Page 1 of 2 12 LastLast
Results 1 to 25 of 29

Thread: Distance good, reading good, intermediate bad. A progressive puzzle.

  1. #1
    Master OptiBoarder AngeHamm's Avatar
    Join Date
    Apr 2010
    Location
    Richmond, VA
    Occupation
    Optical Retail
    Posts
    1,860

    Distance good, reading good, intermediate bad. A progressive puzzle.

    I have a patient, let's call him Stan. He's presented me with a poser.

    Here's his old RX from May 2009:
    -1.75 -0.75 x082 +2.50
    -2.00 -0.75 x099 +2.50
    Varilux Comfort, Poly, Transitions Grey, Crizal Avance. Vertical alignment is perfect, OS OC is just a touch wide, but well within tolerance.

    Here's his new RX from December 2011:
    -1.25 -0.75 x073 +2.50
    -1.50 -0.75 x097 +2.50
    Varilux Comfort 2DRx, Poly, Transitions Grey, Crizal Avance.Vertical and horizontal alignment are spot-on.

    So my excellent doctor pulled his distance RX back a bit and I put him in a progressive with a wider reading and intermediate area. But Stan is having problems. He is complaining that his distance is clear, his reading is clear, but his intermediate is too hard to find the focus in. He's coming in today for a new refraction. The only substantial change from the old lenses to the new is that sphere power change, but I have a hard time imagining that that would affect his intermediate and not his distance or near.

    I have to admit to being a bit stumped. He's worn a nearly-identical PAL design for years, so I can't think that's the problem. His add hasn't changed, nor has his cylinder changed appreciably. I wanted to throw the problem out to my OB homeys today. He comes in at 420 this afternoon (EST). Any thoughts?
    I'm Andrew Hamm and I approve this message.

  2. #2
    Independent Owner kcount's Avatar
    Join Date
    Feb 2009
    Location
    Chicago, Illinois, United States
    Occupation
    Dispensing Optician
    Posts
    1,711
    I had this same issue last summer.
    Take a look at the new Rx, the sph is half the add. Thus the patient is Plano at intermediate. Of course the glasses are not working at intermediate. Any power you give him will resul in the patient saying the vision is better without the glasses at te computer. My suggestion, either educate the patient to this or bump the dist Rx back up.
    "If you don't build your dream, someone will hire you to help build theirs..."-Tony Gaskins

    So I built Prentice Optical Lab.

    Prentice Optical Lab
    Independent Wholesale Optical Lab
    Glenview, IL
    (847) 729-1700

  3. #3
    OptiBoardaholic
    Join Date
    Jul 2010
    Location
    Earth
    Occupation
    Optical Retail
    Posts
    201
    the patient is Plano at intermediate
    The cylindrical correction (-0.75) is still there so it's not Plano.

  4. #4
    OptiGeek Wes's Avatar
    Join Date
    Nov 2007
    Location
    Earth
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    3,177
    Assume your excellent doctor got the current rx correct.
    That means his real intermediate is OD: pl -.75, OS: -.25-.75
    To effectively reach this power in his old rx, he would be looking much lower in the pal, into the wider reading area.
    Perhaps he has trained himself to do this over time as his rx changed from 2009? Is he a heavy intermediate user?
    If so, he may have to either be re-trained, or fit with something that allows more intermediate use at the expense of near, or you could give him a trifocal which would allow clear vision at all distances.

  5. #5
    OptiBoardaholic
    Join Date
    Jul 2010
    Location
    Earth
    Occupation
    Optical Retail
    Posts
    201
    Is the DRx lens frame and/or POW optimized (i'm not familiar with the lens)?

    If it's made with a shorter progression zone to optimize gaze lowering it could reduce the intermediate zone width.

  6. #6
    Master OptiBoarder AngeHamm's Avatar
    Join Date
    Apr 2010
    Location
    Richmond, VA
    Occupation
    Optical Retail
    Posts
    1,860
    Quote Originally Posted by kcount View Post
    I had this same issue last summer.
    Take a look at the new Rx, the sph is half the add. Thus the patient is Plano at intermediate. Of course the glasses are not working at intermediate. Any power you give him will resul in the patient saying the vision is better without the glasses at te computer. My suggestion, either educate the patient to this or bump the dist Rx back up.
    The only wrinkle in this hypothesis is that the same -0.50 was lost in his reading, which he claims is fine. And his distance, which he claims is fine.
    I'm Andrew Hamm and I approve this message.

