How much to expect from OD?

This is a followup to my thread "I think my OD gave up on me". The
brief summary is: I asked to try RGP contacts. The first set back was
pretty good, but they were "low riders" and I got glare from the top
edge of the lens. Night vision was slightly annoying due to some
flaring/starbursting. So I went back and convinced them to address the
problem, which they attempted with larger lenses, but the prescription
came back with too much minus power (and some imbalance) resulting in
eye strain. They ordered one more set and they came back with too much
plus, resulting in blurry vision at distance. At that point, they
basically gave up.

As a result of feedback from this group, I requested that they modify
the lenses for more minus and I would pay the bill ($50). They did
this, and the lenses I got back gave clear vision, but caused (for some
reason) frequent foggy/dry vision (still sharp) and terrible night
vision in terms of starbursting.

So now I'm kind of on my own. No followup was suggested. And as a
matter of fact, none was ever suggested after the first fitting. This
bothered me not only because the correctness of the Rx would not be
confirmed, but also because I wanted to make sure the fit was healthy
for my eyes.

Is it too much to ask that my doctor would actually take an interest in
helping me achieve my goal of clear vision in contact lenses, and
follow through to make sure I'm happy?

From postings here and research elsewhere on the net, I know there are
all kinds of options for contacts. First of all, many brands of soft
toric. Within RGP there are all kinds of parameters: Size, curvature,
rigidity of material, other material parameters, size of OZ, spherical,
back toric, bi-toric, scleral, and surely numerous other things I,
layman, haven't heard of. Is it appropriate to give up after the first
try? I never told them I needed and easy or cheap solution.

The followup after the very first set of lenses really was like that.
I said "the vision is great, but I get a lot of glare, and kind of hazy
night vision. Is there something we can adjust to fix that?" The
reply was basically "no, you'll probably get used to it, have a nice
day." And I was surprised that no over-refraction was done to see
whether the Rx was correct (I read the eye chart, 5 feet away).

One thought I have is this: I don't believe that if the OD was trying
to fit himself in contacts that he would give up without thoroughly
exploring the options. It doesn't seem right to tell me that this is
as good as it gets yet. A more comforting response would be, e.g.,
"There are some other parameters we could play with in RGP, but the
trial and error process could get expensive. Why not try some soft
torics first, and if that doesn't work out, we can consider the
options."

I'm really just interested in generating some discussion on this. I
realize I'm a somewhat difficult patient since I'm astigmatic and have
high standards for my vision. I need to decide whether I should search
for a better OD or not. If I don't, then I have an okay pair of RGPs
that I think could probably be better, but no avenue to improve them.
I'll probably ask to try some soft torics, just so I know what the
current generation is capable of.

The whole experience kind of reminds me of the time I went to the MD
complaining of fatigue. He ordered a blood test and a day later a
nurse called and said "the blood test came back normal, have a nice
day."

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Dear Charles,

I am certain that the ODs who are dealing with you -- are
doing the best they can, consistent with the time available.

Maybe you are expecting too much from them. Perhaps
you can get a more complete answer to your questions
and problems on sci.med.vision.

As you said -- they do this for free.

Best,

Otis

 

Answers are nice, but in the end I need the lenses. I don't think they
can evaluate and prescribe lenses via webcam...

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Unfortunately, fitting gas perm lenses is fast becoming a lost
art and many colleagues do not know how to troubleshoot
problems well (that and it takes up chair time). But, depending
where you live, should be someone who is competent and
know his/her way around gas perms. Call around and, before
you make an appt, inquire about how much experience the
potential provider has in fitting gas perms. If they hedge, or
don't even respond then I would move on.

Good luck to you.

frank

 

To write it down sounds kind of bad, but I originally found this doc
because I was looking for a vision therapist. That's his expertise, or
rather developmental optometry. Maybe I was expecting too much for him
to admit if he's out of his comfort zone dealing with RGP contacts.
Having said that though, I did see the contact "expert" of the practice
for my original followup due to a schedule conflict with my normal
person. It's possible that the expert guy would have done things
differently if I had come back to him with my complaints, although he's
the guy who more-or-less blew off my original concerns.

Thanks for the replies. I'll start asking around for where other
people go. If it comes to it, I could go to the local university (as
suggested), which has a well respected optometry program. Downside is
the 40 minute drive.

 

Just see other optometrists, get second and third opinions. It is
already clear you are super picky and very difficult. You are not happy
with +.25 or -.25, must be plano. I did tell you that you would never
be happy with orthoK as they would make you hyperopic and result in
blurry vision. I do not believe you when you said you can accomodate
thru a -6 lens when RGPs that slightly overcorrect you cause blurry
vision at all distances!

Also you report RGPs arent comfortable. Why dont you just stick to
glasses, I can see(pun intended) that you are much happier with
glasses. You wont be happy with toric contacts, they dont do nowhere
near as good a job as RGP contacts and wont be comfortable either.

 

I told my OD (via lens tech) that I'd like to give some soft torics a
try before I make up my mind whether to live with the RGP annoyances
(that they claim to be unfixable). The lens lady called back and said,
"the doctor said no, he doesn't think they will work for you because
you don't have enough astigmatism."

I said that that seemed impossible since my last "full power" Rx was

R: PL -1.5x180
L: +0.25 -1.0x180

Since I'm happier with 0.25 to 0.5 less cyl correction, a left toric
with -0.75 and right with -1.25 seems nearly perfect.

She said, "I'm just relating what the doctor said, he said he'd be
happy to pass your file along to another doctor if you want to get a
second opinion."

Not very subtle! I guess I will be looking for another eye doc.

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