Understanding why patients have difficulty adapting to Progressives

[charlene in va]

Hello,

I'm fairly new here at Optiboard. I am a dispensing optician working in a two-doctor practice. I am working on a training presentation to share with the 12 other employees that work in our practice.

I want to cover the main reasons for non-adapts to progressive lenses. One of the reasons that I want to include is the difference in "drop zones" in the various types of PAL's. My problem is that while I know there is often a difference, I can't find the information that will tell me exactly what the difference is.

For example, I know from experience that often patients have trouble if they are comfortable with something like an Adaptar and they are switched into something like a Solamax. I understand that there are differences between the two lenses but I want some facts that I can use to show what the differences are.

Does anyone know where I can find these types of comparisons between lenses?

Thanks so much for any help you can offer. I appreciate having a board like this available.

[Barry Santini]

Simple:

1. Evolutionary development has significantly emphasized our sensitivity to changes in peripheral vision and perspective. It got us to where we are today.
2. Progessives are rountinely fitted to middle-aged people, the same group that is much less likely/willing to be rceptive to a change in "habits", particularly postural.
3. That bsame demographic age group views the continual use of eyewear, just for the "convenience" of avoiding taking the same on and off, as a burden, particularly because...
4. Just about everyone shares an *implicit social cognition* that prescirption eyewear is bad, over-priced, and, for readers and progressives, a reminder of one's advancing age.

The recipe to reduce the effects of the above is a less need based, insuranced based approach to vision, and an undertaking of the challenge to raise eyewear to (at least) the generally-accepted fashion levels of facial piercings and/or skin art (tatoo), if not higher, yes?

Rant off.

Barry

[Fezz]

Hello,


I want to cover the main reasons for non-adapts to progressive lenses. One of the reasons that I want to include is the difference in "drop zones" in the various types of PAL's. My problem is that while I know there is often a difference, I can't find the information that will tell me exactly what the difference is.


Does anyone know where I can find these types of comparisons between lenses?

Welcome to Optiboard Charlene!

You bring up some valid points. I highlighted a few things from your post. I will ask you a question, and it is meant as a point of interest, and not a reflection on you or your skill level (which we do not know, or need to know).

If you (us, me, we, etc) had this information, would we be able to decipher it? How would you (me, us, we, etc) use that information to provide a "BETTER" lens option to our patient? Are we educated enough to even begin to understand what it all means? Will you trust those that provide the information? Who should provide that information? Is that information only valid when comparing exact matching rx's ( plano w/+2.00 add?)? Would that information change dramatically if the rx's change dramatically? Would that information be useful than? What is a "drop zone". Is there a standard drop zone? What is it? Why? What determines the drop zone? Who determines?

On, and on, and on! It can get very complicated as you are aware!

[KStraker]

You can compare many of the features you describe with a Rotlex map. Take a look here:http://onlineopticianry.com/maps/

[sandeepgoodbole]

Cost is the factor that makes PALs vulnerable for the Non Adapts. No body bothered so much for an SV or Bifocal non adapt when the spectacles were of highest technical order.. Not getting adpated used to be a 100% responsibility of the user.. Simply Like some cough syrup not getting adapted or working .People just stopped consuming but didnt expect a return of half consumed bottle. .

[FVCCHRIS]

Cost is the factor that makes PALs vulnerable for the Non Adapts. No body bothered so much for an SV or Bifocal non adapt when the spectacles were of highest technical order.. Not getting adpated used to be a 100% responsibility of the user.. Simply Like some cough syrup not getting adapted or working .People just stopped consuming but didnt expect a return of half consumed bottle. .

I like it!

[Chris Ryser]

Hello,

I want to cover the main reasons for non-adapts to progressive lenses.

Very simple.......................................

If you would not have sold them progressives they would not have to adapt.

You should learn before anything else "TO WHOM NOT TO SELL THEM" and warn them that they might not adapt.

Reason:

The higher the reading add gets, the narrower the progressive chanel and reading seg gets.......and...........the larger the lateral distortive, (or as the optical scientists call it "lateral astigmatism") part has grown.

Most people that have worn regular bifocals or OTC's for years and get switched to progressives out of one reason or another have a great chance of becoming non adapts.
They can not hack the distortion that covers 50% of the lens, and hundreds of thousands of consumers that wear them in those small frames that have a reduced height, have barely a few millimeters of pure reading area.

