Lens Choices: Progressive Progress

By Brian P. Dunleavy                                            Photo by Nedjeljko Matura

Jeffrey Anshel, OD, has a story he likes to tell about progressive lenses and the challenges involved in dispensing them to patients. “I had a patient once, a guy in his early 40s, who came in for an exam and said to me, ‘You know, my wife has a pair of these progressive lenses. I tried them on and they didn’t work for me,’” Dr. Anshel, the owner of Poinsettia Eye Center in Carlsbad, Calif., recalls with a chuckle. “I asked him, ‘Do you try on your wife’s shoes, too?’”

He then gave the patient the same simple message he gives all presbyopes—both old and new—who visit his practice: “What I tell my patients who claim progressives don’t work is, ‘60 million people are wearing progressive lenses successfully. Why can’t you?’” Dr. Anshel notes. “Then I say, ‘As with everything else, you have to experiment with the different designs out there and find the one that works the best for you.’”

It’s the same message, he says, dispensers should take into consideration when deciding which progressive lens brands and/or designs to dispense in their practices or optical shops. There are more than 100 progressive brands on the market today, many of which  have unique design characteristics. And, when you factor in the various lens materials and treatments (i.e., photochromic technology) available in progressive designs, dispensers have more than 300 no-line bifocal products to choose from. Complicating matters even further is the fact that, as Robert Davis, OD—a partner in the practice of Davis, Morris & Semel in Pembroke Pines, Fla.—says, “there is no one, perfect progressive design. One size definitely does not fit all.”

So how can dispensers best narrow down a selection of progressive “sizes” to at least fit most of their presbyopic patients satisfactorily?

“I tell my patients who claim progressives don’t work that, ‘60 million people are wearing progressive lenses successfully. Why can’t you?’”
—Jeffrey Anshel, OD,
Poinsettia Eye Center, Carlsbad, Calif.

Thankfully, part of the proliferation of new progressive products has actually helped further define the category. In recent years, no-line lens innovations have fallen into one of three categories: “standard” progressives, “short-corridor” progressives and “computer-vision lenses” or “indoor” progressives.

“Standard” (or “Day-to-Day”) progressives are designed in the tradition of the optical industry’s earliest no-line bifocals. They make up the brunt of the progressive designs on the market. As with their predecessors, standard progressives offer wearers near, intermediate and distance vision, without the unsightly “lines” or segments. But calling today’s designs “standard” is truly a misnomer.

Progressive lens designs have changed substantially in recent years. New “generations” of progressive designs, for instance, are called “soft designs” because they feature a wider corridor between distance and near vision to allow for a smoother transition between segments. Newer designs also offer a wider near-vision segment that makes reading and “close work” easier for progressive wearers.

Not all of the “standard” progressives on the market today are the same. Designs differ from brand to brand, manufacturer to manufacturer. So does the level of technology incorporated into these designs. All of which means dispensers have more to consider when deciding which progressive products to dispense.

“I worked at a chain retailer that was married to one progressive design,” says Dennis Magarahan, office manager for the optometric practice of Drs. Mark and Suzanne Boas in Exton, Pa. “Patients would come in with a particular visual need and we couldn’t meet it. I remembered that frustration even after I came here and it led me to putting a lot of research into what I presented to my patients.”

Most lens manufacturers offer dispensers free samples of their lens products, particularly progressives. Magarahan’s practice will often fit staffers with these lenses—if they are presbyopes, of course—and they have even enlisted the help of presbyopic patients. All of these “experimental” wearers try out the lenses for a few days and come back with comments.

“Sometimes we will eliminate a brand altogether,” Magarahan says. “Most of the time, we’ll see what wearers might like about each lens and make a note of it. You’ll never know when a design’s unique characteristics will come in handy. Some patients like a larger distance area. Some want a bigger reading area. Some need a larger corridor to transition between the two. If you throw all your eggs in one basket, it limits you. Just like with frames, more variety in lens designs makes it easier to tailor eyewear to patients’ needs.”

When it comes to the issue of corridor length, manufacturers have made things somewhat easier on dispensers with the introduction of the “short-corridor” progressive sub-category a few years ago. Designed to fit the smaller frame styles popular today, these lenses feature a compressed intermediate corridor—the area between the near and distance segments. With these lenses, presbyopes can still get the benefits of a progressive lens in frames with fitting heights as low as 14mm.

While some say the visual sacrifice is minimal, others aren’t so sure. Dispensers caution that a lens’ minimum fitting height should depend on the design and the patient’s visual needs—not the size of the frame they want. Some patients, for example, don’t do well with the shorter corridor. “They can get eye strain from moving between the distance and near areas,” says Dr. Davis.

As with any lens in the progressive category, finding the best design is key. Optician Jeff Persky, owner of Westside Opticians in Los Angeles, strongly emphasizes checking with your lab before deciding on what progressives to dispense. “They’ll tell you the truth because they want to avoid returns too,” he says.

