I have an elderly patient (moderate myope) who wants intermediate vision but has been unable to tolerate trifocals. Initially, she was put in trifocals several years ago because "progressives made her dizzy". What PAL would be a good choice for her?
I was thinking Varilux Liberty or Zeiss GT2 because the distance vision above the 180 degree line has no distortion at all. Would Percepta or Image also be good choices (very wide distance with limited distortion)?
I hate to do it. But when I have to, I use the Panamic or Physio. The only ones that have worked for me.
If the progressives "made her dizzy" and the trifocals won't give here intermediate vision. Sell the woman three pairs of glasses, one for each distance. It's your only hope. Otherwise you gonna be doing endless re-makes, over-refractions, etc. all to no avail.
Chip
Yep, after that she run back in demanding trifocals, bifocals, progressives, anything but three pair!!!Originally Posted by chip anderson
We have only one really hard rule:
If they're in trifocals, keep 'em in trifocals!
You have to have a lot of customer motivation for them to adjust to a progressive. I've fit thousands and thousands of progressives but I can only remember one trifocal wearer that made the transition to progressive.
DragonlensmanWV N.A.O.L.
"There is nothing patriotic about hating your government or pretending you can hate your government but love your country."
I try to talk patients out of progressives, if they are in a bifocal or trifocal. I tell them if they want to try progressives, they will have to really work hard to adjust to them. I tell them they have to give the progressives at least a month to adapt to and they have to wear them all the time. I've done a few varilux libertys for patient that will really work at it.
Jeff:cheers:
Anyone figured out the reason trifocal wearers don't convert?
They see better with lined lenses!
"But everyone needs progressive technology today!"
Like Hell.
Chip (Who is at the moment wearing progressives.)
I agree that the intermediate is a lot larger in even a 7x28. Computer lenses don't have an intermediate that is even close to 28mm wide. :cheers:Jeff
In my area, I see a ton of seniors. 9 out of 10 of them are wearing their trifocals too low, virtually at a bifocal hight. They almost always complain about not being able to read...go figure. If I adjust the frame higher to raise them up, they complain that the lines are in their way. I convert many back to bifocals. No sense having a lens
that creates more harm than good. At least they can read a book, magazine, or newspaper...not to forget look up a telephone number in the phonebook. I have also converted many to progressive....with some success. The lens I had the best success with is the Nikon i. No swim, which eliminates the sea sickness, fits low, and has a fairly wide distance area.
Mike:
I don't know who taught you how to measure trifocals but the top of the trifocal should be at the bottom of the pupil. I do see lots of people with this too low and if they have gotten used to this it is difficult to move it. You can try illustrating to them that they have to hold reading material on thier chest to see it, where normal bifocal position for near should be satifactory.
I also find that many opticians and prescribers are reluctant to put the later presbyope in trifocals. Guess they got so much b******* about the bifocal the first time they don't want to go through this again with the patient.
Chip
If I were having trouble making up my mind. Put them all in a bag and shake it up and pull one out. You should be just fine.
Chip, I got my licence 25 years ago. Way back then, the consensus then was tri's fit at mid iris. The day to day low trifocals I see are fitted god knows where. Its true though, that a trifocal wearer is particular about hight and unless they want it different than last time, they decide how high they want it. I can recommend all I want, but if they don't like the hight... it's a redo.
Depends on many factors, so I'll fill in the blanks, and correct me where I'm wrong.
1. She needs the intermediate for the dials on the stove, shelves at the grocery store, card playing, but no prolonged tasks.
2. She's an avid reader.
3. Add is +2.50 or +2.75.
4. Moderate myope means at least four or five diopters.
Zeiss Individual or Hoya ID with the longer 14mm corridor. Might need separate segmented multifocals for extended close tasks, but offers the best chance to get it all in one pair.
If the above lenses break her eyeglass budget, use a soft, long corridor design like the Gradal Top (not the GT2) or ECP. It's likely she will need separate segmented multifocals for extended close tasks.
ECP or GT for driving and general purpose, and a separate ECP/GT with the distance cut about .50 to .75, reducing the Add accordingly, offering improved intermediate vision for short tasks, and good near vision with reduced peripheral blur due to the lower Add. For general purpose use excluding driving.
Some combination of the above, including both pairs with segmented multifocals, with the latter probably the best course, cutting the distance power on the second pair.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
I don't see a lot of trifocal wearers anymore, but I had two today. The woman wanted hers low and that's where I put it. Her husband wears his higher. I look at what they are wearing and if they are happy with it.
I've had several trifocal wears switch and I even have two patients that wear both. One is a pharmacist and the other is a pilot. Both wear their trifocals for work and their progressives the rest of the time. The pilot is one of the pickest patients I have ever had and I was surprised he liked the progressive, but he does. It has to be dead on, though.
I don't ever try to switch them, though. If they are happy I leave it alone. If they want to switch I let them know what to expect and to give it time.
I wear both, interchange during the day. See fine with both but see wider in more fine detail with trifocals.
Chip
I've had a lot of success fitting the SolaONE. I even replaced a Physio with it and got a much better response from the customer. It has a generous mid-range and reading area. Try it, and the worse thing that could happen is you send it back as a non-adapt and give your customer the trifocals. It's worth a shot. I put a 90-year-old in a short-corridor progressive without any problems.
Thank you!
I only wish you were competing against me accross the street, instead of accross the country!
:cheers:
Ophthalmic Optician, Society to Advance Opticianry
Reading area to small on ptogressives.............
Chip is right .............if she need trifocals she must have am add of 2.50 which gets the progressive channel to the minimal and narrowest width.
Yes it would, Image has virtually no distortion in the distance and is the least expensive of all the brands.
Good luck :cheers:
Seems like a contradiction here - she's "unable to tolerate trifocals" but has had them several years?
Senor Hartstein:
Although senor Martellaro is el rey de matching lens designs with his patients, I suggest to you a Zeiss Gradal Top.
Si, it has good distance vision.
Si, it has good intermediate vision.
Asi/asi on near vision.
And senor, the fitting height is very elderly friendly: 20 mm, fit to pupil center.
Buenos dias.
Yes, but it seems swimmy to me. My husband thought so too. Phyiso or even Comfort would be my choice. I have also liked the Sola One, but the distance is not as good. Gradual top in a deep enough frame could also work.
Too bad the old Smart Seg is not made anymore!
Funny you should say that. I am now wearing an old pair of Smart Segs, but my eyes have changed enough so that I *must* change. I am devastated. I am considering Zeiss GT2s, but am still unsure.
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