Are progressives possible with high cylinder prescription?

[dlabow]

HI Everyone,

I have a strong astigmatism, and would appreciate any input on whether I would be be able to wear progressive lenses. My prescription is:

Distance
OD -3.25 -4.75 X 175
OS -3.75 -5.00 X 003
Add approx +1.50

For the last few years I've done well with toric distance contact lenses with slight mono vision, and OTC reading glasses over them if needed for very fine print. I also have a single vision reduced prescription pair of eyeglasses when not wearing my contact lenses that are ok for most intermediate, and close task like just walking around, shopping, computer use, watching TV at home, short term reading, etc. The only problem is I just started driving again after giving up many years of city living, and I cannot drive well with the reduced distance prescription.

It was suggested to me by several practitioners to forget progressives, and just get distance glasses for driving, because of my high cyl. I hate the idea of carrying two pairs of glasses around with me. Also there is a greater expense, along with the concern that as my precription gets worse I may not be able to use the reduced distance prescription.

Would I experience much distortion with progressives with such a high cyl? Also once I adapted to the progressives would I be able switch back and forth with my contacts without having to re-adapt to the progressives each time?

The practitioners office I have been dealing with mainly uses Varilux Comfort, and Seiko Proceed, but has access to other lenses if necessary. I've asked around a bit, and mainly Varilux Comfort, and Zeiss Gradal top has be suggested if I was going to try them. They said the panamic was more difficult to adapt to for a new wearer. I've read about the Zeiss Individual too, but was told they are more difficult to get. I noticed most of these lenses seem to have a cut-off at a -4.00 cyl except the Zeiss Gradal 1.60, but was told that's just a suggestion, and they could grind the other lenses in my cyl.

I like semi rimless frames, and my single vision pair was done in a 1.67 material and came out fine in a 52 eye size . I noticed the Varilux Comfort now has a 1.67 material, so I've been leaning towards that over the Zeiss as a first try because of concern of edge thickness, and strength in a semi rimless. Also would a full rimless be out of the question? Could I go much larger? (ie 54-55 eyesize). Also my actual add is probably closer to between a +1.50 and +1.75, but my doc wants to start conservatively at a +1.25. Is that too low?.

Again if anyone thinks there is any chance a progressive might work with my prescription would you please let me know? I know I've asked tons of questions, and I sincerely appreciate any input on any lenses, etc.

Donna.

[Pete Hanlin]

If it were me, I would probably:
1.) Request that my ECP fit toric lenses (which you have had success with) which correct only the distance vision in both eyes. This will provide the best distance visual acuity.
2.) Have progressive lenses made with a plano distance and an ADD power of +1.50. Or, possibly with a an over-refraction in the distance (to clear up any residual distance ametropia- if there is a significant amount).

In the above scenario, Varilux Panamic would be my recommendation. Also, you would not necessarily require high index lenses, because the lenses will be quite thin (since they are not providing your significant distance power). Your practitioner's comments notwithstanding, Varilux Panamic is ideal for new progressive lens wearers.

However, if you decide to have progressives made with both your full distance prescription and ADD power, I would not recommend Varilux Panamic. Although the design is more elegant than Varilux Comfort, your amount of cylinder will likely interfere with some of the design refinements (this may well be why your practitioner was wisely steering you away from the Panamic design for this scenario). If you wish to wear glasses without contacts, I would then recommend Varilux Comfort.


Overall, I suspect your distance vision will be better with contact lenses- especially if you have them fit in both eyes for distance only. This is because the vertex distance between your eyes and the lenses will be much smaller with contact lenses than with eyeglasses. Pretty much all the optical aberrations which are inherent to eyeglass lenses are reduced to practically zero when the vertex distance is eliminated. That is why contacts will serve you so well.

Alternatively, if you would like to have progressives made with your distance correction AND reading power, I might suggest SolaONE. I am not sure if it is available in your prescription (perhaps Darryl Meister will see this and respond), but the 1.67 version of this PAL design is made using a process which may allow for atoricity on the back surface of the lens. Usually, I believe the benefits gained from "optimizing" a cylindrical surface are minimal- in your case, however, there may be some appreciable visual gain. Again, Darryl would be better able to describe Sola's product.

