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Thread: Lens recommendation...

  1. #1
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    Lens recommendation...

    Hi all,
    Does anyone have a particular favorite prog to dispense, with hyperopes in mind? Something you've seen you have more success with? Larger channels. I have a +4.00 mild cyl patient. 50ish. Put her in a W3 and she was in a HOYA standard, probably summit cd. She absolutely hates the new lens, complains of a much smaller sweet spot in reading and intermediate and all around discomfort. I believe her when she says she has really tried. I know this patient and while a bit of a nervous type, she's honest and not usually high maintenance. I want to do right by her, but it needs to be a lens I can order from essilor so I can get a free remake; otherwise I'd probably put her in an ID lifestyle. I tried the S design myself and found the corridors to be really narrow, so I went to the W3 and its okay. I'm leaning towards Definity Short but have not fit many of these. Opinions?

    Paula S
    ~Follow Your Bliss~

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    I'm really surprised by the dissatisfaction with the W3+. You mentioned a Definity short, is there some reason this patient needs a short channel? What was the seg of her W3+? (That could be the source of the problem. High powered hyperobes really can't afford to lose B under the eye.)

    Also, they're still selling Definity? I thought that had vanished...

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    Try the definity, I've had issues with the W3 with some patients but if I put them in the enhanced then they love it, which is weird but who knows people be crazy. when fitting the W3 make sure you are putting your dots in the CENTER of the pupil, not at the bottom (I was taught that way and have heard its common) butt since I've been doing this I haven't had a non adapt W3. Could that evil poly be the problem?
    "what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    I would try the Camber Steady.

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    Quote Originally Posted by Hayde View Post
    I'm really surprised by the dissatisfaction with the W3+. You mentioned a Definity short, is there some reason this patient needs a short channel?
    Yes, it's a seg ht of 16mm



    Also, they're still selling Definity? I thought that had vanished...
    I've never really sold more than 2 or 3 of these but reading the webpage it looks like they are trying to revamp the usage of this lens. I don't know. Marketing , ya know. The frame does sit farther away from her eyes than I'd like, so we also changed frames. I think that in and of itself will be a big help.
    ~Follow Your Bliss~

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    Quote Originally Posted by kaypaula View Post
    I've never really sold more than 2 or 3 of these but reading the webpage it looks like they are trying to revamp the usage of this lens. I don't know. Marketing , ya know. The frame does sit farther away from her eyes than I'd like, so we also changed frames. I think that in and of itself will be a big help.
    Yeah, I'm not sure any PAL is going to be great for a 16 seg for a +4.25ish/+2.50ish add. Good call considering vertex--it's starting to get relevant at about this range.

    If she can't be persuaded to a taller lens size (or has some neck/posture issue preventing her from tilting back,) I'd experiment with the Shamir Autograph 3, which advertises lots of smarts about vertical power distribution. If you sell Shamir, you could call the rep to see if they're willing to vouch for the A3 for that particular challenge.

    But if you're having luck restyling her to something 20+ in the seg, I'd bet she'll have a whole new experience in her Physio W3+.

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    Master OptiBoarder optical24/7's Avatar
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    If the vertex is beyond 13mm in the as worn position, re-adjust/switch to a frame that sits closer (keyhole effect). High plus, stay away from total backside designs, go with a more front side oriented design. Surprisingly Accolade Freedoms do quite well in this range, just watch lens thickness, induced mag can cause their own set of issues.

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    From my experience with it, Varilux lenses should have a one-year non-adapt clause in which you can switch to any other lens available at your lab for no charge. Contact your Essilor rep about it if they give you guff.

    Sounds like your patient needs something hard-designed, if she is searching for a wider reading zone. The Physio W3+ is a much softer design, hence why she isn't adapting to a slower power buildup. We have encountered this issue with certain hyperopes as well, they don't actually use their intermediate Rx, and they love short corridor lenses. If you really have to use Essilor, try Comfort W2+ Short. Definity, from my experience has more emphasis on the intermediate zone, which may not necessarily be what you're looking for. Otherwise I'd agree with Auto III.

