How do you troubleshoot problems with progressives?

[justdhogan]

OK so I am brand new to the optincinary world. And while I have a doctor with 21 years of experience that oversees everything that I do it would be helpful for me to find my OWN support network. yay. I've found that at the optiboard! (At least we hope).

So here it is. I've got several jobs that I am having probelms with. Not to bad a ratio considering 1. I am a rookie. 2. In reality it's not really a high percentage, say 10% at most (Including all remakes). My question is this:

What steps do you take to determine what the problem is when a PT complains about progressives?

[Robert_S]

I'd say it's one of the hardest parts of the job. First thing to try usually is to adjust the angle of the lenses with a bow angle or pantoscopic tilt. You will find that will solve some issues and is very easy to do. Hopefully it goes without saying to check the alignment of the markings and that the lenses are correct to the Rx. I'll post a more complete answer in the next couple of days, but good question, and I'm interested to see what the more knowledgeable here have to say.

[Wes]

What he said, and:
Convergence can be an issue. Progressives' near is inset 2.5mm each eye compared to the distance. Some people converge more or less, and sometimes unevenly. Also, convergence requirements may be different for minus lenses than for plus lenses. Also, if the patients PD is wider than the frame PD, negative face form may be called for, especially in steeper base curves.

[Barry Santini]

Take the progressive out of the equation by trial-framing both near and distance Rxs. Assess if centration issues are present by subjective analysis of word overlap. Determine if utility issues are present, and related to Rx, corridor length or initial measurements.

B

[Happylady]

You do know that progressives have laser markings on them, right? Mark the nasel and outer circles with a marking pen and lay the lenses on a layout chart for that progressive. Mark the fitting cross on the lenses. Now you can put the glasses on the patient and see if the fitting crosses sit right on the pupil. Often problems with progressives are due to poor fit.

This should always be done if a patient is having a problem with progressives.

[Judy Canty]

Get yourself a copy of "System for Ophthalmic Dispensing" and "Optical Formulas Tutorial". They will be your best friends, hands down. I've given away all my extra copies, but if you ask around or check out ebay, you might find them for a decent price. Whatever you pay, they will repay the cost many times over.

[harry888]

I find the biggest problem with progressives is getting a good height.

Patients have the habit of putting their chin up when leaning forward for you to take that height.

Best solution is to take the height and dot it. Then have the patient get in another position and see if the dot is over the pupil. Can also put a horizontal line through the dot, then have the patient look out the window and ask if the line is above or below their vision.

Harry

[Kallen]

So many tips...all right too! From my experience I always listen to them first. Ask them to define where the vision doesn't feel right. Is it distance? Mid Range? Near? If it is all areas there may be an RX issue but don't jump right to that. Here are my steps:

1) Analyze where the problem seems to be - this streamlines the process unless they simply say "everywhere" usually it is more specific though
2) Mark up the lenses and find where they are fit - Allows you to check seg, symmetry, etc.
3) Watch where the patient moves their head and how - this will show you potential problems (ie: they complain of fuzzy distance vision and dip their chin down and suddenly it's clearer then you know you need to perhaps drop the nose pads and add some panto tilt)
4) Check axis and RX - be sure that everything is right on the RX side of the fence, in general if they see well out of one or two areas, it usually isn't the RX.
5) Ask how long they have been wearing it? Has it only been a day? Are they previous PAL wearers? What did they wear before? How are they using them? What environment? What does their work setup look like? Can they raise their monitor, move things, etc?

Ok, so this went way beyond top 5 tips, there is a whole world and art to troubleshooting progressives, however, keep at it and the more you do it, the more you'll start to see and hear similar things that will lead you to the right steps in what to do case by case.

[sharpstick777]

Welcome to Optiboard!

The first thing you need to get is a solid understanding of the science of optics, pronto, and Judy nailed it on the head.

I could walk you through the steps, but you wouldn't be able to understand the subleties involved. Troubleshooting is one key skill that seperates an Optician from a Frame Stylist and is best found through a combination of experience and knowledge. You seem committed to being a good optician, but its like asking someone to play Mozart their first time on the piano.

The process is elimating possibilties one at a time.

1) re-Verify the eyewear was made correctly. Do you know how to use a lensometer yet and compare that to ANSI standards?

2) Verify there is really a problem. Do you know how the check or verify patients visual accuities yet and compare that to the chart? All trouble shooting begins with verifying there is really a problem, I can't tell you the number of patients who have told me they are not seeing well, but have better VA through their new glasses than old. A lot of time is waisted solving a problem that does not really exist. They just don't know how to verbalize what IS bothering them.

3) How long have they worn them? Every new RX, lens, or material will send new info to the brain, and require some adaptation. Even good lenses can take 2 weeks.

4) look at the old RX. Predictive dispensing will enable you to look at both the new RX, and the old, and determine what problems are common with those changes in power. If your patient's issue is consistant with a standard RX adapation, you should be able to recognize the affect changing certain powers and types will have on the patients vision and visual comfort (two seperate things).

5) Look at the chart. Is there an underlying pathology, medicine or medical condition that is affecting VA? There is nothing worse than spending hours trying fix glasses that are not really broken, only to discover the patient simply has floaters. You should know what medicines, diseases or conditions could impact VA. As a short cut you can simply ask the Dr if their is anything in the patients medical that could negatively impact VA.

Those are the first steps, if you skip one, you are likely to find yourself spending a lot of time solving very few problems...

When you can do those, I will help you with the next steps.

Get yourself a copy of "System for Ophthalmic Dispensing" and "Optical Formulas Tutorial". They will be your best friends, hands down. I've given away all my extra copies, but if you ask around or check out ebay, you might find them for a decent price. Whatever you pay, they will repay the cost many times over.

[justdhogan]

Where to begin. All the input was great. Yeah I can use a lensometer, know about digital etchings, checked fit height, took into account convergence, oh and one interesting fact I came across is when the pt ordered she swore off AR and wanted a higher end PAL. So I put her in a Varilux Psy but of course couldn't do the 360 without crizal. She swears that she sees better out of her old glasses which the fit could be better (I'm learning) in her new glasses. Her main complaint is " The new lenses don't "Grab" the font when reading". End Result:Sold her on the 360 with AR (Her old glasses have it and she didn't know it) new and more precise measurements, seg heights were not the same (which I didn't realize could cause issues) and now are. We will see how it goes.

[sharpstick777]

Great, then let us know how she does. Will you be attending Vision Expo? Great classes there.

Where to begin. All the input was great. Yeah I can use a lensometer, know about digital etchings, checked fit height, took into account convergence, oh and one interesting fact I came across is when the pt ordered she swore off AR and wanted a higher end PAL. So I put her in a Varilux Psy but of course couldn't do the 360 without crizal. She swears that she sees better out of her old glasses which the fit could be better (I'm learning) in her new glasses. Her main complaint is " The new lenses don't "Grab" the font when reading". End Result:Sold her on the 360 with AR (Her old glasses have it and she didn't know it) new and more precise measurements, seg heights were not the same (which I didn't realize could cause issues) and now are. We will see how it goes.