% Non-adapts Of Progressives

[THE MEB]

our business is interested in getting information on the perecentage of non-adapt progressives either nationwide or by a high volume lab. I called the lab we primarily use today, and unfortunately I don't think they have the ability with the software they use to garner that information to us. Do any of you have any ideas on how I may be able to glean percentage of non-adapt progressives from a high sample volume?

[braheem24]

According to one class a friend took 2 years ago, I think the speaker's last name was Ferguson... (I know, this is sounding reliable already )

In a 1 year study at a University level he had 100% adaptation. When people did not adapt to a progressive the students were instructed to switch the patient to another brand instead of a FT or EXEC.

Hope it helps your research,

Ibrahim

[rbaker]

The following will not help you one bit rather it will show you the difficulty of trying to come up with a meaningful metric on non-adapts. The data was pulled from a database that contained every lens sold over a three year period of time.

All of the glasses in the database query were complete pairs of Rx PAL industrial safety glasses with 61% new Rx's and 39% previously worn Rx's. The eyewear was sold by opticians working from three separate mobile vision vans. Every PAL dispensed was an AO Pro 16 regardless of what the employee was wearing in their dress eyewear. 17% of the employees were first time wearers. Here are the re-do/nonadapt statistics:

Optician A 4.7% redo's
Optician B 11.0 % redo's
Optician C 31.5% redo's optician C was unhired and replaced with optician D
Optician D 12.9% redo's

This data clearly shows that, in this case, the principal variable in calculating non-adapts is the optician. I realize that the statistics are quite unusual in that only a single variable existed in the lens brand. But it does point out that in order to evaluate the non-adapts based upon lens brand you would be well advised to use data from only a single optician. In addition it takes a very large data sample to get reliable answers. The data set above contained 9144 records (pairs of glasses.)

[Chris Ryser]

This data clearly shows that, in this case, the principal variable in calculating non-adapts is the optician.

In Europe there was no non adapt warranty and or replacement. Therefore the opticians had to learn to whom to, or not to sell progressives.

Actually Essilor even gave courses to teach opticians the facts.

[RT]

Be careful about mixing the terms "Non-adapt" and "professional". Clearly there is linkage between optician skill and the number of remakes due to fitting issues. The trial that RBaker reports is more likely a measure of the variability of optician skill than a measure of the patient's ability to adapt to a progressive design.

That is one reason why THE MEB reports difficulty in getting good non-adapt data from their labs--it all depends upon how the remake has been categorized when entered into the lab system.

And as RBaker notes, not all progressive wearers are "first timers". If we dispense a progressive to a previous progressive wearer, and there is no adaptation problem, what does that really tell us? Over the last 8 years, lab data suggests a very healthy decrease in "non-adapt" percentage. Lens designers will tell you it's because new designs are better. ECP's will tell you that their skill level has gotten better. The mathematician in me says it's because a greater percentage of progressives are sold to someone who doesn't need to adapt--they adapted years ago. Could be a combination of all these explanations. Or something else.

I'd be hesistant to publish lab data that I have access to, as it can be easily mis-analyzed. However, I can tell you that the percentage of progressive jobs that are remade due to Rx or fitting changes far exceeds the percentage of progressive jobs that are remade due to "non-adapt".

Perhaps Darryl has some data from clinical trials.

[MarcE]

That is one reason why THE MEB reports difficulty in getting good non-adapt data from their labs--it all depends upon how the remake has been categorized when entered into the lab system.

Over the last 8 years, lab data suggests a very healthy decrease in "non-adapt" percentage. Lens designers will tell you it's because new designs are better. ECP's will tell you that their skill level has gotten better. The mathematician in me says it's because a greater percentage of progressives are sold to someone who doesn't need to adapt--they adapted years ago. Could be a combination of all these explanations.

I can tell you that the percentage of progressive jobs that are remade due to Rx or fitting changes far exceeds the percentage of progressive jobs that are remade due to "non-adapt".

All true. Better lenses, better trained fitters, fewer FT conversions have all contributed to lower non-adapt rates. IMO.

I remember a few years ago, Laramy K published their non-adapt rates for their top 10 progressives, and then restated the results because of the definitions of "dr redo", "warranty" "lab error", etc. It could have been good data, but it was uncontrolled because you never know how the lab's customer service rep will code the redo. And you never know what story the customer will give to the lab.
I do remember that the Image had a lower non-adapt rate than Panamic. All were below 4% (based on a sketchy memory), although the total redo rate was near 9%

[AngryFish]

And personal experience as best as I can recall makes this number feel comfortable.

I typically don't exclude many from the progressive option. Usually as long as they know that any attempt to correct for all distances with one pair of glasses by necessity compromises the best attainable vision at all distances their fine. It is when they are lead to believe that they will see like when they were twenty that problems crop up.

