Wrong lenses - Comfort not Panamic

[aamsel]

I recently had both of my true lenses replaced with cataract surgery, and had my first prescription written by an optometrist in my opthomologist's office. She prescribed a progressive with "anti-reflective" and put PA next to the "progressive" checkbox indicating Panamic.
I originally was going to get the glasses made at the optician's office inside my surgeon's office, but decided to go where I have had glasses made for several years.
I walked in and said that I wanted "progressives with the Varilux Panamic lense and Crizal Alize anti-reflective". The manager there said that she could do Panamics with the Crizal but that they usually did Comfort with the Zeiss coating. She told me that since I sat at the computer a lot, that the Comfort would have a wider intermediate range. (I have since read that this is not the true case.) As a side note, the same optician last year made me a set with the Comfort lens that I did not adapt to, we thought primarily because the frame was borderline too small. They ended up making me a set of single-vision reading glasses for my "non-adapt" remake then. That was before my cataract surgeries.
Anyhow, I agreed to let her fill it with the Comforts, and I am not enjoying the glasses at all. I know that I should wear them a lot to try to adjust to them, but feel that I will go blind or crazy before I give them a fair trial. My feeling is that I should go to their store Monday, and ask them to make the lens the way the doctor wanted them made (Panamics with Crizal Alize) unless the coating does not matter. At least I would like to try Panamic.
I do not want to be out of line, please advise me as what I should do. I will be happy to post my prescription if it would help.
Thanks, sorry to bother you,
Andrew
Austin, Texas

[chip anderson]

It is possible that this will make a difference to you. But truthfully, I doubt that you will be able to tell the difference. In fact if you have already been a progressive non-adapt you may always be a progressive non-adapt. You may have to have a visible bi/tri focal or several pairs of glasses.

Of course it is possible that the measurements for your lenses were incorrect (progressives are very fussy about this) and it is possible if you would put the ones you have on, and leave them there during all your waking hours, you will learn to love them before this period has passed. Of course this would require some effort on your part.

Chip

[harry a saake]

Aamsel, i doubt that either one of those progressives, which are both fine progressives, is the problem. What we encounter more, is as we age and the near correction becomes stronger, the field of view becomes less.
I suspect if you took a panamic and a comfort and looked at a plot of both of those lenses and compared a +1.00 to a +2.50 power you would see the same difference in both, both would show a wider field of view on the lower powers and somewhat less on the higher powers.
.....Perhaps Pete , who works for Essilor is around and can substantiate some of this. In both cases i,m going to presume your glasses were made correctly to the rx.

[aamsel]

I DON'T have much correction, as it is.
Here is my RX:

OD- SPH= PL, CYL= -075, AXIS= 160
0S- SPH=-025, CYL=-025, AXIS=080
ADD= +2.50

So you see, I have almost NO distance correction, other than astigmatism. I have never needed distance glasses, they just sharpen things up a little. I still don't know if I need them. I may have been better off with "room distance" glasses, not sure.
The optometrist I saw was great, she spent a huge amount of time doing the Rx, and she recommended progressives. I told her that my last progressives did not work.

Thanks,
Andrew
Austin, Texas

[For-Life]

aamsel,

I wouldn't put much to what the OD prescribed in the exam room. I am not saying that the doctor doesn't know what they are talking about, I am saying that they do not necessarily know the better lens than the optician. Actually I am completely against doctors dispensing in the exam room as I think it is a conflict of interest. I tend to agree with the other posters that the lens type is probably not the problem; however, it could be.

I have found that there are several reasons why certain people cannot adapt to a progressive.

1. The dispenser took binocular measurements instead of monocular (measuring from eye to eye and splitting it, instead of measuring from the eye to the centre for each eye). This also involves fitting heights. The reason for this is that centeration is extremely important to a PAL.

2. Wrong measurements.

3. Customer not wanting it to work. Progressives for me always work on first time presboyes, but I have had trouble in the past with taking people who wear another type of bifocal and having them wear a progressive. The reason for this is sometimes that customer is happy with what they have and they are not going to put up with the work behind making a change. If a customer is motivated to wear a PAL then they will have no problem, if they are not then I know that they are better off with their current bifocal.

4. The frame needs an adjustment. This goes hand and hand with centeration. If the frame is not sitting properly, then there might be some problems.

