Intermediate Question

[PartTimer]

Any help would be appreciated here. I have a patient experiencing issues with intermediate vision and I am still at the beginning of my journey as an optical professional. Patient did not have old lenses when ordering the new pair, and now I have found out through an old receipt what the design was.

Old lenses: Essilor Natural poly. 16 (yes, 16) seg.
OD: plano
OS +0.50 - 0.50 X 105
+1.75 add

New lenses: Unity PLX 15 Fixed design @16mm seg
OD +0.25 sph
OS +0.50 -0.50 X 105
+1.75 add

Exact same B measurement of 26mm as old frame, in general almost identical frame (he didn't want to change much).

Patient is coming in with old lenses for point of comparison, but I'd like to have some ideas before then. My theories are perhaps the new corridor is too short and the design is too soft? I'm thinking about just replicating his old design, but I'd really like to give him a bit of an update, especially since that's what he paid for. If my suspicions are right, perhaps someone can suggest something that incorporates some design features from this side of the year 2000 that might work for him?

[chip anderson]

If it ain't broke, don't fix it.

Chip

[uncut]

If you truly want to help this person see...............start by dispensing a frame with a bigger B dimension..............and heed Chip's well thought out, succinct advice.

[Uncle Fester]

Here is a great read from Opticampus.

http://www.opticampus.com/cecourse.p...essive_lenses/

Scroll down a little more than 1/3 of the page and read about Minkwitz's theorem. Look for the paragraph starting with the number "1" to see why your patient is having trouble (then read the rest of the courses!).

Bookmark the home page and read the other courses. Although you cannot get CE's for them they are a wealth of information. We can thank Optiboarder Daryl Meister from Carl Zeiss for putting it together.

[jspayneii]

I have to agree with the others here. The Natural was originally designed for a 20 seg height. I don't know much about the Unity, but it sounds like the Unity 16mm was actually designed to fit a 16mm seg height. This would essentially compress the intermediate area of the lens.

To uncut's point, a larger b measurement would certainly be beneficial. As well as Chips advice... They are happy with what they had.

[CalCal]

If u can't change the frame I would use the flipper to see if adding or subtracting add power makes any difference. I think the corridor is probably to short. So the flipper can help u determine if less add helps with the computer. Hope this helps and let us know the results. Good luck.

[PartTimer]

Thanks everyone for the sage advice - particularly Chip. Patient will definitely not re-style, he has been adamant on that point. I'll likely just replicate his old lenses.

I've scheduled him time twice already to come by so that I can explain what is likely occurring and resolve the issue. He's flaked both times. If he deigns to show up for his appointments, I might relay the results. Again, thanks to everyone.

Thanks for the link, Fester. I'm studying for cert now, and this will be added to my homework load. Frankly, reading guys like you and Meister's posts in general teaches me quite a bit. Also, shout out to jspayneii for being a worse lurker than I am. 2005 join date? Awesome.

[jspayneii]

Haha! True... I started working in the lab side of the business in 2004 and stumbled across optiboard. Since then, I have gone through phases of checking it frequently and then not at all. Most recently a few weeks ago. I thought I would step out of the shadows and see if I could be helpful.

[Happylady]

I have to agree with the others here. The Natural was originally designed for a 20 height.

I remember when the recommended minumim for the Natural was 24 and the Comfort was 22.

[jspayneii]

I remember when the recommended minumim for the Natural was 24 and the Comfort was 22.

You know, now that you say that... I do remember the minimum seg height changing overnight on the Comfort. The Natural undergoing a similar change would also make sense. Thanks for the correction.

[EyeCare Rich]

You could also choose a longer corridor Unity PLx, and mimic the longer corridor of the Natural, while keeping your "digital" grind.

[PartTimer]

If anyone cares to know the outcome:


After the third reschedule, patient finally did show up. I spent a good amount of time explaining his issues and visualizing things for him. Advised that the best course in the long run would probably be a deeper B measurement; he of course refused, citing his happiness with his previous pair. I remade them in a Natural at 16 seg, and after a few more misses with scheduling, he tried them on and was thrilled. Yet another time when I found it difficult to reconcile objective professional knowledge with the wishes of patients.

This probably comes as no surprise to anyone who responded, and I thank you all for your help. I'll go forward now without attempting to fix the unbroken.

[Robert Martellaro]

Thanks for the follow up. As you learn, we learn.

Your client will really start to appreciate your professional knowledge when the Add power reaches +2.00 or +2.25. Until then, some of these inbetweeners (and others) force us to throw the book out the window.

[Uncle Fester]

If anyone cares to know the outcome:


After the third reschedule, patient finally did show up. I spent a good amount of time explaining his issues and visualizing things for him. Advised that the best course in the long run would probably be a deeper B measurement; he of course refused, citing his happiness with his previous pair. I remade them in a Natural at 16 seg, and after a few more misses with scheduling, he tried them on and was thrilled. Yet another time when I found it difficult to reconcile objective professional knowledge with the wishes of patients.

This probably comes as no surprise to anyone who responded, and I thank you all for your help. I'll go forward now without attempting to fix the unbroken.

A greenie (reputation point) coming your way for the well stated follow up post!

[Celso Cunha]

Any help would be appreciated here. I have a patient experiencing issues with intermediate vision and I am still at the beginning of my journey as an optical professional. Patient did not have old lenses when ordering the new pair, and now I have found out through an old receipt what the design was.

Old lenses: Essilor Natural poly. 16 (yes, 16) seg.
OD: plano
OS +0.50 - 0.50 X 105
+1.75 add

New lenses: Unity PLX 15 Fixed design @16mm seg
OD +0.25 sph
OS +0.50 -0.50 X 105
+1.75 add

Exact same B measurement of 26mm as old frame, in general almost identical frame (he didn't want to change much).

Patient is coming in with old lenses for point of comparison, but I'd like to have some ideas before then. My theories are perhaps the new corridor is too short and the design is too soft? I'm thinking about just replicating his old design, but I'd really like to give him a bit of an update, especially since that's what he paid for. If my suspicions are right, perhaps someone can suggest something that incorporates some design features from this side of the year 2000 that might work for him?

Dear PartTimer.


The PAL has multiple designs, depending on the manufacturer and addition mainly. In your case, you could put a physio that surely the patient would like, because the initial design of these are almost similar (PAL prioritize these two intermediate zone to the detriment of the near zone when used minimum height.
Try searching in the studies of Dr. Sheedy, and the sites www.thelensguru.com or www.lentesprogressivas.com.br (soon) the design of the zones of PAL, and if no complaints, keep the previous design. Complete changes of designer or manufacturer, can not generate adaptations to users.


Regards,
Celso Cunha