Help with Vx Physio 2.0 dispensing

[Nana604]

Hi, I'm looking for a little help regarding the Vx Physio 2.0 lenses. I have a customer currently wearing an older non digital progressive lens and I switched her over to a Physio 2.0. When I dispensed it to her, she found the reading is very low and she did purchase a frame with a deeper lens this time. Her old set B box measures 29 and the new one is 33. She's complaining about how she have to push her glasses up for the reading to be clear but then the distance is blurry but her old ones worked fine. I don't know if I should change the corridor or...?

Please help me....Any suggestions would be appreciated!

[uncut]

Welcome to the forum, Nana604. First, I would suggest that a review of the old and new prescription be done............like, did the distance power become more plus. Post the results, here. It would also be nice to know the previous brand this person was wearing.

Next, re-dot the fitting crosses on the lenses, both new and old pair, and compare them. Ensure that the new ones are fitted correctly. What was this height in comparison to the old? This is more important that the difference in B dimension, as one pair may sit higher or lower that the other. Ta

[Nana604]

It is a different rx. Her old pair is -1.50 +2.50 add / -1.25 +2.50 add and now the new pair -1.00 -0.50 x093 +2.50 add/-0.75 -0.50 x 120 +2.50 add. Also, I do not know what brand she's currently wearing, the logo looks kind of like an S and it's really scratched up so it's very difficult to tell. The fitting height is definitely different from her old ones. Her old pair is very beat up and it's all crooked on her. The old ones seems like they have a 16-17 seg height and the new ones are 21.

[SAD: FNAO]

It is a different rx. Her old pair is -1.50 +2.50 add / -1.25 +2.50 add and now the new pair -1.00 -0.50 x093 +2.50 add/-0.75 -0.50 x 120 +2.50 add. Also, I do not know what brand she's currently wearing, the logo looks kind of like an S and it's really scratched up so it's very difficult to tell. The fitting height is definitely different from her old ones. Her old pair is very beat up and it's all crooked on her. The old ones seems like they have a 16-17 seg height and the new ones are 21.

Seems very strange why she would be complaining about this !!
How far is the full NV correction on the PHYSIO from the fitting cross? Contact VARILUX for this info .

[becc971]

try switching her into a short corridor if possible? we just did this for a patient, she's happy as a lark.

[Happylady]

Physio works best fit pupil center. Have you remarked the lenses to make sure they are fit this way? If everything looks good you could switch her to the Physio Short. I have used this lens often with excellent results.

[DanLiv]

If you trust you lab (or better yet edge yourself) you can order the Physio 2.0 (Enhanced in the U.S.) with a shorter seg height but then edge it at the actual height, replicated a short corridor but maintaining the Enhanced benefits (which going Physio Short, even DRx, loses). E.g. if the pupil height in the old frames is 17, order a 17 seg height and then edge it at the new frame's 21mm. The corridor relative to the patient's angles of gaze should then be more similar to the old glasses.

[Celso Cunha]

Dear Nana,


For you solve your problem adjusting to new PAL is important to know the previous design. If you do not know what it is, has no way of knowing how tall he is, because there are different brands of centralization markdowns cross fitting.
Take old lenses to a laboratory for surfacing free form and ask them to make a map and see where this defectometer starting corridor progressive levels of induced astigmatism.


Also note the pantoscopic angle, which is different from the old frame may hinder the use of the field closely.


Celso Cunha
HOYA - Optotal - Brazil

[DanLiv]

For you solve your problem adjusting to new PAL is important to know the previous design. If you do not know what it is, has no way of knowing how tall he is, because there are different brands of centralization markdowns cross fitting.
Take old lenses to a laboratory for surfacing free form and ask them to make a map and see where this defectometer starting corridor progressive levels of induced astigmatism.

That sounds like exploratory brain surgery to diagnose a headache. Sure it would be great to have such info, but overkill. As commenters have said most opticians here have seen this before. You can either adapt the lens to conform to the patient's acquired behavior, or try to adapt the patient's behavior to comply with the new lens parameters. Guess which is easier.

[EyeCare Rich]

My first instinct is More Panto. Maybe a little faceform as well, but like DanLiv stated above, more important is the patients behavior, getting used to new design, it will take just a little time. Not enough difference in script to make it that bad, so I'm thinking design and fit difference.

[Celso Cunha]

Dear Daniel,


Sorry, but I disagree with your observation.
Intolerance new PAL should be observed in a professional manner and with the best technology currently available, which are maps Deflectometer for example, and not an empirical and amateur.
The maps of the PAL design has a large variability in the distribution of areas of field of vision, and are centered variables with very heights of the corridor.
If other variables such as angle optical panto are not evident from the lack of adaptation factor, the evaluation map deflectometers is necessary for a precise solution to the problem.


