Fitting Guide

PROGRESSIVE LENSES FITTING GUIDE

ESSENTIAL RULES FOR THE SUCCESSFUL FITTING OF PROGRESSIVE LENSES TO YOUR PRESBYOPIC PATIENTS

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 1 24/02/2015 13:02 WELCOME

We are pleased to present this guide which outlines the essential rules for the successful fitting of progressive lenses to your presbyopic patients.

Overall, it guides you through successful fitting from first contact to the final delivery of the spectacles.

A working tool, this guide will be useful for your daily routine and will help you to be successful in fitting progressive lenses and help to guaranteepatient satisfaction.

Please use it for all patients!

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 2 24/02/2015 13:02 FITTING PROGRESSIVE LENSES STEP BY STEP

05 07 17 19 29 31 33 P. P. P. P. P. P. P.

UNDERSTANDINGANALYSING THE PATIENTSELECTING THE PRESCRIPTION THETAKING FRAME THEEDGING/MOUNTING MEASUREMENTDELIVERY S THEANDMONITORING LENSES FINAL FITTING OF THE ADAPTATION 1 2 3 4 5 6 7 03

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 3 24/02/2015 13:02 BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 4 24/02/2015 13:02 UNDERSTANDING THE PATIENT THIS FIRST STEP IS ESSENTIAL 1 TO THE SUCCESS OF LENS FITTING

What was the patient What are the visual 1 wearing before? 2 needs?

TYPE OF LENSES WORN ANALYSING THE PREVIOUS LENSES WHAT ARE THE SPECTACLES USED FOR? nnSingle Vision for Distance, Single nnMeasure the previous correction: Vision for Near, Mid-Distance, Bifocal, sphere, cylinder, axis, addition and nnPermanent or occasional wear? Progressive (brand and type)… prismatic correction if any. nnWorking distances? nnMaterial, colour, coatings… nnDate when given the previous lenses. nnVisual performance with former lenses: SPECIFIC REQUIREMENTS? measure acuity for distance and near nnProfession, hobbies, leisure. vision. nnClarity of vision required. Understand the reasons for any lens nnField of vision needed. change and confirm its need.

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Compare the new Compare the value of 1 prescription with the addition with the previous one 2 the ones suggested in the table AGE ADDITION IF THE DIFFERENCE IS EQUAL TO 44 years 1.00 D (OR MORE THAN)… These typical values should only be 47 years 1.25 D nn0.75 D on the sphere exceeded in cases of real necessity. 49 years 1.50 D nn0.50 D on the cylinder 51 years 1.75 D nn10° on the axis 54 years 2.00 D nn0.75 D on the addition 58 years 2.25 D 63 years 2.50 D ... confirm its necessity with 67 years 2.75 D* the prescriber and ensure its acceptance. 70 years 3.00 D* 75 years 3.25 D* 80 years 3.50 D*

* Additions over +2.50 D are rarely ever necessary, except in case of short reading distance and/or poor visual acuity.

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1 In distance vision

DETECTING UNDER-CORRECTED HYPERMETROPIA This is often the cause of a too strong addition because it relates directly to the value of the addition. >>With the red-green test in distance >>With an additional power of + 0.50 D vision Place the + 0.50 D lenses in front of the If the subject has a clear preference for distance vision correction of the subject and reading on the green background and ask the subject to look in the distance: the letters appear blurred on the red if vision remains clear, or is improved, background, the hypermetropia is probably the hypermetropia is probably undercorrected. under-corrected.

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2 In near vision

USING THE ESSILOR CHECKTEST™ The subject wearing the near vision correction, position the CheckTest at their usual reading distance.

>>With an additional power of - 1.00 D >>With the Helmholtz test pattern Place the - 1.00 D lenses in front of the If the circles in the centre of the pattern near vision correction of the subject: if are seen without deformation, the near the smallest characters can still be read, vision correction is correct for the reading even if with some difficulty, the addition is distance. If the circles are seen deformed, probably too strong. the near vision correction is either too strong or too weak.

