Varilux Liberty: Converting the bifocals?

I have many elderly patients who have spent years in bifocals or who have failed progressives in the distant past. I have started to place some of them in Varilux Liberty. From what I can tell it has been quite successful (the few that I have tried). Seems to have a wide distant, a wide near and even a frugal intermediate. The patients seem to view it as a more cosmetically pleasing "no-line bifocal" and are even surprised to find that they can see some intermediate. So far so good. ANyone else has experience with this.

The potential for this is significant since there are so many bifocal wearers out there. Once they get a whiff that there is an option...

ilan

I haven't been happy with it.

I still find that it comes down to patient motivation.

I have found that if people want to go into a PAL then whether it is Liberty, Super Noline or Panamic they will have success.

But, if they really do not care, then whether it is Liberty, Super Noline or Panamic then they will not have success.

So why switch them to PAL’s when they are apparently happy with their bifocals or trifocals?

Now that I am retired I have become a regular consumer of eye care. It has been an eye opening (no pun) experience. My last encounter with an OD for an “exam” resulted in 5 minutes chair time which consisted of tonometry and the quickest refraction that I have ever had and a 10 minute spiel for some new form of cutting edge (again, no pun) refractive surgery. I was next passed on out to the “optician” (no Rx in hand) where a really major effort was made to put me into polycarbonate PAL’s with AR despite my explaining that I was completely happy with my CR-39 FT 7X28 Trifocals. Cripes, I expected her to ask me if I wanted fries and super size.

So listen up, pioneers. If the old fart or fartette is happy with their glass Krypyoks, give them glass Kryptoks. I have only one nerve left and this really gets on it. Please, please, let us enjoy our golden years in peace.

Remember, Honor thy father and thy mother.

Dick
www.aerovisiontech.com

The merits of intermediate vision warrant at least an effort on our part to discuss PAL's with our elderly patients. Most of the patients in this category have not even remotely considered the possibility that they may be able to see the cans on the supermarket shelves, the dashboards in their cars, their piano keys, the food on the table, the occasional computer screen etc. They have gotten used to image jump across the bifocal segment, bobbing their entire heads closer to or away from objects they want to see etc. If I were to subscribe to the concept that rbaker just espoused I would not have introduced my elderly father to the computer (which he now adores), my mother to the cell phone (on which she yaks 24/7), satellite TV for their living room etc.

Many of our patients have reconciled themselves to bifocals but secretly envy those who have escaped the constraints and the antiquated look of the bifocal. I agree that if Varilux Liberty turns out to be a silly gimmick then we are doing a disservice to those of our elderly patients to whom we have suggested a conversion. But if it really works and we can turbocharge the usual bifocal offering we will be well by our patients.

Incidentally, rbaker, we also offer and practically INSIST on AR coating for all our patients. I feel so strongly about it that I practically give it away. A high quality AR coating should not be an option, it should be a right guaranteed by our constitution :) . I will stand by and argue this opinion if needed.

ilan

I just realized that rbaker is Dick, with whom I've had very pleasant communication in the past. Hi Dick; just to let you know, I am very wary in my practice of gimmicks and fly-by-night concepts. I usually wait at least a year or two before I try anything new eg: accomodative implants, Lasik, new lasers etc. So I am treading gingerly with new innovations in optics also. For example, I am cautiously trying Varilux Liberty, Trivex etc.

ilan

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Originally Posted by ilanh

If I were to subscribe to the concept that rbaker just espoused I would not have introduced my elderly father to the computer (which he now adores), my mother to the cell phone (on which she yaks 24/7), satellite TV for their living room etc.

Many of our patients have reconciled themselves to bifocals but secretly envy those who have escaped the constraints and the antiquated look of the bifocal.

ilan

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Beautifully said ... :cheers:

Karen :nerd:

Please note that I mentioned Trifocals a number of times in my post.

Just to address the computer use I find that all of the PAL's that I have worn do require both vertical and horizontal head translations to clearly see all areas of my 21 inch monitor. I have fit my trifocals so that with my natural posture and position I do not have to move my head at all. BTW I wear a +3.25 Add.

