Hard vs Soft

[optilady1]

Is this still a consideration anymore when deciding on which lens to put a patient in? I typically fit Hoya lenses, and my go to lens used to be a Summit. I started noticing though, that many patients weren't adapting when switched. I would say a good percentage where switched from ovations or illuminas. The biggest complaint was smaller reading area.

If the patient decided to upgrade to the lifestyle ID, the majority of the time they were happy. Every once in a while I'd get the patient who swears he could see better out of his VIP's. Whatever, I'll change them back.

But if the patient didn't want to upgrade, I'd typically change them to a GPW and it would solve the problem. When I called my Hoya lab, I was told by one of the lab guys that exept for the Lifestyle, the GPW has the widest reading area.

So here is my question: Which, in your opinion, is the better way to fit? A harder lens design, because it gives wider reading and distance, or a softer design with less 'swim'. Would I be creating more problems for myself if I were to pose the question to the patient? And do free form lenses fall into the hard vs soft catagory?

Any input would be greatly appretiated. Thanks!!:)

[WFruit]

It depends on the patient. Typically, harder lenses have a wider reading area, but a narrower channel, while softer designs have a wider intermediate, but narrower reading. Obviously someone using their intermediate a lot is going to want that wider area. Conversly, someone who does a lot of reading or close up work is going to want the larger near area.

The GP Wide has the widest reading area of any conventional progressive I can find. And the only lens I've seen currently with a harder design is the VIP. (Oh, and FYI, the GP Wide in Poly has been discontinued.... or at least is no longer being made available to wholesale labs. Hoya says they still have some left, but they aren't making more.)

See Tony's site: http://thelensguru.com/ for some very nice lens maps. No, they are not the be all, end all of choosing a progressive, and yes, it will change with changes in add power, but they still give you a good reference for lens designs, and it's pretty easy to see the hard vs. soft designs.

Typically the current conventional designs try to fall somewhere between hard and soft to try to maximize the benefits of both. Hard vs. Soft is becoming less and less relevent for the majority of patients. Free Form is almost always going to be your best bet, since the distortion in the lens is reduced in both size (smaller area) and severity ("softer" design) which means that you get both wider areas and lower amounts of "swim." And remember that by necessity, shorter corridor designs, even in Free Form, will be "harder" designs (which in Free Form especially is VERY relative).

[HarryChiling]

Is this still a consideration anymore when deciding on which lens to put a patient in? I typically fit Hoya lenses, and my go to lens used to be a Summit. I started noticing though, that many patients weren't adapting when switched. I would say a good percentage where switched from ovations or illuminas. The biggest complaint was smaller reading area.

If the patient decided to upgrade to the lifestyle ID, the majority of the time they were happy. Every once in a while I'd get the patient who swears he could see better out of his VIP's. Whatever, I'll change them back.

But if the patient didn't want to upgrade, I'd typically change them to a GPW and it would solve the problem. When I called my Hoya lab, I was told by one of the lab guys that exept for the Lifestyle, the GPW has the widest reading area.

So here is my question: Which, in your opinion, is the better way to fit? A harder lens design, because it gives wider reading and distance, or a softer design with less 'swim'. Would I be creating more problems for myself if I were to pose the question to the patient? And do free form lenses fall into the hard vs soft catagory?

Any input would be greatly appretiated. Thanks!!:)

I tend to like softer designs for emerging presbyopes and harder designs for the advanced presbyopes. If I had to put a cut off you would more than likely go into a soft design if your add was below a 2.00 and in a hard if the add was a 2.00 or over. Newer lens designs are going to start out soft in the lower adds and get harder as the add goes up, this is the multi design and design by prescription model. Also many current designs will incorporate both hard and soft features.

It's difficult to take a person from a harder design into a softer design, but softer to harder is easier to adjust too and you'll have less issues. If a patient comes in wearing progressives and didn't have a hard time adjusting to progressives you may want to go with the harder design. If they complain of difficulty in adjusting and swim and sway then teh softer design would probably be a better choice. Just make sure to keep them in a current design so they get all the benefits of current technologies.

[MasterCrafter]

I tend to like softer designs for emerging presbyopes and harder designs for the advanced presbyopes. If I had to put a cut off you would more than likely go into a soft design if your add was below a 2.00 and in a hard if the add was a 2.00 or over. Newer lens designs are going to start out soft in the lower adds and get harder as the add goes up, this is the multi design and design by prescription model. Also many current designs will incorporate both hard and soft features.

It's difficult to take a person from a harder design into a softer design, but softer to harder is easier to adjust too and you'll have less issues. If a patient comes in wearing progressives and didn't have a hard time adjusting to progressives you may want to go with the harder design. If they complain of difficulty in adjusting and swim and sway then teh softer design would probably be a better choice. Just make sure to keep them in a current design so they get all the benefits of current technologies.

Great advice Harry!!

I like the freeforms that let you choose what area the pt is using the most. Like a general purpose, intermediate, reading, distance specific.

[Yeap]

hi, i think Harry got all the point. when you fit the patient with free-form lenses i don't think you will encounter lots problem with narrow reading, low adaptation problem. we have upgrade a lot of patient from conventional design to free-form lenses and receive a very good feedback.