As presbiopia advances I have noticed that the middle add powers can sometime signal the possibility of difficulty as the ability to accommodate creates greater dependence on the intermediate, and least usable, part of the lens.

I still have a warm spot in my hart for the FD and ED trifocals.

[just eyes]

I think most non adapts fall into a couple of classifications; regardless of type or brand of lens
1. " I have never been able to wear them, lets try again"
2. unrealistic expections, not educated on use of the lenses
3. optician mis-fit, pd or seg height, adjustment
4. poor manufacturing

For instance, how many times have you solved a progressive problem
with an adjustment?

[RT]

I think most non adapts fall into a couple of classifications; regardless of type or brand of lens
1. " I have never been able to wear them, lets try again"
2. unrealistic expections, not educated on use of the lenses
3. optician mis-fit, pd or seg height, adjustment
4. poor manufacturing

#3 and #4 above are not NON-ADAPTS. One is an ECP error, the other is a lab error. #2 is possibly related to ECP skill--a different ECP might have gotten the patient to adapt to the lenses. #1 is the only one of the 4 situations that could be considered a true NON-ADAPT.

The true non-adapt rate is well under the 4-5% that other posts recall from the past, as measured by all progressives shipped. At the lab level, we can't tell if the job is for a first time progressive wearer or not. So maybe the 5% that others quote is based on their experience with first time progressive wearers. But in terms of all progressives sold, non-adapts are a fraction of the remakes due to ECP error.

[Uncle Fester]

I think most non adapts fall into a couple of classifications; regardless of type or brand of lens
1. " I have never been able to wear them, lets try again"
2. unrealistic expections, not educated on use of the lenses
3. optician mis-fit, pd or seg height, adjustment
4. poor manufacturing

For instance, how many times have you solved a progressive problem
with an adjustment?

Well said!

Andrew Weiss and I both felt we had a 5% failure rate and most of those were problems we saw coming. What Mr Ryser always says is so true- Progressives are not for everyone who needs a multifocal.

[Chris Ryser]

#3 and #4 above are not NON-ADAPTS. One is an ECP error, the other is a lab error. #2 is possibly related to ECP skill--a different ECP might have gotten the patient to adapt to the lenses. #1 is the only one of the 4 situations that could be considered a true NON-ADAPT.

If there is a lab error.....................the lenses should never have left the store and any error should have been detected before delivery to patient. :finger: So that point should not even go under non adapt because the patient did not get what was the correct Rx

[HarryChiling]

The OLA has a program called Shared Lab Data, I would hope that a prog non adapt figure would be included in the data collected, but like mentioned here how many are actual prog non adapt and how many are the various other reason that opticiasn try to pass off as prog non adapt?

[Uncle Fester]

I think most non adapts fall into a couple of classifications; regardless of type or brand of lens
1. " I have never been able to wear them, lets try again"
2. unrealistic expections, not educated on use of the lenses
3. optician mis-fit, pd or seg height, adjustment
4. poor manufacturing

For instance, how many times have you solved a progressive problem
with an adjustment?

If just eyes wrote failure instead of non-adapts would they apply then RT? I see your points as a a lab guy but I also get what j/e meant as I think it was not necessarily the same optician but failures in general.

[THE MEB]

in our particular store I can't remember a non-adapt because of optician error associated with wrong seg heights or pds, the reason being that there are 3 of us(opticians) who have been in the business over 30 years, so in the rare occurence when a seg hgt or pd change is needed, it turns out not to be a non-adapt, but new pals are made with the new measurements. Subsequently, our non-adapts are truley non-adapts. We are conservative, to a degree, with whom we sell pals to, screening history and needs prior to the sell of pals.
I wanted to see , though, what percentage of non-adapts were occuring in GT2's and Compact Ultras nationwide, or at least a high volume, to do a statistical evaluation of success for the major pals, compared to the aforementioned ones. Like some of the threads we have had for those 2 lens types, I am reticent to sell them because of lack of faith in them. I personally don't, but our younger opticians especially push them because they get spiffs on them and they think because they are newer technology, that makes them better. I am trying to convince the docs we work for that these lenses havent been as successful as other pals nationwide. They told me they wanted numbers, not my or others biased opinions before we would change.

[MarcE]

MEB,
It sounds like you really want patient satisfaction stats, no non-adapt rates.
Call up a few of your patients is one thing to do. Ask qualifying fits a couple of questions regarding their satisfaction compared to their previous lens.

The docs asking for numbers sounds like a kid saying "prove it". You can't get these numbers because they are only available to the entity that paid for the wearer studies.

Or you could show all the posts on Optiboard regarding the Compact Ultra. I can hear it now "9 out of 10 Optiboard posters think . . . ."