I'm so glad you took the time to reply to
my post above. I spent a lot of time writing it, so I thank you for your thoughtful and considered reply.
Oh...you didn't. Silly me. Well, at least I got out in front of that one.
Anyway, about your last post, I tend to agree about 90% with it. The 10% where I disagree is when the patient is actively asking for a PAL, no matter the add. You can cajole, reason, beg, plead, talk, or hector them into changing their mind, but if the patient is motivated, they'll make it work. To be clear, I'm not saying that 10% of patients with an add greater than +1.75 are begging for progressives, only that I don't fully agree with your above statement.
All other things being equal, with a competent fitting, appropriate material, AR if applicable, and a well-informed patient knowing what to (and not to) expect out of the lens, it comes down to the patient's motivation. The patients that wear the lens for a day and bring it back are never,
ever going to be happy with a PAL.
I find that the greatest percentage of nonadapts are the 45-50ish +1.00 little-bit-of-cyl previously uncorrected hyperopes. The add doesn't factor into it much other than higher adds being worse, obviously. These are people who, for the first four-plus decades of life, didn't need any help seeing. They've been using +2.00 readers, and they're just great. Suddenly, they're talked into spending an awful lot of money on this (to them) funhouse mirror of a lens, everything's blurry and--what the hell?!?--they're now suddenly having trouble seeing
without glasses at all.
So they try it out for a few days, getting increasingly frustrated, and come in raving and complaining. Those are the nonadapts that you're never going to convince. Myopes are used to correction--they've either always worn glasses or accepted that life's just blurry. Higher-power hyperopes are in much the same boat. So, when situating myself across the dispensing table from a patient with a possible trouble RX like that, I make very clear what they can expect, and that it will
take time to get used to the new glasses. More often than not, however, they end up getting either simple readers or an occupational lens.
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