# Optical Forums > Progressive Lens Discussion Forum >  When should A Progresive should Not be recommended ?

## sandeepgoodbole

Apart from limited spending capacity or tendancy of  patients, what are the considerations to suggest that its Not For You to a willing to pay case ?

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## opticianbart

children

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## NAH

Extreme motion sickness.

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## For-Life

I never liked trying to talk Bifocal wearers into them.  Same with trifocal.  If they are happy with what they have, leave them in it.  If they come in looking for the specific advantages of a PAL, then educate them and then move forward.

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## scriptfiller

What For-Life said; trying to "force" Bif/Trif wearers into them especially if they have an ADD power above +2.00.

I re-fit a PAL wearer into a FT 35 after he had an ADD increase from a +1.50 to +2.25.  He would look ridiculous in a large frame, so we kept him in a 30 B and he could not tolerate the higher power increase ratio within the corridor.

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## chip anderson

A: when the patient is under 40 years of age.
B: When the patient reads with the head in a fixed position and uses eye movement alone for lateral vision.
C: When the patient wants the most precise vision possible at each viewing distance.
D: Patient has any retinal disturbances at all causing less than optimal vision.

You may now expect replies from other optiboarders telling you about all the subnormal acuity patients they sold progressives.   Those higher fees and commissions motivate a lot of improper applications.  So do words like _new_ and _technology._

Chip:cheers:

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## Uncle Fester

> Apart from limited spending capacity or tendancy of  patients, what are the considerations to suggest that its Not For You to a willing to pay case ?


Relatives and close friends.;):D

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## Win C

> A: when the patient is under 40 years of age.
> B: When the patient reads with the head in a fixed position and uses eye movement alone for lateral vision.
> C: When the patient wants the most precise vision possible at each viewing distance.
> D: Patient has any retinal disturbances at all causing less than optimal vision.
> 
> You may now expect replies from other optiboarders telling you about all the subnormal acuity patients they sold progressives. Those higher fees and commissions motivate a lot of improper applications. So do words like _new_ and _technology._
> 
> Chip:cheers:


I have encountered all the above patients and after some education on progressive lenses, they still insist on getting a PAL. In situations like this, you just have to give them what they want.

however, optiboarders should be ethical enough to tell them what suits them best rather recommend something based on higher fees and commisions.

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## Kyle

Everything Chip said.

I can't tell you how many times I've heard an acquaintance of mine sell 1.67's in -1.00 to -2.50 to a former CR39 wearer, pronouncing the higher index lenses as employing the "best technology available". JEEZ!!! I cringe every time.

...and Win C, one would hope this to be true but do understand that not all Optiboarders were created equal which is why this forum is so potentially useful for some. I'll respectfully offer that the person in my example is NOT an avid Optiboarder, if one at all.

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## rdcoach5

> I never liked trying to talk Bifocal wearers into them. Same with trifocal. If they are happy with what they have, leave them in it. If they come in looking for the specific advantages of a PAL, then educate them and then move forward.


If they are happy with their lined bifocal or tifocal, DON"T SWITCH

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## PresbyopicBiker

Monocular patients are also tough. Including those with suppression.  I have had better success with the newer designs.

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## SailorEd

Also, if a patient has ambliopia.  Probably not a good candidate for a progressive ... but a good candidate for a FT-35.

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## giles farmer

A -1.25 44 year old office worker

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## AdmiralKnight

Anyone with a relatively low distance rx, coming from SV readers... or at least make sure you council a LOT.

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## Barry Santini

Re: progressives:

There is far less "subnormal" acuity with a properly-fitted, measured and POW compensated mild-wrap ( 7-9 degree face form) progressive, in my experience.

If you think your client will balk at the price, do what I do...consider lowering your normal mark up, and get them into this terrific new technology.

Sure, goin' about it this way means I'm bringin' home less bacon lately. But it's my way of ensuring succees in the future.

Hey, the internet and insurance are putting downward pressure on your margins anyway. Why not use this situation to get an unexpected (and unsurpassed) result?

Being able to exceed people's expectations in optical is becoming increasingly harder. Client's are jaded by the woo and lure of discount prices from whereever.

