Pal Problems!?

[Bok]

New Rx
R: -2.75/-1.00x92 Add:+2.25
L: -2.75/-0.75x90 Add:+2.25
Vertex tested 12mm
Vertex Specs 12mm
Lens Panorama Plus
Fit Height 6mm above HCL
Panto Tilt 7 Degrees
Frame Shape Depth 32mm

Old Rx
R: -3.00/-1.00x90 Add:+2.00
L: -2.50/-0.75x95 Add:+2.00
Vertex tested 12mm
Vertex specs 12mm
Lens: Panorama Plus
Fit Height 5.5mm above HCL
Panto tilt 7 Degrees
Frame shape Depth 30mm

Px feels that distance vision clear, Near vision clear and comfortable, however intermediate not clear or comfortable, Px is using intermediate seg at a visual distance of around 1m client finds that if raises head while wearing frame at normal position intermediate clear but when using normally cant access intermediate zone without uncomfortable head position, Px finds that if puts frames on bottom of nose and looks through distance seg that intermediate clearer and easier.

Seg Height - Perfect - centre of pupil
Frame fit - Perfect
Checked Rx - Stable/No Change

Tried to lower Add power finds that near not clear enough, tried to modify distance rx feels that is not clear enough, so calculated intermediate rx put into trial frame finds that is perfect, once back into frames finds unusable.

Have tested for muscle imbalance - None
Looked at material/index intolerance - none
looked at previous and new base curves - identical
Tried different lens design/s - same problems
(Firstly Presio, then Sola One, now back to Panorama plus)


Have drawn a short blank on this one, does anyone here have any ideas for a solution to get the clients intermediate working correctly? because I'm out of ideas!

[Mr.Powers]

Hi nope there is no logik to it, unless panorama plus can be made whit a variable corridor lenght.
and that have changede.
Peter

[uncut]

Short, late in day answer: 1 meter is distance VA, not intermediate. Ability, due to age is changing as well. Check for a further reduction in myopia(non timid refraction required) and coach re: trifocal requirement, as a opposed to multifocal(defiency of area).

[GokhanSF]

If you patient is looking for a crystal clear vision at the "intermediate" portion of the lens good luck

[Bok]

Short, late in day answer: 1 meter is distance VA, not intermediate. Ability, due to age is changing as well. Check for a further reduction in myopia(non timid refraction required) and coach re: trifocal requirement, as a opposed to multifocal(defiency of area).

So would lowering the Seg height and changing to a short corridor length lens help with this?

Surely if I have put the intermediate rx into a trial frame and client finds this useful at that 1m distance this should work fine in the progressive lens also? albeit that the px will have distortion to contend with but with only a 0.25 change in rx this would not effect it that severely to the point they are unusable.

Maybe it is just age and the ability to accommodate at that required focal length is effecting this but if the last test results and the trial framed rx of the new rx where more or less identical this would not be the case? px does see better with the new rx to the point where she finds the old rx not useful.

[uncut]

So would lowering the Seg height and changing to a short corridor length lens help with this?

Surely if I have put the intermediate rx into a trial frame and client finds this useful at that 1m distance this should work fine in the progressive lens also? albeit that the px will have distortion to contend with but with only a 0.25 change in rx this would not effect it that severely to the point they are unusable.

Maybe it is just age and the ability to accommodate at that required focal length is effecting this but if the last test results and the trial framed rx of the new rx where more or less identical this would not be the case? px does see better with the new rx to the point where she finds the old rx not useful.

In answer to your question, IMO.....No. I qualify that with the person is searching in the multifocal for a power which is a mere "ribbon" in existance. It's neighboring powers above and below are also useful......at further and nearer distance. Your person is either over-minused for the distance correction, which is giving them discomfort and a lack of resolve at the one meter mark, or is experiencing galloping presbyopia. The person was probably experiencing it before, but the extra -.25 on the left pushed it over the tolerance level, so the search and experimentation is on. "I can see better..................if I turn them upside down!"

The answer to your 2nd question........of course a large 35 mm field of a trial lens is going to be superior to look through.......in a multi that power only exists in a miniscule ribbon, and is not directly in front of the eye.....this only reinforces that the person could use a trifocal, an office lens, or a new refraction.

Dinner bell!

[EyeCare Rich]

If their lifestyle warrants it, I would have to say a second pair of office lenses is in order.

[n711]

If you patient is looking for a crystal clear vision at the "intermediate" portion of the lens good luck

My thoughts exactly.... sounds like they need some task specific eyewear! Or the good 'ol 7x28 tri!

[dbracer]

any ideas for a solution to get the clients intermediate working correctly? because I'm out of ideas!

Have you offered him a short Scotch. I like Jack Daniels Black Label. Frequently straightens out the distance, clears-up the near, and they really don't care 'bout the intermediate. Give it a try.

Respectfully,
dbracer

[GokhanSF]

Here is your solution:

Offer your patient second pair for work...

You're welcome :)

[Optician1960]

Px feels that distance vision clear, Near vision clear and comfortable, however intermediate not clear or comfortable, Px is using intermediate seg at a visual distance of around 1m client finds that if raises head while wearing frame at normal position intermediate clear but when using normally cant access intermediate zone without uncomfortable head position

First I would say that I love my in office lenses and believe in having eyewear that meets the customers lifestyle including multiple pairs as needed.

Second, based on your comments I pasted above, if the Px finds the intermediate more usable by lifting their head (I assume you mean tilt it back), then would it be possible that a "shorter corridor" design might help as it brings the intermediate and reading zones higher into the lens?

The new In Touch lens design that has a quicker first step into the intermediate may also help this Px if the "nearer" intermediate is more important than the "further" intermediate.

[Robert_S]

I don't have experience with the InTouch (the Shamir lens isn't it?) but I agree a short corridor may help. Fitting a softer design progressive (I haven't heard of the Panorama but it sounds hard!) should improve intermediate vision. I would personally recommend the Hoya ID as it has the widest intermediate I am aware of. You could even go a step further and try the ID Mystyle as it will take into account the patient's specific needs. That is your best bet, in my opinion, without trying occupational lenses as others have mentioned. The problem with broaching that topic is that many patients think a varifocal is a lens for 'everything' and it can be hard to change certain people's minds.

Now, please could someone educate me about the 'Panorama'?