Best lens options for different categories of patients

[stedel]

About me:
Hi. I'm a lab tech from Canada. I've been working in optical for just over a year.

My Issue:
A few weeks ago I discovered this forum, and so far I've learnt more about progressives here in a total of a few short hours than in the whole past year from all other sources combined:P. Before finding this board most of the information I got about lenses came from two sources: the opticians' that I work with experience's with various lenses, and sales reps for various companies. Much of what I've been told is... conflicting, to say the least.

Sales reps keep telling me that "digital lenses are wider than conventional!!1eleven1!!", but they can't tell me what "digital" means, nor can most of them even take a shot in the dark about what "freeform" means. I tells ya, Essilor trains their reps well. They also tell me things like "this lens always works for everyone!" I know a sales pitch when I hear it, but I need some help getting to the truth.

My Takeway:
After a few hours of reading threads about lenses and coatings and the like, here are a few things that I think I've gathered:

1. "Digital" doesn't mean much of anything.
2. Essilor is evil.
3. "Freeform" can mean almost anything, and what it means depends on what company you're talking to.
4. What freeform probably *should* mean is "the add power is ground into the lens, not molded onto the front". Close? Yes? No? Maybe? Both? Neither? Quantum superposition of all those options?
5. Essilor is attempting to take over the world one banana stand at a time.
6. Digital/Freeform lenses are often very narrow in the intermediate (moreso than conventional lenses?), despite the sales reps claims.
7. If you make one part of a progressive corridor wider, you have to make other parts narrower. The area of the corridor remains the same.
8. Essilor lenses suck.
9. Nikon Canada (or Nikon as a whole?) uses Essilor lenses, even though their rep tells us they are better. Is this true of anyone else? Who knows... certainly not the sales reps selling the product.

My Problem:
I'd say 80+% of our customers are heavy computer users (I'm told Canadians are among the worst internet addicts? I wouldn't know, with all my long hours online I don't have the time to find someone and ask), and many want a single lens with with wider intermediate that they can still drive in and read with. We sell a separate pair of computer lenses to everyone who will buy them, but some people just don't want to switch between two pairs. I'd ask sales reps what I should be selling, but they're all useless idiots.

My Question:
Right now we sell like 30 different lenses and I just don't see the point. It seems like each optician has their favourite lenses and pushes that lens on everybody. So I'd like a list of a lens or two that will be best for each of the following categories:

• Hyperops
• Myops
• Hi adds
• Low adds
• Heavy computer users (wide intermediate) <---- nearly all our patients want wider intermediate
• Short corridor
• An excellent computer lens
• A lens that's good for people who can't adapt to anything else.

I'm gone for the weekend, so I'll check back in on Monday or Tuesday. Thanks in advance for any advice!

[uncut]

Great first post......that Saskatchewan humor, cold as it is, reallly shines through.

Advice: Fit more trifocals. ......or multifocal contact lenses.

[golfnut]

I have had great success with shamir Intouch for people demanding more intermediate. Also, Icentari intermediate from central optical has done extremely well for us. I use them for a wide variety of RX'S.

[DanLiv]

Right now we sell like 30 different lenses and I just don't see the point. It seems like each optician has their favourite lenses and pushes that lens on everybody. So I'd like a list of a lens or two that will be best for each of the following categories:


Hyperops
Myops
Hi adds
Low adds
Heavy computer users (wide intermediate) <---- nearly all our patients want wider intermediate
Short corridor
An excellent computer lens
A lens that's good for people who can't adapt to anything else.!

One of the most flexible designs out there right now is Zeiss Individual 2. As a fully position of wear compensated backside "freeform" design with variable corridors AND variable design to give sifferent priority to distance, computer, and near, it could take care of most your fits (since "moderately priced" wasn't one of the criteria). Certainly takes care of short corridor, wide intermediate, and can easily handle high/low adds and hyper/myopes.


I haven't had much experience with it, but for high hyperopes and with high adds, Seiko Surmount is specifically designed for such an Rx. It sure is thin too.