With a different PAL type, you might be able to tell that you have a wider distance, or a wider reading, or stuff like that. However, I do not get too many, if no, cases where the PAL type is the reason why they cannot adapt. Actually I have used the Panamic on many clients main glasses and then did a pair of Super No-Lines (a very, very old PAL) in a pair of sunglasses, and the customer had no adaption problems.

Now, you would not be out of line in going to your dispensery and complaining. We want to hear when you have a complaint, because then we can have another chance to make you happy. Tell them that you are having problems and see what they can do about it. Suggest switching to the Panamic, but do push them to switch. The dispenser might agree with you, or the dispenser might have another idea of what is wrong.

[aamsel]

Don't you normally get one remake for a "progressive non-adapt"??? If that was the case, wouldn't the optician or lab consider the switch from Comfort to Panamic as the remake?? Then, if I couldn't adapt to the Panamic, and wanted single vision, the lab wouldn't remake them free??
Also, don't misunderstand:
I went to an Opthamologist for the cataract surgery. When he was done, he had an Optometrist do the prescription. As I said, I think she did a very careful job. Finally, I was going to have it filled in the same office (where there is also an Optician) but decided not to. They did not try to steer me to the place in-office, but certainly let me know it was there. The only reason I went to the Optician that I have used for years instead is that the in-office Optician was pushing a small number of frames that she had in stock, where the place I have used for years has a HUGE selection of frames.
Finally, one of the problems is I don't know if my distance vision is "worth" correcting. Yes, it is a little sharper with correction, but, I really don't know.
Thanks!
Andrew
Austin, Texas

[Joann Raytar]

aamsel,

What exactly is it about the new lenses that you dislike? Is it how you see far away, close up or problems using them around the office?

What size monitor do you use?

At your add power (+2.50), Comfort doesn't appear to be a bad choice at all. Everyone is correct in that frame fit, frame adjustments and lens centering can make a big difference when it comes to progressives. I hate to say it but perhaps just knowing that you received Comfort instead of Panamic is playing a big part in your not adapting. Do you think you may have had your mind set on not being able to wear a Comfort and limited yourself to only one lens possiblity?

[For-Life]

I can't tell you how much you need your distance. It would depend on what your visual acuity is without your glasses. But like I said, I would let the optician try to see if they can solve the problem. I would suggest the panamic if I were you, but I wouldn't hold to it if the optician wants to do something else.

If the worse case scenario happens and your optician goes to a non-adapt and it comes to play that your distance is not a major thing I would ask to be switched to a task specific lens (The Sola Access, Nikon Online, and Rodenstock Office). It is like reading glasses, but it gives you up to 7 feet of distance. So you would get your reading and your intermediate, but you can drive with them. It is a very good lens for those who do not wear distance glasses.

[jediron]

I believe Harry hit the nail on the head. I have found in 30 years of practice that the area of the lens as harry pointed out if it were graphed is much smaller on a +2.00 (Add) as opposed to a +1.00 (Add). This also works in proportion to the size of your frame, pd, seg height and power of the add. Now I also agree with Jo in that
are you letting the opposition to comfort be the deciding factor in whether you can adapt or not? Now I have worn comfort and pan
and I perfer the Pan. myself. I have also tried Navigator, Natural
and Others and have always returned to my Pan's as they have
been more comfortable for the side distortion issue.
:hammer: :bbg: :D

[aamsel]

My gripes are:
Using them for distance is almost like tunnelvision. Using them for intermediate on anywhere from a 14" to 19" flat panel monitor (I don't use CRT's) gives me about 2" of screen that is in focus. I have been back and had the frames adjusted. When driving I have to tilt my head down to see in focus (and this has been adjusted also). The reading portion shows text which has a VERY small focused field, and the text curves widely at the edges (bowed with the center higher.) Medium distance (computer) creates a "parallelogram" effect. As I point my nose across the screen, the entire image (the part in focus and the part not in focus) tilts up to the left, and then down to the right. Very weird.
All in all, if this is something I have to get used to, I don't believe it. I think that the prescription (for the various powers) is dead-on, because the distance, middle and reading are very in-focus for the little part that I can see easily. As for expecting the Panamic, I was not expecting it - the optician told me that Comfort was just as good, and I believed it. It wasn't until I got on the web and read everything I could find, that I saw that Panamic is more the "latest and greatest". I do realize that manufacturer's claims and statistics are not the be-all and end-all, but it does look like the Panamics are the better lense, with later technology.
Thanks!
Andrew
Austin, Texas

Jo said:
aamsel,

What exactly is it about the new lenses that you dislike? Is it how you see far away, close up or problems using them around the office?

