Multifocals and progressives have specified fitting heights. Remember:
1. Adjust the frame to the patient. Include some faceform (about 5 degrees) and pantoscopic tilt (7-10 degrees).
2. Choose sufficient segment heights for all the tasks that the patient needs. Understand the minimum fitting height for progressive designs chosen so that there is ample near and the lab can supply the lens as specified.
3. Fit with short vertex distance—this maximizes the field of view in progressives.
4. In bifocals and trifocals, measure the fitting height to the top of the segment from the bottom most edge of the lens. For bifocals, fit to the top of the lower lid, for trifocals to the lower edge of the pupil. This a starting point, consider the segment height of the previous glasses, height of the patient and patient satisfaction with their previous lenses.
5. If the patient is tall and uses their eyewear while standing, then 1-2mm lower might be better. If only for reading then higher. As a second pair for golf, then much lower so as not to be in the way while putting.