The easy path, IMHO, is in this latest lens FF technology (including SV and FT 28)

One of my equations for success: 

Exceed your client's expectation = building client trust. 

And trust functions like an annuity toward future business success.

One man's opinion...

Barry

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## jpways

I think the simpliest advice I've ever gotten to this question (which is a summary of a lot of these posts), if the patient is wearing a multifocal and you don't have to change lens design/material (due to the fact that either the lens is no longer made, or in the case of a progressive you've fallen under the MFH) don't make any changes. Especially if it means you're keeping a person in glass. And yes so far this year I've dispensed 3 patients in glass progressive lenses, because that's what they were wearing.

For new patients the one question that you need to ask is if they get vertigo/dizzy spells. Depending how bad it is, then no multifocal may be the correct answer. The best example I can think of for this case, is our office once had a patient that when they sat at a stop sign and turned their head to look at it, they got dizzy (this was using a DVO prescription). A patient like that needs 2 pairs of SV lenses, 1 for NVO and 1 for DVO.

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## chip anderson

Now concidering the above post...
If we don't want to dispense these to people who already have a tendancy toward motion sickness and the like...
Could we be inducing motion sickness to those who don't have same but might if things were just a little worse visually...?
Could we be inducing a_ little_ motion sickness in _everyone_ we dispense them to....?
What are we doing to the pilot who hits a little barely controlable turbulance...?

Chip

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## Barry Santini

One caution:

*Every* Bifocal, SV, Porgressive or RX change requires "getting used to".

If you shy away from new lens types, just because you fear that they'll "have an adjustment to make" visually, posturally or perceptually, I think you may short-change a particular client from enjoying the benefits of what they may have enjoyed.

How do you know? You don't.

Try, and try again!

Barry

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## Striderswife

I was going to say the same thing as Barry Santini!!  :D

One thing I tell all my patients is there is not one lens that will serve all purposes for all people.  There are lots of different designs for different tasks, and we just have to find out together what is best for the patient's lifestyle.  With any lens, though, there will be something in the vision that is compromised.

If a patient is happy in his BF/TF, by all means they can stay in it.  If a patient is going from SVNO to full-time wear, we definitely will talk about progressives, and their versatility, but I do my best to let them know what to expect.  And yeah, you'll never know untill you try.

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## sandeepgoodbole

If people are happy, why to change? =  Pro inccumbency. Why not try for some thing which will creat more happiness ? = Anti incummbency.

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## sharpstick777

i sell a lot of Progressives.. about 97% of my multifocals are Progressives.  Including many children with convergence disorders with the Drs permission.

But I warn and screen the following more...

1) patients with Vertigo
2) muscular disorders of the eye that result in abnormal converngence (I have done it successfully)
3) any neurological condition that causes shaking (again, I have done it, but I warn the patient that they could be better off in a lined lens)
4) self corrected mono-vision patients  (OD:  -1.25 OS: Plano  Add: +1.25)
5) low power latent presbyopes who still have good visual acuity w/o glasses and are not motivated to wear glasses yet.
6) engineers who look at blue prints and hate not seeing a straight line

i average about 3 progressive non-adapts per year, and most of those are solved by switching to different brand of progressive lens.

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## sharpstick777

> If they are happy with their lined bifocal or tifocal, DON"T SWITCH


I would disagree... I believe quality of life is greatly improved with Progressive lenses.

I put a 96 year old woman in her first progressives a few years ago... and she was really mad... not at me... but at all the Opticians over the previous 20 years who never even told her about progressive lenses. She said it gave her a new lease on life and she could see better and more naturally than she had in years. Hobbies were more pleasant, everything in her life better, and she loved how they looked on her. She was very very happy with progressives...

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## Chris Ryser

I just wonder whay kind of hobbies a 98 year old still enjoys, and how valid such a comment would be to further sales of Pals. You could probably sell PALS to everyone in an old age nursing home.

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## fvc2020

good Morning 

First I want to ask Chris why do you hate progressives?  It seems like everytime this type of conversation comes up you go on and on about don't use them, don't switch them...

