Transcript Does size-threshold text legibility relate to performance

Progressive Addition
Lenses (PALs)
•Sheedy JE. Progressive Addition Lenses – Matching the specific
lens to patient needs. Optometry 2004;75(2):83-102.
•Sheedy JE. Correlation analysis of the optics of progressive
addition lenses. Optom Vis Sci. 2004;81(5):350-361.
•Sheedy JE, Campbell C, King-Smith E, Hayes, JR. Progressive
powered lenses - the Minkwitz theorem. Optom Vis Sci,
2005;82(10):916-924.
•Sheedy JE, Hardy RF, Hayes JR. Progressive addition lenses measurements and ratings. Optometry 2006;77:23-39.
Progressive Addition
Lenses (PALs)
Distance


Alternative to
bifocals or
trifocals
Advantages
– Cosmetic
– Functional

Patient
preference
Aberrations
Near
Intermediate
Vision with bifocal
compared to PAL
•Wide areas of clear vision
•Distance and near worlds are
separated.
•Unusable visual space between
them
•Image jump
•One continuous world
•Distance and near are connected
•Vision is more “natural”
•Narrow areas of clear vision
•Areas of distortion in world
The Minkwitz Theorem
Minkwitz vG. Uber den flachenastigmatismus bei gewissen
symmetrischen aspharen. Optica Acta 1963;10(3):223-7

Perpendicular
to the vertex
line, the
astigmatism
changes twice
as quickly as
the rate of
change of
power along
the vertex line.
Corridor
zone width
D
D
II
NN
Power
vertex line
Hard vs. Soft Designs
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Rotlex
instrument
Lens Acquisition


12 lenses provides good reliability
while still being logistically feasible
23 lens designs were ordered in pairs
from six different laboratories
– Attempt to avoid getting lenses from the
manufacturer made in the same batch
– Rx: Plano distance power and +2.00 near
add
• All ordered in CR-39, except Rodenstock AT and VE
Illumina which were only available in Polycarbonate
– Thanks to: Walman Optical, Minneapolis, Minnesota;
Diversified Ophthalmics, Cincinnati, Ohio; Hoya Vision Care,
Cleveland, Ohio; Interstate Optical, Mansfield, Ohio; Optical
One Inc., Youngstown, Ohio; Select Optical, Columbus, Ohio;
Toledo Optical, Toledo, Ohio; and Top Network, Columbus,
Ohio
–2
Fitting Cross
–1
+0.25 Limit
1
2
Data
acquired
3
4
5
6
+0.50 Limit
7
8

Mean
scaled
results
9
0.50 DC Limit
1 mm
10
1 mm
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
+1.75 Limit
Data Analysis
Distance viewing
Distance
zone
 Intermediate
viewing zone
 Near viewing zone
 Unwanted
Near
Aberrations
Intermediate
astigmatism