My general "easy fit" lens for people who are finicky is still Varilux Comfort. There is a reason that design has been so popular for so long. The DRx and Enhanced versions get you digital benefits, but it does much with the classic design. I have had conventional Comfort wearers non-adapt to both DRx and Enhanced. Put em back in conventional, everything's dandy again. I think that design is still the best overall balanced lens I've ever fit.


Computer lens? What's not to love about Auto 2 Office? Well priced too. Dunno anything about the new office and workspace coming from Shamir, but everything they make is solidly decent.

Please post more. You are hilarious. :)

[Imran520]

Thanks. These options are useful for patients to choose the lens.

[NCspecs]

My Problem:
I'd say 80+% of our customers are heavy computer users...and many want a single lens with with wider intermediate that they can still drive in and read with..


My Question:
Right now we sell like 30 different lenses and I just don't see the point. It seems like each optician has their favourite lenses and pushes that lens on everybody. So I'd like a list of a lens or two that will be best for each of the following categories

About heavy computer users:

I always explain as succinctly as possible to these patients that they are asking a lot out of a little piece of plastic. They will be able to multi-task beautifully with their progressives but more often than not they will find themselves struggling to do something task specific for long periods of time. I stress this with first time progressive wearers...do not expect these lenses to function like 20 year old eyes.

They don't have to get the computer or hobby specific glasses immediately, let them function a while on their own and let them come back to you when they realize you've pinpointed their needs perfectly. Works for me everytime.


About PALS:
I know you "don't see the point" grasshopper. You are only a year in. Work anywhere else and you'll wish you had 30 different lens types at your fingertips. I can't tell you how many practices here in North Carolina use only Essilor because it saves their "Opticians" from critical thinking/problem solving. Easy just to use one (expensive) brand and not venture any farther.

This is a post for Sharpstick777 if ever I saw one!

One of the most important things he has taught me is the difference in corridor designs. I fit lifestyles AS WELL as perscriptions based on all that I have learned from him. Search his posts on PALS, I have learned so much from him.

[stedel]

...I always explain as succinctly as possible to these patients that they are asking a lot out of a little piece of plastic...do not expect these lenses to function like 20 year old eyes.

That seems like good advice:). It seems like some of our customers expect us to work miracles. Unfortunately neither bionic occular implants nor Geordi`s visor exist just yet (at least not as they appear on TV), so for now they`ll just have to due with our available low tech.

I know you "don't see the point" grasshopper. You are only a year in. Work anywhere else and you'll wish you had 30 different lens types at your fingertips. I can't tell you how many practices here in North Carolina use only Essilor because it saves their "Opticians" from critical thinking/problem solving. Easy just to use one (expensive) brand and not venture any farther.

Ok:). I don`t see the point, but I`ll certainly acknowledge that my lack of perception (haha) may well be due to ignorance.

This is a post for Sharpstick777 if ever I saw one!
One of the most important things he has taught me is the difference in corridor designs. I fit lifestyles AS WELL as perscriptions based on all that I have learned from him. Search his posts on PALS, I have learned so much from him.

I`ve seen a few of his posts, and they`re fantastic! Speaking of corridor designs, that was among my first questions when I started ordering progressives. I`ve yet to be satisfied with the answers people have given me. Hopefully someone here can enlighten me on this subject... and many others as well.

[stedel]

So far recommendations are as follows:

Intermediate: shamir Intouch
General Use: Zeiss Individual 2
Hypers: Seiko Surmount
Conventional: Varilux Comfort
Computer: Auto 2 Office

I have a few questions and comments about those lenses:).

Intermediate: shamir Intouch -- We don`t currently sell Shamir lenses. I don`t suppose anyone has another recommendation?
General Use: Zeiss Individual 2 --We already sell this occasionally, but we don`t have a Zeiss terminal to do all the measurements. Is one really necessary?
Hypers: Seiko Surmount -- I just found a supplier that I like for this lens. I`ll give our impression of this lens once we have more experience with it.
Conventional: Varilux Comfort -- Essilor stopped supplying this lens to us. They only make DS and 360 versions now. I assume it still available through 3rd party labs?
Computer: Auto 2 Office -- Another Shamir lens:(.

