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案例(li)1:14周岁 初三女生(sheng) 初次(ci)配镜无近视家族(zu)史,裸眼(yan)视力(li)(li)R:0.15,L:0.2,OU:0.3-。左右眼(yan)分别雾视至0.12能辨出,看(kan)远(yuan)15分钟(zhong)后(hou),视力(li)(li)分别提升一行,进行主观验光R:-1.50D,L:-1.00D,矫(jiao)正视力(li)(li)单眼(yan)至1.2,右眼(yan)稍(shao)清楚,右眼(yan)为主导眼(yan)。试(shi)戴15分钟(zhong),无不适现象(xiang)。
在(zai)其习(xi)惯(guan)距离内不(bu)戴(dai)眼(yan)(yan)(yan)(yan)(yan)镜(jing)阅读,右(you)眼(yan)(yan)(yan)(yan)(yan)近视力明显(xian)好于左(zuo)(zuo)眼(yan)(yan)(yan)(yan)(yan);戴(dai)镜(jing)后阅读,右(you)眼(yan)(yan)(yan)(yan)(yan)视力好于左(zuo)(zuo)眼(yan)(yan)(yan)(yan)(yan)。很明显(xian)长时间的(de)近距离阅读,右(you)眼(yan)(yan)(yan)(yan)(yan)负(fu)重(zhong)较大(da),右(you)眼(yan)(yan)(yan)(yan)(yan)又(you)为其主导眼(yan)(yan)(yan)(yan)(yan),不(bu)解决掉近用(yong)的(de)屈光平衡问题,右(you)眼(yan)(yan)(yan)(yan)(yan)视力会增长较快,给(ji)其双(shuang)(shuang)眼(yan)(yan)(yan)(yan)(yan)在(zai)矫正基(ji)础上,下加(jia)+1.50D,再测试(shi)近用(yong)视力,视标大(da)小相(xiang)近,清晰度(du)相(xiang)近。双(shuang)(shuang)眼(yan)(yan)(yan)(yan)(yan)视远的(de)正调(diao)节(jie)偏(pian)小,双(shuang)(shuang)眼(yan)(yan)(yan)(yan)(yan)集合功能(neng)很强(qiang),近点(dian)为TTN(近点(dian)至鼻(bi)尖)。为维持双(shuang)(shuang)眼(yan)(yan)(yan)(yan)(yan)的(de)看(kan)远视功能(neng),看(kan)远要清楚远用(yong)镜(jing)度(du)R:-1.50D,左(zuo)(zuo)眼(yan)(yan)(yan)(yan)(yan):-1.00D;为缓(huan)解看(kan)近右(you)眼(yan)(yan)(yan)(yan)(yan)负(fu)担,减(jian)缓(huan)视近调(diao)节(jie)疲(pi)劳(lao),近用(yong)镜(jing)度(du)R:-0.00D,左(zuo)(zuo)眼(yan)(yan)(yan)(yan)(yan):+0.50D。考虑到初三学习(xi)的(de)紧迫(po)性,给(ji)其推荐了渐进多焦镜(jing)。
总结(jie):远(yuan)用屈光(guang)左右眼(yan)相差不大,不进行近视(shi)力的检(jian)(jian)查(cha)和近用视(shi)力平衡,对(dui)(dui)孩(hai)子父母就没有很好(hao)的说服力。对(dui)(dui)于(yu)学(xue)生配镜(jing)(jing),尤其是(shi)左右眼(yan)屈光(guang)参差时,不戴镜(jing)(jing)和戴镜(jing)(jing)的单眼(yan)近视(shi)力都要进行检(jian)(jian)查(cha),以便(bian)确(que)证,让学(xue)生能(neng)双眼(yan)同时使用,维持好(hao)双眼(yan)的视(shi)功能(neng)。
