First time progressive problem with +2.50 add

[Happylady]

I had a patient come in Wednesday that had picked up his glasses the day before. I did not sell them to him. He is a low myope with some cylinder and a +2.50 add. He has been removing his glasses for near but that is not working as well anymore.

His first complaint is that he need to hold his head down while looking at the distance. I lowered them a little but he tends to hold his head up.

Second complaint is the blurry side vision. He was kind of nasty about this.

Third complaint is the narrow channel. He says he needs to turn his head to see the entire computer screen.

He seems very inflexible and not very willing to give them a chance. I talked about the options and told him to come back in two weeks.

I was wondering if changing to a different progressive would be a good idea. He was fit with the Kodak Precise. I have never used the Difinity but I have read good things about it here.

The negatives to it are it seems to have a smaller reading area and the length of time to get it.

I need some imput here!

[chip anderson]

What did you expect putting a first time presbyope in a 2.50 add, feathers.

The stronger the add the more narrow the channel, that's why every one wants to put early (+1.25's) into progressives, to "educate them to progressive limitations that become more limiting with add increase.

Good dispensers check the pupillary spot with the patient standing up in a relaxed non-propped up stance before ever ordering progressives. A lot of them hold thier head up, some hold it down.

Chip:finger:

[hcjilson]

That having been said, Definity would be a viable alternative.....if he's prepared to wait.

[For-Life]

Sounds like the channel may be a little high so he is turning his head down to reach the higher distance, and at the same time catching the channel.

What is the fitting height?

[Happylady]

I remarked the lenses and put stickers on. The fitting height was correct, he just wants to be able to raise his chin and see the distance. I lowered it about 2 mm by adjusting the nosepads and he said it was a little better, he is just used to a single vision lens.

I did explain to him that the stronger the add the less clear the peripheral area. I drew him a picture of how progressives work and told him after awhile most people don't notice the blur. I told him to wear them as much as possible but to wear his old glasses for driving if he perfered.

How much better would the Definity be and how long does it take to get it?

I think he is going to be difficult.

Remember, I didn't sell them to him, another optician where I work did.

[Chris Ryser]

He has been removing his glasses for near but that is not working as well anymore.

Second complaint is the blurry side vision. He was kind of nasty about this.

I need some imput here!

1) You should have known that a +2.50 add on a progressive is a No.........No...........NO for a fist time user. If you start them at a low addition they will be used to it when reaching higher addition stages.

2) At a +2.50 add progressive lenses are at their worst stage in the way of lateral distortion. 2/3rds of the lens is un-usable. Every time you walk through a door, the door frame curves to a round bar. The lens specialist,s of the large corporations have re-named the word distortion to surface astigmatism.........sounds better but resulting in same.

3) The progressive channel at a 2.50 add becomes so narrow that the whole concept of the lens is lost when your patient wants to look at the computer screen or a spread sheet, or at a newspaper where he can only see 1 colomn in sharp letters.

When people get older...........specially in their 60s and further on (a +2.50 add indicates about that age).........the general stage of the persons vision has been reduced compared to younger ages. If they have seen the world for that long in a way that is crisp and clear to them............they will be very disturbed when they suddenly have to face a world that is distorted to 70% of their visual field.

It would be so nice if you opticians out in the field would actually learn to whom NOT to sell progressive lenses..........which are nice and dandy..........but not for everybody.

Even if the manufacturers give you a non adapt warranty, each time you have and use it...........your reputation factor get a minus point, because out of whatever reason you sold a lens you should not have sold, if you would have had the proper judgement.

[hcjilson]

in the post above. I think before he speaks as an authority on lens fitting, he should launch himself into the 21st Century and TRY some of the products he disparages out of hand. It would also help to be a recent practitioner with some hands on experience before touting the virtues of the FVS 35 lens. :D

How much better would the Definity be and how long does it take to get it?

The answer to the first question is about 30% better. A wider field and softer surface astigmatism. I have fit them sucessfully to previous progressive non adapts with a 100% adaptation rate. Over all, in the almost 2 years I have been fitting them,I have had only 2 returned as non adapts and both I chalk up to "buyer's remorse"....which, by the way, is what you may be facing in this case. Please consider this possibility as just as valid as the add being the cause of this problem.

I would also like to remind my learned friend, that as Opticians, we do not have the liberty to "start someone off with a lower power add". We are to fill the Rx as written. After all is said and done, isn't it the patient who told the Doctor that a +2.50 is what he saw best with? ( please pardon preposition) My guess is that the problem lies with the lens design and Definity will solve it.be prepared to wait for it until the kinks from the Roanoke to Dallas move are worked out.

