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Thread: Suggest a good PAL for plano presbyopes?

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    Suggest a good PAL for plano presbyopes?

    What would be a good progressive to use for patients who don't really need to wear progressives for distance but want to wear them mainly for computer and reading? These would be patients who need the distance function some of the time (ie: 10%) but need the intermed and near all of the time. I've used Solamax in many of these patients but have gotten some complaints regarding peripheral distortion. PALs that emphasize distance eg: Percepta, Image have also been poor performers with this group. I would be interested to see what others use.

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    Redhot Jumper Suggest a good PAL for plano presbyopes?

    Anybody who is a plano for distance should not even have a progressive for computer glasses. The best ones for that purpose are a FT 35mm. Why compensate the reading area on a desk when you can give a good wide size of clear area.

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    ABO-AC, NCLE-AC, LDO-NV bob_f_aboc's Avatar
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    Shamir Office, HOYA Tact, Zeiss Gradal RD, Sola Access...
    A lack of planning on your part DOES NOT constitute an emergency on mine!

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    Go balanced, Ilan. You went from one extreme to the other.

    IMHO, balanced is the default position until/unless you have a good reason to do otherwise.

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    One might give some small concideration to how strong the add is.
    If it's over +2.00 he will need either a progressive or trifocal. Under +2.00 a bifocal of any type should work.

    Chip

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    I have a lot of patients that use progressives for reading and computer because they don't want to take their glasses off. One is a factory manager and he needs to have clear distance all the time (he drives trucks). I also have 2 nationally known professional speakers who need to see out over a large audience but still be able to see the keys on their laptop for Power Point. So there is a place for Plano Distance Progressives.

    So you need the lens with clearest distance vision. My first choice would be the Shamir Auto II, I have a pair with almost no distortion above the 180 line. You can also fit a 1-2mm below pupil for added benifit. A second choice would be the Hoya ID Lifestyle, great lens but overpriced IMHO.

    Sharpstick

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    Just because someone doesn't have any distance correction doesn't mean they don't want the distance to be as clear as possible if they wear progressives. My husband has very little distance correction and doesn't like reading or computer lenses because he wants to be able to look around and see clearly. He doesn't want to have to take them off to walk into the kitchen.

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    Quote Originally Posted by Happylady View Post
    Just because someone doesn't have any distance correction doesn't mean they don't want the distance to be as clear as possible if they wear progressives. My husband has very little distance correction and doesn't like reading or computer lenses because he wants to be able to look around and see clearly. He doesn't want to have to take them off to walk into the kitchen.
    Good point. Many times, we put these individuals in lenses like the solamax, but they still wear their glasses all day. They do not want distortion in their distance.

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    Quote Originally Posted by For-Life View Post
    Good point. Many times, we put these individuals in lenses like the solamax, but they still wear their glasses all day. They do not want distortion in their distance.
    Yes, I find these people are very sensitive to distortion in the distance area of the lens. They are used to excellent distance vision.

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    Sometimes I try to induce individuals to 1: get multifocals for reading either with plano distance Rx or 2: plano distance for "readers" over contacts.
    As an inducement (translation: sales pitch) I tell them they can get transitons and so they can fake it some of the time and pretend they are sunglasess.

    Chip

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    I find that Element has been very well received for these type of clients.