Shamir Genesis
Vis Ease Outlk
Rdnstk Life AT
Younger Image
Zei Gradal Top
Sig Kodak
Sig Kod Precise
Varlx Comfort
Varlx Liberty
Vis Ease
Varlx Panamic
Zei Gradal
Rdnstk Life XS
AO Easy
Varlx Ellipse
Sig Kod
AO Compact
SOLAMax
SOLA One
Sig Nav Short
Shamir Piccolo
Pentx AF
Pentx AF Mini
0
5
10
Distance Zone Width (mm)
15
20
Shamir Genesis
Vis Ease Outlk
Rdnstk Life AT
Zei Gradal Top
Younger Image
Sig Kodak
Sig Kod Precise
Varlx Comfort
Vis Ease Illumina
Varlx Panamic
Varlx Liberty
Zei Gradal
AO Easy
Rdnstk Life XS
Varlx Ellipse
AO Compact
Sig Kod Concise
SOLAMax
SOLA One
Sig Nav Short
Shamir Piccolo
Pentx AF
Pentx AF Mini
0
10
20
30
40
Distance Area (mm2)
50
60
70
Pentx AF
Pentx AF Mini
Zei Gradal Brevity
Zei Gradal Top
SOLAMax
Sig Kodak
Varlx Panamic
Rdnstk Life AT
Varlx Liberty
Younger Image
SOLA One
Shamir Genesis
AO Easy
Vis Ease Outlk
Shamir Piccolo
Varlx Comfort
Sig Kod Precise
Vis Ease Illumina
Sig Nav Short
AO Compact
Rdnstk Life XS
Sig Kod Concise
Varlx Ellipse
0
1
2
3
4
Intermediate Zone Width (mm)
5
6
Pentx AF
Pentx AF Mini
Zei Gradal Brevity
Zei Gradal Top
Varlx Liberty
Sig Kodak
SOLAMax
Younger Image
Rdnstk Life AT
Varlx Panamic
SOLA One
Varlx Comfort
AO Easy
Sig Kod Precise
Shamir Genesis
Vis Ease Outlk
Shamir Piccolo
Sig Nav Short
Vis Ease Illumina
Sig Kod Concise
AO Compact
Rdnstk Life XS
Varlx Ellipse
0
5
10
15
20
25
30
2
Intermediate Area (mm )
35
40
45
Varlx Panamic
AO Easy
Zei Gradal Brevity
AO Compact
SOLA One
Pentx AF Mini
Vis Ease Illumina
Shamir Piccolo
Sig Kod Precise
SOLAMax
Shamir Genesis
Pentx AF
Varlx Ellipse
Younger Image
Varlx Liberty
Sig Kod Concise
Zei Gradal Top
Sig Kodak
Rdnstk Life XS
Sig Nav Short
Vis Ease Outlk
Varlx Comfort
Rdnstk Life AT
0
1
2
Highest magnitude unwanted astigmatism (D)
3
Shamir Piccolo
Sig Nav Short
Sig Kod Concise
AO Compact
SOLAMax
Rdnstk Life XS
Vis Ease Illumina
SOLA One
Varlx Ellipse
Younger Image
20
Vis Ease Outlk
16
AO Easy
14
Sig Kod Precise
Pentx AF Mini
Sig Kodak
Shamir Genesis
Rdnstk Life AT poly
Varlx Comfort
Varlx Panamic
Varlx Liberty
Pentx AF
Zei Gradal Brevity
Zei Gradal Top
0
5
Near Zone Width (mm)
10
15
Shamir Piccolo
Sig Kod Concise
Sig Nav Short
Rdnstk Life XS
AO Compact
Varlx Ellipse
Vis Ease Illumina
area to 20.5
SOLAM ax
area to 16.5
Pentx AF M ini
area to 14.5
SOLA One
AO Easy
Vis Ease Outlk
Younger Image
Sig Kod Precise
Varlx Comfort
Sig Kodak
Shamir Genesis
Pentx AF
Varlx Liberty
Varlx Panamic
Rdnstk Life AT poly
Zei Gradal Brevity
Zei Gradal Top
0
20
40
60
80
2
Area of 1.75 D. add (mm )
100
Task analysis
Distance
Intermediate
Near
Ratings
Criteria for calculating ratings from measured values
Rating Category
Distance Zone
Derivative Measures
0-100 scale
50% - width at fitting
cross
5-20 mm
50% - area from 1.5 mm
above fitting cross
15-60 mm2
