Single vision
These lenses come in four varieties:
Spherical
This lens has a single point focus and is employed to correct
spherical focus errors such as myopia (short-sightedness) or
hyperopia (far-sightedness).
Cylindrical
This lens has no point focus but a line focus and is employed to
correct astigmatic focus errors.
Sphero-cylindrical
This lens also has no point focus but has two line foci and is
employed to correct a combined spherical and cylindrical focus
error. The above-mentioned lenses are suitable over the entire
visual range, from distance to close.
Ready made
readers (untested spectacles for reading bought over the counter)
would accommodate many patients. In fact, many optometrists make
available readers in their practices. Nevertheless, the following
needs to be considered:
If glaucoma is diagnosed
sufficiently early, the condition can be treated. The inherent
danger in utilising readers is that they can be purchased in
increasing strengths which may, for a period, alleviate the reading
difficulty but, at the same time, disguise the creeping seriousness
of glaucoma and prevent its early detection.
Reader
lenses are the same power for each eye. Should patients require
different powers, the assumption that the readers are equally
effective is incorrect.
Readers take the form of
spherical lenses and don’t take into account astigmatic correction.
The lenses are set at an average interpupillary distance (PD), which
may induce prismatic effect if this is not the patient's PD. This
may lead to temporary symptoms of eyestrain, tiredness and
inefficiency when reading.
The profession of optometry
has introduced a number of initiatives to accommodate economically
compromised communities throughout South Africa. Therefore, the low
cost of readers should not be seen as the deciding factor.
Ready made readers
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Combined focal length lenses
Bifocal

This
lens permits the user to see clearly in the distance and at close
range. It has a visible line demarcating the distance and near
sections.
Trifocal

This
lens permits the user to see clearly in the distance, at
intermediate distances and at close range. It has two visible lines
demarcating the distance, intermediate and near sections.
Progressive lenses

This
lens is designed to give continuous and uninterrupted vision from a
distance to all closer seeing distances. There is a gentle and
gradual power increase from the distance portion of the lens to the
near portion.
Progressive lenses, also called progressive
addition lenses, progressive power lenses, graduated lenses and
varifocal lenses, are ophthalmic spectacle lenses used to correct
presbyopia and other disorders of accommodation. A gradient of
increasing lens power is added to the correction for the other
refraction error, going from a minimum or nothing at the top of the
lens to maximum magnification at the bottom of the lens. A wearer
can then adjust the lens power required for clear vision at
different viewing distances by tilting his or her head to place the
line of sight through different parts of the lens.
Progressive addition lenses avoid the discontinuities in the visual
field created by bifocal and trifocal lenses. The lenses are also
more cosmetically attractive. The lenses suffer the disadvantage of
creating regions of distortion and blur away from the optic axis,
yielding poor visual resolution. Although manufacturers are
constantly striving to minimize these distortions, some wearers
cannot tolerate the lenses.
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Essilor lay a strong claim to have invented varifocals in 1958 with
their first design of Varilux lens. Early varifocals were relatively
crude designs but modern sophisticated varifocals have gained much
greater patient acceptance and include special designs to cater for
many separate types of wearer application, e.g. for use on with
computers, offering enlarged near and intermediate areas.

The varifocal lens give a progressive vision from near to far, for the
PRESBYOPIC eye. When the designer reduces the amount of astigmatism
which occurs in the lower portion of the lens - in an attempt to
speed the subject's adaptation to progressive lens wear - by
spreading the astigmatism into the distance portion as indicated in
the following figure, this arrangement results in a soft progressive
design. There can be no doubt that when the addition is low and.
hence, the surface astigmatism is low. The soft progressive design
has proved to be the most successful in enabling rapid wearer
acceptance of progressive power lenses.

Many manufacturers now produce progressive lens series that are
deliberately soft in design for the low-addition lenses in the
series, the design tending to become harder as the additions
increase. These are known as multi-design series.The following
figure illustrates how the power law differs with a multi- design
series for the additions. + 1.00. +2.00 and + 3.OOD. It is also seen
that the length of the progression zone reduces as the addition
increases for these lenses.
These features of modern progressive power lenses, together with the
attempts to ensure that prismatic effects are similar at
corresponding points on the lens. so-called horizontal symmetry of
the design, have ensured that the vast majority of wearers will
adapt to progressive lens wear.
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Design diagrams
Traditional progressive lens

Minimum height 24 mm
85% of the addition is obtained after 14mm
of progression
No prismatic compensation
Large field
of view for distant vision
Narrow progression
Good
field for near vision
Inexpensive progressive lens
Indication: For old type of lenses wearer
Modern design

Minimum height 24 mm
85% of the addition is obtained after 15mm
of progression
Prismatic compensation
Maximum of
aberrations under the add.
Medium field of view for distant
vision
Good et large progression zone
Good near
vision: Good Progressive lens for small budjet .
Top modern design

Minimum height 22 mm
85% of the addition is obtained after 14mm
of progression
Prismatic compensation
Maximum of
aberrations under the add.
Large field of view for distant vision
Good et large progression zone
Good near vision: Good Progressive
lens for all.
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Although it is easy to draw some conclusions about the likely
performance of one design over another by inspection of iso-cylinder
diagrams it is more difficult to pontificate over acceptance of the
design from these diagrams. The last figure indicates quite clearly
that the soft design has a narrower intermediate channel and a
narrower near portion than the lens that is described as a hard
design. The widths of these areas could be measured and expressed,
for example, in the same way as we would express the diameter of a
bifocal segment. However the significance of this information is not
immediately apparent. The author wears several different progressive
lens designs.
Each with different characteristics in
their intermediate and near portions, and has no strong preference
(at least, which is related to the optical performance of the lenses
for any one design over another.)
Needless to say the
advantages of progressive designs over other forms of multifocal
correction should be spelt out in simple terms.
These lenses will enable you to focus at all
distances.
To first-time young presbyopes
They will be easier to
get used to than bifocal lenses.
In wear the lenses will restore the
vision of youth.
There are no tell-tale dividing lines on the lenses.
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