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    computer distance progressive?

    A customer came in to the shop asking for a computer distance progressive. Her script is:

    +2.25 SPH
    +2.25 -1.00 020

    2.50 add

    I split the bi-focal add, added it to the sphere and ordered the Varilux XR lens with

    +3.50 SPH
    +3.50 -1.00 020

    2.50 add

    After I ordered it, I started questioning whether or not this is actually going to work. I'm not even sure why I thought it would work.
    The optical manager is 100% convinced that it won't work, but submitted the order anyway.

    Give me your thoughts on this.

    #2
    When you bumped the dist, you also bumped the add by keeping it the same. You should take as much plus out of the add as you bumped the dist. In other words, your new dist power with a 1.25 add would be correct.

    Comment


      #3
      Yeah, you should only use half the add for the near in that case. Easiest solution is to use a NVF design with the original prescribed RX.

      Comment


        #4
        However much you over-plus the distance, you should correspondingly reduce the ordered addition. Otherwise the near Rx gets over-plus as well.

        Other than that, I wonder why you went for the Varilux XR? Extreme overkill for a computer progressive made by converting a general use PAL design, IMHO. And the compensations from the XR design may lead to some interesting end results w.r.t. base curve etc. And since IIRC the Xtend technology effect is less noticeable with lower addition, if that is the case, it means any X series converted as such would also theoretically show less benefits from the Xtend design anyway.

        For computer progressives, if speaking w.r.t. to the Varilux family of lenses, I mostly use the Liberty, or sometimes the Comfort. Almost always works without any complaints whatsoever.

        Comment


          #5
          KIDS KIDS KIDS!

          Why oh why are we still doing this? I swear I will stop this dispensary and turn it RIGHT AROUND, and NO ICE CREAM!

          Please for the love of sweet baby Zeus STOP trying to order "computer" lenses in traditional PALS. They're not made for that. there are CHEAPER, and BETTER lenses out there. And get this - they're actually purpose built for this exact scenario! You don't even have to muck with Rx conversion at all - the lab does it for you 100%! And you get to avoid expensive optician errors like the above here.

          Your patient wants a computer lens? Then GIVE IT TO THEM!

          Easy peasy.

          Now, stop smacking your brother and sister, sit flat in your seats, hush down, buckle up, and we'll go get a Blizzard at the DQ.

          Comment


            #6
            Originally posted by Uilleann View Post
            KIDS KIDS KIDS!

            Why oh why are we still doing this? I swear I will stop this dispensary and turn it RIGHT AROUND, and NO ICE CREAM!

            Please for the love of sweet baby Zeus STOP trying to order "computer" lenses in traditional PALS. They're not made for that. there are CHEAPER, and BETTER lenses out there. And get this - they're actually purpose built for this exact scenario! You don't even have to muck with Rx conversion at all - the lab does it for you 100%! And you get to avoid expensive optician errors like the above here.

            Your patient wants a computer lens? Then GIVE IT TO THEM!

            Easy peasy.

            Now, stop smacking your brother and sister, sit flat in your seats, hush down, buckle up, and we'll go get a Blizzard at the DQ.
            Are we there yet?

            Comment


              #7
              Originally posted by CME4SPECS View Post

              Are we there yet?

              Comment


                #8
                Originally posted by Uilleann View Post
                Please for the love of sweet baby Zeus STOP trying to order "computer" lenses in traditional PALS. They're not made for that. there are CHEAPER, and BETTER lenses out there. And get this - they're actually purpose built for this exact scenario! You don't even have to muck with Rx conversion at all - the lab does it for you 100%! And you get to avoid expensive optician errors like the above here.

                Your patient wants a computer lens? Then GIVE IT TO THEM!

                Easy peasy.
                Respectfully, there's nothing wrong with using a 'traditional' PAL or even a segmented multifocal of any sort for computer (or other occupational) lenses... subject to the patient's exact visual needs, and the dispenser's know-how, of course.

                Since the days of that golden oldies, the Sola Access, I have fit many, many pairs of many, many occupational designs. And just as many converted lenses. Including switching out existing occupational designs wearers into converted lenses.

