Hyperope PAL Non-Adapt

Why is it quite common to see hyperopes non-adapting to PALs? Even when there is little to no change in the Rx and sometimes even to the same design.. I just don't get it??? Since it's all subjective the feedback is usually immediate when they first put the glasses on they throw it off saying it's not working. Once I convince them to put the glasses on so I can check the adjustment and fit they are all hussy and fussy through the whole process and are convinced there's something wrong with the lenses. How do you guys/gals handle this?

SMACK-EM! :banghead:............well..I want to!
Leave your old pair with me and come back in 2 weeks.

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Originally Posted by Oscar

Why is it quite common to see hyperopes non-adapting to PALs? Even when there is little to no change in the Rx and sometimes even to the same design.. I just don't get it??? Since it's all subjective the feedback is usually immediate when they first put the glasses on they throw it off saying it's not working. Once I convince them to put the glasses on so I can check the adjustment and fit they are all hussy and fussy through the whole process and are convinced there's something wrong with the lenses. How do you guys/gals handle this?

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Most have a very short eyeglasses wearing history and hate eyeglasses. Watch out for displaced aggression.

Hone your skills.

Demonstrate the alternatives (SVDO/SVNO, segmented multifocals, CLs, etc.).

Be empathetic, sincere, and conscientious.

You'll lose a few to hypersensitivity/unreasonableness, but many of the rest will come back to you right to the end.

Hope this helps,

Robert Martellaro

It's important to manage expectations before the patient ever picks up their specs. If this is their first PAL or there was a change in the Rx, however small, I always try to let them know what to expect before they leave our office after placing the order. We love to tell patients everything their fancy new lenses will do but it's important the patient knows what they WON'T do as well. Let them know it may take a few days or more to adapt to the new lens. Let them know about the distortion they will see. If you get push back at dispense, be patient with them. Check the measurements, check the Rx, check the fit, and make sure they see you doing it. Build their confidence in your ability to take care of them, and they will be more likely to following your instructions.

You can't please everyone, but one line I learned here on OB has helped a lot in managing expectations and reducing non-adapts: "Progressives are the Swiss Army Knife of lenses - they are good at many things, but not the best at anything." PALs have their limitations like any technology does, and it helps if your patients understand that BEFORE they pick them up!

No matter what your lens reps say, PALs are not a "one size fits all". I'm a hyperope and have been wearing Seiko Surmount for years with no issues at all.

Thanks all. It's not so much an expectations thing or someone going from not wearing glasses to PAL's or first time wearers.. I'm referring to the ones that are seasoned PAL wearers with little to no change in Rx but cry the sky is falling the second they put the glasses on. They are almost always a hyperope. Was just wondering if there was some sort of correlation or am I just crazy lol. I am not deducing that hyperopes are nuts. What i'm wondering is if there's something different in the construction of a lens and our visual system that makes it more difficult with current PAL designs?

Here is a phrase I like to ask. "Is it blurry or does it just look strange?"

Most of the time the response is "It looks strange". That is when I explain "adaption is usually 2 hours to 2 days, but if it's still strange after 2 weeks, we need to see you.

A short eyewear wearing history, resulting in greater sensitivity to magnification and narrowed fields of vision, compared to emmetropes and especially myopes, and less motivation due to good uncorrected distance visual acuity (compared to myopes) are the primary causes.

PALs with wider inter and near fields (softer), longer corridor lengths, and flatter BCs that fit close to the cornea work best for most hyperopes. Myopes benefit from mostly from an opposite approach, that is, an emphasis on shorter corridors and harder designs.

The reason for different the corridor lengths is due to object displacement from induced base up (plus) and base down (minus) prism, and to magnification and minification effects.

Changes from the above factors, and/or due to additional variables (Rx, health, etc) requires a warning to the client that there will be adaptation that may last many days or weeks. Include the warning at both the initial and final fitting.

At the final fitting, have the client look out a window or across the room asking for evidence of distortion, while checking the acuity. Have the client look down and ahead towards the floor and inquire if they see slanting and how severe it is. The floor may look like it bends down into a valley. Tell your client that these distortions are temporary, will disappear entirely with time. I instruct your client to be extremely careful with steps, and with judging distances while driving and parking a car, especially for the first day wear. Some clients should drive home with their old eyeglasses. We can't be to careful, especially with the elderly.

