2. Aim of any vision correction deviceAim of any vision correction device
is to provide good visionis to provide good vision
i.e. minimum change from naturali.e. minimum change from natural
visionvision
3. Options for a Presbyope..Options for a Presbyope..
Single vision lensesSingle vision lenses
BifocalsBifocals
Progressive Addition LensesProgressive Addition Lenses
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4. Single Vision Lenses…Single Vision Lenses…
Corrects only one distance at a timeCorrects only one distance at a time
InconvenientInconvenient
CumbersomeCumbersome
5. Bifocals…Bifocals…
Distinct junction between zones -Distinct junction between zones -
Cosmetically unappealingCosmetically unappealing
Intermediate blurIntermediate blur
Image jumpImage jump
6. PALs…PALs…
Uninterrupted vision for all distancesUninterrupted vision for all distances
No visible junctions - CosmeticallyNo visible junctions - Cosmetically
appealingappealing
ConvenientConvenient
No differentialNo differential
displacementdisplacement
7. If they are so good…If they are so good…
Why aren’t PALs prescribedWhy aren’t PALs prescribed
extensively ??extensively ??
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8. We all share a love - hateWe all share a love - hate
relationship with PALsrelationship with PALs
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9. We love the revenue generatedWe love the revenue generated
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10. But hate it when a patient comesBut hate it when a patient comes
back with some problemback with some problem
11. Peripheral aberrationPeripheral aberration
Some adaptation problemsSome adaptation problems
More critical fittingMore critical fitting
More expensiveMore expensive
Disadvantages..Disadvantages..
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12. Fitting PALs is an art..Fitting PALs is an art..
It requires adequate training & skillIt requires adequate training & skill
It involves communication & counsellingIt involves communication & counselling
skills and convincing powerskills and convincing power
13. And a science..And a science..
It requires :It requires :
A systematic approachA systematic approach
Understanding of potential problemsUnderstanding of potential problems
In-depth study of designsIn-depth study of designs
14. A Successful Marriage..A Successful Marriage..
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23. Step 1Step 1
Identification ofIdentification of
Patient’sPatient’s
Requirements &Requirements &
ExpectationsExpectations
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24. Useful tipUseful tip
Judge the motivationJudge the motivation
Highlight the advantages, but mentionHighlight the advantages, but mention
the limitations as wellthe limitations as well
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26. Useful tipUseful tip
Prefer metal frames with adjustablePrefer metal frames with adjustable
nose padsnose pads
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27. Step 3Step 3
Adjust before taking facialAdjust before taking facial
measurementsmeasurements
Adjust when delivering spectaclesAdjust when delivering spectacles
Frame Adjustment
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36. Useful tipUseful tip
Natural head postureNatural head posture
Sit at the same level as the patientSit at the same level as the patient
Check binocularly from a dist. of 1 metreCheck binocularly from a dist. of 1 metre
Use a fine markerUse a fine marker
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37. Step 8Step 8
Checking the cut outChecking the cut out
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42. Useful tipUseful tip
Use positive languageUse positive language
Remove the markings at the endRemove the markings at the end
Maintain a record of the order formsMaintain a record of the order forms
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45. Trouble shooting ...Trouble shooting ...
When & Why ?When & Why ?
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46. Factors in AdaptationFactors in Adaptation ......
MotivationMotivation
ExpectationsExpectations
Education & EncouragementEducation & Encouragement
Occupation & hobbiesOccupation & hobbies
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47. Sources of errorsSources of errors ......
HeightsHeights
Monocular PDsMonocular PDs
Swapped lensesSwapped lenses
Wrong power & axisWrong power & axis
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48. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Blurry Distance VisionBlurry Distance Vision
Possible CausesPossible Causes
Fitting too highFitting too high
Incorrect RxIncorrect Rx
RemediesRemedies
Open the noseOpen the nose
padspads
Remake lensesRemake lenses
49. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Blurry Near VisionBlurry Near Vision
Possible CausesPossible Causes
Fitting too lowFitting too low
InadequateInadequate
pantoscopic tiltpantoscopic tilt
Incorrect RxIncorrect Rx
RemediesRemedies
Bring in nose padsBring in nose pads
Frame adjustmentsFrame adjustments
Remake lensesRemake lenses
51. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Reading area tooReading area too
smallsmall
Possible CausesPossible Causes
Incorrect PDIncorrect PD
Fitting heights too lowFitting heights too low
RemediesRemedies
Frame adjustmentsFrame adjustments
Refit lensesRefit lenses
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52. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Having to look to theHaving to look to the
side to readside to read
Possible CausesPossible Causes
Incorrect PDIncorrect PD
Swapped lensesSwapped lenses
RemediesRemedies
Refit to correct PDsRefit to correct PDs
Swap lenses if frameSwap lenses if frame
symmetricalsymmetrical
53. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Having to tilt head tooHaving to tilt head too
far back to readfar back to read
Possible CausesPossible Causes
Incorrect PDIncorrect PD
Add too weakAdd too weak
Change in designChange in design
RemediesRemedies
Bring in nose padsBring in nose pads
Increase the addIncrease the add
Refit lensesRefit lenses
54. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Having to tilt headHaving to tilt head
backward for distancebackward for distance
Possible CausesPossible Causes
UndercorrectedUndercorrected
hyperopehyperope
Overcorrected myopeOvercorrected myope
RemediesRemedies
Repeat the refractionRepeat the refraction
Refit lensesRefit lenses
55. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Having to tilt headHaving to tilt head
forward to readforward to read
Possible CausesPossible Causes
Add too strongAdd too strong
RemediesRemedies
Repeat the refractionRepeat the refraction
Refit lensesRefit lenses
56. Complaints &Complaints &
Remedies...Remedies...
PROBLEMPROBLEM
Having to tilt headHaving to tilt head
forward for distanceforward for distance
Possible CausesPossible Causes
Fitting height too highFitting height too high
RemediesRemedies
Frame adjustmentFrame adjustment
Refit lensesRefit lenses
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