Essilor the first to introduce this type of lenses used to give courses to opticians in Europe and taught them to sell, or not to sell, these wonderlenses only to startup reading glass wearers, because they would change every few years, start up with a low add and then progress to higher ones and these people where no problem assuming they were properly fitted.

There are many professions that should not even think of wearing progressives for their work as they do need wide, clear far and near vision. This is a subject I could go on and on.

I have several pairs of progressives, but love to wear my ST35s for work as they provide a much better field of vision, near and far. My progressives are ok for socialising and I won't even see the distortive parts anymore after the 3rd Scotch.

[Now I See]

I've found that there is a direct relationship to the patient's motivation and their adaptability. If they are highly motivated, they will adapt.

I can tell you that I have learned alot from browsing through the threads here and at one time there was a thread that someone went through many designs of the lenses and told us which ones they found to maximize the distance/intermediate, intermediate/reading, and distance/reading....I used it many times, and I'm sorry to say that I cannot find that thread any longer. If you search around on Optiboard, you'll find many helpful threads... :)

You can compare many of the features you describe with a Rotlex map. Take a look here:http://onlineopticianry.com/maps/

Thanks, KStaker! I think this could be a great tool, I'm not sure I know exactly how to read it, though....could be that I just glanced around, I'll go back and take a more thorough look.

[sandeepgoodbole]

http://www.optiboard.com/forums/show...t=Progressives

[sandeepgoodbole]

http://www.optiboard.com/forums/show...t=Progressives

[FourEyez]

I am also new to opti-board...Hey! Ya'll! I have found that face-form has ALOT to do with non-adaption.

[Johns]

Very simple.......................................

If you would not have sold them progressives they would not have to adapt.

So, what you're saying is that if they "have to adapt", then they were not good candidates?:hammer:

And if they get a tint on their lenses, and have to "adapt", then they were not good candidates?:hammer:

And so on...?

Adaption is simply the adjustment to change. Just because you adapt, does not mean the change you're adjusting to is bad.

[sandeepgoodbole]

So, what you're saying is that if they "have to adapt", then they were not good candidates?:hammer:

And if they get a tint on their lenses, and have to "adapt", then they were not good candidates?:hammer:

And so on...?

Adaption is simply the adjustment to change. Just because you adapt, does not mean the change you're adjusting to is bad.

Bancurrept, Unemployed, upset, struggling hard man to Astrologer = My Girl friend wants us to get married. Check my stars, scan my palm and ask your parrot , n tell when would the misery end? Astrologer After all the calculation = It wont . Untill Two years after getting married . ....Man = O does that mean After two years I would be better off ? Astrologer = No. U will get Adapted to the situation, like people get along eventually with Non Adapt, Pal !!

[MIOPE]

Understanding why patients have difficulty adapting to Progressives

There are many reasons and some are caused by lack of comunications between patient and Doctor. Some just, do the exam, write the prescription and sent the patient to make the new lenses.
Half of the time we take to do a exam must be dedicated to talk to the patient. Investigate what are his needs, what he does, etc. Know you patient. He did not came to see me just to get a new prescription. A good prescription alone will not solve his problems.
For example. A person that do a lot of intermediate distance work and his Add now has increased to 2.00 or higher, may be more comfortable with a long corridor progressive that with a short corridor one even if he is wearing a short one on his older glasses.(with weaker add). This is someting that should be mentioned to the patient and if we agree to go to a large corridor multifocal it should be written on the prescription.
Do not let the frame to decide the type of progressive.

Another one is P.D. . It should be messured and rechecked.

A person already wearing bifocals, may be more comfortable with bifocals again if he does not need intermediate distance or has learned to get closer to what he needs to read. Let say that his far distance prescription has not change much but now he need a increase of 0.75 on the Add to read small prints. He could be happier with a smaller increase in Add on the new bifocals and reading glasses as a second pair (far RX plus 2.50 add).

I always explain to this patients what a progressive is, how it works and what are the good, bad and ugly thing about it. I wear them (add 2.50) so it is easy to me to explain.
Present all the choices to the patient and let it decide. Even if he decide to try progressive i will mention that progressive are versatile but not specific. For special works there may be better special lenses (reading glasses, ocupational lenses, etc).
I wear progressive but has reading glasses, far distance glasses to watch TV lying on bed, sun glasses, and a few spare progressive.