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    Eyes eastward... Uilleann's Avatar
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    Did pt have a big add bump recently? May not be the lens - could just be an SRx adjustment.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Any ideas on how we can get this back? I sure miss it (for all it's weakness').

    http://www.optiboard.com/forums/show...guru+lens+maps

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    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by Uncle Fester View Post
    Any ideas on how we can get this back? I sure miss it (for all it's weakness').

    http://www.optiboard.com/forums/show...guru+lens+maps
    Are you talking about the lens guru site? Tony had to shut it down, no support from the 3 O's (big surprise!..not..) It was getting costly and time consuming for him. Couldn't even get a corporate sponsor and none wanted to buy it from him. He's actually move on out of optics (lucky guy). I miss seeing him here...

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Quote Originally Posted by optical24/7 View Post
    Are you talking about the lens guru site? Tony had to shut it down, no support from the 3 O's (big surprise!..not..) It was getting costly and time consuming for him. Couldn't even get a corporate sponsor and none wanted to buy it from him. He's actually move on out of optics (lucky guy). I miss seeing him here...
    I was wondering if there was a way to get the contour plot maps on Optiboard. I'd be willing to chip in to buy them if that's a possibility.

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    Master OptiBoarder optical24/7's Avatar
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    I'll try to get a hold of him to find out what happened to the info he gathered. May be a while, last I talked to him he was having fun in the Sun in Ca.!

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    Was she in Trivex before? Sometimes I have seen people that come from Hoya lenses refit into poly or 1.67 and not deal well with the change. Some people really are that sensitive to material and Progressives have a lot of "off axis" areas to get chromatic problems in.

    I never have issues coming out of the summit and the W3+ is a great lens for a hyperope, I suspect it is a bump in the add and a very short seg height that is making thinks feel bad for her. Demand a 20 seg and restyle in the lowest index lens you feel you can fit.

    Auto III or W3+ if you need a cutting edge lens, I just don't think the problem here is lens design, it so rarely is these days if you are using good stuff.

    The Sola instinctive has held up against the Summit CD so that is about as bargain basement as I get - as long as the material is being matched. If you are incorporating vertex measurement remember to adjust for lens thickness. Restyle her!

  15. #15
    sub specie aeternitatis Pete Hanlin's Avatar
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    Disclaimer- Essilor employee.

    I really think you've hit on the real issue (i.e., increased vertex distance). Also, a +1 to center pupil placement. I know some PALs work better with a modified fit, but Varilux lenses really perform their best at pupil center. Not saying Varilux Physio W3+ is a perfect solution for every patient- and it may not be the best solution for this particular patient at the end of the day- but there are a lot of hyperopes happily wearing that design (as stated, each person's visual system is unique- which is why it's a good thing we have 100s of PALs to choose from). Hoping you find a good solution for this patient- regardless of which design provides the answer.

    Not to get too far off the topic of the original post, but regarding contour plots I really REALLY wish you could determine how a lens will perform based on it's plot (because it would save me a TON of money in wearer studies). Unfortunately, experience shows that contour plots are virtually useless in telling me how a PAL will perform in real life (probably because they only contain information on cylinder and sphere levels without showing the axis of the cyl or the balance of corresponding points).

    That's easy to say, but let me give some examples. First, a couple of contour plots Darryl gave me years ago. The lens on the left has an obviously narrower intermediate and a LOT more unwanted astigmatism than the lens on the right. So, according to the plots, the lens on the right should be far superior...
    Click image for larger version. 

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    The lens on the left is SOLA VIP (which- for its age- is still a decent PAL, I have a pair myself). The lens on the right is SOLA XL, which was originally supposed to replace VIP and later was positioned as a complimentary lens to VIP. VIP has always been FAR more popular and quite a few of them are still sold today.

    Using a more modern example, here are two Plano +2.00 plots I made a few years ago prior to a wearer study (the lens on the right is a non-Varilux Essilor design and the lens on the left is a competitive design). When I made the plots, I thought "We are going to absolutely KILL this lens for distance width!" In real life, however, there was no statistically significant difference in perceived width (in fact, the competitor lens on the left was preferred by one more person in an n=33 study than the lens on the right for distance width, which still left us with a p=1.000, or "no difference"). In fact, there was only ONE statistically significant difference in the perceived performance of these two lenses (the lens on the right was significantly better for transitioning between distance, near, and intermediate).
    Click image for larger version. 

