Progressive options.

[dave.fant.lab]

Good morning,

I have been in the optical field for just over a year now. As you can see (to the left) I joined optiboard about as soon as I started working in the lab here. I changed careers from a job in Law Enforcement to aspirations of becoming an O.D., I am a biology pre-med major and I have hit the ground running doing lab work and optician work at a local O.D.'s office. I have read a lot of threads and I try to educate myself outside of school on the optical profession as much as possible and I have found this website to be an invaluable resource for quality information. There are a ton of great posters on here.

Recently I have been learning a lot more about progressives and I am trying to keep stock in the best possible progressives to meet our patients needs. We have a full surfacing lab, excluding AR. Presently we use Essilor (which seems to be very much hated on here) Ovation, Accolade, and Small Fit. Younger Image and we use ShoreView's for some of our medicaid patients.

For jobs we can feasibly do in-house, I want progressives that offer better peripheral vision. I know digital progressives and Varilux are both premium type lenses, but are required to be labbed out. I am trying to improve our in-house options. Some patients are not overly happy with the visual fields offered by the Image, Accolade, and Ovation. I have heard a lot about Seiko and Hoya and so far I have read mostly great reviews on them. We are looking to potentially open another account or two for more progressive options, but I want them to be the right type of company that has somewhat reasonable prices to go along with a quality progressive lens. Varilux seems to be somewhat unattainable as our Essilor rep stated it is nearly impossible to get a Varilux account in a smaller sized private practice.

I would love to learn more about Zeiss, Hoya, and Seiko; pros and cons. Also any other lens company recommendations would be more than welcome. I have a lot to learn about the business still, but I am constantly trying to learn new things. Thank you for your time and any help would be greatly appreciated.

[DanLiv]

Accolade is already the pinnacle of Essilor's non-Varilux conventional progressive design, and the big companies aren't releasing new conventional designs anymore (were Shamir's Creation and Genesis the last top brand releases?). Since you're looking only at in-house conventional progressive designs, you're capped at several year old technology, and it not going to get any better.

I would say the best general use non-Varilux conventional progressive out there is the Zeiss GT2. It competes directly with the Varilux Comfort and is certainly a good lens. But then Image and Accolade are great when used properly too. In addition to the product research you're doing I also recommend advancing your progressive fitting skills as much as possible. Even the best lens fails with a mediocre fit, and even a mediocre lens works well when fit perfectly.

[Happylady]

All progressives have some blur in the peripheral part of the lens. The higher the add and the more astigmatism the more blur there is. Some of the ones you use like the Image and Accolade have pretty good distance areas already.

For most people, after awhile the brain doesn't "see" the blur. I know for myself I never notice it unless I try to look for it. But some people are more sensitive.

Fit is really important. Explaining what to expect is important. Telling the patients to give it a couple of weeks and to wear them as much as possible helps. Starting with a weak add when the wearers are in their 40's helps.

[EyeCare Rich]

Well said DanLiv! Right on the mark with every comment made. I agree with the GT2 reference. On the lower cost side, I have fit quite a bit of Vision Ease Outlook for a large safety program around town, and it's been pretty comprable to my Zeiss/Shamir lens portfolio. It's not great, but it does pretty well considering the price point. Fitting and communication are key to a good fitting though, and you have to communicate to get a great fit.

[Happylady]

The GT2 has a great distance but the reading area isn't so great.

[EyeCare Rich]

Guess I haven't had any problems there. Seems to be fine, but it's what my patients expect after conversation with them. We each have our own patient experiences with the designs we use. some good some not so good.

[dave.fant.lab]

Is there a "Holy Grail" of progressives somewhere? I do explain aspects of progressives when fitting that I know about. We sell 4 different levels of progressives; when fitting I explain in general what to expect for each level of progressive: the visual fields, what to expect in terms of peripheral blur, taking time to adjust etc. However, I do not know the exact specifics from progressive to progressive across the board. For example, the GT2 being great at distance, but not as great at reading. I am ignorant to that level of knowledge. I want to learn the in's and out's of all of the types of progressives.

[dave.fant.lab]

Accolade is already the pinnacle of Essilor's non-Varilux conventional progressive design, and the big companies aren't releasing new conventional designs anymore (were Shamir's Creation and Genesis the last top brand releases?). Since you're looking only at in-house conventional progressive designs, you're capped at several year old technology, and it not going to get any better.

I would say the best general use non-Varilux conventional progressive out there is the Zeiss GT2. It competes directly with the Varilux Comfort and is certainly a good lens. But then Image and Accolade are great when used properly too. In addition to the product research you're doing I also recommend advancing your progressive fitting skills as much as possible. Even the best lens fails with a mediocre fit, and even a mediocre lens works well when fit perfectly.

I agree with your assessment. I have improved remarkably in fitting progressives since I entered the optical field a year ago, but I know I have a long ways to go. I am never happy with what I know, I always know I can learn more and learn to do things a better way.

Thank you for your information about the Zeiss lens, we are looking into potentially adding them.

[Robert_S]

In my opinion, the best lenses you can acquire semi-finished are the Kodak Precise and Concise (short corridor). I think you should also seriously consider using the Navigator as your budget option, as it's a design that just works. In the UK, you can't get Zeiss semi-finished... maybe that's not the case in North America? If it isn't, I would get the GT2, as others have said.

i have worked with a company that sells to the public and surfaces our own lenses for over ten years, so I'm basing my opinion on that experience. Customers love both the precise and the concise, and also, surprisingly, the navigator.