So 5 more minute could be the difference between success or failure. Yes, we fail when we do not do the best to solve the patients problem. At least this is the way i feel.

[Uncle Fester]

Understanding why patients have difficulty adapting to Progressives

There are many reasons and some are caused by lack of communications between patient and Doctor. Some just do the exam, write the prescription and send the patient on to make the new lenses.
Half of the time we take to do an exam must be dedicated to talking to the patient. Investigating his needs, what he does, etc.
Know your patient. He did not come to see me just to get a new prescription. A good prescription alone will not solve his problems.
For example. A person that does a lot of intermediate distance work and his add now has increased to 2.00 or higher, may be more comfortable with a long corridor progressive than with a short corridor one even if he is wearing a short one on his older glasses (with a weaker add). This is something that should be mentioned to the patient and if we agree to go to a longer corridor multifocal it should be written on the prescription.
Do not let the frame decide the type of progressive.

Another one is P.D. . It should be measured and rechecked.

A person who already is wearing bifocals may be more comfortable with bifocals again if he does not need an intermediate distance or has learned to get closer to what he needs to read. Let's say that his far distance prescription has not changed much but now he needs an increase of 0.75 on the Add to read small print. He might be happier with a smaller increase in Add on the new bifocals and reading glasses as a second pair (far RX plus 2.50 add).

I always explain to this to patients. What a progressive is, how it works and what are the good, bad and ugly things about it. I wear them (add 2.50) so it is easy for me to explain.
Present all the choices to the patient and let them decide. Even if they decide to try a progressive I will mention that progressives are versatile but not specific. For special work distances there may be better specific lenses (reading glasses, occupational lenses, etc).
I wear progressives but have reading glasses, distance glasses to watch TV lying on bed, sunglasses, and a few spare progressives.

So 5 more minutes could be the difference between success or failure. Yes, we fail when we do not do our best to solve the patients problem. At least this is the way I feel.

:cheers::cheers:

[that_guy]

Hey,

Here's two issues you should discuss in your presentation:

1. Inset variations and how frame selection impacts them

Lenses today (typically not including most "free-forms") have near vision insets (add power placement) that is decided by two factors: a. add power b. base curve. Essentially the more plus power we put into the lens, the wider the inset becomes. That inset is decided by monitoring patients convergence based on variations of their RX. Basically, lens manufactures have it figured out how a 'typical' patient's eyes converge based on those factors. When you choose a frame that requires a flat base curve, for instance, a rear mounted lens design, your lab will be required to choose a flatter base curve to make that frame edge out properly. Alternatively, if you choose a frame with exceptionally wrap, your lab will be required to choose a base curve that will work. In those circumstances, they are not the ideal base curve for the patient, and therefore, your patient is receiving an incorrect inset design. Therefore, the patient will most likely have a smaller than normal reading and intermediate channel.

2. Add power (and sometimes base curve) changes in patient's repurchasing habits.

When a patient comes in after 2-3 years for a new pair of eye glasses, they're going to have a typical .50D increase in their add power. Sometimes there will be a slight variation in their sphere and cyl power as well, but we'll discuss that in a moment. This add power increase causes traditional lens designs (withstanding the free-form lens designs mostly) to shrink the width of their corridors. When you present to your patient the option of "staying in what you had before" you're actually telling your patient a lie. With their new add power your question should be, "would you like to have a slightly narrower lens than you did last time?" This can be avoided by choosing most free-form lens designs. You can also have variations in the design if the base curve changes and it's the same conversation, except it's including other aspects of the lens design as well.

Basically, you can avoid both of these issues by fitting a current PAL design. New PAL designs (Free-Form) allow you to specify the inset so the patient receives the absolute best width of a corridor and they also have the same PAL design from .75D add to 3.50D so your patient doesn't experience a decrease in width as they grow older. I didn't mean to turn this in to a conversation about free-form, but every time I hear "let's discuss why some patients can have problems with progressives" we could just as easily say, "90% of these problems could have been avoided in the first place with a free-form lens design." And, when I say a free-form lens design, allow me to emphasize design. I've stated in a few other posts there really are only a few players in this game, Hoya, Zeiss, and Shamir. Zeiss and Shamir allow for slightly more customization, albeit rarely advantageous (individual and autograph II) and Hoya has a more advanced lens design (lifestyle and regular id). But, all three allow for inset design and constant design among the adds.