What size monitor do you use?

At your add power (+2.50), Comfort doesn't appear to be a bad choice at all. Everyone is correct in that frame fit, frame adjustments and lens centering can make a big difference when it comes to progressives. I hate to say it but perhaps just knowing that you received Comfort instead of Panamic is playing a big part in your not adapting. Do you think you may have had your mind set on not being able to wear a Comfort and limited yourself to only one lens possiblity?

[aamsel]

No, not at all. I went in asking for Panamic, and was told that Comfort was just as good. It wasn't until I saw that I was never going to be able to see out of the darned things that I researched the difference in the lenses. If they had worked well, I would never have even thought to do research, or do "bizarre things" like finding this forum!! <grin> I am experiencing EXTREME side distortion with these, a very, very small focused field of vision for the near and middle distance (very small) a tunnel effect on the distance (although a much wider focused field of vision, and I am having to point my nose down to drive (not very safe.) Other than that, they are perfect!!!
Thanks!
Andrew
Austin, Texas

jediron said: ...are you letting the opposition to comfort be the deciding factor in whether you can adapt or not? :hammer: :bbg: :D

[aamsel]

Well, I can see just fine for distance without any correction, the correction just makes everything sharper. However, it is fatiguing to wear them to drive for 20 minutes. I would imagine that I would get used to that?
Andrew
Austin, Texas

For-Life said:
I can't tell you how much you need your distance. It would depend on what your visual acuity is without your glasses. But like I said, I would let the optician try to see if they can solve the problem. I would suggest the panamic if I were you, but I wouldn't hold to it if the optician wants to do something else.

If the worse case scenario happens and your optician goes to a non-adapt and it comes to play that your distance is not a major thing I would ask to be switched to a task specific lens (The Sola Access, Nikon Online, and Rodenstock Office). It is like reading glasses, but it gives you up to 7 feet of distance. So you would get your reading and your intermediate, but you can drive with them. It is a very good lens for those who do not wear distance glasses.

[UFRich]

If you are constantly removing the glasses throughout the day it hinders the adaption to the lens and the Rx. Although you feel confident in the Rx the Dr. provided you with, we are all human and refraction is an art, it wopuld never hurt to have the Rx double checked by another OD or go to your OD and have them test the vision with the glasses. It also is very possible that considering all the complications you have had, you have decide that the lens you have just isn' t going to work. The Panamic is a very good lense, and I am one of those people that want the latest and greatest, but 99.9% of consumers would not be able to tell the difference if they were given a pair of Comforts instead, because it is high quality lense in itself.

UFRICH:cheers:

[UFRich]

Also non-adapt changes, at least with labs I use don't normally include changing progressive styles, unless a very poor progressive was used in the first place.

UFRICH:cheers:

[aamsel]

I wouldn't have expected the lab to absorb it. I would have expected the optician to, because:
1.) I walked in asking for a Panamic with Crizal Alize, and got sold a Comfort with Zeiss, after being told that "nobody has noticed a difference between Panamic and Comfort".
2.) The doctors prescription said "progressive PA" for Panamic.
Andrew
Austin, Texas

UFRich said:
Also non-adapt changes, at least with labs I use don't normally include changing progressive styles, unless a very poor progressive was used in the first place.

UFRICH:cheers:

[Johns]

Aamsel,

If you are experiencing "tunnel vision" , and your driving with your nose down, it sounds like the lens is just sitting a little to high. There's a good chance that a slight frame adjustment at the optician's office will clear it up.

