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Thread: Very high power and cyl progressive

  1. #1
    Master OptiBoarder DanLiv's Avatar
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    Very high power and cyl progressive

    I have a high plus / high cylinder patient I've been fitting successfully for years in the 1.74 Varilux dual-surface designs (Physio 360 and then Physio W3+). However this year her power has pushed outside of Varilux's range. The Autograph Intelligence will accept it, but I would prefer to keep her out of a full backside design due to the exaggerated prism compromises high-hyperopes suffer in those. Back in the day the Seiko Surmount was a design specifically geared to strong hyperopes, but that was quite a few years ago and there must be better designs for this purpose today. If she weren't seeing great I wouldn't concern myself as much, but she still corrects to 20/20 so I want to give her the best I can. Anyone have a favorite?

    +11.50 -6.75 x073 add +2.75
    +10.00 -0.75 x032 add +2.75

    Thanks!

  2. #2
    What's up? drk's Avatar
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    I'd like to learn on this one.

    Can you explain what a prism compromise is, and why does it occur on back surface progressives, and why putting the add on the front is better?

    Also, how would any given design favor high plus patients?

    Thanks!

  3. #3
    What's up? drk's Avatar
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    https://www.optiboard.com/forums/sho...x-replacements

    I guess this current thread answers it?

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    Maybe a camber lens can be fitted very well, it is similar to dual surface concept.folks what do you think?

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    Master OptiBoarder DanLiv's Avatar
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    Quote Originally Posted by drk View Post
    https://www.optiboard.com/forums/sho...x-replacements
    I guess this current thread answers it?
    Quote Originally Posted by optimensch View Post
    By grinders you mean conventional PALs with the "add" on the front surface....? For me the worst part of the situation is the much higher base curves required on "full backside" progressives, which is what most lenses are today. These newer and "better" lenses offer higher curves, increased thickness, magnification for the higher plus, higher add Rxs compared to the bad old grinders. Let's be clear - the newer "better" lenses are better for the manufacturer's profits more than anything else.
    Rant over.
    I do agree with optimensch, I think "free form" backside designs offer some minimal benefits over traditional designs, but they also sacrifice a lot of control because they work with a single surface. The benefit to labs and manufacturers of course is more streamlined production by utilizing spherical SV blanks, and lowers the bar for getting into the lens game since it's primarily optics and software design rather than mass blank manufacture and distribution. Despite the clear monetary benefits to switching to a "free form" model, at least two companies, Essilor and HOYA, continue to argue the optical superiority of dual surface designs and greater ability to fine tune optics when manipulating multiple surfaces. Plus, and I have limited understanding why, but I believe prism thinning is much better achieve in dual surface designs, and in an Rx like this prism thinning will do a lot for the lens cosmetics, and I want it.

    Quote Originally Posted by dima View Post
    Maybe a camber lens can be fitted very well, it is similar to dual surface concept.folks what do you think?
    Yes I would love more info on this too.

  6. #6
    One eye sees, the other feels. OptiBoard Gold Supporter
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    Quote Originally Posted by DanLiv View Post
    I have a high plus / high cylinder patient I've been fitting successfully for years in the 1.74 Varilux dual-surface designs (Physio 360 and then Physio W3+). However this year her power has pushed outside of Varilux's range. The Autograph Intelligence will accept it, but I would prefer to keep her out of a full backside design due to the exaggerated prism compromises high-hyperopes suffer in those. Back in the day the Seiko Surmount was a design specifically geared to strong hyperopes, but that was quite a few years ago and there must be better designs for this purpose today. If she weren't seeing great I wouldn't concern myself as much, but she still corrects to 20/20 so I want to give her the best I can. Anyone have a favorite?

    +11.50 -6.75 x073 add +2.75
    +10.00 -0.75 x032 add +2.75

    Thanks!
    Zeiss might work out if you cut the cylinder to -6.00 DC (sph eqv the difference). Obviously very frame dependent. Both sides surfaced in Germany.

