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Thread: help, need some wisdom!

  1. #1
    Rising Star
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    Unhappy help, need some wisdom!

    All right, I have been struggling to fit a patient with progressives and would like some help. the patient first time started with PALs from my store in '05.

    2005
    rx; -0.50-0.75 x 011
    -0.75-1.00 x 175
    add +1.25 ou

    PAL design: adaptar

    new rx sept 2008
    rx; -0.50-1.00 x 011
    -0.75-1.00 x 176
    add +2.00 ou

    PAL design: Varilux Comfort

    PROBLEM: The patient is complaining that the varilux comfort is blurred much narrower than the adaptor in the intermediate and near zones.

    I switched the patient to the comfort because he wanted a better lens overall in terms of using for computer and mid range viewing. The patients is a stock broker and looks at multiple screens repetitively at his desk and above. He was wearing his old adaptars for work but was having trouble reading. He went for an eye exam with same optometrist as past. The patient picked a new frame that is very similar in depth to his old frame. I matched the fit (panto, face form, bc of lens) of the new frame to the old. Fitting height changed from 19mm down to 18mm. I have tried to keep everything as similar in the new pair as the old pair. The only significant change overall is the reading add power. I know the increased add power will increase the distortion in the lens and require him to wear the glasses more than the normal two weeks to get used to. Have I picked the wrong lens type, going from hard design to a soft design? Or is there something else that I should be looking at.

    Please help with any suggestions. Patient wants a pal and not just a computer or modified computer glasses.

  2. #2
    Master OptiBoarder
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    RE: Comfort vs. Adaptar

    Quote Originally Posted by opti-refractonator View Post
    The only significant change overall is the reading add power. I know the increased add power will increase the distortion in the lens and require him to wear the glasses more than the normal two weeks to get used to. Have I picked the wrong lens type, going from hard design to a soft design? Or is there something else that I should be looking at.

    Please help with any suggestions. Patient wants a pal and not just a computer or modified computer glasses.
    An Increase in Add Power not only increases distortion, it decreases each available reading/ intermediate step. Imagine a set of stairs if you will that is 20 feet long and rises only 5 feet. Easy to walk up and each step is fairly large. Now, try that same length but go up 10 feet. I have to double the number of steps, and each step would be half the size. Same with Progressives. Its not just a matter of distortion, its the physics of doing more in the same space.

    Both the Adaptar and Comfort were designed before people used computers, so with either lens a patient with an increased add power would find a huge drop in what was already a narrow computer area. Its like dropping a musket in water, what was already an old gun just got harder to fire.

    If I also remember right, the Comfort never fit well at low corridor lengths even though 18 was stated as OK. I never had good results with less than a 20mm corridor.

    I would chose a different lens, one that was designed with computer use in mind, and that works well with a 18mm corridor. I use the Definity for most patients, and they often completely adapt in less than 20 minutes (average is about 3 days), changing lenses may solve more than one problem for you.

    Sharpstick

  3. #3
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    The definity seems like a very good lens choice, thank you. I have tried to search the board for more info on the definity but i am having trouble. I understand the concept of the lens, but is it more of a hard or soft design? Or does that even apply to this lens.

  4. #4
    OptiBoard Apprentice csiopticians's Avatar
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    Thumbs up Adaptar VS Comfort

    Quote Originally Posted by opti-refractonator View Post
    All right, I have been struggling to fit a patient with progressives and would like some help. the patient first time started with PALs from my store in '05.

    2005
    rx; -0.50-0.75 x 011
    -0.75-1.00 x 175
    add +1.25 ou

    PAL design: adaptar

    new rx sept 2008
    rx; -0.50-1.00 x 011
    -0.75-1.00 x 176
    add +2.00 ou

    PAL design: Varilux Comfort

    PROBLEM: The patient is complaining that the varilux comfort is blurred much narrower than the adaptor in the intermediate and near zones.

    I switched the patient to the comfort because he wanted a better lens overall in terms of using for computer and mid range viewing. The patients is a stock broker and looks at multiple screens repetitively at his desk and above. He was wearing his old adaptars for work but was having trouble reading. He went for an eye exam with same optometrist as past. The patient picked a new frame that is very similar in depth to his old frame. I matched the fit (panto, face form, bc of lens) of the new frame to the old. Fitting height changed from 19mm down to 18mm. I have tried to keep everything as similar in the new pair as the old pair. The only significant change overall is the reading add power. I know the increased add power will increase the distortion in the lens and require him to wear the glasses more than the normal two weeks to get used to. Have I picked the wrong lens type, going from hard design to a soft design? Or is there something else that I should be looking at.

    Please help with any suggestions. Patient wants a pal and not just a computer or modified computer glasses.
    Adaptar design more harder than Comfort. If we see the Add, it's look rather strange from +1.25 (2005) to +2.00 (2008). Use Comfort with the higher Fitting Height.
    csiopticians@yahoo.com
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  5. #5
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    Blue Jumper

    I would encourage you to try some new digital lenses.
    Physio F360 ( you need a fitting device ) or Biofit Free Frame
    is another product made by Essilor that are very friendly for computer users.
    Good Luck
    Last edited by i care guy; 10-23-2008 at 11:55 AM.

