Please help with Progressive lens choice

**eobob** · 07-17-2023, 03:33 PM

Hi all - I need some help with identifying (though unlikely) or coming up with a lens design to put a pt in. He is a +1.75 OU with +2.25 ADD. Currently wearing a pair of glasses that is 10+years old according to him, no visible markings on the lenses and he can't recall where he got it from. 2 years ago, we tried putting him in Comfort DRx and Comfort 2 (New Comfort), and he just couldn't adapt. For the last two years, unbeknownst to us, he has been using his old glasses and didn't touch his new pair in Comfort 2. He's back again and I would really like to find a lens that he can wear. New this time is that we have the power map of his old and new glasses, and I understand that he most likely needs a "hard" design. I admit I really am not an expert in PAL lens designs, and could really use some help and guidance. I'm also thinking he may currently be in a short design of some sort? I'm thinking of putting him in a hard/older design but unsure of what my options are.

Please see attached for power maps for his old glasses that he likes, and the "new" one from 2 years ago in Comfort 2 that he couldn't wear.

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**Elvis Is Alive** · 07-18-2023, 09:37 AM

I would recommend trying a Zeiss design. They tend to have a design closer to what he is wanting compared to the softer designs by Essilor.

**Robert Martellaro** · 07-18-2023, 11:14 AM

Welcome to OB.

Need more history.

Odds are that 10 years ago they were less hyperopic and presbyopic. Some compromise in the Rx, typically slightly less add power bump might be required. Discuss with client as needed.

Hope this helps,

Robert Martellaro

**eobob** · 07-18-2023, 01:02 PM

Originally Posted by Robert Martellaro

Welcome to OB.

Need more history.

Odds are that 10 years ago they were less hyperopic and presbyopic. Some compromise in the Rx, typically slightly less add power bump might be required. Discuss with client as needed.

Hope this helps,

Robert Martellaro

He is 68yo and his old RX was OD +1.75-0.75x178, OS +1.75-0.75x172 ADD +2.25; new RX this year (and 2yrs ago) is +1.75DS OU ADD +2.25; confirmed that pt doesn't want the cyl both 2yrs ago and this year. Are we incorrect in looking at the power maps and thinking that the old pair most likely has a harder design and wider intermediate?

I believe that he really tried the new pair and just couldn't adjust.

**Robert Martellaro** · 07-18-2023, 06:20 PM

The new Rx is sphere equivalant +0.375 stronger- use your quarter and half diopter flippers over the near gaze and verify the work distance. If they have long arms and hold the card on their lap you've found some or all of the problem.

WRT PAL design, this type of Rx usually calls for a longer and softer corridor. That appears to be the case with their old lenses. Zeiss is mentioned above- the Individual 2I fits that profile somewhat and has worked well in the past for my hyperopic clients.

Confirm no red flags in the frame and lens positioning.

Hope this helps,

Robert Martellaro

**eobob** · 07-18-2023, 06:29 PM

Originally Posted by Robert Martellaro

The new Rx is sphere equivalant +0.375 stronger- use your quarter and half diopter flippers over the near gaze and verify the work distance. If they have long arms and hold the card on their lap you've found some or all of the problem.

WRT PAL design, this type of Rx usually calls for a longer and softer corridor. That appears to be the case with their old lenses. Zeiss is mentioned above- the Individual 2I fits that profile somewhat and has worked well in the past for my hyperopic clients.

Confirm no red flags in the frame and lens positioning.

Hope this helps,

Robert Martellaro

Thanks for the insight, really appreciate it. We've done the the flippers to see if it's just the pt not adapting to the new RX, and no dice. Just seemed like a design issue, so we're really hoping going with a different lens would work. Going through the old forums, seems like Definity/Definity 3 might be an option if trying to stay within the Essilor family. Thoughts on that for this patient?

**Robert Martellaro** · 07-18-2023, 06:38 PM

Definity would be another good choice for sure.

Robert

**chamilun** · 07-19-2023, 02:23 PM

Originally Posted by eobob

Hi all - I need some help with identifying (though unlikely) or coming up with a lens design to put a pt in. He is a +1.75 OU with +2.25 ADD. Currently wearing a pair of glasses that is 10+years old according to him, no visible markings on the lenses and he can't recall where he got it from. 2 years ago, we tried putting him in Comfort DRx and Comfort 2 (New Comfort), and he just couldn't adapt. For the last two years, unbeknownst to us, he has been using his old glasses and didn't touch his new pair in Comfort 2. He's back again and I would really like to find a lens that he can wear. New this time is that we have the power map of his old and new glasses, and I understand that he most likely needs a "hard" design. I admit I really am not an expert in PAL lens designs, and could really use some help and guidance. I'm also thinking he may currently be in a short design of some sort? I'm thinking of putting him in a hard/older design but unsure of what my options are.

Please see attached for power maps for his old glasses that he likes, and the "new" one from 2 years ago in Comfort 2 that he couldn't wear.

that one on the left almost looks like a younger image

**eobob** · 07-19-2023, 03:47 PM

Originally Posted by chamilun

that one on the left almost looks like a younger image

The one on the left is Comfort 2 (New Comfort) and the right is the unknown/beloved/mystery lens.

**chamilun** · 07-19-2023, 04:13 PM

Originally Posted by eobob

The one on the left is Comfort 2 (New Comfort) and the right is the unknown/beloved/mystery lens.

interesting. very different design. wonder if hes been in a hoya

**optical24/7** · 07-20-2023, 04:19 PM

Hyperopic presbyopes many times prefer front/convex side PAL designs (or dual side designs). Definity or Accolade Freedom are duel designs and are in the big E family.

**eobob** · 07-21-2023, 12:51 PM

Originally Posted by optical24/7

Hyperopic presbyopes many times prefer front/convex side PAL designs (or dual side designs). Definity or Accolade Freedom are duel designs and are in the big E family.

Good to know, will remember that. Ended up putting the pt in Definity 3, will report back hopefully with good news and not further assistance.

**mike.elmes** · 07-26-2023, 06:44 PM

The old lens design you said was a short design... that means keep him in a short or harder design.

**SamBlumenthal** · 10-18-2023, 06:26 AM

You could consider alternatives such as:

Look for a traditional PAL design with a longer corridor length and a larger intermediate area.
Some lens manufacturers offer customized PALs. You could work with a lab to design a lens specifically tailored to his needs, using the power maps as a reference.
Adding a light tint or photochromic feature to the lenses can enhance comfort for some wearers.