I have guidelines I use for my patients too.  common sense stuff that is already listed here, however I do recommend progressives for most other wearers.  I don't get paid commission or bonus.  I have no incentive to "sell"something to patient.  In today's life, so many people could use the benefits of progressives.  That 98 year woman might be facebooking or twittering, and listening to her Ipod.  Would a ft 28 work for her, no since now she alot of focal lengths to look at.  Why if she ask would I tell her no.  

Also most people come in knowing what they want.  With proper education patients do fine with progressives.  Take the time to talk to patients get to know them and what they need/what, and then make decisions with them.  

I just tired of the negative remarks.  No Chris I don't just "sell" to my patients, and I don't think most good opticians do

Christina

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## sharpstick777

> I just wonder whay kind of hobbies a 98 year old still enjoys, and how valid such a comment would be to further sales of Pals. You could probably sell PALS to everyone in an old age nursing home.


She enjoys baking, canning, jigsaw puzzles, and gardening.

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## William Walker

I would add high astigmats, 
those with high add powers,
and patients with MD, or similiar situations of central vision loss.

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## lichou

> I would add high astigmats, 
> those with high add powers,
> and patients with MD, or similiar situations of central vision loss.


 
Please define "the high astigmats, and add" for not good candidates wearing PALs

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## lichou

How about a patient's rx with correction of prism

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## William Walker

> Please define "the high astigmats, and add" for not good candidates wearing PALs


As higher and higher amounts of astigmatism get ground into a lens, the channel corridor becomes narrower, giving the patient less room to see.  

A similiar effect happens when introducing a high add power (say +3.00).

I have another thread open right now looking for some sort of formulas to quantify exactly how much occurs in each case, so keep your eyes open!  :)

Thanks for asking.

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## sharpstick777

> I would add high astigmats, 
> those with high add powers,


William,
I have done very well with high astig patients using digital progressive lenses with Atoric designs.  In all but one case the improvement with Atoricity exceeded the inherant impact of cyl on compared with a lined option.

It depends on the angle of astigmatism, age of the pat, parity of the cyl from one eye to the other etc.

one 50 year old patient said his Definity's were the best he had seen since he was 10 years old.

Its harder to get used to because they have been compensating longer, and the change in cyl will affect their spatial relationships more, but they will be happy once they get used the atoric design.

I fit one high cyl patient and at first he could see nothing.  I gave him a magazine to read, it took 20 minutes before he could see the words clearly.  Then in another 10 everything clicked, he could see very well.  Walking was trip for him, but he got used to it.  In 2 days he was very thrilled.

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## William Walker

Hi Sharpstick,

     I should have been a little more specific in my post.  I screen out those patients when I sell a standard design progressive.  In private practice, where I had access to everything under the sun, I did fit those patients, usually with a FF lens.

     As Costco only sells the Ovation, I limit myself more than I do in private practice.

Thanks,
William

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## nooksak

> A: when the patient is under 40 years of age.
> B: When the patient reads with the head in a fixed position and uses eye movement alone for lateral vision.
> C: When the patient wants the most precise vision possible at each viewing distance.
> D: Patient has any retinal disturbances at all causing less than optimal vision.
> 
> You may now expect replies from other optiboarders telling you about all the subnormal acuity patients they sold progressives.   Those higher fees and commissions motivate a lot of improper applications.  So do words like _new_ and _technology._
> 
> Chip:cheers:


Just curious why you would not fit a person under 40? The reason I ask we just recently had an issue with a PT in their late 30's being non-adapt to progressives, should we go with a FT28 or a blended? Thanks,

Mike

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## fjpod

I know I'm a little late to this thread.  

Some of the responses made me scratch my head.

Why not children?

I think many fitters forget that dizzy patients, monocular patients, diseased eye patients are a problem no matter what.

Progressives offer  an appropriate focus for virtually every distance.  True, the advantages of this may not be apparent until someone is nearing 50, and true there may be distortions on the lens in normally unused areas...but still, there are advantages.

Agreed, that in cases such as ARMD, a high powered SV lens might provide better VA for labored reading at a fixed distance, but a VFL might still be a good lens for general use.  Look at it this way, someone with reduced acuity is less likely to notice distortion outside the channel, and can make very good use of the progressive for normal activities.

I just don't buy most of the excuses given not to fit a VFL...cost issues aside.

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## Uilleann

Blind people.

