Very long vertex distances

Do you do anything different for clients with very long vertex distances? I've had two clients last week with a vertex distance of 20-22mm. They prefer wearing the frame this way so there was no way to make it any shorter (same for any other frame). I ordered regular 14mm corridor Hoya Mystyles, lowered the fitting height 1mm and slightly upped the frame's inclination to about 12°. For POW measurements I entered 10° since I lowered the fitting height 1mm. Both clients are low hyperopes with 2-2.25 adds.

Should I have done anything differently?

SV. At this VD, why bother w/PALS?

Your patient is completely sabotaging the function of their lenses.

We get this from time to time, and my optician asks how we should compensate.

My standard response has been: "Do it the regular way because there's no compensation for such position of wear".

And then I slap the patient if they complain.

Ryser's Rule is in play.

*Ryser's Rule- The success of a progressive is directly proportional to the motivation of the patient to wear progressives.

Both clients had progressives before with the same VD. Surely increasing inclination and lowering the fitting height a bit should improve optics?

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Originally Posted by Airegin

Both clients had progressives before with the same VD. Surely increasing inclination and lowering the fitting height a bit should improve optics?

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Dead center of the lens, maybe, a little.

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Originally Posted by AngeHamm

Dead center of the lens, maybe, a little.

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I always ask my clients to sit in a relaxed position the way they sit in front of the TV. I measure the fitting height in this position then let them stand up and compare. Usually this is about 1mm difference. If it's more then I have to explain they can't lean back too much. The rare client who keeps insisting on leaning way back gets a short corridor a couple mm lower which is far from optimal but it keeps them happy at least (never go short with long VD's obviously).

If I had told them progressives can't be done they would have just gone elsewhere. Might as well do my very best to get the best possible result.

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Originally Posted by drk

We get this from time to time, and my optician asks how we should compensate.

My standard response has been: "Do it the regular way because there's no compensation for such position of wear".

And then I slap the patient if they complain.

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You would be a fun doctor to work with :bounce::bounce:

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Originally Posted by NIACITPO

You would be a fun doctor to work with :bounce::bounce:

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Just do not complain about anything!

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Originally Posted by Uncle Fester

Ryser's Rule is in play.

*Ryser's Rule- The success of a progressive is directly proportional to the motivation of the patient to wear progressives.

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I still use this rule almost daily. Whatever happened to Mr. Ryser? Quite enjoyed reading his posts.

Also I second the SV option. With that BVD you can proportionately increase any minus correction or decrease any plus correction using the dioptre formula and adding whatever their BVD is to it, then reversing the calculation. But would this make much sense if they wear them like that?

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Originally Posted by Beeped

I still use this rule almost daily. Whatever happened to Mr. Ryser? Quite enjoyed reading his posts.

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Chris passed away last year.

Chris is missed by us all. Thanks for mentioning him, Andrew.

Both clients got their glasses today and they're very happy. One was even amazed how much better it was than the previous pair.

Why do you think so? suppose it correctly)

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Originally Posted by OliMay

Why do you think so? suppose it correctly)

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Both clients returned for adjustments after about a month and complemented me on how good their glasses were compared to their previous pairs. I lowered the fitting height 1mm, otherwise the progression would come up too quickly due to the large VD. I went with long corridor (14mm) Hoya Mystyles with the correct POW measurements. No issues whatsoever.