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    Point being, although it seems logical you could predict performance from contour plots, you really can't (at least I can't, and I can create some pretty cool plots :^). I've seen this in study after study. Here's why (at least IMO)... Spherical width and max level of astigmatism are NOT the most crucial aspects of a PALs design- but that's all a contour plot will show you. It makes sense if you think about it, a FT28 has 26mm or so of spherical width and virtually no unwanted astigmatism- yet most studies have shown people prefer the functional vision provided by PALs (even though a PAL has significantly less spherical width).

    Progression rate, binocular balance, and prismatic effects all have a profound effect on wearer perception, and none of them are shown by a contour plot. Here's a plot of binocular balance comparing the binocular fields of two generations of Varilux progressive designs (think 14-20 years ago, one of the products isn't even available anymore). The lens on the right provides far superior binocular balance- which is why patients were much more comfortable in this lens (IF it was fit accurately). However, these two designs look very similar on a contour plot (in fact, I remember going back and forth with one educator who plotted the lenses and claimed there was "no difference" between the two). These plots were included in the original education on the new design, but were later abandoned because it was too difficult for most opticians to understand their significance.
    Click image for larger version. 

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    Oh, and yes we still sell DEFINITY (currently DEFINITY 3 :^).
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    Pete,

    I really appreciate this post. As a lab manager, one of my responsibilities is to gauge the various products on the market. Along with that, I also am charged with cost ratios to determine pricing. The tricky part is balancing wearability vs costs, both to our patients and to our manufacturing COGs.

    I look at data. I research. Mapping and plot matrices speak volumes, but like you pointed out, if the end user doesn't like it, it won't move. In my many years in this industry, both from the manufacturing and dispensing side, I have found that the most pedestrian, middle of the road products garner the best overall success. As our industry ventures toward personalization, I find that we create more problems with VA and comfort. This is why I am a proponent of average fit, as compared to personalized POW. Today's FF engines are brilliant, regardless of MFR/design, as they all datamine Framefacts, and combined with the accuaracy of frame tracers, the computations are spot on. If the optician errs on the POW, the best designs are rendered useless.

    As as a profession, I do believe that we overthink, and as a result, under-deliver. We tend to lean towards personal biases, and even become enthralled by the promises from our reps.

    I appreciate the fact that you open with your affiliation. And at the same time, you do not vilify a competitor, and instead, you state facts. Kudos to you.

    E

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    Quote Originally Posted by Pete Hanlin


    Oh, and yes we still sell DEFINITY (currently DEFINITY 3 :^).
    Pete, any idea why Definity 3 is not VSP approved?

    We have a more moderately hyperopia optician who likes Comfort W2 in the Essilor line. She really likes some of the Shamir lenses.

  18. #18
    sub specie aeternitatis Pete Hanlin's Avatar
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    Quote Originally Posted by Happylady View Post
    Pete, any idea why Definity 3 is not VSP approved? We have a more moderately hyperopia optician who likes Comfort W2 in the Essilor line. She really likes some of the Shamir lenses.
    I wasn't aware that DEFINITY 3 was not categorized by VSP- but I'll ask our managed care team on Monday and try to get back to you with an answer!
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

  19. #19
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    Seiko Surmount has performed the best for myself and the majority of hyperopes I have put in this lens. My theory is the zero drop design gets them the plus a bit quicker where they want it.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

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    Quote Originally Posted by Pete Hanlin View Post
    Disclaimer- Essilor employee.

    I really think you've hit on the real issue (i.e., increased vertex distance). Also, a +1 to center pupil placement. I know some PALs work better with a modified fit, but Varilux lenses really perform their best at pupil center. Not saying Varilux Physio W3+ is a perfect solution for every patient- and it may not be the best solution for this particular patient at the end of the day- but there are a lot of hyperopes happily wearing that design (as stated, each person's visual system is unique- which is why it's a good thing we have 100s of PALs to choose from). Hoping you find a good solution for this patient- regardless of which design provides the answer.

    Not to get too far off the topic of the original post, but regarding contour plots I really REALLY wish you could determine how a lens will perform based on it's plot (because it would save me a TON of money in wearer studies). Unfortunately, experience shows that contour plots are virtually useless in telling me how a PAL will perform in real life (probably because they only contain information on cylinder and sphere levels without showing the axis of the cyl or the balance of corresponding points).

