PROGRESSIVE LENSES

1.What are PALs?

Progressive lenses, also known as multifocal lenses or progressive addition
lenses (PAL), are corrective lenses used in eyeglasses to correct presbyopia and other
refractive errors. So, they offer multiple prescription strengths within one lens that
have zones meant for close-up, intermediate, and distance vision. These zones blend into
one another, so the change in power is—you guessed it—progressive, rather than
abrupt. Typically, the top portion of the lens helps with distance viewing, and comes into
play as you look straight ahead. The middle portion is meant for intermediate viewing, such
as when you consult your computer screen by looking slightly below your eye level. Finally,
the near vision zone tends to be at the bottom of the lens, and makes tasks like reading and
sewing a breeze where the addition value prescribed depends on the level of presbyopia of
the patient and the older he is, the higher his addition is. Moreover, wearing progressive
glasses isn’t necessarily for presbyopia only, however, they’ve also proven helpful for
children who have eye muscle and/or eye-focusing issues.
2.Fitting:
*What are the best frames for progressive lenses?
It is important to understand the impact your frame choice has on your lenses. Frame size is
an important consideration since the entire range of vision should fit within the frame.
Therefore, frames with a very short lens don’t tend to fit progressive lenses as well as
frames with a larger lens. Lens shape is important, too. Progressive wearers should avoid
aviators and cat-eyes because both can cut off the bottom portion of the prescription,
resulting in a loss of reading vision.

On the other hand, about 80% of the problems people have with progressive lenses come
from fitting errors.

*Acc to Essilor fitting guide of PALs the steps are as follows:

- Understanding the patient (What was the patient wearing before? What are the visual
needs?)
- Analyzing the prescription and testing it for both far and near
- Selecting the frame:
...Frame selection & adjustment
…Select a frame which is right for the wearer’s face, that is stable on the nose and offers
sufficient height between the pupil and the lower rim of the frame. For optimal visual
comfort, minimum distance of: 17 mm between pupil center and bottom of the frame for
regular progressive lenses.
...Adjust the frame to fit the face of the patient so that, in average: The vertex distance is
approximately 12 to 14 mm. & the pantoscopic angle is in the region of 8° to 12°.
Proceed with the adjustments in the order:
...Adjustment of the front of the frame: projection, inclination, horizontality. Adjustment of the
sides of the frame: opening, shape and length, ear pieces, closure of the sides.
* The frame should always be adjusted before starting to take any measurements.
...After adjustment, if the frame parameters are significantly different from average values,
the choice of a progressive lens with personalized fitting parameters is recommended for
wearer’s optimal vision.
- Taking the measurements
Pupillary Distance and Fitting Height. Pupillary Distance is the distance between the pupils
that’s taken monocularly using a pupilometer or PD ruler & it is common for right- and left-
lens monocular PDs to be different. Whereas, fitting height is done by having the patient
assume normal posture, position yourself at the same eye level or same height as the
patient, mark the pupil center on the demo lenses & measure from the center pupil’s
markings to the deepest portion of the lens.
- Edging/Mounting the lens
- Delivery and final fitting
- Monitoring of the adaptation
*And regarding dispensing it is advisable to remove markings with isopropyl alcohol (not
acetone), instruct patient on proper use of lenses for distance, intermediate and near
viewing & explain proper lens care techniques.

3.Types:

There are several different types of progressive lenses, including:

Computer Progressive Lenses:

or near variable focus lenses, are designed for clear vision in office settings. They’re
designed to reduce visual fatigue (digital eye strain) for people who use a computer for
more than four hours daily and for anyone who needs clear vision from 16 inches to 6 feet
like dentists, artists, and hairdressers. Although these lenses serve a purpose and relieve
discomfort, but they won’t replace your regular glasses.

Premium progressive lenses:

are designed with computerized wavefront technology to provide a better, wider and
smoother vision than other options due to the vast, distortion-free reading area. These
lenses are highly customizable for your individual needs, including prescription, chosen
frame, eye anatomy and your dominant eye. However, they cost significantly more than
other progressive lenses because of these features.