The third category of progressive lenses—“computer-vision” lenses—is more complex. Labeled “indoor progressives” by some dispensers, these lenses provide what many say are the ideal visual powers for the contemporary office setting, especially for computer users. They are seen as a visual solution for sufferers of computer vision syndrome (CVS), the eyestrain or fatigue computer users often feel after extensive time behind the keyboard.

Dr. Anshel, who lecturers nationally on the topic of computer vision, says dispensers will too often prescribe standard progressives for computer users, even though “not all progressive designs will work for them.” To determine whether “computer-vision” lens—or other progressive products—will work well for particular patients, he says, requires special attention to the patient’s workplace environment and the activities of their occupation.

“Progressives are great technology, but they are not necessarily the best lens for using the computer,” he continues. “Because of the way they’re designed, a wearer may have to tilt their head up or down constantly to find just the right area for seeing during certain tasks. Computer-vision lenses, in general, are the better solution. As with any product, though, it’s about practitioners knowing what’s available and how to prescribe it, and my sense is that most practitioners don’t.” Again, he notes, that comes down to research.

Another aspect of progressive dispensing that requires research is understanding how to position these products within the dispensary. A key factor is price. One advantage of the recent proliferation in progressive products is the variety of price points available within the category. With so many base lens materials—and design generations—to choose from, dispensers have a lot of options. Newer designs in premium materials (i.e., high-index plastic) can fetch a high price at retail. On the other hand, dispensers can position older designs in lower-priced materials such as conventional plastic or polycarbonate to more price-conscious patients.

“Managed care is a factor in determining the progressive brands we sell. We have had to set up a tier-pricing system, with lower-end progressives just to accommodate the HMOs.”
—Robert Davis, OD,
a partner in the practice of Davis, Morris & Semel, Pembroke Pines, Fla.
“Managed care is a factor,” notes Dr. Davis. “We sell a lot of higher-priced progressives. But we have had to set up a tier-pricing system, with lower-end progressives just to accommodate the HMOs. They force us to use certain brands, in some cases. More often, though, they limit us to certain price points and materials.”

Most dispensers agree that offering at least a “good, better and best” selection of PALs gives price-sensitive patients the option of choosing a lens that will fit their vision needs and their budget. “Some patients just don’t want to pay top dollar, especially when the economy is like it is now,” Persky says. “We’ve found that we’re more successful when we present options.”

Persky’s shop sells up to 10 progressive brands, with most of its sales “going to two or three big brands.” He sells progressives at retail prices ranging from $110 to $225, the latter usually reserved for high-index plastic. Magarahan deals in 10 different progressive designs allocated into three price points based on material. His low-end PALs in conventional plastic start at $189 per pair. High-index plastic progressives top out at $229 per pair.

The bottom line with all of these pricing plans is to get patients into progressives and keep them away from less expensive (and less lucrative) products such as bifocals. “I have been pushing progressives for years now,” notes C. Earl Loftis, Jr., OD, owner of Eyes on Gervais in Columbia, S.C. “You’re not going to get some patients away from bifocals, but if you’re still putting most of your patients in them you’re crazy. To me, we’re not doing our job as eyecare professionals if we’re not moving patients toward the best products, the best solutions for their vision—like progressives. If you use the right products, you’ll have more satisfied patients.”

Prescribing Progressives
Newer progressive designs have made wearing no-line bifocals easier, but prescribing and fitting them correctly can still be challenging. Before dispensing progressives, remember…

… that one size doesn’t necessarily fit all. Progressive designs differ dramatically, depending on brand and manufacturer. Have any presbyopes on-staff try several designs out themselves and note any “wearability” trends. Also, ask your lab for advice. It’s fine to remain loyal to a certain brand or manufacturer, but explore all the options. It can mean the difference between a happy progressive-wearing patient and a “non-adapt.”

… that short-corridor progressives must be fit with care. Short-corridor PALs are designed to be fit just like regular progressives but, while younger patients generally do well with them because their eyes can transition from the distance to the add very quickly, some older patients and long-time progressive wearers can have difficulty. They sometimes need the full intermediate zone in order to make the transition between distance and near. Remember, too, that all patients lose more intermediate zone as their “add” increases.

… that fitting “indoor progressives” requires more than just the patient’s prescription. To determine whether these products will work well for particular patients requires special attention to the patient’s workplace environment and the activities of their occupation.

… that each “indoor progressive” design also has its own, unique fitting requirements. Ask your lab, as well as the manufacturer, for advice before fitting. Because this is a “second-pair” sale, patient satisfaction is paramount.

L&T expert opinions courtesy of: Jon Bright, The Spectacle Shop, Charlottesville, Va.; Carter Lowry, New Opticians, Lexington, Va.; Jeff Anshel, OD, Poinsettia Vision Center, Carlsbad, Calif.