# Optical Forums > Progressive Lens Discussion Forum >  What would you consider an upgrade to the Essilor Adaptor

## MarcE

I'm hear again humbly asking for the combined experience of the board to help me "WOW" or at least "impress" this patient.  What Progressive lens do think is best?

Here is our red-flag patient of the day:
OD -8.75 -2.25 x 90something  0.75 BD
OS -9.87 -2.25 x 130something - no prism
+3.00 add
Rx notes:  "High index"  "2.00 BC"  No mention of acuities, but I could call and get it if needed.

This new patient presents wearing an Adaptar in 1.60 with a 2.75 add and 0.50BD in the OS.

This doctor does not normally specify BCs. This was done because of a previous issue with base curve.  I trust this OD and believe that a BC within 0.5 of 2.00 would probably lower our risk.  But I almost NEVER specify BCs on progressives.  Too dangerous IMO.
She was also a non-adapt to 1.67 HI.
She also stated that she needed the lens fit a bit low in her current frames, which had a B of 40.

B in new frame is 34 w/ a FH of 20 before any "lowering" is done.
She picked out a frame w/ a 53 eyesize, knowing full well that smaller mean thinner.  But she isn't that concerned about thinness.  She is a "Vision person", to use a Barryism.  At least as much as she can be wearing a high-add no-line w/out AR.

She would not go for the 1.70 lens.  I wouldn't mind giving her a free upgrade to 1.70, but she wouldn't go for AR so I won't give her 2 free upgrades.
1.67 is out due to previous non-adapt.  

So I guess I'm going with 1.60 without AR:hammer:

The question is:  Can I pick a lens that will provide her better vision (especially considering her increasing add and her shorter FH), without being so different from an Adaptar as to cause adaption problems.
Would any of you feel comfortable putting this on a 1.00BC, if the mfg lens chart calls for it?

My short list in no particular order (all in 1.60):
AccoladeNaturalElement standard corridorDefinity (maybe too soft, too different?)And just maybe -Zeiss Individual (even though she didn't get AR, cost is not an issue with this lens if we feel that it will provide a total WOW!)AdaptarAnd chime in on the AtLast! lens - if you feel appropriate.
Please pick your favorite (or another) and post 2-3 sentences explaining your rational.  Remember this is a teaching forum.  Thanks in advance!

Please do not post any replies that contain the term "Flat-top", including all its derivatives such as but not limited to: FT, D28, D35, TF, 7x28, seg, exec, 8x35, CT, Rd24.  The only exception is the AtLast! lens as listed above.

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## Jacqui

I would be looking at the freeforms, by whoever. I think this is a good case for them.

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## hipoptical

Why was she a non-adapt to 1.67? I think you must first answer that question to be successful fitting her into something else. There are different factors you must consider before proceeding, in my opinion. What 1.67 did you use? I would need more info before offering my suggestion from you list...
In saying that, choose the right freeform PAL, and you needn't worry 'bout a thing. You must remember, though, that not all freeform PALs are freeform PALs, and not all are the same. 
However, to answer your question: just about anything made in this decade would be an upgrade to the Adaptar.... if that is your only concern, buy the cheapest lens from Shore in the index you want, and you'll be better off than with the Adaptar.

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## bob_f_aboc

The Autograph II Variable in 1.6 would knock her out of her chair compared to the Adaptar.

They do list the availability of the 1.6 as -10.00 to +6.00 total power up to a +3.50 add.

The 1.67 is very clear and extends the range to -12.50 total power.

I would recommend the 1.67 material.  I wear it in the Auto SV and have had no ill effects.  (I am usually very sensitive to 1.67 and poly)

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## Happylady

Does she like the Adapter? Has she had any problems wearing it in the past?

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## john-atlanta

I second the Auto II variable 1.60.  Definitely a better ABBE value than 1.67 or Poly so I would stay with it, especially since she is not getting AR.

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## KStraker

> The Autograph II Variable in 1.6 would knock her out of her chair compared to the Adaptar.
> 
> They do list the availability of the 1.6 as -10.00 to +6.00 total power up to a +3.50 add.
> 
> The 1.67 is very clear and extends the range to -12.50 total power.
> 
> I would recommend the 1.67 material.  I wear it in the Auto SV and have had no ill effects.  (I am usually very sensitive to 1.67 and poly)


Agreed. Or try Hoya Id Lifestyle 1.67. Not sure if the 1.67 needs ar.

