Lens Choices

   Once in a bifocal, always in a bifocal. That was my philosophy for years until one day in 1997 an 80-year old couple walked into my shop and demanded progressive lenses. Theyd talked to their friends. Theyd seen all the advertising. Theyd done their research. They wanted progressive lenses.
Like any responsible optician, I did my best to talk them out of it. I had visions of falls and broken bones and crutches and wheelchairs and angry adult-sized children.
   Then I stopped, gave them some frames to look at and some literature to read. I went into my lab and took a deep breath. Was what they were asking for so terrible? I already knew that success with progressive lenses, at least way back then, was about 90 percent desire and about 100 percent proper fitting and adjusting. Why not give it a go? After all, they already knew what the fall back was; they were wearing flat-top bifocals.
   I went back and talked with them about progressive lenses just like I would talk to any other patient. We discussed pros and cons, materials, tints and coatings, frame considerations and learning curves. They convinced me that they were going to be successful PAL wearers. I was cautiously optimistic. Perhaps, my old theories were just that old. Perhaps it was time to start offering progressive lenses as an option to everyone.
   Although my first conversion from bifocal to PAL was successful, I still had to make a conscious effort to suggest that change to most of my patients. Like selling second pairs, I made a commitment to offer the PAL option to at least one person a day. After a while, it became second nature to talk about the idea of change to everyone. Talking with my patients is really listening to them. I had to learn to ask questions about their visual environments and then be quiet and let them tell me what they needed. I use my lens center display to help describe the advantages of one lens design over another. My patients understand that I am there to help but that learning to use this new technology is a partnership requiring effort on both our parts.
   My next success was with an accountant for a large chemical corporation. She was convinced that bifocals were the right technology, yet complained regularly about neck pain and eyestrain by the end of her workday. We made a bargain, new progressive lenses in her frame (I kept the old lenses just in case) and shed wear them every day. We spent some time learning how to use the lenses, walking around, sitting at my computer and reading books and newspapers. We made an appointment for two weeks later so I could check her frame adjustment and her progress. At two weeks, she was still learning but making progress. Two weeks after that, she said I could keep the lenses. I was learning as well.
   I learned that listening to needs was paramount, that matching lens design to those needs was also key. I also learned that my patients need to understand that this is a partnership, requiring effort on both our parts. That follow-up appointment turned out to be a great idea. I felt confident enough to actively pursue bifocal to PAL conversions and I have to believe that my enthusiasm and my positive attitude about the changes I was suggesting improved my odds of success. Im a longtime PAL wearer, so I dont have a real understanding of the trepidation my patients feel about changing something as essential to everyday life as the ability to see at near distances. It has become my job to be a coach and a cheerleader for every one of them who chooses to try something new. I havent really kept track of the percentage of conversions Ive made, but Ive been successful enough to have the confidence to at least make the suggestion.
   Continual advances in lens design have significantly broadened the range of options for bifocal and trifocal wearers who are considering PALs. Each new generation of progressives features a softer design than previous ones, making patient adaptation easier. This is important to stress to patients who may have once tried older PAL designs and found them difficult to adapt to.
   One of the latest developments is the Varilux Liberty lens. Introduced in 2004 by Essilor, Varilux Liberty is designed to ease the transition from bifocal to progressive. The lens offers a proprietary design featuring a generous near vision angle, soft design and binocularity.
   Recently, Essilor challenged Eye Health Vision Center in North Dartmouth, Mass., a tri-thalmic practice with four locations, to convert current bifocal patients to Varilux Liberty. Over a three-month period, 117 patients, representing 71 percent of the practices bifocal wearers, were converted with a very low non-adapt rate.
   Mike Horan, regional manager of Eye Healths optical division, attributes the success to both patient and staff education. We take a very aggressive approach when introducing any new technology to our practice, says Horan. We bring local experts to ensure that the staff is as comfortable and knowledgeable as possible. Every patient is given a lifestyle questionnaire to complete and bring into the exam room. Our doctors review that document with their patients and make appropriate recommendations from the chair. Eye Health has become so successful that it now conducts one-day on-site consultations for other area practices.
   Optician Charlie Reischer of Park Slope Optical, a small shop in Brooklyn, N.Y., has also been successful with the Liberty lens. Of the 40 to 50 lenses fitted at his shop, only one has been a non-adapt. According to Reischer, the patient just didnt get it. She just didnt understand how the lens worked and didnt have the patience to weather the learning curve. Asked if he regarded the Liberty as a stepping-stone to the more conventional designs of Panamic or Comfort, Reischer wasnt sure but felt that it could be used not only for bifocal conversions, but also for new wearers who need the wider reading area.
   Jeff Kiener, OD, an independent practitioner in Westerville, Ohio, says that his staff does not aggressively promote bifocal conversion to PALs, although they recommend PALs as an alternative to trifocals. If the social stigma of wearing a bifocal lens is twice that of a single-vision pair of glasses, then a trifocal is easily three times more unappealing to most candidates, says Dr. Kiener. Even using a conventional progressive design as opposed to one specifically designed for that transition, Dr. Kiener says his staffs success rate is above 50 percent.
Most eyecare professionals agree that successful conversions are attainable with most progressive lenses if they are properly fitted and adjusted, and if the patient is properly schooled in their function and use. Reassuring the patient and troubleshooting the lenses after they are fitted are also essential. Although youll probably have to do some hand-holding, the results will be well worth it for your patients as well as for the satisfaction youll get knowing you provided them with the most advanced lenses available. LT

Judy Canty is a licensed optician working
at Powell, Focus and Canty Opticians in Alexandria, Va.