CONTINUING EDUCATION
An Easy Way to Select the Right PAL
By Jenean Carlton BA, ABOC, NCLC
Here’s a scenario that takes place every day in practices across the country: A patient in his early 40s comes into the office for a routine eye exam and tells his optometrist he is suddenly having difficulty reading fine print. He explains that he needs brighter light to read and has to hold reading materials at arm’s length to see the words clearly.
The doctor completes the exam and informs her patient that his vision is normal. She explains that what he is experiencing is presbyopia, a vision condition in which the crystalline lens of the eye loses its flexibility, making it difficult to focus on near objects.
STANDARD PROCEDURE
After discussing lens options, the doctor determines that her patient is a good candidate for progressive lenses and educates him about the benefits of no-line multifocals. After this discussion, she escorts the patient to the dispensary and introduces him to one of the staff opticians.
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Upon completion of the course, supported by an educational grant from HOYA Vision Care, the participant should be able to:
CREDIT:This CE is approved for one (1) credit as a Technical, Level 2 course by the American Board of Opticianry (ABO). The number for this ABO-approved course is STEB138-2. TEST PROCEDURES:Following the article is a test consisting of 20 questions, the answers to which must be completed in the crossword puzzle in order to receive ABO CE credit. Respondents must correctly answer 16 of the 20 questions in order to receive credit. This is a new format for CE, so please remember to write your answers in the correct blank crossword puzzle boxes to complete the course. You may photocopy the form for multiple respondents. Eyecare Business must receive the completed crosswords (via U.S. mail, fax, or emailed scan) by May 15, 2014. We will notify you of results within one month of receipt of your completed crossword test. SPONSORSHIP:This course has been supported by an educational grant from HOYA Vision Care. 
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Next, she discusses the patient’s prescription and lifestyle information with the optician and completes the transfer of patient care by letting her know that the patient is an emerging presbyope and now needs progressive lenses.
The optician reviews the patient’s prescription and looks over the lifestyle questionnaire he completed when filling out the new patient documents. The questionnaire asks about lifestyle, occupation, hobbies, sunwear protection, and more. The optician educates the patient on how progressive lenses closely mimic natural vision by providing a smooth flow of power when viewing objects from distant to near, similar to the natural vision the patient experienced before he became presbyopic.
This scenario seems easy enough, especially for experienced opticians who thoroughly understand their profession. But in reality it’s a bit more complex.
While the conversation is taking place between the patient and optician, the optician is busy thinking, “Which progressive design should I use? There are hundreds of progressive lens options available to me. How do I know which one is best for this patient?”
SO MANY DESIGNS
Selecting a progressive design for a patient is a daunting decision because there are so many lens options from which to choose. Even though consumers are more educated than ever about optical materials—largely from manufacturers marketing directly to consumers through multi-media outlets—in our patients’ eyes we are still the experts when it comes to eyewear. They expect us to select lens designs that will meet their visual and lifestyle needs.
But it’s difficult to stay up-to-date on all the progressive designs in the industry because managing patient care leaves little time for researching product information.
Couple this with the marketing materials practitioners are inundated with about product offerings and many of us are left scratching our heads about lens choices for patients. Wouldn’t it be nice if there were an easier way to select progressive designs for patients? Particularly for those who aren’t opting for individualized lenses? We know the benefits of truly customized lenses that are tailored to a patient’s specifications but, let’s face it, all patients aren’t able to afford the premium price of these high-tech lenses. So, we need an efficient way to select appropriate mid-tier PAL designs for patients.
Understanding these challenges, HOYA has developed a series of lenses designed to fill this need. The company began this project by studying the years of data compiled from HOYALUX iD MyStyle orders.
This image represents how the lens will be represented in a lensometer–no tilt,vertex,or face form. For iD LifeStyle 2, the compensated Rx is provided so the dispenser can verify the power in the as-worn position
DRILLING INTO DATA
HOYALUX iD MyStyle is HOYA’s individualized progressive that is fully customized for each patient’s unique prescription, measurements, and lifestyle. When placing an order for iD MyStyle, practitioners sign into a website dedicated to the ordering process and enter the following patient-specific data: age, previous prescription, brand and style of PAL design previously worn, the new prescription, frame style and size, segment height, vertex distance, pantoscopic angle, and face form angle.
The questions don’t stop there, though. The second part of the ordering process presents 15 different icons to show the many ways patients use their eyes. With the assistance of their optician, patients are asked to click on the icons that best describe how they use their eyes on a daily basis. Information such as how often patients use cell phones, whether or not they drive at night, if they play golf or enjoy listening to music, the amount of time spent watching TV, whether they enjoy outdoor sports, and more is gathered.
The patient quantifies the answers by rating each activity with a star rating from one to five. Five stars indicate that the patient spends a great deal of time each day performing this activity and one star implies the activity is seldom done throughout a normal day.
