Guide ENGLISH

PROGRESSIVE LENSES
FITTING
GUIDE
E SS E N T I A L R U L E S F O R T H E S U CC E SS F U L
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 guarantee patient
satisfaction.
Please use it for all patients!
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FITTING PROGRESSIVE LENSES
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24/02/2015 13:02
UNDERSTANDING THE PATIENT
1 THIS FIRST STEP IS ESSENTIAL
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?
Single
nn Vision for Distance, Single Measure
nn the previous correction:
Vision for Near, Mid-Distance, Bifocal, sphere, cylinder, axis, addition and Permanent
nn or occasional wear?
Progressive (brand and type)… prismatic correction if any. Working
nn distances?
Material,
nn colour, coatings… Date
nn when given the previous lenses.
Visual
nn performance with former lenses: SPECIFIC REQUIREMENTS?
measure acuity for distance and near
Profession,
nn hobbies, leisure.
vision.
Clarity
nn of vision required.
Understand the reasons for any lens Field
nn of vision needed.
change and confirm its need.
05

2 ANALYSING THE PRESCRIPTION
AN OVERVIEW OF THE REFRACTION TECHNIQUES
Compare the new Compare the value of

1 prescription with
2 the addition with
the previous one 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
0.75
nn D on the sphere exceeded in cases of real necessity. 49 years 1.50 D
0.50
nn D on the cylinder 51 years 1.75 D
10°
nn on the axis 54 years 2.00 D
0.75
nn 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.
07

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.
08

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

TESTING THE PRESCRIPTION SU PPLEM ENT
TO CONFIRM ITS ABILITY TO MEET THE PATIENT’S NEEDS
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
Compare
nn 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.
1
clearer on a green background.
Distance Vision (DV) - If vision is not balanced, add +0.25 D
in front of the eye that sees best until
• A preference for the red background
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.
Have
nn the patient look into the distance Confirm
nn the addition with a reading test.
If corrected visual acuity remains poor,
nn
or at an eye chart in the practice. Assess Confirm
nn the RE/LE balance in near vision
understand the reasons why or check the
visual acuity, first with both eyes open (by positioning the septum):
astigmatism using cross cylinder method
and then each eye in turn (occlusion). • Vision should be balanced.
(see page 11).
Confirm
nn the prescription with a binocular • If not, add +0.25 D to the eye that sees
lorgnette of +0.50 D then -0.50 D: less clearly.
• +0.50 D should fog the subject’s vision
• -0.50 D should have no significant effect
2 Near Vision (NV)
(possibly repeat with front +0.25 D and
-0.25 D). Place the NV prescription lens in the trial
Compare
nn 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 Ensure that the patient can see comfortably
nn
using the CheckTest) at a normal reading distance.
Confirm
nn clear vision range in relation to
his/her visual habits and needs.
10

REFRACTION IN DISTANCE VISION (1)
SU PPLEM ENT AN ACCURATE DISTANCE PRESCRIPTION RESULTS IN THE MOST
COMFORTABLE NEAR PRESCRIPTION
Deal with each eye separately starting from >> Verify the cylinder power
Determination
a trial correction (old prescription or results
from an autorefractometer). 2 of the cylinder
(with cross cylinder ± 0.25 D):
Place
nn the minus axis of the cross cylinder
along the direction of the correcting
Determination minus cylinder.
1
USING THE CROSS CYLINDER METHOD
With the subject looking at a line of small
of the sphere >> Verifythe cylinder axis
nn
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 Position
nn the handle of the cross cylinder position of the cross cylinder is preferred.
Place
nn the trial prescription in front of along the cylinder axis direction of the If
nn 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
Fog
nn the eye by adding +1.00 D or +1.50 D With
nn the subject looking at medium size cylinder, add -0.25 D to the correcting
to cause a drop in visual acuity. letters or a target of points, rapidly twirl cylinder.
the cross cylinder and ask the subject Repeat
nn this process until the subject
Unfog
nn 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
Continue
nn until the best acuity is obtained. Turn
nn the axis of the correcting minus power found.
Record
nn 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. Add
nn +0.25 D to the sphere for each
Repeat
nn 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 ref rac tion te chnique s , refer
to t h e O p ht halmic O pt ic s File
“Practical Refraction” of Essilor Academy
available on www.essiloracademy.eu
11