Unless you're surfacing, there's not much to justify the use of adaptars and solamax still. Your patients will eventually learn they can get the exact same thing for less at a mass merchant when they go there for their second pair or an impulse buy. Just go high end and pass the marginal cost increase along to your patient. They won't even feel it.

Hello,

I'm fairly new here at Optiboard. I am a dispensing optician working in a two-doctor practice. I am working on a training presentation to share with the 12 other employees that work in our practice.

I want to cover the main reasons for non-adapts to progressive lenses. One of the reasons that I want to include is the difference in "drop zones" in the various types of PAL's. My problem is that while I know there is often a difference, I can't find the information that will tell me exactly what the difference is.

For example, I know from experience that often patients have trouble if they are comfortable with something like an Adaptar and they are switched into something like a Solamax. I understand that there are differences between the two lenses but I want some facts that I can use to show what the differences are.

Does anyone know where I can find these types of comparisons between lenses?

Thanks so much for any help you can offer. I appreciate having a board like this available.

[Barry Santini]

I think, rather than extolling the expected (and comparative) benefits of the latest FF progressive designs, and their perceived improvement on reading corridor width, we should rather really be investigating then factors behind why:

Varilux Comfort, a 1994 traditional progressive design, continues to prove it's customer-valued reading performance and utility, with acceptable (used to?) peripheral DV performance...especially in the higher adds (+2.50 and over).

My premise is that, since people "get used to" the periphery of most progressive designs, why introduce a more costly lens at these higher add powers when my experience is that they don't deliver a real WOW with reading performance improvements.

FWIW

Barry

[rdcoach5]

Lack of proper pantoscopic tiit and/or excessive vertex distance I have found to be the most common cause of progressiv problems. Even so, there are people who want to be able to scan their complete large screen computer monitor without any head turning. Those people should be put into a single vision computer lens or a bifocal.

[opticianbart]

So 5 more minute could be the difference between success or failure. Yes, we fail when we do not do the best to solve the patients problem. At least this is the way i feel.

+1

Many of the people working in our proffessions (all three O's) neglect to spend those extra couple of minutes, and it can make a world of difference when you do.

[harry a saake]

the problem arises as most of us opticians forget to ask the patient the most basic question

WHAT ARE YOU GOING TO BE USING THESE GLASSES FOR

sounds stupid and you will get a few dumb answers, but most people as you get them talking will now tell you.

now you can determine the proper lens to use whether it be a progressive, d-35, ribbon seg and what have you

also by doing this you can usually get multiple sales of task specific glasses

[Striderswife]

the problem arises as most of us opticians forget to ask the patient the most basic question

WHAT ARE YOU GOING TO BE USING THESE GLASSES FOR

Yes! The most important question is "what are you going to be doing while you are wearing these glasses?" Yeah, it's kind of a "duh" question, but we need to know this!

[MIOPE]

Yes! The most important question is "what are you going to be doing while you are wearing these glasses?" Yeah, it's kind of a "duh" question, but we need to know this!

I agree with that.
Here, there are no opticians. Optometrist are supposed to do both jobs so we are the ones that has to ask that kind of questions.
How is it on your country? In those countries where there are Optometrist and Opticians, does the O.D. write down one prescriptions? Then the Optician use it as a base to produce prescriptions for different kind of lenses (computer, reading,etc).? Or the O.D. should write down one prescription for each lens the patient could need?
Here we should, if we really care about the patients satisfaction. Most just write one prescription beacuse they are conscerned about what the patient can not do with old glasses and forget that the patient will not be able to do with new RX, things that he does with old glasses.
If needed, i use to write the prescription for each lens the patient may needs according to what he usually do. (Computer, piano, very close work,etc). For instance, a progressive weared that has increased its ADD, i will always talk about ocupational lenses in case he would want to be more comfortable while using the computer for many hours. Like this, there are a lot of cases where we do not say, "you need 3 pair of glasses" but in case you feel that you need it, here is the prescription.
Most people do not know that there are better alternatives that a single pair of glasses.
Some do not even know they can buy sun glasses with his prescription. Yes, that is more common that you could think.