:D:D:D:cheers::cheers::cheers:

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## lind2020

When did it become an Opticians duty to choose the lens for a patient? Am I wrong in thinking we're obligated to educate and support the patients choice for their lifestyle? 

Progressives, like everything, are not perfect for every patient. Make sure you do your work and they ought to be happy.

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## Uilleann

> When did it become an Opticians duty to choose the lens for a patient? ...


Really?  Did you _really_ just say that???   :Confused:

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## Uncle Fester

> Why not children?


We have a couple of Pediatric MD's who insist on bisecting the pupil with a FT. I believe it is to force the kids eye into the reading area because of a muscle imbalance but to me it's a moot point as I always follow a Doc's specified lens type.

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## OCP

> When did it become an Opticians duty to choose the lens for a patient? Am I wrong in thinking we're obligated to educate and support the patients choice for their lifestyle? 
> 
> Progressives, like everything, are not perfect for every patient. Make sure you do your work and they ought to be happy.


In Europe opticians choose the lens for the client. We don´t need an eye doctor to do this (what we see as a) simple job. :p

May opticians in US never choose the lens for an patient, or should the eye doctor do that every time?

Mike

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## Robert Martellaro

> When did it become an Opticians duty to choose the lens for a patient?


Facetiousness?




> I have encountered all the above patients and after some education on progressive lenses, they still insist on getting a PAL. In situations like this, you just have to give them what they want.
> 
> however, optiboarders should be ethical enough to tell them what suits them best rather recommend something based on higher fees and commisions.


That just about sums it up in my book.




> A -1.25 44 year old office worker


That's almost like making gravy. 

Try an emmetropic emerging presbyope/avid reader who as been wearing OTCs!

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## fjpod

> We have a couple of Pediatric MD's who insist on bisecting the pupil with a FT. I believe it is to force the kids eye into the reading area because of a muscle imbalance but to me it's a moot point as I always follow a Doc's specified lens type.


 We used to do the same thing...when FTs were more commmon, and we still do some.  But today, we just make sure the childs glasses are not slipping down the nose.  The child gets the plus, and the parent doesn't have to look at the lines.  It also depends on the reason why the child is getting bifocals.

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## lind2020

Choosing ..

You're anti-progressive and the majority of your patients wear flat-top multi-focals, very successfully in you ropinion.

You're pro-progressive and the majority of you patients wear progressives, very successfully in your opinion.

One person is lying to themselves.

So yes, I did say:

When did it become the Opticians duty to decide what a patient can or can't try. I don't "choose" my patients lenses, I educate them and they get the best product we can offer them.

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## Uncle Fester

> When did it become the Opticians duty to decide what a patient can or can't try. I don't "choose" my patients lenses, I educate them and they get the best product we can offer them.


When the lens type is specified on the rx I feel it must be filled as written. That doesn't mean I can't call the doc and see if an exception can be made as I would if say a Comfort 360 was specified and I wanted to use an Autograph 2. Or I can interpet an add to make a pair of glasses for the computer (again only if the Doc hasn't specified.)

Reminds me of the time an MD wrote on the rx Polycarbonate only and the optician at a local major chain changed it to CR-39. When the kid incurred a major eye injury guess who was a witness for the prosecution. (Think it was settled out of court.) The MD sent a letter to all the local places they recommended and asked if we thought it OK to change what was written on a script.

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## D.J. Roff, ABOM

About the only people I recommend not getting a progressive are folks with some kind of motion-sickness or vertigo issue (a real medical concern that the "swimming" effect could exacerbate).  That being said, I once tried taking a man who'd had a brain tumor removed (with all the disorientation and cognitive impairment you might expect) out of his progressive and back to a flat-top, and he couldn't do it... wanted his progressives back.  So I guess acclimation trumps logic, sometimes.

The other cases would be multiple previous non-adapts.  I'm not one to give up in the face of a challenge, but occasionally you just have to tell them it's probably not going to work, if it hasn't the previous two times.

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## Uilleann

> You're anti-progressive and the majority of your patients wear flat-top multi-focals, very successfully in you ropinion.
> 
> You're pro-progressive and the majority of you patients wear progressives, very successfully in your opinion.
> 
> One person is lying to themselves.
> 
> So yes, I did say:
> 
> When did it become the Opticians duty to decide what a patient can or can't try. I don't "choose" my patients lenses, I educate them and they get the best product we can offer them.


