minimal distance area on progressive?

[ilanh]

I noticed that on some of the progressive jobs that my optician was sending out there is about 10-11mm of area between the central pupil marking and the superior eyewire. This tends to be in the smaller frames. Nonetheless, my feeling is that this would probably not be enough. The pupil is so close to the upper frame margin that the patient may be bothered by seeing the upper frame border; also, in order to avoid the upper frame margin one will quickly run into the add area even while trying to see distance. I would imagine that at least 14mm should be minimal. Are there any guidelines?

[SpexAppeal]

Hello~

I'm just a consumer but I recently acquired very small frames with progressives lenses. I spoke to my optician about how he planned to measure it after reading about this here. The frame itself is only 27.6mm high and 47 wide and he measured the height at 15. I have been very pleased with the results. Yes I see a bit of frame around my eyes but it's been easy to adjust to it. Oh I had to get used to wearing my glasses lower with less on top. Reminded me of reading glasses at first but I was highly motivated to have smaller glasses so its not been a problem for me. And I don't miss the larger viewing area that I had in my older glasses. No blurriness or distortion what so ever.

I noticed that on some of the progressive jobs that my optician was sending out there is about 10-11mm of area between the central pupil marking and the superior eyewire. This tends to be in the smaller frames. Nonetheless, my feeling is that this would probably not be enough. The pupil is so close to the upper frame margin that the patient may be bothered by seeing the upper frame border; also, in order to avoid the upper frame margin one will quickly run into the add area even while trying to see distance. I would imagine that at least 14mm should be minimal. Are there any guidelines?

[Framebender]

then get one that you can trust. If you're going to micro manage then why not save yourself a salary and do it yourself?!? Your the same guy that was asking about poly in readers that your Optician was ordering aren't you??

First, I personally wear alot of glasses where I only have 8 to 10 mm of distance in them and I do just fine. Second, if they're not telling you how to do your job what makes you think anyone wants you telling them how to do theirs?? What qualifications do you have to be a dispensing Optician?? Did you hire an Optician or a sales clerk you're just trying to train??

Personally, I'm always surprised when I can find one of you that can refract on a consistent basis! Do what you do best and leave the rest to a qualified professional. If you don't have one then my suggestion would be to hire one!
:hammer: :shiner: :hammer:

[Robert Martellaro]

The guidelines are like this- pre-adjust the frame (pads mostly), ask the client to make note of the position of the boundary at the top of the lens, the boundary at the bottom of the lens when gazing at a magazine or book (the downgaze when reading must be above the inferior eyewire of course!), and whether or not these boundaries feel obvious or aggravating.

10mm to 11mm seems to be typical for PAL wearers who prefer or have been wearing smaller frames. My everyday glasses (-4.50 add +2.25) have 9mm above the fitting cross and 19mm below, with a vertex distance of 12mm. I'm not comfortable wearing a rectangular frame that has a "B" of less than 28mm.

Regards,

[Chris Ryser]

The frame itself is only 27.6mm high and 47 wide and he measured the height at 15. I have been very pleased with the results.

I have seen many crazy statements on optiboard.......................but this one gets or should get the Olympic-Optiboard Gold Medal.

I think your only concern is how Spexy you look in this mini-mouse frame when you look at yourself in the mirror.

You are stuck with a distance vision area of 12.6mm, up and down, which should be grounds enough to revoke your drivers license. I would not even have sold you these glasses and would have told you to find another optician.

This is comparable to an old trifocal where you use the intermediate as your distance portion. For sure this is nothing to be proud of.

[Ory]

You are stuck with a distance vision area of 12.6mm, up and down, which should be grounds enough to revoke your drivers license.

Well, by my quick scrap of paper calculations this should give him a vertical field of approximately 45 degrees, assuming for easy math that his vertex distance is 12.6mm. I think the threat to revoke the license is a tad extreme. Up until recently there was no restriction on vertical fields at all in Ontario. I recall one of my professors telling us that you could wear a jousting helmet to drive and still be legal!

I really do have to wonder who measures their frame to 6/10ths of a mm. How odd.