>>With the red-green test The CheckTest is available from If the letters are seen more clearly on Essilor Academy. Do not hesitate to the green background, the near vision ask for it when visiting our web site at correction is either correct or two weak. www.essiloracademy.eu If they are seen more clearly on the red background, the near vision correction Helmholtz test Image of pattern’s is possibly too strong. pattern centre 09

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Everything takes place at the dispensing • To confirm the RE/LE balance: WITH CHECKTEST™ desk, using a few quick tests and very place +0.50 D in front of both eyes and nnCompare letters on a red background and simple equipment. compare the RE/LE blurring: on a green background: - If vision is balanced, use that • Vision should be balanced or slightly prescription. clearer on a green background. - If vision is not balanced, add +0.25 D Distance Vision (DV) • A preference for the red background 1 in front of the eye that sees best until indicates that the prescription is too balance is achieved. strong. Placing the DV prescription lens in the trial - If it is not possible to achieve balance, ® frame. allow the dominant eye to remain USING A PROXIMETER dominant. nnHave the patient look into the distance nnConfirm the addition with a reading test. nnIf corrected visual acuity remains poor, nnConfirm the RE/LE balance in near vision or at an eye chart in the practice. Assess understand the reasons why or check the (by positioning the septum): visual acuity, first with both eyes open astigmatism using cross cylinder method • Vision should be balanced. and then each eye in turn (occlusion). (see page 11). • If not, add +0.25 D to the eye that sees nnConfirm the prescription with a binocular lorgnette of +0.50 D then -0.50 D: less clearly. • +0.50 D should fog the subject’s vision Near Vision (NV) • -0.50 D should have no significant effect 2 (possibly repeat with front +0.25 D and -0.25 D). Place the NV prescription lens in the trial nnCompare the vision of the two eyes, frame. by occluding each eye in turn: • Vision should be balanced or slightly WITH A READING CHART favour the dominant eye (determined nnEnsure that the patient can see comfortably using the CheckTest) at a normal reading distance. nnConfirm clear vision range in relation to his/her visual habits and needs. 10

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 10 24/02/2015 13:02 REFRACTION IN DISTANCE VISION (1) SUPPLEMENT AN ACCURATE DISTANCE PRESCRIPTION RESULTS IN THE MOST COMFORTABLE NEAR PRESCRIPTION

Deal with each eye separately starting from >>Verify the cylinder power a trial correction (old prescription or results Determination (with cross cylinder ± 0.25 D): from an autorefractometer). 2 of the cylinder nnPlace the minus axis of the cross cylinder along the direction of the correcting Determination USING THE CROSS CYLINDER METHOD minus cylinder. 1 nnWith the subject looking at a line of small of the sphere >>Verify the cylinder axis letters or a target of points, rapidly twirl (with cross cylinder ± 0.50 D): the cross cylinder and ask the subject which USING THE FOGGING METHOD nnPosition the handle of the cross cylinder position of the cross cylinder is preferred. along the cylinder axis direction of the nnPlace the trial prescription in front of nnIf the subject prefers the position when the subject’s eye and measure trial prescription (it should produce the minus axis of the cross cylinder lies the visual acuity. a drop in acuity). along the axis of the correcting minus nnWith the subject looking at medium size cylinder, add -0.25 D to the correcting nnFog the eye by adding +1.00 D or +1.50 D to cause a drop in visual acuity. letters or a target of points, rapidly twirl cylinder. the cross cylinder and ask the subject nnRepeat this process until the subject nnUnfog progressively by -0.25 D steps and which position of the cross cylinder is check that the visual acuity improves. cannot (or can hardly) tell the difference. preferred. Record the minimum value of the cylinder nnContinue until the best acuity is obtained. nnTurn the axis of the correcting minus power found. nnRecord the power of the strongest plus cylinder by 5° towards the minus axis of >>Check the sphere power sphere that provides maximum visual the preferred cross cylinder acuity. nnAdd +0.25 D to the sphere for each nnRepeat this process until the subject -0.50 D added to the cylinder and check cannot (or can hardly) tell the difference. that the best visual acuity is still obtained.

For a more detailed information on refraction techniques, refer to the Ophthalmic Optics File “Practical Refraction” of Essilor Academy 11 available on www.essiloracademy.eu