Finally, Shamir makes a PAL called "Autograph" which I am told also has customized cylindrical surfaces. Again, someone like Laurie Pierce (another OptiBoarder who is associated with Shamir) may be able to describe this product to you to a greater degree.

Good luck, and please let us know your results! Once again, I would recommend continuing contact lens wear- for distance vision only. You can then either wear your progressives all the time, or you can remove them when doing activities that only require distance vision (e.g., watching a movie).

[mrba]

Actually in San Francisco, you are better off requesting a Gradal Individual by Zeiss. It is a similar concept to the autograph, which is not yet released.If you cannot afford that lens, then a Gradal Top is the optimal desighn for your cylinder (astigmatic correction). Avoid short corridor progressives (your eyecare professional will know what that means) as they will be more prone to peripheral distortion due to cylinder.

Good places to get specs in the city are...

City Optix on Chestnut street in the marina
Urban Eyes in the Castro on Market
Hyperoptix on Haight in the upper haight
Dr. Jimmy Fong on Geary
Dr. Yunus Kurtbay on Irving
Dr. Slamovich on market in the financial dist.
Dr Chu (ask for Lisa) in the fillmore
That should cover most of the city, and these folks are all top notch... Remeber that you get what you pay for!

Tell them Scott Balestreri from Bad A$$ optical sent you!

[dlabow]

Pete,

Thanks so much for your quick response. I do get good vision from contact lenses. but a full distance contact correction would require me to wear glasses over my lenses almost all the time which I want to avoid for aesthetic reasons. I tried new contact lenses last week giving me perfect 20/20 vision, but my intermediate vision was compromised too, so he pulled the prescription back in one eye. Also toric lenses can sometimes move around, and when that happens the vision is compromised for a moment. I also still get excellent distance vision at my full correction with eyeglass lenses too, but just can't read, etc. with them.

I'm just getting tired of wearing contacts all the time, and want to give my eyes a break, and maybe wear eyeglasses 3-4 days a week even though I don't like the way they look.. I recently moved to the LA area, and the pollution causes problems some days for contact lenses.

I did call a clinic at one of the optometry schools, and someone mentioned they were having excellent results with the Sola One, but they didn't know if it went up to my cyl, and haven't gotten back to me..
If will interesting to see what Darryl Meister, has to say about the Sola's if he responds.

When I called the lab my practitioner used and asked about the Sola's they said they were sometimes difficult to get, and just suggested the Comfort.. They are an Essilor lab too. If for some reason I can't get the Sola Ones, or my docs office doesn't want to work with them, because they are new can I assume the Varilux comfort would not have too much distortion, and be ok for general wear? Driving is the top priority though right now, so my main concern is will the progressives give me perfect vision for driving with my prescription, or should I get a seperate pair for distance only to drive?.

The office offers a two time try with progressives with different brands, and it they don't work will switch to a single vision with no charge, except the difference between the progressive, so I'm trying to be selective.They are a huge practice with access to many brands, but I don't think they have worked with the Sola Ones yet. If they are that much better for me, and are available in my prescription, I'll push my doc to try them. I'll also inquirer about the "autograph"

Again thanks so much for your input .

Donna

[dlabow]

Hi Scott,

That's funny I moved from San Francisco this January to Southern Ca.. I'm familiar with some of the practices you mentioned. One of them discouraged me from progressives last year. . He acted as if he never saw a cyl as high as mine, so I got the reduced single vision prescription. He was on the Zeiss provider list too. Oh well if I ever move back I'll save your list, and try the others

I'm in the Pasadena area now, and I haven't noticed that many Zeiss practitioners here. I also checked the Zeiss preferred list, and there was none in my area.