REFRACTION IN DISTANCE VISION (2)
AN ACCURATE DISTANCE PRESCRIPTION RESULTS SU PPLEM ENT
IN THE MOST COMFORTABLE NEAR PRESCRIPTION
>> Unfog binocularly FOR THE CYLINDER
3 Binocular balance the eyes in -0.25 D steps until the

maximum acuity is obtained.
Correct
nn the astigmatism only if it results
in a noticeable gain in visual acuity.
>> Check the acuity of each eye Be
nn wary of weak astigmatism, it often
>> Dissociate the subject’s eyes making sure that ocular dominance has varies. Moderate prescriptions with
by
nn 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
with vertical prism: introduce 3∆ base
nn
down before one eye and 3∆ base up recommendations Carefully
nn check binocular balance.
before the other Give
nn priority to the dominant eye:
or FOR THE SPHERE
do not reverse ocular dominance between
by
nn polarization: use polarized tests Always
nn fully correct the ametropia, the eyes.
for visual acuity together with the particularly any hypermetropia, but do In
nn cases of anisometropia, give the
corresponding polarized filters. not overplus. minimum possible difference between
>> Fog both eyes Do
nn 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:
there is a drop in acuity • for hypermetropia, “equalize” the red
AS A GENERAL RULE
and the green or leave “slightly clearer Avoid
nn large changes in prescription: do
>> Balance vision in the right on the green”, not exceed 0.75 D on the sphere, 0.50 D
and left eyes • 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”.
Remember
nn that refraction has not been
undertaken for infinity: add -0.25 D
For a more detailed information to the sphere if necessary.
on ref rac tion techniques , refer
to t he O p ht halmic O ptic s File
12 “Practical Refraction” of Essilor Academy

DETERMINATION OF THE NEAR ADDITION (1)
SU PPLEM ENT 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 Put
nn 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 Ask
nn 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: Adjust
nn 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
For example: Total amplitude of
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
Position
nn 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
If
nn 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
If
nn cannot read the smallest text add 1.25 0.75 1.75
+0.25 D, +0.50 D etc…, binocularly, until 1.00 0.50 2.00
the smallest text can just be read. 0.75 0.50 2.00 on ref rac tion techniques , refer
The amplitude of accommodation 0.50 0.25 2.25 to t he O p ht halmic O ptic s File
= 2.50 - final value which has been added.

13

THE “MINIMUM ADDITION” METHOD SU PPLEM ENT
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 4 Checking the patient’s
visual comfort
at 40 cm (16 in)
Add binocularly + 0.25 D, + 0.50 D, etc… Have
nn 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. Ask
nn 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.
Adjust
nn the value of the addition by 0.25 D
according to the usual working or reading
to t he O p ht halmic O ptic s File distance.
14 “Practical Refraction” of Essilor Academy

SU PPLEM ENT 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 Ask
nn the subject to fixate a cross made Put
nn 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). Ask
nn the subject to confirm that vision is
Position
nn ±0.50 D cross cylinders with comfortable when reading.
their minus axes at 90° in front of both Adjust
nn 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.
Progressively,
nn place +0.25, +0.50,
+0.75 D… lenses in front of the eyes until
the vertical and horizontal lines appear
equally black.
The
nn addition is the value which gives the
best equality between the horizontal and
the vertical lines.

to t he O p ht halmic O ptic s File
15

SELECTING THE FRAME
3 THE CORRECT CHOICE OF FRAME IS IMPORTANT
FOR OVERALL COMFORT
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. The
nn vertex distance is approximately
12 to 14 mm. 8° - 12°
The
nn pantoscopic angle is in the region
10 mm min. of 8° to 12°.
Proceed with the adjustments in the order:

Adjustment
nn of the front of the frame:
14 mm min.
projection, inclination, horizontality. 12 - 14 mm
Adjustment
nn of the sides of the frame:
opening, shape and length, ear pieces,
For optimal visual comfort, minimum closure of the sides.
distance of:
17 mm
nn between pupil center and bottom After adjustment, if the frame parameters
of the frame for regular progressive are significantly different from average
lenses and 14 mm for short corridor values, the choice of a progressive lens
The frame should always be with personalised fitting parameters is
progressive lenses adjusted before starting to take any recommended for wearer’s optimal vision.
nn10 mm between pupil centre and top measurements.
of the frame.
17

4 TAKING THE MEASUREMENTS
Before you take any measurements,
it is essential that the frame be
adjusted to the patient’s face. A CRUCIAL MOMENT FOR THE SUCCESS OF THE SPECTACLES
POSITIONING THE CLIP VIDEO CAPTURE

With an electronic
1 measuring column
Centre
nn
Press
nn
the clip on the bridge of the frame.
the clip’s rear hooks against the
Ensure
nn that the patient adopts a natural
posture; do this by getting them to look
right, then left then straight ahead.
frame: the hooks plane parallel to the
lens plane. Check
nn how the head is held in real time
PREREQUISITE Allow
nn the patient to position the frame on and how the natural posture is kept.
Adjust
nn the frame: reproduce subsequent his/her face. Record
nn the average value of the head
wearing conditions. Check
nn that the clip is still correctly cape angle.
Ensure
nn that the frame is horizontal and positioned. Take
nn the video in two stages:
that the lens planes are symmetrical. - static front view
- dynamic rotational three-quarters view.
Check
nn the position of the frame: right and
left sides in the same plane. Check
nn that the sensors have been read
correctly.
If
nn 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
Adjust
nn the measuring distance and angle of between 15° and 25°.
the height of the camera.
Note
nn how the patient holds the head
during the preparation phase.
NB: Measurement procedure based on the use of the Essilor Visioffice system.
19

4 TAKING THE MEASUREMENTS Before you take any measurements,
A CRUCIAL MOMENT FOR THE SUCCESS OF THE SPECTACLES adjusted to the patient’s face.
PRODUCING THE BOXING FRAME RESULTS SCREEN Check

nn 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
Check
nn 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.
Rimmed
nn frame: align the right horizontal
and vertical markers tangentially with >> Dominant eye
the lens/frame boundary (at the inner Invite
nn 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.
Nylor
nn or rimless frame: position the Ask
nn 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. Place
nn the reading chart in the board hole in the board.
Finish
nn by choosing the type of frame. coupled to the system.
Ask
nn the patient to hold the board like a
book in his/her natural reading posture.
Or
nn 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.

SU PPLEM ENT TAKING THE MEASUREMENTS
A CRUCIAL MOMENT FOR THE SUCCESS OF THE SPECTACLES
CAPE ANGLE POINTS TO WATCH

Default
nn selection: image showing the head cape closest to 0°. AVERAGE VALUE POINTS TO WATCH
If
n 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°
If
n the cape angle is confirmed, the corresponding image should be WRAP ANGLE Between 6° and 8°
Wrap angle value depends on frame type and
selected. design.
EYE ROTATION If RE/LE ERC differences > 2 mm, make sure the
If
nn the cape angle varies, take two measurements and proceed as Between 16 mm lenses are in the same plane i.e. that the frame has
CENTER (ERC)
follows: DISTANCE
and 36 mm 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
Situation 1 Situation 2 =17 mm
Comparing 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
Take the image Scroll the video cursor The reading distance influences the position of
Measurements: the near vision zone.
closest to 0° to select
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
on the use of the Essilor Visioffice system.
21

