When should A Progresive should Not be recommended ?

[William Walker]

I would add high astigmats,
those with high add powers,
and patients with MD, or similiar situations of central vision loss.

[lichou]

I would add high astigmats,
those with high add powers,
and patients with MD, or similiar situations of central vision loss.

Please define "the high astigmats, and add" for not good candidates wearing PALs

[lichou]

How about a patient's rx with correction of prism

[William Walker]

Please define "the high astigmats, and add" for not good candidates wearing PALs

As higher and higher amounts of astigmatism get ground into a lens, the channel corridor becomes narrower, giving the patient less room to see.

A similiar effect happens when introducing a high add power (say +3.00).

I have another thread open right now looking for some sort of formulas to quantify exactly how much occurs in each case, so keep your eyes open! :)

Thanks for asking.

[sharpstick777]

I would add high astigmats,
those with high add powers,

William,
I have done very well with high astig patients using digital progressive lenses with Atoric designs. In all but one case the improvement with Atoricity exceeded the inherant impact of cyl on compared with a lined option.

It depends on the angle of astigmatism, age of the pat, parity of the cyl from one eye to the other etc.

one 50 year old patient said his Definity's were the best he had seen since he was 10 years old.

Its harder to get used to because they have been compensating longer, and the change in cyl will affect their spatial relationships more, but they will be happy once they get used the atoric design.

I fit one high cyl patient and at first he could see nothing. I gave him a magazine to read, it took 20 minutes before he could see the words clearly. Then in another 10 everything clicked, he could see very well. Walking was trip for him, but he got used to it. In 2 days he was very thrilled.

[William Walker]

Hi Sharpstick,

I should have been a little more specific in my post. I screen out those patients when I sell a standard design progressive. In private practice, where I had access to everything under the sun, I did fit those patients, usually with a FF lens.

As Costco only sells the Ovation, I limit myself more than I do in private practice.

Thanks,
William

[nooksak]

A: when the patient is under 40 years of age.
B: When the patient reads with the head in a fixed position and uses eye movement alone for lateral vision.
C: When the patient wants the most precise vision possible at each viewing distance.
D: Patient has any retinal disturbances at all causing less than optimal vision.

You may now expect replies from other optiboarders telling you about all the subnormal acuity patients they sold progressives. Those higher fees and commissions motivate a lot of improper applications. So do words like new and technology.

Chip:cheers:

Just curious why you would not fit a person under 40? The reason I ask we just recently had an issue with a PT in their late 30's being non-adapt to progressives, should we go with a FT28 or a blended? Thanks,

Mike

[fjpod]

I know I'm a little late to this thread.

Some of the responses made me scratch my head.

Why not children?

I think many fitters forget that dizzy patients, monocular patients, diseased eye patients are a problem no matter what.

Progressives offer an appropriate focus for virtually every distance. True, the advantages of this may not be apparent until someone is nearing 50, and true there may be distortions on the lens in normally unused areas...but still, there are advantages.

Agreed, that in cases such as ARMD, a high powered SV lens might provide better VA for labored reading at a fixed distance, but a VFL might still be a good lens for general use. Look at it this way, someone with reduced acuity is less likely to notice distortion outside the channel, and can make very good use of the progressive for normal activities.

I just don't buy most of the excuses given not to fit a VFL...cost issues aside.

[Uilleann]

Blind people.

:D:D:D:cheers::cheers::cheers:

[lind2020]

When did it become an Opticians duty to choose the lens for a patient? Am I wrong in thinking we're obligated to educate and support the patients choice for their lifestyle?

Progressives, like everything, are not perfect for every patient. Make sure you do your work and they ought to be happy.

[Uilleann]

When did it become an Opticians duty to choose the lens for a patient? ...

Really? Did you really just say that???

[Uncle Fester]

Why not children?

We have a couple of Pediatric MD's who insist on bisecting the pupil with a FT. I believe it is to force the kids eye into the reading area because of a muscle imbalance but to me it's a moot point as I always follow a Doc's specified lens type.

[OCP]

When did it become an Opticians duty to choose the lens for a patient? Am I wrong in thinking we're obligated to educate and support the patients choice for their lifestyle?

Progressives, like everything, are not perfect for every patient. Make sure you do your work and they ought to be happy.

In Europe opticians choose the lens for the client. We don´t need an eye doctor to do this (what we see as a) simple job. :p

May opticians in US never choose the lens for an patient, or should the eye doctor do that every time?

Mike

[Robert Martellaro]

When did it become an Opticians duty to choose the lens for a patient?

Facetiousness?

I have encountered all the above patients and after some education on progressive lenses, they still insist on getting a PAL. In situations like this, you just have to give them what they want.

however, optiboarders should be ethical enough to tell them what suits them best rather recommend something based on higher fees and commisions.

That just about sums it up in my book.

A -1.25 44 year old office worker

That's almost like making gravy.

Try an emmetropic emerging presbyope/avid reader who as been wearing OTCs!