[Fezz]

That seems like good advice:).

I`ve seen a few of his posts, and they`re fantastic! Speaking of corridor designs, that was among my first questions when I started ordering progressives. I`ve yet to be satisfied with the answers people have given me. Hopefully someone here can enlighten me on this subject... and many others as well.

Lots of good corridor education in this thread!

http://www.optiboard.com/forums/show...raph-II-Fitter

[NCspecs]

I`ve seen a few of his posts, and they`re fantastic! Speaking of corridor designs, that was among my first questions when I started ordering progressives. I`ve yet to be satisfied with the answers people have given me. Hopefully someone here can enlighten me on this subject... and many others as well.

I wish I could buy you a beer and set you down for a spell. I think you and I are like minded, cut the BS, tell me WHY it works. :)

[Fezz]

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

http://www.optometry.co.uk/uploads/a...13-c-33557.pdf

http://www.opticampus.com/files/fund...ive_lenses.pdf

[EyeCare Rich]

In an earlier post you said, "General Use: Zeiss Individual 2 --We already sell this occasionally, but we don`t have a Zeiss terminal to do all the measurements. Is one really necessary?"

The answer is, no. You don't have to have the ITerminal to fit this lens. You don't even have to do point of wear (POW) measurements to fit the lens. You can do manual measurements using tools provided by Zeiss, or any other lens company doing POW measurements. You don't however get everything possible vision wise without POW measurements on this lens, and a couple others out there. The design is sufficient to be a pretty darn good lens without those POW measurements though. Great questions Stedel!!! Welcome aboard, hope you enjoy the ride on OptiBoard. Lot's to learn here, with a good sence of humor, you will go far!!!! Just ask Johns!

[ChrisinNH]

I see there is a Sheedy Report from 2006...is there some kind of newer version of this report or one someone else did that may be of assistance in picking a lens?

[Robert Martellaro]

I see there is a Sheedy Report from 2006...is there some kind of newer version of this report or one someone else did that may be of assistance in picking a lens?

This may help. http://www.thelensguru.com/index.php/maps.html

My Takeway:
After a few hours of reading threads about lenses and coatings and the like, here are a few things that I think I've gathered:

1. "Digital" doesn't mean much of anything.
2. Essilor is evil.
3. "Freeform" can mean almost anything, and what it means depends on what company you're talking to.
4. What freeform probably *should* mean is "the add power is ground into the lens, not molded onto the front". Close? Yes? No? Maybe? Both? Neither? Quantum superposition of all those options?
5. Essilor is attempting to take over the world one banana stand at a time.
6. Digital/Freeform lenses are often very narrow in the intermediate (moreso than conventional lenses?), despite the sales reps claims.
7. If you make one part of a progressive corridor wider, you have to make other parts narrower. The area of the corridor remains the same.
8. Essilor lenses suck.
9. Nikon Canada (or Nikon as a whole?) uses Essilor lenses, even though their rep tells us they are better. Is this true of anyone else? Who knows... certainly not the sales reps selling the product.

1. Yes
2. No.
3. It's a manufacturing platform.
4. No. Think of it like error correction on optical disc drives.
5. Something like that.
6. No.
7. http://www.opticampus.com/files/prog...presbyopia.pdf
8. No.
9. http://www.optiboard.com/forums/show...l=1#post472027

My Problem:
I'd say 80+% of our customers are heavy computer users (I'm told Canadians are among the worst internet addicts? I wouldn't know, with all my long hours online I don't have the time to find someone and ask), and many want a single lens with with wider intermediate that they can still drive in and read with. We sell a separate pair of computer lenses to everyone who will buy them, but some people just don't want to switch between two pairs. I'd ask sales reps what I should be selling, but they're all useless idiots.