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>>Unfog binocularly FOR THE CYLINDER the eyes in -0.25 D steps until the nnCorrect the astigmatism only if it results 3 Binocular balance maximum acuity is obtained. in a noticeable gain in visual acuity. >> Check the acuity of each eye nnBe wary of weak astigmatism, it often >>Dissociate the subject’s eyes making sure that ocular dominance has varies. Moderate prescriptions with nnby alternate occlusion: rapidly occlude not been reversed between the eyes. oblique axes that may give rise to one eye, then the other, with an occluder distortion. or Some rules and BINOCULAR VISION nnwith vertical prism: introduce 3∆ base down before one eye and 3∆ base up recommendations nnCarefully check binocular balance. before the other nnGive priority to the dominant eye: FOR THE SPHERE or do not reverse ocular dominance between nnby polarization: use polarized tests nnAlways fully correct the ametropia, the eyes. for visual acuity together with the particularly any hypermetropia, but do nnIn cases of anisometropia, give the corresponding polarized filters. not overplus. minimum possible difference between >>Fog both eyes nnDo not over-correct, rather prefer a slight the right and left eyes. with +0.50 D spheres and confirm that under-correction. In the red-green test: AS A GENERAL RULE there is a drop in acuity • for hypermetropia, “equalize” the red and the green or leave “slightly clearer >> nnAvoid large changes in prescription: do Balance vision in the right on the green”, and left eyes not exceed 0.75 D on the sphere, 0.50 D • for myopia, “equalize” the red and by refogging the eye with the better on the cylinder or 10° on the axis, unless the green or leave “slightly clearer on it is really necessary. acuity with a +0.25 D sphere. the red”. nnRemember that refraction has not been undertaken for infinity: add -0.25 D For a more detailed information to the sphere if necessary. on refraction techniques, refer to the Ophthalmic Optics File 12 “Practical Refraction” of Essilor Academy available on www.essiloracademy.eu

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 12 24/02/2015 13:02 DETERMINATION OF THE NEAR ADDITION (1) SUPPLEMENT THE “ACCOMMODATIVE RESERVE” METHOD A classic method for determination of the addition

Measure Determination Verify that the subject 1 the amplitude 2 of the addition 3 can read comfortably of accommodation Normally, subjects should be allowed to nnPut up the distance correction with the In binocular vision with the distance use two-thirds of their total amplitude of proposed near addition in a trial frame. correction in place and the use of a near accommodation at their usual working nnAsk the subject to confirm that vision is vision chart. distance (leaving one-third of their comfortable when reading. total amplitude in reserve) so as to be WITH MOVEABLE NEAR VISION CHART: nnAdjust the value of the addition for the comfortable. subject’s normal working or reading Bring the near vision chart in towards The addition is calculated from: distance. the subject until it is only just legible, Addition = the amplitude of accommodation is the 1 / near distance - 2 / 3 total amplitude. reciprocal of this distance. Usable amplitude Addition Total amplitude of For example: of accommodation for 40 cm (16 in) accommodation nearest reading distance = 0.50 m, (≤ 2/3 acc. max.) (= 2.50 D – 2/3 acc.) amplitude of accommodation = 2.00 D. 3.00 2.00 0.50 WITH FIXED NEAR VISION CHART: 2.75 1.75 0.75 2.50 1.50 1.00 nnPosition the near chart at 40 cm (16 in) 2.25 1.50 1.00 and ask the subject to read. 2.00 1.25 1.25 nnIf can read the smallest text, add -0.25 D, -0.50 D etc..., binocularly, until reading is 1.75 1.00 1.50 no longer possible. 1.50 1.00 1.50 1.25 0.75 1.75 nnIf cannot read the smallest text add +0.25 D, +0.50 D etc…, binocularly, until 1.00 0.50 2.00 For a more detailed information the smallest text can just be read. 0.75 0.50 2.00 on refraction techniques, refer The amplitude of accommodation 0.50 0.25 2.25 to the Ophthalmic Optics File “Practical Refraction” of Essilor Academy 13 = 2.50 - final value which has been added. available on www.essiloracademy.eu

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 13 24/02/2015 13:02 DETERMINATION OF THE NEAR ADDITION (2) THE “MINIMUM ADDITION” METHOD SUPPLEMENT A simple and proven method of determining the addition

4 STAGES Good correction Add + 0.75 D 1 of distance vision 3 to + 1.00 D

Fully correct the ametropia, in particular To the minimum addition to find the any hypermetropia (see pages 11 and 12). comfortable addition value (+ 0.75 D for low additions, + 1.00 D for high additions). Determining the 2 minimum addition Checking the patient’s at 40 cm (16 in) 4 visual comfort

Add binocularly + 0.25 D, + 0.50 D, etc… nnHave the patient evaluate whether to the distance correction until the patient reading is comfortable with the addition just distinguishes the smallest characters: found. the value found is the minimum addition. nnAsk the subject to bring the text closer until the reading of small characters is impossible: it should occur at approximately 25 cm (10 in) from the eyes. If it occurs closer than 20 cm (8 in), the addition is too strong, if it occurs further than 30 cm (13 in), the addition is too low. nnAdjust the value of the addition by 0.25 D For a more detailed information on refraction techniques, refer according to the usual working or reading to the Ophthalmic Optics File distance. 14 “Practical Refraction” of Essilor Academy available on www.essiloracademy.eu

