# Optical Forums > General Optics and Eyecare Discussion Forum >  Can't see well unless glasses are pulled down on nose

## oxmoon

Please help me figure out what is going on here.  Script is -7.75 -1.00 x115 and-8.00 -1.75X84 Add is now 2.25.  This is a remake with same script, except add is now reduced from 2.50.  Patient can see fine if glasses are pulled down about 1/2 inch on the nose, but not in standard wearing position.  I've checked out everything I can think of and it all seems OK.  Fitting cross is right there.  Increased panto does not help.  Lenses are Physio Enhanced, same as he got last time.  PD is 65  33/32.  Old script was -8.00 -.75x112 and -8.50 -1.75X84. Patient is age 65.  Thanks.

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## uncut

> Please help me figure out what is going on here. Script is -7.75 -1.00 x115 and-8.00 -1.75X84 Add is now 2.25. This is a remake with same script, except add is now reduced from 2.50. Patient can see fine if glasses are pulled down about 1/2 inch on the nose, but not in standard wearing position. I've checked out everything I can think of and it all seems OK. Fitting cross is right there. Increased panto does not help. Lenses are Physio Enhanced, same as he got last time. PD is 65 33/32. Old script was -8.00 -.75x112 and -8.50 -1.75X84. Patient is age 65. Thanks.



Reduction in myopia.............only refractionist is reluctant to back it off as much as is required.  Probably, a long armed dude as well, and prefers to read further back?

My first impression, on a Friday PM. :Smile:

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## HindSight2020

Seg height is too high, or needs to have Rx decreased.

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## njeyedr

I see this when the patient was told by his friends" why did you pick such an ugly frame?"

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## rdcoach5

Pulling his glasses down has the effect of reducing power . Confirm by holding plus power trial lenses in front of glasses at proper fit position. Sounds like you need to refer back to the Dr, again.

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## DanLiv

> Pulling his glasses down has the effect of reducing power . Confirm by holding plus power trial lenses in front of glasses at proper fit position. Sounds like you need to refer back to the Dr, again.


Wouldn't pulling the glasses down (and therefore away) increase vertex, and _increase_ minus power? I'm thinking what uncut said, too much minus was taken away. By pulling the lenses away the patient in increasing minus, trying to get back toward the original rx. That extra minus from vertex distance carries into the add as well, so if pulling the glasses away helps both DV and NV, I'm thinking he needs more minus. I'd try a -0.25 trial lens and see what that does. Overrefract DV and NV seperately.

Seg should be fine if it wasn't the problem in the original rx.

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## obxeyeguy

> Wouldn't pulling the glasses down (and therefore away) increase vertex, and _increase_ minus power?


No. Closer add plus, further add minus.

Use The above to correct for vertex change.

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## lensgrinder

The further away the glasses are moved from the eye adds plus to the optical system(i.e. thickness add plus).  You would add minus power to a minus lens to account for the lost power. They are probably losing about 0.06 D of power plus the 0.25 D that was already taken away.

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## harry888

pushing them away adds plus.  Most of my minus 14 spec wearers would prefer to push the specs away than get a multifocal.

Harry

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## oxmoon

Now I'm really confused.  He didn't have to push his old glasses down to be able to see, and he has had some minus removed in this new script already, so how does removing more minus, which is the same thing as adding plus, make it so he can see better in standard wearing position?  He doesn't seem like the kind of guy who worries about how he looks, and I think the frame he picked is not an issue  It's a lot like the old one.

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## Tallboy

^^ I have to ask, was it the same lab surfacing both times?  
I've seen cataracts and retinopathy and dementia or other psychiatric problems that can cause visual disturbances do some crazy things too.

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## Robert Martellaro

> Can't see well unless glasses are pulled down on nose.


At all distances? If objects beyond 10m are clearer with the old glasses, and the old glasses use the same lens design, with no significant disparities in lens position, then he needs a second opinion for the Rx.

If he's complaining about not being able to lean back in his easy chair and watch TV with the new Rx, then tell him that that's normal for those who experience a hyperopic shift. He can either sit up straight, or fit him with task eyeglasses (SV distance or low set multifocal). Most folks just tend to adapt, with minor compensating modifications to their posture.

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## sharpstick777

re refract...  its an RX issue.  No matter what he wore before.

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## uncut

> Now I'm really confused. He didn't have to push his old glasses down to be able to see, and he has had some minus removed in this new script already, so how does removing more minus, which is the same thing as adding plus, make it so he can see better in standard wearing position? He doesn't seem like the kind of guy who worries about how he looks, and I think the frame he picked is not an issue It's a lot like the old one.


Some of the posts above are confuzzzzing, Ox.......focus on this:

A person who is farsighted, when moving the glasses away from the eye is gaining or adding power artificially, commonly seen, right?
A person who is nearsighted, when moving the glasses away from the eye is reducing, or subtracting minus, (wanting more plus) not commonly seen, as typically myopes move more nearsighted, but...........when they are presbyopic, they have been found to need less minus to see at infinity.

When fitting contact lenses................we need to reduce the power of the minus lens to mimic a reduction of about 13 mm,......or closer to the eye. Conversly, we have to add plus power to farsighted contact lens fittings, because of moving the lens closer to the eye, by 13 mm, thereby weakening the original power.

Should be as clear as mud, now, right?

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