Why not SV instead of PALs?

[NCspecs]

I've had a few patients lately who have had the same issue; formerly myopic, now presbyopes, the add power in the rx cancels out the distance in a PAL and they feel like they can just wear their progressive lenses for distance only and see fine at intermediate or near. Not interested in a Ft28 (not surprising in this section of town) and marginally interested in retaining their PALs. Most just throw their glasses in their purse or pocket when they aren't driving or looking at long distances.

My question is this: even though the OD has written an Rx for multifocals, the Pt isn't using them as such and I perceive a lot of abivilence regarding their current PALs. Why not just fit them in a distance Rx and call it a day? Am I doing the Pt a disservice by switching to a distance SV lens from a PAL? I know it could be an issue of the design of lens not being conducive to their lifestyle but should I even attempt a design switch (of PAL) when I know they are just going to be annoyed with the plano at the bottom of the lens anyhow? Thoughts? Concerns? Protestations?

[optical24/7]

Keep in mind for such a patient, PAL's keep them from having to take their glasses off every time they wish to see something near. It can be for convenience that they wear a PAL. Another option is to use either a short "B" frame or customize a rimless/semi-rimless to shorten the B so they can look under their lenses for near tasks. You can also consider adding a Chem clip to them for intermediate tasks if their Rx calls for power at 25 inches or so.

[rbaker]

Why not SV instead of PALs? Why not.

[becc971]

i frequently offer this as an option to people who tell me they take their glasses off to read, or if i'm nervous about putting them in a bi-focal, but most of the time they don't want the on/off inconveniencE :)

[waynegilpin]

"the add power in the rx cancels out the distance in a PAL and they feel like they can just wear their progressive lenses for distance only and see fine at intermediate or near."

______

My wife was in that situation for a few years and kept taking her glasses off when she was reading for any extended period. I kept asking her if there was a problem with the progressives and she always said no. Just preferred to take them off to read. Mentioned it at work one day and someone said, "Why wouldn't she take them off? They're not helping her see any better to read and she gets a bigger field without them."

Duh! Gee kids, THAT could be it. I hate it when I'm not as smart as I think I am.

When the Rx changed a few years later and she needed power again, she stopped doing it.

[DanLiv]

For these customers, and the converse when they are a presbyopic near emmetrope, the benefit of progressive (or multifocal in general) is just as optical24/7 said, they don't *have* to take their glasses off to read, or have to take their glasses off to see distance. I similarly have customers who take their progressives off to read, or only put them on to read. First I press them to make sure they *always* remove them in those cases, rather than just sometimes, because if they do use them more often than they think and you take away that utility by going SV, they and you may find the hard way it was a mistake. But if you discuss it with them and they agree they are really only using the progressives like SV anyway, then one doesn't need to push them to stick with multifocal. It's about convenience, so if it's not convenient, ditch it.

However, I also advise them that their add will increase, and eventually their natural ability to read or see distance without assistance will deteriorate, or the add will get high enough they have to put on reading glasses 50 times a day because everything inside 5 feet is blurry. They are going to be right back into progressives again then, and the narrowness will be even less pleasant with increased add. Keeping the progressive even if they feel they aren't using it much at least keeps their brain acclimated and eases them into heavier usage in the future. A few agree and keep the progressive, but at least in the others they are advised that their current SV option may disappear in the future.

[uncut]

"Come here and look at this, Sweetheart! She said in a sultry voice.

"I panicked, and quickly searched for my minus 2 with a plus 2 add multifocal....where, oh where, did I put them!. On the car dash? On my lap? Are they in the glovebox? If they are, I will have to reach over, discreetly open it while I "distract her" and put them on."


Well....you get the picture....this interlude is brought to you by the makers of multifocals, professionally fitted......see listing under Opticians, or Optometrists.

[mervinek]

It's understandable that they would take them off for long term close work because they would have a wider viewing area...no boundries. That being said, if they are shopping for example, or eating at a restaurant, they would be able to keep them on and see all viewing areas without taking them off. It gives them a choice. SV only would not correct for intermediate and would not give them a wearing choice.... they would HAVE to take them off for close work. I always recommend them this way. Use progressives for "every day" use and take them off (If RX permitts) when doing long term NVO work if they decide.

[uncut]

I've had a few patients lately who have had the same issue; formerly myopic, now presbyopes, the add power in the rx cancels out the distance in a PAL and they feel like they can just wear their progressive lenses for distance only and see fine at intermediate or near. Not interested in a Ft28 (not surprising in this section of town) and marginally interested in retaining their PALs. Most just throw their glasses in their purse or pocket when they aren't driving or looking at long distances.

