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Progressive Spectacle Lens Fitting
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Progressive Spectacle Lens Fitting

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  • 1. PROGRESSIVE ADDITION LENSES
  • 2. Aim of any vision correction device is to provide good visioni.e. minimum change from natural vision
  • 3. Options for a Presbyope..• Single vision lenses• Bifocals• Progressive Addition Lenses
  • 4. Single Vision Lenses… • Corrects only one distance at a time • Inconvenient • Cumbersome
  • 5. Bifocals…• Distinct junction between zones - Cosmetically unappealing• Intermediate blur• Image jump
  • 6. PALs…• Uninterrupted vision for all distances• No visible junctions - Cosmetically appealing• Convenient• No differential displacement
  • 7. If they are so good… Why aren’t PALs prescribed extensively ??
  • 8. We love the revenue generated
  • 9. But hate it when a patient comes back with some problem
  • 10. Disadvantages..• Peripheral aberration• Some adaptation problems• More critical fitting• More expensive
  • 11. Fitting PALs is an art..It requires adequate training & skillIt involves communication & counselling skillsand convincing power
  • 12. And a science..It requires :• A systematic approach• Understanding of potential problems• In-depth study of designs
  • 13. A PAL blank..
  • 14. A Layout card..
  • 15. Whom to fit ?ALL PRESBYOPES ! BUT..
  • 16. Contraindications Field of View
  • 17. Contraindications Direction of Gaze
  • 18. ContraindicationsMobility / Head Movement
  • 19. ContraindicationsPrescriptions • Anisometropia / Antimetropia • High Cylinders • Prisms
  • 20. Fitting ...
  • 21. Step 1Identification of Patient’s Requirements & Expectations
  • 22. Useful tip Judge the motivation Highlight the advantages, but mention the limitations as well
  • 23. Step 2Frame Selection
  • 24. Useful tipPrefer metal frames with adjustablenose pads
  • 25. Step 3 Frame AdjustmentAdjust before taking facialmeasurementsAdjust when delivering spectacles
  • 26. Step 3Frame AdjustmentBack vertex Distance - shorter
  • 27. Step 3 Frame AdjustmentPantoscopic Tilt - 10 to 12 degrees
  • 28. Step 3 Frame AdjustmentFacial wrap - must not be too flat
  • 29. Step 4Monocular PD
  • 30. Step 4Monocular PD 61 Monocular PD Monocular PD 29 32
  • 31. Step 5Monocular PD
  • 32. Step 6Marking the lens insert
  • 33. Step 7Fitting height
  • 34. Useful tipNatural head postureSit at the same level as the patientCheck binocularly from a dist. of 1 metreUse a fine marker
  • 35. Step 8Checking the cut out
  • 36. Delivery ..MarkingsDistance power & prismAdditionFitting cross heights & PDs
  • 37. Delivery ..On eye assessment Frame fit Fitting crosses
  • 38. Delivery ..On eye assessment Distance Vision Near Vision
  • 39. Delivery .. Delivery Instructions
  • 40. Useful tipUse positive languageRemove the markings at the endMaintain a record of the order forms
  • 41. Trouble shooting ... When & Why ?
  • 42. Factors in Adaptation ...MotivationExpectationsEducation & EncouragementOccupation & hobbies
  • 43. Sources of errors ...HeightsMonocular PDsSwapped lensesWrong power & axis
  • 44. Complaints & Remedies... PROBLEMBlurry Distance Vision Possible Causes • Fitting too high • Incorrect Rx Remedies • Open the nose pads • Remake lenses
  • 45. Complaints & Remedies... PROBLEMBlurry Near Vision Possible Causes • Fitting too low • Inadequate pantoscopic tilt • Incorrect Rx Remedies • Bring in nose pads • Frame adjustments • Remake lenses
  • 46. Complaints & Remedies... PROBLEMSwimmy Sensation Possible Causes • Incorrect PD & heights • Inadequate pantoscopic tilt • Facial Wrap • Adaptation Remedies • Increase facial wrap • Pantoscopic tilt
  • 47. Complaints & Remedies... PROBLEM Possible CausesReading area too small • Incorrect PD • Fitting heights too low Remedies • Frame adjustments • Refit lenses
  • 48. Complaints & Remedies... PROBLEM Possible CausesHaving to look to the side • Incorrect PD to read • Swapped lenses Remedies • Refit to correct PDs • Swap lenses if frame symmetrical
  • 49. Complaints & Remedies... PROBLEM Possible CausesHaving to tilt head too far • Incorrect PD back to read • Add too weak • Change in design Remedies • Bring in nose pads • Increase the add • Refit lenses
  • 50. Complaints & Remedies... PROBLEM Possible CausesHaving to tilt head • Undercorrected hyperopebackward for distance • Overcorrected myope Remedies • Repeat the refraction • Refit lenses
  • 51. Complaints & Remedies... PROBLEM Possible CausesHaving to tilt head • Add too strongforward to read • Remedies • Repeat the refraction • Refit lenses
  • 52. Complaints & Remedies... PROBLEM Possible CausesHaving to tilt head • Fitting height too highforward for distance Remedies • Frame adjustment • Refit lenses
  • 53. Summary...Key to problem solving is a systematic approach