Bifocal/PAL Question for the Technical Experts

[eltuna02]

This is my first post in many years. First off, I'm a Marketing Analyst that works for Hoya. Last year, after 17 years in the building that houses Essilor's Dallas Lab, I left and joined Hoya.

My question involves a never ending industry trend to convert as many presbyopes as possible to PALs. Recently, I have seen articles and ads in trade journals that encourage Eye Care Professionals to convert FT Bifocal wearers to PALS. In an unrelated matter, I was asked to take a look at the sphere power distribution for FT 28’s. I expected to see about a 2/3 - 1/3 spilit. Prior to taking a look at the data, I would have agreed 100% with the articles and ads, that there was a lot of potential in this segment, but the results were surprising…over 2/3 of the FT 28’s sold were plus lenses…this was the opposite of the results I was expecting. By the way, the data was the same at both lab groups.

After doing some checking I was able to piece together the following The answer was a little too technical for me, but it has to do with the visual requirements of hyperopes. It seems that they are not good candidates for PAL conversion. If any of you can explain this, so a non-optics person can understand it, I would be appreciate it.

Again, this was not a scientific study, but the conclusion was that older patients (60+ yrs) were not very likely to change, regardless of being a myope or hyperope and additionally, once the add power exceeded a certain power, they were also not good candidates for conversion.
Thus, is there logic to the assumption that hyperopes are not good candidates because of their visual requirements and that myopes with an exceedingly high adds are also not good candidates. If this is true, then the number of potential patients that are good candidates for conversion is relatively small. Further, some elderly patients, especially if their Eyecare Professional is a senior member of the profession, are less likely to be offered conversion or would be willing to try to convert.

If all this is true, the potential market for converting FT wearers to PALs is very small. Pushing PALs on this segment could easily lead to an increase in non-adapts and an increase in cost for the labs. I would be interested in hearing your thoughts on this issue.

[For-Life]

Yeah, I notice that most of my FT's are hyperopes. I think the main reason for that is that I find that most of them are older patients and more likely to have come from Europe where the market is mainly hyperopic versus the North American Myopic market. Due to PAL's not being as widely used and Opticians not knowing how to fit them as well back then they went to the FT a lot instead.

I agree that the potential is not as evident as a recent article I have read has shown. I believe that the biggest problem with adapting flat top wearers to PAL's is the customers will. If the customer does not want to wear a PAL or doesn't care then I do not care if you are fitting a Super Noline or a Varilux Panamic they will have troubles and likewise if they really have the will to change then with the same lenses they will not have troubles.

Recently we have tried out this Varilux Liberty lens and I have found the same thing. I have had failures with it if the customer did not really want to go into a PAL.

[drk]

If that is true, that hyperopes are less likely to be progressive wearers, it could be the difference in onset of the refractive errors.

Myopes ususally emerge relatively young when their visual systems are more plastic.

There are many, many hyperopes that emerge only after presbyopia onsets. They are a tough bunch, because their changes have occurred late.

It is relatively easier to fit these in FT segs, since there are less adaptation effects. (Ask Chris Ryser, segmented lens enthusiast!) Ergo, more hyperopic segmented multifocals made.

Just a theory...:)

[Chris Ryser]

Yeah, I notice that most of my FT's are hyperopes. I think the main reason for that is that I find that most of them are older patients and more likely to have come from Europe where the market is mainly hyperopic versus the North American Myopic market. Due to PAL's not being as widely used and Opticians not knowing how to fit them as well back then they went to the FT a lot instead.

1) There is no difference between a % of hyperopes and myopes in Europe or North America, Remember where your roots came from???

2) Flat Tops were in use long before progressives showed up in Europe as well as on this side of the Atlantic

3)Progressives were invented by SL (Societe des Lunettier) today ESSILOR. They were launched in 1956-57 in Europe only. SL was adding region by region giving courses on how to fit them and only opticians that followed the courses could sells them at the beginning.

4) The main reason for these courses was to teach opticians, to whom not to sell progressives. All people who had been wearing (at the time) Kryptok or Straight Top lenses should be left at status quo, which means do not change the over to progressives. Newcomers to multifocal lenses with a low add were the right and perfect type of people for this type of lenses.

5) There was no such a thing as a NON ADAPT warranty in Europe, so opticians would not go wild and push the product on everybody, but sold them to the good candidates.

After doing some checking I was able to piece together the following The answer was a little too technical for me, but it has to do with the visual requirements of hyperopes. It seems that they are not good candidates for PAL conversion. If any of you can explain this, so a non-optics person can understand it, I would be appreciate .............