Money is no object. I just want the lens that is best for me. Is Zeiss individual available in a1.67 material? Also I was told they only will go to a -4.00 cyl, but in Europe it's available up to a -6.00. Is the gradal top comparable to the varilux, and is that available in a 1.67 material also?

Thanks again for your reponse.


Donna

[Eddie G's]

Did a quick search (on my lab files) and I found a very similar RX and Gradal Top 1.66's were prescribed on April 2001.

She came in a month ago and had no change in her RX so she's still wearing them. They've been proven!

[For-Life]

I have done it before. I find that if you fit the progressive 2mm lower than the OC height you get better results. Since the cylinder pushes up the progressive the lower fitting height brings it down to what it would be without the cylinder.

[Texas Ranger]

I have fit several like yours with 1.60 Varilux lenses with Crizal; I don't think they'll do 1.67's in that high a cylinder. most of the thickness is verical, top and bottom, so a shallow fram of about 30-34mm would work best...

[mrba]

I just called a very good doctor friend in Bellflower Dr. Maggiano. He said he was 45 min from Pasedena, but said Dr. Carl Nicholson is in Pasedena and is very good.

To fit a Gradal Top (which is far above and beyond any Varilux product) the doctor does not need to be Zeiss certified. However, to fit a Zeiss Individual they should be trained to take some basic extra measurements.

I can probably get your lenses from Germany, as most practitioners do not have those connections, even if they are Zeiss cert. My website has all of my digits to contact me, and you are welcome to have any doctor you like call me for a consult.

And As far as your RX goes 1.60 would be fine in a medium to smaller frame. You will have better optics.

And I bet I can guess who told you Single vision only!

Regards,
Scott

[dlabow]

Did a quick search (on my lab files) and I found a very similar RX and Gradal Top 1.66's were prescribed on April 2001.

She came in a month ago and had no change in her RX so she's still wearing them. They've been proven!

HI Eddie,

That's good news. Her cyl was as high as mine? She must have adapted, and likes them very much if she's still wearing them. Is that lens the one that's now available as the 1.67 gradal top?.

My optician charges around the same for the Zeiss as the Varilux, so he said I can try either, but just found out that I only get one re-do on my insurance so I'm trying to be very careful. They usually sell Varilux so I'm hoping they wouldn't have problems fitting me with a Zeiss.

Donna

[karen]

I'm in the Pasadena area now, and I haven't noticed that many Zeiss practitioners here. I also checked the Zeiss preferred list, and there was none in my area.

Donna

Hi Donna! I am a lab rep that works in that area- Dr. Nicholson is good. I really like Dr Tassanari's office-they use a lab that carries both Varilux and Zeiss as well as Sola and could easily fit you in any of the above mentioned lenses. They may not know alot about the Zeiss Individual but can get it. That lens was designed specifically for people with higher cylinder powers or other tricky issues. If Pete says you can wear a Comfort in that RX than you can be assured that it should work-he really knows his stuff. If you go to Tassanari tell Yvette that Karen from Collard Rose sent you. Also, Dr Korth has a nice practice with a great frame selection and also uses a lab that can get you any of those products. I would also recommend anti reflective coating, especially if you use one of the higher index products. Feel free to email me directly if you need more info on any of those doctors and good luck!

[For-Life]

I agree that the Individual is probably best, but Pete is the Ispso out yet?

[Pete Hanlin]

I wouldn't overthink your choice of design if you've narrowed it down to Gradal Top and Varilux Comfort. Both designs are very good and should be capable of providing you with comfortable vision, and adamantly recommending one over the other is an excersize in futility (in my opinion).

Whichever lens you try, if you have a problem with your vision and "run out" of remakes, please contact me (email address is below), and I'll do everything possible to make sure you end up with some lenses you are comfortable with. However, given that you apparently have no trouble wearing glasses, I'm going to speculate that you aren't going to experience too much of a challenge with your progressive lenses- especially since your cylinder is oriented horizontally (if it were oblique, it would affect the progression to a greater degree).