    That's easy to say, but let me give some examples. First, a couple of contour plots Darryl gave me years ago. The lens on the left has an obviously narrower intermediate and a LOT more unwanted astigmatism than the lens on the right. So, according to the plots, the lens on the right should be far superior...
    Click image for larger version. 

Name:	tumblr_ossexxRlpH1tkp167o1_1280.jpg 
Views:	30 
Size:	39.9 KB 
ID:	13388
    The lens on the left is SOLA VIP (which- for its age- is still a decent PAL, I have a pair myself). The lens on the right is SOLA XL, which was originally supposed to replace VIP and later was positioned as a complimentary lens to VIP. VIP has always been FAR more popular and quite a few of them are still sold today.

    Using a more modern example, here are two Plano +2.00 plots I made a few years ago prior to a wearer study (the lens on the right is a non-Varilux Essilor design and the lens on the left is a competitive design). When I made the plots, I thought "We are going to absolutely KILL this lens for distance width!" In real life, however, there was no statistically significant difference in perceived width (in fact, the competitor lens on the left was preferred by one more person in an n=33 study than the lens on the right for distance width, which still left us with a p=1.000, or "no difference"). In fact, there was only ONE statistically significant difference in the perceived performance of these two lenses (the lens on the right was significantly better for transitioning between distance, near, and intermediate).
    Click image for larger version. 

Name:	tumblr_ossexxRlpH1tkp167o2_1280.jpg 
Views:	40 
Size:	72.6 KB 
ID:	13389

    Point being, although it seems logical you could predict performance from contour plots, you really can't (at least I can't, and I can create some pretty cool plots :^). I've seen this in study after study. Here's why (at least IMO)... Spherical width and max level of astigmatism are NOT the most crucial aspects of a PALs design- but that's all a contour plot will show you. It makes sense if you think about it, a FT28 has 26mm or so of spherical width and virtually no unwanted astigmatism- yet most studies have shown people prefer the functional vision provided by PALs (even though a PAL has significantly less spherical width).

    Progression rate, binocular balance, and prismatic effects all have a profound effect on wearer perception, and none of them are shown by a contour plot. Here's a plot of binocular balance comparing the binocular fields of two generations of Varilux progressive designs (think 14-20 years ago, one of the products isn't even available anymore). The lens on the right provides far superior binocular balance- which is why patients were much more comfortable in this lens (IF it was fit accurately). However, these two designs look very similar on a contour plot (in fact, I remember going back and forth with one educator who plotted the lenses and claimed there was "no difference" between the two). These plots were included in the original education on the new design, but were later abandoned because it was too difficult for most opticians to understand their significance.
    Click image for larger version. 

Name:	tumblr_ossfn5YsIo1tkp167o1_540.jpg 
Views:	32 
Size:	22.6 KB 
ID:	13390

    Oh, and yes we still sell DEFINITY (currently DEFINITY 3 :^).
    What's the best way to asses a patient's visual needs and then find the correct lens for them (out of the hundreds you have)?

    Thx

  21. #21
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    Quote Originally Posted by lensmanmd View Post
    Pete,

    I really appreciate this post. As a lab manager, one of my responsibilities is to gauge the various products on the market. Along with that, I also am charged with cost ratios to determine pricing. The tricky part is balancing wearability vs costs, both to our patients and to our manufacturing COGs.

    I look at data. I research. Mapping and plot matrices speak volumes, but like you pointed out, if the end user doesn't like it, it won't move. In my many years in this industry, both from the manufacturing and dispensing side, I have found that the most pedestrian, middle of the road products garner the best overall success. As our industry ventures toward personalization, I find that we create more problems with VA and comfort. This is why I am a proponent of average fit, as compared to personalized POW. Today's FF engines are brilliant, regardless of MFR/design, as they all datamine Framefacts, and combined with the accuaracy of frame tracers, the computations are spot on. If the optician errs on the POW, the best designs are rendered useless.

    As as a profession, I do believe that we overthink, and as a result, under-deliver. We tend to lean towards personal biases, and even become enthralled by the promises from our reps.

    I appreciate the fact that you open with your affiliation. And at the same time, you do not vilify a competitor, and instead, you state facts. Kudos to you.

