Anyone having difficulty with Individual adaptions issues?
Anyone having difficulty with Individual adaptions issues?
large pupil heights are sometimes an issue.
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I try not to fit anything too deep- it extends the intermediate corridor too much and I've gotten a complain that a trapazoidal effect can been seen by the wearer. Also, the reading is too far near the bottom of the lens which making reading difficult. I suppose the new Individual 2 is supposed to address these issues.
"Strictly speaking, there are no enlightened beings; only enlightened activity." -Shunryu Suzuki
Any specifics?Originally Posted by tx11
Our Dr likes to use strictly Zeiss. We have had good success withthe GT23D (and short) But not the individual. We do not use the i-profiler only the i-terminal. Everyone we place in the lower priced GT2 is happy with it but there seems to be adaption issues with the digitals. Does anyone have any tips?
Its just the "progressive old complaint" of not being able to see eually well at intermediate( Computer) and near (reading). We were hoping that the individual would solve all that,but maybe it doesn't work well without the i-profiler recomputations.
I guess I was looking for more information on the kinds of adaptation issues your were finding. Are there similarities in power, frame size/seg placement, etc.? Or is it all over the map?
While digital fitting systems are more accurate, you should still be able to fit them without it. Have you investigated the Individual 2? I am getting some very positive feedback on the various designs.
I have not tried the "regular" individual 2 yet. I have tried the I2 I (reading too narrow) and I2 N (Intermediate too narrow) ( kind of reminds me of the days of thye VIP and XL). I think that the next will be an I2. Mostly fitting 17-18mm seg hts, 175 -250 adds
Optimized lenses do not solve the problems you mentioned. However, you can fine tune the PAL design to increase the near and intermediate function, albeit with a hit on the distance peripheral vision. Zeiss makes this easy by offering three design options, or you can select specific PALs that have fundamental designs that are biased towards near or far utility i.e., distance peripheral vision, corridor length, etc. Here's Zeiss's solution...
http://www.personalizedlens.com/ProfEyeFit.aspx
Our age 40 to age 60 clients are experiencing declining accommodation due to presbyopia. We need to anticipate their loss of near vision, and use lens designs (or mutiple lenses) that provides the best and most comfortable vision for each individual.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
We use pretty much only Zeiss products. We have tried our best to fit the Individual 2 on everyone. We really haven't had problems with the Indiv. 2 but we were having problems in the past 4-6 months with the GT2 3D. I believe, from what a Zeiss rep has told us, that the digital mapping on the GT2 3D is forever changing due to its digital nature. I may be wrong, but I understood it as they are constantly trying to improve it (not that it always works). We have been fitting the Individual 2, 2I, and 2N with little problems and little adaptation. With that said, the people that really like the 2I were having issues with the intermediate of their current progressives. I get the impression that these people are more concerned with the intermediate overall. Also, fit our doc in the 2I and he loves it. Claims it's the best pal he's tried. I actually fit my own mother in the 2I and it did take her a bit to get used to it. I think I over estimated the amount she probably uses a computer/tablet. After about a week she does really like the 2I. Oddly enough, we have not done many 2N's but we work in a techy area so we have a lot of computer users.
I've read that the corridor length can be as long as 16mm. I'm not sure how that's defined, but the corridor length on Individual that I tried 18 months ago was similar to the Physio, and other general purpose designs- too long for my Rx (-4.00 add +2.25) and desires. Fitting height was 20mm. I assume that that was the 16mm corridor, and that the corridor length would cease to increase if the fitting height greater than 20mm!
Tx11,
Yeah, you had to get the order right- XL for emerging presbyopes, and then switch them to the VIP. Get it backwards, and you got nausea with the VIP, and very little near vision with e XL!
It sounds like your way ahead of me- I haven't tried the 2N or 2I. I suspect that the 2I would be similar to the Gradal Top, suitable for mostly hyperopes using a lap top on the lap, maybe tablets, but not avid book or newspaper readers. The 2N looks interesting for myopes- they generally won't miss the intermediate, and the avid readers will need the slightly shorter corridor. I wonder if the distance stays the same with these two variants. My guess is yes, considering that only one zone is being significantly modified.