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 14 24/02/2015 13:02 DETERMINATION OF THE NEAR ADDITION (3) SUPPLEMENT THE “FIXED CROSS CYLINDER” METHOD A reference method for determination of the addition

Fully correct Determine Verify that the subject 1 distance vision 2 the addition value 3 can read comfortably

Use the highest plus sphere which provides nnAsk the subject to fixate a cross made nnPut up the distance correction with the maximum visual acuity (see pages 11 and 12). up of vertical and horizontal lines at a proposed near addition in a trial frame. distance of 40 cm (16 in). nnAsk the subject to confirm that vision is nnPosition ±0.50 D cross cylinders with comfortable when reading. their minus axes at 90° in front of both nnAdjust the value of the addition for the eyes: the subject should report that subject’s normal working or reading the horizontal lines are clearer. distance. nnProgressively, place +0.25, +0.50, +0.75 D… lenses in front of the eyes until the vertical and horizontal lines appear equally black. nnThe addition is the value which gives the best equality between the horizontal and the vertical lines.

For a more detailed information on refraction techniques, refer to the Ophthalmic Optics File “Practical Refraction” of Essilor Academy 15 available on www.essiloracademy.eu

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1 Frame selection 2 Frame adjustment

Select a frame which is right for the Adjust the frame to fit the face of the wearer’s face, that is stable on the nose and patient so that, in average: offers sufficient height between the pupil and the lower rim of the frame. nnThe vertex distance is approximately 12 to 14 mm. 8° - 12° nnThe pantoscopic angle is in the region 10 mm min. of 8° to 12°.

Proceed with the adjustments in the order: 14 mm min. nnAdjustment of the front of the frame: projection, inclination, horizontality. 12 - 14 mm nnAdjustment of the sides of the frame: opening, shape and length, ear pieces, For optimal visual comfort, minimum closure of the sides. distance of: After adjustment, if the frame parameters nn17 mm between pupil center and bottom of the frame for regular progressive are significantly different from average values, the choice of a progressive lens lenses and 14 mm for short corridor The frame should always be progressive lenses with personalised fitting parameters is adjusted before starting to take any recommended for wearer’s optimal vision. nn 10 mm between pupil centre and top measurements. of the frame.

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POSITIONING THE CLIP VIDEO CAPTURE

With an electronic nnCentre the clip on the bridge of the frame. nnEnsure that the patient adopts a natural posture; do this by getting them to look 1 measuring column nnPress the clip’s rear hooks against the frame: the hooks plane parallel to the right, then left then straight ahead. lens plane. nnCheck how the head is held in real time PREREQUISITE nnAllow the patient to position the frame on and how the natural posture is kept. his/her face. nnRecord the average value of the head nnAdjust the frame: reproduce subsequent wearing conditions. nnCheck that the clip is still correctly cape angle. positioned. nnTake the video in two stages: nnEnsure that the frame is horizontal and that the lens planes are symmetrical. - static front view - dynamic rotational three-quarters view. nnCheck the position of the frame: right and left sides in the same plane. nnCheck that the sensors have been read correctly. nnIf possible, remove the presentation • Select the front view corresponding to lenses. Do not take measurements using the determined cape angle. corrective lenses. • Select the three-quarters view, with an nnAdjust the measuring distance and angle of between 15° and 25°. the height of the camera. nnNote how the patient holds the head during the preparation phase.

19 NB: Measurement procedure based on the use of the Essilor Visioffice system.

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PRODUCING THE BOXING FRAME RESULTS SCREEN nnCheck the correspondence between the reading distance and the addition value: Setting boxing tangents is fundamental to the reading distance (in metres) should the accuracy of the measurement: not be greater than the reciprocal of the nnCheck the positioning of the corneal addition (in dioptres). reflexes (cross on reflection) and adjust Example: if add = 2.50 D, them if necessary. reading distance ≤ 0.40 m. nnRimmed frame: align the right horizontal and vertical markers tangentially with >>Dominant eye the lens/frame boundary (at the inner nnInvite the patient to step back from the edge of the frame, do not take the groove column (1.30 m) and hold the board with into consideration). ADDITIONAL MEASUREMENTS arms outstretched. nnNylor or rimless frame: position the nnAsk the patient to fixate the target sticker >>Reading distance straight markers on the front edge of on the base of the column through the the lens. nnPlace the reading chart in the board hole in the board. coupled to the system. nnFinish by choosing the type of frame. nnAsk the patient to hold the board like a book in his/her natural reading posture. nnOr re-position the clip on the old corrective spectacles and ask the patient to read (reading the largest letters in the reading chart allows any under-correction of near vision of about 0.50 D to be taken into account).

