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Thread: Help me, dispensing geniuses!

  1. #1
    What's up? drk's Avatar
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    Confused Help me, dispensing geniuses!

    (I'm new here, so cut me some slack. I know this is the most basic of questions, and as controversial as politics and religion.)

    I have a patient who is essentially -1.50 with a +1.75 add, i.e. her progressives are only to keep her from the inconvenience of taking the glasses off to read. She is in a Panamic at 19 high. She complains that she doesn't see well enough in them to read at all, and has to remove them every time. It seems like she isn't finding an area to look through. (Refraction is correct, but of course;) , and +0.50 over her old glasses doesn't help her see any better.)

    The question is this: is there some subtlety of design that would make this so? I like Panamic because it seems "soft" and relatively distortion-free. Would another design be wider at near, even at the expense of some peripheral distortion? Please advise!

  2. #2
    Optimentor Diane's Avatar
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    Re: Help me, dispensing geniuses!

    drk said:
    (I'm new here, so cut me some slack. I know this is the most basic of questions, and as controversial as politics and religion.)

    I have a patient who is essentially -1.50 with a +1.75 add, i.e. her progressives are only to keep her from the inconvenience of taking the glasses off to read. She is in a Panamic at 19 high. She complains that she doesn't see well enough in them to read at all, and has to remove them every time. It seems like she isn't finding an area to look through. (Refraction is correct, but of course;) , and +0.50 over her old glasses doesn't help her see any better.)

    The question is this: is there some subtlety of design that would make this so? I like Panamic because it seems "soft" and relatively distortion-free. Would another design be wider at near, even at the expense of some peripheral distortion? Please advise!
    drk,

    OK...a few questions first. Age...about 50? What was her previous Rx? Did she previously wear PAL's? What were they? What is the fitting vertex of the old and new glasses? What type of work/visual tasks does she perform? Have you checked the tilt of the glasses? Should be 10 12 degrees for maximum on average. What about face form? Should have normal positive facial wrap or face form...No negative face form at all.

    I'll think a little more.

    Diane
    Anything worth doing is worth doing well.

  3. #3
    One eye sees, the other feels OptiBoard Silver Supporter
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    Make yourself at home.

    With this Rx most folks will remove their glasses for everything except occasional close tasks i.e. glancing at a menu, writing a check, etc. The reading depth and fields of PALs can't compete with mother nature. Simply put, if she can read comfortably without glasses then that's what she is going to do.

    Robert

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    One of the worst people here
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    Here is what I find the biggest problem is. Is it a monocular or biocular measurement. That includes PD and fitting height. If it is biocular that can be the reason why she cannot find that clear area.

  5. #5
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    It may be as simple as...

    Telling her to put the glasses on and KEEP them on. I went through this with my husband and my sister. I finally just told them that I didn't want to hear back from them for a week. It worked. I would have been more tactful...but hey, they're family.

    With the customers who bring me that situation, I try to schedule an appointment with them on a Thursday afternoon or Friday morning. Tell them to wear the glasses as much as possible through the weekend until Monday afternoon when I'll see them again. I advise them that if the glasses are bugging them, to take them off for a couple of minutes to "rest" and then put them on again so that they don't "lose the memory paths that they are creating." 9 times out of 10, it works wonders.

  6. #6
    What's up? drk's Avatar
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    Thanks, one and all for your replies. I was very punctillious about fitting hts, binocualr pd's, etc. and these were glasses I made a year ago, so she's had plenty of time to adapt. I think Robert has it right, probably, and she's probably using them more successfully than she thinks she does, especially for short tasks.;)

  7. #7
    Bad address email on file Darris Chambless's Avatar
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    Listen to Judy.

    And I'll repeat, listen to Judy. With the Rx you gave this person is use to taking the glasses off to see up close anyway and we are all creatures of habbit. She takes the glasses off and she has a very large field with which she can see clearly, with the glasses that field is considerably smaller and she's not use to that so she's fighting against it and not giving it a chance.

    I had an accountant that did this once. Wanted glasses so he didn't have to keep taking them off to read. I made them for him and he came in complaining that he was still taking them off because he could see without them. After hearing him complain about the same thing over and over again I told him I would remake in SV. He said but then I'll have to take them off when I read and I said "Yup!" He didn't want to do that so I handed him the progs. I'd already made for him that he was complaining about and he said "I'm just going to end up taking those off to read!" and I said "Yup!" then he said "So I'm damned if I do and damned if I don't then!??" And I said "Yup!" but followed that with "I can't give you back your 20 year old eyes. I'm not doing this to you it simply happens as a course of nature. You can accept it or not and I can put you back in SV if you wish." He took them, wore them and the last I knew he was doing quite well in them.

    Now I wouldn't recommend you do as I did (I was a little fed up with the guy at the time and felt as if I had little or nothing to lose by doing this) but there is a point in time where you have to let people know there will be some adaption on THEIR part where multifocals are concerned. Let them know that THEY will have to get use to some things and make no bones about it.

    I hope this helps some,

    Darris C.

  8. #8
    Just An Optician jediron1's Avatar
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    Big Smile

    Hey Doc try over refracting her with a -.50 in the reading only and see if that helps. If she is taking off her glasses to read then by
    trying a -.50 your effectively giving her a plano for the reading. I
    know she will still have a residual of a -.25 but I bet that would be the answer. My RX was very close to your Patients and I used to do the same until I had the add reduced and it solved the problem for about a year or two. Hope this helps! Just my two cents.:bbg:

  9. #9
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    I think Judy and Dr. Death are right on the mark. This kind of patient who has been taking glasses off to read will continue to do so and will not have enough exposure to fully adapt to progressives. I always advice to new prog wearers to wear FULL TIME until they feel comfortable then as needed. Do they all listen :hammer:

  10. #10
    Bad address email on file
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    emerging presbyopes

    Explain to them their options and then run like hell! Your better off being the second doc solving their near point problems, u will look like a genius!!

  11. #11
    Bad address email on file
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    emerging presbyopes

    Forgot one thing, do not dispense multifocal until they beg u for one!!

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