Actually - you DID in fact say:




> When did it become an Opticians duty to choose the lens for a patient?...


Not what they can or can't try.  Certainly they can "try" whatever they like - though in all my years dispensing lenses, I've never once had a patient ever ask me to "try" a lens just because they wanted to experience a line, or reduced availability of materials etc.  what I have found consistently (and I believe this applies to just about...oh, umm, I dunno EVERYbody else out there dispensing - doubly so to the majority who post here) is that the patients they see are savvy, and come to them to give them the best quality vision.  And much more often than not, that is likely to be a progressive design for a presbyopic patient.

So - unless you have weeks to take the time to properly explain the differences in modern PAL design, material properties, complex lifestyle considerations, and how all that relates in an optical manner to a PAL, or an office, or a FT or a SV of any flavor, and then demonstrate each of the millions of possible combinations in a real world setting...I would suggest that YOU as the dispenser take the initiative and choose that lens FOR your patients.  You have (or most certainly _should_ have) the knowledge and the skill set to do this effectively, safely, and usually rather quickly in almost every case.

There is no lying to anyone there - Just using the skill set that you have to fill the Rx.  Patients trust you to know what will work best for them, and to explain the how and why of a given lens choice.  Unless they're a recently retired dispenser themselves - they probably aren't going to know what it really is that sets a given lens design apart from another.  That should be our job.  Best!  :cheers::cheers::cheers:

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## beagleman

> I would disagree... I believe quality of life is greatly improved with Progressive lenses.
> 
> I put a 96 year old woman in her first progressives a few years ago... and she was really mad... not at me... but at all the Opticians over the previous 20 years who never even told her about progressive lenses. She said it gave her a new lease on life and she could see better and more naturally than she had in years. Hobbies were more pleasant, everything in her life better, and she loved how they looked on her. She was very very happy with progressives...
> 
> 5) low power latent presbyopes who still have good visual acuity w/o glasses and are not motivated to wear glasses yet.


Thank you, thank you, thank you for your two comments above.  First of all, what is there to lose to have a lined multifocal wearer try a PAL?  If you explain the change in detail and they seem interested in a potentially higher quality of life, then why the heck not try it?!?!?  I think the biggest risk is in NOT trying it.  And then from your previous post, point #5 is also one of my big concerns, the emmetrope who now needs reading correction.  We don't want to dispense a very expensive pair of glasses (with PALs) for somebody who needs help reading, but not in seeing distance.  The patient learns that s/he just paid a bunch of money for "readers" that work horribly....setting up the wrong expectation for the patient.  Only if they insist, "I know I don't need the help with distance, but I don't want readers with the constant taking on and off...I want to keep glasses on"...for those who are OK with becoming full time wearers.  I set up my patients for an expectation that PALs are best thought of as distance glasses that also allow clear vision at closer focal points.  It's unfortunate when they are told PALs are for VDT and near...wow, that's a set up for the wrong expectation!

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## lind2020

O.k. Uilleann, my opinion, methods of sales and general optical knowledge is inferior. I will retract my statement and desist in posting my opinions.

Before I go, I would like to share my humor over the statement you made:

**quote* *
Not what they can or can't try. Certainly they can "try" whatever they like - though in all my years dispensing lenses, *I've never once had a patient ever ask me to "try" a lens just because they wanted to experience a line*, or reduced availability of materials etc. what I have found consistently (and I believe this applies to just about...oh, umm, I dunno EVERYbody else out there dispensing - *doubly so to the majority who post here*) is that the patients they see are savvy, and come to them to give them the best quality vision. And much more often than not, that is likely to be a progressive design for a presbyopic patient. **

In essence because I am a proponent of progressives, but FAR more because it's hilarious that you think your patients are any different or more "savvy" because you post on optiboard then anybody elses.

Again, the funny part is that we probably agree yet you are so caught up in your Optiboard ego, or whatever it is that causes you to attack any opinions professed here,  that you fail to see that. 

Look up the definition of a forum sometime...

