Reverse Multifocals

[iiiiisoptom]

I have a patient for whom I am considering prescribing a pair of reverse multifocals (PALs). I have not prescribed nor dispensed a pair previously (only ever reverse bifocals), and wondered what experiences others may have had with reverse PALs. On the few occasions I've suggested these as an option previously, most patients have thought it a bit bizarre, and have baulked at the idea.
The patient is a hair and makeup artist for film and television, often on outdoor sets. She is a low myope who has resorted (age 44) to looking over the top (she is relatively short and many of the actors are taller than her) of her glasses to inspect her work, but is now finding her near inadequate. She still needs to be able to see the distance clearly when on set.
Rx is R -0.75/-0.25x90 L -0.75/-0.25x90 (Full) Add +1.75 @40cm
Even though she is essentially orthophoric, I thought a small amount of base in and base up* prism may be beneficial for sustaining near fusion in up gaze (*ordered base down before reversal), without interferring with her distance fusional capacity. I am thinking of going for a relatively short corridor lens fitted at he top of the pupil, in order not to create too much distance blur when the head is lowered. I have told the patient that she should consider these glasses as work glasses, and that they may not be suitable for general purpose. As the prescriptions and mono PDs are equal for right and left, I will be able to order the lenses like a standard order from the lab without confusing them and ordering in reverse.
What are my chances of success? Are there any other options anyone may like to suggest as an alternative?
I'll let you know how I get on.

[Chris Ryser]

Stick to a reversed bifocal..........and you will not have to do 6 re-dos and end up naking them in bifocals

[EyeFitWell]

LOL Chris.

iiiiis, please explain, what is the gain here? Makeup chairs (and hair cut chairs, etc) can be lowered to accomodate the height of cutter/make-up-er. How is it that she must look up to see her clients? Would getting used to this be easier than getting used to progressives in the regular position? I mean, it's not like she's sliding under a car and must see what's up under the hood...I just don't see the real gain.
Look forward to your opinions.

[Andrew Weiss]

G'day, mate,

Interesting occupational lens issue. If you haven't done this already, any chance you can watch her work on-site -- both to answer EyeFitWell's question about environmental accommodations as well as to measure exactly how "low" you're going to fit those segs? I'll be interested in your comments on all this.

I've never fit an occupational progressive like that, although I have fit double-Ds and inverted bifocals. While I can see no physiological or technical reason why it shouldn't work in the abstract, especially with the prism you're considering adding, I would be curious to hear how it works in reality.

I hope you're enjoying spring in Sydney. Have a jaffle at the Manley ferry quay for me. :cheers:

[Uncle Fester]

LOL Chris.

iiiiis, please explain, what is the gain here? Makeup chairs (and hair cut chairs, etc) can be lowered to accomodate the height of cutter/make-up-er. How is it that she must look up to see her clients? Would getting used to this be easier than getting used to progressives in the regular position? I mean, it's not like she's sliding under a car and must see what's up under the hood...I just don't see the real gain.
Look forward to your opinions.

My guess is when touching up on set the actor isn't going back to a chair and sometimes they may be under a car!

I agree with Chris or at least offer the option of a lined DD-28 bifocal or trifocal occupational glasses explaining the advantages of function over fashion from the start. My guess is they'd go first with a progressive but the better solution has been suggested from the get go.

-Regards

[Chris Ryser]

The patient is a hair and makeup artist for film and television, often on outdoor sets. She is a low myope who has resorted (age 44) to looking over the top (she is relatively short and many of the actors are taller than her) of her glasses to inspect her work, but is now finding her near inadequate. She still needs to be able to see the distance clearly when on set.

.EyeFitWell....................so what,.................. short, works up wards, maybe needs stepladder, work area is up over her head.

Would qualify for upside down bifocal for work and a progressive for normal wear and if you want to push it get her a pair for the computer.

[Robert Martellaro]

(she is relatively short and many of the actors are taller than her)

So, she's working at eye level to above eye level. She will have to tip her head down significantly, and sustain that gaze for some period of time to get the near focus when working at eye level if you put the near on top. Distance consists of an occasional glance at the director. Sounds to me like she needs a high set (above the pupil) ST35. She can then tip her head down for the occasional distance glance, with a slight chin lift for the taller actor, with no posturing when working at eye level.

Interesting occupational lens issue. If you haven't done this already, any chance you can watch her work on-site -- both to answer EyeFitWell's question about environmental accommodations as well as to measure exactly how "low" you're going to fit those segs?

Right. Have her go through the motions with you taking the place of the actor. Observe the head and eye positions and fit accordingly.

[chip anderson]

Why not just make her a pair of SV lenses for the distance she will be working? She won't need to see beyond arm's lenght or read anything while doing this work. Make her a pair of "Work only" glasses.

Chip

[Robert Martellaro]

Why not just make her a pair of SV lenses for the distance she will be working? She won't need to see beyond arm's lenght or read anything while doing this work. Make her a pair of "Work only" glasses.

Chip

The OP said she needs to see clearly for distance.

She still needs to be able to see the distance clearly when on set. Rx is R -0.75/-0.25x90 L -0.75/-0.25x90 (Full) Add +1.75 @40cm

I take that to mean her uncorrected distance vision is not satisfactory for her needs. It looks like multifocals, unless she wants to try monovision.:(

[Happylady]

Too bad they don't make the Varilux Overview anymore.

[Fezz]

Too bad they don't make the Varilux Overview anymore.

A version can be made! There are s threeads on here about it.

Epic labs can do the job. I spoke to them about a month ago to do one for a patient. He backed out when I quoted him the price!

;):cheers::cheers::cheers::cheers::bbg:

It really wasn't that bad!

[Happylady]

A version can be made! There is a threads on here about it.

Epic labs can do the job. I spoke to them about a month ago to do one for a patient. He backed out when I quoted him the price.

It really wasn't that bad!

Yes, I think I remember reading that thread. So how much did you quote him for the lenses?

[Fezz]

Yes, I think I remember reading that thread. So how much did you quote him for the lenses?

More than enough!