[fjpod]

We have a couple of Pediatric MD's who insist on bisecting the pupil with a FT. I believe it is to force the kids eye into the reading area because of a muscle imbalance but to me it's a moot point as I always follow a Doc's specified lens type.

We used to do the same thing...when FTs were more commmon, and we still do some. But today, we just make sure the childs glasses are not slipping down the nose. The child gets the plus, and the parent doesn't have to look at the lines. It also depends on the reason why the child is getting bifocals.

[lind2020]

Choosing ..

You're anti-progressive and the majority of your patients wear flat-top multi-focals, very successfully in you ropinion.

You're pro-progressive and the majority of you patients wear progressives, very successfully in your opinion.

One person is lying to themselves.

So yes, I did say:

When did it become the Opticians duty to decide what a patient can or can't try. I don't "choose" my patients lenses, I educate them and they get the best product we can offer them.

[Uncle Fester]

When did it become the Opticians duty to decide what a patient can or can't try. I don't "choose" my patients lenses, I educate them and they get the best product we can offer them.

When the lens type is specified on the rx I feel it must be filled as written. That doesn't mean I can't call the doc and see if an exception can be made as I would if say a Comfort 360 was specified and I wanted to use an Autograph 2. Or I can interpet an add to make a pair of glasses for the computer (again only if the Doc hasn't specified.)

Reminds me of the time an MD wrote on the rx Polycarbonate only and the optician at a local major chain changed it to CR-39. When the kid incurred a major eye injury guess who was a witness for the prosecution. (Think it was settled out of court.) The MD sent a letter to all the local places they recommended and asked if we thought it OK to change what was written on a script.

[D.J. Roff, ABOM]

About the only people I recommend not getting a progressive are folks with some kind of motion-sickness or vertigo issue (a real medical concern that the "swimming" effect could exacerbate). That being said, I once tried taking a man who'd had a brain tumor removed (with all the disorientation and cognitive impairment you might expect) out of his progressive and back to a flat-top, and he couldn't do it... wanted his progressives back. So I guess acclimation trumps logic, sometimes.

The other cases would be multiple previous non-adapts. I'm not one to give up in the face of a challenge, but occasionally you just have to tell them it's probably not going to work, if it hasn't the previous two times.

[Uilleann]

You're anti-progressive and the majority of your patients wear flat-top multi-focals, very successfully in you ropinion.

You're pro-progressive and the majority of you patients wear progressives, very successfully in your opinion.

One person is lying to themselves.

So yes, I did say:

When did it become the Opticians duty to decide what a patient can or can't try. I don't "choose" my patients lenses, I educate them and they get the best product we can offer them.

Actually - you DID in fact say:

When did it become an Opticians duty to choose the lens for a patient?...

Not what they can or can't try. Certainly they can "try" whatever they like - though in all my years dispensing lenses, I've never once had a patient ever ask me to "try" a lens just because they wanted to experience a line, or reduced availability of materials etc. what I have found consistently (and I believe this applies to just about...oh, umm, I dunno EVERYbody else out there dispensing - doubly so to the majority who post here) is that the patients they see are savvy, and come to them to give them the best quality vision. And much more often than not, that is likely to be a progressive design for a presbyopic patient.

So - unless you have weeks to take the time to properly explain the differences in modern PAL design, material properties, complex lifestyle considerations, and how all that relates in an optical manner to a PAL, or an office, or a FT or a SV of any flavor, and then demonstrate each of the millions of possible combinations in a real world setting...I would suggest that YOU as the dispenser take the initiative and choose that lens FOR your patients. You have (or most certainly should have) the knowledge and the skill set to do this effectively, safely, and usually rather quickly in almost every case.

There is no lying to anyone there - Just using the skill set that you have to fill the Rx. Patients trust you to know what will work best for them, and to explain the how and why of a given lens choice. Unless they're a recently retired dispenser themselves - they probably aren't going to know what it really is that sets a given lens design apart from another. That should be our job. Best! :cheers::cheers::cheers:

[beagleman]

I would disagree... I believe quality of life is greatly improved with Progressive lenses.

I put a 96 year old woman in her first progressives a few years ago... and she was really mad... not at me... but at all the Opticians over the previous 20 years who never even told her about progressive lenses. She said it gave her a new lease on life and she could see better and more naturally than she had in years. Hobbies were more pleasant, everything in her life better, and she loved how they looked on her. She was very very happy with progressives...

5) low power latent presbyopes who still have good visual acuity w/o glasses and are not motivated to wear glasses yet.

Thank you, thank you, thank you for your two comments above. First of all, what is there to lose to have a lined multifocal wearer try a PAL? If you explain the change in detail and they seem interested in a potentially higher quality of life, then why the heck not try it?!?!? I think the biggest risk is in NOT trying it. And then from your previous post, point #5 is also one of my big concerns, the emmetrope who now needs reading correction. We don't want to dispense a very expensive pair of glasses (with PALs) for somebody who needs help reading, but not in seeing distance. The patient learns that s/he just paid a bunch of money for "readers" that work horribly....setting up the wrong expectation for the patient. Only if they insist, "I know I don't need the help with distance, but I don't want readers with the constant taking on and off...I want to keep glasses on"...for those who are OK with becoming full time wearers. I set up my patients for an expectation that PALs are best thought of as distance glasses that also allow clear vision at closer focal points. It's unfortunate when they are told PALs are for VDT and near...wow, that's a set up for the wrong expectation!