[ilanh]

I believe that the real issue is how much leeway you provide a patient. If the area between the fitting cross and superior eyewire is very narrow he will encounter either the eyewire or the add zone with even minute movements of his eyes. I believe that those opticians who "fit at the inferior margin of the pupil" are also trying to gain some leeway before the add zone hits. From personal experience, I was fit with my first pair of progressives recently "dead center of pupil". The sup. eyewire was about 11mm above this. Since my back and head posture is far from straight, I am plagued by the add zone coming into my distance vision when I look straight and by the sup. eye wire coming into my view when I tilt my head down to avoid the add effect. I would be inclined to:

(a) Fit at inferior margin of pupil
(b) leave 14mm from the inf. pupil margin to superior eyewire as a minimum

[ilanh]

then get one that you can trust. If you're going to micro manage then why not save yourself a salary and do it yourself?!? Your the same guy that was asking about poly in readers that your Optician was ordering aren't you??

First, I personally wear alot of glasses where I only have 8 to 10 mm of distance in them and I do just fine. Second, if they're not telling you how to do your job what makes you think anyone wants you telling them how to do theirs?? What qualifications do you have to be a dispensing Optician?? Did you hire an Optician or a sales clerk you're just trying to train??

Personally, I'm always surprised when I can find one of you that can refract on a consistent basis! Do what you do best and leave the rest to a qualified professional. If you don't have one then my suggestion would be to hire one!
:hammer: :shiner: :hammer:

Framebender,
My personal belief is that if you provide a patient with a pair of glasses that provides him awesome clarity and comfort, he will become a loyal fan of the practice and refer everyone he knows. You get much more "appreciation" effect by excelling in refraction and dispensing than by lowering IOP with a glaucoma med or diagnosing AMD, cataract etc (even though the latter is more important than the former). A patient isn't impressed when you've lowered his eye pressure from 25 to 12 because, for him, this is intangible. But when he puts on those perfect specs that he got from your practice he will be reminded, on a daily basis, of your skills. Therefore, contrary to your rant, I am an excellent refractionist whose redo rate is far lower than most others (as per any lab I have ever worked with). However, after coming up with a precise RX the equally critical part of the equation is the dispensing. After reading the above, do you really think I would leave anything up to chance?

[Framebender]

why not save yourself a salary and do it yourself?? Or hire someone who's skills you do trust?? Or even hire someone to be your puppet that'll do it your way??

I know from your posts, that you are an excellent OMD. You may even be an excellent refractionist, but you know next to nothing about what we do or why. You're weak on materials, lens designs and probably providing individual solutions that meet your patients needs. Anyone can successfuly stuff a progressive in a frame with a 50mm B. Its an art to hear what the patient wants, temper it with what they need and make them feel as though you are providing the best possible solution!

Micro managing a good Optician will either send them down the road or make them shrug their shoulders and quit trying to do a good job. It'll just depend on how bad they need a job!

[rbaker]

Framebender is right on. You can’t micromanage a good journeyman optician.

I would have been out of your office so fast the door wouldn’t have had time to hit me on the butt on the way out. Every MD that I ever worked with practiced medicine. They left the refractions, eye glasses and contact lenses to those with the appropriate skills. They too wanted the best for their patients which is why they hired the best.

If you truly do get more enjoyment and accolades out of the sale of glasses than you do over the medical portion of your practice than by all means drop that portion and go to opticianry school. You just might make a hell of an optician some day.

[SpexAppeal]

Hello Chris~

Believe it or not, I see exceptionally well out of these small frames. I was a bit concerned how they would fit but amazingly I see just fine in all aspects. My prescription changed a bit so I see clearer at distance and I couldn't ask for better close up vision. I see no distortion and I can sit at my computer for hours and see everything on the screen quite well. All in all a fine pair of Minnie Mouse glasses as you call them. Don't ask me to explain it. All I know is my previous glasses were much larger and I saw out of them fine too. But they were old and scratched and out of style. And I needed an eye exam.

