# Optical Forums > General Optics and Eyecare Discussion Forum >  Progressive lens fitting heights ? ? ?

## skirk1975

I have some questions here.  First, it has been my ecperience that SO MANY people come in wearing progressives and when I mark them to check the height they are currently wearing they are SO HIGH!  No way the fitting cross would be on pupil.  They are several millimeters high. What is going on?  When you get on eye level with someone, there is really only one way to fit it. Within a millimeter or two.  Are these people always looking down at the patient?

Also,  there are some who as soon as the patient seems to have any difficulty reading, the automatically say we have to raise the seg height and jack it up a few millimeters?  What is this about.  If that is fit proper on center pupil, than maybe it is the RX? ? ?

What are your experieces with fitting heights.  I am just curious.
:hammer:

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## Agnitio

Heights are a mistake a dispenser must take utmost care to measure correctly when measuring.

I am quite often called upon to check progressive heights another dispenser has measured. It is to my amazment that these can be out by up to 2mm with the other dispenser for the simple fact that they haven't adjusted their chair to be at eye level (all patients sit in a standard flat back chair and the dispenser has an office chair with which they can adjust the height)

When i say 19 and they go "19?....I got 21?!?!?!" i just grimmice. I ask them to sit down and take the heights again looking over their shoulder to see what angle they are viewing from.

Some like to mark up the lens with a sharpie. I strongly disagree with this. Why have another person check your heights if you are makring them with a magic marker?

I think they should either use a device to check the heights such as the frame mountable one we have by essilor or use a pen light and a ruler. Marking up a lens with texter, only to have that number not agreed with by another dispenser does not instill great confidnance in the consumer.

I know that there is a margin for error with progressives through manipulation of the nose pads but i have no qualms about measuring a height 3 times to be sure that the patients posture is at its most natural therefore resulting a more accurate reading.

I think that when all the above and I'm sure there are other things i haven't mentioned are concerned...the fault lies in the hand of optom, and an incorrect add. Perhaps due to cataracts but more than likely due to being rushed and not being able to fit the patient with trial lenses

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## For-Life

You just found the number one reason for non-adapt.  Fitter error.

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## Johns

> You just found the number one reason for non-adapt. Fitter error.


 
When I started to think of all the other reasons for non-adapt that weren't fitter error, they still all came back around to...fitter error!

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## Robert Martellaro

The PALs that I see are usually too low, about 2mm on average, but sometimes by as much as 5mm to 7mm. When I see them too high it's usually because the pads were never adjusted properly, forcing the lenses to sit up and out.




> Also, there are some who as soon as the patient seems to have any difficulty reading, the automatically say we have to raise the seg height and jack it up a few millimeters? What is this about. If that is fit proper on center pupil, than maybe it is the RX? ? ?


Or the corridor length. 

I'm still seeing Rxs with two add powers- the manifest add and then an add "if PAL", usually an extra +.25.  

Regards,

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## EVEC

It is necessary to check multiple measurements...seated, seated as if driving their car, and standing. A small dot bi-secting the pupil is best( I like the new white ink pens to see it in front of pupil). How they sit in the car and how their chin is when standing will effect the distance portion the most. Some people have found that a tall patient will change the progressive ht. as well, because they are usually looking downwards at the world below.

 :Wink:

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## Judy Canty

It's not only knowing where to place that dot we love so much, but also knowing how to properly measure the actual height...not straight down from that dot but to the deepest part of the eyewire.

Nah...we don't need no education....that's what redos are for...

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## harry888

When they look at someone across the desk, patient has a tendency to push chin out.  Thus too low.

Harry

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## Pogu

I was helping troubleshoot a pt's specs from another optical recently, I was glad I didn't blurt out that they were fit atrociously high as they turned out to be Seiko's (zero drop) marked up on a generic (four drop) layout chart!

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## PhillyEyes

Without looking at any real data or statistics, I would say a large amount, probably over 40% of non-adapts and redos are human error (wrong heights, off axis lenses). And a good portion of the rest of the non-adapts because of cheap, union type PAL's that have so much distorion its almost comical. I see it all day long, patient comes in, hates his PAL's and wants something new. As much as you try to explain that they were made too high, or not edged straight, or the brand of lens they were given is HORRIBLE, they have their mind set they will not try a PAL again. 

Because of the previous retailers incompetent staff that couldn't take proper measurments, or the lab tech that passed a PAL not being on the 180 line, or the fact that they were put into the cheapest stock PAL available, this patient does not want to try another PAL, it left a bad taste in their mouth, and now I have to go above and beyond to explain to them if made properly, for what they do, a good-quality PAL would be the best lens available, and they will indeed adapt to this lens.