  7. #7
    Optimentor Diane's Avatar
    Join Date
    May 2000
    Location
    Jackson, GA - Jonesboro, GA no more
    Occupation
    Dispensing Optician
    Posts
    2,331
    Trial him with single vision with the intermediate and see if the complaint is the same. Put him in front of a computer, etc.

    Diane
    Anything worth doing is worth doing well.

  8. #8
    Independent Owner kcount's Avatar
    Join Date
    Feb 2009
    Location
    Chicago, Illinois, United States
    Occupation
    Dispensing Optician
    Posts
    1,711
    Quote Originally Posted by Nikolay Angelov View Post
    The cylindrical correction (-0.75) is still there so it's not Plano.
    True, but the -0.75 is negligable to over all Rx satisfaction. Change this around if the patent had an add that read +1.50 they would forever take their glasses off and say the vision is better without. Why? because the viewing are in a PAL with an Rx near plano is too restrictive. The patient may have some blur sRx but has a near infinite reading area. The same hold true with intermediate. Just because we can quatitatively measure the need for an Rx doesn't mean the patient finds that Rx satisfactory. Barry Santini actually wrote his Masters paper in this very issue. (yes, I actually read papers when people send them to me)

    Quote Originally Posted by AngeHamm View Post
    The only wrinkle in this hypothesis is that the same -0.50 was lost in his reading, which he claims is fine. And his distance, which he claims is fine.
    Actually his reading power is now +0.50 stronger than before.

    Old Rx Near:
    +.75 -0.75 x082
    +.50 -0.75 x099

    New Rx Near
    +1.25 -0.75 x073
    +1.00 -0.75 x097

    I wouldn't be suprised if the chart showed they were ~20/25 Dist and J1 with the old rx. They probably the same with the new Rx. The only difference is the 'need' of the glasses to focus at the defined length (ie computer distance).

    Quote Originally Posted by Diane View Post
    Trial him with single vision with the intermediate and see if the complaint is the same. Put him in front of a computer, etc.

    Diane
    Yep, then break from work early for a cocktail.

    Nikolay, the Drx is a POW compensated Comfort. Given of course they sent in the POW measurments in which case they are "sorta' POW compensated". On another note, why do a compensated lens on so little of a cyl? I hvae yet to have a patient state any marked improvement in vision without first haveing >1.50cyl. exception being emerging presbyopes with their first PAL. (ie: my wife)


    Trust me on this one, I have already been down this road and pulled alot of hair out. (which as you can see from my picture is a difficult thing to do.) Not to mention the remade lenses.
    Last edited by kcount; 01-27-2012 at 11:58 AM. Reason: caught an error.
    "If you don't build your dream, someone will hire you to help build theirs..."-Tony Gaskins

    So I built Prentice Optical Lab.

    Prentice Optical Lab
    Independent Wholesale Optical Lab
    Glenview, IL
    (847) 729-1700

  9. #9
    Master OptiBoarder
    Join Date
    Mar 2010
    Location
    north of 49
    Occupation
    Dispensing Optician
    Posts
    2,977
    Ange:

    Stan, the man is 3 to 4 years older than he was in 2009, and his presbyopia is evolving, even tho no add change..........Either give him a seperate set for occupation, hobby, use with a very generous intermediate, or a trifocal.

  10. #10
    Master OptiBoarder AngeHamm's Avatar
    Join Date
    Apr 2010
    Location
    Richmond, VA
    Occupation
    Optical Retail
    Posts
    1,860
    You guys are fabulous. This is the power of community, professionalism, and the internet at work.

    Stan is coming in in about 30 minutes. I'll let you know what we do.
    I'm Andrew Hamm and I approve this message.

  11. #11
    Rising Star
    Join Date
    Jan 2010
    Location
    Carrollton
    Occupation
    Optometrist
    Posts
    54
    Wes is on the right track. Stan doesn't have enough room in the intermediate corridor at the distance he sits from his computer.

    Stan needs an Office lens.

  12. #12
    OptiWizard Yeap's Avatar
    Join Date
    Mar 2009
    Location
    Malaysia
    Occupation
    Optometrist
    Posts
    352
    is your patient a heavy intermediate user? what i use to do here will be investigate the lifestyle such as how much time he spend on computer or any instrument that he need to operate during his working hour? if so usually we will fit with a occupation related solution such as a extended reading glasses or single vision that suite to his need.
    Yeap


  13. #13
    OptiGeek Wes's Avatar
    Join Date
    Nov 2007
    Location
    Earth
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    3,177
    So what happened with Stan?