案例2:一23岁男青年,土木工程(cheng)毕业学(xue)生,无近(jin)视(shi)(shi)家(jia)族(zu)史。原(yuan)镜R:-2.25D,L:-6.00D。原(yuan)镜配(pei)(pei)(pei)戴(dai)两(liang)年,重新客、主(zhu)(zhu)观验(yan)光,先右(you)后左(zuo),验(yan)光过程(cheng)发现,右(you)眼(yan)(yan)为-2.25D,检(jian)查无散(san)光,进(jin)行(xing)多(duo)次比较,还是原(yuan)镜度(du)最(zui)合适(shi)(shi),但右(you)眼(yan)(yan)视(shi)(shi)力(li)能辨别(bie)至1.0,很清晰(xi)至0.7;左(zuo)眼(yan)(yan)为-6.00D,检(jian)查视(shi)(shi)力(li)较右(you)眼(yan)(yan)清晰(xi),视(shi)(shi)力(li)至1.0。左(zuo)眼(yan)(yan)为主(zhu)(zhu)导(dao)眼(yan)(yan),右(you)眼(yan)(yan)视(shi)(shi)力(li)受(shou)到(dao)轻微压抑。跟(gen)案例1相(xiang)似(si),如(ru)能及(ji)早的(de)(de)进(jin)行(xing)预防控制(zhi),降低左(zuo)眼(yan)(yan)负重,减(jian)缓眼(yan)(yan)外肌(ji)对(dui)眼(yan)(yan)球(qiu)(qiu)的(de)(de)压迫(眼(yan)(yan)外肌(ji)对(dui)眼(yan)(yan)球(qiu)(qiu)的(de)(de)长(zhang)期(qi)压迫会导(dao)致眼(yan)(yan)轴(zhou)的(de)(de)增长(zhang),常人的(de)(de)眼(yan)(yan)轴(zhou)为24mm左(zuo)右(you),当眼(yan)(yan)轴(zhou)长(zhang)度(du)增长(zhang)1mm,眼(yan)(yan)屈光系统可带来约-3.00D的(de)(de)近(jin)视(shi)(shi)度(du)数的(de)(de)增长(zhang)),左(zuo)眼(yan)(yan)也(ye)可能控制(zhi)在(zai)中度(du)近(jin)视(shi)(shi)范畴内。检(jian)查其融(rong)合功能、双(shuang)眼(yan)(yan)影(ying)像大小,均正常。没有任何配(pei)(pei)(pei)镜方法的(de)(de)问题(ti)。因其主(zhu)(zhu)诉:镜片厚(hou)度(du)不(bu)对(dui)称(cheng),感觉不(bu)美观。给(ji)出处理方法:两(liang)镜片选(xuan)择(ze)不(bu)同折射(she)率(lv),右(you)眼(yan)(yan)选(xuan)择(ze)1.553,左(zuo)眼(yan)(yan)选(xuan)择(ze)1.67,来缩短双(shuang)眼(yan)(yan)镜片的(de)(de)厚(hou)度(du)差(cha)别(bie);均选(xuan)用非球(qiu)(qiu),以减(jian)少影(ying)像相(xiang)差(cha)的(de)(de)目的(de)(de)。还可以选(xuan)择(ze)配(pei)(pei)(pei)戴(dai)隐(yin)形眼(yan)(yan)镜,隐(yin)形眼(yan)(yan)镜戴(dai)在(zai)角膜表面,其物象大小接近(jin)于正视(shi)(shi)眼(yan)(yan),并且在(zai)眼(yan)(yan)球(qiu)(qiu)转动时不(bu)棱镜效(xiao)应,配(pei)(pei)(pei)戴(dai)更舒适(shi)(shi)。
总结(jie):不(bu)同折射率的(de)镜片建(jian)议(yi)专(zhuan)门使(shi)用(yong)定制(zhi)片,防止(zhi)镜片膜层的(de)减反射残留色带(dai)来的(de)不(bu)适感。如果顾客比(bi)较(jiao)年(nian)轻,体(ti)制(zhi)很好,适应能(neng)力较(jiao)强,可以事先告(gao)诉(su)他使(shi)用(yong)不(bu)专(zhuan)门定制(zhi)的(de)镜片,需要适应一段时间(jian)。