Is it normal to have no intermediate in PALs?

hi, folks, I'm back. Well, I posted last Fall in trying to change lenses -- I went from Sola VIP Gold (which I don't think they make any more) 1.56 and was almost getting Varilux but then the new optician I went to said she thought Zeiss was the best for me as I said I used the computer and played piano so wanted good intermediate, and of course, I want good reading. I don't remember the brand of Zeiss, whatever the basic one is, I guess (not Brevity).

Okay, then I read some specs on Zeiss' website that implied the fitting height was really big (like min 22 mm) and my frame was 20 mm which is still a lot bigger than many. However, I did read some optical article that rated Zeiss about highest in intermediate zone. I was just afraid I wouldn't have hardly any reading vision. Anyway, when I pick them up I question about that and they say Zeiss website is out of date and it's now 18 minimum or something. I thought that was fishy, did they just change what it said but keep the lenses the same?

Much to my surprise -- I can read very well and the reading area seems even bigger than my last pair so I am very pleased with that. However, to my greater surprise, the intermediate area seems worthless. In fact, I'm not sure I use the intermediate area for anything. I see much better looking more through the bottom of the lens (ie, tilting my head up a bit to look down) at both my computer and music on the piano. Both my computer screen and piano music are not dead-on from my face, but a little lower to begin with, and both are about arm's length from my face (around 24"). The piano music is a bit closer, maybe 18-20", from my face.

This isn't a major deal, but I have had to generally tilt my head up a bit when I would prefer not to, as I don't think that's so great on your neck. I think I may use the intermediate area for watching TV or something, but that's pretty far away (maybe 8 feet). I think the distance vision seems okay, I don't notice any problems driving or walking around that bother me.

Is this normal? My prescription has a +2.00 add on the reading part. That was the only change, it used to be +1.75, I think. I sort of recall the optician telling me something about maybe tilting my head a little, but I'm not sure. Last night I went to another optical store as I was thinking of getting a second cheap pair of single vision glasses just in the reading prescription to see how that worked for things, since I seemed to be using it so much. YOu can get a single vision pair pretty cheap, so why not. Now when I was telling the optician in that store kind of why, he said that something was wrong, that I wasn't supposed to have to tilt my head at all for the intermediate vision area and to work on the computer, that maybe they weren't fit right.

I don't know. The optician company that fit them seemed to take a lot of time with them (both fit by hand and some machine) in measuring the midpoint, and are well regarded in the area. I do have a warranty for a bit longer so I was thinking of going back to them to complain but am not sure what happens--it's not that close to where I live so is a bit of a trip for me, which is why I ask. I also might be afraid that if I complain and they refit them by centering them differently, maybe there will be something else about them I like less than the way they are now. They are expensive, of course, but I paid a reasonable price for them (around $380 including the Zeiss AR coating, and they are 1.67 index, for the lenses only).

What do you think? Is it normal to have to tilt your head a little for the intermrediate area when you have a +2 add or should I go back? I'm just surprised since Zeiss is touted as being the best for the intermediate area.

thanks
Christina

Yes, you should have to tilt your head back to see the intermediate. If not, you'd have to lower your head to walk around! Think about it.

Yes you will have to tilt your head to use your intermediate. But if your tilting your head all the way so that your actually using the near vision part of the lensfor the intermediate, go back and talk to the Optician and they'll be able to tell what you need to do in order to use the lenses correctly.

Sometimes a PAL cannot accomplish everything.

For things like playing the piano what you want is a second pair of task specific lenses (Shamir Office, Sola Access, Nikon Online, ect)

let's start by talking about the ht of 18.

The reason for that discrepancy in data is that a few years ago, as small frames began to become much more popular, somehow, somewhere, someone determined that the min ht on a progressive lens can be where the wearer receives 85% of the add...not 100%. Zeiss is not the only culprit here, as every lens at one time had minimum hts of 22 and 23, now they're 18 & 19, and the design is still the same.

There are a handful of progressive lenses that give a decent intermediate area, including Gradal. Other options are the Definity and the Autograph, however, the reality is, no progressive lens will allow you to sit comfortably at a computer monitor for an extended period of time. The best investment a computer user can make is in a pair of computer occupational lenses, such as Office lenses by Shamir or Access by Sola or Tact by Hoya.

Here is the study you probably used in your choice of Zeiss.

http://optometry.osu.edu/research/CO...SciArticle.pdf

Note that its the Zeiss Gradal Top. Are you sure you got that model?

If you have that model, check to see if you can get the intermediate zone into focus by rotating your head from side to side. If looking at an angle improves things, have you pupil distances rechecked. (I had that problem recently).

Yes, do get a single vision pair (or two). Start with a 1.5 add and see how they work. You might want a little higher or lower add for one of your tasks. Then, just leave the appropriate pair on your computer desk and/or piano.

