Ophthalmic Lenses
What's Your Favorite PAL?

We asked optometrists across the country why they prefer one progressive lens rather than another. Here's how they picked their PALs.

by John Murphy, Senior Editor

There are three things you can count on in life: death, taxes and bifocals, says optometrist Timothy Pease of Green Bay, Wis. You can gripe about the first two, but with progressive addition lenses, the third is a moot point.

When progressive addition lenses (PALs) first emerged on the scene, doctors and opticians had some serious gripes about them. But in the past few years, the technology has improved so that progressive lenses now account for one of every four pairs of lenses sold, according to the Jobson Optical Group Data Base. That's up 25 percent since many of the new designs first came out in 1995. Baby boomers are glad they don't have to wear their grandfather's old bifocals.

What are some of the qualities that lead a doctor or optician to pick one progressive lens over another? Optometrists we interviewed for this article agree on one thing: Premium lenses with minimal distortion are the best, and a lot of premium lenses available are pretty good. In other words, very few points distinguish a doctor's lens of choice from the other good choices available.

While each doctor we spoke with has a preference for a premium lens brand, they agree on another point: Measuring and fitting a PAL the right way is more important than anything. Even the best progressive lens isn't going to make up for a shoddy fit.
Here are some characteristics of progressive lenses that led these O.D.s to their lenses of choice.

Minimal Distortion
"You're always going to get some failures" with progressive lens wearers, says Harvey Magaziner, O.D., of Mount Airy, Md. But he says you can minimize them by choosing a PAL with minimal side distortion.

Dr. Magaziner, who opts for the Zeiss line of PALs, notes that a wider channel is generally better to minimize peripheral distortion. Dr. Pease agrees, although he chooses the Varilux Comfort, not only for his patients but for himself.

All progressive lenses have some optical aberration, Dr. Pease explains. But the better lenses shift the aberrations as far as possible out of the field of view. He claims his field of view with the Varilux Comfort is comparable to that with a single-vision lens.

Douglas Schroeder, O.D., of Sunset Eye Center in Sunset Hills, Mo., says his lens of choice is a "soft lens" design. Such a lens allows a smooth undistorted transition from the central vision area to the peripheral zone, which he finds in the Kodak Vision PAL from Signet Armorlite.

3 Ways to Make Your Patient and PAL Happy
A few minutes of counseling before you dispense a PAL prescription can save you some unnecessary chair-time afterward. These tips can help you avoid call-backs and re-fits with PALs.

1. Double-check the fit. Nine times out of 10 the patient's problem with progressive lenses is that they were measured inaccurately or fit poorly. First do your frame adjustments to make sure the patient is fit properly. Then take accurate measurements.

2. Make the lens fit the lifestyle. It has to fit more than just the eyeball. Your PAL choice—of brand, material or design—may change depending on the patient's activities. Ask about the patient's work and lifestyle.

3. Tell patients what to expect. Spend some quality time telling your patients (even those who've worn a different PAL) that they'll have to go through an adaptation period. Although this may take two weeks, advise them it could take as long as three.

The Kodak PAL is a soft lens in that it doesn't have an abrupt optical transition between zones, concurs Bernard Schnur, O.D., of Pacific Vision Care Optometric Services, in Lakewood, Calif. He also recommends the lens for his patients who do near-vision work.

Dr. Schnur says the Varilux Comfort is also a good "soft lens" for general purposes. Better yet, for a lens with minimal or no distortion in the distance, Dr. Schnur had made his own lenses in-house using the Innotech Excalibur system. Unfortunately, he can't make them any more since Innotech stopped distributing the lens-making materials to optometrists.

Adaptation
Adapting to a progressive lens isn't a major feat for most patients, but it's not minor either. New progressive lens wearers can require up to three weeks to adapt to their lenses. That makes the adaptation period key when doctors choose a PAL.

Wider is better, says Tim Kret, O.D., of Fort Worth, Texas. A progressive lens with a wider intermediate zone makes adapting much easier. Dr. Kret, who estimates that his acceptance rate is about 95 percent, prefers the Varilux line.

When Stephen Glasser, O.D., of Washington, D.C., fit 15 of his patients with SOLA Optical's Percepta lens, he hoped they would adapt with minimal difficulty. When none called him back after two weeks, he wondered if they'd left him for another practice. In fact, not one had adaptation problems. Dr. Glasser often opts for the Percepta, which has different lens designs depending on the patient's prescription. It's especially good for patients with significant anisometropia, he says.

Successful adaptation hinges less on the lens of choice than on patient education, says Radford, Va., optometrist Carroll Poovey. "You don't hand someone a no-line bifocal and not talk to them about it," he says. Minimize your PAL failures by explaining to patients the difficulties they might encounter.

Astigmatism
Although you'll want to choose a progressive lens with minimal peripheral distortion for most patients, it's even more critical for astigmats. "I know when I give [astigmats such a] lens, I'm not going to get a lot of complaints," Dr. Magaziner says. For lesser amounts of peripheral distortion, he opts for American Optical's AO Pro for patients with very mild amounts of cylinder correction. For those with greater cylinder, he goes with a Zeiss lens.

Computer Users
Before you choose a progressive lens, find out what tasks the patient needs it for. Says Dr. Glasser, "Be inquisitive."

If you learn that your patient is a transcriptionist and does a lot of computer work, for example, ask how far away the reference text is. Her answer may prompt you to choose a different lens. For those who use a computer only occasionally, Dr. Glasser still goes with his regular progressive lens of choice. But for a patient who needs a PAL solely for near work, he uses a lens with a large reading area at the bottom and the mid-range at the top, such as the SOLA Access.

Dr. Poovey favors another such lens for computer users, Zeiss's Gradal RD. But he notes that a patient who uses this kind of PAL would also need a second pair of glasses for everyday use and distance vision.

Smaller Frames
Frame styles have gotten smaller in the past few years, making it difficult to create a progressive lens with adequate optical zones to fit them. For patients who choose a smaller frame, Dr. Fitch picks a PAL like American Optical's AO Compact that has optics that fit into a smaller design. He says the AO Compact will be even better when it comes out in a high index material. The thing to keep in mind with a compact lens, Dr. Schroeder cautions, is that you lose some of the intermediate vision with the smaller lens size.

Price
Premium lenses come at a premium cost. Still, just about all the optometrists we talked to believe the extra investment in a premium PAL is worth the improved optics.

"There's definitely a difference in price between a premium and a standard lens," Dr. Schroeder says. But, he adds, some price-conscious people or some first-time bifocal wearers do fine in a less-expensive design that has a "harder" optical transition. 

If cost weren't a factor, says Dr. Poovey, then every patient could use a custom-designed lens like the Rodenstock Multigressiv. The lens is custom-made at the factory for a patient's individual prescription. The downside: It costs more than double any other PAL.

So what else do you look for in a PAL? "I'm still waiting for the progressive lens that has no distortion in the distance and no distortion up close," Dr. Schnur says.

While you're waiting, think about one other thing. Consider the service after the sale. Do the lenses come with a good warranty? Does your rep respond to your problems quickly? Many optometrists develop a brand loyalty owing to the service they receive in addition to the quality of the lens.

 

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