50% - width at 1.25 D add 2-5 mm
Intermediate Zone
50% - area from 0.75 to
1.50 add
10-30 mm2
50% - width at Y
0-15 mm
50% - area to Y +0.5 mm
0 - 100 mm2
Largest magnitude
2.75 - 1.25 D
Near Zone*
Astigmatism
* Near zone ratings reported for a specified fitting
height. Fitting
height determined by adding 2
mm to the Y value
Single Attribute Ratings
Distance Rating
Intermediate Rating
PAL Design
Mean
Shamir Genesis
Vis Ease Outlk
Rdnstk Life AT poly
Younger Image
Zei Gradal Top
Sig Kodak
Sig Kod Precise
Varlx Comfort
Varlx Liberty
Vis Ease Illumina
Varlx Panamic
Zei Gradal Brevity
AO Easy
Rdnstk Life XS
Varlx Ellipse
AO Compact
Sig Kod Concise
SolaMax
SOLA One
Sig Nav Short
Shamir Piccolo
Pentx AF
Pentx AF Mini
Mean
77.8
70.7
67.5
57.5
57.2
45.9
42.1
39.0
34.8
34.2
32.5
30.2
27.1
26.9
25.2
21.0
20.5
19.0
18.2
15.5
13.5
-4.2
-4.6
33.8
SD
Ranges of nonsignificant
differences
PAL Design
Mean SD
Ranges of nonsignificant
differences
Pentx AF
13.1 ●
100.4 35.9 ●
Pentx AF Mini
13.8 ● ●
79.1 7.4 ●
17.7 ● ●
Zei Gradal Brevity
70.3 12.9 ● ●
●
●
15.5
Zei Gradal Top
66.6 8.5 ● ● ●
●●●
11.8 ● ●
Sig Kodak
61.1 7.0
●●
●●●
14.1
SolaMax
60.6 3.6
●●●
●●●
13.3
Varlx Liberty
59.9 13.0
●
●
●
●●●●
14.9
Varlx Panamic
56.1 6.0
●●●●
●●●●
10.5
Rdnstk Life AT poly 56.0 13.8
●●●●
●●●●
18.3
Younger Image
55.7 12.4
●
●
●
●
●
●●●●
7.7
SOLA One
53.8 6.2
● ● ● ● ● ● AO Easy
●●●●
13.7
49.1 5.5
● ● ● ● ● Varlx Comfort
●●●●●
6.6
47.3 8.1
● ● ● ● ● Shamir Genesis
●●●●●
11.7
45.9 2.9
●
●
●
●
●
●●●●●
6.2
Sig Kod Precise
42.5 7.6
● ● ● ● Vis Ease Outlk
●●●●●
12.7
42.2 4.2
● ● ● ● Shamir Piccolo
●●●●●
11.3
38.7 3.2
●
●
●
●●●●●
Vis Ease Illumina
11.0
34.6 12.5
● ● ● Sig Nav Short
●●●●
5.9
32.3 19.7
● ● AO Compact
●●●
15.5
27.0 5.4
● Sig Kod Concise
●●●
7.4
26.9 3.7
●
●●
Rdnstk Life XS
19.7
26.4 7.5
● Varlx Ellipse
●
17.7
22.8 4.3
Mean
25.7
50.3 21.4
Single Attribute Ratings
Near Zone Rating
Fitting Height 16
PAL Design
Mean
SD
Shamir Piccolo
Sig Kod Concise
Rdnstk Life XS
Varilux Ellipse
AO Compact
Sig Nav Short
Vis Ease Illumina
SolaMax
AO Easy
Pentax AF Mini
SOLA One
Vis Ease Outlk
Sig Kod Precise
Younger Image
Pentax AF
Varilux Comfort
Varilux Liberty
Rdnstk Life AT poly
Shamir Genesis
Varilux Panamic
Sig Kodak
Zei Gradal Brevity
Zei Gradal Top
Mean
33.7
31.6
30.0
29.1
29.0
28.7
22.8
19.3
18.4
18.1
17.7
17.3
16.7
16.1
11.3
10.1
10.0
8.8
8.6
8.3
7.5
6.5
0.0
17.4
2.1
2.7
1.5
1.8
3.4
12.7
4.7
4.5
4.4
7.2
4.1
3.2
4.0
6.9
10.5
6.9
7.2
6.1
5.1
6.0
8.1
9.5
0.0
11.0
Ranges of nonsignificant
differences
●
●
● ●
● ●
● ●
● ●
● ●
● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ● ●
● ● ● ●
● ● ● ●
● ● ●
● ● ●
● ●
● ●
● ●
● ●
● ●
●
Fitting Height 18
PAL Design
Shamir Piccolo
Sig Kod Concise
Sig Nav Short
AO Compact
Rdnstk Life XS
Varlx Ellipse
Vis Ease Illumina
SolaMax
SOLA One
Younger Image
