When problems with progressive lenses occur, eyecare professionals often react by simply reverting to FT35-lined bifocals. After all, remakes into FTs are free from the lab.

In reality, this is similar to buying a manual typewriter because your word processor broke down. Isn't it time to manage progressive non-adapts instead of running from them?

AN OUNCE OF PREVENTION

Here are some strategies to help minimize progressive lens non-adapts:

�       Train your staff. Every clinician in your practice should know the differences between brands of progressive lenses, and know how to mark and measure the placement of progressives. Many non-adapts are simple centration errors that can be corrected without re-examination by the doctor.

�       Match lens design to patient needs. I only fit six brands of progressive lenses. Each one is my lens of choice for a specific level of presbyopia, and I price them accordingly.
First-time patients with a +1.50D add can wear almost any brand, so I give them a soft designed, less expensive brand. As the add progresses, so does the sophistication of the design -- and the price. (Avoid forming paradigms about which brand is "the best.")
I explain to the patient that not all progressives are the same, and that I'll use my experience to choose the least expensive lens possible that will still do the job. Then it's not a shock when I suggest a $300 lens instead of the $150 lens I fit him with last time.
Make sure your optician also knows the differences between brands so that as the patient's add increases he has alternatives to offer (besides FT-lined bifocals). He must also be able to explain the differences to the patient.

�       Prevent centration errors. Many times incorrectly made glasses are dispensed simply because it took too long to find the marks on the lens for check out. Insist that lenses be returned from your lab pre-marked for quick checking by your optician before they're dispensed.
(If you have difficulty finding the nearly invisible centration circles, consider investing in a black light. Or, use a lensometer to mark the pupillary distance; then draw larger circles around those dots. Progressive centration circles are usually located within these circles.)
Remember: The higher the add power, the less margin you have for centration errors. Be sure to define quality boundaries with your lab.

HANDLING COMPLAINTS

When non-adapts happen (in spite of your best efforts), I recommend having your optician follow this protocol:

�       Ask to see the previous pair of glasses as well as the new pair.

�       Mark centration circles on both the old and new pair of glasses.

�       Ask the patient to stand about 4 feet away and check that the fitting crosses dissect both pupils. Do this with both the old and new pair. Do the fitting heights match? Man-ually hold the glasses so the fitting cross dissects the pupil. Does this improve vision?

�       Check the power and axis of both pairs to determine if the lenses are made correctly.

Once you have an idea what the problem is, test your assumptions by asking the patient to explain the difficulty. Determine whether:

�       lens centration is off

�       power or axis are off (check power with hand-held lenses or arrange a re-check exam)

�       lens design is wrong

�       patient is truly a non-adapt.

MOVE FORWARD, NOT BACK

Remember, your business is to re-store a patient's vision to as near perfect as possible with the least discomfort. Your patients will appreciate that you kept them in progressives.

Questions about this article? E-mail them to leona@neta.com. Your comments are welcome.