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Ophthalmic Lenses 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. Minimal 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.
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 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 Computer Users 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 Price "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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