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## Uilleann

> O.k. Uilleann, my opinion, methods of sales and general optical knowledge is inferior. I will retract my statement and desist in posting my opinions.
> 
> Before I go, I would like to share my humor over the statement you made:
> 
> **quote* *
> Not what they can or can't try. Certainly they can "try" whatever they like - though in all my years dispensing lenses, *I've never once had a patient ever ask me to "try" a lens just because they wanted to experience a line*, or reduced availability of materials etc. what I have found consistently (and I believe this applies to just about...oh, umm, I dunno EVERYbody else out there dispensing - *doubly so to the majority who post here*) is that the patients they see are savvy, and come to them to give them the best quality vision. And much more often than not, that is likely to be a progressive design for a presbyopic patient. **
> 
> In essence because I am a proponent of progressives, but FAR more because it's hilarious that you think your patients are any different or more "savvy" because you post on optiboard then anybody elses.
> 
> ...


Hehe - clearly there's been a mis-communication on my part - and for that I humbly apologize.  :shiner:  

If you read my statement - it was not about *me* in any way.  But rather the patient base that *we* as a profession are now dealing with.  The ARE in fact very savvy, more knowledgeable (sadly sometimes misinformed however) and can sometimes throw each of us for a surprise loop if we assume or take for granted they know nothing about the lens, or quality of vision they seek.

I waste far too much time on these boards, you're absolutely right!  It's a good thing I only lurked for years here before I started posting anything!  That would truly show how much time I've spent here.   :Cool:   There's a lot of beer to be drunk, and I need to get to it!  :cheers:  In the mean time, again, sorry for the confusion, all the very best of luck in your ongoing progressive dispensing, and I do hope that your patients are coming to you for your expertise, knowledge and skill in choosing the very best lens for them and their visual needs!  (Pints on me if ever you're out this way!) 

Bri~
:cheers::cheers::cheers:

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## EyeGurl

Me and the doc. exchange looks all the time.  She will rec a PAL for a plano emerging presbyope.  ERRRRGGGGG!  I want them in an office lens or reading glasses only.  I hate in when they feel ripped off when they look through their pea sized reading area.  What can you do?  She signs the checks and wants to have the pal sale?  Now on another note, I put a patient in the Hoyalux ID in 1.70 or 1.74, he was a high myope and when he put them on he was like I don't like this everything is in 3D.  I was like, well you are now seeing the world how you everyone else sees it.  He was so happy after a couple days!  We always start out with at least a lifestyle or higher with new patients and I always try to get them into freeform.  People with slight motion sickness or other pal probs in the past love it!  We do not even offer cheap lenses, so we hardly have any probs, usually just buyers remorse is underneath there complaint.

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## Happylady

> Me and the doc. exchange looks all the time.  She will rec a PAL for a plano emerging presbyope.  ERRRRGGGGG!  I want them in an office lens or reading glasses only.


If you put them in an office or reading lens then you are taking away their distance area when they are wearing glasses. If an plano emerging presbyope is going to adjust to ever wearing progressives then the best time is to start them off in them right away.

I put my plano emerging presbyope husband in a progressive at age 43.

Do you wear progressives?

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## SailorEd

> If you put them in an office or reading lens then you are taking away their distance area when they are wearing glasses. If an plano emerging presbyope is going to adjust to ever wearing progressives then the best time is to start them off in them right away.
> 
> I put my plano emerging presbyope husband in a progressive at age 43.
> 
> Do you wear progressives?


I totally agree with you.  We do it all the time.  With office lenses or readers they take them off and put them on and take them off and put them on and ditto, ditto, and ditto.  

Those that get those eventually will come back in and get progressives anyway.  They can put them on and leave them on while driving, reading and whatever they are doing.  It's a GOOD idea.

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## Uilleann

An emerging pres. pt. should be the *perfect* PAL candidate almost every time in my own estimation.  The low adds (+0.75 - +1.25 usually) offer the absolute widest reading and intermediate zones when compared against higher adds of say +2.25 and up later in life.  Particularly in lower overall Rx's, non-adapt issues should be virtually a non-issue with a properly fit lens coupled with proper patient education and realistic expectations of lens performance.

