What are your general rules of thumb for selecting PALs?

[Prentice Pro 9000]

Hey guys,

So I've been an optician for about a decade. I've done my research and can describe all the key points about PALs(total backside on a single vision, dual-surfaced, old school stock lens, non-linera vs linear power gradients, hardending of radial astigmatism when you shorten a corridor, compensated rxs, target add value, etc). I'm def more well-versed than lens-crafter folk, but I find that I keep getting surprised all the time with PAL lenses that either shouldn't work and do, or ones that should work and don't. So I was wondering what your specific go-tos are for these different rxs and why.

1. Low hyperope with low add

2. high hyperope with low add

3. low hyperope with high add

4. high hyperope with high add

5. low myope with low add

6. high myope with low add

7. low myope with high add (minus into plus)

8. high myope with high add

9. High astigmatism over +/- 3.00

10. absolute best peripheral vision

11. absolute widest corridor (and whether the width is only noticeable within a certain rx range)

12. go-to office lens (as well as which ones you've tried but are not that great)

Thanks!!!!

[becc971]

Following this could be an interesting discussion AND valuable

[Uncle Fester]

Me- "Are you happy in your current progressives?"

If yes- done!

You really need to break this out to Essilor, Zeiss, other.

Also- how many designs are there--- hundreds and hundreds!!!

A poster the other day was asking for a flow chart and that would be really what I think you want as it would bring cost into the picture which is a driving force for most patients.

Sharpstick had a post a few years ago that I think referenced this- I'll try to dig it up.

Found it! Post #11 especially. This has Hall of Fame potential in my book:
http://www.optiboard.com/forums/show...e+Intermediate

[Prentice Pro 9000]

Me- "Are you happy in your current progressives?"

If yes- done!

You really need to break this out to Essilor, Zeiss, other.

Also- how many designs are there--- hundreds and hundreds!!!

A poster the other day was asking for a flow chart and that would be really what I think you want as it would bring cost into the picture which is a driving force for most patients.

Sharpstick had a post a few years ago that I think referenced this- I'll try to dig it up.

Found it! Post #11 especially. This has Hall of Fame potential in my book:
http://www.optiboard.com/forums/show...e+Intermediate

Oh totally. TOTALLY! I'm all about keeping people in what they are currently wearing. I'm more so talking about new PAL wearers.

[Hayde]

Lots of variables about individual patient needs could shake this list up. How do patient's read? What are the reading/With what device? Peculiar occupation or recreational uses? What are they currently in and do they have any complaints with it. Assuming they're first time-PAL wearers or in something they say has room for improvement, and "low add" =/>+1.25, here's my best stab:

1. Low hyperope with low add
Kinda hard to screw this one up. Pay attention to other clues to gleen a design preference, but odds are any reliable design worth selling at all will produce patient satisfaction.

2. high hyperope with low add
Varilux designs (and I see a lot of happy patients like this in Zeiss lenses, too.)

3. low hyperope with high add
Varilux S or Physio W3+; Shamir Autograph 3 for controlling tricky angles or, more likely, high-use contemporary computer/tablet readers.

4. high hyperope with high add
Same as 3, prioritizing the Shamir A3. Again, Zeiss and its 6 drop will likely excel here too.

5. low myope with low add
No PAL is going to make this patient leap for joy. Try to talk him out of it until his ADD climbs up high enough to pay off the aggravation of PAL distortions. Push an inexpensive FT if he really wants a MF that still preserves his familiar lens optics. Make sure he owns the decision of purchasing a PAL instead of you having left any doubt that you preferred not to sell it.

6. high myope with low add
Shamir Autograph 3, or if not a short channel PAL by someone else.

7. low myope with high add (minus into plus)
Shamir Autograph 3; possibly a Varilux depending on Px Hx or peripheral needs.

8. high myope with high add
Shamir Autograph 3; or Varilux Short Channels

9. High astigmatism over +/- 3.00
Don't shake the table, if their powers are stable and ok with what they're in...better not fool with it. If they need to change, the axis could be pertinent to your decision. (Let's hope the OD tried to steer potential Aniseikonias into CLs. If someone has a finely tuned chart of what precise PAL is broken by which cylinder power vector, that'd be pretty cool! But I wouldn't hold my breath. Generally speaking, fancy free-forms could easily end up being less preferable than traditional designs.

10. absolute best peripheral vision
Show me someone dissatisfied with a properly fit Varilux S who liked anything better?

11. absolute widest corridor (and whether the width is only noticeable within a certain rx range)
This used to be easier to discuss when 'hard' v 'soft' designs had more pertinence in lens distinctions. As it is now, I can't really corroborate any hunches here about modern options that carry any significant patient feedback regarding 'comparisons.' I can regurgitate lens rep propaganda here, but I can't vouch for it.

12. go-to office lens (as well as which ones you've tried but are not that great)
Shamir Computer/Workspace

Thanks!!!!

Now I will say there are other great lens designs out there that I personally haven't had the opportunity to sell--and I look forward to different colleague experiences for my own edification. :)


Edit: started this post before Uncle Fester made a great observation and a super link.

[Prentice Pro 9000]

Hayde. When you as tricky angles, you mean reading angle?

[Prentice Pro 9000]

Hayde "Px Hx"?

[Hayde]

Hayde. When you as tricky angles, you mean reading angle?

Usually...sometimes up top, but that's pretty darn rare.

Hayde "Px Hx"?

"Patient History," Sorry :)

[Robert Martellaro]

I don't bother looking at PAL history. Instead, I determine what the client needs, and then provide it. Hints- watch for too strong adds, and make sure the near zone is J1 pristine, without posturing, especially for advanced presbyopes and avid readers. There's not much we can do with zone widths, so I'd recommend concentrating on zone position. You'll learn the most by wearing the lenses.

Hope this helps,

Robert Martellaro

[Prentice Pro 9000]

I don't bother looking at PAL history. Instead, I determine what the client needs, and then provide it. Hints- watch for too strong adds, and make sure the near zone is J1 pristine, without posturing, especially for advanced presbyopes and avid readers. There's not much we can do with zone widths, so I'd recommend concentrating on zone position. You'll learn the most by wearing the lenses.

Hope this helps,

Robert Martellaro

Do you find that a lot of people just bypass the intermediate and use their reading instead?

[Robert Martellaro]

Do you find that a lot of people just bypass the intermediate and use their reading instead?

Jake,

I think of the intermediate zone as a bridge between destinations.

Cheers,

Robert Martellaro

[harry a saake]

Jake,

I think of the intermediate zone as a bridge between destinations.

Cheers,

Robert Martellaro

find out what the patient is using them for, then suggest the appropriate style, person who only looks near on occasion can usually suffice with a standard progressive, a person who is on a computer will probably have more use for a wide reading area. do they have any hobbies, if so what?, ask questions instead of selling your favorite or the most advanced design because it costs more. when you do this, you will uncover a need for more then one pair of glasses

[Chris Ryser]

You'll learn the most by wearing the lenses.

Hope this helps,

....................and if you are over 70 years of age and have had progressive lenses for 30 years, you find out that they are hard to use, because the intermediate and reading area has become very narrow and the distortion on the side very large and the field of clear vision is very limited.

[Robert Martellaro]