SECOND PHOTOGRAPH RESULTS SCREEN

With a dispensing desk
2 electronic measuring Ask
nn the patient to lower the head by
at least 10° and fixate the bright dot.
system Take
nn the picture when the screen changes
to green (correct head position).
PREREQUISITE AND POSITIONING OF
THE CLIP
Proceed as shown on page 19.
nn
FIRST PHOTOGRAPH
nnPosition the apparatus approximately
60-90 cm from the patient with his/her eyes READING DISTANCE
approximately 20 cm above it.
Ask
nn 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. Or re-position the clip on the old
nn
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).
On
nn the first photograph, check the red Take a picture and follow instructions on
nn
dotted ring over each iris is centered screen to calculate the reading distance.
properly. If not, position it manually.
Proceed
nn as shown on page 20 to adjust
boxing lines.
The
nn 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

adjusted to the patient’s face. A CRUCIAL MOMENT FOR THE SUCCESS OF THE PAR SPECTACLES
>> Position the pupillometer >> Take the measurement

With traditional
3 instruments
Take
nn the measurement, preferably with
the patient in a standing position.
for distance vision (at infinity) and,
for near vision (at 40 cm).
Set the pupillometer measuring distance
nn Move the right and left reticles to bring
nn
MEASURING THE MONOCULAR (at infinity and then at 0.40 m). them into line with the corneal reflexes.
PUPILLARY DISTANCES Lift
nn up the forehead rest and position Take the measurement with both eyes
nn
the pupillometer on the customer’s nose open and then each eye in turn, using
Using a Corneal Reflection Pupillometer
(for example, suggesting that they “hold the pupillometer’s eye occluder.
(CRP).
it like a pair of binoculars”). If there is a deviating eye and/or split
nn
Ensure
nn 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.
Release
nn the forehead rest. Check that the
>> Note the pupillary distances
pupillometer is horizontal and in contact
with the patient’s forehead. Read
nn the right and left monocular
pupillary distances.
Note
nn 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).
Note
nn 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

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).
Position
nn the frame on the patient’s face Get the customer to adopt a natural
nn
and ensure that it is properly adjusted. position and look into the distance at eye
Take
nn 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. Position the white line on each cursor
nn
Position
nn 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
Check
nn that the position of the frame on
using a pen-torch.
the patient’s face has not changed.
Pupillary height = distance separating the centre Read the tangent graduation at the
nn
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 Note whether there is a difference
nn
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.

adjusted to the patient’s face. A CRUCIAL MOMENT FOR THE SUCCESS OF THE SPECTACLES
TAKING ADDITIONAL >> Vertex distance Measuring the vertex distance:

MEASUREMENTS Position
nn 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.
Get
nn the patient to look into the distance.
Position
nn the tool on the side of the frame,
parallel to the arm.
Bring
nn the extremity of the tool at the level
of the apex of the cornea.
Note
nn 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.
25

>> Pantoscopic tilt Measuring the pantoscopic tilt:

Remove
nn the display lenses (except for
rimless or nylor frames).
Position
nn the frame on the patient’s face
and ensure that it is perfectly adjusted.
Get
nn the patient to look into the distance,
in a natural position.
Apply
nn the lateral face of the tool against
the edges of the frame.
Measuring the wrap angle:
Read
nn the pantoscopic angle shown by
Pantoscopic tilt = the angle between the lens the bubble level. Place
nn the tool flat (on a table).
plane and the vertical plane. Position
nn 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.
Read
nn 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

>> Reading distance
This distance allows the lateral positioning Measuring the reading distance:
of the lens’s near vision zone to be optimised The
nn 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).
Give
nn the patient a reading text and ask
him/her to read medium-sized characters.
Ensure
nn that the patient adopts a natural
reading position.
Using
nn 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.
27

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
Have
nn the customer look into the distance, full pupil centring. Meeting this
pupillary distances and heights measured
position yourself facing him/her at eyes centring condition is essential for
and mark the positioning of the near vision
height and check that the centring crosses achieving optimum vision comfort.
circles. Allow the customer to re-position
coincide with the centres of the pupils
the frame on his/her face.
(see photograph to right).
The
nn 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.
28

5 EDGING/MOUNTING THE LENSES
A FEW STEPS TO FOLLOW
Check the conformity Far vision Addition
1
Example
of the lenses and their R/L DD