So, far from minimizing the value of intermediate vision I feel that we should do all that we can to enhance it. And, PAL’s ain’t necessarily going to enhance intermediate vision. Sometimes they do – sometimes they don’t.

I also understand the economic forces that are involved in today’s dispensing marketplace. But, perhaps of greatest concern is what I call the “Whippersnapper Syndrome.” The vast majority of today’s opticians are trained on the job. Now, I don’t want to get into that here, but their training is marketing oriented rather than optical oriented. That is to say, the emphasis of training is focused on the sale of products an opposed to solving visual problems. Just take a look at what passes for continuing education programs these days. As a result of this training, or lack there of, and the youthful pre presbyopic age of most eye glass sellers we find ourselves at the mercy of the Whippersnapper Syndrome.

I was taught, many years ago, that you can not improve on an asymptomatic patient. It was true then and it is true now. There is nothing wrong with having a patient try a PAL. But, I they are not happy and prefer what they had, stop whipping them and give them what they want. And, when they come back in a few years later, give them a break, don't replay a broken record.

As an aside, I worked in occupational safety for the final few years of my work life. We provided safety eyewear, on site, with a mobile vision van. We had contracts with a number of manufacturing, biotech and medical enterprises throughout New England. Contractually, some of these organizations did not provide their employees with PAL’s due to cost factors. These employees were fitted with either bifocals, trifocals or occupational lenses as appropriate for their Rx and work place environment. Out of over a thousand cases where this substitution was made I only had two “impossible” situations where the companies made exceptions. Quite surprisingly, or perhaps not. all of the other employees adapted quite well to their bifocals or trifocals, in fact, most actually preferred them over their PAL dress eyewear.

So, I am going to leave the turbocharging to the Whippersnappers while I await an epiphany on AR.

Quote:

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Originally Posted by ilanh

The merits of intermediate vision warrant at least an effort on our part to discuss PAL's with our elderly patients. Most of the patients in this category have not even remotely considered the possibility that they may be able to see the cans on the supermarket shelves, the dashboards in their cars, their piano keys, the food on the table, the occasional computer screen etc. They have gotten used to image jump across the bifocal segment, bobbing their entire heads closer to or away from objects they want to see etc. If I were to subscribe to the concept that rbaker just espoused I would not have introduced my elderly father to the computer (which he now adores), my mother to the cell phone (on which she yaks 24/7), satellite TV for their living room etc.

Many of our patients have reconciled themselves to bifocals but secretly envy those who have escaped the constraints and the antiquated look of the bifocal. I agree that if Varilux Liberty turns out to be a silly gimmick then we are doing a disservice to those of our elderly patients to whom we have suggested a conversion. But if it really works and we can turbocharge the usual bifocal offering we will be well by our patients.

Incidentally, rbaker, we also offer and practically INSIST on AR coating for all our patients. I feel so strongly about it that I practically give it away. A high quality AR coating should not be an option, it should be a right guaranteed by our constitution :) . I will stand by and argue this opinion if needed.

ilan

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In the last few years I have had one non-adapt.

This lady, I thought wanted the intermediate vision. We talked about it. So we put her into a PAL.

She comes back. She never understood what she was getting and was happy with the lines. To her and many others they do not want to do the work. They do not want a change. They would like the intermediate area, but without the work.

Put them in a trifocal, works great.

Every new presbyopia patient gets a PAL in my office. They love them and I have no non-adapts through them. But if they are used to the flat top, leave them in the flat top.

I have a lady in a wheel chair who was wearing a flat top. Her daughter and her wanted the Progressive, they asked for the progressive, and the lady showed the dedication to go into the progressive. So when we did it, she had no troubles with the progressive.

But many do not care enough to be willing to change.


As for the Liberty, I bet it is the Super Noline with the Varilux price tag. A placebo like lens.

