Help/tips needed for PX remake - particular need

Hi everyone,
We have a PX who came for yearly check and need to update their progressives.
The requirement they mentioned to the optometrist at testing time was if the reading can be better for close objects.

They were currently wearing a roughly 5 year old (scratched up and crazed) OSA Accolade Freedom Progressive in a full metal frame.
R: -1.25
L: -1.75
Add: +1.75

His new RX is:
R: -1.25
L: -1.75
Add: +2.50

He just turned 54

He wanted the "best" lenses. and he wasn't going to be wearing them for computers use (he can just take off specs to see screen).
So we went with our best design option, Zeiss Smartlife individual Progressive (balanced) with Digital measurements taken for heights, FWA, BVD etc
He re-used another frame, which was plastic but he has sufficient vertex distance 14.5mm and the panto was about 5.5 degree and FWA was 3.4 degree

He called us up, roughly 2 hours after collecting them, complaining that he's at home a lot and now compared to the old one, he cant see his kitchen benchtops properly. He has to "tuck his chin in" to see them clearly now. He said however normal distance is "brilliant" and the reading is good for phone etc.

I was trying to explain over phone the increase in reading power affects the middle vision more.
I asked him what is the rough cm to the benchtops - he said about 60-70cm*

We didn't use a short corridor so I was thinking that cant really be the problem. its more a medium/regular: 13mm corridor (17min fit height) design balanced, for the new specs.

My guess is because the power is changing faster along the corridor due to the higher add that at his comfortable level looking at benchtops, the power is stronger in the intermediate than his previous specs.

He will come back this week for me to check everything again and do some testing with him *I will confirm if his 60-70cm estimate was accurate.

I am going to try increase the pantascopic tilt more (to mimic some of his head tucking movement)

The Optometrist is suggesting to remake with a +2.00 add if that doesn't help, but to remind him that his reading wont be as good as he wants.

I was also thinking, should I change the design to "Active Intermediate" and increase the corridor length to stretch out the power more?
Otherwise, possibly also lowering the fitting heights a smidge maybe.

What are some of your thoughts on how to proceed?

Many thanks!

You are understanding it well.

He's lost intermediate vision because of the increase in add power has altered the corridor. There is less area, now, for him to see intermediate distances.

Yes, you could change to an intermediate-heavy design and he may like that better, but the near zone size will decrease and you're back where he started.

Or, you could just remake the guy to intermediate/near or "indoor PALs" like Zeiss has and he could have intermediate/near but no distance. At 54, I think it's not a bad gambit, actually. The Zeiss OfficeLens Room is what I love to wear. https://www.zeiss.com/vision-care/us...fice-lens.html

Quote:

---

Originally Posted by Apar83

They were currently wearing a roughly 5 year old (scratched up and crazed) OSA Accolade Freedom Progressive in a full metal frame.
R: -1.25
L: -1.75
Add: +1.75

His new RX is:
R: -1.25
L: -1.75
Add: +2.50

He just turned 54

---

Fail for general purpose and healthy eyes.

Quote:

---

The Optometrist is suggesting to remake with a +2.00 add if that doesn't help, but to remind him that his reading wont be as good as he wants.

---

I'm age 70 -3.00 add 2.25; my Apple Watch watch is readable at 25cm, J1 at 40cm. PAL design is Zeiss Ind. 2N.

Use your -.25/-.50 flippers to check for best acuity/comfort over the new eyeglasses at 40cm, and to the countertop height (typically about 93cm). Use a PAL design that provides the full add where needed (a couple mm higher than average).

Hope this helps,

Robert Martellaro

I bet you love to see those +2.75 and +3.00 adds, Robert.

Quote:

---

Originally Posted by drk

I bet you love to see those +2.75 and +3.00 adds, Robert.

---

Reluctantly, with PALs, for 3 D and above. Usually associated with vision loss. Prefer segmented but it's like pulling teeth. Balance is a huge concern. SVNO is always on the table. Probably a few pages in some chapter somewhere.

All the best,

Robert Martellaro

Thanks for all the replies everyone.
I forget to mention they were also photochromic and he needs them for driving. So that rules out office lenses.
Just an update: He came in today, and we tested it with -0.50 trial lenses over inter/near area and it was much better for his "countertop" area.
I also got him to test near vision by bringing reading chart closer and he could still see ok.

I have one. Robert will like it.

So we all have those mature presbyopes who are myopic and take their glasses off to read and have never had a multifocal (due to poor care, IMHO).

This guy is 61 and he reports that he's a PAL non-adapt. He's about -1.75 with a diopter ATR in SVDO. I tell him how much he's missing by having to remove them for every blessed thing (ask me how I know), and suggest he try a PAL again.

I opt for essilor's Varilux X (because I just saw a rep) knowing that they do a good job with global astigmatism management on their PALs (and if you believe it, they claim a little depth-of-focus voodoo in their corridor/near zone) and of course it's atoric which never hurts.

Here's the kicker: I only Rxed +0.75 for the add. The plan was to 1.) give the guy some usable intermediate vision. It's a bear, young whippersnappers, being an absolute presbyope and it virtually hurts to look up close when you're old like me. 2.) Maybe adapt him a little to PALs...we can build him up, gradually. Training wheels!