    E
    I think there is also something to be said for the old rule "keep them in the PAL they already have". If what they have is decent, then it's going to perform better (in their mind) than this jazzy new thing you just sold them on.

    I find that most places order top of the line lenses without even doing any POW measurements or understanding compensation. AND I LIVE IN DC, where people spend money and you'd think that money would buy the best service.

    There's also the fact that FF designs are a little unpredictable. I think an Auto3 in plus vs minus is almost a completely different lens. Where as an older and awesome primarily frontside design is easier to know.

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    Quote Originally Posted by Jubilee View Post
    Seiko Surmount has performed the best for myself and the majority of hyperopes I have put in this lens. My theory is the zero drop design gets them the plus a bit quicker where they want it.
    Is that the one with variable inset and corridor length?

  23. #23
    sub specie aeternitatis Pete Hanlin's Avatar
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    Quote Originally Posted by Jaketull View Post
    What's the best way to asses a patient's visual needs and then find the correct lens for them (out of the hundreds you have)? Thx
    Actually, the optician has a lot more to do with making a lens "correct" for the patient than any other factor. I know it's not sexy, but the single most important factor in patient satisfaction with a lens is the placement of the fitting reference point in the center of the pupil. If I can do that, give me just about any progressive lens and it should work pretty darn well for a large majority of patients. When someone contacts me to say "8 of the 10 hyperopes I put in [enter design here] non-adapted," my first thought is "You're fitting the lens incorrectly." (Regardless of whose design they're talking about.)

    To this day, when I fit lenses (I fit a lot of my coworkers with eyewear) I spend a lot of time ensuring that I'm putting that cross right in front of the visual axis of the eye. Yes, this usually involves having "dots" on the demo lenses. I take my measurements, then put them on the lens, then look at the patient with the dots to fine tune them. Then I usually have the patient look down and then look back up at me to ensure s/he doesn't have an unusual head cape (most people have a natural head turn when looking straight ahead- usually it's only a degree or so, but some can be quite pronounced). And... I've never had a particular problem making myopes, hyperopes, astigmats, or even (gasp) engineers quite happy with their progressive lenses. Could I do an even better job with an automated measuring device? Perhaps, but since I'm usually sitting at my desk when someone requests a fitting...

    That's not to say that an individual patient may really like one design more than another- even when they are both fit perfectly. I've been involved in dozens of wearer tests, and one thing is blatantly obvious- the human vision system is complex, and there will always be a small group of people that prefer a design that the majority of people don't. If I tested SOLA VIP against one of the Hoyalux iD designs, I can guarantee in a test of n=100 someone would state they preferred VIP (even though iD is a much better design that would be preferred by 98+% of wearers). The problem is I haven't yet found a way to look at those 100 people and predict WHICH 1 or 2 might prefer SOLA VIP. So, if I'm a dispenser who has a choice between the two, I'm going to best serve my patients by fitting the Hoya product. (What becomes interesting is when the optician, OD, etc. happens to be that one person that likes an inferior design... we live in a very experiential field :^). Disclaimer- Essilor employee... From the wearer studies I've been a part of, I would be very comfortable recommending Varilux products to the entire range of my patients. In controlled settings, the lenses perform exceptionally well on the entire range of Rxs out there. That said, there are several non-Varilux lenses I would also be very comfortable recommending- because they also perform very well.

    You mentioned that Autograph III seems to be a completely different lens in plus or minus. Actually, any good modern PAL design will be different for various levels of ametropia due to multi-design (actually, numerous traditional PALs are multi-design as well... I think we forget a traditional lens has 144 individual skus, so they are quite capable of being pretty darn "custom"). For example, in a single design the rate of progression should be different for a hyperope vs. a myope due to prismatic effects (a myope is fortunate to be reading through base down prism- which displaces the near image upwards, a hyperope is reading through base up prism, which moves the image downwards). Ditto for near inset- the larger the ADD power and/or the higher the distance plus power, the greater the inset will need to be due to prismatic effects. Likewise, the level of presbyopia should be accounted for by variation of the base design. The near zone of a +3.00 ADD has a focal length of 33cm, which requires more inset than a +1.00 ADD, and higher levels of ADD require a distribution with more power at the top of the progression.

