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Thread: Would you upgrade to Free form progressive from Executive tri-focals lenses?

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    OptiBoard Apprentice LAGUNAEYEDESIGNER's Avatar
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    Big Smile Would you upgrade to Free form progressive from Executive tri-focals lenses?

    Today, we have a challenge. Patient is a female-70 years old (healthy) wears executive tri-focal lenses for more than 20 years. She is just ok with executive tri-focals lenses and is so motivated to upgrade her lenses to free form progressive. The reason to upgrade is tiring of the lines and wanted to look younger with no-lines-bifocals (progressive). Patient understood the pros/cons of free form and be awared of non-adapt when upgrade to free-form progressive from executive tri-focals. She accepted the challenge and willing to give it a try.

    OD: +2.75 -0.25 x 85 Add +2.75
    OS: +3.00 -0.25 x 30 Add +2.75

    Question: what free form progressive out there should she try out? Please share your views. Many thanks. Laguna.

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    Quote Originally Posted by LAGUNAEYEDESIGNER View Post
    Today, we have a challenge. Patient is a female-70 years old (healthy) wears executive tri-focal lenses for more than 20 years. She is just ok with executive tri-focals lenses and is so motivated to upgrade her lenses to free form progressive. The reason to upgrade is tiring of the lines and wanted to look younger with no-lines-bifocals (progressive). Patient understood the pros/cons of free form and be awared of non-adapt when upgrade to free-form progressive from executive tri-focals. She accepted the challenge and willing to give it a try.

    OD: +2.75 -0.25 x 85 Add +2.75
    OS: +3.00 -0.25 x 30 Add +2.75

    Question: what free form progressive out there should she try out? Please share your views. Many thanks. Laguna.
    Not going to matter much. Hoya ID is the best, I think, but a Shamir or Zeiss or even Varilux will be OK for this Rx. The issue isn't going to be which PAL; she's in for big-time culture shock whatever lens you choose.

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    ATO Member HarryChiling's Avatar
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    Go Seiko Surmount.

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    Is she using 3rd party or private pay? is cost a deterrent or is she spending her kids inheritance? Hoya and Zeiss are priced high on private pay. We have found better successes with Hoya on + and much less so on -. Varilux id not offering a comparative "freeform" lens at this time. Closest might be the Physio Enhanced Fit. The Shamir Autograph has and excellent combination of tech materials availability and cost. The Seiko or "some" house freeforms are very very good and and excellent value. We had some Seike Succeed from Pech in years past and it was good but their new pro in my opinion is much improved. I cannot comment on the improvements of the Surmount. There is also an MIT freeform out there. I do not have personal experience e on it but have been give mixed feed back so far.
    What is she expecting from her lenses and how will she be using them? Possibly an indoor progressive or a specialty lens like the ATLast would server her best for he needs.
    Other ideas?

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    OptiBoard Apprentice LAGUNAEYEDESIGNER's Avatar
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    Quote Originally Posted by blinkvelo View Post
    Is she using 3rd party or private pay? is cost a deterrent or is she spending her kids inheritance? Hoya and Zeiss are priced high on private pay. We have found better successes with Hoya on + and much less so on -. Varilux id not offering a comparative "freeform" lens at this time. Closest might be the Physio Enhanced Fit. The Shamir Autograph has and excellent combination of tech materials availability and cost. The Seiko or "some" house freeforms are very very good and and excellent value. We had some Seike Succeed from Pech in years past and it was good but their new pro in my opinion is much improved. I cannot comment on the improvements of the Surmount. There is also an MIT freeform out there. I do not have personal experience e on it but have been give mixed feed back so far.
    What is she expecting from her lenses and how will she be using them? Possibly an indoor progressive or a specialty lens like the ATLast would server her best for he needs.
    Other ideas?
    Thanks all for your inputs. This is a private pay and cost is not a problem. More than 10 years ago, she and her husband did try out essilor comfort (with other O.D.) which did work out for her husband but not her. This time, we upgraded her husband lenses from essilor comfort to autograph II 18mm fixed and it was sucessful. And she would like to give it a try again. She just uses her lenses for daily use only.

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    Master OptiBoarder cleyes's Avatar
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    Quote Originally Posted by LAGUNAEYEDESIGNER View Post
    Thanks all for your inputs. This is a private pay and cost is not a problem. More than 10 years ago, she and her husband did try out essilor comfort (with other O.D.) which did work out for her husband but not her. This time, we upgraded her husband lenses from essilor comfort to autograph II 18mm fixed and it was sucessful. And she would like to give it a try again. She just uses her lenses for daily use only.
    Doesn't sleep in them eh? LOL

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    Quote Originally Posted by blinkvelo View Post
    Is she using 3rd party or private pay? is cost a deterrent or is she spending her kids inheritance? Hoya and Zeiss are priced high on private pay. We have found better successes with Hoya on + and much less so on -. Varilux id not offering a comparative "freeform" lens at this time. Closest might be the Physio Enhanced Fit. The Shamir Autograph has and excellent combination of tech materials availability and cost. The Seiko or "some" house freeforms are very very good and and excellent value. We had some Seike Succeed from Pech in years past and it was good but their new pro in my opinion is much improved. I cannot comment on the improvements of the Surmount. There is also an MIT freeform out there. I do not have personal experience e on it but have been give mixed feed back so far.
    What is she expecting from her lenses and how will she be using them? Possibly an indoor progressive or a specialty lens like the ATLast would server her best for he needs.
    Other ideas?
    The Pech Pro and most lab brand free form lenses are a Seiko design; they all work about the same. I just sent to 6 sets of lenses to be mapped; they are the only free form ones in the study. I sent in a Kodak Unique, Pech Pro and a Shamir Autograph II with the following RX; one of each with a plano +200 add and the other in a +2.00 - 2.50 x045 with a +2.50 add. Harry and I want to see how the lens designs change from the fake world of plano +2.00 add to a real RX that tests the design with some oblique axis and a higher add.
    We are betting that it is almost identical as when I use all 3 brands, we have complete success with all of them and I order them based on prices since the patients cannot tell the difference. We have done thousands of free form lenses and this has been the case for over 7 years of using them as much as possible.

