Progressive lenses

[rfish777]

When your fitting a small frame with a B-dimension less than lets
say 40 mm, what progressive do you use? I prefer the A.O. Compact, what do you like? :bbg:

[JennyP]

rfish:
I wear a Moschino 3081-V, 41 eye, with a 28 B, fit at 20 seg using an AO compact (poly and AR) for a -1.75 and slight cyl, OU, and a 2.50 add. I do wear it down my nose a little and tell my patients that most people can't tolerate this fitting (at least in my experience) but if they really really really want to wear a small B frame, and are willing to really really really work at it, they may learn to wear it. I point to my close-set eyes and the position of the frame on my nose, and I mention the nausea I have sometimes experienced, and then I show them a slightly bigger frame (and probably more attractive on them) and mention that it should be much easier to use with their Rx. If they choose to go ahead with a small frame, most of them feel challenged to spend the extra time learning to use the lens. And if you are gonna do all this, why wouldn't you want AR too?
JP (ok, this may have been more info than you wanted, but I felt chatty tonight!!:D )

[Jeff Trail]

rfish,

I know that a lot of people in our industry might be surprised by the amount of PAL's you can actually fit low, I have worked hard with all my accounts to place fitting charts supplied by the lens makers on all the dispensing tables..it takes but a second to put a "temporary" dot on the frame demo lens and line that on the chart and see exactly where the reading circle will fall ... I have found that you can fit a lot more PAL's into those frames than just going with the hype and fitting every "low" fitting with the A.O., PLUS the patients can really get a feel for how the design sets in the frame and can get a good visual by looking at the charts as well... most of my accounts now agree with me and they said it even makes selling even easier by being able to show the patient the chart and frame... (that said)
I like the Solamax better than the A.O.. and fitting the Essilor Natural often in the 18 to 20 mm height. I have not really run into many problems.. I think the shape of the frame and the mono PD has more effect than the fitting height on the type of PAL we tend to use.. one of the main problems we were running into is the "type" of person who was buying, say they are a new presbyop than those AO's and Solamax's were being no problem to pop people into but than fitting a long existing presbyop who actually needed those three power area's were becoming an adaptation problem.. lets face it to move to points closer together (fitting cross and reading area) you have to lose something and in the case of these shallow PAL's the thing that gets reduced is the intermediate area.. new presbyops are not really needing that intermediate (most of the time) so they do not miss it as much..BUT those people who really need that arms length to 8' they usually hate those shallow fit PAL's..and the ones that are going from an existing PAL with a deeper coridoor to the shallow..yikes
Try using the charts and you might be surprised by the number of PAL's you can fit perfectly well in those smaller frames...
I know we (my lab) see a lot of orders for the Younger Image and the Essilor Natural, more so than the lens just "designed" for the shallow fits and they seem to be working out just as well..

Jeff "just another option to ponder" Trail

[Alan W]

Jeff, I couldn't agree more with the your philosophy. There is a lot more latittude than we think in PAL selection and determination of brand suitability. Patient motivation, stage of presbyopia, and useage still remain vaiables in the equation. In addition, I submit that the opticians relationship with the prescribing doctor often influences the ultimate success of the patients experience. Briefly, let me explain:
1, I like to use the Outlook lens. It works adequately.
2, The "Naturals" work well even when taken to the limit and beyond. ( There's that relationship issue) In lower presbyopic prescriptions many of the doctors I work with understand, after we discuss it, that an add prescribed +0.25 - +0.50 greater than normal, when used in a frame that will lose the near window, becomes a different progressive lens of its own. True, with a limited to no intermediate (refer to Jeffs comments regarding the need for intermediate in lower presbyopes), it performs well ONLY for patients insistant on a small frame WHO are very low adds.
3, While I am an advocate of consumer satisfaction and wish to accomodate the buyers desires always, I am still acting as the consumers agent, and reserve the right to smash 'em over the head with a mallet, dismember their arms and break their legs if they don't pay heed to my advice when I say.....NO!

Have a nice day!

[sticklert]

Hi I work for a wholesale lab which is a part of Hoya. I just wanted to mention two progressive lenses that my accounts have been dispensing. They have both proven to be very successful at 17mm. One progressive is the Hoya Summit 1.6, and the other is the Shamir Piccolo. And the feedback I have been recieving is, the Summit is softer with little peripheral distortion. However, I have had some opticians tell me they have fit the Piccolo at 16mm with little problems.:D

[JRS]

Say hello to Ray & Lydia - plus all the gang up there Sticklert. Been awhile since I've seen any of them.

[Jackie L]

AF-Mini here. Pentex manufactures it. We have fit as low as a 14 with pretty good results.

[Texas Ranger]

Just another thought. We make a supreme effort to dissuade folks from getting any multifocal lens in the very shallow shapes. They cause the wearing to look under the frame in a normal looking down motion and requires them to lower their head unnaturally when reading. the ones that do get them are generally quite unhappy. they also limit greatly the distance viewing area. If they have a very minor ditance rx, like a +.25 w a +1.75 add, and want a shallow shape, why not just make them up as zeiss rd of rodenstock office? They'd get more use out of them.