Ohhh mannn, only if these mega-big lens manufacturers knew that more than half of their non-adapts were human error maybe they would invest in some sort of an idiot-proof device that any "clerk" can use to take an accurate height.  :Rolleyes:  (maybe they would sell alot more)

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## AngeHamm

In our practice, we find that nearly 100% of progressive non-adapts are of the "patient decides not to adapt" variety.

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## PhillyEyes

> In our practice, we find that nearly 100% of progressive non-adapts are of the "patient decides not to adapt" variety.


+1 ... same goes for me

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## pseudonym

If someone has trouble adapting to our budget no-line bifocal, it's my own fault for selling it to them in the first place.  When it goes on sale, I do a real tap dance to avoid letting them buy it. I tell them it has a very narrow reading area, that only people with a +1.50 or lower ADD power like it, and I say this while pointing to the +2.50  on their own Rx.  I tell them that the higher their ADD power the narrower the area of clear reading zone will be in the budget lens.

 While they are still busy being disappointed about the budget lens, I tell them the very reasonable upgrade price on the very best Carl Zeiss lens with a WIDE reading area and they say YEAH, GIMMEE THE ZEISS! 

If I can't make that happen, I remind them that the standard FT-28 is also free with that sale. If they say they don't like lines, I ask them if they've noticed that I'm wearing a lined bifocal. Usually they can't even tell. 

 To date, I have not sold the budget progressive. It's my personal mission to never sell it. I even printed up the distortion grid from thelensguru in case some engineer insists on buying it.

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## PhillyEyes

lol, when that engineer tries out-talking you on that budget lens you will put him in his place with those lens maps!

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## harry a saake

best way to check if your measurement is right is to use Saake,s rule of 35

you will find if measured correctly, 99 per cent of the time that progressive will be 3 to 5 mm above the center line, and conversely lines will be 3 to 5 below, try it and see if it does not work for you

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## Barry Santini

> best way to check if your measurement is right is to use Saake,s rule of 35
> 
> you will find if measured correctly, 99 per cent of the time that progressive will be 3 to 5 mm above the center line, and conversely lines will be 3 to 5 below, try it and see if it does not work for you


This is exactly what online sites use to interpolate e height measurement they don't get supplied. frames Direct as much as said so.

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## Golfnorth

If I can't make that happen, I remind them that the standard FT-28 is also free with that sale. If they say they don't like lines, I ask them if they've noticed that I'm wearing a lined bifocal. Usually they can't even tell. [/QUOTE]

Why even sell progressives at all to your customers? You are wearing a lined bifocal and surely you are wearing the best lens on the market!

Regards,
Golfnorth

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## pseudonym

> Why even sell progressives at all to your customers? You are wearing a lined bifocal and surely you are wearing the best lens on the market!
> 
> Regards,
> Golfnorth


I cheat. There's no A/R on the bifocal. With the store lights bouncing around, the line is less noticable. OK I know this, but I also know that most people with over +2.00 ADD are making themselves miserable trying to see their computer with their progressive. 

Progressives are a compromise between vanity and vision. If I can get them to buy the SolaOne with A/R for driving and a bifocal with computer power in distance/ reading power in the segment for office work, they love them.

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## Judy Canty

Hmm.  I have never had a problem using my laptop or desktop with my PAL.  I'm currently wearing a SightStar365, but also have a Surmount in my current rx which has a +2.50 add.  

I think that if you let your patients know they're going to be unhappy, they probably will be. Fortunately, my Optician (me) never told me to expect a problem.

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## anthonyf1509

[QUOTE=I think that if you let your patients know they're going to be unhappy, they probably will be. Fortunately, my Optician (me) never told me to expect a problem.[/QUOTE]

+1!

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## PhillyEyes

> I cheat. There's no A/R on the bifocal. With the store lights bouncing around, the line is less noticable. OK I know this, but I also know that most people with over +2.00 ADD are making themselves miserable trying to see their computer with their progressive. 
> 
> Progressives are a compromise between vanity and vision. If I can get them to buy the SolaOne with A/R for driving and a bifocal with computer power in distance/ reading power in the segment for office work, they love them.


I agree somewhat...even with higher adds, its more in the mind, I sell them a digital PAL and say you cant sit at the computer for 6 hours, but for general work the PAL will be fine, give it a shot and if you feel its not good enough for the computer you need to get a seperate pair of computer specs

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## pseudonym

> I think that if you let your patients know they're going to be unhappy, they probably will be. Fortunately, my Optician (me) never told me to expect a problem.


I don't tell them, they tell me. Many people say they struggle to see the screen with their old progressives. These are not occasional computer users, but people who are in front of the screen for hours a day. I love to hear someone say they're on the internet rarely because I can sell them a compact fit progressive in the 25 B measurement fashionable frame they like and they won't miss the intermediate zone they aren't getting. 