My question is this: even though the OD has written an Rx for multifocals, the Pt isn't using them as such and I perceive a lot of abivilence regarding their current PALs. Why not just fit them in a distance Rx and call it a day? Am I doing the Pt a disservice by switching to a distance SV lens from a PAL? I know it could be an issue of the design of lens not being conducive to their lifestyle but should I even attempt a design switch (of PAL) when I know they are just going to be annoyed with the plano at the bottom of the lens anyhow? Thoughts? Concerns? Protestations?

Thoughts:

Avoid being coerced, commissioned into the "onepairswissarmyknifeeyeglasses" mentality.

Concerns:

Management/public tries to make all patients/products fit into the littlequare box of utilitariansim. It's a North American phenomena, really. Dropit.

Protestations:


Management take note:

Allow your dispensers to put humanity and individualism on the front lines......give them enough time/education to help them discern and implement eyewear multiples with the person's job, lifestyle, anatomy and optics, influencing the number and type of eyewear dispensed. Give them the wisdom and warehouse of raw material to build visual devices that rock! The people they help may not instantly want everything, but usually will come back to purchase suggested specialty devices.


NC:

A distance pair is a superior channel surfing from an armchair device.

Your question of disservice.....none, unless the patient never utilizes the most important power in their arsenal of eyewear. In the cases eluded to in your post with myopes that the add is zeroish powers, but if their add calculates to plus .25 or more, the disservice begins.

[Happylady]

I can do this, I see fine up close with no correction. I did make myself one pair of distance only clear glasses and I have a pair of distance only suns.

I greatly prefer my progressives. The distance only clear ones were good for watching TV in bed but not being able to see close was a hassle. This was a few years ago and they were narrow and I kept having to look under them. Tried it and hated it and left them by the bed.

I do wear the distance only suns but I prefer my suns with the progressive. They are okay for driving or for a walk but any other time I don't like not being able to see up close. I have no issues with my progressives- I see great with them. I do sometimes remove them for extended close work.

I offer people a choice of distance only sunglasses and discuss the pros and cons. I think the lower powered myopes that don't wear progressives/bifocals often just wear their glasses for driving/tv/movies and walk around in a slight blur most of the time.

[NCspecs]

Thanks y'all.

I guess no one has mentioned any solutions/problems I haven't thought of myself. I'm a big fan of task specific eyewear; I always suggest a pair of reading only or computer only SV glasses especially to my first time PAL wearers.

I guess at the end of the day I'm going to just educate the patient regarding their options and let them tell me what they think they may need. I haven't taken anyone away from a progressive back to a SV yet.

Great to hear so many perspectives, appreciate all the unique feedback.

Oh...and thanks for keeping it classy. ;)

[SeaU2020]

When they say they see better without the pal, that's all I need to hear. They can have s/v. I explain that I am the opposite...I have 20/20 distance but I CHOOSE progressives so I don't have to take my glasses on and off all day long. It's like I think a hard case is always better, but if a person wants a soft case because they won't use a hard one, let them have it the way they want it.

[Now I See]

FWIW...I do well with SV, but opt for my PAL, not because I can see sooooo well through them, nope...it's because when I am reading or doing any kind of up close activity, I can't accommodate back to distance very quickly. My vision stays blurry for a long time...it's very uncomfortable. With my PAL's I can accommodate much easier, and my eyes don't feel as tired. If you haven't, I would try to get a feel for whether the patient is having any difficulty accommodating, if accommodation is the cc, then you might want to keep them in the PAL.

[SeaU2020]

FWIW...I do well with SV, but opt for my PAL, not because I can see sooooo well through them, nope...it's because when I am reading or doing any kind of up close activity, I can't accommodate back to distance very quickly. My vision stays blurry for a long time...it's very uncomfortable. With my PAL's I can accommodate much easier, and my eyes don't feel as tired. If you haven't, I would try to get a feel for whether the patient is having any difficulty accommodating, if accommodation is the cc, then you might want to keep them in the PAL.

Good point! That's a perspective I hadn't considered.

[NCspecs]

FWIW...I do well with SV, but opt for my PAL, not because I can see sooooo well through them, nope...it's because when I am reading or doing any kind of up close activity, I can't accommodate back to distance very quickly. My vision stays blurry for a long time...it's very uncomfortable. With my PAL's I can accommodate much easier, and my eyes don't feel as tired. If you haven't, I would try to get a feel for whether the patient is having any difficulty accommodating, if accommodation is the cc, then you might want to keep them in the PAL.

Good point! That's a perspective I hadn't considered.

Me either, thanks for that. This is exactly the discussion I was looking for, appreciate it!