# Optical Forums > Progressive Lens Discussion Forum >  First time progressive problem with +2.50 add

## Happylady

I had a patient come in Wednesday that had picked up his glasses the day before. I did not sell them to him. He is a low myope with some cylinder and a +2.50 add. He has been removing his glasses for near but that is not working as well anymore.

His first complaint is that he need to hold his head down while looking at the distance. I lowered them a little but he tends to hold his head up.

Second complaint is the blurry side vision. He was kind of nasty about this.

Third complaint is the narrow channel. He says he needs to turn his head to see the entire computer screen.

He seems very inflexible and not very willing to give them a chance. I talked about the options and told him to come back in two weeks.

I was wondering if changing to a different progressive would be a good idea. He was fit with the Kodak Precise. I have never used the Difinity but I have read good things about it here.

The negatives to it are it seems to have a smaller reading area and the length of time to get it.

I need some imput here!

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## chip anderson

What did you expect putting a first time presbyope in a 2.50 add, feathers.

The stronger the add the more narrow the channel, that's why every one wants to put early (+1.25's) into progressives, to "educate them to progressive limitations that become more limiting with add increase.

Good dispensers check the pupillary spot with the patient standing up in a relaxed non-propped up stance before ever ordering progressives.  A lot of them hold thier head up, some hold it down.

Chip:finger:

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## hcjilson

That having been said, Definity would be a viable alternative.....if he's prepared to wait.

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## For-Life

Sounds like the channel may be a little high so he is turning his head down to reach the higher distance, and at the same time catching the channel.

What is the fitting height?

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## Happylady

I remarked the lenses and put stickers on. The fitting height was correct, he just wants to be able to raise his chin and see the distance. I lowered it about 2 mm by adjusting the nosepads and he said it was a little better, he is just used to a single vision lens.

I did explain to him that the stronger the add the less clear the peripheral area. I drew him a picture of how progressives work and told him after awhile most people don't notice the blur. I told him to wear them as much as possible but to wear his old glasses for driving if he perfered.

How much better would the Definity be and how long does it take to get it?

I think he is going to be difficult.

Remember, I didn't sell them to him, another optician where I work did.

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## Chris Ryser

> *He has been removing his glasses for near but that is not working as well anymore.*
> 
> *Second complaint is the blurry side vision. He was kind of nasty about this.*
> 
> *I need some imput here!*


1) You should have known that a +2.50 add on a progressive is a No.........No...........NO for a fist time user. If you start them at a low addition they will be used to it when reaching higher addition stages.

2) *At a +2.50 add progressive lenses are at their worst stage in the way of lateral distortion.* *2/3rds of the lens is un-usable*. Every time you walk through a door, the door frame curves to a round bar. The lens specialist,s of the large corporations have re-named the word *distortion* to *surface astigmatism*.........sounds better but resulting in same.

3) The progressive channel at a 2.50 add becomes so narrow that the whole concept of the lens is lost when your patient wants to look at the computer screen or a spread sheet, or at a newspaper where he can only see 1 colomn in sharp letters.

*When people get older...........specially in their 60s and further on (a +2.50 add indicates about that age).........the general stage of the persons vision has been reduced compared to younger ages. If they have seen the world for that long in a way that is crisp and clear to them............they will be very disturbed when they suddenly have to face a world that is distorted to 70% of their visual field.*

It would be so nice if you opticians out in the field *would actually learn to whom NOT to sell progressive lenses*..........which are nice and dandy..........but not for everybody. 

Even if the manufacturers give you a non adapt warranty, each time you have and use it...........your reputation factor get a minus point, because out of whatever reason you sold a lens you should not have sold,  if you would have had the proper judgement.

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## hcjilson

in the post above. I think before he speaks as an authority on lens fitting, he should launch himself into the 21st Century and TRY some of the products he disparages out of hand. It would also help to be a recent practitioner with some hands on experience before touting the virtues of the FVS 35 lens. :D 




> How much better would the Definity be and how long does it take to get it?


The answer to the first question is about 30% better. A wider field and softer surface astigmatism. I have fit them sucessfully to previous progressive non adapts with a 100% adaptation rate. Over all, in the almost 2 years I have been fitting them,I have had only 2 returned as non adapts and both I chalk up to "buyer's remorse"....which, by the way, is what you may be facing in this case. Please consider this possibility as just as valid as the add being the cause of this problem.

I would also like to remind my learned friend, that as Opticians, we do not have the liberty to "start someone off with a lower power add". We are to fill the Rx as written. After all is said and done, isn't it the patient who told the Doctor that a +2.50 is what he saw best with? ( please pardon preposition) My guess is that the problem lies with the lens design and Definity will solve it.be prepared to wait for it until the kinks from the Roanoke to Dallas move are worked out.

Lastly, my learned friend is DEAD WRONG with the following statement.