Lastly, my learned friend is DEAD WRONG with the following statement.

your reputation factor get a minus point, because out of whatever reason you sold a lens you should not have sold, if you would have had the proper judgement.
__________________

Conversely, your reputation gets plus points for confronting a problem and seeking help for the solution. Bear in mind the author of the last quote comes from Montrebec and hasn't quite adapted to the warm Florida Sunshine yet. To my knowledge he is no longer actively practicing as an Optician and as a consequence is unaware of some of the recent development in this field.We've been trying, unsucessfully, to get him to attend Vision Expo's but he doesn't value them very highly.

[QDO1]

what about the patient (child for example) who has had IOL'sI have sucsessfully fit quite younger patients a few like this, with Progressives

Its not that great a technical problem, and they sure appreciate the cosmesis, and the fact they have intermediate vision. I admit often I make suplemental pairs for specific tasks too, but with such patients you have do something, and whatever pair of spectacles you make is a comprimise. The art of the profession is making sure the comprimises are the best ones

[Happylady]

Chris, I KNOW that it isn't a good idea to get a first progressive with a +2.50 add. I know this. But that is what I have here. Like I said I didn't sell them to him but I am sure he wanted progressives and not a trifocal. I ALWAYS think it is better to start with a lower add, but it is too late with this man.

I have sold first progressives in the past to people with higher adds and many of them did just fine with them. Some didn't. Some of the ones I expected wouldn't like them did great. Some of the ones who I expected to like them didn't. I find it is hard to predict.

My husband wears a +2.50 progressive and he is only 54. I put my mom in a progressive back in the late 80's(the VIP) and she loved them. She was in her 60's at the time.

I live in the Dallas area by the way. How long is it taking to get the Definity lens?

[C-10]

I have not fitted the Kodak Precise or the Difinity and excuse my ignorance but I do not know their fitting heigh going back to For- life question WHAT IS THE FITTING HEIGH In any pal we fit will have the non useable portion on the lens ( as we all Know) the challenge here is to move that portion out view for the client if you are fitting around 20mm in that frame I would move into a short corridor lens about 17mm and then drop the height about 2mm this with lower the non usable portion of the lens giving clearer distance but bring his read up where he can use it. If you are using a 17mm go to a 15mm height. Saying all this your Client has to understand the limitation of the lenses he has lost the ability of his accommodation for close and has to live with that. (You could go into the Ipseo but you will also have to watch the fitting heights) I think if do this you will find things will work out. The second thing I would do Happlyladdy is I would make a fuss over him. Let him known that he not alone in his problem and you are going to help him along spend some times in the fitting. Some time that all some one need.

[QDO1]

Chris, I KNOW that it isn't a good idea to get a first progressive with a +2.50 add. I know this. But that is what I have here. Like I said I didn't sell them to him but I am sure he wanted progressives and not a trifocal. I ALWAYS think it is better to start with a lower add, but it is too late with this man.

That is an excelent point. As Opticians we have to deal with what lands in front of us. Sometimes that means a presbyope with a 2.50 add, or as I met last year - a man who had been insitutionalised in a mental hospital 70 years ago for being blind, who following a "blanket we will test everyone in the home regime", was found to have cataracts and a -8.00 RX. This man certainly wasnt complaining about any sort of blur when I fitted his spectacles following a cataract operation (zeiss gradal BTW)

[drk]

What hasn't been mentioned is that a good optician would recognize this potential problem in advance, and would advise the patient on what they're getting into. Not necessarily to discourage it, because I think such things are worth a try, but in order to keep the patient's disappointment to a minimum and the dispenser's perceived expertise at a maximum. It's difficult, after the fact, to gain back that trust.

If it were me, I would not go Definity, now. I would remake to a segmented multifocal, and tell him there is a new lens around the corner for next time, and try to start from square one, again.

[llal98@aol.com]

I just wanted to add my 2 cents - that Definity is the first progressive that I feel comfortable wearing outdoors, walking around, crossing the street, driving, whatever. My previous ones (Panamic, Kodak, Adaptor) were fine for at home or teaching, but I was always more aware of the peripheral blur outside. My frst pair were a +1.75 add and now I wear a +2.50 and, by the way, I'm only 47! (Runs in the family - my Mom is 72 and has a 3.75 add).

