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Dr. Betta welcomes your questions - please click here to send your optical inquiries to Dr. I.C. (his lab assistant forwards all his mail directly to him)

I had a patient who is a first time progressive wearer, said that her distance and intermediate vision was fine however when she got to her read she said that 25% to 30% of a normal book page was not in focus and she needed to move her head from side to side to read. I suspect it is because 80% of the add power was cut out as the frame had a very small "B" measurement and she had a plus correction on top of a 2.75 add. However I am not 100% sure.

Is this a normal occurrence for the read on a first time progressive wearer?

I was told it is but feel that the patient should at least be able to see a complete page without turning her head from side to side to read a normal page. I would appreciate your input towards the correct diagnosis for this patient.

There are a few questions that first need to asked.

1 What kind of progressive lens is it

2 What is the power of the add

3 We are assuming that the PAL was measured correctly and it is high enough and the pd's are correct and accurate.

The PAL design generally allows continuous vision from distance to near point. Assuming that the prescription is correct and all parameters are accurately measured the simple test I would try is bringing the lens in closer to the eye and making sure the pantoscopic tilt is sufficient as to bring the bottom of the lens closer to the cheek without touching. This will allow the eye to have an effectively larger reading area as the gaze rotates downward to the reading area. You also want to make sure that the fitting cross of the lens is high enough. A low fitting forces patients to read in the intermediate portion of the PAL and that is dramatically narrower than the reading area.

There are new lenses on the market that do seem to have better reading areas. If the suggestions above offer no relief talk to you lab about some newer designs.

Also remember that the stronger the add power the more defined the edges of the transitions zone will in the reading area.

Try this first it has worked many times but you may in fact have cut the Add out of the lens completely because of that narrow B measurement. Most PALS specify at least 18mm of height, some newer narrow styles are designed for 16 mm. If you in fact ordered a new generation PAL for narrow frames double check to see if in fact you received the right progressive.

Is there a Federal Law that says all contact lens wearers must have yearly eye exams? In the past my daughters eye exams (with contacts) have been every 2 years. The Dr. office now says "every year" because of this new law. I can't find anything written that addresses that specific issue. If there is that's fine, but sometimes I think we are called back for rechecks that aren't necessary, except for adding more money to their pockets. Thanks for your assistance.

To my knowledge, I do not know of a Federal Law which dictates a doctor's protocol for prescription expiration. However professional standards do dictate that a patient, especially a contact lens patient (because a device is actually worn in the eye), be examined on a regular basis. For a contact lens patient, it is typical for follow up exams to be scheduled as needed (sometimes weekly, sometimes monthly or quarterly), particularly for a new lens, and overall evaluation of the integrity and health of the eye on an annual basis.

The annual eye exam is 90% an evaluation of the health of the eye and its abillity to adapt to another year of contact lens wear... only 10% of the exam is dedicated to evaluation of acuity. Changes in tear consistency and flow, integrity of the lids, blink rate and corneal health are just a few of the aspects of contact lens wear which require careful and periodic examination in order to ensure a healthy contact lens fit and wearing schedule. To have annual examinations of the eyes, especially for a contact lens wearer, is good professional practice and in the best interest of the patient.

Dear I.C.: If I can get my continuing education for my state license every year from suppliers and online why should I belong to OAM? Bill from Boston

Dear Bill: OAM is there for all opticians in the state, we do run educational courses and the funds raised go toward things like protecting your license. In states where there are no license requirements, the pay scale for opticians is much lower. The fee of $90.00 is a small investment to protect ones license and livelihood. But that's my opinion. OAM meets as a board about eight times each year, and along with routine business much time is devoted to lining up quality speakers for our association. You would be surprised how much work goes into setting up one of those meetings. Ask Blair Wong or Gary Lawton next time you see them.

Dear I.C.: I have had a question about the tolerance for a pair of lenses I have to order. Where can I find the list of standards? Ed from Worcester

Dear Ed: I have found the source for information is the Internet. The American National Standards Institute has listings for so many things, it will amaze you. If you log onto their website, for a fee you can download the latest standards available. It is a must for every office to have a copy. They can be reached at www.ansi.org It is an interesting site to visit. Good Luck.

Dear I.C.: I have noticed recently that it is getting harder to find licensed opticians. Any advice for someone who is looking? Helpless in Massachusetts

Dear Helpless: It does seem that there is more need for experienced opticians, however, the enrollment in our schools are low and dropping. You can help build the future of our profession in the future by encouraging young people to learn our craft. You might even want to consider it yourself! OAM has information about educational opportunities and available scholarships. Go out and be an ambassador for our profession.

Dear I.C.: Recently, I was questioned by a patient about the quality of her son's sport frame. I told her that the glasses were made of Polycarbonate and made to the 3.0 mm standard. Then I wondered if there are standards published? Dan from Seekonk

Dear Dan: If you're interested in standards for sport glasses, sunglasses, etc. go to the web and punch in www.astm.org There you will find the standards for so many things you will be amazed. You can also purchase the written standards for future information. It is nice to have this kind of information at your fingertips, available to you when a patient makes a query. Also be aware that the material thickness standard is due to be updated very soon. Keep an eye out.

Dear I.C.: I have been looking for a source that has all the progressive lenses along with their associated technical data. Does any such thing exist? Denise from Cambridge

Dear Denise: I would recommend contacting your lab first or one of our corporate sponsors, but you can also reach The Optical Laboratories Association at www.ola-labs.org You should be able to get all the info you could want. A new edition of the progressive identifier is going to be available soon.