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## gunner05

Stay away from 1.67 sans AR.  This is a patient I probably would want to scream at, from what you've said so far.   That being said, I honestly would probably think about the Natural.  As much as I really don't like selling it compared to my other lenses, I am thinking that I've had fewer non-adapts moving my old adaptar patients to that than I did with the ovation and such.  That being said, I don't really have the full picture.

I guess cost is an issue here, since they won't spring for AR?  You said they are a vision patient so why in the heck would they not want AR?  Also, she does realize that she's not going to be able to use the periphery on her lenses with that high of an RX anyways right?  It just seems that a lot of this isn't adding up, but that's why I said this patient would probably make me want to scream at them as well.

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## chip anderson

If she doesn't have a complaint and is happy, why upgrade?  
No need to improve on something that is working perfectly.  
If she has a complaint or wants to move up, then move up.

Chip

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## chip anderson

I just had a patient in who is a retired M.D. and has Parkinsons.  He is having trouble with swimmy vision in progressives.  His ophthalmologist who is a very, very good one has suggested bifocals or trifocals.
Should I be concerned that he is going downward on the technological scale?  Should I get all wrapped up in trying to experiment with the latest superzoomo progressives with wider channels, etc?
Of course not, the man has some uncontrolable head and eye movement and we are going to put him in a trifocal.
OK, I'm ready for all you expert whippersnappers to tell me why I'm wrong.

Chip

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## gunner05

Yes, Chip, you are an idiot.

Now that that's out of the way, I agree with what you did there.  But even a blind squirrel sometimes finds acorns ;)

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## Happylady

I guess she doesn't want AR because she's had bad ARs in the past. Once someones had a bad experience with AR it's hard to get them to try again.

If she is happy with Adapter and has not had any problems with it, I would not change her. So the important question is whether is has been happy with Adapter.

Don't do 1.67 without AR.

Edited to say I didn't mean to get that annoying blue bouncing thing in my post and I don't think I can edit it out. :(

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## MarcE

> It just seems that a lot of this isn't adding up, but that's why I said this patient would probably make me want to scream at them as well.


Yes, I understand. It's not quite adding up. But since she know what "didn't work" and she has notes to back it up, I don't want to put her in something that goes against what she said. Because if she isn't WOWed by the new vision, then she will blame the AR or the 1.67, or the BC, or the . . .

Chip: no I don't think going "backwards" to the TF was a bad idea in the Parkinson's case. It probably was a very smart choice. However, in this case I would like to "upgrade" her because I don't think she knows exactly what she has been missing vision-wise. She is a big talker and if I could give her a level of vision that she hasn't ever had before, she will create a couple of fistfulls of new referrals. And she came to us with an outside Rx because of a friend of hers that just raved about how good we are and the great new high-tech lenses that we provided for him.

Thanks so much for all the input:cheers:!
Natural and Adaptar recieved a vote, as did "any freeform" and the Auto II. 
I took all the input into account and leaned toward the "freeform" vote. Ultimately I choose the Indo Expert in 1.60 because it is slightly "harder" than many of the other freeform choices. I thought it might provide many of the benefits of the freeform without being too soft for an old Adaptar wearer. Maybe I'm wrong - but we shall see.

Post suspended for about a week . . . . .

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## Happylady

Yes, please update when she gets the glasses.  :)

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## chip anderson

If you really want to upgrade her the Zeiss Individual in 167 is the best lens I have ever worn.

Chip

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## KStraker

> I just had a patient in who is a retired M.D. and has Parkinsons.  He is having trouble with swimmy vision in progressives.  His ophthalmologist who is a very, very good one has suggested bifocals or trifocals.
> Should I be concerned that he is going downward on the technological scale?  Should I get all wrapped up in trying to experiment with the latest superzoomo progressives with wider channels, etc?
> Of course not, the man has some uncontrolable head and eye movement and we are going to put him in a trifocal.
> OK, I'm ready for all you expert whippersnappers to tell me why I'm wrong.
> 
> Chip


No, but if a better flat top has come along, you might want to consider it. You mean the  brand new Zeiss Individual is better than an a 30 year old Adaptar? Who would have thunk it. I guess this technology stuff does something after all.