20 NB: Measurement procedure based on the use of the Essilor Visioffice system.

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CAPE ANGLE POINTS TO WATCH

nnDefault selection: image showing the head cape closest to 0°. AVERAGE VALUE POINTS TO WATCH n If a cape angle is observed, confirm the patient’s head posture is PANTOSCOPIC Between 8° and Watch out for the head held too high or too low. natural and the frame is properly adjusted. TILT 12°

n Wrap angle value depends on frame type and If the cape angle is confirmed, the corresponding image should be WRAP ANGLE Between 6° and 8° selected. design. EYE ROTATION If RE/LE ERC differences > 2 mm, make sure the nnIf the cape angle varies, take two measurements and proceed as Between 16 mm CENTER (ERC) lenses are in the same plane i.e. that the frame has and 36 mm follows: DISTANCE been properly adjusted. MONOCULAR Monocular pupillary distances depend on the cape angle. PUPILLARY If the monocular distances are inconsistent, check that the crosses are Two measurements: Average value DISTANCES matching the corneal reflexes. Cape 1 and Cape 2 (AV) Allow for different RE/LE height differences in the Minimum values: order and for the fitting. Short progressive FITTING Note that RE/LE height differences can be due to the designs =14 mm HEIGHT frame not being horizontal. Other designs If necessary, take the measurements directly on =17 mm Comparing Situation 1 Situation 2 the display lenses. Cape 1 – Cape 2 > ± 2° Cape 1 - Cape 2 ≤ ± 2° the two measurements Unstable AV AV = (Cape 1 + Cape 2)/2 If measured while wearing the old prescription and reading the text on the reading tablet (with choice of line according to the patient’s reading ability): READING Between 28 cm and Make sure that the reading distance measured DISTANCE 50 cm suits the value of the prescribed addition The reading distance influences the position of Measurements: Take the image Scroll the video cursor closest to 0° to select the near vision zone. front view strictly < ± 5° the image showing AV DOMINANT Holding the board with arms extended and both - EYE eyes open: the customer fixates the target sticker. HEAD-EYE Stability coefficient should be less than or equal No average value COEFFICIENT to 0.15. Visioffice HEAD CAPE = 0° HEAD CAPE = AV results page NB: Measurement procedure based 21 on the use of the Essilor Visioffice system.

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With a dispensing desk SECOND PHOTOGRAPH RESULTS SCREEN nnAsk the patient to lower the head by 2 electronic measuring at least 10° and fixate the bright dot. system nnTake the picture when the screen changes to green (correct head position). PREREQUISITE AND POSITIONING OF THE CLIP nnProceed as shown on page 19. FIRST PHOTOGRAPH nnPosition the apparatus approximately 60-90 cm from the patient with his/her eyes READING DISTANCE approximately 20 cm above it. nnAsk the customer to hold the board like a nnAsk the patient to sit in a comfortable upright book in his/her natural reading posture. position with a straight back and both feet on the floor. nnOr re-position the clip on the old nnAsk the patient to turn his head left and right corrective spectacles and ask the patient and then to look straight ahead at distance. to read the text (reading the largest letters in the test allows any under- nnTake the picture when the screen changes to correction of near vision to be taken into green (correct head position). PRODUCING THE BOXING FRAME account). nnOn the first photograph, check the red nnTake a picture and follow instructions on dotted ring over each iris is centered screen to calculate the reading distance. properly. If not, position it manually. nnProceed as shown on page 20 to adjust boxing lines. nnThe boxing tangent positioning is crucial for accuracy of the measurement.

