Look out for the 'orange peel'

One day a patient of mine came to the office complaining that she was 'not seeing well any more' and, at the same time, she was unhappy because her spectacles were 'already wrong'. A year and a half earlier, she had been fitted with new spectacles - a pair of high-quality progressive lenses, lightweight, with a hard coat and anti-reflection coating. Her prescription was BE -0.50 DS, Add 2.25. She was examined and her visual acuity, at distance with spectacles, measured RE 6/7.5, LE 6/7.5, BE 6/7.5 (all uncertain); with no signs of pathology, internally or externally. Further testing showed: BE -0.50 DS, Add 2.25 with visual acuity of RE 6/5, LE 6/5, BE 6/5 and, with that prescription in the trial frame, she exclaimed: 'This is much better.' The spectacle lenses had no scratches or distortions on the surfaces to account for the acuity reduction. However, with the focimeter, I got a surprise. Both lenses measured in the vicinity of -0.50 DS in the distance portion, with a very unclear image. I then examined the surfaces with a magnifier and here the problem became 'clear'. All four surfaces looked like orange peel and I was surprised that the visual acuity reduction was not more pronounced. The reduced visual acuity with the old spectacles, the same degree of myopia and two lines better visual acuity with the same prescription meant that the culprit had to be the lenses. They were promptly exchanged with excessive explanations from the manufacturer on how the impossible could happen. The comfort of lightweight lenses is obvious and that they are used more and more is understandable. However, one cannot help thinking, that many of our patients are walking around with reduced visual abilities, caused by the 'orange-peel' effect and not knowing why? Vigo H Nielsen Svendborg, Denmark