Sorry to question your obvious dislike for the Liberty For-Life, but the Liberty is not a Super NoLine

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Originally Posted by JRS

Sorry to question your obvious dislike for the Liberty For-Life, but the Liberty is not a Super NoLine

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LOL, no, but it is not a lens that deserves to have the Varilux price tag either.

Pricing is not my area, so I can't help much there. I'm on the technologies side - lenses (designs) and equipment (new developments).

Getting back into the OptiBoard monitoring mode and noticed this thread...

I think For-Life has hit upon a crucial point when it comes to patient motivation. Its like a tread mill... Can it really help you lose weight? Sure! However, if you aren't motivated to use it, it becomes just another- expensive- horizontal surface in the house upon which to set stuff!

PALs are the same way. I don't really believe there is any question that a PAL provides the patient with the potential for better overall vision (especially in the intermediate ranges). However, if you have absolutely no desire to acclimate your visual habits to the design, you will probably forever be hung up on the shortcomings. This isn't to say that bifocal wearers are intolerant, lack flexibility, or are any less discriminating than PAL wearers. It just means they either lack the need for the improvements PALs provide or have acclimated themselves to the relative strengths/weaknesses of segmented lenses.

Regarding Varilux Liberty, the design has now been on the market long enought for us to conduct longer term "in-field" performance evaluations, and- to my own admitted surprise- the results have been extremely positive among ECPs using the product. To For-Life's point again; however, this is not to say that Varilux Comfort, Varilux Panamic, SolaMax, Definity, etc., etc., shouldn't work exceptionally well for bifocal conversions, either. It comes down to patient- and practitioner- motivation.

My biggest complaint about opticians/doctors who try to sell progressive lenses to patients who are current fused wearers is that the only thing that is explained/told to the patient are the pros of the lens. I find it very rare that an optician, or a doctor for that matter, looking to get the most $ possible (and I understand it's a business, so I have no problem with that), will neglect to tell the patient about how much narrower the distance, intermediate, and reading will be. Every lens, regardless of type, has a pro and a con, and most, in the interest of profits, want to show only certain sides of that.

I've had plenty of patients in the past six months that come to me after seeing my doctor, telling me the doctor prescribed a progressive, when, after discussing it further with the patient, find that their lifestyle works best with a lined bifocal or trifocal (in order to get the most from one pair). I am all for a progressive, as long as they don't mind also buying a sv reading pair for the Wall Street Journal they read every morning, etc...

It's almost become part of my regular conversation with patients to tell them that the doctor is the best qualified person to create their prescription, but when it comes to designing their lenses, let me take care of that part.

I always tell patients when selling progressives that there will be distortion on the sides as well as explain more or less what they will experience. Progressives are pretty cool. I work in a chain so we tend to shy away from Varilux lenses (we offer them, but it is way more expensive than an independant optician would charge). I have a lot of success with Essilor Natural lenses. If it is a first time progressive I also mention that the distortion will seem to encroach (narrower field of view) as their prescription gets stronger and it is perfectly normal. What's funny is that most people I encounter are very vain and dread lined bifocals so they make an effort to get accostomed to them. The problem, sometimes, is that they will try so hard that when something is legitmately wrong they don't come back until the company policy of 60 days for a doctor Rx change is past. I tell most people about a week or so to get used to them and to come back if their experience is sub par. I'm all for the "ain't broke don't fix it" philosophy though when it comes to bifocals. I ask bifocal wearers if they are happy with their bifocals. If yes I usually just suggest A/R, otherwise I inquire as to what their problem with them is and put a solution to it.

I have found success with the liberty, with one non adapt.
I first put her in a panamic because of lens size, not considering the fact that she was a ft 35 wearer!! She HATED having to move her head. So, risking another re do, I tried her in the liberty. She gave it about a month, and gave up...back to ft 35. other than that, all my converted bifocal wearers have been quite happy.

In the UK Liberty is not promoted as a ideal start for bifocal wearers, just as an entry point varifocal i.e cheaper than comfort or panamic. I am not sure how well it has been recieved in the UK, the cheaper varifocal end of the market is packed and I see it as essilor trying to get a share of that end of it.