AO Easy
Vis Ease Outlk
Pentx AF Mini
Sig Kod Precise
Sig Kodak
Shamir Genesis
Varlx Comfort
Rdnstk Life AT poly
Varlx Panamic
Varlx Liberty
Pentx AF
Zei Gradal Brevity
Zei Gradal Top
Mean
Ranges of nonsignificant
differences
Mean SD
50.1
48.5
48.2
45.1
43.7
40.0
38.3
38.2
34.8
32.7
32.5
32.3
31.9
31.5
28.6
27.8
27.4
27.2
27.1
26.2
23.5
17.3
15.3
33.3
2.5
4.0
10.0
4.5
1.7
2.3
3.6
4.0
3.8
4.9
3.2
3.1
4.1
2.8
7.5
6.6
5.7
6.5
3.3
9.3
15.2
15.9
8.5
11.5
●
●
●
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● ● ●
● ● ● ●
● ● ●
● ● ●
● ●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
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Single Attribute Ratings
Astigmatism rating
Rating Fit Height 22
PAL Design
Mean
SD
Varlx Panamic
AO Easy
Zei Gradal Brevity
AO Compact
SOLA One
Pentx AF Mini
Vis Ease Illumina
Shamir Piccolo
Sig Kod Precise
SolaMax
Pentx AF
Shamir Genesis
Varlx Ellipse
Younger Image
Varlx Liberty
Sig Kod Concise
Zei Gradal Top
Sig Kodak
Rdnstk Life XS
Sig Nav Short
Vis Ease Outlk
Varlx Comfort
Rdnstk Life AT poly
Mean
73.9
67.9
67.7
67.4
66.6
64.2
64.0
57.9
56.3
56.1
55.3
55.3
54.6
52.3
51.1
51.0
47.5
46.9
46.6
46.3
43.5
42.7
19.4
54.5
2.3
2.5
4.0
4.0
3.1
4.4
7.6
2.1
4.8
2.8
20.0
3.2
4.5
3.1
3.3
3.5
2.7
3.1
3.2
10.9
2.4
6.3
4.5
12.8
Ranges of nonPAL Design
significant
differences
●
Shamir Piccolo
●●
AO Compact
●●
Sig Nav Short
●●
SolaMax
●●
Rdnstk Life XS
●●
Sig Kod Concise
●●
Vis Ease Illumina
●●
SOLA One
●
Younger Image
●
Rdnstk Life AT poly
●●
Sig Kod Precise
●●
Varilux Ellipse
●●●
AO Easy
●●●
Varilux Comfort
●●●●
Vis Ease Outlk
●●●●
Sig Kodak
● ● ● ● Pentax AF Mini
● ● ● Shamir Genesis
● ● ● Varilux Liberty
● ● ● Varilux Panamic
● ● Zei Gradal Top
● Pentax AF
● Zei Gradal Brevity
Mean
Mean SD
79.9
72.7
70.7
70.4
70.1
68.0
67.1
61.7
61.3
60.7
59.2
58.1
57.8
56.7
55.8
55.7
55.7
55.4
53.1
52.0
43.8
42.7
32.7
59.2
2.1
6.5
6.6
3.9
2.5
6.8
2.9
5.6
7.3
4.2
3.4
3.7
6.0
8.5
5.7
8.6
4.7
4.8
12.0
5.6
8.5
23.3
28.8
14.0
Ranges of nonsignificant
differences
●
●●
●●●
●●●
●●●●
●●●●●
●●●●●
●●●●●
●●●●●
●●●●●
●●●●●
●●●●
●●●●
●●●●
●●● ●
●●● ●
●●● ●
●●● ●
●● ●
●● ●
● ● ●
● ●
●
Distance, Intermediate and Near (FH 18) Combined
Without Astigmatism
With Astigmatism
PAL Design
Rdnstk Life AT poly
Shamir Genesis
Younger Image
Vis Ease Outlk
Zei Gradal Top
Sig Kodak
Pentax AF
Zei Gradal Brevity
Varilux Liberty
SolaMax
Sig Kod Precise
Varilux Panamic
Varilux Comfort
AO Easy
Vis Ease Illumina
SOLA One
Pentax AF Mini
Shamir Piccolo
Rdnstk Life XS
Sig Kod Concise
Sig Nav Short
AO Compact
Varilux Ellipse
Mean
Mean
50.9
50.5
48.6
48.4
46.4
45.2
41.4
40.9
40.3
39.2
38.7
38.6
37.9
36.2
35.7
35.6
35.5
34.1
32.3
32.0
32.0
31.0
29.3
39.2
Ranges of nonSD
significant
differences
5.7 ●
5.0 ●
5.0 ●
4.2 ●
3.3 ● ●
4.1 ● ● ●
● ● ●
11.9
● ● ●
8.0
● ● ●
3.5
