Help troubleshooting PAL problem

[gogetter]

Story: Mr. S (65yrs) has been having problems with his intermediate vision since picking up 2 months ago. His story has always been consistant. Can see distance great and can see/read a book great, but his computer distance is absolutely not as good as they are in his old glasses. HOWEVER!, in his old glasses his distance was always "very poor, but tolerable" and his intermediate always great.

Comparing: Both lenses are Varilux Physio; Both materials Poly. Shapes slightly different. Old pair more rectangularly curved and new pair more Harry Potter Roundish. Old seg 26, New seg 23. Old Pair full metal. New Pair Framless.
After comparing how the Old glasses sit on his face compared to the way the new ones are fitting, this is where i found consierable differences. 1. The older glasses sit further away from his eyes and the new ones fit very closely. Both have appropriate pano. 2. The Varilux fitting cross is sitting 4-5mm's above his pupil, most likely, for a majority of the time he has had his old pair, prior to buying the new ones. I immediately understood why his distance vision "was always poor, but tolerable". Now that the new ones are sitting perfectly in place hes getting the opposite reaction. "Distance is Great, BUT, Intermediate Sucks".

Notes: He's a business professional who give presentations and speaches and "needs to be able to see his laptop and see his audience at the same time". Evne when he moves the New Glasses around on his face, up, down, further out, he "still cant find a spot that is as clear as the old ones".
I tried adjusting the new glasses to sit how the old ones sit (fitting cross about 5mm above pupil) and his intermediat was still not as sharp. Needless to say distance became horrible.

Is there any other type of lens I should try? I was thinking of a blended bifocal type lens, that can give him Distance and intermediate, but Im not sure which to use because I have not used one on a patient before. I also thought about switching him into the new Zeiss GT2HD PAL, but im not sure if that would be counterproductive. He does not want lined bi or trifocals PERIOD.

OLD RX: +3.00 -0.50x056
+2.25 DS
Add: 2.50

New RX: +2.50 -0.50 x 055
+2.25 DS
Add: 3.00

Is it possible that Mr. S has somehow adapted to wearing the old glasses incorrectly and when wearing the new one with all measurements correctly placed, it is confusing his brain?

Need suggeston on different lens options or fitting options.

** If theres any information that i may be missing please let me know.

Thanks,

GG

[optilady1]

Is it possible that Mr. S has somehow adapted to wearing the old glasses incorrectly and when wearing the new one with all measurements correctly placed, it is confusing his brain?

Yes, sounds like it, since he was viewing his computer distance most likely though his reading portion, if his old glasses were sitting so high. Now he's wearing them where they are supposed to be, and it's much narrower than before. Also, if he was wearing his old ones farther away, he was inducing a lot more plus overall with the glasses, so that is probably screwing him all up too. what I would do, is draw a picture, explaining how his old pal's were sitting so much higher, and he was looking through a different part of them. I'm not really sure which progressive out there have a wider computer area, but I know there are a bunch of lab gal;s and guys who would be able to tell you.

[mcmanisdl@hotmail.]

I recommend verifying the distance correction first. It strikes me as unusual to have .50 decrease on someone 65. He may be overminused, That power was giving him more intermediate. Adjust his old pair and new pair to have similar positioning. If that doesn't work, cut the add to 2.25 so that the intermediate s bigger and move to a PAL with a larger intermediate such as Definity.

[gogetter]

I recommend verifying the distance correction first. It strikes me as unusual to have .50 decrease on someone 65. He may be overminused, That power was giving him more intermediate. Adjust his old pair and new pair to have similar positioning. If that doesn't work, cut the add to 2.25 so that the intermediate s bigger and move to a PAL with a larger intermediate such as Definity.

With the new RX his distance and Near are "the best they have ever been". With that said, would there still be a need to verify the distance? Then intermediate is what "sucks". Will cutting down the add from +3.00 to +2.25 affect how well he sees at near? He realy likes his near vision out of the +3.00.

I did adjust the new pair to fit exactly like the old one and the out come was as follows: He could see a bit better at intermediate but not nearly as sharp as when he has his old glasses on. AND his distance became non-existant because now the fitting cross sits about 4-5 mm's above his pupil (This is how he wore the old glasses for a long time, to which his main complaint was ," My distance sucks, but is tolerable/ functioinable, and my intermediate is great").

I am def open to PALS with bigger intermediates. Thanks for the suggestion. Hopefully it one of my that i will get.

[Nikolay Angelov]

Look at the RX:

Distance power reduced by 0,50D !
Add increased by 0.50D to reach 3.00D. The increase in ADD will reduce corridor width (intermediate zone).

AFAIK the recommendation for PALs is: correcting Far to the MAX and using minimum ADD for near.
I.E. the opposite of what was done.


I believe the Physio is frame and fitting height optimised.
The new eyeglasses progression length has probably been reduced because of the reduced Fitting Height (you can measure it with a good digital lens meter).
This means higher rate of progression in the progressive channel and thus further reduction in corridor width (intermediate zone).


Some options:

Redo the refraction with PAL in mind. Change lens shape to increase fitting height (rimless right?).

Offer an additional Office progressive (occupational PAL), for near, intermediate work and presentations.

You can also use Rodenstock's Impression FreeSign and modify the DF reference point. Bring DF higher to increase Progressive length if intermediate is priority (don't overdo it, since the intermediate will eat in and reduce the distance portion of the lens).


PS: DO NOT duplicate the original horrendous fit. This will make things WORSE.
You will get better results only if you solve the real issues (and do a proper fit).

Best regards,
Nikolay Angelov

[chip anderson]

Have patient hold reading material at the proper distance. Try -0.5 & -0.25 flippers over. If near is still OK but perhaps a little further away, add is too strong.
Very few people need a +3.00 add (I'm 69 and just got to 2.75 and I do a lot of very close small jobs) unless they have a retinal problem (MD, or the like).

Chip

[Robert Martellaro]

It strikes me as unusual to have .50 decrease on someone 65.

Unless he has a nuclear sclerotic cataract(s).

Very few people need a +3.00 add (I'm 69 and just got to 2.75 and I do a lot of very close small jobs) unless they have a retinal problem (MD, or the like).

Chip

I don't like to go over +2.75 in PALs- there's just too strong of a blur boundary and power creep into the distance zones, and narrow zones in general, for most folks to be comfortable with.

gogetter,

Try managing the powers (bump the plus on the distance, cut the add) to help your client see better, or more like his old glasses, when he's at the lectern. Do this with a separate pair of course.

[braheem24]

old glasses are...

+.50 more distance
have a greater vertex on a +3.00
sit 4mm too high

new glasses are

.50 less magnification
sit closer which means more of the above
fit lower which means more of the above

[DragonLensmanWV]

You also might want to try a Hoya progressive. I've found their digital progressives include a more generous intermediate.