I'll fit the frame and make sure the pupil falls with in 5mm of half the B measure. I'll use that as my fitting height; e.g. B measure is 34mm and the pupil sits at 19mm so I order with a 17mm fitting height. Seems odd but an old-timer showed this to me and it's worked great, consistently! I'll also take into account working distances and age to estimate accommodative (sp) ability. If the pt is over 50 we almost always go for the High Add unless focal distances are off the average. Hope this helps.
CS
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