Ground-View progressive lenses:

are great for golfers and anyone who needs to see clearly when looking down. This type
provide better vision along the bottom and sides of the lens. Moreover, they use patented
technology to reduce lens distortions, giving you a ground view that closely mimics natural
vision.

Standard progressive lenses:

also known as regular progressive lenses, are the most basic option that work for most
people. They provide a wide reading area but are less specialized than other lenses, have a
longer drop between prescriptions, require larger frames and tend to cost less than
specialized progressives.
Short corridor progressives:
are designed to fit into small frames so they trade practicality for a more fashionable
look. However, some have difficulty transitioning to these lenses because of the lens size as
vision can get more distorted, the reading area is reduced and they cost more than standard
progressive lenses.

Transition progressive lenses:

are not an official type of progressive lens but rather a brand of photochromic lenses. These
lenses darken when exposed to UV light to provide shade for your eyes and operate as a
useful alternative to sunglasses.

4.Advantages:
Here are a few benefits of progressive lenses:

• Improve vision at all distances in a single lens: progressive lenses provide the
correction required for a patient with presbyopia to see clearly at all viewing
distances, typically adjusted by tilting the head slightly.

• Progressive addition lenses avoid the discontinuities (image-jumps) sometimes

found with bifocal and trifocal lenses.
• Some people find them more cosmetically attractive as they offer a seamless
transition without a noticeable line
• Help you save money since you don’t need to purchase multiple pairs of glasses for
different vision issues, one pair is enough.

5.Disadvantages:
Here are a few downsides of progressive lenses:
• Peripheral Distortion: Progressive lenses suffer regions of aberrations and geometric
distortions in the periphery, leading to poor vision when turning the eyes down and to
the sides.
• Fitting: Progressive lenses require careful placement relative to the wearer's pupil
center for a distance-viewing reference position. Incorrect specification of the fitting
location can cause problems for the wearer like narrow fields of view, clear vision in
one eye only...
• Can take time to get used to: Progressive lenses can be difficult to get used to
initially, but getting into the habit of turning your head to look at objects instead of
moving your eyes as while reading can help.
• Cost: Progressive lenses are more expensive than bifocal and single-vision lenses
due to higher manufacturing and fitting costs.
6. Case Reports
After welcoming him, reading the prescription, and knowing that it’s not his first experience
with progressive lenses, we started choosing a big frame in order to fit the lens inside (both
near & distance) then did adjustment so it’s perfectly fit on him. After that, we measured the
PD via a PD ruler, marked the O.C on the lenses, discussed the types of coatings & he
chose AR. When he came back to take it, the optician reminded him that he needs time to
get used to his new diopters. So, he tried it and everything was ok. Also, she convinced him
not to wear it while driving back home until he get used to it.
However, when recommending a progressive lens design, an eyecare practitioner will
usually ask the customer some questions about their lifestyle, what are prescription
restrictions or recommendations and cost of lenses.
For those new to progressive lenses, an accommodation period, from few hours to two
weeks, is often required to the brain to adapt. During this period, side effects can include
headache and dizziness. Some wearers find the visual discomfort caused by these
distortions outweigh the benefits of wearing PALs; this is known as progressive non-
tolerance.

7. Frequently Asked Questions

- What is the best type of progressive lenses?
The best type of progressive lenses for you will depend on your unique needs and
preferences. For example, computer PALs are ideal if you need to focus on a vision zone
about arm’s length from your eyes. Ground-view progressive is best for looking down.
- What is the most advanced progressive lens available?
Varilux® X Series™ progressive lenses are considered the most advanced lenses
available today. They use patented technology to eliminate the visual distortions common
among other progressive lenses.
- Are PALs suitable for someone with astigmatism?
Yes, progressive lenses can be used to combat astigmatism.