No one has complained about the Ft-28 with computer Rx in distance and reading in segment. Many have come back to tell me how much more comfortable they are at work.  It's a good second pair. 

I might try selling a progressive with computer Rx in distance and reading in near, but it would be more expensive. People want their second pair to be the cheapie. Is that how you do it or do you depend on the intermediate zone being adequate in the standard Rx?

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## sharpstick777

> In our practice, we find that nearly 100% of progressive non-adapts are of the "patient decides not to adapt" variety.


This can be overcome and even almost eliminated by a thorough explaination at dispense of what patients will experience.  My Progressive non-adpat rate was less than .5% which was almost as low as my SV non-adapt rate at .3% .

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## Robert Martellaro

> I might try selling a progressive with computer Rx in distance and reading in near, but it would be more expensive. People want their second pair to be the cheapie. Is that how you do it or do you depend on the intermediate zone being adequate in the standard Rx?


I tried that at first, but too many folks came back complaining about the line (disturbing/aggravating). Nowadays I use a PAL for the computer eyeglasses if the client's general purpose eyeglassses are PALs.

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## imann

Hello everyone!! This my first post ever. Im hoping you all can help me out. 

S= Patient sees better with old glasses. (PAL) 5 year old pair of glasses! Last pair.
O= I checked the old and new glasses to look for any differences in measurements besides the Rx change which was very minimum.  
A= I found two different fitting heights on the old glasses. One was on center with the pupil and the other was 3mm higher. The new glasses where made    on center OU with the pupil, which caused the patient not to see better because see was used to the wrong fitting height. This produced the wrong            power throughout the PAL corridor.
P= Im making the new glasses with the same base curve and i will fit the patient with only half of the incorrect fitting height, which is 1.5mm up instead. 

Any ideas??

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## Uncle Fester

Don't fix what was not broken (to the patient).

At this point I'd put them back into the same design and height even if you think it's too low (see post below as to why)- unless you are willing to remake them a third time.

fwiw- About one in six need two different heights.

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## waynegilpin

> Don't fix what was not broken.


Halleluiah!!!!!!!!!!!!!
X2
+1
Yup.  What he said.
Should be tattooed on the back of every opticians hand.

Uncle Fester, can I buy you a drink?

Don't introduce so many variables so that, if there is a problem, you can't figure out which one of your "bright ideas" caused the problem.

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## Uncle Fester

Sure! Maybe some of this "sipp'n liquor"?


https://vsliquor.com/products/remy-m...SABEgKCwfD_BwE

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## waynegilpin

> Sure! Maybe some of this "sipp'n liquor"?
> 
> 
> https://vsliquor.com/products/remy-m...SABEgKCwfD_BwE


$3,500?  No problem.   Picked up a bottle and shipped it out to the "position without dimension".  It took the post office a while to look up that zip code.   Hopefully you'll get it by the time Luzerne Optical gets my wife's frame that I mailed a week ago.  Merry Christmas Fester.

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## Quince

I'm having a hard time with this. 

Is the doctor the same as the one who wrote the rx 5 years ago?
Did the current doc look at the old glasses before prescribing?

I feel like these things matter in leaving things be. My instinct is shift things in the right direction gradually, which it sounds like you are doing. The thing is, if they keep getting made off, then every new pair they get will result in the same issues if left alone. The prescribed strengths will never be matched and if they go anywhere else, well that just doesn't look good when they walk in with your matched heights in a newer set.

I know a lot of practices wouldn't care about the after, but that is a decision you need to make.



Another thing I'm finding hard to swallow- there is no listing of how long that bottle has been aged? On the other hand, I'm sure that golden amber nectar goes down quite smoothly.

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## Kwill212

> Don't fix what was not broken (to the patient).
> 
> Leave them in the same design and height even if you think it's too low- unless you are willing to remake them a third time.
> 
> fwiw- About one in six need two different heights.





> Halleluiah!!!!!!!!!!!!!
> X2
> +1
> Yup.  What he said.
> Should be tattooed on the back of every opticians hand.
> 
> Uncle Fester, can I buy you a drink?
> 
> Don't introduce so many variables so that, if there is a problem, you can't figure out which one of your "bright ideas" caused the problem.


And on the other hand you can get a tattoo that says "your glasses won't be any better than your last pair because I'm afraid I might have to do some troubleshooting and actual optical work"

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## waynegilpin

> And on the other hand you can get a tattoo that says "your glasses won't be any better than your last pair because I'm afraid I might have to do some troubleshooting and actual optical work"


Wow.  And you have a nice day also.

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## drk

I'm a "breaker", too.

I call it "hubris", but that's my M.O.