Regards,
Celso Cunha
HOYA - Optotal - Brazil

[Jason H]

Danliv,

If Physio Enhanced is a molded front design, how much can the corridor be changed (even with digital backside surfacing) depth-wise? At least that portion of the bifocal Rx would be a fixed length no matter which seg height you choose. Wouldn't short corridor be more practical? Mabye the cart is too far in front of the horse here too - I'd like to know her previous brand and double check the segs. Simple things first.

[optical24/7]

The OP doesn't mention if the patient is going from a metal frame to a plastic. Plastic's fit closer (shorter vertex dist). The eye needs to rotate more to reach her full reading.

Essilor has many designs that use the dual add technology they obtained by purchasing Definity ( Ipeso, S series, Accolade Freedom, ect.) Dan gave good advice on how to "work the system" with these designs. Order a shorter fitting height than needed (assuming you edge your own). They will apply more add on the back to shorten the corridor.

[Robert Martellaro]

It is a different rx. Her old pair is -1.50 +2.50 add / -1.25 +2.50 add and now the new pair -1.00 -0.50 x093 +2.50 add/-0.75 -0.50 x 120 +2.50 add. Also, I do not know what brand she's currently wearing, the logo looks kind of like an S and it's really scratched up so it's very difficult to tell. The fitting height is definitely different from her old ones. Her old pair is very beat up and it's all crooked on her. The old ones seems like they have a 16-17 seg height and the new ones are 21.

A 16mm fitting height implies a shorter corridor. This is most likely the primary reason for your client's excessive posturing and general near discomfort with their new lenses. The +.25 sphere equivalent change can not overcome the (suspected) change in corridor length.

You're not the only one to encounter this with folks who switched their very narrow frames from 5+ years ago to the deeper frames today. Add this phenomenon to your watch list for future fittings!

Physio works best fit pupil center. Have you remarked the lenses to make sure they are fit this way? If everything looks good you could switch her to the Physio Short. I have used this lens often with excellent results.

Yup.

Note: All general purpose PALs are designed for center pupil positioning, unless the client is very tall.

If Physio Enhanced is a molded front design, how much can the corridor be changed

As much as is required by fitting height and maybe the lens shape. The regular physic short, in some materials, is generated on a regular corridor Physio.

The OP doesn't mention if the patient is going from a metal frame to a plastic. Plastic's fit closer (shorter vertex dist). The eye needs to rotate more to reach her full reading.

This must be taken into account also! As a rule, we should fit as close as possible, but be on the lookout for poorly fit old frames i.e., vertical midpoint too high, with too much vertex distance.

[DanLiv]

Sorry, but I disagree with your observation.
Intolerance new PAL should be observed in a professional manner and with the best technology currently available, which are maps Deflectometer for example, and not an empirical and amateur.
The maps of the PAL design has a large variability in the distribution of areas of field of vision, and are centered variables with very heights of the corridor.
If other variables such as angle optical panto are not evident from the lack of adaptation factor, the evaluation map deflectometers is necessary for a precise solution to the problem.

Yay, a good professional dispute! I, in turn, disagree with your assessment. I agree this situation should be addressed in a professional manner. Ophthalmic optics relies on not only optical physics but also human physiology, psychology, and behavior, and no amount of theoretical data will solve these equations. This is an empirical matter (so is all the best science), and can be handled no more professionally than by critical observations and the experienced instincts of a good optician.

This thread is full of such good opticians who have by an large made the same professional assessment as I. 9 times out of 10 if a skilled judgment calls for it, the "take two and call me in the morning" solution is the correct approach. If the most obvious course of action does not solve the problem, then further analysis is called for. However, if the most obvious course of action solves the problem, why delve further?

Even if one did map the two lenses, what would you do with that? See that one has a corridor for a 16-17mm pupil height, and the other a longer corridor commensurate with a 21mm height? The solution would be to either train the patient to utilize the longer corridor (hard), restyle the frame to a similar fit to the old one (still hard), or redesign the lens with corridor length similar to the old lens (easy). That is the same conclusion derived by the empirical expertise of the opticians here, without any additional time or expense to patient or optician.

To say that intolerances (and this is a minor one) are only addressed professionally through the application of objective techbnology in lieu of empirical insight and expertise is to dismiss the entire field of professional opticianry. I think even the best ophthalmologist in the world with the most advanced deflectometer in his back room would be a wasteful and poor substitute for a good optician.

[Celso Cunha]

Sorry, but disagree again Daniel, this is not a professional dispute, as well as an ophthalmologist, I am also optical.
All prescriptions optics are a set of optical physics and subjectivity (clinical experience), as well as adaptations or adjustments not the PAL.
But is not that why we leave aside the technology.
If simple and practical solutions to solve the problem, all right. But when we do not resolve to make use of all available technology.
Allow me to disagree yet again their words, ophthalmologists have no deflectometers, are laboratories working with free form surfacing that has.
I have a Rotlex to for my research and evaluations of PAL.

Best regards

Celso Cunha
Hoya-Optotal. Brazil