Help! +13.00 questions about lens designs

**pezfaerie** · 05-19-2016, 04:30 PM

I have a patient that is currently in a lenticular rd 22. His rx is : OU +13.00-0.75x180 Add:+2.50
He wants a digitally surfaced lens if at all possible. So far, the lab has tried a Shamir Duo and a Shamir Auto II with no success at cut out or blank availability. They also, tried their in house brands and though they can manipulate the software when it comes to blank selection they couldn't do it.

My question is: Is there any digitally surfaced lens Bifocal or progressive that would work in this power or is the patient pretty much stuck wearing the Lenticular?

Thanks

**Quince** · 05-19-2016, 04:45 PM

Identity Optical recently did a -20.00 with some cyl for us. Not sure if this is in their range, but it would be my first stop!

**mshimp** · 05-19-2016, 06:38 PM

Not that I'm aware of.

**uncut** · 05-19-2016, 07:30 PM

I would check with Zeiss, and Rodenstock, and not necessarily in that order.

**peyes** · 05-19-2016, 10:02 PM

The aspheric lenticular that he is wearing is the best he is going to get...right now. Distance contacts with reading over would be nice.

**ml43** · 05-19-2016, 10:46 PM

for high plus Rx's especially PAL,

an aspheric front surface will yield the best results cosmetically, and optically if you consider lens thickness.

IOT camber really shines in this area, as you get the thinness of a molded/front aspheric PAL, and the benefits of a digitally processed lens and design flexibility.

Seiko Surmount also excells by using a convex add section. I believe the superior does this as well if I remember correctly.

**Robert Martellaro** · 05-20-2016, 08:02 AM

Originally Posted by pezfaerie

I have a patient that is currently in a lenticular rd 22. His rx is : OU +13.00-0.75x180 Add:+2.50
He wants a digitally surfaced lens if at all possible. So far, the lab has tried a Shamir Duo and a Shamir Auto II with no success at cut out or blank availability. They also, tried their in house brands and though they can manipulate the software when it comes to blank selection they couldn't do it.

My question is: Is there any digitally surfaced lens Bifocal or progressive that would work in this power or is the patient pretty much stuck wearing the Lenticular?

Thanks

Zeiss might be able to make a PAL in a 1.74, but the off-axis vision will be poor. They'll probably need a better solution for near tasks (see below).

http://questopticallab.com/services.html

Talk to Michael Walach. They use a semi-finished Super Modular round 22mm and work the ocular surface on a free-form generator. Expect to see a cr39 and at least a +14 Bc. While you're there, check if they can put together a pair of SVNO in a high Abbe material.

For traditional solutions, use a Super Modular (Essilor) or Bristol.

http://www.bcdlens.com/downloads/BCD..._Reference.pdf

**Jason H** · 05-20-2016, 08:20 AM

Eek!, Shamir's Rx range will get that far , but I'd really rather use an auto 3 1.74 index. Auto 2 was never really great for big hyperopes. Mechanix's aside this is a huge communication issue - Is your patient motivated towards the limited channel of a progressive? Big difference from what they're used to. If they get cold feet - there is much to be culled from Robert Martellaro's typically great advice. But if they're keen on a progressive, and properly understand the difference involved - try a 1.74 Autograph 3 from Shamir.

**Tallboy** · 05-20-2016, 10:17 AM

I would try an IOT lens like Camber - they can play with cutout and lens design much more. I can't remember if I've gone quite to +13.00 but I've gotten close, definitely in the +9, +10 range.

Good luck to you, I hope you metered his expectations well withing a cautious reality. Its likely going to be a bumpy ride for a while at best.

**other_bill_fea** · 05-20-2016, 03:00 PM

Camber only goes to an 8 base 1.67, so I don't think you're going to have any luck getting it that high. That might just be in the range of a high-based (11-12) 167 backside free-form design, assuming a small frame, but usually the high plus are more difficult than the high minus. If you have particulars of the rest of the script/frame, I can try and calculate it to see if it would be possible.

I do know Rodenstock offers custom-made-in-germany options for the really high stuff, but I don't know about the cost/time for that. Could be an option if you have to have something besides what he's currently wearing, however.

**Robert Martellaro** · 05-20-2016, 05:54 PM

Originally Posted by other_bill_fea

I do know Rodenstock offers custom-made-in-germany options for the really high stuff, but I don't know about the cost/time for that. Could be an option if you have to have something besides what he's currently wearing, however.

Up to +13 D for the Hyperop.

http://www.interoptik.ro/en/lentile-...ession-hyperop

I'm not familiar with the details of the Hyperop's surface design, maybe similar to Zeiss's approach, where they work the front curve and place the PAL design on the front with a free-form generator, and then on the back with a free-form or traditional generator. I would give the nod to Zeiss, especially with the additional base curve reduction possible with the 1.74 refractive index, probably about +9, allowing an ocular curve of roughly -1. Still, probably unwearable for most, although the significantly improved cosmesis might provide enough motivation to overcome the poor vision compared to traditional and proper solutions.

**Dr. Bill Stacy** · 05-22-2016, 10:15 AM

Here I thought aphakia was a thing of the past, except for babies until their eyes are mature enough to handle an IOL. I'm assuming this patient is an aphakic adult. If instead it's a phakic hyperope, it needs to have cataract surgery or refractive lens exchange to rid itself of the horrible optics of that Rx. If aphakic, there'd better be a good reason not to implant iols. Or as we did in the old days, it's either contacts or its aspheric lenticulars and watch your step.

**Speed** · 05-22-2016, 03:02 PM

Originally Posted by Robert Martellaro

Zeiss might be able to make a PAL in a 1.74, but the off-axis vision will be poor. They'll probably need a better solution for near tasks (see below).

http://questopticallab.com/services.html

Talk to Michael Walach. They use a semi-finished Super Modular round 22mm and work the ocular surface on a free-form generator. Expect to see a cr39 and at least a +14 Bc. While you're there, check if they can put together a pair of SVNO in a high Abbe material.

For traditional solutions, use a Super Modular (Essilor) or Bristol.

http://www.bcdlens.com/downloads/BCD..._Reference.pdf

Walach made a strong plus for us. I can't describe here. It was a design I had not thought of before. PM and I' send and email or call you.

**ThatOneGuy** · 05-23-2016, 12:12 PM

Individual 2 1.74 would be stellar, unless you need a large blank.

**pezfaerie** · 05-24-2016, 03:17 PM

Thank you all for the suggestions. It seems that the software has no issues with it but in real life manufacturing of the lens isn't going to happen. But we shall see...still not giving up just yet.

**uncut** · 05-28-2016, 10:10 PM

I believe that technology can produce what your heart desires, but please remember that the patient is visually best served with a segment with a NOC that is close to the DOC.

If you have a opportunity, find a copy of "Spectacles for Aphakia" by Benton and Welsh, that will assist you in serving this person.

**jspayneii** · 06-02-2016, 02:41 PM

According to the chart I have, the 1.74 in the Varilux Physio DRX, or W3 up to a +13.00. Also, Hoya makes up to a 19 base in Trivex, which might work for the house brand digital progressives as well. I would also be willing to run some calculations if you provide the other measurements.

James