                It just so happens that over time, my local demographic favours converted lenses. Mostly due to multiple monitors side by side at eye level. I've yet to find occupational designs that truly excel in this area, compared to converted lenses.

                Frankly, in my current practice, I dispense more occupational multifocals (converted lenses or otherwise) than general PALs, since these days it seems most folks can dispense the latter competently enough... the former not so much.

                As to the difficulty of the Rx + fitting conversion, IMHO it is no more tedious nor tricky than doing the same for a contact lens patient; it's just part and parcel of occupational lens dispensing.

                Your mileage may vary, I guess.

                Comment


                  #9
                  Originally posted by AndyOptom View Post
                  However much you over-plus the distance, you should correspondingly reduce the ordered addition. Otherwise the near Rx gets over-plus as well.

                  Other than that, I wonder why you went for the Varilux XR? Extreme overkill for a computer progressive made by converting a general use PAL design, IMHO. And the compensations from the XR design may lead to some interesting end results w.r.t. base curve etc. And since IIRC the Xtend technology effect is less noticeable with lower addition, if that is the case, it means any X series converted as such would also theoretically show less benefits from the Xtend design anyway.

                  For computer progressives, if speaking w.r.t. to the Varilux family of lenses, I mostly use the Liberty, or sometimes the Comfort. Almost always works without any complaints whatsoever.
                  I used the XR lens because I am extremely limited as to which lenses I'm "allowed" to use. I do not make any decisions at the shop where I work. I am a minion, at best, I do what I'm told.

                  Comment


                    #10
                    This one is definitely going to be a remake. And this is why I told the optical manager not to submit it right away. I knew something wasn't right with this order and so did she, but she ordered it anyway.

                    Just to clarify, I am a minion at this shop. I do not make any decisions. Aside from the occasional self-pay, I do not submit orders to the lab or insurance. I'm not even allowed to know how to submit orders to insurance. When the optical manager is on vacation, the office manager submits the orders or they sit until the optical manager comes back to work. I order the lenses I'm told to order, all Varilux. I'm allowed to use the Comfort DRX, Comfort MAX, X & XR. When a customer is using a certain insurance, it's always X or XR (preferably XR) no matter what.

                    Before anyone tells me to find a different job -- not going to happen. I make good money and the schedule is perfect for me. My options in this area for employment are extremely limited. I'd basically be shooting myself in the foot if I left this job. If the optical manager wants to be queen of the castle, so be it. I do what I'm told, I don't ask questions, and I don't take the heat when mistakes are made. I intend to work at this shop until the doctor retires, which I'm told will be in 10 years, unless he can find someone to take over the practice before then.

                    Comment


                      #11
                      Originally posted by AndyOptom View Post

                      Respectfully, there's nothing wrong with using a 'traditional' PAL or even a segmented multifocal of any sort for computer (or other occupational) lenses... subject to the patient's exact visual needs, and the dispenser's know-how, of course.

                      Since the days of that golden oldies, the Sola Access, I have fit many, many pairs of many, many occupational designs. And just as many converted lenses. Including switching out existing occupational designs wearers into converted lenses.

                      It just so happens that over time, my local demographic favours converted lenses. Mostly due to multiple monitors side by side at eye level. I've yet to find occupational designs that truly excel in this area, compared to converted lenses.

                      Frankly, in my current practice, I dispense more occupational multifocals (converted lenses or otherwise) than general PALs, since these days it seems most folks can dispense the latter competently enough... the former not so much.

                      As to the difficulty of the Rx + fitting conversion, IMHO it is no more tedious nor tricky than doing the same for a contact lens patient; it's just part and parcel of occupational lens dispensing.

                      Your mileage may vary, I guess.
                      Respectfully - there is everything wrong with it.

                      Some people just seem to love slapping buggy wheels on racecars, and wondering why things don't work. Enjoy your repeated remakes I guess. *shrug*

                      Comment


                        #12
                        Being quite particular on my complaint cases at work, I do track my lens remakes, and Jan-Jun 2024, I have had exactly 3 remake cases out of more than 250 dispensed pairs of lenses. None of which involved a converted multifocal (I recall enquiring here about such a case fitted by a colleague of mine, if that counts then sure, make it 4 remakes). And this success rate pretty much goes back to 2016 when I first started seriously studying + dispensing more occupational lenses. So, hardly repeated remakes, if any at all, truthfully.

