reading glasesses only to a progressive

**jamie w** · 09-25-2009, 01:18 PM

Hi everyone,
I would like some advice from fellow optiborders on patients who have been wearing reading only glasses for many years and swithching them to a multi-focal lens. I have had 2 cases this week of pts I thought were motivated enough to try a multi-focal lens. Both had complaints of decreased distance vision and tired of always taking their glasses on and off. Both patients have come back to me complaining that they can not read with progressive's. In one case I remade the glasses raising the seg but explained she would not have as much area for distance. Her reply was "I do not wear them for distance.", even though she had the above complaint. She has returned saying the glasses give her migraines. Consequently, I thought an ocupational lens for instance an Office might be a better fit for her but at this point I do not want to eat the cost of another remake if the office does not work. My question is what is other peoples protocol when fitting these kind of patients? Is there a progressive you would recommend for these patients?

**Happylady** · 09-25-2009, 01:36 PM

It is very hard to switch from a reading lens to progressives. Most of these people have excellent distance vision and expect the distance vision through the progressives to be as good as their natural vision. They are also used to a large reading area and find the smaller area that progressives offer a problem.

If they can do without intermediate then a flat top bifocal can offer a large reading and a clear distance area. But generally these patients don't want that.

Personally I try to head off the problem by offering progressives to people right from the start, even people without any distance correction. I never just assume that people just want reading glasses if they are emmetropes. I discuss both reading glasses, progressives, and bifocals with them and explain the benefits of all of them.

My husband's first pair of glasses at age 43 were progressives. He later tried both reading and computer lenses and disliked them because of their lack of distance area.

For patients that need clear vision at all distances and want to switch to progressives from reading glasses I think it is important to prepare them for an adjustment period and tell them it will take time. They need to understand that no glasses will give them the vision back they had before they were 40.

**jamie w** · 09-25-2009, 02:12 PM

happy lady,
thanx for all the advice. I do try to educate my patients on what their expectations should be when switching to a progressive, however I cringe every time my doctor brings the patient out who has previously been a RO rx and wants to try a prog. Do you have a go to lens or a lens of prefrence which offers a wider reading area? I have heard of fitting a short corridor lens like a auto 2 fixed 11 in a deeper frame to make the reading area higher and gives the patient less of a downgaze before they reach the reading area. However it is hard to get someone who is used to just buying RO lenses to spring for such an expensive progressive.

**chip anderson** · 09-25-2009, 02:47 PM

You wouldn't have these complaints except for the fact that they do have decreased distance vision and inferior vision at near compared to the readers. You can go through the motions of educating (selling) the patient but the result will be the same.

This is kind of like thinking a patient with low correction is a good canditate for contact because he refuses to wear his glasses. He refuses to wear his glasses (usually) because he doesn't need them bad enough to put up with them. This being the case he is even less likely to put up with contacts.

Chip

**jamie w** · 09-25-2009, 03:35 PM

chip,
The description you provide for yourself is very fitting.
With that being said, these 2 particular pts complained of decreased distance vision w/out correction. Both had a little plus power in the distance that the doctor prescribed. So my original question still stands is there a better progressive or progressive lens of choice or should these pts be put in RO prescription and maybe another pair to correct their mild refractive error for distance?
jamie

**For-Life** · 09-25-2009, 04:20 PM

I would suggest trying a task specific lens like the Sola Access, Essilor Interview, or the Shamir Office instead. It will allow them to keep their glasses on more, with wider reading and intermediate areas.

**chip anderson** · 09-25-2009, 05:23 PM

Actually the description is courtesy of Mr. Fesmire and Mr. Mahol.

Figured I might as well beat them to the punch for future references rather than have them say this about me.

Chip

**Happylady** · 09-25-2009, 10:12 PM

Originally Posted by For-Life

I would suggest trying a task specific lens like the Sola Access, Essilor Interview, or the Shamir Office instead. It will allow them to keep their glasses on more, with wider reading and intermediate areas.

These are great choices for people who don't need distance in their glasses. But if you need to be able to see distance and near at the same time they aren't going to work.

One lens I like that has a good reading area is the Sola One. But it's distance is not as good as some though I thought it was good. That is the problem, a lens with a great distance doesn't have as good a near and visa versa.

**Yeap** · 09-28-2009, 02:13 AM

I have this experience as well. they seem to understand how the PAL works for them, but later they will be back here complaint that the PAL can't read. but once i try the Rx with the trial lens it seem to be fine for them.. i will say that they are actually get use to the reading posture using the Read only lens but they always assume that the PAL should work the same..

**Robert Wagner** · 10-01-2009, 01:43 PM

Like you all are saying "I just can't read out of this progressive" (from single vision readers only)

Here is something I have tried and it seems to work.

Mark up the lenses with the mfg's marks and when you mark up the near circle, put a leap tape (for edgeing lenses) exactly where the reading portion is and have the patient try them, this also helps you see if the PD's are correct and takes away the unwanted "soft focus".

These are always the hardest IMHO to fit however if you give the patient real expectations and not the "sale job" your sucess will be much better.

Good luck,
Robert ;)

**Happylady** · 10-01-2009, 02:43 PM

I have also found that many of these former reading glass patients are looking through the wrong part of their progressives to read. I will stick a post it note or hold a piece of paper over the distance area of the lenses and ask them if the can read. They always (almost) say yes. I find that just telling people that they need to look through the lower part of the lenses doesn't mean that people will do it.

**DragonLensmanWV** · 10-01-2009, 02:46 PM

Originally Posted by Happylady

I have also found that many of these former reading glass patients are looking through the wrong part of their progressives to read. I will stick a post it note or hold a piece of paper over the distance area of the lenses and ask them if the can read. They always (almost) say yes. I find that just telling people that they need to look through the lower part of the lenses doesn't mean that people will do it.

That was going to be my suggestion. Chances are, they're still lowering both their chin and eyes to try to read without keeping their head level.

**fagin** · 10-05-2009, 04:54 PM

I have often found a significant hurdle is the change of corrected retinal image size in a PPL compared to a SV reading lens. The user is used to everything appearing a bit BIGGER when viewed through their reading lenses, but with a progressive lens variation in magnification across the field is undesirable, therefore when they view through the reading area of their new progessives, although the object is in focus, it is smaller, so vision is percieved as being worse.

This is more apparent still in back surfaced progressive lenses, so often a bit of "old technology" on the lens choice can reap rewards.

**Happylady** · 10-06-2009, 11:22 AM

I just had a women come in yesterday that had gotten her first progressive after always wearing reading glasses. Her distance vision had gotten worse (about a +1.00 with some cylinder) and the doctor had recommended trying a progessive. She had a +2.25 add. I didn't sell them to her.

She didn't like the small reading area and the blur on the sides were bothering her. I talked to her about computer lenses, bifocals, and reading glasses and she decided to go back to reading glasses. I did remind her that while the distance area of the progressives had some blur on the sides the new lenses would have NO distance area and no intermediate area.

**Win C** · 10-07-2009, 03:43 AM

I personally would not try to switch them from single vision readers (esp if they had been wearing one for years) unless there is a reason for me to do so. It would be even more difficult if their distance vision is perfect.

I would find out what their specific needs are or if they have any specific visual problems which a progressive may help. If after asking them some questions and telling what a progressive can and cannot do for them and they say they are fine with readers, I will leave it as that.