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Thread: Plano Presbyopes - Take 2 :)

  1. #1
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    Question Plano Presbyopes - Take 2 :)

    Apart from reading optiboard, it's hard to find objective opinions on complex questions. I've been in the business 5 years and still feel way too much like a rookie when it comes to progressives. I'm 41 and know my days are numbered, but all I have to go on right now is patient feedback...and my growing optical chops.

    So, if you don't have an ax to grind, or a lens to sell, and you are confident in making a recommendation, please weigh in on the following. I'm not just looking for your recommendation, but for someone to inform and critique my deduction and thought process. I want to become more of a progressive expert. This will also serve as a sort of litmus test...one that will help me figure out who I can turn to on Optiboard in the future. You know, the kind of person some of you have (in your well-seasoned network of professionals) who you can turn to, get a straight answer, and know you're getting a great perspective.

    The scenario:

    • 2 patients in the past day have a plano Rx with a 1.75 add
    • Both patients, for various reasons, want to leave their glasses on...they like their frames, and don't want the hassle of taking them on and off
    • Patient A: covered for any PAL they want (through their insurance). He is also a strong iScription candidate (lots of higher order aberrations).
    • Patient B: getting her first pair of glasses ever...safeties, and she doesn't want to spend much more than the company's limited PAL allowance. Oh, and she operates a microscope much of the day.


    My best guess:

    • I most often dispense Zeiss and Shamir products. So my first thought would have been the Shamir Office for both, but that would have messed with their distance when needed.
    • My next thought was a lined bifocal (probably 35mm), but, neither want lines. That leaves me with a progressive.
    • Patient A is covered for anything. So I'm thinking that a freeform digital will optimize the experience for the patient and give them a less-compromised distance periphery and large-as-possible channel (especially with POW measurements). The Zeiss Individual and Auto II are compensated for his frame (seg of 21), so I'd probably go with either one.
    • Patient B is covered for this level PAL: GT2, Creation, SolaOne, SolaMax, Ovation...you get the idea. I'm inclined to try the GT2 first...for no other reason then I've dispensed more of them.


    OK. Have at it!
    -roscoe

    PS - If you have any other resources or expert advice on progressives, I'd love to create a compendium of PAL designs, their unique characteristics, and what Rx's are the best for each design, PLEASE enlighten me. Thanks!
    Last edited by Roscoe; 02-13-2013 at 04:18 PM.

  2. #2
    OptiBoardaholic kentmitchell1961's Avatar
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    I like your conclusion for patient A. PT B may have some issues with safeties with a less advanced prog, but if is only willing to do the minimum....

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    One professional (OD) I consulted recommended that I consider lowering the seg 3mm and bumping the add to 2.25, thus keeping the distance clear and helping them get to the target add power at the bottom of the lens. Sounds interesting, but would any of you advise such a thing?
    Last edited by Roscoe; 02-13-2013 at 04:38 PM.

  4. #4
    OptiBoardaholic kentmitchell1961's Avatar
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    with the safeties, lowering the seg is a good idea. As to raising the power, I would consult with the Doc on that one..

  5. #5
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    If you are trying to get them into the reading area fast don't drop the seg. Instead use a short corridor progressive. It gives a higher quicker to reach reading area.

  6. #6
    Bad address email on file Randle Tibbs, ABOM's Avatar
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    You must remember when bumping the add, you are not only affecting the add power but the other parameters as well, plus you are creating a smaller reading zone with the increase in add power.

  7. #7
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Do you have this site bookmarked?

    http://www.opticampus.com/courses.php

    Under "Courses" be sure to read "Optics of progressive lenses".

    I'd be suspicious that she has never cheated with an OTC reader. They both need the usual 10-15 minute discussion as to their expectations of fields of view through the corridor, especially if they've used readers.

    I end the discussion with a lighthearted statement that as a rule we're over 95% successful in fitting new progressives if you are patient for the first few weeks and have listened to what we just talked about. That said I always hear "will I get used to them" and the honest answer is probably!

    In honor of Optiboarder Chris Ryser (who's not a fan of progressives) I've created-

    Ryser's Rule-- The success of a progressive is proportional to the desire to wear a progressive.

    PS I wouldn't monkey with the add in any molded progressive and probably not with a compensated digital.

  8. #8
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    Welcome to Optiboard rsmithfvc!

    Why undersell pt B with a grinder? Plano Distance patients immensely prefer FF distance emphasised lenses, because that is where FF finds the most gain in most designs.

    I would recommend the Shamir InTouch for both Plano Progressive pts, the distance is terrific so its more like not having lenses on.

  9. #9
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    I would agree with you initial assesment. Individual for patient A, GT2 for pt B (if they will not budge). I also agree with Sharpstick above. The InTouch is a fantastic lens for the power range you are looking at, especially for todays presbyopes. I also have to say no way to bumping the add, will create a smaller area to view at the near point.
    Welcome to Optiboard, and best wishes on your journey within the world of optics. Uncle Fester is leading you to a great place to learn, from a master!

  10. #10
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    Thanks for the quick feedback and advice, everybody. I've been in optics for 4.5 years, but only on Optiboard this past year...and only posting more recently. It will be a growing trend, I can see that.

    Well, I'm definitely going to try the InTouch. With all of the new lenses we see coming out, it's sometimes hard to know when/if to try any of them. As an experiment (and at the encouragement of an OD), and before I heard all of your helpful feedback, I ordered one pair with lowered seg and bumped add. Gulp. Well, I'll be sure to let you know how it goes...and my guess is that we might have to remake if your suspicions were well founded.

    -roscoe

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