> your reputation factor get a minus point, because out of whatever reason you sold a lens you should not have sold, if you would have had the proper judgement.
> __________________


Conversely, your reputation gets plus points for confronting a problem and seeking help for the solution. Bear in mind the author of the last quote comes from Montrebec and hasn't quite adapted to the warm Florida Sunshine yet. To my knowledge he is no longer actively practicing as an Optician and as a consequence is unaware of some of the recent development in this field.We've been trying, unsucessfully, to get him to attend Vision Expo's but he doesn't value them very highly.

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## QDO1

what about the patient (child for example) who has had IOL'sI have sucsessfully fit quite younger patients a few like this, with Progressives

Its not that great a technical problem, and they sure appreciate the cosmesis, and the fact they have intermediate vision.  I admit often I make suplemental pairs for specific tasks too, but with such patients you have do something, and whatever pair of spectacles you make is a comprimise.  The art of the profession is making sure the comprimises are the best ones

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## Happylady

Chris, I KNOW that it isn't a good idea to get a first progressive with a +2.50 add. I know this. But that is what I have here. Like I said I didn't sell them to him but I am sure he wanted progressives and not a trifocal. I ALWAYS think it is better to start with a lower add, but it is too late with this man.

I have sold first progressives in the past to people with higher adds and many of them did just fine with them. Some didn't. Some of the ones I expected wouldn't like them did great. Some of the ones who I expected to like them didn't. I find it is hard to predict. 

My husband wears a +2.50 progressive and he is only 54. I put my mom in a progressive back in the late 80's(the VIP) and she loved them. She was in her 60's at the time. 

I live in the Dallas area by the way. How long is it taking to get the Definity lens?

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## C-10

I have not fitted the Kodak Precise or the Difinity and excuse my ignorance but I do not know their fitting heigh going back to For- life question WHAT IS THE FITTING HEIGH In any pal we fit will have the non useable portion on the lens ( as we all Know) the challenge here is to move that portion out view for the client if you are fitting around 20mm in that frame I would move into a short corridor lens about 17mm and then drop the height about 2mm this with lower the non usable portion of the lens giving clearer distance but bring his read up where he can use it. If you are using a 17mm go to a 15mm height. Saying all this your Client has to understand the limitation of the lenses he has lost the ability of his accommodation for close and has to live with that. (You could go into the Ipseo but you will also have to watch the fitting heights) I think if do this you will find things will work out. The second thing I would do Happlyladdy is I would make a fuss over him. Let him known that he not alone in his problem and you are going to help him along spend some times in the fitting. Some time that all some one need.

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## QDO1

> Chris, I KNOW that it isn't a good idea to get a first progressive with a +2.50 add. I know this. But that is what I have here. Like I said I didn't sell them to him but I am sure he wanted progressives and not a trifocal. I ALWAYS think it is better to start with a lower add, but it is too late with this man.


That is an excelent point.  As Opticians we have to deal with what lands in front of us.  Sometimes that means a presbyope with a 2.50 add, or as I met last year - a man who had been insitutionalised in a mental hospital 70 years ago for being blind, who following a "blanket we will test everyone in the home regime", was found to have cataracts and a -8.00 RX.  This man certainly wasnt complaining about any sort of blur when I fitted his spectacles following a cataract operation (zeiss gradal BTW)

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## drk

What hasn't been mentioned is that a good optician would recognize this potential problem in advance, and would advise the patient on what they're getting into.  Not necessarily to discourage it, because I think such things are worth a try, but in order to keep the patient's disappointment to a minimum and the dispenser's perceived expertise at a maximum.  It's difficult, after the fact, to gain back that trust.

If it were me, I would not go Definity, now.  I would remake to a segmented multifocal, and tell him there is a new lens around the corner for next time, and try to start from square one, again.

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## llal98@aol.com

I just wanted to add my 2 cents - that Definity is the first progressive that I feel comfortable wearing outdoors, walking around, crossing the street, driving, whatever. My previous ones (Panamic, Kodak, Adaptor) were fine for at home or teaching, but I was always more aware of the peripheral blur outside. My frst pair were a +1.75 add and now I wear a +2.50 and, by the way, I'm only 47! (Runs in the family - my Mom is 72 and has a 3.75 add).

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## Happylady

> I just wanted to add my 2 cents - that Definity is the first progressive that I feel comfortable wearing oudoors, walking around, crossing the street, driving, whatever. My previous ones (Panamic, Kodak, Adaptor) were fine for at home or teaching, but I was always more aware of the peripheral blur outside. My frst pair were a +1.75 add and now I wear a +2.50 and, by the way, I'm only 47! (Runs in the family - my Mom is 72 and has a 3.75 add).


How is the reading area of the lens? I understand the distance and intermediate are great but the reading is only fair. Do you find that to be a problem?

