Results 1 to 5 of 5

Thread: Need recs for PAL optimized for intermediate but with good distance

  1. #1
    OptiBoard Novice
    Join Date
    Apr 2012
    Location
    SF Bay Area
    Occupation
    Optometrist
    Posts
    3

    Need recs for PAL optimized for intermediate but with good distance

    I have a patient wearing Varilux Physio Enhanced who states that it doesn't meet her needs for computer. Reading and and distance is fine. She states that her older pair, also Varilux Physio Enhanced but smaller frame with nosepads, is better. Rx has not changed significantly. Reviewing last year's exam, my notes stated her older pair wasn't meeting her computer needs and I had recommended a 2nd pair NVF last year. Despite my best efforts explaining lens expectations and recommending a 2nd pair NVF yet again, she insists on a single pair of glasses that is optimized for her computer and reading but still has good distance for driving and doesn't understand why her older pair is now better. She states that she has to tilt her head back to get better computer vision. She is on computer 10+ hours/day.

    I've considered the following options.
    1) Add nosepads to frame to move intermediate up. Pt declined because of additional cost.
    2) Remain with Varilux Physio Enhance, and adjust Rx more towards intermediate. Some distance Rx will be lost.
    3) Change to NVF with decent distance.

    Here is Rx and measurements
    Rx
    OD -3.25 -0.25 x 100 30.5/29.0
    OS -3.50 -0.50 x 060 31.0/29.5
    ADD +2.25

    Mono PD (Dist/Near)
    OD 30.5/29.0
    OS 31.0/29.5

    Seg height: 22mm
    Vertical B height: 32mm
    Working distance: 52cm

    Thanks in advance for any advice!

  2. #2
    One eye sees, the other feels OptiBoard Silver Supporter
    Join Date
    Jul 2002
    Location
    Wauwatosa Wi
    Occupation
    Dispensing Optician
    Posts
    5,458
    Quote Originally Posted by DrJennyT View Post
    I have a patient wearing Varilux Physio Enhanced who states that it doesn't meet her needs for computer. Reading and and distance is fine. She states that her older pair, also Varilux Physio Enhanced but smaller frame with nosepads, is better. Rx has not changed significantly. Reviewing last year's exam, my notes stated her older pair wasn't meeting her computer needs and I had recommended a 2nd pair NVF last year. Despite my best efforts explaining lens expectations and recommending a 2nd pair NVF yet again, she insists on a single pair of glasses that is optimized for her computer and reading but still has good distance for driving and doesn't understand why her older pair is now better. She states that she has to tilt her head back to get better computer vision. She is on computer 10+ hours/day.

    I've considered the following options.
    1) Add nosepads to frame to move intermediate up. Pt declined because of additional cost.
    2) Remain with Varilux Physio Enhance, and adjust Rx more towards intermediate. Some distance Rx will be lost.
    3) Change to NVF with decent distance.

    Here is Rx and measurements
    Rx
    OD -3.25 -0.25 x 100 30.5/29.0
    OS -3.50 -0.50 x 060 31.0/29.5
    ADD +2.25

    Mono PD (Dist/Near)
    OD 30.5/29.0
    OS 31.0/29.5

    Seg height: 22mm
    Vertical B height: 32mm
    Working distance: 52cm

    Thanks in advance for any advice!
    Welcome to OB.

    The older pair is 'better' because the Enhanced is a variable corridor lens- a narrow frame/low value seg height gets a shorter corridor, reducing the chin lift needed to bring enough plus power into play for the 52cm work distance, near eye level gaze, assuming a typical desktop monitor.

    The +2.25 Add, an unusually close work distance, combined with a very high frequency of use, strongly indicates computer eyeglasses.
    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.



  3. #3
    OptiBoard Novice
    Join Date
    Apr 2012
    Location
    SF Bay Area
    Occupation
    Optometrist
    Posts
    3
    Quote Originally Posted by Robert Martellaro View Post
    Welcome to OB.

    The older pair is 'better' because the Enhanced is a variable corridor lens- a narrow frame/low value seg height gets a shorter corridor, reducing the chin lift needed to bring enough plus power into play for the 52cm work distance, near eye level gaze, assuming a typical desktop monitor.

    The +2.25 Add, an unusually close work distance, combined with a very high frequency of use, strongly indicates computer eyeglasses.
    Thanks Robert for the info. Yes I totally agree that a 2nd pair NVF is what she needs, and this is the second year I have recommended it. She still insists on one pair to meet all her needs. After much explanation of expectations, I was able to have her prioritize her visual needs and "warned" I may have to take away a little from her distance Rx to optimize computer vision. I even demo'ed +0.50 to +1.00 over distance so she could experience how her distance may be affected. In essence, she reluctantly agreed to redoing her current pair into an NVF and using her older pair for general purpose.

