Fitting an Exotropic 16 year old patient with a Progressive Lens

[jc17777]

Px came back from the optomologist and was recommended a Progressive lens. I was just wondering if there are any special fitting parameters I should take into account with this or any special fitting tips that you guys would have. Thanks

[Quince]

As a general rule of thumb (therefore not pertaining to exotropic factor) I like to try and put minors in anti-fatigue lenses if their ADD power is +1.25 or lower. It is more of a training-wheel into PALs and can make the transition into multifocals much easier.

Pertaining to the exotropic nature- this is one of the very few instances I will use the Dr's PD measurement. It usually does not match my own but is somehow more accommodating. (Given that it is a Dr I trust.)

[jc17777]

It is a +2.00 Add. I was just asking mostly pertaining to seg ht and panto vetex ect. I know with Bifocals for children with strisbismus you fit the seg at pupil ht so I wasnt sure with a progressive if I fit it center pupil or what is recommended(I havent done one in awhile so I am having a brain fart at the moment). Sorry I should have been more clear about that in the initial post

[Quince]

No worries! Thought I'd give my 2 cents!

[Robert Martellaro]

Use a design that has a shorter corridor, as opposed to a longer corridor.

Segmented multifocals, where the segment bisects/splits the pupil, are typically used specifically for convergence excess esotropia.

Hope this helps,

Robert Martellaro

[jc17777]

Use a design that has a shorter corridor, as opposed to a longer corridor.

Segmented multifocals, where the segment bisects/splits the pupil, are typically used specifically for convergence excess esotropia.

Hope this helps,

Robert Martellaro

That does help, thank you

[OpticalDinosaur]

Rather than use a PAL, have you considered the Shamir Duo? Is the recommendation for a PAL for intermediate use or to deter from a line that creates image jump? The Duo accepts prism better and less likely to encounter the prism conflicts PAL's endure.

[Chris Ryser]

At a +2.00 add it is at the upper limit for PALs and their increased distortion over the lens.

Why not give a 16 year old some clear vision throughout the lens.

[Robert_S]

Use an invisible Bifocal. Shamir Duo is the best, as Optical Dinosaur suggested!

[drk]

As Robert mentioned, the purpose of an add in an exotropia is different than an esotropia. (In an esotropia you use a seg and split the pupil.)

In an exotropia the very likely cause is accommodative insufficiency, a much more mild situation, and it is amenable to PALs.

As to the type, with a +2.00 add (which is quite high for an accommodative case) you would treat it as any other case. Short corridor is fine. Blended/invisible bifocal is fine. I'd probably just look at the distance refractive error and wear recommendations and decide from there.