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Thread: What would YOU do?

  1. #1
    Master OptiBoarder NCspecs's Avatar
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    What would YOU do?

    Hey kids, I have a hypothetical for us to play with today:

    Lets say I have a patient who is wearing an Accolade or an Ovation from a turn & burn Optical (I know there is a difference but it's been a decade since I've touched either lens) and is complaining vaguely about their intermediate and reading. They are on the computer all day and I have suggested task-specific lenses for their computer work but they won't bite. My natural inclination is to try a different PAL.

    My first instinct is to turn to the Definity or the Hoya IDLifestyle because of the plus shaped corridor. Would you agree with this choice?

    Now lets also take into account the vast possibilities in the differences in Rx, mild to strong refractive correction, astimatic, and higher plus powers. What if the patient has a high cyl? then what?

    I'm looking to pick brains here so keep it useful.
    "Strictly speaking, there are no enlightened beings; only enlightened activity." -Shunryu Suzuki

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    Quote Originally Posted by NCspecs View Post
    Hey kids, I have a hypothetical for us to play with today:

    Lets say I have a patient who is wearing an Accolade or an Ovation from a turn & burn Optical (I know there is a difference but it's been a decade since I've touched either lens) and is complaining vaguely about their intermediate and reading. They are on the computer all day and I have suggested task-specific lenses for their computer work but they won't bite. My natural inclination is to try a different PAL.

    My first instinct is to turn to the Definity or the Hoya IDLifestyle because of the plus shaped corridor. Would you agree with this choice?

    Now lets also take into account the vast possibilities in the differences in Rx, mild to strong refractive correction, astimatic, and higher plus powers. What if the patient has a high cyl? then what?

    I'm looking to pick brains here so keep it useful.
    You might get more responses if you provided the specific rx information.

    Regards,
    Golfnorth

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    Can we pin them down to any more details of their complaint with the channel? I might be inclined to a Shamir fixed-corridor progressive to control the channel accordingly, but unless I know more about what they're unhappy with, I wouldn't touch it at all.

    Either of your lens options will widen the channel considerably, which may be what they were unhappy with in the first place anyway.

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    I'd reach for the Definity.

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    Definity springs to mind immediately. I initially didn't have much success fitting it, but for the right person/environment/lifestyle if its the first that comes to mind I use it
    "what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy

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    Quote Originally Posted by NCspecs View Post
    Hey kids, I have a hypothetical for us to play with today:

    Lets say I have a patient who is wearing an Accolade or an Ovation from a turn & burn Optical (I know there is a difference but it's been a decade since I've touched either lens) and is complaining vaguely about their intermediate and reading. They are on the computer all day and I have suggested task-specific lenses for their computer work but they won't bite. My natural inclination is to try a different PAL.

    My first instinct is to turn to the Definity or the Hoya IDLifestyle because of the plus shaped corridor. Would you agree with this choice?
    It won't help with what is most likely the problem- posturing to bring some plus power into play. See the image below. A short corridor would help somewhat, and a Chemistrie clip will fix the posturing, but will overpower the near zone optics for the desktop, unless you cut it in half so they can look under it, which I haven't tried (just thought of it).

    Now lets also take into account the vast possibilities in the differences in Rx, mild to strong refractive correction, astimatic, and higher plus powers. What if the patient has a high cyl? then what?
    Most of that doesn't matter, except for the add power at 40cm- over +1.75 may need intermediate correction, preferably task eyeglasses when the frequency of use is high. We need to get the power correct, where it's needed, without posturing, offering generous vertical and horizontal zone widths.

    The reading complaint may be a normal reaction to the limits of functionality with PAL near zone placement, an Rx problem, or a PAL design with a too long corridor.

    Task eyeglasses will solve both problems. The key is that "they are on the computer all day", and that they are symptomatic. Even without symptoms, I've trial framed folks who didn't realize they were lifting their chin severely, and were amazed at the clarity when compared to the dinky little area in the corridor where the vision was just only tolerable.

    I'm looking to pick brains here so keep it useful.
    I hope this helped.
    Attached Thumbnails Attached Thumbnails Chin lift.jpg  
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    Master OptiBoarder NCspecs's Avatar
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    Quote Originally Posted by Golfnorth View Post
    You might get more responses if you provided the specific rx information.

    Regards,
    Golfnorth
    Quote Originally Posted by Hayde View Post
    Can we pin them down to any more details of their complaint with the channel? I might be inclined to a Shamir fixed-corridor progressive to control the channel accordingly, but unless I know more about what they're unhappy with, I wouldn't touch it at all.

    Either of your lens options will widen the channel considerably, which may be what they were unhappy with in the first place anyway.
    I'm not thinking of a specific patient, only a general situation that seems to come up a lot in my dispensary. I got to thinking about it yesterday and I thought I would put it out there for my OptiFriends to chew on. I like considering other perspectives- I respect a lot of opinions here.
    "Strictly speaking, there are no enlightened beings; only enlightened activity." -Shunryu Suzuki

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    Master OptiBoarder NCspecs's Avatar
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    Quote Originally Posted by Robert Martellaro View Post
    It won't help with what is most likely the problem- posturing to bring some plus power into play. See the image below. A short corridor would help somewhat, and a Chemistrie clip will fix the posturing, but will overpower the near zone optics for the desktop, unless you cut it in half so they can look under it, which I haven't tried (just thought of it).