Ther is a very simple explanation to this problem..........................

Myopes are not a good conversion for any multifocal lens. If a myope is a, excuse my language, run of the mill myope, he just takes off the glasses for reading. He lift s them or slides them down nose and looks over them and has best and most perfect, near vision needed. They usuall tend to resist buying multifocals until yhey have to. In these cases any multifocal type will bother them and specially progressives with their distortion areas are driving them up the wall.

[For-Life]

1) There is no difference between a % of hyperopes and myopes in Europe or North America, Remember where your roots came from???

I have always read that approximately 2/3 of Europeans who needed glasses were Hyperopic and approximately 2/3 of North Americans who needed glasses were Myopic.

[Robert Martellaro]

Fact...

Because of a hyperopic shift http://www.optometrists.asn.au/gui/files/ceo826236.pdf emmetropes and low myopes trend toward hypermetropia after age fifty or so. Probably the reason your going to see more hyperopes, at least in the US.

Hyperopes have a harder time with multfocals for a couple of reasons. Many, if not most hyperopes have never worn glasses before presbyopia kicks in. They have to get glasses AND multifocals. Myopes have probably worn glasses for the majority of their life.

Primarily opinion...

I believe that the brain can adapt to lenses that decrease in power with more ease than a lens that increases in power. One reason might be that the field of vision is smaller with hyperopes wearing PALs due to magnification effects. PAL manufactuers adjust the design to compensate, probably by stiffening the design a bit, not a good thing for first time PAL wearers. Quite a balancing act I'am sure.

I've noticed that as we grow older our tolerance for change decreases. Not an age group that takes risks. They like it right the first time and don't like surprises. If changing a ST wearer to PAL is going to improve their quality of life, be it cosmetic or visual issues, than PALs should be considered. There had better be some motivation because, and it matters not what brand and what the manufactuers say, a +2.50 add power PAL is a real optical mess, with newly placed strong boundaries and blur zones that the brain has a hard time sorting out.

Regards,

[drk]

Bravo, Robert.

[chip anderson]

What are our reasons for pushing PAL's?
1) Cosmetics: important to patient only, if it's not important to the patient, it's not important.
2) It's high tech: So What, new ain't always better.
3) It sells for $180.00 instead of $80.00, my commissions are higher. This is probably the real reason for pushing PAL's.
4) The patient doesn't have a jump there is probably something to this, but if the patient doesn't think it's important, it's not important.
5) No fixed focal lenght, something to this, but must be compared to restricted fields and distortion.
6) They are getting better all the time?

Now for the replies that tell me I am living in the stone age and giving the opticians who swallow all that sales pitch stuff to tell me how advanced they are.

Chip

[For-Life]

What are our reasons for pushing PAL's?
1) Cosmetics: important to patient only, if it's not important to the patient, it's not important.
2) It's high tech: So What, new ain't always better.
3) It sells for $180.00 instead of $80.00, my commissions are higher. This is probably the real reason for pushing PAL's.
4) The patient doesn't have a jump there is probably something to this, but if the patient doesn't think it's important, it's not important.
5) No fixed focal lenght, something to this, but must be compared to restricted fields and distortion.
6) They are getting better all the time?

Now for the replies that tell me I am living in the stone age and giving the opticians who swallow all that sales pitch stuff to tell me how advanced they are.

Chip

In a recent article it really bothered me that what an optician makes off a PAL compared to a Flat Top as a selling point. I have never been a fan of selling something over another to make an extra $$$. I think that type of thinking will make the sale, but lose the client.

[Darryl Meister]

I'll throw in a few comments here, and summarize some other good points:

1. Hyperopia is actually more common than myopia in the first place. Epidemiological studies of the distribution of refractive error have demonstrated that the population distribution is skewed towards hyperopes -- particularly in the Plano to +2.00 range (see studies Stromberg, Sorsby, and others).

2. Refractive surgery is more common in myopia, which reduces the number of myopic wearers that much more.

3. As Chris pointed out earlier, myopes are less likely to need a reading correction, and may find that removing their distance glasses for prolonged near work is preferable. If cost is an issue for the wearer, which is obviously a consideration with progressive lenses, they would be even more likely to "tough it out" without bifocals -- or even to purchase over-the-counter readers.

