progressive lens with a lot of intermediate

[Scrumblydumpus]

So I have a patient who is complaining and insisting on a redo on his new progressive rx because the intermediate is not big enough. I tried to explain to him the benefits of a computer lens, but he wasnt having any of it.

My biggest issue is, he is currently in a physio... one of my go to lenses for wider intermediates. Anyone got suggestions for a PAL with a wider intermediate?

Our next try is going to be a GT2 I think.

[lynnshewmaker]

Definity also has a nice intermediate range, but physio would be our first choice.

[Robert Martellaro]

So I have a patient who is complaining and insisting on a redo on his new progressive rx because the intermediate is not big enough.

Does he mean bigger vertically or horizontally? In other words, his he saying that he has to lift his chin to see the object, or his he saying he has to move his head to the right or left to keep the object in focus?

If the latter, there's probably not much you can do beyond making sure the vertex distance is as short as possible. Some lenses spec out with wider corridors but the difference is minor- some people can see a difference, but most will not, myself included.

If the latter, then a shorter corridor will help, although the consequences are a more dynamic/busy lens, with the potential for reduced distance acuity on-axis, and a much higher likelihood of off-axis distance blur.

If the object in question is a desktop monitor at essentially eye level, then there will still be some chin lifting going on, even with the shortest corridor lens, albeit much less so compared to moderately long corridors like the Physio.

You might also want to look at the change in Rx; any increase in minus or decrease in plus on the distance will have a negative impact on the intermediate vision. If true, don't blame the decreased utility at intermediate on the lens design!

Hope this helps,

[rinselberg]

Want to gamble some money on an idea from someone who isn't an Eye Care Professional?

Look at the website for the atLast! lens:

http://www.atlastlens.com/

If you take the text on the website at face value, the atLast! lens is aimed specifically at this situation: A dissatisfied PAL wearer who needs (or wants) more or better intermediate vision.

The lens is new, so there has not been much discussion of it yet on this forum.

[IndianaOD]

Is the Autograph II out of the question? Otherwise, have the patient decrease the monitor height if its eye level or higher.

[Trevor D]

The atLast Enhanced Multifocal

Seems to be a blended round seg embedded into a progressive lens!

According to the wesbite, a lab in California named "Bad *** Optical" can supply you with it! :p

[For-Life]

What was the patient wearing before?

[rinselberg]

Seems to be a blended round seg embedded into a progressive lens!

According to the wesbite, a lab in California named "Bad *** Optical" can supply you with it! :p

Bad As* Optical (make that last "*" into an "s")

http://www.badassoptical.com/

[rdcoach5]

Use GT2 or Definity

Do not use the At Last for this patient. It has a very small vertical intermediate. It does have a wide horizontal zone but it is really only suited to someone who could wear a blended bifocal. It's a lot better blend without all the blur in the blend zone. I would guess the intermediate is around 3 mm or so in height. There is a wide distance zone and near zone but even our Pixel Optics Rep said not to use it for someone who needs a wide intermediate.

[Happylady]

I have a patient who is a pilot and he loves the Rodenstock Life lens. He's tried Definity and says the Life is better. He says the Definity is good but the Life has a bigger intermediate area. He is a hyperope.

[DragonLensmanWV]

Is the Autograph II out of the question? Otherwise, have the patient decrease the monitor height if its eye level or higher.

I have the Auto II and in my opinion, while I love them, the intermediate is the weakest part. Note that I have a 3.00 add though.

[Scrumblydumpus]

We talked to the patient & the doc and decided to lower his add and raise the seg a bit. We are going to keep him in the physio, but if he still has trouble I may mention the raising the monitor idea.

I thought Shamir's big thing with the autograph series was to minimize intermediate to make near/distance as good as possible?

[Happylady]

We are going to keep him in the physio, but if he still has trouble I may mention the raising the monitor idea.

Generally I find lowering the monitor is helpful with computer users. Having the screen too high is a common problem.

[IndianaOD]

We talked to the patient & the doc and decided to lower his add and raise the seg a bit. We are going to keep him in the physio, but if he still has trouble I may mention the raising the monitor idea.

I thought Shamir's big thing with the autograph series was to minimize intermediate to make near/distance as good as possible?

Hmm, if that's true I didn't know it.

[Jubilee]

You can specify the corridor lenght in a situation like this to have more vertical room in the intermediate.


A couple of other good computer lenses... For width of intermediate, Solamax. For length, the original Gradal Top. For those with Higher adds, have a longer corridor length will give them a true computer zone.

For lower adds, the short corridors work by bringing the magnification up higher in the lens.