22 NB: Measurement procedure based on the use of the Essilor M’eye Fit System

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With traditional >>Position the pupillometer >>Take the measurement nnTake the measurement, preferably with for distance vision (at infinity) and, 3 instruments the patient in a standing position. for near vision (at 40 cm). nnSet the pupillometer measuring distance nnMove the right and left reticles to bring MEASURING THE MONOCULAR (at infinity and then at 0.40 m). them into line with the corneal reflexes. PUPILLARY DISTANCES nn nnLift up the forehead rest and position Take the measurement with both eyes open and then each eye in turn, using Using a Corneal Reflection Pupillometer the pupillometer on the customer’s nose the pupillometer’s eye occluder. (CRP). (for example, suggesting that they “hold it like a pair of binoculars”). nnIf there is a deviating eye and/or split nnEnsure that the pupillometer is positioned perception, take the measurement one L R as the frame will be. eye at a time using the eye occluder. nnRelease the forehead rest. Check that the >>Note the pupillary distances pupillometer is horizontal and in contact with the patient’s forehead. nnRead the right and left monocular pupillary distances. nnNote whether there is a lack of symmetry between the right and left distances and confirm. (If there is any doubt, take Monocular pupillary distance = the distance between the root of the nose and the centre of the measurement again, checking that the pupil. the pupillometer is correctly positioned on the patient’s nose). nnNote the binocular pupillary distance, the sum of the two monocular distances.

To ensure optimum comfort, use tools that guarantee a measurement accuracy of at least ± 0.5 mm on the heights and monocular pupillary distances, taking any asymmetry into consideration. 23

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MEASURING PUPILLARY HEIGHTS >>Position the tool on the >>Take the measurement customer’s frame for distance vision, in a standing position Using the Height Measuring System (HMS). nnPosition the frame on the patient’s face nnGet the customer to adopt a natural and ensure that it is properly adjusted. position and look into the distance at eye nnTake the instrument between your height. (To do this, get them to look right, thumbs and index fingers and hold the then left, then straight ahead). movable clips open. nnPosition the white line on each cursor nnPosition the instrument on the frame over the centre of the pupil, using the using the upper clips and release the clips knurled knobs on the sides. Stand facing on the bottom of the frame. Centre the the customer, and at same height to avoid instrument on the bridge of the frame. any parallax error. If the centre of the pupil is difficult to see, create a corneal reflex nnCheck that the position of the frame on using a pen-torch. the patient’s face has not changed. Pupillary height = distance separating the centre nnRead the tangent graduation at the of the pupil from the tangent at the bottom of bottom of the frame before removing the frame (at the base of the groove). it and note the pupillary height, taking the depth of the lens groove into consideration. Must be read in the boxing system (in relation to the horizontal line tangential to nnNote whether there is a difference the bottom of the frame and not in relation between the right and left heights and to the point on the edge of the frame confirm. (If there is any doubt, take the directly below the pupil centre). measurement again, checking that the frame is correctly adjusted horizontally).

To ensure optimum comfort, use tools that guarantee a measurement accuracy of at least ± 0.5 mm on the 24 heights and monocular pupillary distances, taking any asymmetry into consideration.

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TAKING ADDITIONAL >>Vertex distance Measuring the vertex distance: MEASUREMENTS nnPosition the frame on the patient’s face in for personalised progressive lenses the adopted position and ensure that it is Using the measurement tool (Fit System®). properly adjusted. nnGet the patient to look into the distance. nnPosition the tool on the side of the frame, parallel to the arm. nnBring the extremity of the tool at the level of the apex of the cornea. nnNote the distance separating the apex of the cornea from the plane of the lenses. Vertex distance = the distance between the rear surface of the lens and the apex of the patient’s cornea.

This tool allows to determine the lens personalisation parameters: vertex distance, pantoscopic tilt and wrap angle. These parameters allow the lens design calculation to be optimised according to the lens’s exact position in front of the patient’s eye.

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>>Pantoscopic tilt Measuring the pantoscopic tilt: nnRemove the display lenses (except for rimless or nylor frames). nnPosition the frame on the patient’s face and ensure that it is perfectly adjusted. nnGet the patient to look into the distance, in a natural position. nnApply the lateral face of the tool against the edges of the frame. Measuring the wrap angle: nnRead the pantoscopic angle shown by Pantoscopic tilt = the angle between the lens the bubble level. nnPlace the tool flat (on a table). plane and the vertical plane. nnPosition the frame on the tool, symmetrically in relation to the It corresponds to the tilt of the frame in graduations, with the arms exactly relation to the primary horizontal direction >>Wrap angle (or face form angle) horizontal. of gaze. nnRead the angle indicated by the graduation aligned with the temporal edges of the frame (must be identical right and left).