Given that my computer and probably your sheet music consumes most of your field of vision, I doubt that an "occupational progressive" would be better than single vision. If you want to try an "occupational progressive", I suggest you read.

http://optometry.osu.edu/research/CO...ndHardyOPL.pdf

to select one that would meet your needs. They are quite different.

<<Yes you will have to tilt your head to use your intermediate. But if your tilting your head all the way so that your actually using the near vision part of the lensfor the intermediate, go back and talk to the Optician and they'll be able to tell what you need to do in order to use the lenses correctly.>>

Maybe I'll go back to them just to show them the problem and see what they say, because I will admit some of the things folks say on here I am having trouble understanding, but I appreciate the tips and it gives me something to think about LIke the guy who said I would have to tilt my head to use the intermediate <<Yes, you should have to tilt your head back to see the intermediate. If not, you'd have to lower your head to walk around! Think about it.>> Well, I'm not sure, but I guess you are saying you would use distance vision to walk around. So, if the intermediate area doesn't start until a little below the middle of your eye (is that right?), I can see what you are saying there.

So how come I have opticians telling me I'm supposed to be able to read a computer through the intermediate area without lowering my head? One guy told me that and he was a licensed optician and this is in Virginia which actually required you to be licensed not just certified.

Now I don't know where the intermediate and near part change, all I know is I tilt my head a little bit, not a lot, but it is clearer towards the bottom of the lens than right in the middle. It was the same way with my last pair of progressives, also (which had +1.75 for reading).

Actually, one thing I didn't like about the optical company where I got my new glasses, even though they seem good, is they gave me absolutely no records as to what I ordered and what my glasses are. I think I will get that out of them, anyway, as I want to have it. I know it was not the kind for small frames, so probably was Gradal Top. I'll find out. a 20-21 mm fitting height isn't really that small nowadays compared to what some kids want. I did read that article by the optometrist at OSU, but I know it is a couple years old by now--but that's where I got the info that Zeiss was so good in intermediate, although the optician told me that, also.

You are right that my piano music and computer do occupy most of my vision when using them (as well as reading when I do that). I have thought of getting a pair of those "office" or computer glasses which are really progressive bifocals as I understand it, but they are almost as expensive as the progressive trifocals, so I thought I'd try getting the single vision pair first and seeing how that goes. I ordered them last night, and the optical company had a sale, so they were only $100 (and that included high index lenses, although not the thinnest). I don't know that they were going to make them as +1.50, though, they just took my prescription and I suppose they'll use it (I did have a +1.75 last time for a couple years). This is a chain where I just went because they are cheap and I was always happy with them when I had single vision, but the optician on duty didn't say anything to imply they would make them different than +2.

The thing that worried me a little is because my eyes are so different, when you +2, one of the eyes is positive and one negative. It is true my one eye doesn't need much for reading, so is close to zero, but I am not farsighted and never have been. My right eye is -5.50 and the left is -1.75. So if you add 2 to each, you get -3.5 and +.25. I asked the optician about that, but she didn't seem to understand what I was getting at (in fact, she said she didn't, but not to worry as they would be okay if that was my prescription). I didn't like her and won't go back to that store. Maybe a +.25 isn't going to be noticebly different than zero so it's not a problem anyway, I just wondered as I never in my life have had a prescription that was +.

Maybe my whole problem is just my assumption that the intermediate area (due to the name) is in the middle of the lens, and of course, it is more towards the bottom. When reading the computer right now, though, I can see the farther down the lens I look, the clearer the computer font is.

How far away is your computer? Have the optician also double check the fitting height. The way a progressive is designed, the intermediate comes in beginning just under the eye.

It is possible that the seg is fit a bit low. Sometimes raising the lenses a bit by increasing the tilt, and adjusting the pads will help that come in at a better place for you. I have some patients who prefer to have these lenses fit a bit on the "high" side. Ask the optician to check the fit of the progressive, and work with them to see whether raising it a bit helps, or if it will interfere with distance vision.

The location of your monitor also comes into play. The closer it is, the more of your reading power you is needed to see it clearly. Does it sit above, on level, or below the plane of your eye? This also can affect how the lens performs for you...

The more details you can provide the more helpful we can be. While I am certianly no expert in ergonomics, so of the others on here can help you in making sure that the best combination of factors can be found.

Cassandra

your spectaclkes may well need a simple adjustment

Back when you originally asked us about lens designs, I mentioned a professional optician may well recommend a two pairs of spectacles soloution... your Zeiss lens is a good choice for that methodology

well, I thought I'd give you guys a follow-up and maybe this can help you with some experiences for those opticians on here who see other patients.