    Barry

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    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by ilanh View Post
    What would be a good progressive to use for patients who don't really need to wear progressives for distance but want to wear them mainly for computer and reading? These would be patients who need the distance function some of the time (ie: 10%) but need the intermed and near all of the time. I've used Solamax in many of these patients but have gotten some complaints regarding peripheral distortion. PALs that emphasize distance eg: Percepta, Image have also been poor performers with this group. I would be interested to see what others use.
    Ovation and Panamic have been great go to lenses in this instance. The biggest thing you or your opticians I should say could do is help the patient grasp the concept that a compromise must exist somewhere. With any Plano add patient you will be introducing a compromise in the distance to create a wider reading and intermediate area and this compromise goes into an area that the patient came into your office with no complaints about. If they are using the lenses for distance only 10% of the time you might as well eliminate the distance portion so that any compromise there is moot and focus on occupational lenses in which case any would do equally well, if a progressive is a must then again the above two with a firm understanding at exam, fit, and dispense will do your patient much more justice than any design alone.
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    Quote Originally Posted by ilanh View Post
    What would be a good progressive to use for patients who don't really need to wear progressives for distance but want to wear them mainly for computer and reading? These would be patients who need the distance function some of the time (ie: 10%) but need the intermed and near all of the time. I've used Solamax in many of these patients but have gotten some complaints regarding peripheral distortion. PALs that emphasize distance eg: Percepta, Image have also been poor performers with this group. I would be interested to see what others use.
    The short answer is that what you're asking for doesn't exist in a PAL. For most folks it will have to be two pair.
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    Solamax is an option that I've used in the past because the intermediate and reading are very wide. The distance is not good but this compromise can be explained to the patient who will not really need to wear it for distance that often. It's good enough to walk from the computer room into the kitchen or to glance up from your musical score and see the audience. Sola VIP also seems to be a design that stresses interm/near and may be an option. Gradal RD, Shamir Office, Access etc are not appropriate for people who need to actually see more than a few feet for distance. I haven't tried the natural, ovation or panamic for this specific indication.

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    Master OptiBoarder OptiBoard Gold Supporter DragonLensmanWV's Avatar
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    Of all the progressives we've tried we had the poorest results with Solamax.

    If you have the room, a Comfort or Natural will work well, and as HArry pointed out, the Ovation/Panamic is also a good one. About the last thing you need is some freeform hoopla for this.
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    Quote Originally Posted by DragonLensmanWV View Post
    Of all the progressives we've tried we had the poorest results with Solamax.

    If you have the room, a Comfort or Natural will work well, and as HArry pointed out, the Ovation/Panamic is also a good one. About the last thing you need is some freeform hoopla for this.
    I would disagree. Compliance is higher when DVA is good, and with my Autograph II's I have the same distance vision I get with Single Vision. The Element as Barry reccomended will share most of the advantages of an Auto II in these circumstances and actually cost less than most grinders.

    Sharpstick

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    What's up? drk's Avatar
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    You could try the more refined SolaOne...

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    ATO Member HarryChiling's Avatar
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    I gotta say when FF lenses are recommended to even the most basic Rx like a plano with add, I start to wonder about the recommenders fitting skills. In a situation such as this one the FF lenses are going to have the least amount of WOW, I guess if the element is cheap it might be worth considering, but the autograph 2 is overkill. Why not put the guy in a 1.74 lens as well and tell them that the only option available frame wise is gold and wood.

    Selling isn't a bad thing but overselling is a bad thing and in this case a traditional lens is going to perform just as poorly as any FF lens.
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    Bravo! Harry

    But then the concept of a Pal at all for this application is overselling.

    Chip

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    Quote Originally Posted by chip anderson View Post
    Bravo! Harry

    But then the concept of a Pal at all for this application is overselling.

    Chip
    we can move to a communist society where they only provide metal round frames, flat tops, and glass lenses.

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    Quote Originally Posted by DragonLensmanWV View Post
    Of all the progressives we've tried we had the poorest results with Solamax..
    But what exactly do you mean? We too have had poor results with Solamax but mainly with the distance. Solamax is abysmal for distance. However, if patients truly do not need distance and simply want the progressive for intermed and near, why should solamax' lousy distance be an issue? It's supposed to be the best for interm and near. This is at the crux of the issue. If I have a patient that simply needs to see their computer and their reading material I give them Access. If I have someone who needs to see computer, reading material AND 10 feet around them I give them Gradal RD or Office. But occasionally I have someone who wants to see computer and reading material but also wants to be able to see distance occasionally eg: at a presentation, in a boardroom etc. For these people I would like to find a PAL which preserves the undistorted purity of the intermediate and near zones but gives them a tiny bit of distance (just enough to get by on). It would be nice to have something like a trifocal in which there is a tiny sliver of distance at top and huge interm and reading zones on the bottom.