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## llal98@aol.com

The distance and intermediate are great. I can use my computer at school with no problem - it's a laptop and the height of my table works fine for me. At home, my screen is larger and I wear single vision glasses for the computer. The reading area is not terrible in the Definity, but it is somewhat smaller than in the Panamic. As a teacher, I spend lots of time hitting the books, so I have always worn single vision glasses for extended periods of reading. I was able to get inexpensive glasses for my single vision pairs, and since I only wear them at home I don't worry about having trendy or fancy frames - anything sturdy and well-fitting is fine with me.

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## rinselberg

Time out!






> Even if the manufacturers give you a non-adapt warranty, each time you use it, your reputation factor gets a minus point because out of whatever reason, you sold a lens you should not have sold, if you would have had the proper judgement.





> Conversely, your reputation gets a plus point for confronting a problem and seeking help for the solution.


We have _offsetting reputation points_. The moderator will reset the poster's reputation score to what it was before the dispute. Discussion will resume from the last post on the thread. Play optics!

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## QDO1

> Time out!
> 
> 
> 
> We have _offsetting reputation points_. The moderator will reset the poster's reputation score to what it was before the dispute. Discussion will resume from the last post on the thread. Play optics!


boy im confused

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## sharon m./ aboc

I had a similar problem with a lady in a flat top. I wasn't the original optician that fitted her but she had about 2 or 3 remakes before I delt with her. She comes in to the shop...tries on her new specs, throws her head way back and says the line is still too high. I told her she was tilting her head back and she proceeded to 
"rip me a new one." In fact now that I think about it she wasn't "a lady" at all and another innocent bystander thought she was a friend of mine and was joking with me. Ha! Anyway, what should you do with those who like to hold their noses in the air and need an add power?

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## chip anderson

Check the seg.ht. with the patient standing up in a "relaxed normal stance".  Adjust seg. ht. accordingly.

Chip

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## Chris Ryser

> *I would also like to remind my learned friend, that as Opticians, we do not have the liberty to "start someone off with a lower power add". We are to fill the Rx as written.*


Thanks for the military advice. However you must have misunderstood what I was saying.

*I am of the opinion, and probably not wrong, ........that it is not wise to start a patient on progressives when the add is +2.50.*

The best cases are to start patients on progressive lenses when the add is low, which means in military terms..................when they are still useful and able.  Nothing has to do with the RX.   

:D

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## sharon m./ aboc

I think we all agree that a 2.50 add isn't ideal for a first time PAL, but since we are opticians and not at liberty to change the add power are you suggesting 
happylady scrap the whole progressive thing and put this patient in a flat top bifocal or trifocal?

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## QDO1

the dispenser has no choice in the rx to the RX that is presented to him.  What he does have is the professional judgement as to waht to do next, with the RX presented.  In my judgement, often the awkward adaption period that a patient will have to go through with a lens choice, is worth it in the long run, be it adaption to bifs or Pals

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## sharon m./ aboc

I hope Happylady lets us know how this unfolds.  Maybe he'll get used to them....she did say he was kind of cranky about his peripheral vision(or the lack of it)  And that he was a low myope.  I think the patients that don't need much distance correction are the ones that have the hardest time adjusting to progressives there's not as much incentive to keep them on and try to get used to them.   KEEP US POSTED HAPPYLADY

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## Robert Martellaro

> His first complaint is that he need to hold his head down while looking at the distance. I lowered them a little but he tends to hold his head up.


Follow Chip's advice. Distance objects should appear clearest in a relaxed standing position. If the object looks clearer by raising or lowering the chin then the fitting cross is either too high or too low.




> Second complaint is the blurry side vision. He was kind of nasty about this.


After checking the distance vision show the client that the object will be blurred when the head is turned to the side (keeping the gaze straight ahead), and that the blur will increase the further the head is turned. Might be a good time to show the client the blur when looking one to six feet down and ahead when looking at the floor. Don't wait for the client to show you these anomalies, hold their hand and walk them through it.




> Third complaint is the narrow channel. He says he needs to turn his head to see the entire computer screen.


 That's right, these are not computer glasses. Neither would be a ST28, nor a ST7x28. 

I can't emphasize how difficult it must be to dispense a pair of glasses ordered by someone else. My only recommendation is to have the other optician read Dr. K's post for a good dose of wisdom, and then read rinselberg's post and just try to laugh half as hard as I did when I read it.

Regards

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## C-10

> I  put this patient in a flat top bifocal or trifocal?


Why would you go into a Flattopor trifocal? He will then just complain about the line. By lowering the channel you will give better distance vision and put them into a shorter channel will bring up the reading.

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## C-10

> put this patient in a flat top bifocal or trifocal?


Why would you go into a Flattop or triocal? He will then just complain about the line. By lowering the channel you will give better distance vision and put them into a shorter channel will bring up the reading.

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## chip anderson

C10  Yes he should have had ST or 7/28.   If he complained about (or does when the dispenser gives up and does this like he should have to begin with) the line you tell him: "This is what you have to have to see.  Notice how you can now see at the proper distances and move your eyes side to side.  You can see fine details that you could not see before."

Now what's wrong with that, everyone assumes (and you know about that word) that problems will occur before they happen.

Chip

And yes, you can now make almost as much money on 7/28 as you can on progressives.

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## sharon m./ aboc

C-10: "put this patient in flat top bifocal or trifocal" .....I was asking Chris if that was what he was suggesting to Happylady since she can't change the add power.  And Chip is right some patients prefer the jump of the lined bifocal to the blurred peripheral vision.   Everybody is different.  Thank God.

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## Happylady

> I hope Happylady lets us know how this unfolds. Maybe he'll get used to them....she did say he was kind of cranky about his peripheral vision(or the lack of it) And that he was a low myope. I think the patients that don't need much distance correction are the ones that have the hardest time adjusting to progressives there's not as much incentive to keep them on and try to get used to them. KEEP US POSTED HAPPYLADY


I'll let you know what happens. The optician who sold them to him had a baby a few days ago and won't be bad till the end of Febuary. He did tell me she told him it would take a couple of weeks to get used to them.

I wanted him to try them for a couple of weeks before I remade anything. If he can get used to the blur on the sides I can remake them slightly lower since he likes to hold his head up. I didn't want to do this until he tried them for awhile since I think he might not get used to the side blur and might perfer a flat top of some sort. 

 I did suggest he might need special glasses for computer. I just don't want to rush into remaking them and then have to remake them a second time.

He doesn't seem flexible. He wants glasses that work like his distance glasses did when he was in his thirties and nothing will do that.

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## QDO1

> C10 Yes he should have had ST or 7/28. If he complained about (or does when the dispenser gives up and does this like he should have to begin with) the line you tell him: "This is what you have to have to see. Notice how you can now see at the proper distances and move your eyes side to side. You can see fine details that you could not see before."
> 
> Now what's wrong with that, everyone assumes (and you know about that word) that problems will occur before they happen.
> 
> Chip
> 
> And yes, you can now make almost as much money on 7/28 as you can on progressives.


are there any circumstances you would recommend a progressive?

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## Chris Ryser

> *Why would you go into a Flattop or triocal? He will then just complain about the line. By lowering the channel you will give better distance vision and put them into a shorter channel will bring up the reading*.


The line is a visible item....................and easily to understand that when you cross the line on a FT your are crossing a visible obstacle. Psychologicalle acceptable by an intelligent person. Have to get used to it is a point that is easy to understand.

Being at the age of a 2.50 addition, means having seen clearly on a lateral plane for 55 and more years. Having to get used to 2/3 of distortion (excuse the expression, it is now called surface astigmatism) across the full lens is another matter. Like having walked on 2 legs and suddenly you are only on one without a cane.

*Using a shorter channel defies the purpose of a progressive lens.............which is supposed to have a smooth changeover from distance to reading with usable vision at any distance between the two.* 

Short channels have been developed put on the market for those little narrow frame to provide at least some reading portion.

I have a pair of progressives in a small frame that I use for social events and always get compliments that I look younger and more modern............but heck...........when I am home and in the office I prefer my Flat Top 35mm in a large frame and dont have the feeling that I am drunk after my first scotch.

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## Chris Ryser

> *are there any circumstances you would recommend a progressive?*


Anybody getting into reading additions first time is often the most ideal customer to be started on progressives. They are no problem cases and most of the time will continue to use them when its time to change glasses.

But any optician should know that they are not the universal solution for every body and every case. 

*And if you dont agree with this statement you have to be a very greedy optician who want to sell the highest priced item to everybody.*

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## C-10

I personally feel that is a cop out. Fitters run to flattops when they get into trouble fitting progressive. I dont know how many people to come in my store fitted with a flattop because no one took the time to fit them with a pal. Most pal that we fit today are aspherical in so doing that you are giving them better vision. Compared to flattops are spherical. With all the new technology in pals we have today (and seem that there isnt a month that goes by that a new pal is on the market) Flattops should not be in our vocabulary when it comes to fitting 1st time multifocal wears be a add of +1.00 to +3.50 How new are flattops on the market? It is old technology it was good but its old. When we were selling a majority of flattops, we had troubles with them now we have progressive it hasnt change. Any prostheses with not take the place of the real thing.

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## C-10

> *And if you dont agree with this statement you have to be a very greedy optician who want to sell the highest priced item to everybody.*


Greed has nothing to do with it I sell low end pals and High end pals but 85 % of my multifocals are progressive its moving with the times and flattops are old. You said how young people said you look with your pals. Be sides there is nothing wrong with getting paid for something you can do well. *Profit is not a four-letter word

*

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## chip anderson

C10  A presbyope with at 2.50 add is not a first time presbyope.  He has been a presbyope for 10+years (whether he admitted it or not) or he has had a traumatic catarac extraction.

Make yourself an ST bifocal and wear it for a week, you will find you see so much better than even you did with the best fitted best designed progressive.


And as to your question, yes I probably do 90% progressives on my presbyoptic patients.  But the other 10% are quite happy and probably see better.

