Download Lauren Fiscale The New England College of Optometry Hoya Grant

Lauren Fiscale
The New England College of Optometry
Hoya Grant and Scholarship Case Report
KS, a forty eight year old Caucasian female presented with trouble adapting to her
Varilux Physio progressive addition lenses (PAL). An unsuccessful PAL wearer in the
past, the patient tried wearing these glasses for one month before returning to the office.
As a craft stylist for a children’s magazine, the patient has high visual demands at many
different ranges. Her unremarkable medical and social histories provided little insight as
to her trouble adapting to her new lenses.
Patient History
KS was very motivated to be a successful PAL wearer. She had tried PALs in
2000 without any luck. She then started using a near ision only prescription. She wore
this on the tip of her nose so she could look over the top uncorrected in order to view
objects at distance. She came into the practice looking for a progressive lens because she
would like to wear glasses so she doesn’t have to constantly change her head position to
see clearly. Her occupation of being a craft stylist for a children’s magazine demands
sharp vision at all ranges throughout the workday. It would be more convenient for her
to wear a PAL instead of switching glasses numerous times throughout the day.
She was dispensed a Varilux Physio PAL with a prescription of +0.75 -0.25 X 145
in her right eye and 0.75 -0.25 X 075 in her left eye with and add of +1.75. At the time of
dispensing, the patient had difficulty finding the appropriate portion of the lens to see
clearly through at various distances. She was encouraged to walk around town with her
glasses for an hour and report back to the office. When the patient returned she did not
exhibit any improvement in finding clarity with her glasses. She also was experiencing
swimming effects with the lenses and felt nauseous. She was re-educated on the PAL
adaptation process and advised to try the lenses for a few weeks and follow up with
progress at that time.
When KS presented for examination one month later her primary concern with
her PAL involved her near vision. She felt the reading segment was not large enough. In
addition to having to extend her arms all the way out to read the book, the patient reports
moving her head and book around in order to read. KS also has difficulty with her
intermediate vision while using the computer for work. In order to see the monitor screen
clearly , she needs to use her reading portion of the PAL, which requires her to tilt her
head backward. The distance portion of the PALs alleviates the strain KS experiences
without any correction, however she does not feel her vision is sharp though the lenses.
She complains of need ing to wait until she is close to traffic signs before being able to
read them. She also experiences common PAL non -adapt symptoms such as skewing,
swimming effects, ground jumping up at her and trouble with her depth perception. She
further reports seeing yellow halos around objects; especially at distance.
Examination
At examination her uncorrected visual acuity at twenty feet was 20/20 - in the
right eye, 20/20+ in the left eye and 20/15 with both eyes. Vision without her glasses at
16 inches was 20/50- OD and 20/30- OS and 20/40 OU. With her PALs, the patient’s
distance visual acuity was 20/20 in each eye; however she subjectively liked her vision in
the right eye better than the left eye. She also noted a yellow halo around the letters in
the Snellen chart. Vision at sixteen inches was 20/20 through each eye with her glasses.
The patient achieved this measurement by tilting her head back and she observed a
shadow around the letters of the near acuity chart. KS was refracted again with +0.750.50 X 080 OD and +0.25 sph OS with an add of +2.00. She noted that the halos seen
with the PAL disappear while u sing the phoropter lenses. KS was happiest with a trial
frame prescription of +0.75 -0.50 X080 OD and +0.50 sph OS with an add of +1.75. A l
of the ocular findings being unremarkable it was concluded that the patient was having
trouble adapting to her Physio PALs. Using the same frame, a Hoya iD Lifestyle lens
was selected to replace the Varilux Physio for this patient whose lifestyle requires clear
dynamic that only a progressive can give.
Dispensing
The positive reaction to her Hoya iD Lifestyle lens was instantaneous when KS
tried on her new PALs. She reported being able to see far away clearly; she remarked
that it was effortless. She no longer had to tilt her head back to look close-up. She can
focus right away when switching gazes from distance to near; both views being
immediately clear to her. KS also notices a huge improvement in her comfort leve Her
old PALs made her very nauseous and she was having trouble walking while wearing
them. The new lens eradicated the distortions that were making her sick before. She says
the colored halos have disappeared along with the swimming effects. The floor is n o
longer jumping out at the patient and her depth perception has returned to normal. Also
notable is that KS reports it is a lot easier to find the right places to look through her
lenses when looking at different distances. She reports the transition between the
different prescriptions in the corridor is smoother and she doesn’t need time for objects to
come into focus when changing gazes. Her measured visual acuity through the lenses at
distance and near was 20/20 OD and OS. Most markedly, the patient did not have to tilt
her head backward in order to read the card clearly. She is personally much happier with
the clar ity and comfort of her new lenses. At a one week follow up KS is still very
pleased with her new PALs. She reports all the same f
ith the glasses as she did
at dispensing. The patient is very happy to report that reading books is effortless now
with her Hoya lenses.
Discussion
A few design advantages of the Hoya iD Lifestyle may explain why KS adapted
to this lens and not the Varilux Physio. First of all, the Hoya iD Lifestyle is digitally
surfaced on the back side, providing for a custom fit for each prescription. Digital
surfacing will also start the patient out with clearer
ions
Furthermore the back of the lens has horizontal progression of the prescription,
minimizing the skewing effects that are usually induced by a PAL. Meanwhile the front
surface of the Hoya iD Lifestyle has a vertical power progression. This accounts for both
the gradual corridor prescription progression and nominal time needed to focus from
distance to near that the patient noticed. Having the combined front and back surface
progressions helps to minimize head movement by making the vision through the Hoya
iD Lifestyle as close to natural vision as possible.
Switching from a Varilux Physio PAL to a Hoya iD Lifestyle changed th is
patient’s viewpoint on progressive lenses. Instead of being a nuisance to wear a PAL, it
became a convenient part of everyday life. Now it is only necessary to wear one pair of
glasses to enjoy clear comfortable vision throughout the day.