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    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by For-Life View Post
    we can move to a communist society where they only provide metal round frames, flat tops, and glass lenses.
    I'm not suggesting that everyone should get the cheapest product in the store, but the situation presented isn't going to work in a PAL very well and throwing money at it isn't going to solve the problem, neither is calling anyone that suggests anything but the most fat cat capitalistic approach of the most expensive product first. If the element is comparable in price to a traditional PAl then of course like I said it would be worth consideration, but a Autograph 2 is still a PAL and a PAL is going to have the same characteristics no matter how precise, it's overkill. What I am suggesting isn't even from the realm of optical knowledge, I am suggesting the principles of kindergarten play apply here, a round hole will not accept a square peg even and expensive square peg.

    Quote Originally Posted by Robert Martellaro
    The short answer is that what you're asking for doesn't exist in a PAL. For most folks it will have to be two pair.
    This is the best suggestion offered along with the an occupational lens. For the same price as an Auto 2 the patient can more than likely pick up two pair and each will accomplish their task flawlessly and provide the patient with what they need. A traditional PAL for every day use and the occupational PAL (like the RD in this case) for close up, intermediate, and occasional far. The old one pair approach is outdated, change your thinking.
    Last edited by HarryChiling; 04-11-2009 at 11:02 AM.
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    Quote Originally Posted by ilanh View Post
    But what exactly do you mean? We too have had poor results with Solamax but mainly with the distance. Solamax is abysmal for distance. However, if patients truly do not need distance and simply want the progressive for intermed and near, why should solamax' lousy distance be an issue? It's supposed to be the best for interm and near. This is at the crux of the issue. If I have a patient that simply needs to see their computer and their reading material I give them Access. If I have someone who needs to see computer, reading material AND 10 feet around them I give them Gradal RD or Office. But occasionally I have someone who wants to see computer and reading material but also wants to be able to see distance occasionally eg: at a presentation, in a boardroom etc. For these people I would like to find a PAL which preserves the undistorted purity of the intermediate and near zones but gives them a tiny bit of distance (just enough to get by on). It would be nice to have something like a trifocal in which there is a tiny sliver of distance at top and huge interm and reading zones on the bottom.

    Unfortunately, they don't make the Sola ED-Tri any more. That would have been perfect.
    Our problem with the SolaMax was that, of the first 12 pairs we sold, we had 5 or 6 non-adapts. Now, we regularly get around 98% acceptance with ANY other progressive so that was a wake-up call. So I don't consider it a viable lens for us because so far, everyone we fit seems to actually like being able to see at a distance. They really hated backing up their car with them.


    Now, if we could just get Younger to reintroduce their 10/30 progressive, which I liked for a wide intermediate/near lens.But not a short-corridor design though.
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    Quote Originally Posted by bob_f_aboc View Post
    Shamir Office, HOYA Tact, Zeiss Gradal RD, Sola Access...
    Mega dittos on the Shamir Office! Dont mess with a progressive unless they NEED distance clear and can't look over the top for some reason.
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    Quote Originally Posted by HarryChiling View Post
    I'm not suggesting that everyone should get the cheapest product in the store, but the situation presented isn't going to work in a PAL very well and throwing money at it isn't going to solve the problem, neither is calling anyone that suggests anything but the most fat cat capitalistic approach of the most expensive product first. If the element is comparable in price to a traditional PAl then of course like I said it would be worth consideration, but a Autograph 2 is still a PAL and a PAL is going to have the same characteristics no matter how precise, it's overkill. What I am suggesting isn't even from the realm of optical knowledge, I am suggesting the principles of kindergarten play apply here, a round hole will not accept a square peg even and expensive square peg.
    that is cool. My comment was not directed at your previous one. You are correct in the fact that we should find the best value for the customer, and not everyone needs super free form.

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