● ● ●
3.0
● ● ●
4.0
● ● ●
3.5
● ● ●
6.2
● ● ● ●
2.0
● ● ● ●
8.2
● ● ● ●
2.2
● ● ● ●
4.7
● ● ● ●
2.0
● ● ●
5.6
● ● ●
3.3
● ● ●
7.2
● ●
4.0
●
2.5
8.1
PAL Design
Shamir Genesis
Younger Image
Zei Gradal Brevity
Varilux Panamic
Vis Ease Outlk
Zei Gradal Top
Sig Kodak
Pentax AF
AO Easy
SolaMax
SOLA One
Rdnstk Life AT poly
Sig Kod Precise
Varilux Liberty
Vis Ease Illumina
Pentax AF Mini
Shamir Piccolo
AO Compact
Varilux Comfort
Sig Kod Concise
Rdnstk Life XS
Sig Nav Short
Varilux Ellipse
Mean
Mean SD
51.7
49.6
47.6
47.4
47.2
46.6
45.6
44.9
44.2
43.4
43.3
43.1
43.1
43.0
42.8
42.6
40.1
40.1
39.1
36.7
35.9
35.6
35.6
43.0
3.5
4.1
6.5
2.5
3.2
2.7
3.0
6.1
1.7
2.0
2.0
4.4
3.3
2.3
4.5
4.0
1.6
3.6
5.0
2.8
4.2
3.6
2.6
5.6
Ranges of nonsignificant
differences
●
● ●
● ● ●
● ● ●
● ● ●
● ●
● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ● ●
● ●
●
●
●
●
Summary
Lens design
Best rating for
distance
vision
Best rating for
near vision
(FH 18)
Best rating for
unwanted
astigmatism
Rating
Lens design
Rating
Shamir Genesis
77.8
Vis Ease Outlk
70.7
Rdnstk Life AT
67.5
Younger Image
57.5
Zei Gradal Top
57.2
Shamir Piccolo
50.1
Sig Kod Concise
48.5
Sig Nav Short
48.2
AO Compact
45.1
Rdnstk Life XS
43.7
Varlx Ellipse
40.0
Vis Ease Illumina
38.3
SolaMax
38.2
Lens design
Varlx Panamic
73.9
Varlx Ellipse
15.1
AO Easy
Zei Gradal
Brevity
67.9
Rdnstk Life XS
15.6
Sig Kod Concise
15.8
AO Compact
67.4
AO Compact
15.8
SOLA One
66.6
Sig Nav Short
16.0
Pentx AF Mini
64.2
Shamir Piccolo
16.0
Vis Ease Illumina
64.0
Vis Ease Illumina
16.8
67.7
Best rating for
general vision
- not
considering
astigmatism
Best rating for
general vision
- including
astigmatism
Shortest
corridor
lenses
Rdnstk Life AT
50.9
Shamir Genesis
50.5
Younger Image
48.6
Vis Ease Outlk
48.4
Zei Gradal Top
46.4
Sig Kodak
45.2
Shamir Genesis
51.7
Younger Image
49.6
Zei Gradal Brevity
47.6
Varilux Panamic
47.4
Vis Ease Outlk
47.2
Min Fit ht
Which PAL should
be used?
There are literally an infinite
number of possible designs
 There are many, many
designs in the market from
which to choose.
 The information provided by
manufacturers is inconsistent
and nearly impossible to
compare

Premises



Significant differences exist
in the optical characteristics
of the various PALs
These differences affect the
size of the field of fixation for
distance, intermediate and
near vision.
Patient lifestyle
characteristics are a factor in
determining patient PAL
design preference

Member
– Vision Ease

Affiliate Members
– Lens Crafters
– Shamir Insight
– Carl Zeiss Vision
– J&J Spectacle Lens Group

Supporting groups
– Optical Laboratories Association
– COLTS laboratories
Collaborators










Charles Campbell
Ray Hardy
John R. Hayes
Chunning Huang
Matt Helfrich
Ewen King-Smith
Priya Ramamoorthy
Allan Yi
Karl Citek
Bret Andre