An eye mover uses a greater percentage of the lens while a head mover will stay in central channel of the lens, explained Kirk Harris, OD, of Doctor’s Vision Center in Washington, N.C. Harris was an early proponent of the lens and has been successful for a year and a half in presenting this as a lens that offers personalized vision.

Kirk Harris, OD

“Patients dislike having to point their head,” he said. “Patients have adapted but not enjoyed that older style of lens. In my experience, it’s wonderful for those people who can just put it on and not feel limited.”

To underscore the personalized nature of the Varilux Ipseo lens, the wearer’s initials are engraved on the lens itself.

“I use common world comparisons that most people experience every day,” said Harris, who believes in educating and not just selling his patients. “I explain that this is a lens built to your specifications, in the same way that a car can have settings just for you.”

Carl Zeiss Vision (CZV) also takes a high-tech approach to measuring patients for PALs. Last month at International Vision Expo East, CZV introduced the latest version of its Eye-Terminal, a patient fitting, measurement and consultation device. Eye-Terminal employs a precision digital camera, a computerized measuring system and a patented laser speckle-target system that assures proper distance fixation by the patient. Eye-Terminal automatically takes all progressive lens fitting measurements to an accuracy of 0.1mm. At the same time, it takes all measurements needed to create advanced customized progressives using direct surface manufacturing, including back vertex distance, pantoscopic angle and frame wrap. Eye-Terminal’s consultation module allows patients to see how they look in their chosen frames, and offers interactive demonstrations of lens enhancements.

Optician Paul Dimos uses the Zeiss Eye-Terminal to measure a patient for glasses.

Paul Dimos, an optician who owns Eye Look Off Lexington in Lexington, Mass. has been using the Eye-Terminal for the past two-and-a-half years.

“It’s a great unit,” said Dimos. “I’m a believer that in order to take proper measurements, you need a device like this. A standard pupilometer is accurate for taking PDs, but not for dotting lenses. Eye Terminal gives you all vertical, height, monocular PD and total PD. It also has the capability of measuring vertex distance, distance of eye to lens, curve of frame and pantoscopic tilt. There is a menu, depending on what lenses you’re using--bifocals, trifocals, progressives, single-vision or aspheric lenses. It’s very accurate for aspheric lenses which must be fitted a certain way. You can’t put the lens smack against the cornea with an aspheric. The distance has to be calculated, and this unit does the calculation for aspheric and atoric lenses.”

Dimos also likes other features of the unit, such as its ability to demonstrate the difference between bifocals and PALs and AR lenses and non-AR lenses as well as the ability to display tinted and photochromic lenses.

“It’s a complete solution,” said Dimos. “From a technical point-of-view, it is very accurate. I also like that it’s impressive to clients. You can walk them through the measuring steps, and other patients see we have the latest technology. All measurements are computerized. At the end, we dispense Zeiss lenses, which is what we mainly use. The patients can see the difference in the whole process for selecting the frames and lenses.” Upon dispensing the patient’s eyeglasses, Dimos provides them with a print out generated by the Eye-Terminal which includes the patient’s photo and all the measurement details.

Indo Lens U.S. also offers a system that allows ECPs to measure each patient’s “visual strategy,” which the company defines as “a coordinated set of eye and head movements that come into play when performing a visual activity.” The system employs Indos’ proprietary Visual Map technology.

Ophthonix, a relatively new player in the PAL market, takes a different approach to patient measurements. In order to prescribe Ophthonix’s iZon PAL, optometrists must use the company’s proprietary Z-View aberrometer to evaluate low- and high-order aberrations. These captured data, including the high-order aberration measurements of spherical aberration, coma, and trefoil, are transmitted to the Ophthonix lab where the lens is laser generated. This information can be sent to the lab electronically, or faxed or sent as hard copy.

Brian Chou, OD, of Carmel Mountain Vision Care in San Diego, reports good patient response to the Ophthonix iZon High Resolution Progressive lens. As with the single-vision iZon lens that the practice has fit for several years, patients respond well to the “high definition” clarity of the PAL lens optics. The company claims to make each lens to the “ocular fingerprint” of the individual wearer.

Brian Chou

“Both iZon lenses attempt to correct higher order aberrations of the eye,” said Chou, “and it’s a real point of distinction from using wavefront technology to only control inherent aberrations of the spectacle lens.”