    I'm leaning towards using a Gradal RD or Shamir Office to achieve most of her needs.

  4. #4
    One eye sees, the other feels OptiBoard Silver Supporter
    Join Date
    Jul 2002
    Location
    Wauwatosa Wi
    Occupation
    Dispensing Optician
    Posts
    5,458
    Quote Originally Posted by DrJennyT View Post
    Thanks Robert <snip> I even demo'ed +0.50 to +1.00 over distance so she could experience how her distance may be affected.
    Your welcome. Assuming she wasn't posturing, the +1.00 to +1.50 "over" should have sealed the deal.

    I'm leaning towards using a Gradal RD or Shamir Office to achieve most of her needs.
    Unless she needs distance utility, the trading floor for example, I'd consider a more dedicated computer monitor lens instead of the office or desk lenses, especially under the conditions you described above.

    For simplicity's sake, I'll reduce my Rx to -4.00 add +2.25 OU. Work distances are 25" to 30", and about 16" to the desktop. I used a PAL that has a generous distance zone, Spectrum I believe, with -2.75 on the top aand a +1.00 Add. The fitting cross is aligned with the bottom third of the screen. I have dual monitors at home and both are essentially clear edge to edge. No fatigue, very clear across the entire horizontal field, with zero posturing. You just won't get that type of performance with the 'office' type PALs.
    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.



  5. #5
    Bad address email on file
    Join Date
    Feb 2012
    Location
    Brazil
    Occupation
    Ophthalmologist
    Posts
    20
    Quote Originally Posted by DrJennyT View Post
    I have a patient wearing Varilux Physio Enhanced who states that it doesn't meet her needs for computer. Reading and and distance is fine. She states that her older pair, also Varilux Physio Enhanced but smaller frame with nosepads, is better. Rx has not changed significantly. Reviewing last year's exam, my notes stated her older pair wasn't meeting her computer needs and I had recommended a 2nd pair NVF last year. Despite my best efforts explaining lens expectations and recommending a 2nd pair NVF yet again, she insists on a single pair of glasses that is optimized for her computer and reading but still has good distance for driving and doesn't understand why her older pair is now better. She states that she has to tilt her head back to get better computer vision. She is on computer 10+ hours/day.

    I've considered the following options.
    1) Add nosepads to frame to move intermediate up. Pt declined because of additional cost.
    2) Remain with Varilux Physio Enhance, and adjust Rx more towards intermediate. Some distance Rx will be lost.
    3) Change to NVF with decent distance.

    Here is Rx and measurements
    Rx
    OD -3.25 -0.25 x 100 30.5/29.0
    OS -3.50 -0.50 x 060 31.0/29.5
    ADD +2.25

    Mono PD (Dist/Near)
    OD 30.5/29.0
    OS 31.0/29.5

    Seg height: 22mm
    Vertical B height: 32mm
    Working distance: 52cm

    Thanks in advance for any advice!
    Dear DR JennyT,

    Two situations must be discussed with the patient.

    First question:
    - If she is satisfied in the intermediate vision with your PAL before, or does't?

    If she is satisfied, see if the mounting height, centering mounting cross, and pantoscopic angle are similar. If everything is similar, I suggest requesting a contour map of these lenses deflectometer measurements at a laboratory that works with free form, for compare.

    If she's not satisfied with the old PAL, an occupational lens is recommended. This is common in patients who use more than six hours a day their computers, and have additions greater than 2.00D.

    I hope this helps.
    Regards,
    Celso Cunha

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Distance good, reading good, intermediate bad. A progressive puzzle.
    By AngeHamm in forum General Optics and Eyecare Discussion Forum
    Replies: 28
    Last Post: 02-13-2012, 10:50 AM
  2. intermediate pal (access) or short corridor with intermediate at top
    By tolpuppy in forum Progressive Lens Discussion Forum
    Replies: 7
    Last Post: 08-27-2010, 12:41 PM
  3. Intermediate Distance Correction
    By msawyer in forum General Optics and Eyecare Discussion Forum
    Replies: 13
    Last Post: 03-05-2008, 06:48 AM
  4. Distance/intermediate in computer progressive?
    By Kel in forum Progressive Lens Discussion Forum
    Replies: 6
    Last Post: 11-21-2006, 12:27 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •