We are all aware of the impact computers have on our daily lives. 

Most of us are also aware of the impact that computers are having on the visual and physical comfort of our patients. How we approach the problem and provide sensible solutions is what sets us apart from the competition. Educating yourself and becoming pro-active in providing solutions for your patients is vital to your optical success. 

The big buzz word in computer lenses is occupational progressives. Most of these progressives provide the computer user with the viewing needs to accomplish their daily computer usage. These occupational progressives generally have a large reading area and a wide intermediate channel. The wide reading and intermediate areas provide the computer user with a very functional solution. Most of the available occupational progressives do not provide any, or very minimal distance viewing ability. 

Fitting occupational progressives is very easy. Most of the available lenses are fit exactly like conventional progressive lenses - at center of pupil. The Essilor Interview and the Sola Access should be fit lower. They should be fit to the lower eyelid, or about 2-4 mm below the pupil. They should also be measured with monocular near measurements, not monocular distance as in a conventional progressive. You should become familiar with the fitting requirements, frame size measurements and power limitations for these lenses. When ordering these occupational progressives, it is usually recommended that you order them using the exact prescription as written by the Doctor. You should note in any special instruction areas for the lab to convert Rx. Most laboratories will do this automatically. A call to your laboratory to confirm their ordering preferences is strongly recommended. 

Occupational progressive lenses are a very good choice for computer users. I have used several of the above lenses with great success. I am not using them as much as some of my colleagues, though. I am using more single vision and flat top bifocals for computers users. I find that most patients are very satisfied with these options. The cost advantage of these options versus the occupational progressives is very attractive to many patients. Patients often complain about the price of regular eyewear. Trying to convince a patient to purchase a second pair of eyeglasses is sometimes impossible. Having several options is key to success. I find that when you educate a patient about the design, function, and width of available reading areas, that they often choose a single vision or flat top bifocal.

The most important factor in success with the single vision or flat top bifocal is finding the correct distance from the eye to the computer screen. I have the patient measure the distance and let us know. We also discuss the visual needs of their workday. Some patients are just typing away, looking at the screen for 8 hours a day. Other patients have up close reading needs, computer screen needs and even farther out demands that require more flexibility in the lens design. I like to use a wide flat top bifocal like an ft-35, ft-45 or even executive style bifocals. The segment line can be placed higher or lower than normal, depending on the visual demands of the patient. I will even use various tri-focal configurations, like E-D Tri-focals. This is a tri-focal that looks similar to an executive bifocal, with a flat top segment in the lower portion of the lens. It is a good option for those patients that not only need reading and computer distance clarity, but also have distance vision demands.

I like to trial frame the patient when they are going with a single vision or flat top bifocal. Trial framing can avoid many costly remakes. Most patients can be shown quickly how a computer Rx can benefit them. I use a +/-1.00 and a +/- 1.25 flipper over their current eyewear. This is a great visual tool that solidifies the computer eyewear purchase. I have the patient sit at one of my desks, or dispensing tables, and situate a reading card at the approximate height and distance of their computer. A majority of the time, the resultant power is approximately 50-60% of the add power. We fit a trial frame with the compensated Rx, and have them try out that Rx. I then use flippers that have +/- 0.25 and +/- 0.50 to refine the final Rx. All of the Rx modifications are discussed with the prescribing doctor and a computer Rx is written out or approved and notated in the patient's chart. 

It is important to discuss the limitations of any computer lens with the patient. Patients must have a reasonable understanding of how the lens works, the distances that it will be most efficient, and the lack of distance vision. A discussion of anti-reflective coating is suggested as well. I rarely use anti-reflective coating for computer glasses. I find that the patient is concerned about cost, and that when you start adding to the tally, they balk. Every office and location is different. There are some optical professionals that also suggest using various lens tints. Here again, you must decide if the benefit is real and if you want to provide the option to your patient. 

We are the optical professionals. We are the ones that the patient trusts. We are the ones that must be knowledgeable about available lens options. Contact the above listed manufacturers about their occupational progressive lenses. Educate yourself about converting working distance compensated Rx's. Think about using single vision and flat top bifocal for computer use. It is important to engage your patient in conversation. By asking a few simple questions, you may uncover hidden needs that you can fill. Most of your patients use computers on a daily basis. Talk to them about their usage. Ask them about there problems. Educate them about all of the available solutions to their computer usage. You can differentiate yourself from the competition by becoming a computer lens expert. Your patients deserve it!

Bob Fesmire, ABO/NCLE