Use a 'computer' lens, not an 'office' lens, that is, a multifocal lens with the distance set for monitor distance, the near for the desktop.

My Question:
Right now we sell like 30 different lenses and I just don't see the point. It seems like each optician has their favourite lenses and pushes that lens on everybody. So I'd like a list of a lens or two that will be best for each of the following categories:

• Hyperops
• Myops
• Hi adds
• Low adds
• Heavy computer users (wide intermediate) <---- nearly all our patients want wider intermediate
• Short corridor
• An excellent computer lens
• A lens that's good for people who can't adapt to anything else.

I'm gone for the weekend, so I'll check back in on Monday or Tuesday. Thanks in advance for any advice!

Hyperopes need slight softer boundaries, longer corridors, an slightly wider near zone width. Myopes need slight harder boundaries and slightly shorter corridors. This is due to object displacement from prismatic effects, and from magnification/minification.

Hope this helps,

[optical24/7]

Robert nailed your questions. Also, read everything Robert writes!

[sharpstick777]

I'd like a list of a lens or two that will be best for each of the following categories:

• Hyperops
• Myops
• Hi adds
• Low adds
• Heavy computer users (wide intermediate) <---- nearly all our patients want wider intermediate
• Short corridor
• An excellent computer lens
• A lens that's good for people who can't adapt to anything else.

I'm gone for the weekend, so I'll check back in on Monday or Tuesday. Thanks in advance for any advice!

Hyperops: Seiko Surmount, Zeiss Individual 2, Definity (only the Surmount and Individual offer fully free-form optomized corridors in the US, Zeiss will hold an edge in higher Hyperopes because its more adaptive and allows slightly higher BC in high plus powers, as it goes to dual add)
Myopes: Most lenses are optimized for low myopes, so its fairly easy. For high Myopes the Auto III, Seiko Superecede, Zeiss Individual, Shaw Lens, Stealth PRO HD, and Ice-Tech.
Hi adds: Harder designs: for wider corridors: Surmount WS, iD/Lifestyle, Supercede, not as hard but the Definity is decent. For better distance: Zeiss Individual, Shaw Lens, Stealth HD, Shamir Spectrum, the Auto series will provide good distance and low distortion in high adds, but the corridor does narrow more than other, must pair with Office type lens.
Low adds: Softer designs: Shamir InTouch, Zeiss Choice, Seiko Succeed, Autograph Series
Heavy computer users (wide intermediate) <---- nearly all our patients want wider intermediate: Seiko Surmount is often 4-8X wider in the intermediate than most progressives.
Short corridor. Any lens that has multiple corridor or variable fitting options, (like 14,16,18, 20) All newer Free-form Zeiss, Seiko and Shamir adapt well to shorter corridors, MUST be 100% Free-form, HYBRID Lenses do NOT do well in shorter corridors. lenses with only 2 fitting heights do not do as well.
An excellent computer lens: Shamir Office /Desktop, Seiko PC Wide, Zeiss has new options but I have not tried them.
A lens that's good for people who can't adapt to anything else: The Seiko Surmount with its reverse geometry design often works with spacial distortions, as does the Autograph series due to its very low distortion and soft design. Prism? iD Lifestyle, Definity, Surmount Large Reading: Stealth Plus or Stealth Pro RD Aniseikonia and Anisometropia: The Shaw Lens (ps, server is not allowing me to edit this well)

[sharpstick777]

1. Digital/Freeform lenses are often very narrow in the intermediate (moreso than conventional lenses?), despite the sales reps claims.
2. If you make one part of a progressive corridor wider, you have to make other parts narrower. The area of the corridor remains the same.
3. Essilor lenses suck!