I wish that I could say I have all the problems you feel one should be having with small glasses, Mr. Ryser. But the fact is I simply am not. I can send you a photo of my glasses if you wish~on my face. :D

I have seen many crazy statements on optiboard.......................but this one gets or should get the Olympic-Optiboard Gold Medal.

I think your only concern is how Spexy you look in this mini-mouse frame when you look at yourself in the mirror.

You are stuck with a distance vision area of 12.6mm, up and down, which should be grounds enough to revoke your drivers license. I would not even have sold you these glasses and would have told you to find another optician.

This is comparable to an old trifocal where you use the intermediate as your distance portion. For sure this is nothing to be proud of.

Originally Posted by SpexAppeal
The frame itself is only 27.6mm high and 47 wide and he measured the height at 15. I have been very pleased with the results.

[ilanh]

Framebender is right on. You can’t micromanage a good journeyman optician.

I would have been out of your office so fast the door wouldn’t have had time to hit me on the butt on the way out. Every MD that I ever worked with practiced medicine. They left the refractions, eye glasses and contact lenses to those with the appropriate skills. They too wanted the best for their patients which is why they hired the best.

If you truly do get more enjoyment and accolades out of the sale of glasses than you do over the medical portion of your practice than by all means drop that portion and go to opticianry school. You just might make a hell of an optician some day.

Wow, you guys are really defensive. I wonder why? Is it considered so abnormal to take an interest in a business that you own and which consumes a large financial outlay and risk? And when I ask an academic question on progressives what makes you think that I micromanage anyone? I already know her perspective on the issue, I simply want to understand the global issues around it. I am learning about things, not ordering her to do things my way. Also, do you ever realize how much of the sale occurs right at the MD's or OD's examining room before the patient even gets to the optical shop? But this only works if the MD or OD is very knowledgeable about the options. SO relax and don't worry that one of your own is getting abused....she's very, very happy where she is!

[Chris Ryser]

Wow, you guys are really defensive. I wonder why? Is it considered so abnormal to take an interest in a business that you own and which consumes a large financial outlay and risk?

ilan................I think you are doing the right thing. You own the place, you finance it and you want to see a profit. By doing that as a business owner you want to know as much as possible about your business venture and it's complications.

However you should not forget that having an optical retail business like you do, you and your confreres have set yourself up as competition to the opticians that in prior days were living of the prescriptions your profession produced and every ophthalmologist that runs his own optical store is deviating from the established system. So you can not blame opticians to be a bit touchy on that subject.

Are there any barrieres that prevent you from also operating a drug store ?

The large optical corporations are closing in on retail opticians from all sides and soon will become dictatorial when their controlled market share becomes large enough. That will also affect your retail business when the time comes.

In the meantime I think you should stay interested in the practical side of your optical business and continue to give some input to the optiboard, as far as I can see you are the only MD ophthalmologist with an active participation here.

[chip anderson]

Illani:

According to the Federal Trade Commission, none of the sale is supposed to happen in the examination room. Not even a referral to anything you have a financial interest in over other products and services. Read Eyeglass 1.
Second, those eye doctors that have optical shops, do so appearently for financial gain, not financial outlay. Something is wrong at your shop if it is an expense.

Chip

[SpexAppeal]

Hello ilanh~

You brought up a good point. I think for me some of it is about compromise and what I will tolerate in the name of vanity. Many, many years ago when I was fitted for my first pair of hard contact lenses, the ophthalmoligist told me something interestingly true. He said "You are here for contact lenses for one reason only---vanity. The more vain you are, the easier it will be for you to adjust to them in your eyes". He was absolutely correct. And, with these narrower frames I acquired recently some of that applies in this situation.

Sure, if I look straight ahead with my chin raised a bit I do see a bit of the close-up vision. If I tilt my head down ever so much then my distance comes into full view. And yes I then see a bit more of the top frame. Does this bother me? Not in the least. Any part of the frame I happen to see just doesn't seem significant. I've adapted to it and truthfully I hardly know it's there. I just know how to move my head in such a way that I am always able to see in every situation. Again maybe if I wasn't so "vain" this would be an issue for me. But just the fact that I am finally "in fashion" and can wear slimmer glasses makes me happy and able to do just fine. Listen if I had my way I would love to be able wake up in the morning and never have to worry about wearing glasses. But since that's not an option this is a good compromise. I also wouldn't mind having the money to buy several pairs of fashionable progressives so I can coordinate my wardrobe. :) That might happen to a certain extent if I decide to make it a priority.