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## hipoptical

> I just had a patient in who is a retired M.D. and has Parkinsons.  He is having trouble with swimmy vision in progressives.  His ophthalmologist who is a very, very good one has suggested bifocals or trifocals.
> Should I be concerned that he is going downward on the technological scale?  Should I get all wrapped up in trying to experiment with the latest superzoomo progressives with wider channels, etc?
> Of course not, the man has some uncontrolable head and eye movement and we are going to put him in a trifocal.
> OK, I'm ready for all you expert whippersnappers to tell me why I'm wrong.
> 
> Chip


There are some freeform lenses that would have no swimminess, but you would have to know what they are and where to get them- thus no experimenting. In saying that- if I was in your position, I would very likely do what you did. 
So (in jest) I say that you are wrong because you don't know what you could know. 
Or: ignorance is bliss, and in this case a satisfied and well-cared-for patient.

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## chip anderson

Any lens (with any power) will have swimmnes if either the observer or the lens is vibrated. Take the very best free form lens you can find, or any sphere for that matter and wiggle it in front of your eyes. You will also find this to be much worse in any aspheric or progressive.

I can even remember many years ago wearing some glass drilled rimless glasses that were quite stable in normal circumstances but I found that I couldn't wear them on my motorcycle over about 35 mph because the vibration was so bad it was worse that driving in the rain with no windshield and wet glasses.
A patient with any form of nystagmus of the head or eye will be dealing with this effect.

Chip

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## hipoptical

You know... I didn't even think about the glasses moving apart from his face. I was only thinking of them moving with his face as his face would shake. You're right- any lens will have the swim, and even the best digital PAL would be worse under those conditions. Good thought.

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## carnzo

Adapter come on, who still uses this?  Most of my patients are not driving cars that are 20 years old so why is the patient using this lens in the first place.  Put this patient in a Hoya Lifestyle or Kodak Unique.  But remember with the Unique you need 10mm above the pupil for it to work.  Both lenses can be ordered w/o ar but should have it.  Also, do not put this person in polycarbonate unless you want a remake.

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## dbracer

> Any lens (with any power) will have swimmnes if either the observer or the lens is vibrated. Take the very best free form lens you can find, or any sphere for that matter and wiggle it in front of your eyes. You will also find this to be much worse in any aspheric or progressive.
> 
> I can even remember many years ago wearing some glass drilled rimless glasses that were quite stable in normal circumstances but I found that I couldn't wear them on my motorcycle over about 35 mph because the vibration was so bad it was worse that driving in the rain with no windshield and wet glasses.
> A patient with any form of nystagmus of the head or eye will be dealing with this effect.
> 
> Chip


Does that mean you need to improve your lens or your motorcycle?

dbracer

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## dbracer

I know of no company that handles optics and light aberration science better than Shamir, especially if you use their best. I believe few will argue -- if they've read the science.   

And, I know of no one that knows the science or works harder, at least on this forum, than Darryl Meister. 

Does that confuse you? It does me sometimes also.

He's a good man. He is generous with good information and where to find it. And, although he represents a company, he also represents the facts to a fault. 

Ask his opinion.

dbracer

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## DragonLensmanWV

With that high of a minus, there will be minimal swimminess, regardless of add power. I had a 3.25 add when I was the -15. Never saw any swimminess, either you were in focus or not. I think the flat front curve and high power mask a lot of the abberations, at least that was my experience.

I have the Auto II (Not variable) and the hoya ID Lifestyle in identical frames. There is noticeable better intermediate vision with the ID LIfestyle.
My favorite high-minus lens was the Hoya ECP.

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## OCP

> With that high of a minus, there will be minimal swimminess, regardless of add power. I had a 3.25 add when I was the -15. Never saw any swimminess, either you were in focus or not. I think the flat front curve and high power mask a lot of the abberations, at least that was my experience.
> 
> I have the Auto II (Not variable) and the hoya ID Lifestyle in identical frames. There is noticeable better intermediate vision with the ID LIfestyle.
> My favorite high-minus lens was the Hoya ECP.