Chip

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## For-Life

It still sounds that it may be to high for him.  Move it to the bottom of the pupil and it drop the channel so that he does not have to lower his head to get into the distance and then he will not catch the channel and get the distorition.

I agree with C-10 that switching to the flat top may be just a cop out when the PAL with even the same design can still be fixed.

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## Chris Ryser

> *It is old technology it was good but its old. When we were selling a majority of flattops, we had troubles with them now we have progressive it hasnt change. Any prostheses with not take the place of the real thing.*


*Statistic on multifocal lenses show that 47% are using progressives**and**53% are wearing Flat Tops* 


Now please explain why the majority is still using the so called technology and how much money you are loosing, or how much more yopu could produce, by not having these customers in your store, or by respecting them and givbe them what they want.

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## C-10

> *Statistic on multifocal lenses show that 47% are using progressives*
> 
> 
> 
> *and*
> 
> *53% are wearing Flat Tops* 
> 
> 
> ...


Maybe we are not doing our job right if 53% of our client is wearing flattops maybe we are slow to in brace the new technology. All I am saying here if we run into a problem with our Pals, the answer always is, put them into Fts Its like a having a sore finger we just remove it instead of finding the answer. If we are going by percentages why do we if up so few AR is that AR is no good I dont Think so its because we are afraid to get out there and recommend them. (Don't forget alot of that percenage are our how should I put this Older Clientele )

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## spartus

> *Statistic on multifocal lenses show that 47% are using progressives*
> 
> *and*
> 
> *53% are wearing Flat Tops* 
> 
> 
> Now please explain why the majority is still using the so called technology...


Cost.

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## Chris Ryser

> *Its like a having a sore finger we just remove it instead of finding the answer.*


I am sorry................but that is not the case.

I bet you don't like to eat tripe, brain or sweet-bread....................but if the restaurant owner insists that you order tripe, you walk out and go somewhere else were they wont try to force you to eat any tripe.

If your gas station wants to force you to drive your car on super gasoline when you want regular...................you go to another gas station where they willingly sell you what you want and need.

If your haberdasher makes you pants that are 2 inches too short, and insists that lowering the too short pants on your waist will make you look ok you will look for another supplier.

*The sore finger in this case is that you would insist that the customer get used to something he does not want to get used to............which is having to live with a distorted sight that he never had so far in his life, is not used to it and has all the intentions of not wanting to get used to.*

All the talk about latest technology does not help and calling Flat Top archaic is wrong, because they have their place in the sun for many years to come as do manual transmissions on sports and other cars. What's right for one, might NOT be right for another.

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## For-Life

> *Statistic on multifocal lenses show that 47% are using progressives*
> 
> 
> 
> *and*
> 
> *53% are wearing Flat Tops* 
> 
> 
> ...


A lot of dispensers cannot fit a PAL to save their life.  

I get a lot of people come into my practice and talk about the troubles they had with PAL's from other stores, yet I never have troubles even with Super No Line.

I think tha says it all.

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## Happylady

I think a lot of our feelings about progressives are based on our own experience with them. I notice Chris is often very down on progressives, he(or is it she?) has not been successful personally with progressives and it shows in what he says about them. 

I have progressives and I honestly don't even notice I am wearing them 95% of the time.

Chris, what progressives have you tried?

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## spartus

It's probably not so much what progressives he's tried, it's just that he's perfectly happy with a FT35. It suits his needs and does what he expects it to do. 

You can fiddle over fitting heights, progressive designs, materials, anti-reflective coats and everything else, but it really comes down to the patient's motivation. Assuming it's fit correctly, when the patient is motivated to make it work and educated to understand what the lens does (and doesn't) do, you will have very very very few nonadapts.

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## chip anderson

Don't know about Chris, but I have worn Super NoLine, Panamic, Gradal, Comfort was happy with all but I still feel I have better vision and more detail with lined bifocals, in glass no less.    

While I am also an optician, I am an ocularist and paint/vien very find details and subtle colors in prosthetic eyes.  I can do this with progressives but I think I do it better with lines, or single~vision.   And yes, I can have anything I want free.  Seems that every lecture I go to someone gives me a certifercate for the latest and greatest optical devise to try free.  

I am not saying that progressives don't have thier place, but I am saying that they are not superior (Or even equal) for many applications.

I _really_ wouldn't want my eye surgeon working on me in bifocal contacts either although I am somewhat famous for fitting same.


Chip:cheers:

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## Chris Ryser

> *I notice Chris is often very down on progressives, he(or is it she?) has not been successful personally with progressives and it shows in what he says about them*.


*Happylady, I am a him.................................in the optical environment since having worn diapers.*

I have been involved in progressives for 3 years before they came on the market in the late 50's. I did some market research jobs for the original originators of the lenses, then SL which is today Essilor.

Progressives then were the biggest novelty and newest technique in the early 1960's.