I've fit numerous patients with high cylinder in Varilux Comfort with good results. I do not have a lot of experience with Gradal Top, but I hear it is a very good design as well. If you elect Varilux Comfort, I would recommend you have the lenses fit at pupil center (which should be the normal fitting). That said, For-Life's suggestion of having the lenses fit a bit low isn't without merit. Your sphere and cylinder combine to create a lot of minus power in the vertical meridian. Therefore, you'll experience a bit of base down prism while reading. This will have the effect of "shortening" the progression (not really a bad thing). Actually, Varilux Panamic is designed to take this into account, but- as I've previously mentioned- I'd be more comfortable recommending Varilux Comfort for you (pun intended ;^).

Either way, very good luck to you- and do let us know if you experience difficulties with your lenses.

[Pete Hanlin]

I agree that the Individual is probably best, but Pete is the Ispso out yet?
Sorry, I didn't see this until after I had made the above post...

The answer is "yes" and "no." Varilux Ipseo is currently in a limited roll-out. At issue is not the design concept- which has already been successfully rolled out in Europe and Japan- but in refining presentation techniques of the new technology.

Varilux Ipseo is a very unique product in that the design is customized not only by prescription but by wearer visual habits as well. Specialized equipment is required to fit the design, so everyone won't be able to begin fitting Varilux Ipseo straight away.

As I recall, Varilux Ipseo was test marketed in Canada, so you may have some actual experience with the product. I have experienced the equipment in France. You should see the St. Maur research center where they design stuff like this. It looks like very interesting work, and they work on everything from children's vision to new concepts for presbyopic correction. The test itself (Vision Print System) only takes about 90 seconds and is quite simple- but it does identify the patient's visual habits (turns out I view peripheral objects with a head/eye movement ratio of about 30/70).

Anyway, as time goes on we should see additional machines becoming available in both Canada and the US. I'll certainly be happy to post a notice (in the new products section, of course) when Varilux Ipseo has its full scale launch.

[Robert Martellaro]

Donna,

Concentrate on finding an optician who fits lenses (and frames) with a high degree of precision, less so on the lens brand. If you can find a source for an "atoric" PAL (progressive addition lens) you should use that lens, but I'am not aware of US supplier that can grind (or cast) a cylinder power over 4.00D. This will change over time so keep asking your optician for updates.

You must have a backup pair of glasses for the times when you can not wear your contacts, so I would try the PALs and hope for the best. Full-time wear would be preferred but there will still be some adaptation even when worn intermittently. Pals over your contacts for near and far tasks would be an excellent choice as Pete suggested.

Hope this helps

Robert

[sjthielen]

I agree that a choice of either the gradal top or comfort with your rx is not that great of a deal. The choice you make on the dispenser of the product is going to have a far greater infuence on your success. However is you can get your Rx done in the zeiss Individual, I think that lens is far greater lens desiegn for your Rx. By they way I have dispenced Rx's with greater cyl than yours in both comforts and tops with success.

[dlabow]

I wouldn't overthink your choice of design if you've narrowed it down to Gradal Top and Varilux Comfort. Both designs are very good and should be capable of providing you with comfortable vision, and adamantly recommending one over the other is an excersize in futility (in my opinion).

Whichever lens you try, if you have a problem with your vision and "run out" of remakes, please contact me (email address is below), and I'll do everything possible to make sure you end up with some lenses you are comfortable with. However, given that you apparently have no trouble wearing glasses, I'm going to speculate that you aren't going to experience too much of a challenge with your progressive lenses- especially since your cylinder is oriented horizontally (if it were oblique, it would affect the progression to a greater degree).

I've fit numerous patients with high cylinder in Varilux Comfort with good results. I do not have a lot of experience with Gradal Top, but I hear it is a very good design as well. If you elect Varilux Comfort, I would recommend you have the lenses fit at pupil center (which should be the normal fitting). That said, For-Life's suggestion of having the lenses fit a bit low isn't without merit. Your sphere and cylinder combine to create a lot of minus power in the vertical meridian. Therefore, you'll experience a bit of base down prism while reading. This will have the effect of "shortening" the progression (not really a bad thing). Actually, Varilux Panamic is designed to take this into account, but- as I've previously mentioned- I'd be more comfortable recommending Varilux Comfort for you (pun intended ;^).

