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Thursday / May 30.
HomemicontactPresbyopia: The Trials and Tribulations

Presbyopia: The Trials and Tribulations

Alan Saks recounts his experience as a presbyope coming to terms with progressive lenses.

Hi, my name is Alan and I’m a presbyope…
I’ve been blessed to have been spectacle free for most of my life. My low, mixed stigmatism placed the circle of least confusion on the retina, and I was able to maintain a poor 6/6. I’m also a form fruste keratoconic. The resultant, small, inferior ‘bifocal cones’ kept me seeing well at near until around the age of 50, delaying presbyopia a few years longer than expected. My small pupils also provided a useful extended depth of focus.

Finding the right individualised solution for a person is critical to success. We should never give up on ourselves, or our patients

When I started struggling with fine near vision, a few manufacturers offered me their latest, greatest, presbyopia-correcting progressive lenses. Alas, all the ones I tried drove me nuts!

The reading zone seemed very small – covering a sweet spot of only a few centimetres on an A4 page or laptop screen – never mind the swim effect and trapezoid distortion.

I tried to adapt but gave up. My near vision issues were happily solved with degressive occupational lenses from the likes of Zeiss, Rodenstock, and Nikon, and I managed well for several years, wearing them as needed. I also wore a pair of round segment bifocals for the beach, driving, and reading in the sun.

I was still able to manage decent size print, uncorrected, in good light…

Then seven years ago, around the time I left New Zealand, an expert dispensing optician, good friend, and colleague, offered to design me some individualised Zeiss DriveSafe progressives. He assured me I’d be happy. Based on my previous experience, I was sceptical.

He set me up with a pair of sunglasses, and a general-purpose photochromic set. As soon as I put them on, I was amazed at how good they were, with excellent distance, reading and intermediate vision, and a lack of apparent distortion. I was an immediate convert. Since then, I’ve worn them all my waking hours for all tasks – from long sessions on the computer to driving, going to the beach, in the workshop, and gardening.

Finding the right individualised solution for a person is critical to success. We should never give up on ourselves, or our patients.

Progressive Flexibility

While attending a few conferences in the latter half of 2022, a couple of manufacturers suggested I try their new progressive lenses. Having recently purchased a Silhouette crystal frame and a pair of Oakley sunglasses, I agreed.

For the Oakley sunglasses I obtained some uber cool, blue-mirror, Oakley Prizm Deepwater polarised progs, which are based on a Shamir progressive design. Again, I was sceptical as to whether I would adapt but was super impressed with the quality of vision and easy adaption. While paddle boarding on our lake I could see the bottom, and fish were easy to spot. My near vision and computer vision is also good. Using my iPhone on the beach is no problem.

For my Silhouette frame, I chose to upgrade my Zeiss DriveSafe Rx with my latest prescription. They work perfectly, as always.

I was also recommended Hoya’s top-of-the-range, customised iD Myself progressives. I gave them a go, and concurrently obtained a pair of iD Workstyle 3 occupationals, fitted to my trusty Lindberg rimless frames. The iD Myself lenses are very impressive and arguably the best all round progressives for my visual needs.

Amazingly, I can now swap between my various glasses and progressive designs with zero adaption. Occasionally, I even find myself walking around in my occupationals, only noticing the distance blur when I look in the far distance.

A Confluence of Factors

Am I now more adapted to progressive lenses?

Am I more flexible and tolerant than I used to be? (I thought we became less adaptable, more inflexible, and crankier with age).

Or has lens design and technology improved dramatically over the past decade or two?

I’d suggest it’s a combination of factors.

Based on my experience, it might be worth suggesting to your trickier patients (and previous progressive non-adapters – even going back 10, 20 or 30 years) that they give modern progressive designs a try. I’d pick the high-end premium designs, individualised for the patient/frame/usage. I think this minimizes adaption problems and enhances outcomes.

Rarely did I have to take people out of progressives during my practice days. I expect this to be even less of an issue now with all the fantastic options we have. Single vision, bifocals and occupational designs also have their place.

Functional, tailored, multiple pairs make for happy patients, practitioners, and suppliers.

You may have noticed that I am no longer writing the milenses section of mivision. After three years, I have shifted my focus to cover eye care conferences. My long-standing micontact missive continues, while a team from Optical Dispensers Australia brings a fresh approach to milenses.