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## Uncle Fester

My replies are to post #25 
" I checked the old and new glasses to look for any differences in measurements besides the Rx change which was very minimum. "

You got to know when to hold'em and when to fold'em.

I'm guessing drk, that you have no problem with the optician giving the bill for a third redo, to the office manager and when complaints continue (followed by they want their money back) you do- because that .25 cylinder change didn't create the great improvement in vision the patient was expecting.

Or better still when the add goes up to a +2.75 from a +2.50. We see this a lot from MD's when the patient complains the reading needs to be sharper but the doctor neglected to tell them they will now have to hold the reading material closer.

Anyone else in the trenches remember complaints when switching the same rx from an original Comfort to the new and improved Comfort DRX*? IN THE SAME FRAME!!!

*Or fill in the latest generation progressive's improvement here_______.

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## drk

_"Oh Ruby, don't take your love to town..."

"You picked a fine time to leave me Lucille..."_

You know, Fester, Kenny Rogers expresses the optician blues pretty well.

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## Uncle Fester

Squeezed margins from managed care have taught me that sure- I'll upgrade and adjust measurements for everyone- but won't hesitate to sound retreat when I've only got that one time n/c redo.

From Genisis:

"Just as I thought it was going alright
I find out I'm wrong, when I thought I was right
It's always the same, it's just a shame, that's all"

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## drk

"Oh no not this confused again.
Oh no, not the same mistakes again..."

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## Quince

> Squeezed margins from managed care have taught me that sure- I'll upgrade and adjust measurements for everyone- but won't hesitate to sound retreat when *I've only got that one time n/c redo*.


A better lab will cover more than one time. Totally understandable reason, given that most of us don't get to choose the labs, but if so, why not encourage a change to a lab that won't hold you to just one? Why not unlimited? 

*cough Cherry Optical cough*

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## mervinek

> A better lab will cover more than one time. Totally understandable reason, given that most of us don't get to choose the labs, but if so, why not encourage a change to a lab that won't hold you to just one? Why not unlimited? 
> 
> *cough Cherry Optical cough*


On the flip side, why should the lab the eat costs when so often they deal with opticians who have no clue what they are doing?  My lab works with me.  If you are a decent practice and have the occasional odd situation, yes, they should help you out.  Maybe speak to a manager?  However, having worked in the lab and having seen some really stupid stuff come from some ODs and opticians, I don't feel they should have to eat it.  Just my 2 cents.

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## Quince

I should have clarified. Though they will give free redos and warranties, they do want to know why and look for solutions when there is a pattern. My comparison is based off of years of struggling to get Hoya to cover anything at all. When you find yourself lying to your lab to satisfy the patient, it's time to make the switch. I'm sure there are many other lab in the inbetween that are fair but have limitations.

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## Don Gilman

> On the flip side, why should the lab the eat costs when so often they deal with opticians who have no clue what they are doing?  My lab works with me.  If you are a decent practice and have the occasional odd situation, yes, they should help you out.  Maybe speak to a manager?  However, having worked in the lab and having seen some really stupid stuff come from some ODs and opticians, I don't feel they should have to eat it.  Just my 2 cents.


+1, sorta like wrecking your car and asking the dealer to replace it. If I were in the lab business, as I was for 30 years, I would sell insurance for jobs that my customers thought could be problems.

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## Uncle Fester

> "Oh no not this confused again.
> Oh no, not the same mistakes again..."


I never make a mistake.

In fact, I thought I made a mistake once- but I was wrong.   :Rolleyes: 


My only fault is modesty.
 :Wink:

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## Kwill212

> +1, sorta like wrecking your car and asking the dealer to replace it. *If I were in the lab business, as I was for 30 years, I would sell insurance for jobs that my customers thought could be problems*.


They already do, it's called raising the price, the "free" remakes are already factored into the labs bottom line. Labs are smart enough to know that most opticians aren't smart, and most doctors are cranking out as many refractions as possible in a day, if they are even doing the refractions  instead of passing if off to a "technician". Labs have raised prices to cover remakes. If you get a good lab and you have a practice with a low remake rate, you can easily negotiate lower prices.

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## Barry Santini

As if the 15-17% overall remake is actually manageable or avoidable within today’s optical landscape.

Respectfully, I see this as naive.

B

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## Kwill212

> As if the 15-17% overall remake is actually manageable or avoidable within today’s optical landscape.
> 
> Respectfully, I see this as naive.
> 
> B


Feel free to continue to be naive Barry. But when my remake rate is far, far lower than 15-17% it's just reality for me.

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## Barry Santini

Yes, Certainly YMMV.

B

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## Jason H

This is an awful thread.

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## Judy Canty

> This is an awful thread.


And an old one at that!

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