[Happylady]

I just wanted to add my 2 cents - that Definity is the first progressive that I feel comfortable wearing oudoors, walking around, crossing the street, driving, whatever. My previous ones (Panamic, Kodak, Adaptor) were fine for at home or teaching, but I was always more aware of the peripheral blur outside. My frst pair were a +1.75 add and now I wear a +2.50 and, by the way, I'm only 47! (Runs in the family - my Mom is 72 and has a 3.75 add).

How is the reading area of the lens? I understand the distance and intermediate are great but the reading is only fair. Do you find that to be a problem?

[llal98@aol.com]

The distance and intermediate are great. I can use my computer at school with no problem - it's a laptop and the height of my table works fine for me. At home, my screen is larger and I wear single vision glasses for the computer. The reading area is not terrible in the Definity, but it is somewhat smaller than in the Panamic. As a teacher, I spend lots of time hitting the books, so I have always worn single vision glasses for extended periods of reading. I was able to get inexpensive glasses for my single vision pairs, and since I only wear them at home I don't worry about having trendy or fancy frames - anything sturdy and well-fitting is fine with me.

[rinselberg]

Time out!

Even if the manufacturers give you a non-adapt warranty, each time you use it, your reputation factor gets a minus point because out of whatever reason, you sold a lens you should not have sold, if you would have had the proper judgement.

Conversely, your reputation gets a plus point for confronting a problem and seeking help for the solution.

We have offsetting reputation points. The moderator will reset the poster's reputation score to what it was before the dispute. Discussion will resume from the last post on the thread. Play optics!

[QDO1]

Time out!



We have offsetting reputation points. The moderator will reset the poster's reputation score to what it was before the dispute. Discussion will resume from the last post on the thread. Play optics!

boy im confused

[sharon m./ aboc]

I had a similar problem with a lady in a flat top. I wasn't the original optician that fitted her but she had about 2 or 3 remakes before I delt with her. She comes in to the shop...tries on her new specs, throws her head way back and says the line is still too high. I told her she was tilting her head back and she proceeded to
"rip me a new one." In fact now that I think about it she wasn't "a lady" at all and another innocent bystander thought she was a friend of mine and was joking with me. Ha! Anyway, what should you do with those who like to hold their noses in the air and need an add power?

[chip anderson]

Check the seg.ht. with the patient standing up in a "relaxed normal stance". Adjust seg. ht. accordingly.

Chip

[Chris Ryser]

I would also like to remind my learned friend, that as Opticians, we do not have the liberty to "start someone off with a lower power add". We are to fill the Rx as written.

Thanks for the military advice. However you must have misunderstood what I was saying.

I am of the opinion, and probably not wrong, ........that it is not wise to start a patient on progressives when the add is +2.50.

The best cases are to start patients on progressive lenses when the add is low, which means in military terms..................when they are still useful and able. Nothing has to do with the RX.

:D

[sharon m./ aboc]

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?

[QDO1]

the dispenser has no choice in the rx to the RX that is presented to him. What he does have is the professional judgement as to waht to do next, with the RX presented. In my judgement, often the awkward adaption period that a patient will have to go through with a lens choice, is worth it in the long run, be it adaption to bifs or Pals

[sharon m./ aboc]

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

[Robert Martellaro]

His first complaint is that he need to hold his head down while looking at the distance. I lowered them a little but he tends to hold his head up.

Follow Chip's advice. Distance objects should appear clearest in a relaxed standing position. If the object looks clearer by raising or lowering the chin then the fitting cross is either too high or too low.

Second complaint is the blurry side vision. He was kind of nasty about this.

After checking the distance vision show the client that the object will be blurred when the head is turned to the side (keeping the gaze straight ahead), and that the blur will increase the further the head is turned. Might be a good time to show the client the blur when looking one to six feet down and ahead when looking at the floor. Don't wait for the client to show you these anomalies, hold their hand and walk them through it.

Third complaint is the narrow channel. He says he needs to turn his head to see the entire computer screen.

That's right, these are not computer glasses. Neither would be a ST28, nor a ST7x28.

I can't emphasize how difficult it must be to dispense a pair of glasses ordered by someone else. My only recommendation is to have the other optician read Dr. K's post for a good dose of wisdom, and then read rinselberg's post and just try to laugh half as hard as I did when I read it.

Regards

[C-10]

I put this patient in a flat top bifocal or trifocal?

Why would you go into a Flattopor trifocal? 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.