What would you consider an upgrade to the Essilor Adaptor

[MarcE]

I'm hear again humbly asking for the combined experience of the board to help me "WOW" or at least "impress" this patient. What Progressive lens do think is best?

Here is our red-flag patient of the day:
OD -8.75 -2.25 x 90something 0.75 BD
OS -9.87 -2.25 x 130something - no prism
+3.00 add
Rx notes: "High index" "2.00 BC" No mention of acuities, but I could call and get it if needed.

This new patient presents wearing an Adaptar in 1.60 with a 2.75 add and 0.50BD in the OS.

This doctor does not normally specify BCs. This was done because of a previous issue with base curve. I trust this OD and believe that a BC within 0.5 of 2.00 would probably lower our risk. But I almost NEVER specify BCs on progressives. Too dangerous IMO.
She was also a non-adapt to 1.67 HI.
She also stated that she needed the lens fit a bit low in her current frames, which had a B of 40.

B in new frame is 34 w/ a FH of 20 before any "lowering" is done.
She picked out a frame w/ a 53 eyesize, knowing full well that smaller mean thinner. But she isn't that concerned about thinness. She is a "Vision person", to use a Barryism. At least as much as she can be wearing a high-add no-line w/out AR.

She would not go for the 1.70 lens. I wouldn't mind giving her a free upgrade to 1.70, but she wouldn't go for AR so I won't give her 2 free upgrades.
1.67 is out due to previous non-adapt.

So I guess I'm going with 1.60 without AR:hammer:

The question is: Can I pick a lens that will provide her better vision (especially considering her increasing add and her shorter FH), without being so different from an Adaptar as to cause adaption problems.
Would any of you feel comfortable putting this on a 1.00BC, if the mfg lens chart calls for it?

My short list in no particular order (all in 1.60):

• Accolade
• Natural
• Element standard corridor
• Definity (maybe too soft, too different?)
• And just maybe -Zeiss Individual (even though she didn't get AR, cost is not an issue with this lens if we feel that it will provide a total WOW!)
• Adaptar
• And chime in on the AtLast! lens - if you feel appropriate.

Please pick your favorite (or another) and post 2-3 sentences explaining your rational. Remember this is a teaching forum. Thanks in advance!

Please do not post any replies that contain the term "Flat-top", including all its derivatives such as but not limited to: FT, D28, D35, TF, 7x28, seg, exec, 8x35, CT, Rd24. The only exception is the AtLast! lens as listed above.

[Jacqui]

I would be looking at the freeforms, by whoever. I think this is a good case for them.

[hipoptical]

Why was she a non-adapt to 1.67? I think you must first answer that question to be successful fitting her into something else. There are different factors you must consider before proceeding, in my opinion. What 1.67 did you use? I would need more info before offering my suggestion from you list...
In saying that, choose the right freeform PAL, and you needn't worry 'bout a thing. You must remember, though, that not all freeform PALs are freeform PALs, and not all are the same.
However, to answer your question: just about anything made in this decade would be an upgrade to the Adaptar.... if that is your only concern, buy the cheapest lens from Shore in the index you want, and you'll be better off than with the Adaptar.

[bob_f_aboc]

The Autograph II Variable in 1.6 would knock her out of her chair compared to the Adaptar.

They do list the availability of the 1.6 as -10.00 to +6.00 total power up to a +3.50 add.

The 1.67 is very clear and extends the range to -12.50 total power.

I would recommend the 1.67 material. I wear it in the Auto SV and have had no ill effects. (I am usually very sensitive to 1.67 and poly)

[Happylady]

Does she like the Adapter? Has she had any problems wearing it in the past?

[john-atlanta]

I second the Auto II variable 1.60. Definitely a better ABBE value than 1.67 or Poly so I would stay with it, especially since she is not getting AR.

[KStraker]

The Autograph II Variable in 1.6 would knock her out of her chair compared to the Adaptar.

They do list the availability of the 1.6 as -10.00 to +6.00 total power up to a +3.50 add.

The 1.67 is very clear and extends the range to -12.50 total power.

I would recommend the 1.67 material. I wear it in the Auto SV and have had no ill effects. (I am usually very sensitive to 1.67 and poly)

Agreed. Or try Hoya Id Lifestyle 1.67. Not sure if the 1.67 needs ar.