[lind2020]

O.k. Uilleann, my opinion, methods of sales and general optical knowledge is inferior. I will retract my statement and desist in posting my opinions.

Before I go, I would like to share my humor over the statement you made:

*quote *
Not what they can or can't try. Certainly they can "try" whatever they like - though in all my years dispensing lenses, I've never once had a patient ever ask me to "try" a lens just because they wanted to experience a line, or reduced availability of materials etc. what I have found consistently (and I believe this applies to just about...oh, umm, I dunno EVERYbody else out there dispensing - doubly so to the majority who post here) is that the patients they see are savvy, and come to them to give them the best quality vision. And much more often than not, that is likely to be a progressive design for a presbyopic patient. **

In essence because I am a proponent of progressives, but FAR more because it's hilarious that you think your patients are any different or more "savvy" because you post on optiboard then anybody elses.

Again, the funny part is that we probably agree yet you are so caught up in your Optiboard ego, or whatever it is that causes you to attack any opinions professed here, that you fail to see that.

Look up the definition of a forum sometime...

[Uilleann]

O.k. Uilleann, my opinion, methods of sales and general optical knowledge is inferior. I will retract my statement and desist in posting my opinions.

Before I go, I would like to share my humor over the statement you made:

*quote *
Not what they can or can't try. Certainly they can "try" whatever they like - though in all my years dispensing lenses, I've never once had a patient ever ask me to "try" a lens just because they wanted to experience a line, or reduced availability of materials etc. what I have found consistently (and I believe this applies to just about...oh, umm, I dunno EVERYbody else out there dispensing - doubly so to the majority who post here) is that the patients they see are savvy, and come to them to give them the best quality vision. And much more often than not, that is likely to be a progressive design for a presbyopic patient. **

In essence because I am a proponent of progressives, but FAR more because it's hilarious that you think your patients are any different or more "savvy" because you post on optiboard then anybody elses.

Again, the funny part is that we probably agree yet you are so caught up in your Optiboard ego, or whatever it is that causes you to attack any opinions professed here, that you fail to see that.

Look up the definition of a forum sometime...

Hehe - clearly there's been a mis-communication on my part - and for that I humbly apologize. :shiner:

If you read my statement - it was not about *me* in any way. But rather the patient base that *we* as a profession are now dealing with. The ARE in fact very savvy, more knowledgeable (sadly sometimes misinformed however) and can sometimes throw each of us for a surprise loop if we assume or take for granted they know nothing about the lens, or quality of vision they seek.

I waste far too much time on these boards, you're absolutely right! It's a good thing I only lurked for years here before I started posting anything! That would truly show how much time I've spent here. There's a lot of beer to be drunk, and I need to get to it! :cheers: In the mean time, again, sorry for the confusion, all the very best of luck in your ongoing progressive dispensing, and I do hope that your patients are coming to you for your expertise, knowledge and skill in choosing the very best lens for them and their visual needs! (Pints on me if ever you're out this way!)

Bri~
:cheers::cheers::cheers:

[EyeGurl]

Me and the doc. exchange looks all the time. She will rec a PAL for a plano emerging presbyope. ERRRRGGGGG! I want them in an office lens or reading glasses only. I hate in when they feel ripped off when they look through their pea sized reading area. What can you do? She signs the checks and wants to have the pal sale? Now on another note, I put a patient in the Hoyalux ID in 1.70 or 1.74, he was a high myope and when he put them on he was like I don't like this everything is in 3D. I was like, well you are now seeing the world how you everyone else sees it. He was so happy after a couple days! We always start out with at least a lifestyle or higher with new patients and I always try to get them into freeform. People with slight motion sickness or other pal probs in the past love it! We do not even offer cheap lenses, so we hardly have any probs, usually just buyers remorse is underneath there complaint.

[Happylady]

Me and the doc. exchange looks all the time. She will rec a PAL for a plano emerging presbyope. ERRRRGGGGG! I want them in an office lens or reading glasses only.

If you put them in an office or reading lens then you are taking away their distance area when they are wearing glasses. If an plano emerging presbyope is going to adjust to ever wearing progressives then the best time is to start them off in them right away.

I put my plano emerging presbyope husband in a progressive at age 43.

Do you wear progressives?

[SailorEd]

If you put them in an office or reading lens then you are taking away their distance area when they are wearing glasses. If an plano emerging presbyope is going to adjust to ever wearing progressives then the best time is to start them off in them right away.

I put my plano emerging presbyope husband in a progressive at age 43.

Do you wear progressives?

I totally agree with you. We do it all the time. With office lenses or readers they take them off and put them on and take them off and put them on and ditto, ditto, and ditto.

Those that get those eventually will come back in and get progressives anyway. They can put them on and leave them on while driving, reading and whatever they are doing. It's a GOOD idea.