                        On average, maybe 1 or 2 out of every 5 pairs I fit are dedicated designs, the remainder converted lenses. Per the patient's needs and wants.

                        End of the day, lenses are pieces of ophthalmic material shaped to bend light as we fit them to... And yes, I'd agree, in some cases even I wouldn't advocate such solutions or would question their specific means of implementation (notice how my initial reply did question the OP's choice of converted PAL).

                        Even in medicine, off-label prescribing + dispensing is a tried and tested approach to managing many conditions. Why not apply that logic here?

                        ​​​​​​Seriously, if there's some law or several of optical dispensing which I'm violating, despite the high patient success rate, do let me know. Beyond saying that it's wrong and being told by you to fit a dedicated design, I've not heard exactly why it's a problem on technical grounds. Considering my converted fits are often the same price as a dedicated design or even cheaper, with the satisfaction rate I don't see how it's a disservice done to the patients.

                        The OP has decided to go this route for whatever reason of their own, barring a rock solid clinical justification not to dispense lenses as such, why not help them work towards making this approach work for them, if it adds one more tool to their optical arsenal without adding problems?

                        Comment


                          #13
                          Interesting thread. This is the sort of nitty gritty optical nerd stuff needed on OptiBoard. Glad to see this content!

                          Comment


                            #14
                            Why not just do the Shamir Workspace?

                            Comment


                              #15
                              Originally posted by AndyOptom View Post
                              Being quite particular on my complaint cases at work, I do track my lens remakes, and Jan-Jun 2024, I have had exactly 3 remake cases out of more than 250 dispensed pairs of lenses. None of which involved a converted multifocal (I recall enquiring here about such a case fitted by a colleague of mine, if that counts then sure, make it 4 remakes). And this success rate pretty much goes back to 2016 when I first started seriously studying + dispensing more occupational lenses. So, hardly repeated remakes, if any at all, truthfully.

                              On average, maybe 1 or 2 out of every 5 pairs I fit are dedicated designs, the remainder converted lenses. Per the patient's needs and wants.

                              End of the day, lenses are pieces of ophthalmic material shaped to bend light as we fit them to... And yes, I'd agree, in some cases even I wouldn't advocate such solutions or would question their specific means of implementation (notice how my initial reply did question the OP's choice of converted PAL).

                              Even in medicine, off-label prescribing + dispensing is a tried and tested approach to managing many conditions. Why not apply that logic here?

                              ​​​​​​Seriously, if there's some law or several of optical dispensing which I'm violating, despite the high patient success rate, do let me know. Beyond saying that it's wrong and being told by you to fit a dedicated design, I've not heard exactly why it's a problem on technical grounds. Considering my converted fits are often the same price as a dedicated design or even cheaper, with the satisfaction rate I don't see how it's a disservice done to the patients.

                              The OP has decided to go this route for whatever reason of their own, barring a rock solid clinical justification not to dispense lenses as such, why not help them work towards making this approach work for them, if it adds one more tool to their optical arsenal without adding problems?
                              • The OP can't even convert an Rx properly based on their own posts. Pretty basic, day 1 sort of stuff. Piling on with an inappropriate optical design isn't going to [and didn't] help matters. It will result in a remake.
                              • Using a lens with a fundamentally different optical design than a purpose made optic isn't being avant garde. The "off-label" analogy you use may work for some medications that have known side effects above and beyond their initial intended cure. Optic's don't work the same way however, as you're no doubt aware.
                              • Cost. COG comparison easily shows an increase of anything from 210% to 300% more using an XR [as the OP had done] as opposed to using dedicated computer designs available from the big E currently. There isn't an owner on the planet who would think that a wise decision.
                              • Time/trust. It doesn't make sense to waste a patients time, and risk their trust with sloppy dispensing. They have options, and likely may not return to you in future.
                              I don't personally care what anyone dispenses. But when you do it wrong, choose an inappropriate/ineffectual optic that doesn't work, have remake(s), and ask for advice here, be prepared to learn from those mistakes.

                              Peace all!

                              Comment

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