  6. #6
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    In the past month I have had to upgrade two patients. Due to their fear of spending money right now they opted for a cheaper progressive (we use Image). Distortion and narrow viewing area was apparent for both of them. I upgraded both of them to the Varilux Physio and now everybody is happy. Of course it would have been easier if they had listened to me in the first place.

  7. #7
    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Quote Originally Posted by opti-refractonator View Post
    The definity seems like a very good lens choice, thank you. I have tried to search the board for more info on the definity but i am having trouble. I understand the concept of the lens, but is it more of a hard or soft design? Or does that even apply to this lens.
    I believe Definity is a soft design. 0.75 of the add is surfaced on the rear of the lens. This mitigates corridor shrinkage due to increased differential betwen DV and NV powers. The lens is incredibly smooth, with a very wide DV horizon and a very wide intermediate. The reading area is nothing to brag about, but even so, it is my "go-to" lens for computer users.

    If you want to stay with a hard design, try the Zeiss GT2. Only suggestion: fit the top of the corridor at the base of the pupil, not at the center. Zeiss has a very wide corridor also and has a bigger reading area than the Definity. Distance vision horizion is fine so long as you fit it correctly.

    Or, you could go with the latest excellent free-form designs like the Zeiss Individual, Shamir Autograph II, etc.

    To learn more about these different lenses and people's experiences with them, just search for them by name on OptiBoard. There have been many threads on Definity, GT2, Physio 360, Autograph II, etc.
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

  8. #8
    Bad address email on file JanMueller's Avatar
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    Try Impression FreeSign and spread the design parameters DF and DN to get a "longer" corridor. The longer the corridor the wider the intermediate zone is (just remember the Zeiss RD with stunning 25mm).
    We have fit an Architect with Multigressive MyView and he was disappointed. Used them much at intermediate. Then switched him to FreeSign and now he is our biggest Fan. His wife came in last week and said "I want exactly the same lenses like my husband has. He is blown away by the quality".
    I am sorry, but I guess Physio has not this ability...
    ALL patients we fit with FreeSign can't be quiet, they tell it to anybody how they love these lenses.
    Had an plastic surgeon with everything you can imagine. Anisometropia, high cylinder on one eye, wants to wear his glasses as if their were sloping, and he insists that the left lens must be further away from his head than the right one. Nothing was normal. We sold him FreeSign, he put them on... and he just smiled, paid and said "Thank you, I had a nice day". Never had such a wow with any other product so far.

  9. #9
    Master OptiBoarder
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    It is interesting to see the various names for these lenses that are used throughout the world!

  10. #10
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    Blue Jumper

    Quote Originally Posted by JanMueller View Post
    Try Impression FreeSign and spread the design parameters DF and DN to get a "longer" corridor. The longer the corridor the wider the intermediate zone is (just remember the Zeiss RD with stunning 25mm).
    We have fit an Architect with Multigressive MyView and he was disappointed. Used them much at intermediate. Then switched him to FreeSign and now he is our biggest Fan. His wife came in last week and said "I want exactly the same lenses like my husband has. He is blown away by the quality".
    I am sorry, but I guess Physio has not this ability...
    ALL patients we fit with FreeSign can't be quiet, they tell it to anybody how they love these lenses.
    Had an plastic surgeon with everything you can imagine. Anisometropia, high cylinder on one eye, wants to wear his glasses as if their were sloping, and he insists that the left lens must be further away from his head than the right one. Nothing was normal. We sold him FreeSign, he put them on... and he just smiled, paid and said "Thank you, I had a nice day". Never had such a wow with any other product so far.

    Who makes the Freesign lenses? Rodenstock or Zeiss?

    Regards, M

  11. #11
    Bad address email on file au's Avatar
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    Who makes the Freesign lenses? Rodenstock or Zeiss?
    must be Rodenstock !

    :cheers:

  12. #12
    Bad address email on file JanMueller's Avatar
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    Yes it's Rodenstock! Nicest lens I know so far. The "normal" Impression (that means without the ability to change DF and DN) is still wonderful but you can use the Impression FreeSign in cases where I once said "never give him PAL's".

  13. #13
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    According Rodenstock Canada, Freesign won't be available until next year.

    As noted before the longer the corridor the wider the intermediate. Does this also apply equally to freeforms eg impression, sola HD, individuals? How can we order a short corridor lens for a patient in a deep frame and still get the better optics of free form?

  14. #14
    Bad address email on file au's Avatar
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    Rodenstock have a very good software to show customers how do a progressive lens work according to distance + intermediate + near. It help everyone to understand the relation between 3 parts. It is like 100% is full mark, someone want distance 50, intermediate 20 and near 30, whatever you change, total will not exceed 100, this is the law !

    Unlike other pal, all give yourself imagination of how their pal works, after a lot of case study, we will have a lot of conclusion on the pals.

    :cheers:

  15. #15
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    I agree that the definity is a good choice! It is more of a soft design choice. And it has the Add power split between the back and front of the lens for more comfort. The lens is only a little more in price. I use the definity a lot! Just understand that with that add power change everything is different, explaining that to a patient is a challenge in itself. The definity is also available in a short corridor. Definnity short. Or another suggestion is a pair of computer glasses 2 zones computer and reading. FT28 or computer progressive. Proit browser was my favorite. But it's now been discontinued. Good luck

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