Short Stop
Stop and think about short corridor PALs for boomers and seniors. Here are ways they can work well for your patients of a certain age
By Karlen McLean, ABOC, NCLC
Short corridor PALs are touted as being the perfect presbyopic lens selection for small, fashionable frames. Most baby boomers these days are seasoned multifocal and PAL wearers who want options in eyewear, including smaller frames with short B-measurements.
Here, ECP experts weigh in on PAL solutions for the boomer and senior sets.
SENIOR SELECTIONS
Short corridor PALs may be a highly viable option in many cases. "The most important thing is patient selection," says Jim Lewis, president of Harvey & Lewis Opticians in Hartford, Conn. "You're looking for someone who is motivated enough to overcome the limitations of the lens with the primary issue as vanity."
Adds Randall I. Shadd, optician-owner of Artisan Optical in Las Cruces, N.M.: "You can sense on an individual basis how patients will behave with various lenses. I want patients to understand what they're giving up and what they're getting with short corridor progressives."
Converts: Conversion from flattops to PALs has become less challenging and more appealing, notes Craig Thomas, OD, of First Eye Care in Dallas. "New PAL technology is easier to adapt to and use. We use them when the frame style and size dictate it," he says.
| CHECKLIST: personality pointers |
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| When working with seniors, patience pays. Some points to live by when dispensing to seniors are: - Address medical reasons behind any recommendations you make. - Don't sell. Explain why you're suggesting a certain frame and lens combination. - Point out features, explain benefits briefly, then more in-depth if called for. - Repeat recommendations and wearing instructions as often as necessary during the first visit and again on dispensing the eyewear. - Remember that some seniors can be suspicious of "young whippersnappers" who are telling them about their vision. You have to earn their trust by being honest, patient, and precise in your recommendations. - Ask if they'd like a follow-up telephone call around two weeks after dispensing to discuss how they're doing with their new eyewear, and be sure to make the call. - When converting bifocals to PALs, point out the advantages of gaining intermediate vision, such as reading charts on a wall, seeing items on a grocery shelf, or dashboard gauges. - Have giveaways available, such as cleaning kits, upgraded fashion cases, or even lens options like AR. Offering a little something extra as a bonus for them enhances their perception of your practice. - If a patient is clearly happy with the eyewear they now have, even if it's a large frame with flattops, don't push. Seniors typically don't go back to places where they feel they've been strong-armed. |
Women: Generally, senior women tend to be the most adaptable to short corridor PALs in smaller frames, since they're highly motivated by fashion and are willing to make "lens amends" to achieve personal appearance goals.
Selecting small frames isn't a problem with short corridor PALs. Images courtesy of, top to bottom: Thai Optical, Carl Zeiss Vision, and Signet Armorlite
"One senior lady who drives a convertible and even got rid of the cane she was using because she didn't like its looks recently came to us seeking smaller frames," Shadd recalls. "She was into it more for the fashion aspect than the medical aspect. We put her in short corridor lenses and she's happy."
Fresh look: Seniors tend to keep their current Rx longer than other patients. This may be because of fixed incomes with cost as a factor, but can also be clinically valid, as patients 60 years and older usually experience a period of stability for refractive error. It can be up to five years before an Rx changes in this life stage, resulting in frame and lens style lag.
"Seniors frequently come into our practice wearing larger frames and flattop bifocals," says Kirk Smick, OD, of Clayton Eye Center in Atlanta. "They're aware they're not fashionable and want to freshen their look. We recommend smaller frames and short corridor PALs."
| QUIZ: multiple choice |
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| Short corridor PALs can operate as a primary pair of eyewear, but do you know are other options instead of or in addition to short corridor PALs? 1. How can I present computer eyewear to the senior market? a. Explain that those who spend many hours a day on a computer can see more comfortably with short corridor PALs with an intermediate vision top and near vision bottom. b. By making sure seniors take off their computer eyewear and put on their regular eyewear after computer sessions. c. A short ECP-to-patient course on computer eyewear features, benefits, and usage can help seniors grasp the necessity for computer eyewear while learning how to best use it to full advantage. 2. Conversion-friendly PALs are a good choice because: a. Some PALs in the marketplace today offer easier adaptation when patients convert from flattops to PALs. b. Some PALs can be measured and used effectively as a short corridor option. c. Several hard designs work well for conversion, while soft designs are good for early presbyopes. 3. How are blended or round segs a viable option? a. For those who don't want the line but don't want PALs either due to expense or adaptation issues. b. For those with vanity as a major consideration: lines aren't as apparent as in a flattop, so blended and round segs offer vanity appeal. c. For patients who are not trying to meet their intermediate vision correction with these lenses. 4. How and when does reading-only eyewear come into play? a. For seniors who do a lot of reading of the newspaper or at a desktop, for example, consider near-vision eyewear, even half-eyes. (Ask patients to re-create their reading habits in the practice so that the reading task distance can be measured and the Rx modified if necessary to their preferred viewing distance.) b. When users are seeking a great second or third pair or something that can be modified for specific hobbies. 5. Television eyewear calls for short corridor PALs when: a. Seniors watch television while sitting back in an easy chair. b. Watching TV while reclining in a bed. c. Both activities. Either can place the multifocal or PAL segment squarely in their distance field-of-view, diminishing their distance vision. Offer to make them a single-vision, distance only pair of glasses specifically for TV viewing. HINT: All of the above works for all of the questions above. |
CHALLENGES & COMPROMISES
Short corridor progressives won't work for every senior. Some prefer larger frames and are less adaptable to new technology.
At Harvey & Lewis Opticians, the staff is careful when switching flattop wearers to PALs and tries to identify patient motives combined with medical need. "Seniors may stick with larger frames and regular PALs," says Thomas. "Several older men still prefer a double-bridge large frame with flattops or regular PALs."
"We don't use short corridor PALs to flip flattop wearers as a rule," notes Shadd. "With short corridors, the intermediate corridor is typically short-changed, and the main advantage of going with PALs is a gain in intermediate vision."
Short-corridor PALs enhance intermediate vision. Shown above: Seiko Optical Products. Shown below: Essilor of America
"The biggest complaint from flattop wearers is usually the width of the reading versus dealing with the intermediate zone," says Lewis. "Also, someone who's used to half-eyes with a large field of view may find progressives difficult."
But, Shadd adds, "One instance where using short corridor progressives for flattop conversion works is if there's a light distance Rx and emphasis is more on intermediate and near vision, not distance vision."
The final consideration is giving people what they want. "Short corridor progressives are mentioned most often in frame selection, where we'll tell patients that because of newer lens designs their choice of frames is not as limited as it used to be," Lewis says. "People love this because now they can get the frame they want without having to worry that the reading area will be cut off." EB
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