Regardless, I would think that the standard design would service the needs of the average wearer, and that might be where your running into trouble, by not using the balanced design, if I've read you correctly. Another recommendation is to increase the fitting heights slightly.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
Yes, we've always had trouble with the Individual, for whatever reason. It's interesting that someone mentioned the GT23D design may have changed because we've had a couple of adaptation issues with that as well recently, one being with someone who wore the GT23D already and had only a small Rx change... prior to this we've been very successful with the GT23D
However, I must say that the new progressives from Zeiss (in the UK they are called 'Superb' and 'ProgressivePlus2') have been fantastic; virtually no non-tolerances and impressive wearer responses. And of course the Individual SV is an amazing lens.
Fitting height issues abound with variable corridor length designs. Choose shorter than the fit suggests and you narrow the intermediate, etc. I prefer to choose my own, based on wearer usage, rx, age. Seiko Perfas allows corridor length choice in all their designs, and Digital Eye labs has some simliar choices.
I am loving the new Shamir Intouch, which by design does away with fitting height issues since the add power comes on faster in all fiiting heights (also avoiding narrow near zones..).
I also noticed that the GT23D and Individual2 are coming back from the lab thick. When I asked if they could thin them up a bit I was told that the lab techs could not change any part of the surfacing process because it was free form. Any suggestions? Thanks.
I fit Individual 2 and gt2 3d all day every day. Virtually no issues when used "correctly." High Hyperopes reject Individual, but love individual 2. Alternatively, GT2 3D works, but doesn't get rave reviews from hyperopes. Myopes LOVE Individual/2 all day every day. The only time you should be using 2i or 2n is for "specialty" purposes. If the person wants general use out of the progressive, use the balance lens. If they are using them as glorified readers, use 2n or 2i depending on the work they do. 2i and 2n were developed to make lens customization quick and functional for those who feel they need to change an already rockstar lens design. That being said, I also don't recommend using it over 22ish mm because of the long corridor and reading issues mentioned above. Also, what lab is doing the work? I've had issues with labs cutting lenses too big for frames causing flex and unwanted distortion before. Finally, I find patients don't recognize how great individual 2 is until you point it out to them. When you challenge them to see how good their distance/reading vision really is, they will suddenly realize what they couldn't see before...
[QUOTE=Robert Martellaro;440384] The 2N looks interesting for myopes- they generally won't miss the intermediate, and the avid readers will need the slightly shorter corridor. QUOTE] Your patients wont be missing the intermediate in a 2n...they'll miss their distance. Think Hoya Mystyle with heavy emphasis on near work.
Both distance and intermediate, according to this...
http://vision.zeiss.com/content/dam/...012FNLAppd.pdf
One could argue that that if all they did with the 2n was to shorten the corridor, the distance periphery could have been kept the same as the balanced profile. That would have been my preference. However, adds over +2.50 will benefit from the increased width, or to put it another way, less or no decrease in width, compared to +2.50's and +2.25's.
As is typical with PALs, and ophthalmic optics in general, there are going to be compromises and trade-offs, regardless of my desire to have the cake and eat it too!
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
The individual 2 is what we fit exclusively at our office is a great lens for all. With the adjustable corridor, it has made fitting even difficult patients pretty painless. I have run in to trouble when the frame is very deep, in which case the patient has difficulty reaching the reading area. Other than that, this has hands down been the best progressive I have fit.
The fact of the matter is the individual 2 should provide the most consistent results for all patients, due to the powers being optimised individually for every patient as opposed to being a result of an average from the fitting parameters typically selected for a progressive.
There is no reason why a patient would tolerate a GT23D or GT23DV or any of Zeiss' other current lenses over the individual, unless you had taken inappropriate measurements.
To date, individual 2 is performing extremely well, including better with high hyperopes.
was told by Zeiss rep to measure 1mm above pupil. been doing that and its better but may up it to 2mm. that 7mm drop is nuts..
fitting right on pupil cause almost a 100% fail and was to the point of swearing them off, but seems to be better now.
OVERDUE UPDATE....Raising seg height 1 1/2mm to 2mm definitely helps. Using the I2 quite a bit now. working better. Still using I2I and I2N sparingly. Thanks for all the suggestions. Also getting better at measuring with the I terminal (definitely have to watch pt. posture)
do you not think all the patient trials will have been conducted with pupil on centre? The lenses do work when fitted correctly...
10 - 12 degree panto also helps quite a bit and is in the fitting guide lines
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