I have a lot of older patients whom I have seen for many years. They are wearing older design progressive lenses and I have been steadily upgrading them to modern design progressive lenses with less peripheral distortion. About 1 out of every 5 upgrades leads to the patient returning with a complaint of not being able to get on with the modern lens. What should I do?

The transition from an older design to a newer one is not always smooth. My advice is to thoroughly prepare the patient for the new modern progressive lenses through counselling at the time of the dispensing.

Before choosing which modern progressive lens design to use, do some research and find out which progressive design produces the best results when converting from an older or lower-quality version. Do your best to find the lens that produces less peripheral distortion.

Skilful counselling can make a huge difference in the acceptance of new glasses. Discuss an expected adaptation period of 10 to 14 days and emphasize the positive aspects of the new design; wider corridor, larger reading area and less peripheral distortion. Remind the patient about what it felt like when they had their first progressive lens and how it was worth going through the adaptation period to get the benefit of being able to view distance, intermediate and near without having to remove or change eyewear.

The perception of distortion will diminish as the patients successfully move through the adaptation period.

If you continue with this number of problems then reconsider the modern progressive lens you are upgrading to and choose another.

In my experience taking the time to warn people of what to expect during the adaptation process and reminding them of the benefits of successful wear is usually adequate for the patient to persist for long enough to be successful.