Progressive addition lenses presentation at www.eyenirvaan.com

PROGRESSIVE
ADDITION LENSES
Nilesh Thite M. Optom, FIACLE
To view more presentations and articles, visit www.eyenirvaan.com

Aim of any vision correction deviceAim of any vision correction device
is to provide good visionis to provide good vision
i.e. minimum change from naturali.e. minimum change from natural
visionvision

Options for a Presbyope..Options for a Presbyope..
 Single vision lensesSingle vision lenses
 BifocalsBifocals
 Progressive Addition LensesProgressive Addition Lenses

Single Vision Lenses…Single Vision Lenses…
 Corrects only one distance at a timeCorrects only one distance at a time
 InconvenientInconvenient
 CumbersomeCumbersome

Bifocals…Bifocals…
 Distinct junction between zones -Distinct junction between zones -
Cosmetically unappealingCosmetically unappealing
 Intermediate blurIntermediate blur
 Image jumpImage jump

PALs…PALs…
 Uninterrupted vision for all distancesUninterrupted vision for all distances
 No visible junctions - CosmeticallyNo visible junctions - Cosmetically
appealingappealing
 ConvenientConvenient
 No differentialNo differential
displacementdisplacement

If they are so good…If they are so good…
Why aren’t PALs prescribedWhy aren’t PALs prescribed
extensively ??extensively ??

We all share a love - hateWe all share a love - hate
relationship with PALsrelationship with PALs

We love the revenue generatedWe love the revenue generated

But hate it when a patient comesBut hate it when a patient comes
back with some problemback with some problem

 Peripheral aberrationPeripheral aberration
 Some adaptation problemsSome adaptation problems
 More critical fittingMore critical fitting
 More expensiveMore expensive
Disadvantages..Disadvantages..

Fitting PALs is an art..Fitting PALs is an art..
It requires adequate training & skillIt requires adequate training & skill
It involves communication & counsellingIt involves communication & counselling
skills and convincing powerskills and convincing power

And a science..And a science..
It requires :It requires :
 A systematic approachA systematic approach
 Understanding of potential problemsUnderstanding of potential problems
 In-depth study of designsIn-depth study of designs

A Successful Marriage..A Successful Marriage..

A Layout card..A Layout card..

Whom to fit ?Whom to fit ?
ALL PRESBYOPES !ALL PRESBYOPES !
BUT..BUT..

ContraindicationsContraindications
Field of ViewField of View

Direction of GazeDirection of Gaze

Mobility / Head MovementMobility / Head Movement

PrescriptionsPrescriptions

Anisometropia / AntimetropiaAnisometropia / Antimetropia

High CylindersHigh Cylinders

PrismsPrisms

Step 1Step 1
Identification ofIdentification of
Patient’sPatient’s
Requirements &Requirements &
ExpectationsExpectations

Useful tipUseful tip
Judge the motivationJudge the motivation
Highlight the advantages, but mentionHighlight the advantages, but mention
the limitations as wellthe limitations as well

Step 2Step 2
Frame SelectionFrame Selection

Prefer metal frames with adjustablePrefer metal frames with adjustable
nose padsnose pads

Step 3Step 3
Adjust before taking facialAdjust before taking facial
measurementsmeasurements
Adjust when delivering spectaclesAdjust when delivering spectacles
Frame Adjustment

Step 3Step 3
Back vertex Distance - shorterBack vertex Distance - shorter
Frame Adjustment

Step 3Step 3
Pantoscopic Tilt - 10 to 12 degreesPantoscopic Tilt - 10 to 12 degrees
Frame Adjustment

Step 3Step 3
Facial wrap - must not be too flatFacial wrap - must not be too flat
Frame Adjustment

Step 4Step 4
Monocular PDMonocular PD

Step 4Step 4
MonocularPDMonocularPDMonocularPDMonocularPD
32322929
6161

Step 5Step 5

Step 6Step 6
Marking the lens insertMarking the lens insert

Step 7Step 7
Fitting heightFitting height

Natural head postureNatural head posture
Sit at the same level as the patientSit at the same level as the patient
Check binocularly from a dist. of 1 metreCheck binocularly from a dist. of 1 metre
Use a fine markerUse a fine marker