After collecting this data for years, HOYA discovered trends in how patients use their eyes based on age, lifestyle, etc. The end result led to the development of a new mid-tier product that is less expensive than an individualized lens and doesn’t require the extra measurements of a customized PAL, but, according to the company, consistently delivers superior visual performance and facilitates easy selection of the best design for a patient.
SELECTING THE RIGHT PAL
HOYA’s new progressive offering is the HOYALUX iD LifeStyle 2™. HOYA has taken the features of the iD LifeStyle and added more customization to the lens by offering it in two design options: HOYALUX iD LifeStyle 2 Clarity™ and HOYALUX iD LifeStyle 2 Harmony™. Both the Clarity and Harmony designs are available with corridor lengths of 11mm and 14mm, corresponding to minimum fitting heights of 14mm and 18mm.
Both designs provide characteristics that enhance the visual performance for two distinct groups of presbyopes: those who require a wide distant zone and those who need a generous reading area. By offering two designs that complement each other, eyecare professionals can easily and quickly select the progressive that best meets patients’ visual demands without spending hours of research studying scientific papers and marketing materials about progressive designs.
HOYALUX LIFESTYLE 2 CLARITY
The HOYALUX iD LifeStyle 2 Clarity design is developed for distant vision comfort and offers wide, clear, unobstructed viewing above the 180 line. This design makes Clarity the ideal PAL for pre-presbyopes, early presbyopes, and mature presbyopes requiring clear distant vision. It is especially beneficial to pre-presbyopes and early presbyopes who still have some accommodative power and don’t yet need a lens design that offers a super wide near zone. The typical patient fitted with Clarity is from the age of 35 to 50 and leads an active lifestyle, such as an avid golfer or someone who spends lots of time driving.
The HOYALUX iD LifeStyle 2 Clarity is available in two corridor lengths: 11mm and 14mm, corresponding to minimum fitting heights of 14mm and 18mm.
Because the Clarity design is optimized for the distance viewing field, the progression of power along the corridor occurs quickly, indicating that the distance zone is wide and clear. Lens designs that feature a quick rate of power change along the corridor are classified as “harder” designs, indicating that patients will experience wide and comfortable viewing zones when looking through the areas of the lenses that have been optimized for peak performance.
| Digital Measuring |
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Spectangle is HOYA’s digital measuring app originally developed for the iD MyStyle lens. The app runs on an iPad2 platform and is available for purchase through iTunes. Once the app is uploaded, dispensers can order a fitting kit from HOYA which includes a measurement lock-on device. Once the lock-on device is positioned onto a frame, opticians are able to take pictures of the patient with the iPad’s camera. Sensors on the lock-on device enable the app to precisely configure the measurements needed for advanced PAL lenses including pantoscopic tilt, face form angle, back vertex distance, fitting height, A, B, DBL, and more. Though the Harmony and Clarity designs don’t require all of these measurements, Spectangle is an ideal tool for taking the PD and fitting heights needed to accurately fit these lenses. |
HOYALUX ID LIFESTYLE 2 HARMONY
Designed around near vision comfort, the HOYALUX iD Life-Style 2 Harmony is for presbyopes and mature presbyopes who depend primarily on the near zone of their lenses to perform the majority of their daily visual tasks. The typical patient fitting with the Harmony design is 50 years of age and older and requires a large reading zone because of their occupation, such as an office worker or editor who works on a computer much of the day, or even a doctor who needs to chart patient information while taking care of patients.
Harmony is optimized for the near zone to be the widest and clearest field and, as an added bonus, the distance zone offers a generous width for comfortable, safe driving. The HOYALUX iD LifeStyle 2 Harmony is available in two corridor lengths: 11mm and 14mm, corresponding to minimum fitting heights of 14mm and 18mm. Harmony is a softer lens design featuring a slower rate of power change along the progressive corridor when compared with the quick rate of power change along the corridor of the Clarity design. Because of the slow rate of power change on the surface of the Harmony lens, the corridor is bordered by low amounts of unwanted astigmatism in the periphery of the design. This equates to more stable vision for patients by providing less distortion and “swim effect” when walking or turning their head abruptly.
MINIMIZING SKEW DISTORTION
Since progressive lenses entered the market in the early 1970s, the power corridor has typically been positioned on the front surface of the lenses. This was particularly the case when lenses were fabricated with traditional methods using a surfacing wheel embedded with fine diamond particles to roughly grind the prescription into a semi-finished lens blank. This traditional method of surfacing lenses is still used in many labs today, particularly when fabricating high-powered and specialty lenses.
