Progressive Dispensing

Welcome to our continuing series of Credit Educations Courses for Opticians.

This course has been approved for one hour of credit by the American Board of Opticianry. No fee is required for ABO credit.

Learning Outcomes:This article is presented at a beginner level and is designed to help eyecare professional be more knowledgeable in the area of progressive lenses. At the conclusion of the article, participants should be able to:

1. Better understand specific questions to ask patients before the dispensing or exam process begins.

2. Know how to use that information to provide patients with the best PAL for their needs.

3. Know how to target discussions to the category of patient: first-time wearer, consumer upgrading from bifocals, etc.

4. Take measurements and make sure the frame is appropriate to the lens.

5. Differentiate among the various recent advances, such as all-aspheric designs, short corridor designs, and internal PALs.

Test procedures: Read the article and then click on the "Take The Test" button at the bottom of the page. This will open a new window with a test consisting of 15 questions. To receive ABO continuing education credit, respondents must correctly answer 12 of 15 test questions. Simply click on the best answer for each question and click the submit button at the end of the test. Your test answers will be automatically sent to Seiko Optical and we will send your CEC or notify you of test failure within 7 to 10 business days.

Note: Some states do not accept home study courses for continuing education credit. Check with the licensing board in your state to see if this course qualifies.

Progressive Dispensing: Tips, Techniques, and Technology

Introduction

With our population living longer, more active lives, multifocal lenses are becoming a larger part of the dispensing mix. More and more consumers are turning to progressive lenses as the best way to get the visual acuity they need, without letting the world know they wear multifocals. Today's PALs are not "your grandfather's bifocals."

With increased demand for these lenses, manufacturers are constantly improving their designs and offerings in this product category. There are now short corridor, computer use, photochromic, and polarized PALs. Also available is a lens with the progressive surface on the back side, Seiko's 1.67 Super Proceed Internal.
The ECP needs to be aware not only of the latest technology and designs, but how to fit and prescribe the appropriate lenses for each patient. This requires taking the time to understand a patient's lifestyle as well as his or her Rx.

This course is designed to help in all the areas mentioned above. By knowing about the newest products and technologies, you are able to better determine the best eyewear options for each patient. Also reviewed are fitting techniques, to ensure your patients get the perfect fit for their new eyewear.

We hope this course adds to your knowledge and helps you grow your progressive business.

This course will provide simple techniques to help dispensers select the best progressive addition design for each patient. The information provided will also encourage opportunities for dispensing multiple pairs of eyewear.

This course includes measuring and fitting information that will help improve the success of every progressive fitting. New developments and technological advancements in progressive designs are also explained in detail.

Patient Information

Effective dispensing of progressive lenses requires obtaining detailed information from each patient. Dispensers need to know four important items. The information required to provide the best progressive for each patient's visual needs includes, but is not limited to:

Patient's prescription: The correction will often influence the type of lens material recommended by the dispenser as well as the lens design selected for the patient.

Occupation: How they use their eyes at work helps dispensers determine which progressive design to choose for that patient. The progressive design used for a patient working as a musician in a symphony orchestra will most likely differ from the progressive design selected for a long distance truck driver. The length of time a patient spends at a computer for both work and leisure is another critical bit of information.

Leisure activities: What kind of hobbies does the patient have? Do any of them involve close-up work that will be best served by a particular progressive design?

How and when: Will they be wearing their glasses full time or only to supplement contact lenses? This information helps determine which progressive will be dispensed and also reveals when more than one pair of glasses will be required.

The use of a Lifestyle Questionnaire can aid enormously in gathering information and is recommended as the best way to obtain the four important items listed above as well as the following information. It's important to understand the patient's previous experiences with eyewear. What did they like about their previous glasses and what did they not like? Did their previous eyewear experience only involve single vision lenses? If they previously wore multifocals, were they bifocals, trifocals or progressives? In some cases, the patient may have no previous experience with eyeglasses. Each situation requires a somewhat different approach by the dispenser.

Develop the habit of writing down details as the patient provides them. This requires maintaining a file for each new patient. Listen carefully as they answer questions and avoid guessing at what the patient's previous eyewear experience might have been. Don't judge their circumstances or needs by physical clues such as the way they dress. Developing this detailed information for each patient takes time, but the rewards more than justify the dispenser's investment.

Utilizing Information

Based on details provided by the patient, the dispenser then must translate that information into lens recommendations based on the patient's individual needs. To do this requires two things: the dispenser's detailed understanding of what lenses are available and the benefits and advantages provided by each type of lens.
Knowing and understanding all details of the patient's normal routine provides another valuable resource for the dispenser. It opens up opportunities for multiple pair dispensing. Based on the patient's lifestyle, dispensers can make valuable recommendations on special-use eyewear designed specifically for the way the patient uses their eyes--for both work and leisure activities. Special-use eyewear might include sunwear, sports or safety eyewear, photochromic eyewear, distance-only eyewear for television viewing, backup eyewear for contact lens wearers, and computer or work-related eyewear.

Discuss cost vs. benefits and how the recommended eyewear will benefit the patient. Most eyewear consumers go through life without ever understanding all the options available for their eyewear. Explaining options has become an important professional responsibility as well as a hallmark of good dispensing.

Explaining Progressives

Many, if not most, progressive wearers are never informed about the details of how progressive addition lenses do their work. The mechanics of how these marvelous lenses perform their magic are never explained. That explanation should be part of the learning experience for every progressive wearer. This learning process is just as important for those who have been wearing PALs for years as it is for first-time wearers.

Explain with simple drawings how the various sections of the progressive are positioned: the distance area, the progressive channel or intermediate area, and the near or reading portion of the lens. Explain how the lens design follows the natural way eyes are used and how the brain quickly learns to use the correct part of the lens for each visual task. With first-time wearers, explain that the learning process generally only involves the first few days of wearing their new lenses.