The sup. eyewire was about 11mm above this. Since my back and head posture is far from straight, I am plagued by the add zone coming into my distance vision when I look straight and by the sup. eye wire coming into my view when I tilt my head down to avoid the add effect. I would be inclined to:

[loncoa]

at how pissy some people get when they're on this forum. Is that what this is here for? So we can cut those down who ask questions? I don't get it. I'm all for pointing out mistakes but I'm surprised to hear the vitriol.

[Robert Martellaro]

I believe that the real issue is how much leeway you provide a patient. If the area between the fitting cross and superior eyewire is very narrow he will encounter either the eyewire or the add zone with even minute movements of his eyes.

If the eyewire bothers my client I choose a different frame. If the "add zone" interferes with the straight-ahead gaze then there is a change in Rx, lens design, or the fitting cross is too high. The two are not related, if I understand your statement correctly.

I believe that those opticians who "fit at the inferior margin of the pupil" are also trying to gain some leeway before the add zone hits.

The best way to get some "distance cushion" below the straight ahead gaze is to use a lens design that has a slower progression near the fitting cross. Moreover, PAL manufacturers use ray tracing to minimize on and off-axis aberrations. I believe they start from a given set of fitting parameters- eight to ten degrees of panto, 12mm to 14mm vertex, and a fitting cross center pupil. If we change the fitting parameters without changing the lens design the aberrations will increase.

Regards,

[drk]

Ilan is rare. He's an MD that appreciates optics. He must be a details guy. It can be done, since I do it too, sans surgery, of course.

If there were thousands of Ilans, I guess there would be reason to get huffy. But he's sort of a one-of-a-kind creature, so let's treat him with the respect he deserves. We might learn something.

I should incur a lot of wrath, too, but you all have treated me with quite a bit of tolerance.

Most MD's have less hands-on desire on their opticians.

AND, if there were more well-trained opticians out there, then maybe he wouldn't have to know it all.

[ilanh]

If the eyewire bothers my client I choose a different frame. If the "add zone" interferes with the straight-ahead gaze then there is a change in Rx, lens design, or the fitting cross is too high. The two are not related, if I understand your statement correctly.

Hi Robert,
I believe that the two are indirectly related. The central pupil marking is too variable to rely upon. A couple of inches difference in head or shoulder posture will move the pupil significantly above or below the marking. We use all the tricks imaginable to eliminate this posture marking error...we ask the patient to walk around naturally and then freeze them to do the marking. We then draw directly across the central mark with a thick sharpy to "bisect the pupil". We then have the patient walk around a bit more and see if the pupil is generally above or below that mark. Despite all of this there are those patients that come back and complain that when they look at distance they are seeing the add zone. Invariably I find that the visual axis is too low on the lens. Hence the fudge factor of marking at the bottom of the pupil. Likewise, with the superior eyewire, what may bother the patient in the 10 minutes he is in the optical may be very different than in real life when different "postures" start to cause the eyewire to interfere with his vision.

Ilan

[Chris Ryser]

Likewise, with the superior eyewire, what may bother the patient in the 10 minutes he is in the optical may be very different than in real life when different "postures" start to cause the eyewire to interfere with his vision.
Ilan

That is corret...............therefore you should make a point of that argument at the moment of sale when the patient chooses the frame. Poeple still choose the frames that are not ideal for they lens they want.

In order so that they dont come back with complaints warn them ahead of every aspect they will have to get used to.

[Cherry Optical]

I have seen many crazy statements on optiboard.......................but this one gets or should get the Olympic-Optiboard Gold Medal.

I think your only concern is how Spexy you look in this mini-mouse frame when you look at yourself in the mirror.

You are stuck with a distance vision area of 12.6mm, up and down, which should be grounds enough to revoke your drivers license. I would not even have sold you these glasses and would have told you to find another optician.