The lenses got introduced bit by bit in different geographical areas in Europe by SL giving introduction courses to opticians. This was done to make sure the opticians would NOT sell the lenses to poeple which would have to be strated out with higher additions to prvent comebacks ...like non adapts.
Opticians were taught which ones would be good cases for wearing the lenses as well as the ones that should not wear them.

In the old days when still in the retail I personally sold hundreds od progressives with one record..............I never had a comebach nor a non adapt. But there were many cases where I refused to give them a progressive out of technical reasons.

In my opinion progressives belong all into the same pot, even if the different manufacturers claim otherwise. They are all made on the same principle with microscopic differences, so you can really sell anyones make or name product.

*I am absolutely NOT anti progressives................but I hate to see all these opticians making claims on who and what is a better lens, and push these lenses onto patients that actually should wear another type lens which will give him or her technically a better vision, and that takes some learning and product knowdledge. Opticians today in general, get the facts from big corporation advertising and brainwash.*

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## Happylady

Chris, 

I have been in this business for about 25 years and I personally wear progressives. I have tried many different ones and they ARE different from each other.

I can wear anything, but I can tell that I like my Sola Ones a whole lot more then my Hoya CDs, they are very different. Sure, all progressives are the same like all vehicles are the same.

What progressives have you worn?

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## Chris Ryser

> *I think we all agree that a 2.50 add isn't ideal for a first time PAL, but since we are opticians and not at liberty to change the add power are you suggesting* 
> *happylady scrap the whole progressive thing and put this patient in a flat top bifocal or trifocal?*


I never suggested to change the add or RX...................*I said do NOT start a customer on progressive lenses that has an add of 2.50*........start them on low adds (in younger years) and you will have complications nor problems.

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## drk

If it's a decently-designed and fitted progressive, and the patient gave it a fair go, but it fails, then don't hesitate to change to a segmented!

Whether you fit a progressive or a segmented multifocal should NOT be a matter of philosophy. 
The philosophy should be that you understand the pro's and con's of each design, and fit the lens to the patient, not vice-versa.

Segmented multifocals and progressives are such different animals that I don't believe anyone can legitimately proclaim "we do progressives" or "we do segmented multifocals" as a preference.

While they both serve a common need, it's like an tomato and an orange. Both fill you up, but some people need lycopene and some need vitamin C. Some people are allergic to tomatoes. Some people don't like the taste of an orange. (Inane analogy.)

The lenses are as different as night and day, and both have their distinct roles. Don't be fooled by their overlapping utilities.

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## Happylady

Chris, I am guessing he waited to go into progressives because he could read without glasses. You can tell someone that it is easier to go into progressives with a low add, but it can be hard to make a patient care about something 10 years in the future. All he knows is that he can remove them to read NOW, so why spend the money for progressives because in 10 years it will be harder to get used to them.

What progressives have you worn?

Drk, yes flat tops and progressives are very different lenses. I get a little peeved when I hear the term "no line bifocal". Progressives are NOT bifocals. It is even worse when I hear opticians or eye doctors call them that.

I also think there is a place for both and I do sell trifocals and bifocals sometimes.

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## Chris Ryser

> *Chris, I am guessing he waited to go into progressives because he could read without glasses.*


*It is an old hat in the optical profession that all people that have a sizable myopy = short sighted...............are very picky personalities in everything they do.*

This seems to be due to the fact that when removing their corrective glasses they look through a microscope and see small details all enlarged. They can see small details much better than normal sighted people.

When using a progressive with an add of +2.50 they first see the distortion they have never expirienced and they refuse to adapt to that feeling of seeing crooked straight lines.

This is one reason why an optician should know when and what is needed for every case.

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## shellrob

> I personally feel that is a cop out. Fitters run to flattops when they get into trouble fitting progressive. I dont know how many people to come in my store fitted with a flattop because no one took the time to fit them with a pal. Most pal that we fit today are aspherical in so doing that you are giving them better vision. Compared to flattops are spherical. With all the new technology in pals we have today (and seem that there isnt a month that goes by that a new pal is on the market) Flattops should not be in our vocabulary when it comes to fitting 1st time multifocal wears be a add of +1.00 to +3.50 How new are flattops on the market? It is old technology it was good but its old. When we were selling a majority of flattops, we had troubles with them now we have progressive it hasnt change. Any prostheses with not take the place of the real thing.


C-10, you took the words right out of my mouth. So many Opticians rush to a ft, becuse they either don't know how to fit a progressive correctly and /or correctly troubleshoot any problems after dispensing. This is why 53% of the presbyopes wear ft vs progressives. Not enough competent Opticians to fit them correctly.

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## Happylady

So Chris, you have said many times that all progressives are pretty much the same. Why will you not tell us what progressives you have personally tried?

