Yes, I know the best advice is to not do it at all.
I have 2 different people today that are long time NVO wearers and now they want to wear progressives. I have explained the drawbacks, and both are fairly motivated. Rx of first is +0.50 with (gulp) +3.25 add, and Rx of second is +2.00 in distance with +2.25 add.
I am thinking GT2 would be a good choice in that it will give sharp distance and minimal eye movement to get to the full add, but I would like some feedback.
Shamir duo
I think, you should check Maui Jim......!!!!!!!!!!!
Shamir duo isnt really a progressive because it gives no Intermediate. It would just be an invisible BifocalOriginally Posted by pknsbeans
I'm not following the Shamir Duo suggestion either, but I'd be grateful to hear your thinking, Pk.
With a +3.25 add, I'd be thinking a tall channel with a healthy intermediate rather than a short one. [The new version of] Shamir Spectrum or the Shamir Autograph 3, both customizing the power distribution according to script, might be advisable. I can't think of a current Varilux that wouldn't work fine for either Rx. The manufacturer's customer satisfaction guarantee of the Varilux "S" is always a tempting recommendation for a first time PAL wearer, especially if you anticipate trouble. (A guy who waits until his add is +3.25 before trying a multifocal = "anticipate trouble.")
Well, I figured if they were NVO and only now want a progressive, they probably were seeing fine and maybe wanted an Rx they didn't have to keep taking on and off without the appearance of a line. The OP mentioned crisp distance with minimal eye movement to the full add power, so the first thing that came to my mind was the duo. Gives crisp dist into full add without all the distortion a +325 add will have. If the NVO worked so far, they clearly don't miss not having intermediate vision anyway. My second choice would be either a camber or comfort but it sounds like the gt2 is similar to the comfort.
You know, I think you've got a point! I guess it's a question of how much he'll miss the middle---but if he gets a wider near reading zone with that much power then he might just be perfectly fine with it. Thanks Pk! :)
This is a great case study.
I would never do a +3.25 in a PAL. That's a low vision add, in my book. Keep that in another lens type. I'd reduce the add to +2.50. That's obviously a pseudophake with macular disease.
The other guy is a slow-progressing hyperopic presbyope. Those people tend to be skittish, but they're so blind they're at your mercy.
In my mind, a softer PAL would be a good move, in these cases. I tend to revert to the Sola One for this. I know that many house digitals have a so-called "hourglass" shape ("female", or "soft" vs. "T-shaped, or "hard' or "male").
(Who would think discussing 65-year-olds could be so sexy? Well, maybe Robert...)
I think it's a cool one, too! Hope we get to hear how it turns out.
I hear you about 3.25 in a PAL. I was going with the OP already stipulating he wish he didn't have to, but the patient is determined to learn the hard way. Had such a patient a few years ago eventually settle on 2 PALs, one distance with a diminished ADD, and the other 'desk PALs.'
If we're stuck on the rails of the patient's learning curve, I say try the "S" first so he can experience the PAL risk free. From there he's more apt to listen to the optician explain & digest the dynamics of his remaining options--and he may dive straight to FTs, or maybe Pk's Duo if the periphery doesn't scare him off.
As for the potential low-vision...in my experience it kinda factors out. Have a lot of those high adds with atrocious acuities insisting on PALs. True, they're rarely impressed, but for whatever reason they're devoted to PALs over FTs and not shy about it. (I wonder if image jump in FTTs is what they find debilitating? I'd be lying if I said I could get a clear, consistent answer. Sometimes this particular patient base has a limited tolerance for questions trying to pull precise complaints out of them.)
I've noticed a lot of fans of this lens going back a ways, but I'm fuzzy on the difference between it and the Percepta. (I've haven't had either on a working formulary.)
It's always the quiet ones....
Percepta is a dude. NTTAWWT.
My intuition (I'm not as wise as drk) is that someone who has been using NVOs would be exceptionally frustrated by a soft progressive as they are used to full add or none (their NVOs being worn or not worn). Yet, they have never experienced swim or distance correction at all. This is truly the issue I was looking to get feedback about. I figured something like GT2 which is fairly soft in the distance and hard in the near would be a good choice.
(Please don't say that, ak47.)
I'm worried about swim more, too. I think the softies are good for near zone width...it's the distance that suffers.
Really there's not a single "right" answer!
As Yogi Berra once said, when you come to a fork in the road, take it.
No, and yes, respectively. Exceptions may apply. The devil is in the details.I have 2 different people today that are long time NVO wearers and now they want to wear progressives. I have explained the drawbacks, and both are fairly motivated. Rx of first is +0.50 with (gulp) +3.25 add, and Rx of second is +2.00 in distance with +2.25 add.
What are you wearing right now?
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
I've always pictured the doc wearing blue scrubs with little teddy bears on them.......( Oh, and the teddy bears have their heads cut off...)
This thread has gone south. Would Robert or 24/7 care to inject his insight into my question?
Sorry AK, just thinking about what drk was wear got me off topic...
My 2 cents; I don't like ANY total backside design for those type of Rx's, I prefer dual designs ( front and back ). I'd use a Definity 3, S Design or even an Accolade Freedom ( depending on frame shape, fitting hgt and budget.)
Scenario #1 depends on the details. I'd use a Zeiss 2n or Varilux New Comfort, or as drk suggests, a cut add with a distance emphasis per the below scenario, with SVNO on the side.
Scenario #2 I'd bias the design towards the distance vision because they'll still use their SVNO for most near tasks. Your gt2 (3d) suggestion is on target, if still available. Choice 19mm if not. Probably worn as needed depending on blur tolerance and driving license restrictions. If full-time wear, and an avid reader, consider Auto 3 18mm, Zeiss balanced or 2n, or the less aggressive power profiles of the Varilux S and Definity rec. by 24/7.
Hope this helps,
Robot Martellaro
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
Yes, I know the best advice is to not do it at all .........................
Just stick to what you know is the best advice, because you are right.
Your patients being "fairly motivated" is half of the battle. These days, PAL designs are so smooth that it is usually only the most stubborn and inflexible thinking that results in a non-adapt. That said, manage your patients' expectations. More importantly, make sure they understand that getting a PAL doesn't relegate their NVOs to a drawer somewhere. PALs are great for general use, but dedicated readers, especially for your patient with a +3.25 add, will still work better for some applications.
We need to do a better job educating patients that one pair of lenses does not apply to every activity, any more than one pair of shoes would.
I'm Andrew Hamm and I approve this message.
I would go with Hoya ID for both. Great for first time wearers and high adds.
I've had great success with the ID Lifestyle 2 Clarity with previous PAL non-adapts.
I'm Andrew Hamm and I approve this message.
I plan to just use a magnifying glass when I finally can't extend my arms far enough...
You can design a holster for it also.
First time progressive wearer with an ADD that strong is like a 20% success rate in my book - they are going to need to be MASSIVELY motivated. Plano with a high ADD are the most difficult to satisfy customers, followed only by Myopes who can read 20/20 with their glasses off.
You must be BRUTALLY honest with them about their success rate, and that is with the best of the best lens and perfect fit. It can work though, I know people who have made the transition, but most people end up using them as very VERY expensive reading glasses - taking them off at any opportunity they have.
As long as you give them the truth up front, they can't be upset if they don't end up liking them.
I guarantee I can get something that will work well enough for less than $1, with free shipping, from China, on eBay...
I have a lot of success with Varilux S Design and Zeiss Individual 2N.
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