1. 1. That is due to 2 major reasons. When progressives first launched they competed against the ST-28, so they often kept the reading wider, at the cost of the intermediate, because computers were simply not widely used then. Today, most lenses are distance emphasized, which means the reading and intermediate is narrower. Most T and Hourglass shaped designs will have VERY narrow intermediate zones as result. The second reason is that as add power goes up, the lens either must get harder or the reading will narrow. Most manufacturers choose a little harder, and little loss of reading width today. 2. yes, its also more true in higher adds and shorter corridors 3. I have been very disappointed in Essilors recent lens releases, but I have no doubt that they will make improvements in the future.

[Happylady]

Definity lenses have wide intermediates compared to many other progressives. One of the best things computer users can do is lower their monitors. If someone is having to raise her chin to see the computer, the monitor is too high!

Problem with above-most monitors don't adjust up and down. They should but they don't.

[jonadonis]

By far the most intelligent question I have ever heard an optician ask! My answer ignores all the new digital and freeform labels and hits the basics of PAL Magic. Please read my article at: http://jutwald.com/2013/08/07/op-blog-3-pal-selection/ Thanks,

Jonadonis

[Happylady]

By far the most intelligent question I have ever heard an optician ask! My answer ignores all the new digital and freeform labels and hits the basics of PAL Magic. Please read my article at: http://jutwald.com/2013/08/07/op-blog-3-pal-selection/ Thanks,

Jonadonis

Interesting but I'm a little confused. You place lenses in different groups based on corridor length but you also mention the corrections. So for corrections over -7, the only lens you would use is the Autograph 2? Am I reading this correctly?

[jonadonis]

Close! Please name for me a list of your favorite lenses that have a minimum fitting height of 12 mm. Any of them would work well on a -7 patient. Fit normally, the reading section will be in the right place with an ultra short lens. She would hate a Comfort or Y image because the reading area will be in the basement. On the other extreme, if her hubby walked in the door a +3, he would love the Y image because, fit normally, the reading section is exactly in the right place. For him, it also takes a bigger B measure. He would hate the short lens because it has no intermediate range (in his Px).
Allow me to logic this a little differently. If we can get any corridor length we want between 12 and 26, why do we put people in short corridor lenses? To fit smaller frames? Not me! Then why don't we put everybody in short lenses? Because it does not work optically. High plus? Long lens. 20 deg panto. A little extra vertex just magnifies more. High minus? Short lens, little panto, little vertex. There are reasons for the exceptions. Thanks for reading.

jonadonis

[Happylady]

Interesting ideas, but I've had very good success with short corridor lenses, even fit at 19 or 20 high. One of my personal favorites is the Physio Short and I have fit with on both + and - corrections.

[jonadonis]

Interesting ideas, but I've had very good success with short corridor lenses, even fit at 19 or 20 high. One of my personal favorites is the Physio Short and I have fit with on both + and - corrections.

I agree, sort of. Personally I have successfully worn a Physio Short. My Px is +0.75 with a 2.25 add. I would use the same lens for a patient with Px -1.00, 2.25 add. The relevant fact is, the Phys St. is not a short lens. It is a mid length lens just like the Nav Short, the Definity Short, the Seiko Proceed II and the Precise Short, as it says in my article. I fit them at 18 all day. All of these are shorter than Comforts, Adaptars and Images. Does that make them short? No. A COSE soft 14 is a short lens. A Sh Att III 12 is a short lens. A Zeiss GT2 Short is a moderately short lens.

Thanks,

jonadonis

[mervinek]

Definity lenses have wide intermediates compared to many other progressives. One of the best things computer users can do is lower their monitors. If someone is having to raise her chin to see the computer, the monitor is too high!

Problem with above-most monitors don't adjust up and down. They should but they don't.

+1 I feel like I need to have that tattooed on my forehead! Lower your monitor or raise your seat with progressive usage!

[stedel]

I'm just going through a Seiko pricebook right now and determining selling prices and such for the various lenses we're going to sell, and I came across the Seiko Supernal. Does anyone know what type of person that lens is targeted toward? The marketing material that came with the pricebook suggests that it crosses over with or replaces the Surmount, but I don't trust PR.