Wrap angle = the angle formed by the plane passing though the edges of the right or left calibre of the frame – at its two extremities – and the plane tangent to the frame’s bridge in its middle. 26

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>>Reading distance

This distance allows the lateral positioning Measuring the reading distance: of the lens’s near vision zone to be optimised nnThe patient should wear his/her near (the shorter the reading distance, the greater vision correction (either on a trial frame the inset). or by using the previous spectacles). nnGive the patient a reading text and ask him/her to read medium-sized characters. nnEnsure that the patient adopts a natural reading position. nnUsing a tape measure or other suitable device, measure the distance between the reading chart and the lens plane. The reading distance (in metres) cannot be greater than the reciprocal of the addition (in dioptres).

Distance separating the reading plane from the lens plane.

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Checking 4 measurements

Using a Ditest or centring chart, mark the CHECKING IN DISTANCE VISION distance vision centring crosses on the All our designs are calculated for nnHave the customer look into the distance, pupillary distances and heights measured full pupil centring. Meeting this position yourself facing him/her at eyes and mark the positioning of the near vision centring condition is essential for height and check that the centring crosses circles. Allow the customer to re-position achieving optimum vision comfort. coincide with the centres of the pupils the frame on his/her face. (see photograph to right). nnThe RE and LE pupillary heights are usually similar. If a difference in height is observed: • check the adjustment of the frame, especially any horizontal misalignment, often a cause of difference in height. • check that the subject’s face is indeed vertically asymmetrical. If a difference in height is confirmed, reproduce it in the glazing.

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Far vision Addition Check the conformity Example R/L DD Sph Cyl Axis Add of the lenses and their 70/75 +3,25 +0,75 030 +1,25 Prescribed power 1 +3,12 +0,62 025 +1,14 Power measured markings with focimeter

nnChecking distance vision power: nnThe complexity of some progressive designs measurement is made by placing the and their various optimisation parameters concave face of the lens in contact with make the location and control of near vision the bearing cone of the focimeter. The power on the focimeter difficult. Make a distance vision control circle must coincide simple and reliable check by reading the with the bearing cone of the focimeter, temporal engraving of the addition value. the axis of the lens being horizontal. nnChecking the correct positioning of nnThe designs of some lenses take complex markings in relation to the engravings. optimisation criteria into account nnVerification of the prism: this is done by (aspherisation, customisation, etc.) placing the focimeter on the prism control affecting the direct reading on the point (middle of the 2 micro-circles). focimeter. These lenses are supplied with The prism measured is the resultant of the double labelling. thinning prism (2/3 of the addition) and a corrective prism if any.

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Make sure that both Check the conformity Make sure the frame centring and mounting 3 of the mounting 4 is correctly set up 2 are made in the Using the Ditest device or the centring chart, Pre-adjust the frame paying particular Boxing system check: attention: nnthe right and left PDs, nnto the positioning of the lenses in the same plane, nnAll values must be given in the Boxing nnthe right and left heights, system. nnthe horizontality of the mounting: nnto the pantoscopic angle. nnCentring and edging equipment must by the alignment of the micro-circles. work in this system. Retain (or retrace) 5 the lens markings until delivery

For the final fitting and checking on the patient’s face.

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Adjust the frame Check the vision Inform the patient about 1 to the patient’s face 4 quality the learning period 6 necessary for each new nnRespect the frame position chosen by nnIn distance vision using a visual acuity the patient. test. pair of lenses nnIn near vision using a reading test. Check centring using 2 markings Give recommendations nnIn distance vision: fitting cross in 5 to assist adaptation correspondence with pupil centre for the right and left eyes. nnDistance vision at eye level, looking straight ahead. nnNear vision in the lower part of the lens, by lowering the eyes (and slightly raising Finalise the frame the head if necessary). 3 adjustment nnTo begin, all head and eye movement should be carried out slowly.

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1 Visual comfort 2 Visual transparency 3 Visual efficiency

nnPerfect adjustment is essential to obtain nnRecommend that the lenses always be nnExplain to your patients how presbyopia the greatest benefit from a progressive wiped with a microfibre cloth and, if they develops over time. lens design. are very dirty, washed in lukewarm water nnAdvise them to have their eyes checked nnEncourage your patients to visit you and liquid soap or a suitable product that regularly, so that they are always wearing regularly to have their spectacles checked does not contain any harsh chemicals. a correction suitable for their needs, thus and adjusted. nnRecommend that spectacles be stored in making it easier to adapt to a change of a case after use, that they never be put prescription. lenses face down and that they never be exposed to a heat source (car windscreen, etc.)

