difference. The patient will need an adaption period you must explain that. Pantoscopic tilt as well as oc height are necessary in fitting theses lenses.

Yes indeed all of this was taken into consideration. The patient has severe structural ocular conditions which make it seem that no Rx is really going to be perfect. We went with the standard 12mm vertex I believe. We also selected a super-modular from quest. Small A size oval. The job came out exceptional for what it was and yet the patient says that they saw better in the chair. And so that is what is leading me down this path of wondering what the absolute best option is vision-wise.

[optical24/7]

Trail lenses over the new ones will tell you if it’s a power issue.

[PRECISIONLAB]

Chadwick Optical’s High Plus Options

[rdcoach5]

For those of us who lived before there were implants, try to increase or decrease panto and face form. If you can increase vertex distance (adjustable nosepads ) , try that. If that helps and you can't adjust the frame out, over refract with trial lenses.

[drk]

"Seeing better in the chair" is sometimes an unavoidable situation. How small are phoroptor lenses? 20 mm? And glass.

[Prentice Pro 9000]

"Seeing better in the chair" is sometimes an unavoidable situation. How small are phoroptor lenses? 20 mm?

You would know better than I would about the diameter for the phoroptor.

So the question remains: should we try to reproduce a the phoropter lens a close possible?

[drk]

I don't think that's likely. And I don't know how a patient would be able to legitimately say "Oh, I KNOW I saw better through the doctor's thing-a-ma-jobby than through these coke-bottles!"

I mean, what are they doing? Putting on the glasses, taking them off, running into an exam room, dialing up their lens power, and looking at the chart?

It's probably just an expectations thing.

I would respond: "These lenses are the EXACT 'strength' that the doctor prescribed. You need time to adjust to the new powers."

[Prentice Pro 9000]

I don't think that's likely. And I don't know how a patient would be able to legitimately say "Oh, I KNOW I saw better through the doctor's thing-a-ma-jobby than through these coke-bottles!"

I mean, what are they doing? Putting on the glasses, taking them off, running into an exam room, dialing up their lens power, and looking at the chart?

It's probably just an expectations thing.

I would respond: "These lenses are the EXACT 'strength' that the doctor prescribed. You need time to adjust to the new powers."

I get that. But in your experience do you think an aspheric full-view-ish lens is better or and egg yolky lenticular? Or is it just random preference?

[drk]

(No experience to contribute, sorry.)

[Robert Martellaro]

Prentice Pro 9000,

Corrected curve theory/best form breaks down over plus eight or nine diopters, where only aspheric/atoric surfaces are capable of reducing marginal astigmatism. So yes, aspheric/atoric surfaces are preferred for high plus Rxs. Hint: don't use high-index due to high CA levels, instead use cr39 and control weight and thickness by careful frame selection, combined with lenticulation (when available) for more latitude with frame selection.

Best regards,

Robert Martellaro