So he comes in today wanting the same lenses in his older frame because "these are the best lenses I've ever had! I can see everything!". Somehow the power of the mini-add is perceived as sufficient. (Might explain why he didn't like a fuller add, too...some people like RM (myopes) don't need as much. Now hyperopes...)

Quote:

---

Originally Posted by drk

I have one. Robert will like it.

So we all have those mature presbyopes who are myopic and take their glasses off to read and have never had a multifocal (due to poor care, IMHO).

This guy is 61 and he reports that he's a PAL non-adapt. He's about -1.75 with a diopter ATR in SVDO. I tell him how much he's missing by having to remove them for every blessed thing (ask me how I know), and suggest he try a PAL again.

I opt for essilor's Varilux X (because I just saw a rep) knowing that they do a good job with global astigmatism management on their PALs (and if you believe it, they claim a little depth-of-focus voodoo in their corridor/near zone) and of course it's atoric which never hurts.

Here's the kicker: I only Rxed +0.75 for the add. The plan was to 1.) give the guy some usable intermediate vision. It's a bear, young whippersnappers, being an absolute presbyope and it virtually hurts to look up close when you're old like me. 2.) Maybe adapt him a little to PALs...we can build him up, gradually. Training wheels!

So he comes in today wanting the same lenses in his older frame because "these are the best lenses I've ever had! I can see everything!". Somehow the power of the mini-add is perceived as sufficient. (Might explain why he didn't like a fuller add, too...some people like RM (myopes) don't need as much. Now hyperopes...)

---

This may work on a case by case basis. It may also backfire a few months down the road for this patient(always the pessimist). But it would have a spectacular failure rate if you started dropping every myopic patient's add.

Quote:

---

Originally Posted by drk

I have one. Robert will like it.

---

Me like. Us myopes do have less accommodative demands, but at this power it's probably small pupils, long arms, blur tolerance, and/or denial. Regardless, thanks to your somewhat out of the box prescribing, he won't know what he has until it's gone.

Robert

Quote:

---

Originally Posted by Apar83

Thanks for all the replies everyone.
I forget to mention they were also photochromic and he needs them for driving. So that rules out office lenses.
Just an update: He came in today, and we tested it with -0.50 trial lenses over inter/near area and it was much better for his "countertop" area.
I also got him to test near vision by bringing reading chart closer and he could still see ok.

---

I start managing expectations at this age explaining that 50 somethings are losing accommodation never to be found again :cry:

I explain that the doc is ramping up the add significantly but it comes with the tradeoff he now has to face.

I usually explain this with a wink and a nod that starting in our late forties and especially in our 50's and 60's this is our new world and congratulate them for living so long!

I relate as a kid I was better than 20/15 but now struggle to achieve 20/20 and can no longer follow a golf ball off the tee the way I did in my youth.

Most everyone accepts this and I might trial lens over his old pair a +.25 +.50 and +.75 being careful to explain the corridor width will be narrowed in the new lenses.

I'll show them this contour plot from an Opticampus picture to let them visualize the problem:

http://216.144.236.77/progressive_le...es/Slide13.GIF



I've now got them expecting better but prepared for the limitation which most all accept and appreciate.

Quote:

---

Originally Posted by Uncle Fester

I relate as a kid I was better than 20/15 but now struggle to achieve 20/20 and can no longer follow a golf ball off the tee the way I did in my .

---

Hey Fester, you mind PMing me a list of the courses you play? I have a lucrative golf ball retrieval business……




Great way to explain and give a visual!

Quote:

---

Originally Posted by optical24/7

Hey Fester, you mind PMing me a list of the courses you play? I have a lucrative golf ball retrieval business……




Great way to explain and give a visual!

---

My ball always finds the short grass!

And as a self professed compulsive truthteller I would have to say that even if it was false...:rolleyes::bounce:

Myrtle Beach in 12 days!!!

Use an intermediate biased FF. IOT. Zeiss. Whatever.
when in doubt, in today’s world, always go with intermediate biased FF. It’s what the majority of PAL wearers use PALs for. Period.

I agree with lensmand but to me the issue was the "3 step" change in the add without an explanation of what to expect with that amount of change regardless of design emphasis.

That's a lot of add for a 54 year old and would raise a red flag as the doc kicked the add too much imo.

"The requirement they mentioned to the optometrist at testing time was if the reading can be better for close objects."

Quote:

---

Originally Posted by lensmanmd

Use an intermediate biased FF. IOT. Zeiss. Whatever.
when in doubt, in todayÂ’s world, always go with intermediate biased FF. ItÂ’s what the majority of PAL wearers use PALs for. Period.

---

Interesting. I will take that on board.
It makes sense when they are choosing the Individual.

But if they are on more on a budget and end up choosing the "Pure" or the "Plus" designs.
Those are a a default "Balanced" based design from what i've been told by the rep and understand of their profile.

The only other one i can think of with more intermediate and in that price range is the standard Drivesafe progressive, but the Near area is a bit more narrower than the others.

Here in Australia we don't have access to the other Zeiss lenses such as: Light D, V etc..
The rep may pressure them to bring them in as a more budget conscious option instead of using older/cheaper alternatives.

Are they any good to use? How do their profiles compare to the Synchrony range (Progressive HD, Ultra HDC)?
We still have access to that, however we can only order them with lesser coatings (HMC+) and the older photofusion tech (Not X)

Many thanks.

The Light D was TOO good, IMHO.