Intermedia width is the Hoya strategy, and no other progressive lenses offer you this width. Bad you get worse distance and near zone. Thats the "Asia" style when this region is reading vertical and not horrisontally like the rest of us.
Zeiss, Rodenstock & Shamir does it different.
Better reading and distance zone, and a little smaller intermedia.

Simple as this.

I beleive for sure, that it´s better for the user to get so much distance zone as possible. The Auto II got the widest distance zone on the market so far.

So it´s not a question of "which product is best" but which product fit your client best. Try to change a hoya ID to Auto II and they will all appriciate the larger distance zone, and then sell additionel a pair of Autograph Office for the computer work if the Auto II is not enough. That is (in my oppinion ofcause) the best way to help your client. Hoya ID is not an bad lens, just a different way to build the design that fit asian people better.

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## RT

> Thats the "Asia" style when this region is reading vertical and not horrisontally like the rest of us.


That's an odd assertion since the design criteria for Hoyalux ID and ID Lifestyle came from Europe.

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## MarcE

> Please do not post any replies that contain the term "Flat-top", including all its derivatives such as but not limited to: FT, D28, D35, TF, 7x28, seg, exec, 8x35, CT, Rd24. The only exception is the AtLast! lens as listed above.


Seems that Chip was the first one to break my rules in post #10.  Why did you do it Chip? I was hopeful especially after your statement about your Zeiss Individuals being "the best thing to happen in my 40 years of presbyopia"??

You just couldn't help yourself, could you.;)

Anyway, the lenses are back from the lab, but not dispensed.

Turns out that the Indo Expert that I ordered is out of range because of the total power.  So the lab substituted the Autograph II.  The lenses look great, considering.

We shall see if she sees in HD . . . .

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## OCP

> That's an odd assertion since the design criteria for Hoyalux ID and ID Lifestyle came from Europe.


Please tell me why the ID family got wider intermedia, and smaller distance and reading zone than Individual, Precision and Autograph then.! I guess you cant answer that, because your wrong.
This way to design lenses has always been the Hoya ideology.
Thats it.

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## DragonLensmanWV

> Please tell me why the ID family got wider intermedia, and smaller distance and reading zone than Individual, Precision and Autograph then.! I guess you cant answer that, because your wrong.
> This way to design lenses has always been the Hoya ideology.
> Thats it.



OOH!

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## RT

> This way to design lenses has always been the Hoya ideology.





> Thats the "Asia" style when this region is reading vertical and not horrisontally like the rest of us.


The assertion that HOYA's ID family of designs is based on "Asia" style reading vertically and not horizontally is factually incorrect.

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## hipoptical

Someone from Hoya who knows better should answer this, but I believe this to be true:

The first Hoya lenses were designed for the Asian market, and when brought to the US (or Europe) they were not overwhelmingly received. The lenses you see today are different from those initial designs, and are better suited for the market they are sold in. I first heard "Asian-design" from my Essilor rep (see, I can say Essilor) years ago, but have not heard it in years until now.

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## OCP

> Someone from Hoya who knows better should answer this, but I believe this to be true:
> 
> The first Hoya lenses were designed for the Asian market, and when brought to the US (or Europe) they were not overwhelmingly received. The lenses you see today are different from those initial designs, and are better suited for the market they are sold in. I first heard "Asian-design" from my Essilor rep (see, I can say Essilor) years ago, but have not heard it in years until now.


Hoya will always argue that this is a European design. Ofcause.
But anyone here should ask her self, why Hoya make wider intermedia and smaller reading and distance than Zeiss, Rodenstock and Shamir? Do anyone here realy think that it´s because they cant find out how to do it???
You can make the zone exactly the way you think your customer prefer, but it´s not the filosophy of Zeiss, Rodenstock and Shamir to make a progressive lens this way. They all think it´s more important with a larger distance field. One of the most fashionable stores in the world, based in Bangkok, Isoptik ( isoptik.com/ ) knows that, and are only selling Impression and never ID lenses. Hoya will ALLWAYS claim that the design is European but a secret to you all..........................IT IS NOT.