First, yes, I checked and I do indeed have Zeiss Gradal Tops. I think someone above seemed surprised or didn't think that was likely given what I said? well, they are.

Second, as for where my monitor etc is, I think I said exactly where my computer monitor was and the distance from my eyes in my original post:
<<Both my computer screen and piano music are not dead-on from my face, but a little lower to begin with, and both are about arm's length from my face (around 24"). The piano music is a bit closer, maybe 18-20", from my face.>>

These cannot be changed. My optician said something about how the lower the piano music the better or something, but you cannot change the position of that, which he didn't understand. My piano is a certain height, as is the keyboard, and the music rack is a certain position and there is no way I can lower that. A music rack is always a couple inches about the keyboard, and the keyboard is approximately parallel to your forearms when they are held out fairly straight. My computer screen cannot be changed because it's on my desk which cannot be altered in height (and my chair has to be a certain height in order for me to fit my legs under my desk).

Now, I think when Jubliee suggests adjustment, I think she means to have the glasses remade, right? You can't adjust them once they are made, at least not much. I know some may disagree or have other experiences, but I think once you start getting to the point where someone can't see well and you start fooling around with the position of pads and tilting the lens in and out, it is a lost cause. That's just my experience. I had an optician doing that once and it was a waste of time and didn't make much difference -- the prescription was bad.

Anyway, I know someone suggested two pairs of glasses originally and I didn't want to do that because I was hoping one pair would suffice. Actually what was suggested was what I didn't get and still am not getting -- another expensive pair of bifocals (I think this is what some people call occupation glasses, but that terms doesn't mean much to me as a lot of what I want them for has nothing to do with my work, most of it doesn't) that are near/intermediate only. I asked about them and they were almost as expensive as the PAL trifocals. Anyway, I sure am glad I didn't get them as the intermediate zone is pretty worthless to me, as that was my original problem. I just don't think it's good for much of anything for me. Jubillee said the intermediate started "just below the eye" which must be a mistake. I assume she meant just below the pupil or middle of the eye or something. If so, then clearly you would have to be looking down a little to use it.

Okay -- this is what I did. I went back to the optician where I got them made, explained my problems and he checked them out, the measurements, etc., and he said he did NOT recommend I get them remade given my prescription, usage, and the way he checked me out in person as to reading, etc. He said he thought that if the fitting position were raised, he thought I'd be unhappy with the way it affected my distance vision or something else. I don't remember it all, but he very clearly did not recommend I have them remade. He thought they were best for me the way they were and said there was nothing that abnormal about having to raise your head slightly for the computer and piano.

He thought my idea of getting a pair of single vision glasses was a good idea. In fact, he didn't recommend I get a pair of bifocals (ie, computer glasses). He said maybe in the future when I got more presbyopic or something, that might be okay, but he didn't think it would do much for me now, and they are a lot more expensive than single vision glasses. I didn't want them, as I wasn't liking the intermediate vision for anything anyway. The things opticians and articles tell you is the intermediate zone is not for me (comptuter, etc). I don't know what is supposed to be intermediate, but it's a lot farther than 3 feet for me where the reading presciption isn't good anymore.

So, I got my single reading vision glasses (they did just do them straight from the PAL prescription, I think, or +2). And -- I LOVE THESE!!! This is the greatest thing I did, and it was so cheap. I could have got them for only $60 if I hadn't had the high index thing which I may not have needed for the reading prescription as it wasn't very high. It is great to be able to have my entire view the same prescription and now I can read entire pages, an entire sheet of newspaper, an entire page of music, all with the same prescription and I have a much wider viewing area for any of these tasks now than I have had since first getting progressives. This reading presciption is fine for my computer, as well as reading. It is much better than my PALs for my computer screen (which, as I said is at least arm's length away and what many opticians told me was "intermediate zone").

Now it is true real distance is a little fuzzy for me now and that's kind of weird when I look up at the clock or walk into the kitchen, but I can even view myTV with them on and it's about 6-8 feet away, and it's not that bad that it really bothers me. You know you don't usually have to have a TV program that precise anyway, as it's not text, so if I am sort of watching TV (or glancing at it) and sort of reading the paper, these glasses are okay.

I've had PALs about 7 years now, I think, and had the +2, as mentioned. So, I just think maybe this might be a consideration for some patients rather than suggesting a pair of the "computer" or occupation glasses that are more expensive. I'm really glad I didn't get them now that I see how well these single-vision near prescription ones work and work very well for the things I thought were supposed to be intermediate. I bet I would still not be seeing things as well if I had gotten them instead.

Have you concidered raising you? Screw the seat up a little higher and see if it helps.

Are you saying that your single vision glasses are both +2.00? I am glad you found something that worked. So often people want one pair of glasses to do everything and they often won't.