70/75
Sph
+3,25
Cyl
+0,75
Axis
030
Add
+1,25 Prescribed power
markings
+3,12 +0,62 025 +1,14 Power measured
with focimeter
Checking
nn distance vision power: The complexity of some progressive designs
nn
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. Checking
nn the correct positioning of
The
nn designs of some lenses take complex markings in relation to the engravings.
optimisation criteria into account Verification
nn 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.
29

5 EDGING/MOUNTING THE LENSES
A FEW STEPS TO FOLLOW
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:
the
nn right and left PDs, to
nn the positioning of the lenses in the
All
nn values must be given in the Boxing the
nn right and left heights, same plane,
system. the
nn horizontality of the mounting: to
nn the pantoscopic angle.
Centring
nn 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.
30

6 DELIVERY AND FINAL FITTING
THE MOMENT OF TRUTH
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
Respect the frame position chosen by In distance vision using a visual acuity
nn
the patient.
nn
test. pair of lenses
In
nn near vision using a reading test.
Check centring using
2 markings
Give recommendations
In
nn distance vision: fitting cross in 5 to assist adaptation
correspondence with pupil centre for the
right and left eyes. Distance
nn vision at eye level, looking
straight ahead.
Near
nn vision in the lower part of the lens,
by lowering the eyes (and slightly raising
Finalise the frame
3 adjustment
the head if necessary).
To
nn begin, all head and eye movement
should be carried out slowly.
31

7 MONITORING OF THE ADAPTATION
FOR LONG-TERM SATISFACTION
1 Visual comfort 2 Visual transparency 3 Visual efficiency
Perfect
nn adjustment is essential to obtain Recommend
nn that the lenses always be Explain
nn 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 Advise
nn them to have their eyes checked
Encourage
nn 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. Recommend
nn 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.)
33

7 MONITORING OF THE ADAPTATION
FOR LONG-TERM SATISFACTION
Certificate of Guaranteed
4 authenticity 5 adaptation
Essilor
nn lenses are supplied with a State
nn 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. Under
nn this offer, the customer has
Tell
nn 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
C E R T I F I CAT E O F A U T H E N T I C I T Y 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 the conditions in the Essilor Progressive
E N
LE: -2.50 (+0.50) 160° Add 2.25
Lenses adaptation guarantee described in
CI M the general conditions of sale.
SPE
VARILUX® STYLIS
CRIZAL / E-SPF-25
GOOD VISION OPTICAL

Street of Vision, 14
CITY OF SIGHT
34

SOLVING ADAPTATION PROBLEMS
SU PPLEM ENT IT IS NECESSARY TO FOLLOW A PRECISE SEQUENCE IN ORDER TO
DETERMINE THE PROBLEM. THOROUGH RESEARCH MUST BE CONDUCTED.
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
Check the correct Validate the subject’s
found, etc.
4 centration of the 6 prescription
lenses
2 Measure the lenses Measure
nn the visual acuity at distance and
the reading ability at near.
In distance vision and in near vision, frame
Power of distance vision, near vision and positioned on the wearer’s face. Confirm
nn the value of the addition as
addition. related to the age.
35

SOLVING ADAPTATION PROBLEMS SU PPLEM ENT
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
e
V
As lens ram
eN
eD
e
ef
ht
nc
nc
at s /ey
on
ig
n
h
st a
st a
es
rm of t
io
he
ism
i si
en
t
ct
di
di
en
ev
el
g
ion
fle
at
ry
ry
n
in
st m
WEARERS COMPLAINTS POSSIBLE SOLUTIONS
nc
nc
t io
m
er
re
ll a
ll a
nt
tig
st a
st a
ti -
lin
di
ju
ou
pi
pi
An
Inc
Ad
Ad
Pu
Pu
Fo
Di
Di
M
Modify the adjustment by lifting the frame
nn
Has to raise the head or lift lenses
Increase the distance or near powers
nn
to read
Mount
nn new lenses higher up
Modify the adjustment by lowering the

nn frame
Needs to lower lenses or head
Reduce the distance or near powers
nn
to see better in distance vision
Mount new lenses lower
nn
Modify the adjustment

nn
Needs to tilt head to see clearly Modify the centring
nn
Check the astigmatism
nn
Check the addition

nn
Has a very reduced near vision field. Reduce the addition and increase the distance power
nn
Fatigue after prolonged Check the astigmatism
nn
work in near vision Modify the adjustment by lifting the frame
nn
Modify the centring: mount lenses higher
nn
Verify the balance between right and left lenses

nn
Reduce the distance power
nn
Reduce the addition
nn
Sees out of focus in lateral vision
Check the distance PDs and modify the centring
nn
Check the pantoscopic angle
nn
Check the adjustment and the pantoscopic angle
nn
36