This is comparable to an old trifocal where you use the intermediate as your distance portion. For sure this is nothing to be proud of.

Chris:

I hate to seem that I am picking on you lately, but you really seem to have lost it. Perhaps your expertiece in dispensing eyewear has gotten a little rusty or maybe you would make a great safety eyewear dispensing Optican....

Many professionals in the industry (especially lens and lab folks) like to think that patients go to their eye clinic (or should go to their clinic) to buy lenses, unfortunetly they do not (and never will).

A professional friend of mine has done his own survey of patients that purchased their glasses someplace other than his clinic and have had "problems" with their eyeglasses. He estimates that of those patients, 20% were never comfortable with their FRAMES in the first place.

Call it vanity, maybe its just the way us selfish, greedy, vain Americans are (I don't agree with this), but if we look good, we can see good. I like to say that you need to remember that seeing and looking are very different.

So debate the merits of the visual acuity of short fit progressives and small frames all you want... but when your clinic loses a patient because the patient really wants a small frame, there may be no one left to argue with.

Adam

"Ma'am, with your BIFOCAL (read as: "Lady, your old", which women really love) you need to pick a larger frame." <- Good luck with that one!

[loncoa]

With the lenses available today there is no reason to be unable to successfully fit small frames (no, I don't mean 20mm deep). With proper patient education and skilled fitment they can be very happy with their glasses. If we don't do this (and skillfully), you know who will? The guy next door. So by honing your expertise (and lens selection) in fitting progressives to small frames, you kill 3 birds with one stone; you satisfy your patient, you make money, and you save them from someone else who might not do as good a job as you.

[Happylady]

I have not yet had a patient complain about not having enough distance area vertically in a small frame because of the size of the frame. It just seems to be a non problem.

My new progressives are in a frame with a B measurement of 26. The fitting height is 17. I believe the drop on this progressive(the Varilux Physio) is 2 or 3 millimeters.

I have absolutely NO problems with the distance area in this frame. I do not have to tip my head down at all to see distance. I notice no blur or distortion on the upper sides. Only if I look way to the outside of the lens and look for any blur do I notice any. My add is +2.00.

I had Hoya CD lenses in this frame before also set at 17. I did feel like I had to slightly tip my head down to see distance and I noticed a lot of blur on the sides with this lens.

What I do notice is that it would be nice if my frame was deeper in the reading area. Because of the small B measurement the reading area is good but not as deep as I would ideally like. Another 2 or 3 millimeters would be great.

[SpexAppeal]

Hello~

As a consumer all I seem to see are those small frames out there. Oh there are larger ones of course. But I would think if an optician is selling these fashionable narrower frames then they better darn well know how to fit them. I guess I lucked out and got one who is willing to appease his customers. Chris might say "humor" them. My optician is not 100% thrilled with fitting shorter progressives but he also knows that it would look pretty silly to have all those small frames on display to tease the patients and then tell them, "Sorry, we can't fit those." So he learned how to fit them according to the manufacturer's standards. He tells people what to expect and hopes that most of them will be 'vain' like me and do quite well.

Oh and you know who does tease customers with their narrow frames but cannot offer anything lower than a 17 progressive? Pearle Vision. Seems ludicrous to me and I told them so. They know it- but as always with these large corporations their hands are tied.

With the lenses available today there is no reason to be unable to successfully fit small frames (no, I don't mean 20mm deep). With proper patient education and skilled fitment they can be very happy with their glasses. If we don't do this (and skillfully), you know who will? The guy next door. So by honing your expertise (and lens selection) in fitting progressives to small frames, you kill 3 birds with one stone; you satisfy your patient, you make money, and you save them from someone else who might not do as good a job as you.

[Chris Ryser]

I hate to seem that I am picking on you lately, but you really seem to have lost it. ......................................

Call it vanity, maybe its just the way us selfish, greedy, vain Americans are (I don't agree with this), but if we look good, we can see good. I like to say that you need to remember that seeing and looking are very different.
Adam

I love you picking on me.............specially when you end up agreeing with me all the way.

:D