Results 1 to 1 of 1

Thread: Sharing - New Staff Progressive Fitting Guide

  1. #1
    Rising Star
    Join Date
    Jun 2016
    Location
    Malaysia, SEA
    Occupation
    Optometrist
    Posts
    55

    Sharing - New Staff Progressive Fitting Guide

    So, we've taken on a new optometrist on staff, and as per the national norm here, he will be expected to dispense progressives. Being the resident geek of sorts, the task of coaching him on PAL selection more or less got pushed to me, and after some thinking, this was the approach I advised him on.

    We have had positive results so far considering he's a complete newbie to hands-on dispensing (less than half a year on the workforce), and for cases when he does have doubts, he measures and records everything to be rechecked by his manager or myself prior to ordering.

    Therefore, here is the fitting procedure I provided to him, in hopes that someone (maybe other newbies out there?) will find it useful :)

    It's a long post, but I've not figured out how to do the dropbox thing...

    ---

    Standard operating procedure

    - If it isn't broken, don't fix it. Unless there is a complaint by the patient that you are confident will be resolved by a restyle, don't change it.

    - Required lifestyle information: occupation (and vision needs), hobbies (and vision needs), basic medical history

    - Refraction: verify VA with the habitual correction (distance and near) before even taking out the trial frame. During refraction, at every step, any noticeably large changes to the Rx (particularly on the cyl axis/power) should be viewed as suspect if there isn't a correspondingly noticeable increase in VA. Trial frame the final results for a walkabout in the shop. For doctor Rx, trial frame it and record the VA, then explain what they can expect out of any changes it has compared to their current Rx.

    - Sit the patient down, explain the Rx changes (if any, and if so, why you as the examiner are changing it), and remind them of the inherent drawbacks of a progressive. Explain your top two (ONLY two) choices of optical outcomes with the major pros and cons.

    - If the patient agrees, proceed with the fitting. Adjust the frame into the patient's required wearing position. Then measure monocular PD, fitting height (pupil center), vertex/panto/wrap (just in case).

    Now you can go and consult the price lists for a choice of lens design, if you don't already have one in mind.

    ---

    Fitting criteria for PALs

    - Poor PAL candidates: Medically: patients with a history of motion sickness, vertigo, strokes, falls (bifocals may be better). Lifestyle: only wears glasses for indoor tasks or has unusual vision ergonomics (ref. occupational PAL). Optical: severe anisometropia/antimetropia, longtime bifocal/contact lens users (unless sufficiently motivated to try PAL and thoroughly debriefed on the consequences of switching over).

    - Avoid downgrading a design if possible, since not all the advertised upgrades of a design are marketing hype (and you don't want to find out which are the genuine article, the hard way).

    - Lifestyle: Asian designs tend to favour intermediate/near function, European designs tend to favour distance vision.

    - Hardness/softness: Asian designs favour softer designs, European designs usually a little harder.

    - Lens curvature: Asian designs normally use flatter blanks (possibly due to higher prevalence of myopia), Europeans somewhat more curved. May affect the precal, so if the patient is an existing Asian design wearer at a particular index, don't be surprised if the European design equivalent needs to bump the index up a step for similar cosmetic results. Will also affect the final frame fitting, since flatter lenses will splay the temples.

    - Default POW: if not fitting a customised PAL for higher prescriptions and/or unusual frame geometry, take note of the default POW values for the design you want to fit. Due to the high Rx and/or frame geometry, it's best to fit the design whose default POW values closely matches the frame geometry. Otherwise, for such patients, I'd recommend a POW-customised design.

    - Customised POW: vertex distance can be reduced slightly for high minus (due to the final product being thicker than the demo lenses), wrap angle can be reduced slightly (final product is often flatter than demo lenses or due to the frame splaying when worn), panto can be increased slightly (since the lens back surface often curves outwards beyond the frame itself)

    - Corridor: shorter vertex distance and/or more panto means a shorter corridor/ longer vertex distance and/or less panto means a longer corridor. This is my primary recommendation for corridor selection since ocular rotation does not lie, as opposed to possibly misleading lifestyle information from the patient. Otherwise, in the 'average' fit, longer for hyperopes and shorter for myopes... if in doubt, take the selected frame and draw a horizontal line on the demo lens at the level of the would-be near circle, and check if the line bisects the reading material when viewed in their habitual reading position. If it does, you are good to go (indicating that the near circle will be in the right position based on their habitual ergonomics). Anisometropic patients may tolerate a short corridor better, if in doubt about corridor length choice.

    - Materials: High index may use flatter blanks by default if not a POW-customised design, and the physical weight of the final product may be heavier if the thickness reduction is less significant than the increase in material density. Do not unnecessarily up-sell into high index.