First-time wearers: If this is their first pair of progressives, explain (and diagram) how the reading portion of a progressive is less than they have been used to but their brain and eyes will quickly accommodate to this smaller reading area. Following the first several days, their brain takes control and awareness of the differences vanish completely.

It's wise to discuss the peripheral areas found on either side of the progressive channel. Explain that these areas of mild blur or sway are designed specifically to help channel the eyes back toward the clear intermediate area of the progressive channel. Again, a simple drawing helps them understand this. Awareness of those peripheral areas gradually fades away and is not a problem after the first several days.

Upgrading to PALs: Bifocal wearers become accustomed to a world divided into two areas: distance viewing and reading viewing. They learn to accept the world with a visible line separating those two areas. Upgrading to a progressive adds a whole new dimension to their world--sharp clear vision in an intermediate area that has been a blur to them in the past (the amount of blur depending on the strength of their add power).

Changing designs: This becomes a more common task for dispensers as the variety of progressive designs continues to increase. Sometimes a different design is required for a shorter channel because the patient chooses a shallow frame. Sometimes the design is changed from a hard design to a softer design--or vice versa.

For example, patients who complain about the blurred areas on either side of their PALs may be more comfortable in a softer design with the blur spread over a wider area. As a consequence, blur is less noticed by the wearer.

To fixate on one progressive lens design and totally exclude all other designs is inevitably unfair to the patient. The way progressive wearers use their eyes depends on a variety of factors that include the type of work they do, the kind of prescription they wear, and the type of frame they choose. Don't get locked into a fixed routine that ignores the differences.

Fitting and Measuring Procedure

The normal tendency of the patient is to select the frame first. Avoid that by insisting that lenses be discussed first. It's easy to explain that eyewear is a medical device and the most important components in a pair of glasses are the lenses. These should always be determined first. Explain that the effectiveness of many modern lenses depends on the type or shape of frame they go in and that lenses must be decided upon before frame selection.

Some lens designs work best when the frame has adjustable pads, like those found on most metal or rimless mountings. This is particularly true with progressives. Avoid overly large or aviator style frames. Make sure the selected frame has a proper pantoscopic tilt or permits adjusting the tilt.

Frame fitting and measuring: The frame should fit as close as possible to the face. Observe how the frame is positioned on the patient's nose. Adjust the frame so that 30 percent of the vertical height is positioned above the pupil. If the pupil sits high in the frame, increasing the pantoscopic tilt will lower it. To raise the pupil's position in the frame, decrease the tilt. If necessary, re-position the nose pads for best fit. Once a frame fits properly, carefully determine the fitting height by placing a small dot on the demo lens in the center of each pupil. Measure and record these heights.

PD measurement: Next take accurate monocular PD measurements. The best method is with an electronic pupilometer. Before taking PD measurements, ask if the patient has had his or her eyes measured with this instrument before. If the answer is no, explain exactly what you are doing and how precise the final measurements will be. This is a small detail but inevitably impresses patients once they understand what you are doing.

Technical Advances

There have been numerous advancements in the design and technology used in modern progressive addition lenses. For example:

All-aspheric designs: All progressive lenses use aspheric curves in the bottom portion of the lens. Some of the more recent designs feature aspheric curves in the top portion of the lens as well. This design feature enhances both visual benefits and cosmetic appearance of the lenses.

Short-corridor designs: As modern frame fashions grew smaller, it created a need for progressive addition lens designs that had a shorter progressive channel. Conventional design PALs simply have their reading area cut off in vertically shallow frames. Typical short corridor designs include the AF Mini, AO Compact, and the Seiko Proceed II Short. These progressives are designed specifically for modern frame styles. Most short corridor designs, however, provide less control of unwanted astigmatism, combined with a reduced intermediate viewing area. These compromises should be recognized by the dispenser.

Photochromic options: Modern photochromic progressives get darker faster and lighten up faster indoors. More than ever, they are suitable for full-time wear. Some versions are now made in mid-index form, and photochromic polycarbonate lenses are also available. One company produces the only photo-chromic lenses made in high index 1.66/1.67.

Internal PALs: The newest advancement in progressive design positions the progressive power curves on the back surface rather than the traditional front side of the lens. Placing progressive curves on the backside positions them closer to the eyes and provides considerably improved optics for the wearer. Another advantage is that magnification differences between the various visual areas of the progressive are reduced. Visual fields are expanded and the design makes it possible to better control off-center astigmatism and power errors. Internal design PALs provide atoric compensation for each prescription. The front surface is spherical and eliminates any possibility of shape distortion.

In Review

Providing the maximum benefit of modern progressive lenses requires fully understanding exactly how wearers use their eyes in everyday life. The best way to compile this important information is to make sure every patient fills out a Lifestyle Questionnaire. If a questionnaire is not used, ask questions that reveal exactly how patients use their eyes--at work and for leisure activities. A questionnaire form is preferred because it is available for use by both doctor and dispenser. In addition, it becomes a permanent part of the patient's office records. Only with this detailed information is it possible to determine the best progressive to meet the patient's visual needs.

Understanding exactly how each patient uses their eyes at work and at play makes it possible for dispensers to make valid recommendations on special-use eyewear. This encourages multiple pair dispensing and provides better service to the patient.

Dispensing progressive addition lenses that best serve the patient's visual needs requires precise measurements and skillful fitting. Take the time to do it right, and progressive refits will be a thing of the past. Take advantage of the advanced technology now available in modern progressive addition lenses. There are currently more than 150 progressive variations available, making it possible to dispense PALs that are exactly right for each patient.

This concludes the article. Click the button below to take the test.