2nd time PAL wearer difficulty

[Freebird]

So, I have a patient who bought new glasses from us back in May (Varilux S Design). She had only bought PAL's once before at a major national chain, and had lost them (the best I can figure is that the old lenses were either the Illumina or Oulook).

With her old PAL's, she had never been real happy with the reading area and would just take the glasses off to read.

When she picked up her new glasses, she said right away that the distance was great, but that the reading was almost un-usable. I noticed that the seg was rather low, so we remeasured and made the lenses again. Now, however, she says that both the distance and the reading are bad. The only way she can see clearly through the distance is if she tips the glasses so that the temples are about an inch over her ears (massive panto), and the only way she can see for reading is if she lifts the glasses up and reads through the extreme bottom of the lens.

Her Rx is minor (OD: -1.50 +0.50 x180, OS: -2.25 +0.75 x15, Add: 2.25). I can put only a little panto on the frame, but that still won't help her reading. I feel like moving her into a short corridor lens may work, but I wanted to hear some other thoughts?

Thank you! I appreciate everyone's insight!

[Slim]

At 225 read I start considering the use of a shorty. What did you put her in? whats the seg and B ?

[Uncle Fester]

Wow! I'd suggest a little Season All along with some salt and pepper for these expensive lenses you're eating.

My thought would be to cut your loses and put her into an Image short fitted just below the pupil. What's the B dimension on the new frame and fit height?

Be sure she understands that her natural nearsightedness is going to trump the fields she'll get with any progressive.

[Happylady]

Are they too high now?

I have some S series lenses and a correction very similar to hers. I can read with them fine but of course it's better with no glasses at all. With her correction it will always be better with her natural vision up close.

[Uilleann]

Not nearly enough info to really figure out the nuts and bolts of what's going on. We would need to know not only the previous make and SRx, but also the frame dimensions and pertinent POW differences then to now. With that said, I would think just the opposite re: short corridor. I'd go longer as the add goes up to help minimize the swim at distance. Also, as far as the S series goes, you aren't out anything. They're guaranteed. If they need to be re-worked, the lab will do it. If it's a wash out and you want to try something else, they'll refund you in full for the lenses, and you can apply it towards a different design.

[Chris Ryser]

Having had PALS before, she never used this is her first real pair and with a 2.25 addition she will never get used to it.

An ST28 would be a much happier solution. There is just too much distortion all over the lens whatever type you use. .........and never forget that myops are much more picky with details.

[Happylady]

Funny- my glasses with a similar rx and a +2.25 add don't have distortion all over the lens. Yeah, if I turn my head all the way to one side and peer through the very bottom outside corners I supposed you could call it distortion. I don't really hold my head that way ordinarily though. When I just look around normally everything is nice and clear.

[Chris Ryser]

Funny- my glasses with a similar rx and a +2.25 add don't have distortion all over the lens. Yeah, if I turn my head all the way to one side and peer through the very bottom outside corners I supposed you could call it distortion. I don't really hold my head that way ordinarily though. When I just look around normally everything is nice and clear.

Happy...................You gave been an advocate of progressives forever on OptiBoard and have been wearing them happily for years since you needed a reading addition. How many happy customers have you had that started out with with + 2.25 add, and not properly fitted ?

[ThatOneGuy]

I am having the same problem in sunglasses with an autograph SV. The problem in my case is the lens was designed with a panto of 9, but the bevel was cut in such a way that the as worn POW is -4 panto. Make sure the lens is mounted in the frame correctly, because what I heard you say in the original description is that the patient can see perfectly out of the lenses...you just have to lift the temples an inch off her ears.

[sharpstick777]

RE: 225 Add. Distortion increases geometrically relative to Add Power and corridor height, which means shorter corridors in higher adds will create MORE total distortion. Going short in a 225 would create more problems.

RE: S Series. If you read the other S threads, not one person says the S has great reading. Its a V shape with the reading being very narrow by design. Narrower reading=lower geometric distortions. It also has a very high non-adapt rate (some people quote 25% or more). Its simple, switch this patient into a lens with wider reading.

Currently I am not impressed with ANY of Essilors Free-form lens options, but if you want to stay Essilor I would put this patient into the Physio DRx (wide distance, and let them know adaptation can be long in that lens) or Definity 3. Fundamentally I think Essilor is WAY behind in lens technology (I still have not worn an Essilor lens better than the Old Mutigressiv 2 by Rodenstock from 2000), but if you want to try other FF lenses, with wider reading, you can try the iD Lifestyle or Seiko Surmount WS. Between the 2 the Surmount will offer the wider distance zone, but specify near PD for best results.

You have a design issue, that has been fairly common and well described other places here on Optiboard.

[Uncle Fester]

You have a design issue, that has been fairly common and well described other places here on Optiboard.

I still read the OP as someone who wants to see distance and read which a lower fit Image short will do.

If it's not a matter of cost to the business then go for Sharpsticks suggestion.

[Happylady]

Happy...................You gave been an advocate of progressives forever on OptiBoard and have been wearing them happily for years since you needed a reading addition. How many happy customers have you had that started out with with + 2.25 add, and not properly fitted ?

I agree that it's better to start with progressives with lower adds. And fitting properly is very important.

The problem I run into with first time progressive wearers at a higher adds is that generally they were wearing reading glasses before. (Unless they are myopes) Reading glasses have there own issues-blurry distance, on and off all the time, no intermediate in higher adds- but they do have great reading!

And going from the large reading area of a reading glass to the smaller area of a progressive is where I see problems. Not with any distortion.

Bifocals of course have a bigger reading but they have issues too. No intermediate, and a blurry line cutting right across your vision.

As to your question about how many happy customers have I had starting out with a higher add- I don't keep track but plenty. But if they are wearing readers I do warn them the reading area will be smaller. And I tell them to put them on and wear them as much as possible for the first month.

[Plausible]

I agree that it's better to start with progressives with lower adds. And fitting properly is very important.

The problem I run into with first time progressive wearers at a higher adds is that generally they were wearing reading glasses before. (Unless they are myopes) Reading glasses have there own issues-blurry distance, on and off all the time, no intermediate in higher adds- but they do have great reading!

And going from the large reading area of a reading glass to the smaller area of a progressive is where I see problems. Not with any distortion.

Bifocals of course have a bigger reading but they have issues too. No intermediate, and a blurry line cutting right across your vision.

As to your question about how many happy customers have I had starting out with a higher add- I don't keep track but plenty. But if they are wearing readers I do warn them the reading area will be smaller. And I tell them to put them on and wear them as much as possible for the first month.

Great answer Happylady!!! Very well said, Thank You!!!