    Most of that doesn't matter, except for the add power at 40cm- over +1.75 may need intermediate correction, preferably task eyeglasses when the frequency of use is high. We need to get the power correct, where it's needed, without posturing, offering generous vertical and horizontal zone widths.

    The reading complaint may be a normal reaction to the limits of functionality with PAL near zone placement, an Rx problem, or a PAL design with a too long corridor.

    Task eyeglasses will solve both problems. The key is that "they are on the computer all day", and that they are symptomatic. Even without symptoms, I've trial framed folks who didn't realize they were lifting their chin severely, and were amazed at the clarity when compared to the dinky little area in the corridor where the vision was just only tolerable.

    I hope this helped.
    Beyond useful.

    Thanks Robert, that was fantastic. I need to get the ODs on board with suggesting task-specific eyewear. I truly believe that is the only solution. Also, a big thank you to Fezz and Becc971, I'm glad you chimed in too. You both pretty much validated my typical choice when I can only make one pair.
    "Strictly speaking, there are no enlightened beings; only enlightened activity." -Shunryu Suzuki

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    I have all 3 lenses in the same RX, and my preference is the Seiko Surmount. Although all have wide intermediate, the distance width in the Definity and iD series tend to terribly narrow. In both I can turn my head only a few degrees and get some blurr. At only 30 degrees off center I have lost all DVA in both. There are mixed reviews here but other people report the same issue.

    The Surmounts are not edge to edge clear in the distance, but they are 4 to 6 times wider than the Definity or iD series in my RX. I have double monitors and the Surmount is even wider than most of my computer lenses in the intermediate zones. Its the only lens I don't have turn my head to see both screens.

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    Quote Originally Posted by sharpstick777 View Post
    I have all 3 lenses in the same RX, and my preference is the Seiko Surmount. Although all have wide intermediate, the distance width in the Definity and iD series tend to terribly narrow. In both I can turn my head only a few degrees and get some blurr. At only 30 degrees off center I have lost all DVA in both. There are mixed reviews here but other people report the same issue.

    The Surmounts are not edge to edge clear in the distance, but they are 4 to 6 times wider than the Definity or iD series in my RX. I have double monitors and the Surmount is even wider than most of my computer lenses in the intermediate zones. Its the only lens I don't have turn my head to see both screens.
    You said in a previous post that your add is +1.50. Unless the monitors are very close to your eyes, let's say less than 22", it's likely that your accommodative reserves are sufficient to give you proper focus through the distance correction of you PALs. In other words, you're not using the intermediate portion of the PAL to see the screen, you're using the distance. That's going to change as you get older though, and the first sign will be that you'll have to posture vertically to see small text clearly on a desktop monitor.
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Quote Originally Posted by Robert Martellaro View Post
    You said in a previous post that your add is +1.50. Unless the monitors are very close to your eyes, let's say less than 22", it's likely that your accommodative reserves are sufficient to give you proper focus through the distance correction of you PALs. In other words, you're not using the intermediate portion of the PAL to see the screen, you're using the distance. That's going to change as you get older though, and the first sign will be that you'll have to posture vertically to see small text clearly on a desktop monitor.

    I actually do use the intermediate of my PALs for my computer, even at 1.50 Add. Using the Distance portion my monitor is blurry at about 30". I have to pull back to about 5 feet until my monitor is clear in the distance portion of my RX.

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    Quote Originally Posted by sharpstick777 View Post
    I actually do use the intermediate of my PALs for my computer, even at 1.50 Add. Using the Distance portion my monitor is blurry at about 30". I have to pull back to about 5 feet until my monitor is clear in the distance portion of my RX.
    You're over-minused/under-plusssed at distance, or your add isn't for 40cm. It's time for a refraction! If true, I welcome you to the 'adds over +1.75 club'. You're about to find out how little utility we can get out of the intermediate with progressive addition lenses.
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    Experience is the hardest teacher. She gives the test before the lesson.



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    Quote Originally Posted by Robert Martellaro View Post
    You're over-minused/under-plusssed at distance, or your add isn't for 40cm. It's time for a refraction! If true, I welcome you to the 'adds over +1.75 club'. You're about to find out how little utility we can get out of the intermediate with progressive addition lenses.
    yea, its time. But I got a toss a lot of test lenses in my current RX. time to start testing lenses all over again.

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    Quote Originally Posted by Robert Martellaro View Post
    You're over-minused/under-plusssed at distance, or your add isn't for 40cm. It's time for a refraction! If true, I welcome you to the 'adds over +1.75 club'. You're about to find out how little utility we can get out of the intermediate with progressive addition lenses.
    I should share that I use my intermediate when I reached +1.25 add in a new RX, and in +1.50 even more so. Not everyone accommodates evenly, although we can guess at reasonable working distance, two +2.50 adds may need different working powers at 50". Its one reason we should always refract or at least trial frame to determine intermediate RXs accurately.

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