[Stopper]

It seems to me that you have never really worn lenses on a full time basis. (Correct me if I'm Wrong) It has been my experience that patients that don't need to wear their glasses full time have the most trouble adapting to any progressive. There is a learning curve with any new tool or equipment that you aquire and progressives are no different. You need to decide if progressives is what you really want or need. If yes, you are going to have to follow the advise of the others and try to wear them full time until you get adapted. If you keep taking them on and off you will never adapt. I don't want to sound harsh. Just trying to give some input.
Good luck

[jediron]

Johns could be right. What your were talking about before with the fields on the sides being distorted is hard to understand with
the prescription you have. Usually the higher the cylinder power
the harder it is to adjust to a progressive lens. The cylinder power
is accentuated in a progressive lens because of the nature of that type of lens. If your were to graph a progressive lens and then graph in the power constraints for a higher cylindrical lens
the graph will become progressively more distorted as the power of the add increases and as the power of the cylinder increases.
What it sounds like to me is the height of the progressive is high causing you to look through part of the intermediate which has a
small area for viewing and you would incounter side distortion.
This is somewhat confirmed by you saying that you tip your head
down to view distance while driving. I don't think an adjustment
will solve the problem because it seems from what your saying
they are too high and need to be placed at the pupil line. It should bi-sext the pupil. Only a thought take it or leave it.
:bbg: :D

[Robert Martellaro]

The optician probably raised the fitting cross in an ill-advised attempt to address the clients complaint of uncomfortable vision when used at the monitor.

Andrew,

Computer glasses can be made that will provide a wide field of vision on both the vertical and horizontal meridian, without posturing. In other words, when you sit down and look at the monitor the entire screen will be clear without moving your head in any direction. There is usually an additional area towards the bottom of the lens that will provide good focus for closer tasks when looking at objects on the desktop and for normal reading. This pair of glasses would be in addition to your every day glasses or driving glasses. Measure the distance to the monitor and to the desktop with a tape measure when sitting in a comfortable and typical position. Make note of the height of the monitor i.e. is the central area exactly at eye level or slightly below eye level. Give this information to an optician who has experience fitting this type of lens. Depending on the work distances, the lenses might be single vision (unlikely unless the monitor is in your face at 16"), special design progressive addition lenses that are meant to be used just for this task, or multifocals (PALs or standard lined bifocals) where the distance potion of the lens is set to monitor distance.

Hope this helps

Robert

[Texas Ranger]

Aamsel, you are right, you don't have much of a "distance" rx need, and you're trying to use them at a PC. A few weeks ago, I got a pair of "Nikon Online" lenses for wear in the office. what a joy ! I have my "regular" glasses to wear outside the office, when I need to drive the car, watch TV, movies, etc, but when I come in in the mornings, I put my Nikon lenses on, and wear them all day in the office. the difference? they don't have my "distance " rx in them, the top of the lenses are ).75 weaker than my distance Rx, so I can see about a 10' circle around me, helps especially at the PC and at the dispensing table, while the near add power is my full reading power, all the way across the bottom of the lenses, like a SV reading lens...I have fit about 20 pair on others now, and they all love it! it is not a "replacement", it is an "occupational" lens, just for your work, sort of like if you do a lot of bowling, you might get your own special shoes! see, everyone wants one lens design to do it all; and there isn't such an animal...best wishes.

[Cowboy]

Aamsel,

There are several reasons to suggest a progressive lens to a patient. The newest and latest techological advances are atributed the needs and suggestions of consumers just like you. So yes, the panamic would be slightly better (how much, that is an individuals opinion). However, what I have been reading leads me to believe that the true objective has not been met. What is that objective, it is exactly what you want. However, that may not be obtainable with just one pair of eyewear. I think sitting down with (or without) your optician and list out your daily activities, from morning to night, and on weekend activities, to really pin- point the areas that would be beneficial from a progressive, a single vision lens, or even lined or specialty computer vision no-lines. What this will do is enable you to see what direction you should really be headed in. Progressives are not for everybody, but an Optician is.

good luck on finding your answers, and I hope I was some help to you.

Cowboy

[For-Life]

Texas Ranger said:
Aamsel, you are right, you don't have much of a "distance" rx need, and you're trying to use them at a PC. A few weeks ago, I got a pair of "Nikon Online" lenses for wear in the office. what a joy ! I have my "regular" glasses to wear outside the office, when I need to drive the car, watch TV, movies, etc, but when I come in in the mornings, I put my Nikon lenses on, and wear them all day in the office. the difference? they don't have my "distance " rx in them, the top of the lenses are ).75 weaker than my distance Rx, so I can see about a 10' circle around me, helps especially at the PC and at the dispensing table, while the near add power is my full reading power, all the way across the bottom of the lenses, like a SV reading lens...I have fit about 20 pair on others now, and they all love it! it is not a "replacement", it is an "occupational" lens, just for your work, sort of like if you do a lot of bowling, you might get your own special shoes! see, everyone wants one lens design to do it all; and there isn't such an animal...best wishes.