Step 8Step 8
Checking the cut outChecking the cut out

Delivery ..Delivery ..
MarkingsMarkings
Distance power & prismDistance power & prism
AdditionAddition
Fitting cross heights & PDsFitting cross heights & PDs

On eye assessmentOn eye assessment
Frame fit Fitting crosses

On eye assessmentOn eye assessment
Distance Vision Near Vision

Delivery Instructions

Use positive languageUse positive language
Remove the markings at the endRemove the markings at the end
Maintain a record of the order formsMaintain a record of the order forms

TAKE ATAKE A
BREAK !!!BREAK !!!

Trouble shooting ...Trouble shooting ...

Trouble shooting ...Trouble shooting ...
When & Why ?When & Why ?

Factors in AdaptationFactors in Adaptation ......
MotivationMotivation
ExpectationsExpectations
Education & EncouragementEducation & Encouragement
Occupation & hobbiesOccupation & hobbies

Sources of errorsSources of errors ......
HeightsHeights
Monocular PDsMonocular PDs
Swapped lensesSwapped lenses
Wrong power & axisWrong power & axis

Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Blurry Distance VisionBlurry Distance Vision
Possible CausesPossible Causes
 Fitting too highFitting too high
 Incorrect RxIncorrect Rx
RemediesRemedies
 Open the noseOpen the nose
padspads
 Remake lensesRemake lenses

PROBLEMPROBLEM
Blurry Near VisionBlurry Near Vision
 Fitting too lowFitting too low
 InadequateInadequate
pantoscopic tiltpantoscopic tilt
 Incorrect RxIncorrect Rx
RemediesRemedies
 Bring in nose padsBring in nose pads
 Frame adjustmentsFrame adjustments
 Remake lensesRemake lenses

PROBLEMPROBLEM
Swimmy SensationSwimmy Sensation
 Incorrect PD & heightsIncorrect PD & heights
 InadequateInadequate
pantoscopic tiltpantoscopic tilt
 Facial WrapFacial Wrap
 AdaptationAdaptation
RemediesRemedies
 Increase facial wrapIncrease facial wrap
 Pantoscopic tiltPantoscopic tilt

PROBLEMPROBLEM
Reading area tooReading area too
smallsmall
 Incorrect PDIncorrect PD
 Fitting heights too lowFitting heights too low
RemediesRemedies
 Frame adjustmentsFrame adjustments
 Refit lensesRefit lenses

PROBLEMPROBLEM
Having to look to theHaving to look to the
side to readside to read
 Swapped lensesSwapped lenses
RemediesRemedies
 Refit to correct PDsRefit to correct PDs
 Swap lenses if frameSwap lenses if frame
symmetricalsymmetrical

PROBLEMPROBLEM
Having to tilt head tooHaving to tilt head too
far back to readfar back to read
 Add too weakAdd too weak
 Change in designChange in design
RemediesRemedies
 Bring in nose padsBring in nose pads
 Increase the addIncrease the add

PROBLEMPROBLEM
Having to tilt headHaving to tilt head
backward for distancebackward for distance
 UndercorrectedUndercorrected
hyperopehyperope
 Overcorrected myopeOvercorrected myope
RemediesRemedies
 Repeat the refractionRepeat the refraction

PROBLEMPROBLEM
forward to readforward to read
 Add too strongAdd too strong
 RemediesRemedies
 Repeat the refractionRepeat the refraction

PROBLEMPROBLEM
forward for distanceforward for distance
 Fitting height too highFitting height too high
RemediesRemedies
 Frame adjustmentFrame adjustment

Summary...Summary...
Key to problem solving is a systematicKey to problem solving is a systematic
approachapproach

The end could beThe end could be
this..this..

Or like this….Or like this….

Progressive addition lenses presentation at www.eyenirvaan.com

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Progressive addition lenses presentation at www.eyenirvaan.com