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Certificate of Guaranteed 4 authenticity 5 adaptation

nnEssilor lenses are supplied with a nnState that Varilux and Essilor progressive certificate of authenticity guaranteeing lenses carry the Essilor guarantee of their origin and identifying the types of adaptation within a one month period. lens worn and the exact prescriptions. nnUnder this offer, the customer has nnTell the patients how important it is one month from the date of delivery to keep this certificate and present to express any persistent difficulty in it every time they visit their Eye Care adapting, despite wearing the spectacles Professionals. regularly. If the cause of the difficulty requires that the spectacles be modified, replace the lenses, giving consideration CERTIFICATE OF AUTHENTICITY to the analysis of the reasons for the N° 0109127512344 Ms Mary Martin failure to adapt. For this, comply with RE: -2.75 (+0.75) 160° Add 2.25 LE: -2.50 (+0.50) 160° Add 2.25 the conditions in the Essilor Progressive Lenses adaptation guarantee described in the general conditions of sale. VARILUX® STYLIS CRIZAL / E-SPF-25

GOOD VISION OPTICAL Street of Vision,SPECIMEN 14 CITY OF SIGHT

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GENERAL STEPS Record the precise Check the adjustment 1 complaints of the 3 Remark the lenses 5 of the frame wearer Fitting crosses for distance vision and near Vertical and horizontal alignment, Type of problem encountered, frequency vision circles. pantoscopic tilt and stability. and particular circumstances of problem, distances concerned, expedient solutions found, etc. Check the correct Validate the subject’s 4 centration of the 6 prescription Measure the lenses lenses 2 nnMeasure the visual acuity at distance and In distance vision and in near vision, frame the reading ability at near. Power of distance vision, near vision and positioned on the wearer’s face. nnConfirm the value of the addition as addition. related to the age.

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 35 24/02/2015 13:03 SOLVING ADAPTATION PROBLEMS SUPPLEMENT A TABLE OF POSSIBLE CAUSES TO EXPLORE This table relates to the complaints sometimes presented by wearers with characteristics which were eventually blamed.

CHARACTERISTICS EVENTUALLY BLAMED

WEARERS COMPLAINTS POSSIBLE SOLUTIONS Anti-reflectionPupillary Pupillarydistance MountingNVdistance DistanceDV height Additionvision AdjustmentDistance Inclinationlens/eye Former of the frame lensesAstigmatism

nnModify the adjustment by lifting the frame Has to raise the head or lift lenses nnIncrease the distance or near powers to read nnMount new lenses higher up

nnModify the adjustment by lowering the frame Needs to lower lenses or head nnReduce the distance or near powers to see better in distance vision nnMount new lenses lower

nnModify the adjustment Needs to tilt head to see clearly nnModify the centring nnCheck the astigmatism

nnCheck the addition Has a very reduced near vision field. nnReduce the addition and increase the distance power Fatigue after prolonged nnCheck the astigmatism work in near vision nnModify the adjustment by lifting the frame nnModify the centring: mount lenses higher

nnVerify the balance between right and left lenses nnReduce the distance power nnReduce the addition Sees out of focus in lateral vision nnCheck the distance PDs and modify the centring nnCheck the pantoscopic angle nnCheck the adjustment and the pantoscopic angle

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CHARACTERISTICS EVENTUALLY BLAMED

nnCheck distance and near pupillary distances and heights to confirm centring nnCheck distance and near powers, astigmatism and Sees double at distance or near or both balance between right and left eyes nnCheck the adjustment and pantoscopic angle nnCompare with the previous spectacles

nnMake new lenses with an anti-reflective coating Sees light sources doubled nnVerify the astigmatism

nnCheck the astigmatism nnReduce the addition nnCheck the distance and near PDs and the heights Sees lines deformed to check centring nnModify the adjustment by lifting the frame or mount the new lenses higher

nnCheck the distance and near PDs and the heights to check centring Has burning, itching sensation, nnCheck distance and near powers, astigmatism and feels ocular fatigue balance between right and left eyes nnCompare with the previous spectacles nnMake new lenses with an anti-reflective coating

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 37 24/02/2015 13:03 BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 38 24/02/2015 13:03 For further information or for downloading or ordering this Progressive Lenses Fitting Guide, visit our website at: www.essiloracademy.eu

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 39 24/02/2015 13:03 are trademarks of Essilor International – ® and Varilux and ® © Copyright Essilor Academy Europe – All rights reserved - Essilor Produced by Essilor Academy - English - 2015

www.essiloracademy.eu

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