Because manufacturing progressive lenses in this manner required the corridor to be on the front surface of the lens, it wasn’t possible to fabricate progressives with the corridor on the back, surface of the lens, or have the corridor split between both the front and back surfaces like the HOYALUX iD Lifestyle 2 designs, which are fabricated with free-form technology. Without being able to manipulate the curvatures of both the front and back surfaces with freeform manufacturing methods, frontsurface corridor lenses can create a significant amount of “swim effect,” causing patients to feel unsteady and even dizzy when wearing progressive lenses.
Spectangle is HOYA’s digital measuring device that precisely configures measurements needed for advanced PAL lenses such as vertex distance, fitting height, face form angle, and more
Skew distortion, often referred to as “swim effect,” is a real problem for patients whether they are new to progressive lenses or have worn PALs for years. It is frequently the reason patients have problems adapting to progressive lenses.
Skew distortion is due to the combination of the complex distribution of power on both the front and back surfaces of progressive lenses. The complex changes in power on both surfaces create unwanted cylinder in areas of the lens and, because of this, objects can seem to sway, move, or become distorted because of the power changes in magnification along the power corridor and unwanted cylinder in the periphery. Though some level of skew distortion is unavoidable in progressive lens design, free-form surfacing allows more flexibility to manipulate the distribution of optics on the lens surfaces by using free-form technology on both sides of the lenses. This technique greatly reduces the overall level of skew distortion.
After much research and years of working on this problem, HOYA has developed a proprietary method of drastically eliminating skew distortion. HOYA reports that its Integrated Double Surface (IDS) technology manipulates the design on both the front and back surfaces to result in smoother transitions between the distance and near zones, wider viewing fields, and virtual elimination of blurring and swaying sensations in the peripheral areas of progressives.
SELECTING A FRAME
The best frame choice for PAL wearers is a frame that offers a “B” measurement that is deep enough to house the entire length of the power corridor. Frames with “B” measurements that are too narrow result in the near zone being edged off in the finishing process and near vision problems for presbyopes.
Frames with adjustable nose pads are also good options for PAL wearers as nose pads allow dispensers to make adjustments in the height of the progressive corridor if needed. If the fitting height of a PAL is too low, simply adjusting the nose pads closer together will raise the fitting height. If the segment height is too high, widening the nose pads slightly will lower the corridor placement and allow the patient to use his or her eyewear more comfortably.
ADJUST THE FRAME FIRST
It’s important to always adjust the frame prior to taking any measurements. Adjust the frame for the patient just as you would when dispensing the finished eyewear, making sure the frame has 7 degrees to 12 degrees of pantoscopic tilt and the proper amount of face form wrap. With progressives, the frame should be fitted as closely as possible with a maximum vertex distance of 12mm so the patient can appreciate wide fields of vision through the zones of the lenses.
A BETTER WAY TO MEASURE
Free-form fabricated lenses offer a level of optical performance that simply wasn’t available with traditionally surfaced lenses. However, for these advanced lenses to provide the best vision possible, it’s imperative to provide manufacturers with precise ocular measurements when ordering these lenses.
Though it’s possible to take such critical measurements as the monocular PD, fitting height, vertex distance, and more with standard measuring tools, such as a millimeter ruler, distometer, or corneal reflex pupilometer, modern digital measuring devices are able to take these measurements more quickly and accurately.
Because free-form lenses are the best the industry has to offer, and come at a premium price to the practice, as well as to consumers, why take a chance on making an error by taking measurements with older, more subjective methods?
Depending on the lens design, being off even by 1mm on a monocular PD can mean the difference between patients being able to easily move their eyes down a PAL corridor to easily see objects from distance to near. The inset for the PAL corridor is dependent on the monocular PD for each eye; if either measurement is off, then the patient will have difficulty gaining one fused image when looking at objects through his or her progressive lenses and will particularly have difficulty reading with his or her PALs.
Too often, the measurements needed for PALs such as monocular PD, vertex distance, pantoscopic angle, face form wrap, and segment height are incorrect because of errors made by dispensers. The bottom line is that taking these measurements manually, even in the most skilled hands, is difficult because patients move their heads and eyes while dispensers attempt to take measurements.
Doesn’t it make more sense to eliminate these errors all together by incorporating the use of digital measuring devices in your dispensary? This way the chance of measurement errors occurring is greatly reduced, which means fewer remakes for your practice and a higher level of patient satisfaction.
Digital measuring devices bring lots more to the table than just taking measurements, though. Many of them will also let you know if the frame isn’t fitted correctly. For example, if one of the temples is lower on one side than the other, the program will bring this to your attention before taking any measurements. This is a good feature, as it’s important for a frame to be adjusted accurately prior to taking any measurements.
Additionally, some of these devices even assist ECPs with educating patients about premium lenses, AR coatings, polarized lenses, and more. Some even allow patients to view photos of themselves, side-by-side, wearing several different frame options.
This feature helps patients to make quicker decisions about frame choices and also gives dispensers an opportunity to explain how some frames will work better with progressives and with a patient’s Rx, because of the frame shape and the depth of the “B” measurement.