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## xiaowei

> Thats the "Asia" style when this region is reading vertical and not horrisontally like the rest of us.                      
> 			
> 		
> 
> The assertion that HOYA's ID family of designs is based on "Asia" style reading vertically and not horizontally is factually incorrect.


It is also incorrect, because for example in China, successively after the writing reform in 1955, vertical writing/reading is no longer used for any current documents, also not writing/reading from right to left.

(However, some books will still start from the "last" flap!)

"Today, the left-to-right direction is dominant in all three languages for horizontal writing: this is due partly to the influence of English, and partly to the increased use of computerized typesetting and word processing software, most of which does not directly support right-to-left layout of East Asian languages. However, right-to-left horizontal writing is still seen in these scripts, in such places as signs, on the right-hand side of vehicles, and on the right-hand side of stands selling food at festivals. It is also used to simulate archaic writing, for example in reconstructions of old Japan for tourists, and it is still found in the captions and titles of some newspapers."

http://en.wikipedia.org/wiki/Horizon..._Asian_scripts

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## Now I See

> Seems that Chip was the first one to break my rules in post #10. Why did you do it Chip? I was hopeful especially after your statement about your Zeiss Individuals being "the best thing to happen in my 40 years of presbyopia"??
> 
> You just couldn't help yourself, could you.;)
> 
> Anyway, the lenses are back from the lab, but not dispensed.
> 
> Turns out that the Indo Expert that I ordered is out of range because of the total power. So the lab substituted the Autograph II. The lenses look great, considering.
> 
> We shall see if she sees in HD . . . .


Have you dispensed them yet...any results??

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## MarcE

Sorry it took so long for an update.

Here is what we did:

As you recall, we ordered an Indo Expert, but the total power was out of range, so the lab substituted the Auto II.

The distance vision in the Auto II was great and but the near was not so good.  She took them for a week and couln't get used to the "magnification", although the near vision was better.  

According to her, "Everything is 1.5 times larger than it should be":hammer:

I'm sure these new high-tech lenses have more "true" vision with less minimization.  But what are going to tell someone who has been seeing the world at half size for over 50 years.

Next try was a Natural 1.60 on a 2.00base, no roll.  The reasoning was because of the relatively long corridor of a Natural and a MFH of 18mm, which is what the frame would allow.  Also, it comes in a 2.00BC, which the OD specified.  Also it comes in 1.60, which the pt prefers over 1.67, and regular plastic (this is her personnally provided history)

The lab provided a polish and charged extra for it even though we specifically said "No Polish".  Not the same lab that provided the first freeform.
She immediately didn't like the polish, so I removed it per Optiboard instructions (thanks to Chip or Chris R or Harry C, I can't remember who to give credit to). Anyway, I digress . . . 

She didn't like the lenses at first (maybe she was used to the "natural vision" provided by her freeform lenses).  After 3 days, she really liked the lenses for distance and really liked them at near.

But she doesn't have any intermediate vision (of course not).  But she claims that she did in her old specs.

In case I didn't tell you about her change in Rx:  the change was an extra -0.50D in the OD and -1.00D in the OS.  And we upped the add by +0.25 to a +3.00.

So she was having great luck using the top half of her old specs for computer work.  But her distance acuity was 20/60:hammer:

But you can't convince her of that.  She just thinks that we gave her a substandard lens.  So when I started talking about a pair just for "indoor" use, she started crying.  Now we are just trying to get more money from her :Eek: .  And she couldn't possibly be changing out different pairs of specs.

So, this is what we will do as of today:
Add +0.25 to cyl OD and add +0.25 to sphere OS and reduce add to +2.75 (this was OK'd by prescribing OD).Change lens to Adaptar (which has a wider corridor, so I hear?).Rechecked PD.  Left may have been off 0.5mmShe picks the pair she wants to keep.However, I haven't decided on the add.  Would a higher add (+3.50) help her get into the intermediate faster and therefore be more comfortable?  Or would a lower add maximize the corridor width?

High myopes please chime in.

Thanks for listening!