SU PPLEM ENT SOLVING ADAPTATION PROBLEMS
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
e
V
As lens ram
eN
eD
e
ef
ht
nc
nc
at s /ey
on
ig
n
h
st a
st a
es
rm of t
io
he
ism
i si
en
t
ct
di
di
en
ev
el
g
ion
fle
at
ry
ry
n
in
st m
WEARERS COMPLAINTS POSSIBLE SOLUTIONS
nc
nc
t io
m
er
re
ll a
ll a
nt
tig
st a
st a
ti -
lin
di
ju
ou
pi
pi
An
Inc
Ad
Ad
Pu
Pu
Fo
Di
Di
M
Check
nn distance and near pupillary distances and
heights to confirm centring
Check distance and near powers, astigmatism and
nn
Sees double at distance or near or both
balance between right and left eyes
Check the adjustment and pantoscopic angle
nn
Compare with the previous spectacles
nn
Make new lenses with an anti-reflective coating

nn
Sees light sources doubled
Verify the astigmatism
nn
Check the astigmatism

nn
Reduce the addition
nn
Check the distance and
nn near PDs and the heights
Sees lines deformed
to check centring
Modify the adjustment by lifting the frame or
nn
mount the new lenses higher
Check
nn the distance and near PDs and the heights
to check centring
Has burning, itching sensation, Check distance and near powers, astigmatism and
nn
feels ocular fatigue balance between right and left eyes
Compare with the previous spectacles
nn
Make new lenses with an anti-reflective coating
nn
37

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 40
www.essiloracademy.eu
© Copyright Essilor Academy Europe – All rights reserved - Essilor® and Varilux® are trademarks of Essilor International –
Produced by Essilor Academy - English - 2015
24/02/2015 13:03

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PROGRESSIVE LENSES

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Please use it for all patients!

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What was the patient What are the visual

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Compare the new Compare the value of

* Additions over +2.50 D are rarely ever

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USING THE ESSILOR CHECKTEST™

>> With an additional power of - 1.00 D

>> With the red-green test The CheckTest is available from

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For a more detailed information

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>> Unfog binocularly FOR THE CYLINDER

3 Binocular balance the eyes in -0.25 D steps until the

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Measure Determination Verify that the subject

amplitude of accommodation = 2.00 D. 3.00 2.00 0.50

= 2.50 - final value which has been added.

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Good correction Add + 0.75 D

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Fully correct Determine Verify that the subject

For a more detailed information

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1 Frame selection 2 Frame adjustment

Proceed with the adjustments in the order:

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POSITIONING THE CLIP VIDEO CAPTURE

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PRODUCING THE BOXING FRAME RESULTS SCREEN Check

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CAPE ANGLE POINTS TO WATCH

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SECOND PHOTOGRAPH RESULTS SCREEN

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>> Position the pupillometer >> Take the measurement

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MEASURING PUPILLARY HEIGHTS >> Position

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TAKING ADDITIONAL >> Vertex distance Measuring the vertex distance:

This tool allows to determine the lens

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>> Pantoscopic tilt Measuring the pantoscopic tilt:

Wrap angle = the angle formed by the plane

BH010-ESSILOR-GUIDE_ADPATATION_VP_UK-40P-210x150-A05.indd 26 24/02/2015 13:03

>> Reading distance

Distance separating the reading plane from

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Check the conformity Far vision Addition

of the lenses and their R/L DD

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1 Visual comfort 2 Visual transparency 3 Visual efficiency

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CI M the general conditions of sale.

GOOD VISION OPTICAL

* Additions over +2.50 D are rarely ever