My sister-in-law called, worried about her husband. He was having headaches and neck and shoulder pain, and she didn’t know why. My optical instincts kicked in, and I asked when he had his last eye exam. It was about four years ago. He is 65, working from home on digital devices, and wearing the readers he got at his last exam. I told her his complaints were consistent with digital eye strain, that he needed an eye exam, and most likely progressive lenses. “But they’re so expensive!” she replied. I did my best to convince her that the investment was well worth it. It worked.
It turned out that Bill not only needed a distance prescription, but prism. Not having had a distance prescription before, and now prism, I knew it would likely be a difficult adjustment for him. However, I was pleased to hear that he bought a pair of photochromic progressives and a pair of readers. Then Bill called. He had picked up the glasses two days before and was very uncomfortable with the progressives. Distance seemed to be acceptable, just “a little weird.” The bigger problem seemed to be at near. He works on two computer screens and two phones. He needs a wide field of vision but was only seeing clearly for less than the width of the page. I was waiting to be blamed for the expensive recommendation, but fortunately Bill was willing to listen.
Bill’s difficulty got me thinking about a common ECP anxiety: Fitting progressives too high. I’ve found that, especially with first time progressive wearers, some opticians are reluctant to fit progressives as high as they should be so as not to “interfere” with the patient’s distance vision. But don’t patients get progressives because they need reading correction, too? The miracle of progressive lenses is that when fit properly, they correct distance and near with a bonus at intermediate; good vision everywhere it’s needed.
Proper fitting height is critical, especially with today’s advanced lens designs. They are custom created to match lenses to individual prescription, unique measurements, visual demands, and position of wear. I find it helpful to remember that marking the pupil is marking the distance center of the lens. The fitting reference point (FRP) or fitting cross should be directly over the pupil. The lens design will naturally “progress” from the distance power to the near power, ensuring that the near power is positioned properly.
So don’t second guess yourself or the lens. Be bold! Put that progressive height where it belongs. You can learn more about an adaptive lens technology that changes with the digitally connected wearer's age-related vision requirements with our CE, SMARTLIFE: The Evolution of Lens Design for Dynamic Connectivity, at 2020mag.com/ce. This course is free, supported by an educational grant from ZEISS Vision Care.