    ZI2_FitDisp_Guide_051012FNLAppd.pdf

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



  7. #7
    Master OptiBoarder DanLiv's Avatar
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    Quote Originally Posted by Robert Martellaro View Post
    Zeiss might work out if you cut the cylinder to -6.00 DC (sph eqv the difference). Both sides surfaced in Germany.
    Ah yes I'd completely forgotten about Zeiss 1.74 being a different animal from the rest of the portfolio! Thanks for the reminder. However it's that 6.75D cyl that's killing my options, at 6D I could still do Varilux.

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    Quote Originally Posted by DanLiv View Post
    full backside design due to the exaggerated prism compromises high-hyperopes suffer in those.

    Thanks!
    Could you explain this more? I still am unclear to what you are referring to by this.

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    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by drk View Post
    I'd like to learn on this one.

    Can you explain what a prism compromise is, and why does it occur on back surface progressives, and why putting the add on the front is better?

    Also, how would any given design favor high plus patients?

    Thanks!
    My 2 cents as a hyperope;

    With total backside design PAL’s, it creates a bi-convex design in the umbilic, not following eye rotation as well as total front side or duel surface designs.

  10. #10
    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by DanLiv View Post
    I have a high plus / high cylinder patient I've been fitting successfully for years in the 1.74 Varilux dual-surface designs (Physio 360 and then Physio W3+). However this year her power has pushed outside of Varilux's range. The Autograph Intelligence will accept it, but I would prefer to keep her out of a full backside design due to the exaggerated prism compromises high-hyperopes suffer in those. Back in the day the Seiko Surmount was a design specifically geared to strong hyperopes, but that was quite a few years ago and there must be better designs for this purpose today. If she weren't seeing great I wouldn't concern myself as much, but she still corrects to 20/20 so I want to give her the best I can. Anyone have a favorite?

    +11.50 -6.75 x073 add +2.75
    +10.00 -0.75 x032 add +2.75

    Thanks!
    Do you have a good relationship with the prescribing doctor? If this was my office, I'd be talking with my doc about the costs and benefits of pulling that cyl back to -6.00. First of all, there just isn't that much of a functional difference between the two. Second of all, if a patient with a really tricky RX is comfortable in one particular PAL design, they may be "losing" more by changing that aspect of the glasses more than they "lose" by compromising on the cyl power. Zeiss and Varilux lenses feel really​ different to some of us folks with challenging prescriptions.
    I'm Andrew Hamm and I approve this message.

  11. #11
    Master OptiBoarder DanLiv's Avatar
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    Quote Originally Posted by AngeHamm View Post
    Do you have a good relationship with the prescribing doctor? If this was my office, I'd be talking with my doc about the costs and benefits of pulling that cyl back to -6.00.
    Good point, that may be the best solution all around. Sometime we make things harder than they have to be, thanks for simplifying things!

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    I hope you can redo lens with -6 cyl with varilux or Zeiss. BTW Camber are good lenses they have 2 suface (back individual freeform and front variabile curve) and usually are very cosmetics

  13. #13
    Master OptiBoarder DanLiv's Avatar
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    Ugh, I'm back. So the doc dropped the cyl to -6.00 to be within Varilux parameters, but the power is outside my normal lab's range so they outsource to a specialty Essilor lab, but that lab will only AR coat with Sharpview (Essilor's entry-level AR). I really don't want to put this customer in that, it's just not going to survive the typical two-year cycle of her lens replacements. And I finally found the parameters for the Seiko Surmount and it's cyl caps at -5.00, so that's a no-go too.

    Am I out of options?

    I am going to reach out to Zeiss about the German-produced dual sided 1.74. I had a Zeiss account in 2010...

  14. #14
    Master OptiBoarder AngeHamm's Avatar
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    Zeiss will be happy for the business. And that German 1.74 lens is the best I've ever worn, not even close. It may take a month or more, though.
    I'm Andrew Hamm and I approve this message.

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