The iZon progressive works well on patients that fall within the available parameter range of -6.00 to +4.00D sphere with up to -4.00D cylinder and up to a +3.50 add, according to Chou. The practice charges a $100 to $200 premium over other high-end PAL lenses. The iZon lenses are generated in a 1.6 high-index material with a full complement of lens treatments. “It’s a premium lens for patients who want the very best,” Chou noted.

Observing Body Movements
Observing head and eye movements may be second nature for a good optician. “Any dispenser should observe head movement automatically as part of the regular criteria,” said Tiernan. “Consider their height and posture, how they’re using their eyes and what applications they’re using their glasses for.

“If someone has stooped posture or a dropped chin, we know we have to raise the mid and reading section of lens,” he said. “They may require a single vision lens for intermediate, depending on Rx needs. We’ve been doing it so long it’s second nature. For entry-level dispensers, they need to learn those things. They need to ask questions and be observant.”

And there are times when an optician must steer a customer away from a frame choice that won’t accommodate the advantages of premium PAL features.

“Customers often pick out frames that won’t work well with progressives, and I tell them so,” said Binkowitz. “I say ‘I’d be happy to take your money but you won’t like what I make,’ and they say, ‘Show me what will.’”

Manufacturer Information Helpful
Consumer information from manufacturers can be helpful in both explaining a new PAL design and in assuring a wearer that they are getting a host of cutting-edge benefits that justify a premium price.

“Before a new progressive wearer leaves, I give them the product information brochure,” said Bregman. “If they’re wearing a premium lens, I want them to know what they’ve got and all the advantages. If someone else says they also got progressives and they paid less, I want them to be able to know the premium aspects so they’re comparing apples and oranges.”

Still, Bregman said that most manufacturer-supplied brochures have room for improvement. “They have pretty pictures, but they’re probably written by someone at an ad agency who never fit a pair of progressives.”

At Fortney Eyecare stores in southeast Michigan, information pieces like a desk blotter than details the benefits of PALs are helpful. By doing a good job of presenting premium PALs, opticians can achieve a higher level of compliance and easy adaptability and have fewer redoes than ever before, said president Bill Fortney.

Bill Fortney

“We feel you’re going to get better clarity with a premium lens that’s state of the art,” said Fortney. “You’ll be happier wearing that lens and have a better and wider viewing area.”

At Fortney Eyecare, opticians often fit the Kodak Unique from Signet Armolite as well as the Essilor Definity. “These are high-end lenses for us, with AR coating, all the lens treatments, all the bells and whistles,” said Fortney. “You have to present the benefits if the sale is $50 to $70 more, and people are paying $275 for lenses.”

Specialty PAL Fits
The latest generation of PALs also allows for specialty fitting, which often delights wearers. For presbyopes with heavy computer usage, Binkowitz fits the Shamir Office PAL, which appeals to users with its larger reading segment.

“It’s like an easy-to-wear sneaker in a six-foot world,” said Binkowitz, who added that wearers of the Office lens almost universally also have a pair of Varilux Comfort lenses for other life tasks. Priced as a package with a special frame for $249 complete, it’s an easy sell, said Binkowitz. “Every patient we fit with the Shamir Office comes back and thanks us.”

Not for All Practices or Retail Outlets
Latest technology PALs do not yet fit every practice or retail venue. Wavefront or freeform lens designs are not offered at Optical Outlets, a 37-office chain in central and western Florida. However, president Robert Lewenson, OD, says he is open to new technology and meets regularly with manufacturer reps to discuss new designs and materials.

“Our patients are price sensitive,” Lewenson explained. He offers, as a special package, complete pairs of eyeglasses with PAL lenses for $99.99, though there are premium lens options going up from there. At present, his stores fit 100 to 200 progressive lens spectacles each day, most often the Vision-Ease Outlook or the Essilor Natural.

Lewenson envisions a time when wavefront and freeform technology in PALs will be commonplace, and he is acquiring new equipment in anticipation of that. “We just bought a new lens generator from Gerber [Coburn] that has capacity to do freeform,” he said. “We’re not yet doing wavefront, but one day you’ll be buying lens blanks from a manufacturer and be manufacturing your own progressives, and we’ll be set up for that.”

Better Vision Ahead
As the latest generation of PALs is being accepted by dispensers and wearers, the day is rapidly approaching when an even higher level of vision may be possible.

“Laser vision correction has driven this technology,” said Kolkmann. He added that with the aid of a computer, a lens designer can design pretty much anything, but the manufacturing process lags behind--at least for now. “They’re already on their way to a truly more individualized lens with more usable areas throughout the whole lens surface.”

--With contributions from Andrew Karp, group editor, lenses and technology