High astig--best progressive?

[haliopt]

Customer has a Rx of +3.75-8.00*172 +2.25
+3.75-5.75*013 +2.25

She wants to try progressive lenses. Any idea (experience) what lenses may be the best? I use Panamic more times than not for most customers.

Thanks Haliopt

[Texas Ranger]

I'm a big Panamic fan too, but I think i'd try this with an atoric rodenstock multigressive II in 1.6 AR. AR is important on high cyl rxs because of the weird nature of the ghost images they produce...and be especially sure you have exact monocular pds' and monocular seg heights...

[Robert Martellaro]

I'm pretty sure the multigressiv cuts off at four diopters of cylinder. But I would strongly agree that an atoric surface should be used. The question is who can do it? I believe the atoric cast PAL's cut off at two or three diopters. Your only hope is probably one of new four axis generators like the rxd lathe or the schneider machine. An Atoric PAL > 4.00 cyl would certainly be a welcome addition to the products we have a available for our clients.

I'am probably telling you something you already know, but a straight top, possibly slabbed, or separate readers will provide much better vision for near tasks . Otherwise a PAL that is less aspheric with a reasonably short corridor might be best. The varilux comfort for instance.

Robert

[Pete Hanlin]

Since Panamic's design is built around the periphery of the lens (which is going to be full of marginal astigmatism and spherical error in this Rx anyway), I would definitely use something different.

If I were dispensing to this patient, I think I would find a lab that could make up the script in a VIP. First, none of the "atoric" PALs are going to be available in this script anyway. Second, the VIP is a pretty straight-forward, hard, design.

The patient isn't likely going to be able to get much use out of the intermediate anyway, so I'd go with a design that provides a large, well defined reading area. In fact, I would be tempted (if it weren't for the relatively advanced nature of the presbyopia) to simply try a blended on this patient. If the PAL you choose doesn't work, this could be a fall-back option.

Good luck, and let us know how it turns out!

Pete