  14. #14
    Manuf. Lens Surface Treatments
    Join Date
    Aug 2002
    Location
    in Naples FL for the Winter months
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    23,240

    Redhot Jumper The intermediat is narrow.....the power increases fast ...................

    It is very simple ............at a 2.50 add the patient is in another category --------> old, older or real old.

    The intermediat is narrow.....the power increases fast and the head position has to move little by little to find the right spot. Many of the old people do have mobility problems, the head bent forward and lots more.

    They do not care that much anymore about wearing PALs, as the first hand choice of PALS is to make you look younger, but at a 2.50 add the face is seeded with wrinkles, so put them in a flat top and you will see they will be happy customers.
    Chris Ryser
    ________________________________________
    DLO. NA.IC.I.T.PO

    http://optochemicals.com............................. http://arcoatings.com

  15. #15
    Optician Extraordinaire
    Join Date
    Jun 2005
    Location
    Somewhere warm
    Occupation
    Dispensing Optician
    Posts
    3,123
    Quote Originally Posted by Chris Ryser View Post
    It is very simple ............at a 2.50 add the patient is in another category --------> old, older or real old.

    The intermediat is narrow.....the power increases fast and the head position has to move little by little to find the right spot. Many of the old people do have mobility problems, the head bent forward and lots more.

    They do not care that much anymore about wearing PALs, as the first hand choice of PALS is to make you look younger, but at a 2.50 add the face is seeded with wrinkles, so put them in a flat top and you will see they will be happy customers.
    There are many people with 2.50 adds in their mid 50's. I wear a 2.50 add and I am certainly not old, I'm 55. My face is not seeded with wrinkles.

    My progressives have a very useable intermediate area. I think a lot of the problems that people have their computer screens too high so they have to tilt their head back to see the screen. If the screen is low enough progressives often work well at computers.

  16. #16
    Master OptiBoarder
    Join Date
    Jan 2010
    Location
    In Flux
    Occupation
    Dispensing Optician
    Posts
    1,555
    Considering the decline in minus power, I would bet he is overplussed now even for reading but with the early development of cataracts the reading overplus is tolerable but not so much at intermediate as the overplussing in interemediate further narrows the width of field and might be more agravated by the positional development of the cataract.

  17. #17
    Master OptiBoarder
    Join Date
    Jun 2008
    Location
    Seattle WA
    Occupation
    Optical Wholesale Lab (other positions)
    Posts
    3,137
    The Comfort was designed before computers become common, its emphasis is entirely reading, after all its competition was ST-28's so any intermediate was in improvement over the ST-28. The intermediate is incredibly narrow.

    The New Comfort did move the corridor slightly, so he is losing binocular symmetry. To make it worse he is trying to find his old power, which is not where he is used to it.

    This is really a lens design issue, not an RX issue. You may want to consider another lens.
    Beer is proof that God loves us and wants us to be happy ~Benjamin Franklin

  18. #18
    Manuf. Lens Surface Treatments
    Join Date
    Aug 2002
    Location
    in Naples FL for the Winter months
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    23,240

    At the end they are still all the same ...............................

    Quote Originally Posted by sharpstick777 View Post

    This is really a lens design issue, not an RX issue. You may want to consider another lens.


    That is the perfect answer and solution for this thread. PALs are PALs and they have their limits even if the manufacturers design and redesign the power and distortion areas can not be overcome. At the end they are still all the same with tiny small differences, but they fetch a mighty dollar and that is why we have to move them.
    Chris Ryser
    ________________________________________
    DLO. NA.IC.I.T.PO

    http://optochemicals.com............................. http://arcoatings.com

  19. #19
    OptiGeek Wes's Avatar
    Join Date
    Nov 2007
    Location
    Earth
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    3,177
    Quote Originally Posted by AngeHamm View Post
    You guys are fabulous. This is the power of community, professionalism, and the internet at work.

    Stan is coming in in about 30 minutes. I'll let you know what we do.
    Hey, Stan is 2 weeks late!

  20. #20
    Optician Extraordinaire
    Join Date
    Jun 2005
    Location
    Somewhere warm
    Occupation
    Dispensing Optician
    Posts
    3,123
    Quote Originally Posted by Chris Ryser View Post
    At the end they are still all the same with tiny small differences, but they fetch a mighty dollar and that is why we have to move them.
    Chris, I know you don't personally like progressives but plenty of people wear them happily and see great with them. That is the reason I sell them, not because they cost more then bifocals.