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## suwit

> I had a patient come in Wednesday that had picked up his glasses the day before. I did not sell them to him. He is a low myope with some cylinder and a +2.50 add. He has been removing his glasses for near but that is not working as well anymore.
> 
> His first complaint is that he need to hold his head down while looking at the distance. I lowered them a little but he tends to hold his head up.
> 
> Second complaint is the blurry side vision. He was kind of nasty about this.
> 
> Third complaint is the narrow channel. He says he needs to turn his head to see the entire computer screen.
> 
> He seems very inflexible and not very willing to give them a chance. I talked about the options and told him to come back in two weeks.
> ...



if  use PALs to first time wearer at ADD 250
must use only very good PALs like PANAMIC , DEFINITY , RD Impression ILX Xs

in your patient should use Impression ILT Xs very good when drive he will
see clear from right end to left end
a bit face down and read but for computer use is ........:idea:

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## Chris Ryser

> *So Chris, you have said many times that all progressives are pretty much the same. Why will you not tell us what progressives you have personally tried?*


Right now I gave a pair of PANAMIC which seems to work alright...........I can see................can read.............perfect adjustment. I have surfaced and tried many brands in my lab, and I am not old fashioned and I believe my record in R&D of new products proves that.




> *C-10, you took the words right out of my mouth. So many Opticians rush to a ft, becuse they either don't know how to fit a progressive correctly and /or correctly troubleshoot any problems after dispensing. This is why 53% of the presbyopes wear ft vs progressives. Not enough competent Opticians to fit them correctly.*


You got a good point in that statement..................but still dont admit that everything in this world has its place. *I just love to have a clear vision across my whole desk* and still be able to see my computer screen. 

And you guys would and could not provide that to me, because you would insist selling me something that would be contrary to my personal needs. 

I am not the only crazy one in this world that prefers............what you call old, finished, gone, cheap old technology............because it is technologically better suitable in my case and probably thousands of others.

*A one way arritude of not admitting that there are many other ways to achieve the best result in every individual case, is driven narrow mindededness or pure greed.*

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## QDO1

Of course all designs are different from eachother.  If they were all the same, Dr Sheedys report would be 3 lines long.  The art of the Optician is matching the best product(s) to the patients visual, physical and social needs

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## shellrob

Chris, if you walked into my office and wanted ft's, you would get them from me. I'm not going to try to change your mind at all or talk you into a lens you don't want. Now, if you were to walk in my office needing bifoals and not knowing what you need or want, then yes progressives is what you will get. We could go on all day and have in the past about this subject. The fact remains, progressives are not for everyone and will not work for everyone, but it does take the correct fit to even have a fighting chance.

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## C-10

> Chris, if you walked into my office and wanted ft's, you would get them from me. I'm not going to try to change your mind at all or talk you into a lens you don't want. Now, if you were to walk in my office needing bifoals and not knowing what you need or want, then yes progressives is what you will get. We could go on all day and have in the past about this subject. The fact remains, progressives are not for everyone and will not work for everyone, but it does take the correct fit to even have a fighting chance.


 
Your right  here 
selling any product if the person can not use or will not work for them dosn't help anyone.If a client feels you sold them something that was not right they wil never come back.

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## Chris Ryser

> *Your right here* 
> *selling any product if the person can not use or will not work for them dosn't help anyone.If a client feels you sold them something that was not right they wil never come back.*


Thank you both of you.................so we finally reached an agreement 

:cheers:

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## shellrob

ABSOLUTLEY!!!!!!!:cheers:

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## Happylady

I agree,too. I even sold an executive trifocal to a woman last year. She loved them!

But it is important for patients to understand what is available so they can make a good choice. Going back to the orginal patient, if he had gotten progressives 10 years ago when his add was only a +1.25 chances are he would have adapted easily.

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## Chris Ryser

> *Going back to the orginal patient, if he had gotten progressives 10 years ago when his add was only a +1.25 chances are he would have adapted easily*.


Yes he would most probably have adapted easily, knowing all the facts and being able to face them knowingly.

At that add he has a much wider field of vision and an easier adaptation period. On the other hand you just invite trouble when selling them to a first time user that has a high addition.

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## feornot

Production of the Definity was slowed by the move from Roanoke to Dallas but the Definity outsold its projections by leaps!  Essilor advised 1,000 at the National Sales Meeting last week in Phoenix to support existing Definity accounts and give production time to ramp up once the equipment from Roanoke is all in place.  Maureen Cavanaugh is National Sales Manager of Definity at Essilor and I wish you could have seen the sales curve once Essilor took over from J&J!  Turnaround is an uncertain, since it's affected by frame-to-come and how efficient the dispenser was.  Check the Definity.com website.

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## feornot

Hi Chris. I respect your opinion (they're like noses: we've all got one) and am glad you like your Panamics, since they're harder to fit than COMFORT, which have the lowest non-adapt of any PAL. Of course, every lens has spherical aberrations--even spherical SV! Light reflects off any surface or none of us could see anything, and light reflected off front and back surfaces of any lens and refracted through any lens at different points of reference produce aberrations. Check out the :cheers: Robert Louis Stevenson quote: "There is so much good in the worst of us and so much bad in the best of us, that it behooves all of us not to talk about the rest of us." 