[gunner05]

Stay away from 1.67 sans AR. This is a patient I probably would want to scream at, from what you've said so far. That being said, I honestly would probably think about the Natural. As much as I really don't like selling it compared to my other lenses, I am thinking that I've had fewer non-adapts moving my old adaptar patients to that than I did with the ovation and such. That being said, I don't really have the full picture.

I guess cost is an issue here, since they won't spring for AR? You said they are a vision patient so why in the heck would they not want AR? Also, she does realize that she's not going to be able to use the periphery on her lenses with that high of an RX anyways right? It just seems that a lot of this isn't adding up, but that's why I said this patient would probably make me want to scream at them as well.

[chip anderson]

If she doesn't have a complaint and is happy, why upgrade?
No need to improve on something that is working perfectly.
If she has a complaint or wants to move up, then move up.

Chip

[chip anderson]

I just had a patient in who is a retired M.D. and has Parkinsons. He is having trouble with swimmy vision in progressives. His ophthalmologist who is a very, very good one has suggested bifocals or trifocals.
Should I be concerned that he is going downward on the technological scale? Should I get all wrapped up in trying to experiment with the latest superzoomo progressives with wider channels, etc?
Of course not, the man has some uncontrolable head and eye movement and we are going to put him in a trifocal.
OK, I'm ready for all you expert whippersnappers to tell me why I'm wrong.

Chip

[gunner05]

Yes, Chip, you are an idiot.

Now that that's out of the way, I agree with what you did there. But even a blind squirrel sometimes finds acorns ;)

[Happylady]

I guess she doesn't want AR because she's had bad ARs in the past. Once someones had a bad experience with AR it's hard to get them to try again.

If she is happy with Adapter and has not had any problems with it, I would not change her. So the important question is whether is has been happy with Adapter.

Don't do 1.67 without AR.

Edited to say I didn't mean to get that annoying blue bouncing thing in my post and I don't think I can edit it out. :(

[MarcE]

It just seems that a lot of this isn't adding up, but that's why I said this patient would probably make me want to scream at them as well.

Yes, I understand. It's not quite adding up. But since she know what "didn't work" and she has notes to back it up, I don't want to put her in something that goes against what she said. Because if she isn't WOWed by the new vision, then she will blame the AR or the 1.67, or the BC, or the . . .

Chip: no I don't think going "backwards" to the TF was a bad idea in the Parkinson's case. It probably was a very smart choice. However, in this case I would like to "upgrade" her because I don't think she knows exactly what she has been missing vision-wise. She is a big talker and if I could give her a level of vision that she hasn't ever had before, she will create a couple of fistfulls of new referrals. And she came to us with an outside Rx because of a friend of hers that just raved about how good we are and the great new high-tech lenses that we provided for him.

Thanks so much for all the input:cheers:!
Natural and Adaptar recieved a vote, as did "any freeform" and the Auto II.
I took all the input into account and leaned toward the "freeform" vote. Ultimately I choose the Indo Expert in 1.60 because it is slightly "harder" than many of the other freeform choices. I thought it might provide many of the benefits of the freeform without being too soft for an old Adaptar wearer. Maybe I'm wrong - but we shall see.

Post suspended for about a week . . . . .

[Happylady]

Yes, please update when she gets the glasses. :)

[chip anderson]

If you really want to upgrade her the Zeiss Individual in 167 is the best lens I have ever worn.

Chip

[KStraker]

I just had a patient in who is a retired M.D. and has Parkinsons. He is having trouble with swimmy vision in progressives. His ophthalmologist who is a very, very good one has suggested bifocals or trifocals.
Should I be concerned that he is going downward on the technological scale? Should I get all wrapped up in trying to experiment with the latest superzoomo progressives with wider channels, etc?
Of course not, the man has some uncontrolable head and eye movement and we are going to put him in a trifocal.
OK, I'm ready for all you expert whippersnappers to tell me why I'm wrong.

Chip

No, but if a better flat top has come along, you might want to consider it. You mean the brand new Zeiss Individual is better than an a 30 year old Adaptar? Who would have thunk it. I guess this technology stuff does something after all.

[hipoptical]

I just had a patient in who is a retired M.D. and has Parkinsons. He is having trouble with swimmy vision in progressives. His ophthalmologist who is a very, very good one has suggested bifocals or trifocals.
Should I be concerned that he is going downward on the technological scale? Should I get all wrapped up in trying to experiment with the latest superzoomo progressives with wider channels, etc?
Of course not, the man has some uncontrolable head and eye movement and we are going to put him in a trifocal.
OK, I'm ready for all you expert whippersnappers to tell me why I'm wrong.