4. As Robert pointed out earlier, many begin drifting towards hyperopia in their 20s or 30s, probably because of an increase in thickness of their crystalline lenses. This will also hurt progressive lens conversions, since elderly wearers are less likely to convert to progressive lenses. Many have grown comfortable with bifocals, and see the benefits of progressive lenses (particularly cosmetics) as less of a compelling proposition.

Best regards,
Darryl

[Joe Stella]

***

[ikon44]

In my experience, most hyperopes start off just needing reading glasses then as they get older they start needing them for distance as well. In todays hi tech multi tasking world a straight forward pair of readers is no good for a lot of people, and we normally start them off with a degressive reader if they have several tasks at varied distances, also to day people are more conscious of their appearance, so they dont want too be peering over a pair of half eyes or have their specs slung round their neck on a speck cord.
Once introduced to the concept of variable focus lenses these clients usually adapt well to PALs.
The only time i dispense FT28 s seems to be too over 70s, and even then i sometimes get asked by them for varifocals, as their sons and daughters are using them now .

[jofelk]

Don't know how much relevance my personal situation is, BUT, I am in my 40's wearing: -1.00 -0.50 OU, need bifo, but prefer to remove my glasses during work day at the lab. I tried progressives for lab work, they do not offer a comfortable near and reading area for all day intermediate and close. I will do without as long as possible.

[drk]

In my experience, most hyperopes start off just needing reading glasses then as they get older they start needing them for distance as well. In todays hi tech multi tasking world a straight forward pair of readers is no good for a lot of people, and we normally start them off with a degressive reader if they have several tasks at varied distances, also to day people are more conscious of their appearance, so they dont want too be peering over a pair of half eyes or have their specs slung round their neck on a speck cord.
Once introduced to the concept of variable focus lenses these clients usually adapt well to PALs.
The only time i dispense FT28 s seems to be too over 70s, and even then i sometimes get asked by them for varifocals, as their sons and daughters are using them now .

Robert, we think alike, but you are a bit ahead of me!

I've recently begun defaulting to a "degressive reader" (BTW, I think we should lobby for the term "regressive" to replace "degresssive" because it better complements "progressive".) instead of SVNO. And not just for the +2.00 adds, anymore, but more into the lower adds (except +0.50, or something super-low).

My thinking is this:
1.) I need to make more money. (JUST KIDDING!!!!)

2.) Certainly a +1.50 add, but even a person with a +1.00 add would appreciate a regression of -0.75. I think it makes the glasses more wearable, and the reading area is still probably large enough for general-purpose use. (This assumes that the frame used is not a smaller-sized half-eye frame, where SVNO would be generally mandatory.)

3.) I will take any chance I get to distance myself from the OTC readers market. While we keep a modest, modest supply around as a necessary convenience, we are less likely than ever to promote such a product when we have substantially better alternatives available. (That's what our mission is about: substantially better alternatives to the cheap stuff of this world.)


Have you a favorite NVF/Task lens/Regressive reader?

[Andrew Weiss]

Bravo to Robert, Chris, Darryl. Uncle Fester and I could not agree more.

One thing that's helped me has been my own experience, as a hyperope who began wearing glasses fulltime in my early 30's. I moved into a FT35 at age 40, and into a progressive at age 46. The move from SV to FT was easy. The move from FT to progressives was really difficult. Why do I stay in progressives? Because I don't have the image-jump, and because the power progression gives me as close to natural vision as I can get a my age. But it took me over a month to adapt, not something I'd recommend to most people. Note: from my experience, aspheric design in progressives makes a big difference for hyperopes.

There's nothing wrong with FTs. And, as one of the doctors here likes to say, the trifocal is the most underused lens in the industry.

[Chris Ryser]

Don't know how much relevance my personal situation is, BUT, I am in my 40's wearing: -1.00 -0.50 OU, need bifo, but prefer to remove my glasses during work day at the lab. I tried progressives for lab work, they do not offer a comfortable near and reading area for all day intermediate and close. I will do without as long as possible.

Jofelk,,,,,,,,,,,,, some advise

Do like me......wear your progressives at the cocktail party only. After the 3rd Scotch you will feel very comfortable with them and you also will be very fashionably looking.

:cheers: :cheers: :cheers:

[jofelk]

Jofelk,,,,,,,,,,,,, some advise

Do like me......wear your progressives at the cocktail party only. After the 3rd Scotch you will feel very comfortable with them and you also will be very fashionably looking.

:cheers: :cheers: :cheers:

Chris,
The cocktail party seems to be the place I can see best without my glasses!