In the optical business we don't have the luxury of combining lenses as telescope makers do, so we have to make a single lens do what optics say it can't. No progressive (ashperic by definition) is perfect, nor is any spheric lens. Check out http://physics.about.com/cs/optics/g...calaberrat.htm
by a Google search on "spherical aberration:" A perfect lens or mirror (either converging or diverging) would have a hyperbolic curvature of its face(s).




> Anybody getting into reading additions first time is often the most ideal customer to be started on progressives. They are no problem cases and most of the time will continue to use them when its time to change glasses.
> 
> But any optician should know that they are not the universal solution for every body and every case. 
> 
> *And if you dont agree with this statement you have to be a very greedy optician who want to sell the highest priced item to everybody.*

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## Happylady

Feornot, I am curious where you got your imformation that the Comfort has the lowest non adapt of any progressive. I notice that Varilux doesn't push this lens and recommends it only for current Comfort wears that are happy with their glasses.

My brother wears a Comfort and when he tried the Panamic he didn't like it. My first progressive was a Comfort but with a +1.25 add it was a no brainer. I haven't tried it since. I have also had a Panamic with a +1.75 add and I did like it.

Why do you say the Panamic is harder to fit?

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## feornot

Re COMF PAL lowest PNA: it's got to be in an old study somewhere in my attic (that's not my head, honest, although there are assuredly cobwebs in both).  The COMFs been out there since 1994 so it's gathered a lot of study.  I've just never forgotten that study.  But then I admit the "n" size in most optical studies is really low, barely ever statistically significant, I'm afraid (sorry again: my science background).  In the optical business we tend to try PALs once and switch--once burned, twice shy--but in science that one-trial decision tree doesn't hold any water.  We do this because it's cost-driven, I think (we get one PNA free) or because pts confront us and retail's really hard;).


The COMF design was extremely forgiving.  You could fit it wrong and pts still loved it.  COMF is at the peak of its revenue stream, Bob Colucci, president of Essilor IDD said in Dallas a month or more ago, so it could still be around as long as the VIP and the SNL!  PANAM's design is a more sophisticated algorithm and in the standard 2-add PANAM's channel's wider than COMFs and just as soft as COMF: I get to talk to the Varilux technical people (because they let me and take my calls).

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## mike.elmes

That statistic (53% wear ft's) seems quite high:drop: ...I own a business in western Canada in a senior citizens mall(primary clientelle) and I would say our percentages are significantly lower.I switch happy flat top wearers, daily, to progressives.Even last week, I had an 85 year old lady walk out of here wearing her first progressive, an ellipse no less:bbg: . Attitudes have been changing, amongst Opticians in the past 5- 10 years as we slowly conquor the public's fears of non adapt, armed with MUCH improved lens technology.

I love this new forum!! :cheers: 


> C-10, you took the words right out of my mouth. So many Opticians rush to a ft, becuse they either don't know how to fit a progressive correctly and /or correctly troubleshoot any problems after dispensing. This is why 53% of the presbyopes wear ft vs progressives. Not enough competent Opticians to fit them correctly.

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## Chris Ryser

> *That statistic (53% wear ft's) seems quite high ...I own a business in western Canada in a senior citizens mall(primary clientelle) and I would say our percentages are significantly lower.I switch happy flat top wearers, daily, to progressives.*


That is nice for you pockets............and obviously you must be a good salesman to do it.

Maybe your happy flat top customers are in a stage were they dont see the difference any more. Could be a ne way of making money...............sell pals to the real old ones..............they have to money and dont see the difference.

:D

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## mike.elmes

In many cases the seniors come in with their kids who are wearing pals. If a senior is sure footed and of sound mind I simply present the options. The success or failure hinges greatly on the optician's thoroughness at showing the senior the correct use of the lenses during the pickup. Our success rate on pals in this office is 93%. I can't remember the last time I had a non adapt....

I am really only selling the nikon i , and Varilux products including Ipseo, which I have only recently aquired an Ipseo Vision Print System....2 months ago.:o

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## sharon m./ aboc

Q 10,                                                                                                                                                                                  I never said "I put this patient in a bifocal or a trifocal." That was a question I was asking what people were "suggesting" Happylady do with this patient. You really shouldn't take quotes out of context.

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## sharon m./ aboc

wrong thread.

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## sharon m./ aboc

wrong thread. ok it is the right thread the above message was for Q 10.

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## au

Hi happylady,

Becaus he tried the traditional PAL he has experience on that. He will compare what you fit to him again. I suggest office PAL and convinced him wear it in the working area (I hope he is not outdoor workman). 

The reason is compare to traditional PAL the side blur vision will be much less.
The up and down position will not affect much for office PAL because distance is blur already.(must explain carefully and make sure pt understand)
The intermediate and reading area will much wider than traditional PAL.

hope this help

:cheers:

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## Happylady

Everyone, this thread is over a year old!

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