Troubleshooting guidance for a potential progressive non-adapt

[eyemechs]

Hi all, I'm hoping someone can give me guidance (as I've exhausted my IRL brains trust on this one).

I have a px, an late 50s investment advisor who sits on his PC all week, goes acrobatic aircraft flying on weekends, and does photography in his spare time.

He has been wearing 2 SV pairs (SVD and SVI) for the past year.

Given Rx (old SVD): R -525/-100x129 L -400/125x067
Given Rx (old SVI): R -350/-100x129 L -225/-125x067
Our PAL: R -450/-100x130 L -400/-125x073 Add +175

The old SVs were completed without heights accounted for. A vertical decentration of approx 10-11mm exists in both lenses.

Verting his SVD at actual pupil as worn showed prisms of R 6.0D BU and L 3.6D BU, with some horizontal prism of about 0.40D BO.

He's become used to these despite the prism and, what I assume would've been initial slight distortion with being off-centre.

We ended up making him a pair of PALs non too dissimilar to the Varilux X, in a frame shape almost identical to his SVD pair (base curves match, oval/rectangular shaped, next to no decentration). He is not adapting and is complaining of swim effects to the point of vomiting. POW parameters, etc have all been checked and cleared.

Can't seem to troubleshoot this one. Would his VI on his old pairs be 'throwing off' the numbers so to speak?

[Robert_S]

Increasing wrap and panto and lowering heights through adjustment should help with the swim

The reduction in -sph power in the Right eye won't be helping at all

You said the frame is similar but that's irrelevant here as the use case and lens type of the glasses is so different. A deeper frame with longer corridor will be better, with advice to continue with svi for computer use

[optical24/7]

Trial frame the distance only w/without 2D up OD to rule out power/prism issues.

[Robert Martellaro]

Adaptation, about 10 to 30 days. Will still need task eyeglasses for the monitor.

Try this with a pint-

[drk]

The first thing I always look at are the cylinder axes: this is an oblique astigmat, which means it's a potential anisekoinia issue. But in this case the axes did not change significantly. I GUESS we could consider undoing the 5 degree shift OS as a Hail Mary solution.

The next thing to check is change in the vertical meridian for vertical imbalance when reading...OD used to be about -5.75 and now it's -5.00, and OS stayed at about -4.62. So the vertical imbalance has decreased, so that's good.

Thus, you didn't make a monster.

The other guys...they may have.

You're saying that due to crappy opticianry he was looking through 2.5^ BU in primary gaze and has adapted to that. IF WE ASSUME HE HAS NO ORGANIC UNFORSEEN VERTICAL IMBALANCE IN HIS MUSCLES, he may need time to adapt to the loss of that. Another Hail Mary, though, would be to trial lens, say, about 1^ BU OD and see how he feels about it. If he likes it, you titrate out their (his, really--sucker!) mistake...remake with a little unwanted/habitual BU this time, and take it all the way out in the future.

The main reason he's probably not adapting, though, is the standard: "I've waited too dang long to adapt to a multifocal lens and now I'm an old 50-something fart and I'm Type A" which is something you cannot fix. I have begged and pleaded for some of my patients in this position to AT LEAST PUHLEEZE let me put a +1.00 in their new glasses for training wheel purposes and bring them along gradually. I get it--your visual system is crystallized, but unless you like the look of a second pair of glasses in your nerd shirt pocket or don't mind segments (and by the time they're 60, all pretense of attractiveness has been dropped, at least in men who have that societal luxury---but have you seen some of the bad female plastic surgery click baits? eeeek) then we have to move slowly towards multifocality!

[Uncle Fester]

I think it was John at Laramy K that gave me this phrase I use before someone in a demanding field wants to switch to progressives from single vision:

"Progressive lenses are a compromise and compromised pair of glasses."

And then we should throw in "Ryser's Rule":

The success of a progressive is directly proportional to the motivation to wear a progressive.

Occam's razor.
https://www.merriam-webster.com/dict...am%27s%20razor

[mervinek]

I think it was John at Laramy K that gave me this phrase I use before someone in a demanding field wants to switch to progressives from single vision:

"Progressive lenses are a compromise and compromised pair of glasses."

And then we should throw in "Ryser's Rule":

The success of a progressive is directly proportional to the motivation to wear a progressive.

Yes... I actually tell my patients this too! Once you become a presbyope...it's all a compromise. Do you compromise by having multiple pairs or do you compromise with smaller areas in one pair and all the stuff that goes with it? It's a compromise...you choose where you want to compromise.

[optical24/7]

……
"Progressive lenses are a compromise and compromised pair of glasses."……

The phrasing I used regularly was something like..” Progressive lenses are the Swiss Army knife of lenses. They have areas of distance and near and most all in between. But they are a Jack of all trade, master of none lens. If you use your vision extensively at a given distance it may be beneficial to get pair of glasses geared for that task. Right tool for the right job.”

[AngeHamm]

Ryser's Rule is evergreen, as is the tendency of increasing panto to relieve an awful lot of PAL ills.

[Kwill212]

I would start with trial framing the new Rx. Seems like a dubious change for someone in their late 50s. Next I would asses their desire and motivation level for switching from SV to PAL. Then I would throw everything about their old glasses out the window. Fit them in the best lens I think will work for them, fit correctly, and tell them to wear them for 2 weeks. No other glasses and asses from there. I would also tell them they need an occupational pair for extensive PC/indoor work.