    I don't think you believe me when I say I see really well with my progressive glasses and have no issues with them. I never notice any "distortion" either. And it's not just me-lots of people do well with them.

  21. #21
    Doh! braheem24's Avatar
    Join Date
    Feb 2001
    Location
    KOCF & 89ft ASL
    Occupation
    Other Eyecare-Related Field
    Posts
    3,829
    Stan was using his .50 under-corrected reading zone for intermediate.

    Once corrected he did not like having to use the intermediate channel for the computer.

    In case it's not solved, drop him to a +2.00 ADD and everything will be better except J1.

  22. #22
    OptiGeek Wes's Avatar
    Join Date
    Nov 2007
    Location
    Earth
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    3,177
    Quote Originally Posted by braheem24 View Post
    Stan was using his .50 under-corrected reading zone for intermediate.

    Once corrected he did not like having to use the intermediate channel for the computer.

    In case it's not solved, drop him to a +2.00 ADD and everything will be better except J1.
    That's what I thought...

    Quote Originally Posted by APBOD View Post
    Wes is on the right track. Stan doesn't have enough room in the intermediate corridor at the distance he sits from his computer.

    Stan needs an Office lens.
    Quote Originally Posted by Wes View Post
    Assume your excellent doctor got the current rx correct.
    That means his real intermediate is OD: pl -.75, OS: -.25-.75
    To effectively reach this power in his old rx, he would be looking much lower in the pal, into the wider reading area.
    Perhaps he has trained himself to do this over time as his rx changed from 2009? Is he a heavy intermediate user?
    If so, he may have to either be re-trained, or fit with something that allows more intermediate use at the expense of near, or you could give him a trifocal which would allow clear vision at all distances.

  23. #23
    Master OptiBoarder AngeHamm's Avatar
    Join Date
    Apr 2010
    Location
    Richmond, VA
    Occupation
    Optical Retail
    Posts
    1,860
    Sorry, guys. I wrote a long response two weeks ago and posted it and it vanished into the ether.

    Turns out Stan had a slew of other issues that he couldn't be bothered to share with his optician once he was in the doctor's chair. Changed his RX but kept him in the same lens style. The doctor and I are very skeptical that changing his lens style--which he's been wearing for a decade--is the solution to his problem. I'm pretty sure he just needs an RX tweak and is being all engineer about it.

    The part that made me feel good is that, in mid-exam, the doctor came to the lab and asked me to do a re-check lot of details that I had already worked on the day before. It was a nice moment of synergy in the office; both of us examining the same issues in the same order with minimal communication.
    I'm Andrew Hamm and I approve this message.

  24. #24
    Master OptiBoarder AngeHamm's Avatar
    Join Date
    Apr 2010
    Location
    Richmond, VA
    Occupation
    Optical Retail
    Posts
    1,860
    (Also: the guy barely uses his computer, which renders a lot of his complaints kind of weird.)
    I'm Andrew Hamm and I approve this message.

  25. #25
    Master OptiBoarder
    Join Date
    Jun 2008
    Location
    Seattle WA
    Occupation
    Optical Wholesale Lab (other positions)
    Posts
    3,137
    Quote Originally Posted by AngeHamm View Post
    The doctor and I are very skeptical that changing his lens style--which he's been wearing for a decade--is the solution to his problem. .
    Actually, Varilux did that for you. The Comfort 2 is a more radical change than they have let on. The loss of intermediate in the new Comfort lens is a common report, I trouble shoot about 40 RX problems a week. Please update us though if you were able to fix his issues.
    Beer is proof that God loves us and wants us to be happy ~Benjamin Franklin

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Intermediate Distance Correction
    By msawyer in forum General Optics and Eyecare Discussion Forum
    Replies: 13
    Last Post: 03-05-2008, 06:48 AM
  2. A good progressive to replace trifocals?
    By ilanh in forum General Optics and Eyecare Discussion Forum
    Replies: 22
    Last Post: 11-05-2007, 04:09 PM
  3. 1.5 Progressive lenses good price
    By C&A Optical in forum Optical Marketplace
    Replies: 3
    Last Post: 06-08-2007, 07:08 AM
  4. Distance/intermediate in computer progressive?
    By Kel in forum Progressive Lens Discussion Forum
    Replies: 6
    Last Post: 11-21-2006, 12:27 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
OptiBoard is proudly sponsored by:
Younger Optics and Vision Equipment