Hoyalife Lifestyle iD question

[Beeped]

Good morning all,

I'm having a particular issue I need some help with.

The case:

The patient is a first time varifocal wearer. Was originally put in a Shamir Piccolo while an Impression Freesign 2 was ordered.
I assumed they would make the same mistake again.
So this time we went for a Hoya Lifestyle iD that emphasises intermediate/reading.

In the Piccolo, PX did not see intermediate at all. Distance and reading were crystal.

In the Lifestyle iD reading and distance are clear (provided a little bit of head tipping which I adjusted) but the intermediate is incredibly swimmy.

PX works with 3 monitors and sees them wave. I have confirmed all basic measurements are correct. PD's, OC's and vertical heights seem to be good.

RX: RE Plano sph -0.50 cyl x 86 Add +2.00 Inter add +1.25
LE +0.50 sph -1.75 cyl x 82 Add +2.00 Inter add +1.25

Is surface astigmatism involved in this?

Any suggestions or tips?

Thanks in advance!

[Chris Ryser]

The patient is a first time varifocal wearer.

RX: RE Plano sph -0.50 cyl x 86 Add +2.00 Inter add +1.25
LE +0.50 sph -1.75 cyl x 82 Add +2.00 Inter add +1.25

Any suggestions or tips?

..................the answer is highlighted in red.

The addition indicates an older age group person, who was reading with lenses he/she got used to, over the last many years, and has problems with the habitual distorsions this type lenses come with.

[lensmanmd]

PX works with 3 monitors and sees them wave.

I believe that this is the main culprit. PX needs to swivel to view the three monitors. Have you had your PX look at just one monitor straight on and provide feedback? Also, are all three monitors aligned on a plane, or curved so that they are all at the same viewing distance?
I do not believe that your PX is a PAL non-adapt. I'm sure that the PAL works well for his daily needs, just not his computer needs. I would strongly recommend computer lenses as a work/hobby pair.

[Beeped]

The screens are curved to be roughly at the same distance. I guess it is my fault for not managing expectations properly. Am I correct in thinking that with this RX, most lenses would give that amount of visual distortion in the intermediate? You are very correct in saying the PAL does very well in day to day life, just the screens are a bit difficult. We'll consider exploring bifocals or single vision intermediate glasses as a computer pair.

Thank you all for replying!

[Quince]

I agree with lensmanmd. Any wearer with multiple monitors is going to have a hard time in a PAL. If I am shooting for a PAL with the most accommodating intermediate section, I go for the Shamir InTouch. That being said- I always let the patient know that this will still not be perfect. A workstation pair (Tact, Workspace, etc.) is the BEST option for most dual+ monitor users. But it needs to be a secondary pair where this lens will not be functional for distance.

It usually comes down to- do you want a pair that is good at everything but not great for work? Or do you want to have a separate pair that is optimized for work?

[cowboytelemark]

A workstation pair (Tact, Workspace, etc.) is the BEST option for most dual+ monitor users.

Not necessarily. I just had a non-adapt to that exact solution. My patient STILL gets too much swim at intermediate, so she is going to have to go to a SV intermediate or digital ST28. I would probably recommend one of those as the secondary pair, especially as the pt is a first time PAL wearer.

[Quince]

Not necessarily. I just had a non-adapt to that exact solution. My patient STILL gets too much swim at intermediate, so she is going to have to go to a SV intermediate or digital ST28. I would probably recommend one of those as the secondary pair, especially as the pt is a first time PAL wearer.

"Best" might have been an exaggeration. SV would be the best. I think my mind was on track with still trying to fit all levels, distance through reading, in one lens.

I've only had one cup of coffee...

[cowboytelemark]

Beeped, which IDLS did you put her in? I have had MUCH better luck with the Clarity VS the Harmony, even for some hyperopes.

[Kwill212]

As others have said there is no everyday PAL that is going to make them happy at their monitors. Depending on their need of their workstation, there are other better solutions. If they only need to see their monitors, obviously SV set for the working distance is the best. If they need monitor distance and near point the best lens would be a PAL with super wide distance vision, take away the intermediate power from the near and add it to the distance. So for your patient,

+1.25 sph -0.50 cyl x 86
+1.75 sph -1.75 cyl x 82
+.75 add
(I would probably adjust this to +1.00 over their distance Rx, unless they have a very close monitor setup.)

Presto, instant custom computer PAL with the entire top of the lens set for monitor distance and full near in the bottom. This has always worked better for me than any type of manufacturers computer lens, especially for multiple monitor setups. This can also be done with a lined bifocal.

If they need to see monitor distance and full distance for some reason, then you can fit them in a FT45 or Executive with a super high seg height, at or above pupil center depending on monitor height, with the near portion set up for monitor distance. The entire seg will give them midrange without moving their head and they can peek over the seg for distance vision. This works incredibly well for orchestra players also.

If they want to work at three monitors, and get up and walk around, and see near, etc, etc. Make them your favorite office PAL, sprinkle some magic pixie dust on it, and tell them to move their head back and forth at their monitors.

[Tallboy]

FT 35s and executives are great, the Gradal RD was also good. I do very well with the digitally designed, customized to wearer use, office lenses I finish and dispense.

[Chris Ryser]

It looks like we are back to my original post and suggestion.

[Robert Martellaro]

FWIW, with exceptions, for healthy eyes, I start to consider task eyeglasses when the add power reaches +1.75 D, especially when the object is near the primary gaze.

Good and Daum, recognizing the shortcomings of typical PALs for computer users, investigated changing the fitting height and prescription of PALs for computer users. They determined that PALs were preferred with +0.75 D in the top of the lens with the normal near power, indicating that PALs as normally prescribed did not optimally meet the viewing needs at a computer.

https://www.aaojournal.org/article/S...031-X/fulltext

Hope this helps,

Robert Martellaro