First time progressive problem with +2.50 add

[C-10]

put this patient in a flat top bifocal or trifocal?

Why would you go into a Flattop or triocal? He will then just complain about the line. By lowering the channel you will give better distance vision and put them into a shorter channel will bring up the reading.

[chip anderson]

C10 Yes he should have had ST or 7/28. If he complained about (or does when the dispenser gives up and does this like he should have to begin with) the line you tell him: "This is what you have to have to see. Notice how you can now see at the proper distances and move your eyes side to side. You can see fine details that you could not see before."

Now what's wrong with that, everyone assumes (and you know about that word) that problems will occur before they happen.

Chip

And yes, you can now make almost as much money on 7/28 as you can on progressives.

[sharon m./ aboc]

C-10: "put this patient in flat top bifocal or trifocal" .....I was asking Chris if that was what he was suggesting to Happylady since she can't change the add power. And Chip is right some patients prefer the jump of the lined bifocal to the blurred peripheral vision. Everybody is different. Thank God.

[Happylady]

I hope Happylady lets us know how this unfolds. Maybe he'll get used to them....she did say he was kind of cranky about his peripheral vision(or the lack of it) And that he was a low myope. I think the patients that don't need much distance correction are the ones that have the hardest time adjusting to progressives there's not as much incentive to keep them on and try to get used to them. KEEP US POSTED HAPPYLADY

I'll let you know what happens. The optician who sold them to him had a baby a few days ago and won't be bad till the end of Febuary. He did tell me she told him it would take a couple of weeks to get used to them.

I wanted him to try them for a couple of weeks before I remade anything. If he can get used to the blur on the sides I can remake them slightly lower since he likes to hold his head up. I didn't want to do this until he tried them for awhile since I think he might not get used to the side blur and might perfer a flat top of some sort.

I did suggest he might need special glasses for computer. I just don't want to rush into remaking them and then have to remake them a second time.

He doesn't seem flexible. He wants glasses that work like his distance glasses did when he was in his thirties and nothing will do that.

[QDO1]

C10 Yes he should have had ST or 7/28. If he complained about (or does when the dispenser gives up and does this like he should have to begin with) the line you tell him: "This is what you have to have to see. Notice how you can now see at the proper distances and move your eyes side to side. You can see fine details that you could not see before."

Now what's wrong with that, everyone assumes (and you know about that word) that problems will occur before they happen.

Chip

And yes, you can now make almost as much money on 7/28 as you can on progressives.

are there any circumstances you would recommend a progressive?

[Chris Ryser]

Why would you go into a Flattop or triocal? He will then just complain about the line. By lowering the channel you will give better distance vision and put them into a shorter channel will bring up the reading.

The line is a visible item....................and easily to understand that when you cross the line on a FT your are crossing a visible obstacle. Psychologicalle acceptable by an intelligent person. Have to get used to it is a point that is easy to understand.

Being at the age of a 2.50 addition, means having seen clearly on a lateral plane for 55 and more years. Having to get used to 2/3 of distortion (excuse the expression, it is now called surface astigmatism) across the full lens is another matter. Like having walked on 2 legs and suddenly you are only on one without a cane.

Using a shorter channel defies the purpose of a progressive lens.............which is supposed to have a smooth changeover from distance to reading with usable vision at any distance between the two.

Short channels have been developed put on the market for those little narrow frame to provide at least some reading portion.

I have a pair of progressives in a small frame that I use for social events and always get compliments that I look younger and more modern............but heck...........when I am home and in the office I prefer my Flat Top 35mm in a large frame and dont have the feeling that I am drunk after my first scotch.

[Chris Ryser]

are there any circumstances you would recommend a progressive?

Anybody getting into reading additions first time is often the most ideal customer to be started on progressives. They are no problem cases and most of the time will continue to use them when its time to change glasses.

But any optician should know that they are not the universal solution for every body and every case.

And if you dont agree with this statement you have to be a very greedy optician who want to sell the highest priced item to everybody.

[C-10]

I personally feel that is a cop out. Fitters run to flattops when they get into trouble fitting progressive. I don’t know how many people to come in my store fitted with a flattop because no one took the time to fit them with a pal. Most pal that we fit today are aspherical in so doing that you are giving them better vision. Compared to flattops are spherical. With all the new technology in pals we have today (and seem that there isn’t a month that goes by that a new pal is on the market) Flattops should not be in our vocabulary when it comes to fitting 1st time multifocal wears be a add of +1.00 to +3.50 How new are flattops on the market? It is old technology it was good but it’s old. When we were selling a majority of flattops, we had troubles with them now we have progressive it hasn’t change. Any prostheses with not take the place of the real thing.

[C-10]

And if you dont agree with this statement you have to be a very greedy optician who want to sell the highest priced item to everybody.

Greed has nothing to do with it I sell low end pals and High end pals but 85 % of my multifocals are progressive it’s moving with the times and flattops are old. You said how young people said you look with your pals. Be sides there is nothing wrong with getting paid for something you can do well. Profit is not a four-letter word

[chip anderson]

C10 A presbyope with at 2.50 add is not a first time presbyope. He has been a presbyope for 10+years (whether he admitted it or not) or he has had a traumatic catarac extraction.

Make yourself an ST bifocal and wear it for a week, you will find you see so much better than even you did with the best fitted best designed progressive.


And as to your question, yes I probably do 90% progressives on my presbyoptic patients. But the other 10% are quite happy and probably see better.

Chip

[For-Life]

It still sounds that it may be to high for him. Move it to the bottom of the pupil and it drop the channel so that he does not have to lower his head to get into the distance and then he will not catch the channel and get the distorition.

I agree with C-10 that switching to the flat top may be just a cop out when the PAL with even the same design can still be fixed.

[Chris Ryser]

It is old technology it was good but it’s old. When we were selling a majority of flattops, we had troubles with them now we have progressive it hasn’t change. Any prostheses with not take the place of the real thing.

Statistic on multifocal lenses show that 47% are using progressives

and

53% are wearing Flat Tops

Now please explain why the majority is still using the so called technology and how much money you are loosing, or how much more yopu could produce, by not having these customers in your store, or by respecting them and givbe them what they want.

[C-10]

Statistic on multifocal lenses show that 47% are using progressives



and

53% are wearing Flat Tops

Now please explain why the majority is still using the so called technology and how much money you are loosing, or how much more yopu could produce, by not having these customers in your store, or by respecting them and givbe them what they want.

Maybe we are not doing our job right if 53% of our client is wearing flattops maybe we are slow to in brace the new technology. All I am saying here if we run into a problem with our Pals, the answer always is, put them into Fts It’s like a having a sore finger we just remove it instead of finding the answer. If we are going by percentages why do we if up so few AR is that AR is no good I don’t Think so it’s because we are afraid to get out there and recommend them. (Don't forget alot of that percenage are our how should I put this Older Clientele )

[spartus]

Statistic on multifocal lenses show that 47% are using progressives

and

53% are wearing Flat Tops

Now please explain why the majority is still using the so called technology...

Cost.

[Chris Ryser]

It’s like a having a sore finger we just remove it instead of finding the answer.

I am sorry................but that is not the case.

I bet you don't like to eat tripe, brain or sweet-bread....................but if the restaurant owner insists that you order tripe, you walk out and go somewhere else were they wont try to force you to eat any tripe.

If your gas station wants to force you to drive your car on super gasoline when you want regular...................you go to another gas station where they willingly sell you what you want and need.

If your haberdasher makes you pants that are 2 inches too short, and insists that lowering the too short pants on your waist will make you look ok you will look for another supplier.

The sore finger in this case is that you would insist that the customer get used to something he does not want to get used to............which is having to live with a distorted sight that he never had so far in his life, is not used to it and has all the intentions of not wanting to get used to.

All the talk about latest technology does not help and calling Flat Top archaic is wrong, because they have their place in the sun for many years to come as do manual transmissions on sports and other cars. What's right for one, might NOT be right for another.

[For-Life]

Statistic on multifocal lenses show that 47% are using progressives



and

53% are wearing Flat Tops

Now please explain why the majority is still using the so called technology and how much money you are loosing, or how much more yopu could produce, by not having these customers in your store, or by respecting them and givbe them what they want.

A lot of dispensers cannot fit a PAL to save their life.

I get a lot of people come into my practice and talk about the troubles they had with PAL's from other stores, yet I never have troubles even with Super No Line.

I think tha says it all.

[Happylady]

I think a lot of our feelings about progressives are based on our own experience with them. I notice Chris is often very down on progressives, he(or is it she?) has not been successful personally with progressives and it shows in what he says about them.

I have progressives and I honestly don't even notice I am wearing them 95% of the time.

Chris, what progressives have you tried?

[spartus]

It's probably not so much what progressives he's tried, it's just that he's perfectly happy with a FT35. It suits his needs and does what he expects it to do.

You can fiddle over fitting heights, progressive designs, materials, anti-reflective coats and everything else, but it really comes down to the patient's motivation. Assuming it's fit correctly, when the patient is motivated to make it work and educated to understand what the lens does (and doesn't) do, you will have very very very few nonadapts.