[Happylady]

I'm sorry, I was thinking of the original Gradual Top, not the GT2 when I said the reading wasn't good. I haven't tried the GT2, we don't do any Zeiss in the office I work at now.

I have to agree about the Navigator lens. My most recent lenses are the Varilux S 4D, the top of the line Zeiss (the name escapes me-I won it), and the Navigator Short. They are all great, I like the Navigator Short just as much as the other two. I was honestly surprised at that!

[Robert_S]

I just thought of a problem, though... In the UK signet has discontinued their semifinished photochromic lenses in anything other than sunsensors.

[EyeCare Rich]

[QUOTE=Happylady;461014]I'm sorry, I was thinking of the original Gradual Top, not the GT2 when I said the reading wasn't good. I haven't tried the GT2, we don't do any Zeiss in the office I work at now.

Totally agree about the original Gradal Top. Reading was not its strong suite. Fantastic distance area for the era it was launched in. Still a great design for sunglasses if pt doesn't read a whole lot.

[jefe]

Try the Vision Ease Illumina and their new Novella conventional lens.

[Jason H]

A lot of good advice here - but I'll add one thing. With all of the lens styles and especially the explosion of availiable digital product availiability - it's important to bear in mind how increaces in add power affect the width of corridors. In my experience - It is the single most important consideration when coping with complaints about width. Managing patient expectations and taking good measurements are a faster solution to the complaints described, in my opinion. This is just expanding a bit on the opinions above of Happylady and Danliv.

[Happylady]

Jason, you are so right about add powers. They also effect the peripheral areas of the lenses. What I find is if a person is comfortable with progressives it's a non issue. But watch out for the first time progressive wearer at age 55. Especially if they were wearing readers.

[EyeCare Rich]

A lot of good advice here - but I'll add one thing. With all of the lens styles and especially the explosion of availiable digital product availiability - it's important to bear in mind how increaces in add power affect the width of corridors. In my experience - It is the single most important consideration when coping with complaints about width. Managing patient expectations and taking good measurements are a faster solution to the complaints described, in my opinion. This is just expanding a bit on the opinions above of Happylady and Danliv.

Be aware of cyl. as well, that will kill the peripheral in standard progressive design as well. Much better with digital, but still an issue to be addressed when communicating with potential new wearer progressive wearers.

[Robert Martellaro]

But watch out for the first time progressive wearer at age 55. Especially if they were wearing readers.

No problem, just watch them take off their PALs and put on their SVNO to read!

Be aware of cyl. as well, that will kill the peripheral in standard progressive design as well. Much better with digital,

I suspect that very few FBS PAL designs are capable of rearranging the progressive optics when there is substantial Rx Cylinder, especially at an oblique axis, so that they are kept close to the intended design regardless of the Rx. Some of the Zeiss products for sure, probably not many others.

[DanLiv]

Is there a "Holy Grail" of progressives somewhere? I do explain aspects of progressives when fitting that I know about. We sell 4 different levels of progressives; when fitting I explain in general what to expect for each level of progressive: the visual fields, what to expect in terms of peripheral blur, taking time to adjust etc. However, I do not know the exact specifics from progressive to progressive across the board. For example, the GT2 being great at distance, but not as great at reading. I am ignorant to that level of knowledge. I want to learn the in's and out's of all of the types of progressives.

This info is not sitting out there in clear form. You have to hunt it down through dispensing experience, reading lens design articles and product white papers, talking to brand technical staff (reps can be good, but most have poor technical knowledge of their products), and discussing with other opticians. There are lots of poorly educated opticians out there, and the industry isn't doing much to alleviate that.

There is no Holy Grail lens. If there were it would be all we talk about here, and you would know about it. Different designs are better at different things, and once you get familiar with companies' design theories you can understand the effects. With Zeiss, for example, they place huge importance on "zero distortion above the 180", or the patient's pupil height. This promotes better distance vision peripheral clarity because there is almost no more distortion than SV above the 180, but amounts of distortion are theoretically fixed and it has to go somewhere. So they cram more distortion in the near vision zones leading to less width and a "harder" design.

Varilux, conversely, likes to blend distortions widely over the entire lens area. This softens sharpness of vision in all the lens periphery, but since you have the whole lens to soak up the distortion there is less apparent in the near vision areas, so the wearer gets the illusion of a wider reading zone and feels less "swim and sway" from rapid distortion changes. Many wearers are less disturbed by, and often unaware of, the low level DV distortion but definitely notice the ease of wear and good NV.

The newest designs are putting extra emphasis on intermediate zones, previously the most neglected area of vision in a progressive, to address modern mobile and tablet usage. But it's all a trade-off, so that improved intermediate costs the wearer something in DV, NV, or comfort.

Youcan use one lens for every pateint, but you're only going to get maybe at best 70% satisfied wearers. That other 30% really needs some more customized solution. As the optician you have the option to either figure out what else is out there that will address the patient's need, or shrug and say that's the best we can do, get used to it (which is the retail optical solution). You are trying to do the former, so congrats.