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## rdcoach5

That lens was a bad design

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## OCP

> Sorry it took so long for an update.
> 
> Here is what we did:
> 
> As you recall, we ordered an Indo Expert, but the total power was out of range, so the lab substituted the Auto II.
> 
> The distance vision in the Auto II was great and but the near was not so good.  She took them for a week and couln't get used to the "magnification", although the near vision was better.  
> 
> According to her, "Everything is 1.5 times larger than it should be":hammer:
> ...


You or your products is not the issue here. Tell your customer to try a different optician. She loves to drag you round in her ring of problems.
You gave her Auto II and she like it, but anyway she could not accept the clearer near sight. Tell her it cant be different than that.
Just my two cent.

Mike.

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## labrat13

I think anything is better than adaptar. I have had great luck with naturals.

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## jefe

The thread started with the question, "What would you consider an upgrade to the Essilor Adaptar?"  

Perhaps the better question is what is NOT an upgrade to the Essilor Adaptar?

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## Now I See

> Sorry it took so long for an update.
> 
> Here is what we did:
> 
> As you recall, we ordered an Indo Expert, but the total power was out of range, so the lab substituted the Auto II.
> 
> The distance vision in the Auto II was great and but the near was not so good. She took them for a week and couln't get used to the "magnification", although the near vision was better. 
> 
> According to her, "Everything is 1.5 times larger than it should be":hammer:
> ...


What a nightmare! :drop:

Just my thinking, here (and I'm sure this job has long been completed...but...) As the add goes up, the reading "zone" is compromised somewhat...so I would think that you would want to keep the add lower to maximize the area.

Hopefully this all got resolved and she is happy (and so are you :D)

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## rdcoach5

> I'm hear again humbly asking for the combined experience of the board to help me "WOW" or at least "impress" this patient. What Progressive lens do think is best?
> 
> Here is our red-flag patient of the day:
> 
> 
> We remade every one of these to something else.The best are
> OD -8.75 -2.25 x 90something 0.75 BD
> OS -9.87 -2.25 x 130something - no prism
> +3.00 add
> ...


First, almost anything is better.the Adaptar was a total failure.. if you want the best:

Autograph2  Zeiss Individual or Definity


2nd Best

GT2  Physio  Creation

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## eyemanflying

Any other PAL brand in the world is better.  Even a hard Navigator!

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## Refractingoptician.com

> Any other PAL brand in the world is better. Even a hard Navigator!


strange, I have never had a redo with an adaptar, but then you guys certainly know more than I .

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## eyemanflying

> strange, I have never had a redo with an adaptar, but then you guys certainly know more than I .


If Adaptar is your lens of choice, it certainly must be because of price and not of quality  There are many more brands I would recommend over that at a better price.

I've had numerous non-adapts over the years with Adaptar.  I refer to it as the non-Adaptar.

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## Mr.Goggle

keep her on the program that works for her!  Someone like that probably resists anything that feels different.  Some people think that anything that don't feel perfect right off the bat is wrong.

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## Happylady

> strange, I have never had a redo with an adaptar, but then you guys certainly know more than I .


I put my dad in an Adapter back in the early 90's. He had worn a flat top for 20 years and liked the Adapter better. I used Adapter's quite a bit back then with no real issues. I haven't used one in years, though.

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## eyemanflying

For all those dispensers out there still supplying this garbo as their lens of choice, take a look at the calendar - it's 2009.  Do yourselves and your patients a favour and get with the times.

Cut the ponytail, ditch the aviators and park the camaro.

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## rdcoach5

> I'm hear again humbly asking for the combined experience of the board to help me "WOW" or at least "impress" this patient. What Progressive lens do think is best?
> 
> Here is our red-flag patient of the day:
> OD -8.75 -2.25 x 90something 0.75 BD
> OS -9.87 -2.25 x 130something - no prism
> +3.00 add
> Rx notes: "High index" "2.00 BC" No mention of acuities, but I could call and get it if needed.
> 
> This new patient presents wearing an Adaptar in 1.60 with a 2.75 add and 0.50BD in the OS.
> ...


 
If ever a patient for free-forrm , this is it If the Rx is correct, check it, and measurements are DEAD ON, put this person in Autograph 2 or Zeiss Individual. If price is an object, put them in Physio or GT2 or Creation. As for the At Last lens, USE IT IF YOU WANT A RE-MAKE. Sorry , Cindy, but I will NEVER use it again!

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