    - Base curves: If needed, remove the demo lenses and measure the bevel curve since demo lenses are often more curved than the bevel. For more curved frames, it can be beneficial to order a slightly lower curve but increase the edge thickness, then adjust the bevel to accommodate the high base (cosmetically not the best result, but should be easier to adapt than a high-base PAL). Avoid 'matching base curve' if possible.

    - Prism thinning: Usually will not affect vision, could be advisable to opt for no prism thinning if you are prescribing prism.

    - Occupational PAL: Do not recommend based on the size of the intermediate/near zones, but rather, on the postural benefits of these designs (which is something you can guarantee the design will achieve compared to a normal PAL, unlike zone width...). Useful for patients who use desktops a lot, or who have unusual vision ergonomics (surgeons, mechanics, architects). Also useful as the primary pair recommended to those hyperopes who have only ever worn ready-made SV readers. A useful option is to manually convert a general use PAL into an occupational PAL based on trial frame results for intermediate/near (choose designs with wider distance for maximal intermediate function). Record the near PD and lower lid margin height as well when fitting since some designs use these measurements instead of the usual PAL fitting parameters.

    - Bifocals: For patients requiring edge-to-edge clarity, and who do not mind losing the intermediate range. Blended bifocals are handy for cosmestics, particularly as improvised occupational multifocals.

    ---

    At collection

    - Confirm that the frame is sitting level on their face. If any nosepad adjustments are to be done, mark up the fitting crosses to make sure the lenses aren't accidentally raised above the pupil center.

    - Take a walkabout around the shop to confirm that they can see well at distance, use your near chart to confirm that they can see clearly at intermediate and near. Inform them that on the first day with new progressives, it's alright if they feel a little unusual, but clear vision should already be in place.

    - Tell them to look straight ahead, then move just their eyes to the sides. Yes, I know this is pointing out the dreaded distortion zones, but I prefer to do it this way... inform them that these are normal components of PAL design, and that some head movement is necessary to maintain sharp vision. My patients have so far been appreciative of the reminder, and that I'm up front with it (if you recall, even before I quoted a price, I've already pointed this out).

    - Lastly, tell them to look straight ahead, then move just the eyes downwards. Advise them that until they get used to it, be a little more careful around stairs and uneven ground.

    ---

    So, as can be seen, my main intention with this guide was to drill into our new member of staff that patient profile/examination/expectation management must be locked down before a price quotation is made, and that in my humble opinion, doing so is the key to a better practitioner/patient experience with PALs at the end of the day.

    For patients who walk in asking for a price quote before anything else, my advice to him was: if it is an existing wearer quote them for that design, if no history of PAL or no current lenses on hand then quote for a mid-range lens... then inform them that subject to eye examination results the final price quotation would vary.

    I also told him to invest in perhaps a generic pair of PAL for himself, with a lower Add (maybe a +1.00). That way, he'll have firsthand experience with swim/distortion/demonic possesion/whatever, and may even find it easier empathise with patients this way. It amuses me that the majority of PAL sales done worldwide are likely by people who have no personal experience with the product itself! :P

    (yes, I wear progressives full-time, currently with a 1.50 Add in a short corridor. I love my Nikons)

    End of the day, as I told him, don't be afraid to politely let the patient walk if it comes to that. Our boss is himself a dispensing optician (still licensed and in practice), and is supportive of our decisions from a professional viewpoint. Therefore, he (the newbie) should capitalise on the fact that we have a rare, conducive working environment to do our jobs as professionally as we can.

    Hope this helps :)
    Last edited by AndyOptom; 03-08-2018 at 10:43 PM.

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Understanding fitting guide for verifying progressives
    By iokuok2 in forum Progressive Lens Discussion Forum
    Replies: 7
    Last Post: 02-22-2017, 10:28 PM
  2. Trying To Find a Fitting Guide for Seiko Super MV 1.67 or 1.74
    By Lelarep in forum General Optics and Eyecare Discussion Forum
    Replies: 1
    Last Post: 11-10-2015, 01:39 PM
  3. Fitting Guide for Rigid and Soft Contact Lenses
    By Diane in forum General Optics and Eyecare Discussion Forum
    Replies: 8
    Last Post: 03-31-2011, 02:21 PM
  4. Progressive lens fitting
    By skirk1975 in forum General Optics and Eyecare Discussion Forum
    Replies: 2
    Last Post: 02-22-2006, 08:38 AM
  5. progressive height fitting guide ??
    By GOS_Queen in forum Progressive Lens Discussion Forum
    Replies: 9
    Last Post: 06-20-2005, 05:38 AM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •