Common Problem with PAL

[justdhogan]

I have had an issue many times with PAL wearers. The complaint is "I can see better if I lift my lenses up" On the surface it would tell one it is a seg height issue. So we remake them 1mm, 2mm, 3mm, or even higher and.... Same problem. So I'm at a loss. Go to the Doc and then he's frustrated by cost and unhappy patient. And the problem won't happen again for a long time, then bam....Here's another one. Various lens designs, materials, base curves, and lens designs. So I have a theory: If they have been fit high before on their seg and adapted to it, does that essentially not change what they need for correct fit correction?

[NCspecs]

BC and material have nothing to do with a fitting issue. This is an important reason to remember to check what a patient was wearing previously and do some critial thinking before making new lenses.

Three possible reasons why this is happening:

1. the Pt was previously wearing a short corridor lens and has grown accustomed to where the near in a short corridor is situated. My advice in most of these cases is keep them in what they like or prep people if you are going to change their PAL. after shelling out a couple hundred bucks most people don't appreciate irritating surprises.

2. You are fitting only one kind of PAL and surprise, surprise it doesn't apply to everyone. This is why I adore variable corridors- I'm the boss of the near, we aren't at the mercy of the design. Fit on the OC and adjust the corridor if necessary. Have a good repotoire of lenses in your optical batman belt so you can fit according to Rx, budget, and lifestyle.

3. You learned to take segs from an old-timer who thinks everybody should be in a Comfort with a dropped seg about 4 mm below the OC. If this is the case, staaaaaaaaaap! ;)

[D_Zab]

Did you try adjusting the frame to reduce the panto? What lens designs are your patients wearing?

Like NCspecs mentioned if you are fitting everyone in the same lens design there may be the occasional adaptation issues when switchign from a frame with less B measurement or a lens where the fitting height was a little off, putting them in a smaller fixed-corridor design may help. Otherwise switching them to a lens that factors in POW measurements may resolve the issue.

[opty4062]

BC and material have nothing to do with a fitting issue. This is an important reason to remember to check what a patient was wearing previously and do some critial thinking before making new lenses.

Three possible reasons why this is happening:

1. the Pt was previously wearing a short corridor lens and has grown accustomed to where the near in a short corridor is situated. My advice in most of these cases is keep them in what they like or prep people if you are going to change their PAL. after shelling out a couple hundred bucks most people don't appreciate irritating surprises.

2. You are fitting only one kind of PAL and surprise, surprise it doesn't apply to everyone. This is why I adore variable corridors- I'm the boss of the near, we aren't at the mercy of the design. Fit on the OC and adjust the corridor if necessary. Have a good repotoire of lenses in your optical batman belt so you can fit according to Rx, budget, and lifestyle.

3. You learned to take segs from an old-timer who thinks everybody should be in a Comfort with a dropped seg about 4 mm below the OC. If this is the case, staaaaaaaaaap! ;)

Agreed. Don't underestimate the value of a critical look at what your patient currently wears. The type of lens, fit and segs etc, are important. Also, when you have to ask to see the current ones and they take them out of the case, they will usually put them on all snug up on their face, kinda like people who suck in their gut to make their pants fit look better. Make sure to observe their natural posture and where they usually wear their frames. For example, my Dad wears trifocals and when the frame is snug on his face the seg is way too high. He prefers to wear them down his nose a bit because he also has hearing aids and this is most comfortable for him.