Either way, very good luck to you- and do let us know if you experience difficulties with your lenses.

Hi Pete,

Thank you so much for your advice, and that generous offer. I have a little more research to do before I make my final decision, but if I have any problems down the road with the lens I choose, and run out of "re-makes" I'll let you know.

Donna

[dlabow]

Donna,

Concentrate on finding an optician who fits lenses (and frames) with a high degree of precision, less so on the lens brand. If you can find a source for an "atoric" PAL (progressive addition lens) you should use that lens, but I'am not aware of US supplier that can grind (or cast) a cylinder power over 4.00D. This will change over time so keep asking your optician for updates.

You must have a backup pair of glasses for the times when you can not wear your contacts, so I would try the PALs and hope for the best. Full-time wear would be preferred but there will still be some adaptation even when worn intermittently. Pals over your contacts for near and far tasks would be an excellent choice as Pete suggested.

Hope this helps

Robert

Thanks for your advice Robert. I know getting a good prescription is half the batte. I have found an extremely patient optometrist who took a lot of time getting my prescription prescise. The rest now depends on the other variables like proper ftting, lens choice, etc. I have to depend on a skilled optician, lab, etc. for this.

But you're right. I do need back-up pairs of glasses. There are many times that I just can't wear my contact lenses for various reasons.

The only (PAL) I found so far that was approved for my cyl and went up to a -6.00 cyl, and fit other needs was the Zeiss Gradal top 1.60 . But I don't think that's an atoric lenses.

I did some additional research yesterday, and I've been told the Zeiss Individual can only be made by the Zeiss facility in Virginia, and -4.00 cyl is the cutoff in this country. I'm going to see if the lab my optometrist uses can have them made in Germany. It doesn't seem that should be a big deal, just a little more time consuming. If I find out otherwise I'll post it here. Hopefully things will change in the near future, but most of the labs, etc., I've talked to aren't as optomistic, because they say the higher cyl powers aren't as popular

Donna

[Homer]

I am completely against the concept of "one-near-one-far" vision correction. It's a stupid compormise but, as you said, for astehetic (i read pretentious) reasones you are already caught in a compormising position ( you do not have binocular vision either close or at distance) so why not continue????

Just get a pair of progressive lenses that will correct your distance vision, over your contact lenses, in the "reading" eye and have plano (window pane) in the other eye (with appropriate progressive add) ....so you could aim your car more accurately and read a contract more accurately. The rest of the time you could live in the fuzzy world of "one-near-one-far" and impress everybody you meet.

Don't go spendin' $1000 for glasses that you won't like wearing and probably won't wear. Spend $500 for a pair that will bring you back to reality when ever you want to go there.

[Lyrix76]

Hello Donna, just wanted to say something really quick, first off if you did decide to go with any lens (progressive, sv, bifocal so forth) with an rx such as the one that you have, I would definitely advise against purchasing a full rimless frame, or even a semi-rimless frame, because of the extra weight & thickness that will be produced. Also, there aren't many labs out there that will put such a high astigmatic rx into a fully rimless (or drill mount as we call them here) frame. Hope this helps, good luck w/your search. Lyrix76

[Jerry Thornhill]

Karen,

Jog your memory. Remember Arlin at the clothing store in Newport. He had a -9.00 cylinder and we successfully put him in a progressive.

I have had success using different progressives over the years with high cylinders.

Shamir's Genesis works well and I have had success with cylinders to -11.50.

Jerry

[Danno]

While involved with beta testing the new generation of "Freeform Progressives" we found this technology was most helpfull to patients with higher prescriptions and especially high cylinder corrections.

Lenses like the Shamir Autograph and Zeiss Individual as well as the Perfas lens from Seiko/Pentax all worked very well. With this new technology wearing progressives should give you very natural vision at all distances.