    Craig

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    OptiWizard Pogu's Avatar
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    Quote Originally Posted by LAGUNAEYEDESIGNER View Post
    she and her husband did try out essilor comfort (with other O.D.) which did work out for her husband but not her. This time, we upgraded her husband lenses from essilor comfort to autograph II 18mm fixed and it was sucessful. And she would like to give it a try again.
    This give the Autograph II a psychological advantage, IMO. I'm sure her husband notices the advantages and has boosted her confidence in the new technology.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Ryser's Rule- The success of a progressive is proportional to the motivation of a patient to wear it.

    Go for it!

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    Master OptiBoarder cleyes's Avatar
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    Quote Originally Posted by Uncle Fester View Post
    Ryser's Rule- The success of a progressive is proportional to the motivation of a patient to wear it.

    Go for it!
    I've been saying to same to my patients for years!
    WE SEE THINGS NOT AS THEY ARE, BUT AS WE ARE..... Anais Nin

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    Why not encourage the person to use both types of devices? The concept of substitution as the "only use" device is myopic. Upgrade the exec tris to the latest RX too.

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    One eye sees, the other feels OptiBoard Silver Supporter
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    Quote Originally Posted by LAGUNAEYEDESIGNER View Post
    Today, we have a challenge. Patient is a female-70 years old (healthy) wears executive tri-focal lenses for more than 20 years. She is just ok with executive tri-focals lenses and is so motivated to upgrade her lenses to free form progressive. The reason to upgrade is tiring of the lines and wanted to look younger with no-lines-bifocals (progressive). Patient understood the pros/cons of free form and be awared of non-adapt when upgrade to free-form progressive from executive tri-focals. She accepted the challenge and willing to give it a try.

    OD: +2.75 -0.25 x 85 Add +2.75
    OS: +3.00 -0.25 x 30 Add +2.75

    Question: what free form progressive out there should she try out? Please share your views. Many thanks. Laguna.
    Quote Originally Posted by LAGUNAEYEDESIGNER View Post
    Thanks all for your inputs. This is a private pay and cost is not a problem. More than 10 years ago, she and her husband did try out essilor comfort (with other O.D.) which did work out for her husband but not her. This time, we upgraded her husband lenses from essilor comfort to autograph II 18mm fixed and it was sucessful. And she would like to give it a try again. She just uses her lenses for daily use only.
    Would you upgrade to Free form progressive from Executive tri-focals lenses?
    Short answer-

    No. I would estimate a less than two percent chance of success. The vision will generally be poorer with PALs, with significant adaptation concerns. Note the previous unsuccessful attempt to convert from segmented to PALs. I would try ST's first, preferably in Trivex (look for deep depressions and redness on the sides of her nose).

    Longer answer-

    You should be concerned for her visual well being- even with normal, healthy eyes, an age 70 client receives a third to half the light to the retina than a twenty year old. This concern should be visible on your face and in the tone of your voice. Recommend lens and frame designs that will provide the best possible vision. Drive it home.

    I would tell her that PALs will offer decreased visual performance, with some degree of blur at the distance periphery, potentially on the straight ahead gaze, with significantly reduced field of vision at near, with an adaptation time, if any, of two days to eight weeks. She may need SV readers or ST28's to supplement the PALs if she's an avid reader.

    If she absorbs all of the above and is still strongly twisting your arm for PALs, then determine her visual needs and proclivities, and have at it. Hint- hyperopes will probably prefer longer corridors (fit close, and no lower than 19mm usable). First time PAL wearers will prefer reduced amounts of unwanted surface astigmatism and swim. A few designs that have one or both of these features are Zeiss Individual, Hoya iD, Essilor Definity.

    Good luck, and whatever happens, report back, Ok?
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



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    I took a 92 year old woman out of Tri-s and into a progressive and she did great. In fact, she was ANGRY that someone had not dispensed progressives to her sooner!

    I will second the suggestion of the Seiko Surmount, perfect for that RX.

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    Master OptiBoarder NCspecs's Avatar
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    Funny, just this week I just switched a 79 year old patient out of a trifocal (35 with no A/R) into the Physio Enhanced with Avance; she practially danced out the door! when I sold it to her I told her in I didn't expect her to like it much but when I dispensed the specs she asked me if I wanted her to count the bricks in the building across the street. Hehe, I love my sassy older patients. She said she was more pleased with this pair of glasses than she had been with any other pair in a long time.

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    Master OptiBoarder cleyes's Avatar
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    When my hyper-aware, hyper critical mom wanted to try progressives @ age 65, I used reverse psychology. Told her "older" patients had a difficult time changing from 20 yrs of bif. use to this "newer design". She is the type who would make detailed notes of ALL the negatives she perceived, and call me daily with a blow by blow. I pitied her OD. Well it worked, she toughed it out for a few weeks, then called me to tell me how wrong I"d been! Don't dare tell her to this day!!
    WE SEE THINGS NOT AS THEY ARE, BUT AS WE ARE..... Anais Nin

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