Progressive nonadapt

[Chris Ryser]

I suspect that when : "The patient wore progressives before." he had not worn any other type of bifocal. He became acustomed to the type of vision one gets with progressives. Now his brain knows there is something better. His years in trifocals taught him what it's like to see and now he can't accept the abberration.

Chip

Any 80 years old that is normally on the highest addition which produces on a progressive the smallest corridor, and the fastest transition to the reading part as well as the largest possibel distortion of the lens..................and furthermore has worn clean and clear trifocals will for sure not adapt to the optically worst lenses he can buy. Just put him back in trifocals and he will be thankfull to you forever.
I fully support Chips version.

[Robert Martellaro]

Sometimes the simplest explanation, or solution, is the best one. But there are two items here that I can't ignore: a 30° head turn clears the near vision, and the cylinder powers have opposing signs.

Fabian,

You can make this work. The problem is very likely a fudged Rx for the right eye. Get a second opinion, triple check the lens position, and remake. You will be a hero!

[Fabian Corio]

Confirmed: He is coming next Tuesday.

[sharpstick777]

Fabian,

Time to troubleshoot.

Let's firm up that Rx for starters. Is it written in minus or plus cylinder? If the Rt cyl is +1.25, and he's over plused (old Rt sph equiv -.75, new +.12), then a turn to the left will decrease the plus power improving his near vision. Check the right eye distance and near vision with a trial frame or hand helds over the eyeglasses.

If that's not it, then supply the true seg height (fiiting cross to the bottommost part of the eyewire using your best guess for the inset), describe how the client is so sure that the problem is the right eye, why a +2.75 Add (instead of +2.50), which eye is dominant, and pathology, if any, beyond the usual haze in 72 year old lens.

In cases like this you can simply check the reading power by holding a -+.25 trial lens or flipper over the reading zone and see if that reduces the issue. I have seen cases in older patients where a add power change in ONE EYE only would solve these issues.

[sharpstick777]

Any 80 years old that is normally on the highest addition which produces on a progressive the smallest corridor, and the fastest transition to the reading part as well as the largest possibel distortion of the lens..................and furthermore has worn clean and clear trifocals will for sure not adapt to the optically worst lenses he can buy. Just put him back in trifocals and he will be thankfull to you forever.
I fully support Chips version.

I fit a 96 year old woman into her first Progressive about 8 years ago, and she was so mad that no one offered her a Progressive before! (she was shaking mad) She loved them, even after wearing a Tri-focal for over 40 years. After that I never fit another tri-focal, and have not to this day.

I would disagree with progressives being the optical worst lens, I would give Executive Bi-focals that honor by far.

Don't give up, you will solve this and have a patient for life.

[optilady1]

I fit a 96 year old woman into her first Progressive about 8 years ago, and she was so mad that no one offered her a Progressive before! (she was shaking mad) She loved them, even after wearing a Tri-focal for over 40 years. After that I never fit another tri-focal, and have not to this day.

I would disagree with progressives being the optical worst lens, I would give Executive Bi-focals that honor by far.

Don't give up, you will solve this and have a patient for life.

Speaking of executive's being yuck, I read a pair for the doctor this morning, and the add was about 20 degrees off from the distance. For all you wise all knowing ones out there, was this normal?

[sharpstick777]

Speaking of executive's being yuck, I read a pair for the doctor this morning, and the add was about 20 degrees off from the distance. For all you wise all knowing ones out there, was this normal?

Unfortunately, you will rarely get great accuracy with Executives any more. They take a tremendous amount of skill to get right and those people with that skill are mostly retired. Or tired. There are a few people here on Optiboard who can do them well though, I think Jacqui does a great job on them.

[kelanor]

I'll apologize in advance because I haven't read this whole thread...but what kind of frame is he wearing? I've had similar problems in the past when patients choose a an aviator style frame and have a relatively narrow pd.

Part of the reading area get cuts out on the nasal edge due to the combo of shape and pd.

[markallen]

really

[snotbagel]

Ok....this RX has ANTI_METROPIA..plenty to throw off near vision in a progressive.

How to fix?..

Autograph 2 11mm fixed corridor, and order a base curve close to his old pair. They will feel like trifocals to him..

BTW, had some patient with bell's palsy, and their near vision excursion was different right and left, as well as one eye lagging vertically. You can mix fixed corridor lengths to match!

[sharpstick777]

Speaking of executive's being yuck, I read a pair for the doctor this morning, and the add was about 20 degrees off from the distance. For all you wise all knowing ones out there, was this normal?

Optilady, I too have noticed the Execs have dropped in quality the last few years. As Jacqui and Chris have said, they can make them well. Unfortunately I can't, and neither can my current suppliers. There is a lot of patience and skill required to make an Exec and those people are becoming rarer.