Anticipate. We know most of what's going to happen, both good and bad, especially if you have a trial frame and lens kit (should be required for all dispensing opticians). Stay in control, don't let there be any surprises, and be confident that your recommendations are base on science and experience, for each individual client that you provide care to.

Hope this helps

Robert Martellaro

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Originally Posted by Robert Martellaro

The reason for different the corridor lengths is due to object displacement from induced base up (plus) and base down (minus) prism, and to magnification and minification effects.

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I understand the reasons for different corridor lengths laid out here. But, have always been curious what impact prism thinning has on this. Does a PAL with 2.00 D prism thinning negate the need for the longer corridor?

The reason for different the corridor lengths is due to object displacement from induced base up (plus) and base down (minus) prism, and to magnification and minification effects.

I thought it had to do with vertical frame dimensions?

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Originally Posted by Kwill212

I understand the reasons for different corridor lengths laid out here. But, have always been curious what impact prism thinning has on this. Does a PAL with 2.00 D prism thinning negate the need for the longer corridor?

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Two prism diopters worth, equal to about .6mm of displacement.

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Originally Posted by Don Gilman

The reason for different the corridor lengths is due to object displacement from induced base up (plus) and base down (minus) prism, and to magnification and minification effects.

I thought it had to do with vertical frame dimensions?

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Frame shape is a different issue, and primarily for variable corridors only. PALs designs might use one, both, or neither optimization, although modifying the corridor length for short or tall frame shape is not really an optimization, it's just to keep opticians from doing anything stupid, like putting a long corridor PAL in a frame with a 25mm B for a myopic accountant.

Modyfying corridor length by refractive error may have started with Essilor's Ovation (see image below).

http://osagrind.com.au/productinfofo...Ovation_lo.pdf

Hope this helps,

Robert Martellaro

This thread should be required reading.

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Originally Posted by Robert Martellaro

Two prism diopters worth, equal to about .6mm of displacement.

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Do you ever read the answer to a question, and then realize how dumb the question was? Thanks Robert, should have been able to figure that out on my own. Hope it helps someone else.

No dumb questions, just dumb answers.

Moreover, you make us think about what else yoked prism can do, bad or good. For example, it changes our perception, enough that we might not want to use it for thinning a lens on a plano sphere add +2.50 multifocal Rx, but wouldn't blink twice on a +2.00 add +2.25. Or, used on a minus lens, or as one of many trouble shooting variables we routinely encounter, etc.

Best regards,

Robert Martellaro

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Originally Posted by jrumbaug

Here is a phrase I like to ask. "Is it blurry or does it just look strange?"

Most of the time the response is "It looks strange". That is when I explain "adaption is usually 2 hours to 2 days, but if it's still strange after 2 weeks, we need to see you.

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I am taking that phrase and putting it directly into my toolbox, thank you.

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Originally Posted by Robert Martellaro

PALs with wider inter and near fields (softer), longer corridor lengths, and flatter BCs that fit close to the cornea work best for most hyperopes. Myopes benefit from mostly from an opposite approach, that is, an emphasis on shorter corridors and harder designs.

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In a market flooded with so many specialty and digital PALs, all of whom claim to be the new best thing ever that all of our patients will love, it seems like some manufacturer would come up with lens design and marketing acknowledging this explicitly. The "Super Plus" and "Super Minus" progressives, designed for the unique needs of your patients' most extreme prescriptions.

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Originally Posted by AngeHamm

In a market flooded with so many specialty and digital PALs, all of whom claim to be the new best thing ever that all of our patients will love, it seems like some manufacturer would come up with lens design and marketing acknowledging this explicitly. The "Super Plus" and "Super Minus" progressives, designed for the unique needs of your patients' most extreme prescriptions.

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Wish they were available across the pond!

https://www.rodenstock.com/uk/en/pro...ve-lenses.html

So often when it's the best "If you have to ask how much they cost you can't afford them".

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Originally Posted by Uncle Fester

Wish they were available across the pond!

https://www.rodenstock.com/uk/en/pro...ve-lenses.html

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We can get Zeiss PALs in the US.

I looked at Rodenstock frames a few weeks ago. They were contemporary in appearance, and sensibly engineered. I didn't ask if their lens division is re-entering the US market.

Best regards,

Robert Martellaro