Chip

There are some freeform lenses that would have no swimminess, but you would have to know what they are and where to get them- thus no experimenting. In saying that- if I was in your position, I would very likely do what you did.
So (in jest) I say that you are wrong because you don't know what you could know.
Or: ignorance is bliss, and in this case a satisfied and well-cared-for patient.

[chip anderson]

Any lens (with any power) will have swimmnes if either the observer or the lens is vibrated. Take the very best free form lens you can find, or any sphere for that matter and wiggle it in front of your eyes. You will also find this to be much worse in any aspheric or progressive.

I can even remember many years ago wearing some glass drilled rimless glasses that were quite stable in normal circumstances but I found that I couldn't wear them on my motorcycle over about 35 mph because the vibration was so bad it was worse that driving in the rain with no windshield and wet glasses.
A patient with any form of nystagmus of the head or eye will be dealing with this effect.

Chip

[hipoptical]

You know... I didn't even think about the glasses moving apart from his face. I was only thinking of them moving with his face as his face would shake. You're right- any lens will have the swim, and even the best digital PAL would be worse under those conditions. Good thought.

[carnzo]

Adapter come on, who still uses this? Most of my patients are not driving cars that are 20 years old so why is the patient using this lens in the first place. Put this patient in a Hoya Lifestyle or Kodak Unique. But remember with the Unique you need 10mm above the pupil for it to work. Both lenses can be ordered w/o ar but should have it. Also, do not put this person in polycarbonate unless you want a remake.

[dbracer]

Any lens (with any power) will have swimmnes if either the observer or the lens is vibrated. Take the very best free form lens you can find, or any sphere for that matter and wiggle it in front of your eyes. You will also find this to be much worse in any aspheric or progressive.

I can even remember many years ago wearing some glass drilled rimless glasses that were quite stable in normal circumstances but I found that I couldn't wear them on my motorcycle over about 35 mph because the vibration was so bad it was worse that driving in the rain with no windshield and wet glasses.
A patient with any form of nystagmus of the head or eye will be dealing with this effect.

Chip

Does that mean you need to improve your lens or your motorcycle?

dbracer

[dbracer]

I know of no company that handles optics and light aberration science better than Shamir, especially if you use their best. I believe few will argue -- if they've read the science.

And, I know of no one that knows the science or works harder, at least on this forum, than Darryl Meister.

Does that confuse you? It does me sometimes also.

He's a good man. He is generous with good information and where to find it. And, although he represents a company, he also represents the facts to a fault.

Ask his opinion.

dbracer

[DragonLensmanWV]

With that high of a minus, there will be minimal swimminess, regardless of add power. I had a 3.25 add when I was the -15. Never saw any swimminess, either you were in focus or not. I think the flat front curve and high power mask a lot of the abberations, at least that was my experience.

I have the Auto II (Not variable) and the hoya ID Lifestyle in identical frames. There is noticeable better intermediate vision with the ID LIfestyle.
My favorite high-minus lens was the Hoya ECP.

[OCP]

With that high of a minus, there will be minimal swimminess, regardless of add power. I had a 3.25 add when I was the -15. Never saw any swimminess, either you were in focus or not. I think the flat front curve and high power mask a lot of the abberations, at least that was my experience.

I have the Auto II (Not variable) and the hoya ID Lifestyle in identical frames. There is noticeable better intermediate vision with the ID LIfestyle.
My favorite high-minus lens was the Hoya ECP.

Intermedia width is the Hoya strategy, and no other progressive lenses offer you this width. Bad you get worse distance and near zone. Thats the "Asia" style when this region is reading vertical and not horrisontally like the rest of us.
Zeiss, Rodenstock & Shamir does it different.
Better reading and distance zone, and a little smaller intermedia.

Simple as this.

I beleive for sure, that it´s better for the user to get so much distance zone as possible. The Auto II got the widest distance zone on the market so far.

So it´s not a question of "which product is best" but which product fit your client best. Try to change a hoya ID to Auto II and they will all appriciate the larger distance zone, and then sell additionel a pair of Autograph Office for the computer work if the Auto II is not enough. That is (in my oppinion ofcause) the best way to help your client. Hoya ID is not an bad lens, just a different way to build the design that fit asian people better.

[RT]

Thats the "Asia" style when this region is reading vertical and not horrisontally like the rest of us.

That's an odd assertion since the design criteria for Hoyalux ID and ID Lifestyle came from Europe.