    Whew, unfortunately the next few weeks will be pretty busy at work- but I've enjoyed diving back into Optiboard for a few days. I will note that- in the ophthalmic world- hyperopes have been dealt the "short straw." The optics of plus lenses (particularly progressives) are just far more challenging than those associated with myopes.
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

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    Pete teaches badass continuing education classes if you ever are able to get to one. I still use the things he taught me everyday when troubleshooting progressives. Listen to this man.

  25. #25
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    Quote Originally Posted by Pete Hanlin View Post
    Actually, the optician has a lot more to do with making a lens "correct" for the patient than any other factor. I know it's not sexy, but the single most important factor in patient satisfaction with a lens is the placement of the fitting reference point in the center of the pupil. If I can do that, give me just about any progressive lens and it should work pretty darn well for a large majority of patients. When someone contacts me to say "8 of the 10 hyperopes I put in [enter design here] non-adapted," my first thought is "You're fitting the lens incorrectly." (Regardless of whose design they're talking about.)

    To this day, when I fit lenses (I fit a lot of my coworkers with eyewear) I spend a lot of time ensuring that I'm putting that cross right in front of the visual axis of the eye. Yes, this usually involves having "dots" on the demo lenses. I take my measurements, then put them on the lens, then look at the patient with the dots to fine tune them. Then I usually have the patient look down and then look back up at me to ensure s/he doesn't have an unusual head cape (most people have a natural head turn when looking straight ahead- usually it's only a degree or so, but some can be quite pronounced). And... I've never had a particular problem making myopes, hyperopes, astigmats, or even (gasp) engineers quite happy with their progressive lenses. Could I do an even better job with an automated measuring device? Perhaps, but since I'm usually sitting at my desk when someone requests a fitting...

    That's not to say that an individual patient may really like one design more than another- even when they are both fit perfectly. I've been involved in dozens of wearer tests, and one thing is blatantly obvious- the human vision system is complex, and there will always be a small group of people that prefer a design that the majority of people don't. If I tested SOLA VIP against one of the Hoyalux iD designs, I can guarantee in a test of n=100 someone would state they preferred VIP (even though iD is a much better design that would be preferred by 98+% of wearers). The problem is I haven't yet found a way to look at those 100 people and predict WHICH 1 or 2 might prefer SOLA VIP. So, if I'm a dispenser who has a choice between the two, I'm going to best serve my patients by fitting the Hoya product. (What becomes interesting is when the optician, OD, etc. happens to be that one person that likes an inferior design... we live in a very experiential field :^). Disclaimer- Essilor employee... From the wearer studies I've been a part of, I would be very comfortable recommending Varilux products to the entire range of my patients. In controlled settings, the lenses perform exceptionally well on the entire range of Rxs out there. That said, there are several non-Varilux lenses I would also be very comfortable recommending- because they also perform very well.

    You mentioned that Autograph III seems to be a completely different lens in plus or minus. Actually, any good modern PAL design will be different for various levels of ametropia due to multi-design (actually, numerous traditional PALs are multi-design as well... I think we forget a traditional lens has 144 individual skus, so they are quite capable of being pretty darn "custom"). For example, in a single design the rate of progression should be different for a hyperope vs. a myope due to prismatic effects (a myope is fortunate to be reading through base down prism- which displaces the near image upwards, a hyperope is reading through base up prism, which moves the image downwards). Ditto for near inset- the larger the ADD power and/or the higher the distance plus power, the greater the inset will need to be due to prismatic effects. Likewise, the level of presbyopia should be accounted for by variation of the base design. The near zone of a +3.00 ADD has a focal length of 33cm, which requires more inset than a +1.00 ADD, and higher levels of ADD require a distribution with more power at the top of the progression.

    Whew, unfortunately the next few weeks will be pretty busy at work- but I've enjoyed diving back into Optiboard for a few days. I will note that- in the ophthalmic world- hyperopes have been dealt the "short straw." The optics of plus lenses (particularly progressives) are just far more challenging than those associated with myopes.

    I'm sorry, I know you're busy, I just want to make sure I understand. Why would a +3.00 add require more inset? Like... I get that with a shorten focal length, there is a larger angel of convergence. But people are going to just hold things where it's comfortable and not try to darn near cross their eyes, correct?

    But that raises an interesting question, should the add change based on their PD?

    Am I totally getting this all wrong?

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