+8 add

[eycon]

A patient just walked in with the following Rx

OD balance
OS -2.50 +8.00 x130 Add +8.00

He wanted to try progressive. I've never seen an add power above +5 for a progressive and didn't think they exist in a +8 add. So I told him it probably can't be done. And even if such a power exist and that lens can be surfaced, I told him that he'll probably have a hard time adjusting because of the distortion. But he wanted me to find out if such a lens can be made. I've tried my labs and they said no. So I'm throwing this out there for other experts. Questions:

1. Does a +8 add exist in progressive? If so, who makes them?
2. If such a lens exist, can it be surfaced to a +8 cyl?
3. If such a lens exists and can be surfaced, would you even try to make them?

I think the patient will probably not be able to get used to them even if it can be made. I've already recommeded to him to get use two pairs, one for distance and one for reading. But he wanted to try progressive!!!!!

Any advice? Thanks

[Judy Canty]

A quick look through my Lenses book indicates that SOLA XLGold in Spectralite is available with a +7.75 add.

[shanbaum]

I think that should be 7.75 base, no?

[chip anderson]

Any patient that needs a +8.00 add, has so much macular degeneration, or media problems he want see anything through a progressive. Patient needs a bifocal that gives the biggest broadest, clearest image possible. Select a bifocal that does same. Any time you use a progressive on more than a +3.00 add you and the patient are just going to waste money on a useless product.


Chip

[Judy Canty]

Nope, it's listed as an add power...

[Matthew]

I have been wrong in the past, but I have never seen any mainstream progressive above a 3.50 add. :hammer:

Probably anything printed above that is a missprint and can be verified with any manufacturer.

[Diane]

I hate to go against what may appear as attempting to please the patient, because that's what I believe we should attempt to do, but with the nature of this Rx, I don't believe the technology in any lens would render a satisfactory product. You're looking at an oblique axis, and with that amount of cylinder and the add power, the end result would be extremly poor, both cosmetically and visually. I believe that by design, any progressive, with any of the current technology that I am aware of, anyway, would produce such a narrow reading area, that it would virtually be unusable without a great deal of head movement. I'm waiting for someone to enlighten me on this topic, otherwise. I believe that we have significantly better technology than in the very near past and that same technology will improve dramatically in the future, so never say never....Gotta have this to make it work. Asphericity on both front and back surfaces, high index of refraction, with superior abbe values, and a blending design that won't narrow the progressive corridor with this high of an add power.

If the patient would consider multiple pairs and IF a progressive is available at all, (which I don't see in my lenses book), let them consider it only for part time wear and use a more conventional lens for most of the time. I agree that the best may actually be single vision for distance and single vision for near. Does the patient have an intermediate visual requirement???? Obviously with this Rx, standard bifocals and standard single vision lenses would restrict the patient to exactly those specific distances. I would also wonder what routine visual tasks that the patient had on regular basis. Also what would be the best corrected visual acuity with this Rx. Is there any corneal pathology?

Not sure, but another option may be...let's think about this one. Multifocal toric contact lenses up to what is available for you and then a progressive addition lens in spectacles that we can work with and that will provide the cosmesis and technology to give the best vision.

Just my feeble attempts at this one.

Diane

[JRS]

Perhaps another alternative would be the use of a FRESNEL (some call them press-on or stick-on lenses) lens to supplement the typical 3.50 add of a progressive. Or you could consider a single vision lens with a +8.00 fresnel cut as a FT - of any size you prefer.
Given that this person only has 1 working eye, he/she may be adaptable to almost anything that they feel comfortable with.

Best of luck.

PS - if your interested in reviewing the uses of FRESNEL lenses, try these sites;

www.fresnel-optics.com
www.fresneltech.com

[Jerry Thornhill]

Just checked Sola's web site to make sure but XL Gold highest add 3.50, Base 7.75. The highest add that I have seen available I believe is a 4.00. A 3.50add is available from many different manufacturers.

I did an 8.00 add this week in a FT-28. Unfortunately it is only available in a 4.25 Base from Younger which wouldn't be feasible for this patient.

It is available in higher base curves in a Round 22. I didn't check Aire-O-lites availability on what they have and it maybe available in other bifocal type.

I have done as high as a 9.25 cylinder in a Progressive that was successful the add was only a 2.50 though. We have been doing this persons rx in progressive for the past 7 years.

The most unusual one that I have done successfully is:
+4.25-8.75 x 30 2.0 prism diopters base up
+4.00-8.25 x 165 2.0 Prism Diopters Base Down
2.50 add OU

This lady has been in a progressive since VIP Gold first came out and gets 3 new pair every year. How well she sees I do not know but she is happy and can pass her eye exam for a drivers license.

Jerry