Shouldn't be hard to do with any number of lenses available today - digitally surfaced or not.  I would side with the doc in this case.  Best to you both though, of course!  :cheers::cheers::cheers:

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## Happylady

Plus, if they don't want a distance area they really don't need an office type lens yet because with a low add they should be able to see the computer distance and the reading distance with the same correction. So all they would need would be a reading only correction. Which they can buy at the drugstore. So they don't need your glasses.  :Eek: 

If someone really does want just reading glasses make sure he/she understands the glasses will blur the distance. People getting their first reading correction usually don't realize this.

So listen to your doctor/boss, she isn't wrong. For some people just reading is fine but for many people progressives will serve them better, especially if you think long term.

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## Uilleann

Years before I was a dispenser, I was working at our local planetarium.  I was in my early/mid twenties at the time.  I was having a difficult time seeing the darkened monitors in the star theater during star/laser shows.  I had a great knowledge of astronomical optics and applications back then, but didn't know about ophthalmic optics yet.  And for the life of me, I couldn't figure out why my new *expensive* glasses (reading/computer SV) worked so very well for the computers, but blurred horribly when I'd look up at the dome.  Ideally, I could have used a low add progressive design even then for my occupation.

Presently, I've just had a new set of glasses made up with Essilor's Anti-Fatigue lens, which gives a +0.60 diopter bump over my light myopic correction towards the bottom of the lens.  I've only had them about a week, but I can say that I feel more comfortable reading without looking under my lenses.  There is _zero_ swim or distortion in the lens, and it's a nice to have that tiny bit of plus there for all the near stuff I'm used to seeing without glasses.  And no - I'm not *quite* ready to admit defeat and jump into a progressive for the time being.  Give me another five-ten years for that.  :p  But when I reach my mid forties, I will certainly be reaching for a nice, low add progressive as I 'emerge' myself into the joys of presbyopia.  

:cheers::cheers::cheers:

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## D.J. Roff, ABOM

> I totally agree with you. We do it all the time. With office lenses or readers they take them off and put them on and take them off and put them on and ditto, ditto, and ditto. 
> 
> Those that get those eventually will come back in and get progressives anyway. They can put them on and leave them on while driving, reading and whatever they are doing. It's a GOOD idea.


BUT... it doesn't always work.  

I talk to my patients about this all the time, stressing the lifestyle-enhancing aspects of NOT having to take glasses off all the time, NOT having to hunt for a pair of readers, etc.  Yes, it's a good idea.  But if I'm going to have a non-adapt, 99% of the time, this is where it's going to happen.  I think that's what EyeGurl was trying to say.  It doesn't mean we shouldn't try, it just means we have to do a lot of education with those patients... and be prepared for some hand-holding.

Best solution for these folks is multiple pairs, like a progressive for everyday and an Office lens for work... but that's a tough sell, if someone has worn NO glasses for 43 years.  Again, worth trying, just be a realist.

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## SailorEd

> It doesn't mean we shouldn't try, it just means we have to do a lot of education with those patients... and be prepared for some hand-holding.
> 
> Best solution for these folks is multiple pairs, like a progressive for everyday and an Office lens for work... but that's a tough sell, if someone has worn NO glasses for 43 years. Again, worth trying, just be a realist.


And there it is ... the "golden rule" in opticianry (and most other things).  EDUCATION!  We have to educate.  Our patients don't really know what's out there.  They have no idea what a Near Variable Focus lens is.  We have to tell them.  I have a pair of (something or other) Peepers.  What they are is a double small B measurement rectangle that a person slides behind their glasses.  The power in the rectangles is plus 1.12.  Those wearing lined bifocals or progressives put them on and look straight ahead at an object that I am holding about "screen length" away and are amazed that they can look "straight on" without having to raise their head to bring the screen into focus.  That's the way I demonstrate office lenses.  Even if they don't buy right then, I've put it in their minds and many, many times, they've come back after a few months and bought a pair.  I sold a lady a pair that worked down at our courthouse.  Within two weeks 4 of her co-workers came in to get them (none of them current patients).  Word spreads quickly.  Two of them want to Wally World and asked for them and they didn't know what they were talking about.  

Yes, first educate the patient what is out there and then allow the patient to make an INFORMED decision.  Education is the key.

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