I know. The Online and its competitive lens like the Access and the Office are the most underrated lenses on the market. I am the only store that dispenses them in town and I have gained a lot of customers because of that. I use it for office workers with low distance, piano players, teachers, shop workers, and so forth. It is an unbelievable lens for people who want a wider intermediate and reading zone. I have not had one failure with that lens.

[Pete Hanlin]

Hello aamsel,

Sorry for not seeing this thread sooner- as indicated earlier, I do work for Essilor (and things have been pretty busy lately, so I haven't had time to visit the forum as often as usual).

Harry is absolutely correct, as the ADD power increases (in your case, it appears to be +2.50, which is customary for a post-cataract patient) the near field in any PAL will become slightly more restricted.

I tried to read as much of the thread as possible, but I did not see that your previous Rx- or your age- has been posted. This is relevent, because your cataract surgery has probably increased your ADD power. If you are a relatively new presbyope (i.e., under 55 or so), your previous ADD power was most likely a few steps lower than +2.50. Therefore, the ADD on the new lenses may be significantly higher- and therefore more restrictive- than your previous lenses.

Regarding the differences between Comfort and Panamic. It appears that you have been wearing Panamic in the past? If this is the case, it is at least theoretically possible that you are noticing a difference in design. The two lenses are designed quite differently.

First, your optician is correct- technically speaking, the intermediate "zone" is wider in Comfort. However, the intermediate area of binocular vision is larger in Panamic. This is part of the difference in design philosophy. Panamic was designed using an approach called "Global Design Management." In short, this means the most important consideration when designing the lens was to provide both eyes with similar images- regardless of their position behind the lenses.

Second, For-Life and others here are also correct. Improper fitting is the number ONE reason that progressive lenses fail. I am by no means suggesting your optician has failed to fit your lenses properly. However, it is an unfortunate fact that the skill level among opticians in this country varies greatly from office to office.

My advice would be as follows. Give the lenses a fair try (it always comes back to that with us Opticians, doesn't it ;^). Try them for two weeks solid. If, after this period, they are still causing you any discomfort, by all means get a second opinion regarding the fit of the lenses. Make sure the Optician is licensed (or, if this is not applicable in your state, make sure they are certified by the American Board of Opticianry), and have them "re-dot" the lenses to verify proper fit.

If the fit is proven to be accurate, then I would suggest changing back to Panamic. If the fit is inaccuate, you should have the lenses remade and can use either Comfort or Panamic depending upon your own personal preferences.

Please do let us know how you progress (no pun intended). If you encounter any problems along the way, please feel free to email me at the address below. I am sure your Optician is quite capable and is dedicated to getting you seeing your best. Give the lenses a try, and go from there.

Best regards, and good luck-
Pete

[rfin56]

I am an eyeglass wearer with limited vision (except for the periphery) in my
left eye. I was recently prescribed panamic lense for the right eye, balance
lens for the left. I read your online contribution from 2003 in which you
argued:

"Panamic was designed from the "outside in." On a monocular basis, Panamic was
not designed to have the widest periphery. Rather, the periphery was designed
to provide binocular fusion across a wide area. In other words, while the
intermediate area that is free of unwanted astigmatism may actually be narrower
in Panamic, it is better balanced. This means binocular vision is improved as
both eyes encounter similar amounts of astigmatism on either side of the
intermediate zone."

Does this mean that I might be better off if I used a Comfort or Liberty lense
in the rights eye? Would this help increase reading a comuter usability vs
panamic (since I cannot gain from the binocular advantages of panamic in any
event).

Thank you for your advice.

Bob

[Chris Ryser]

Go back to a regular bifocal.............that is the reason you were a non adapt before your cataracts. At least you will be able to read properly and see clearly for distance. At your age you should never have changed in the first place and have continued with what you had before.

When progressives came on the market we learned...........never to switch older people to progressives. Problems from visuial to psychological reasons and not worth the effort and money.