Another reason to use digital measuring devices in your office has to do with patient’s perception. Patients are accustomed to living in a high-tech world. If a practice utilizes the latest-and-greatest equipment during the eye exam and then uses outdated tools, such as a PD ruler, to measure patients for premium free-form lenses, patients may sense a disconnect between the technology used during the exam and that used in the dispensary when ordering lenses. This disconnect could have a negative affect on your business, especially because some companies are advertising their digital technologies directly to consumers. Patients want to know that all aspects of your practice, including the dispensary, are keeping up with current technology. Incorporating digital measuring devices in your dispensary is one way to accomplish this.
VERIFY CUT OUT
Dispensers should always verify that the lenses will cut out by using a cut-out chart supplied by the vendor before submitting the order to the laboratory. With free-form manufacturing, it’s rare to have a lens not cut out.
However, it is a good habit to check that the lenses will cut out properly with the chosen frame. Checking that the lenses will cut out by using a cut-out chart keeps patients from having to come back in the office to select a new frame and may prevent the practice from losing a patient.
VERIFICATION
The HOYALUX iD LifeStyle 2 Clarity and Harmony designs are fabricated with free-form manufacturing technology. All HOYA lenses are calculated to deliver the accurate prescription power when worn by the patient; the company includes a compensated Rx form with each order so dispensers can quickly and accurately verify the power of the lenses using a manual lensmeter.
Because of the optimization achievable with free-form technology, the compensated prescription values may differ slightly from the prescribed correction. When verifying the distance power of finished HOYA progressive lenses with a lensmeter, measure the compensated distance power in the center of the distance-checking circle. When verifying the add power, measure the compensated add power in the center of the circle in the near zone. Likewise, verify the compensated prism at the prism reference point mark, which is located just below the fitting cross.
| Puzzle: A New Test |
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For continuing education credit, insert the correct answer to each question (there are four options following each question) in the appropriate boxes in the crossword puzzle accompanying this course. The first section is for answers that run across in the puzzle, the second is for answers that go downward. You can mail, fax, or scan and email the completed crossword puzzle to us at Eyecare Business, as indicated at the bottom of the test. Do NOT place the answers in the questions, as we will only accept tests for credit that have the answers in the crossword puzzle itself. We hope you have fun with this all-new format for CE. |
TWO OPTIONS
The new HOYALUX iD LifeStyle 2 is the next generation of progressive lenses from HOYA. This new lens series offers practitioners two design options: HOYALUX iD LifeStyle 2 Clarity and HOYALUX iD LifeStyle 2 Harmony. Each design provides characteristics that enhance the visual performance for two distinct groups of presbyopes—those who require a substantial distant zone and those who need a large reading area.
By offering two unique designs, ECPs are able to easily select the progressive that best meets the visual demands of their patients.
The most accurate and easiest way to obtain measurements for Harmony, Clarity, and other advanced lens offerings is to use a digital measuring device. Incorporating the use of one of these devices in your practice will greatly diminish the percentage of remakes in your office while increasing customer satisfaction.
This course has been supported by an educational grant from HOYA.
Crossword
To receive one CE credit, please complete this crossword puzzle and submit it and the test form to Eyecare Business no later than May 15, 2014. You may photocopy and mail this page, scan and email it, or fax the finished puzzle and form. To fax, send it to 402-327-9299; to scan, email it to eyecarebusinesseditor@broadcastmed.com; and to mail a hard copy, send it in a stamped envelope to: De Long/HOYA CE, 3630 S. 76th St., Lincoln, NE 68506. If you have any questions, email us at eyecarebusinesseditor@broadcastmed.com.
Click here to download a printable PDF version of this CE course
across
6. A ______ asks patients about their occupation, hobbies, sunwear protection, and more.
7. _______ is designed around near vision comfort.
10. The _____ for progressive corridors is dependent on the monocular PD for each eye.
11. Clarity is ideal for pre-presbyopes, ____ presbyopes, and mature presbyopes.
13. ________ is designed for distant vision comfort.
14. Clarity is especially beneficial to early presbyopes who still have some _____ power.
19. Frames with _____ nose pads are a good idea for progressive lens wearers.
20. Harmony is a ____ lens design featuring a slower rate of power change along the corridor.
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- - Digital measuring device
- - Integrated Double Surface
- - Swim effect reduction
- - Adjustable nose pads
2. HOYA’s new progressive is the HOYALUX iD ____. (Two words)
3. Wouldn’t it be nice if there were an easier way to select ___ designs for patients?
5. The most accurate way to obtain measurements for advanced lenses is with a digital ____device.
9. HOYA includes a ____Rx form with each order.
12. The Clarity design is optimized for the ____viewing field.
17. Always ____ the frame prior to taking any measurements.
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