Need some guidance for PX with heights difference >3mm for new progressives

Hi all,
Just was seeking some guidance about making new lenses for PX.

We are making a new pair of progressives for him (Zeiss Progressive Smartlife Individual 1.67 as our practice mostly use Zeiss now)
His age is: 57 years old His New RX Is:
RE: -5.25/-0.50 x 110
LE: -5.50/-0.75 x 50
Add" +2.25
We are using that new Visufit 1000 (9 camera half circle measuring device) The Measurements were:
PDR 31 PDL: 32
RE Height: 26.9mm LE Height: 30.2mm

Frame is Full Rim Shell 56 - 18 B Height is: 43mm

Now my concern is that big difference in heights between the 2 eyes. I double checked the fitting to make sure nothing was sticking up one side etc. His eyes do naturally have a bit of difference visually.


For comparison His old pair from 3.5 years ago we did:

Hoya Lifestyle V + Harmony 1.67 Eyona (11mm corridor)

RX: -5.25
LE: -5.00/-0.75 x 30
ADD: +2.25

Manual measurements at that time

RPD: 31.5 LPD: 31.5

REH: 24.5 LEH: 25.5 (we averaged to 25)

Full Rim Shell Frame 52 - 17 B Size: 34mm

His previous specs before that where also quite similar (design and heights the same for both eyes).


Now I have already mentioned to him because the new frame is larger compared to his old one and there is an RX change, there will be more of an adjustment period to get used to them to help manage expectations, which he's ok with.

I haven't ordered just yet and am planning to keep corridor similar 11 or 11.5mm ( design is variable in 0.5mm increments)

But I am now confused. As advice on old posts searched and other sites will differ. The rule I always see is to average below 2mm difference and over 2 to do on a case by case basis.
Some other people suggest to order different heights if it is over 1mm

Should I just trust the new technology in the lenses and the accuracy of the measurements?

Just would like some thoughts before I place the order tomorrow.

Many thanks!

I would say keep as close to old measurements, especially pd as he is already accustomed to that, he's 57 and probably been in PAL lens for some time, my gut would tell me to match what was previous unless there have been major complaints by the patient. As far as height, I would go 28.5 ou.

The fitting heights and pupil heights should be identical. I would need a real good reason to deviate from the measured position.

Make sure that both you and the wearer are in agreement with the level of the frame. This might be the only place for compromise.

Measure manually.

Hope this helps,

Robert Martellaro

Yeah, I would re-measure a few times. Couple of different methods. Then you have an accurate result.

It's a bit of a logical fallacy to trust a historic measure but not a current measurement. Maybe you were drunk last time. Maybe something's changed on his skull.

Regardless, you are stuck with a bit of an adaptation worry. There's no harm in fudging just a little back toward the original heights. If the difference today is 3mm, why not fit it with a 2mm difference, and go from there?

Also, yes, I would trust the technology rather than try to finesse customizations into a lens design that has its own customization built in.

Thanks for all the replies and suggestions!

Quote:

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Originally Posted by Optical Roy

I would say keep as close to old measurements, especially pd as he is already accustomed to that, he's 57 and probably been in PAL lens for some time, my gut would tell me to match what was previous unless there have been major complaints by the patient. As far as height, I would go 28.5 ou.

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+1 IF the patient has been using a progressive with the same seg heights and hasn't had problems, I would hesitate to use different segs. I have used different SH in certain situations (like an asymmetric patient) but it doesn't come up often.

I think Brooks + Boorish had a 1 in 6 ratio of patients needing different fitting heights.

This past thread may also interest you...


https://www.optiboard.com/forums/sho...itting+heights

I'm hesitant to follow digital measurements for segs- but if that is what your office has been doing an getting good results, it should be factored in. I have yet to set a seg more than 2 off and do agree that in small differences, it is better to meet in the middle. I would follow the suggestions of comparing manual measurements and then probably doing a small amount of fudging to get you to a 2mm difference- probably 27/ 29.

Quote:

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Originally Posted by Quince

I'm hesitant to follow digital measurements for segs- but if that is what your office has been doing an getting good results, it should be factored in. I have yet to set a seg more than 2 off and do agree that in small differences, it is better to meet in the middle. I would follow the suggestions of comparing manual measurements and then probably doing a small amount of fudging to get you to a 2mm difference- probably 27/ 29.

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You've never seen a patient with more than 2mm of difference in pupil heights, never?!? What kind of magical place do you live in with only perfect symmetrical people? Never had a patient with one eyebrow way up in the sky and wants their frame level with their eyebrows instead of their eyes? Makes the fitting heights way different.

Quote:

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Originally Posted by Kwill212

You've never seen a patient with more than 2mm of difference in pupil heights, never?!? What kind of magical place do you live in with only perfect symmetrical people? Never had a patient with one eyebrow way up in the sky and wants their frame level with their eyebrows instead of their eyes? Makes the fitting heights way different.

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Lol not symmetrical people, just lucky with well fit frames. I guess I've been fortunate that the patients let me fit the frame to the best of their ability and very few have insisted on awkward or unconventional fits.

Just an Update: We ended up ordering with the height difference, but lowering the LE a little to make it less. PX collected recently and everything was fine, vision was clear for all zones.
The lens design is fully compensated so i think that did help a lot. If it was a non compensated older style lens i think i would've been a bit more worried.

Opticians for the win!