[chip anderson]

Don't know about Chris, but I have worn Super NoLine, Panamic, Gradal, Comfort was happy with all but I still feel I have better vision and more detail with lined bifocals, in glass no less.

While I am also an optician, I am an ocularist and paint/vien very find details and subtle colors in prosthetic eyes. I can do this with progressives but I think I do it better with lines, or single~vision. And yes, I can have anything I want free. Seems that every lecture I go to someone gives me a certifercate for the latest and greatest optical devise to try free.

I am not saying that progressives don't have thier place, but I am saying that they are not superior (Or even equal) for many applications.

I really wouldn't want my eye surgeon working on me in bifocal contacts either although I am somewhat famous for fitting same.


Chip:cheers:

[Chris Ryser]

I notice Chris is often very down on progressives, he(or is it she?) has not been successful personally with progressives and it shows in what he says about them.

Happylady, I am a him.................................in the optical environment since having worn diapers.

I have been involved in progressives for 3 years before they came on the market in the late 50's. I did some market research jobs for the original originators of the lenses, then SL which is today Essilor.

Progressives then were the biggest novelty and newest technique in the early 1960's.

The lenses got introduced bit by bit in different geographical areas in Europe by SL giving introduction courses to opticians. This was done to make sure the opticians would NOT sell the lenses to poeple which would have to be strated out with higher additions to prvent comebacks ...like non adapts.
Opticians were taught which ones would be good cases for wearing the lenses as well as the ones that should not wear them.

In the old days when still in the retail I personally sold hundreds od progressives with one record..............I never had a comebach nor a non adapt. But there were many cases where I refused to give them a progressive out of technical reasons.

In my opinion progressives belong all into the same pot, even if the different manufacturers claim otherwise. They are all made on the same principle with microscopic differences, so you can really sell anyones make or name product.

I am absolutely NOT anti progressives................but I hate to see all these opticians making claims on who and what is a better lens, and push these lenses onto patients that actually should wear another type lens which will give him or her technically a better vision, and that takes some learning and product knowdledge. Opticians today in general, get the facts from big corporation advertising and brainwash.

[Happylady]

Chris,

I have been in this business for about 25 years and I personally wear progressives. I have tried many different ones and they ARE different from each other.

I can wear anything, but I can tell that I like my Sola Ones a whole lot more then my Hoya CDs, they are very different. Sure, all progressives are the same like all vehicles are the same.

What progressives have you worn?

[Chris Ryser]

I think we all agree that a 2.50 add isn't ideal for a first time PAL, but since we are opticians and not at liberty to change the add power are you suggesting
happylady scrap the whole progressive thing and put this patient in a flat top bifocal or trifocal?

I never suggested to change the add or RX...................I said do NOT start a customer on progressive lenses that has an add of 2.50........start them on low adds (in younger years) and you will have complications nor problems.

[drk]

If it's a decently-designed and fitted progressive, and the patient gave it a fair go, but it fails, then don't hesitate to change to a segmented!

Whether you fit a progressive or a segmented multifocal should NOT be a matter of philosophy.
The philosophy should be that you understand the pro's and con's of each design, and fit the lens to the patient, not vice-versa.

Segmented multifocals and progressives are such different animals that I don't believe anyone can legitimately proclaim "we do progressives" or "we do segmented multifocals" as a preference.

While they both serve a common need, it's like an tomato and an orange. Both fill you up, but some people need lycopene and some need vitamin C. Some people are allergic to tomatoes. Some people don't like the taste of an orange. (Inane analogy.)

The lenses are as different as night and day, and both have their distinct roles. Don't be fooled by their overlapping utilities.

[Happylady]

Chris, I am guessing he waited to go into progressives because he could read without glasses. You can tell someone that it is easier to go into progressives with a low add, but it can be hard to make a patient care about something 10 years in the future. All he knows is that he can remove them to read NOW, so why spend the money for progressives because in 10 years it will be harder to get used to them.

What progressives have you worn?

Drk, yes flat tops and progressives are very different lenses. I get a little peeved when I hear the term "no line bifocal". Progressives are NOT bifocals. It is even worse when I hear opticians or eye doctors call them that.

I also think there is a place for both and I do sell trifocals and bifocals sometimes.

[Chris Ryser]

Chris, I am guessing he waited to go into progressives because he could read without glasses.

It is an old hat in the optical profession that all people that have a sizable myopy = short sighted...............are very picky personalities in everything they do.

This seems to be due to the fact that when removing their corrective glasses they look through a microscope and see small details all enlarged. They can see small details much better than normal sighted people.

When using a progressive with an add of +2.50 they first see the distortion they have never expirienced and they refuse to adapt to that feeling of seeing crooked straight lines.

This is one reason why an optician should know when and what is needed for every case.