Bifocal & multifocal

Capt. Dr. Deependra Kumar Sah

M.Optom (Bharati vidyapeeth,Pune)
B.Optom (TUTH, IOM)

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Bifocal spectacles
• Two power in a spectacle lens; one for distance and another for near.
• RE) +2.00/-1.00 X 180 ; Add +2.00

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Various portion power in bifocal
• Distance power
• Near power(near portion power)
• Addition(add)
RE) +2.00/-1.00 x 180 (Distance power)
add+2.00D
so, power in near portion will be +4.00/-1.00x 180
• Therefore, if single reading glass is prescribed for above patient, the
power in full lens will be +4.00/-1.00 x 180

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Trifocal or intermediate correction power
• Trifocal lens is needed when addition increases above +1.50.

• It is because intermediate distance can not be clear enough through

near unless they go nearer or not clear through distance unless you
go far away.

• To solve it, trifocal or PAL(progressive addition Lens) was developed.

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• Usually, intermediate portion have 50% power of addition.

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Bifocal measurements
(Bifocal starts from ciliary line or lower limbus)

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Segment measurement
• Segment inset = distance IPD- near IPD

• Total inset = Frame PD- near IPD

• Inset(outset) = frame PD- distance IPD

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How bifocal is made
• Fused

• One-piece

• cemented

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Fused
• Segment is made up of higher refractive index than distance part.
• Fused bifocal is possible only in glasses due to high temperature.
• No ledge due to fusion inside counter-sink.

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One-piece bifocal
• Made up of one material with change in curvature so the ledge is felt
in near area.
• Possible in glasses and plastic both.

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Types of bifocal
• Round (Kryptok, fused)

• Flat top(D-shape, fused)

• Executive (Franklin, one-piece)

• Ultex bifocal (Round, one-piece)

• Double segment bifocal : for painter, librarian

• Upcurve (minus add or Rede –rite): for barber

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Segment centre
• Round is used in 22 mm round segment(Seg centre is 11 mm below
top)

• Flat top is made in 22 mm with optical centre is 5mm below top.

• In executive type, segment centre is on dividing line at top.

• Ultex is usually found in 19 mm size, so optical centre is 19 mm below

top.
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Trifocal
• Usually trifocal is needed once add power goes beyond +1.50 D.

• Intermediate task is completed well through trifocal with power of

50% of near add .

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Image displacement in bifocal
• Differential displacement at top of segment (Image jump)

• Differential displacement at reading level (usually 11 mm below

distance pupil centre or optical centre or MRP.)

• Total displacement at reading level

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Image jump
• It occurs due to prismatic effect at top of segment caused by add power.

• Prismatic effect due to distance power is suddenly changed by add

power at top of segment where eye sight crosses.

• So, it causes sudden displacement of image called Image jump.

• No image jump in case of executive style.

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Differential displacement at reading level
• Reading level is 11mm below distance optical centre or MRP.
• It is prismatic effect at reading level due to near add.

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• Differential displacement at reading level is zero for Flat top D-bifocal.

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Total displacement at reading level

• it is the total sum of prismatic effect due to distance power at reading

level + differential displacement at reading level due to add power.

• Prismatic effect due to distance power is already accustomed or

adapted so, differential displacement at reading level is clinically
significant.

• Image jump is not bothersome due to small pupil and smaller vertex
distance.

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Who needs earlier add?(Accommodation
• Hyperope need earlier add than emmetrope than myope.
• Spectacle wearing myope need more accommodation when shifted to
contact lenses or go under refractive surgery.

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Horizontal prism at near in bifocal
• By changing the value of segment inset, prism can be created in
bifocal.

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Bifocal power measurement
• It is done on lensometer with front near surface in stop since add is
on front side.

• Near front vertex power- distance front vertex power= add

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Progressive addition lenses
• It is invisible multifocal lens in which power gradually increases from
distance portion towards near portion through corridor.

• It is made with change in front surface curvature.

• The line between different portion is invisible .

• It is made up of single material (One-piece).

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Frame selection for PAL
• The frame must have enough vertical height (B-dimension) so that full
near area will be in lower part. (18 mm fitting height)

• Nasal area should not be cut like in Aviator.

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• Minimum vertex distance is preferable so that maximum filed of view
is achieved.
• Adjustable frame should be prescribed for pantoscopic tilt and face
form tilt (metal supra frame or full frame with nose pad).

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PAL lens selection
• What is the purpose of progressive? (general purpose or special)

• Small vertical height frame should choose short corridor lens.

• If cylinder is significant, atoric design should be the choice.

• Long time computer(Intermediate work) should be prescribed near

variable focus or occupational progressive lens.

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Methods of PAL fitting measurements
• Monocular PD is measured.

• Frame is fit well on face with vertex distance, face form, pantoscopic
tilt ,frame height, nosepad alignment all in correct position.

• If no lens in frame, then transparent tape is used instead of lens.

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• The patient looks at nose bridge of optometrist, a horizontal line is
drawn through centre of both pupil.

• Then frame is placed on centration chart of manufacturer and fitting

height + monocular PD is measured.

• Minimum blank size is measured through centration chart by placing

cross of lens on chart cross.

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Major areas or points in PAL lens
• Distance reference point(at centre of distance arc)
• Near reference point (at centre of near circle)
• Fitting cross (at centre of pupil)
• Prism reference point (centrally located point below fitting cross)

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Hidden engravings on PAL lens
• Add power is given on temporal side of lens, seen with UV lamp or
against tube light.

• Logo of manufacturer is given on nasal side.

• Progressive identifier (all information about PAL lens like fitting cross,
distance power )

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Remarking of PAL
• It is possible through hidden engravings with help of manufacturer
chart.
• Visible markings are removed with alcohol swab.

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Optical unwanted cylinder in PAL lens
• Unwanted cylinder is induced because of constant change of
curvature .
• Amount of cylinder increases if add increases or design becomes
harder.

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Design of lens
• Hard design (Mono-design) :

• Soft design(Mono-design)

• multidesign

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Hard design
• Faster rate of change of curvature from far to near

• Small corridor

• Larger distance and near viewing areas

• But maximum distortion due to high amount of unwanted cylinder.

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Soft design
• Rate of change of curvature is slow means that corridor is larger.

• Less distortion due to less cylindrical effects.

• Smaller area of viewing for near or far.

• Good for novice presbyopes, gets adapted to PAL easily.

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Multidesign
• It is softer in upper part of near add and harder in lower part of near
add.

• It is usually needed for high add.

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Contour plots
• Used to evaluate PAL lens about it’s design, cylindrical amount.

• It does not give idea about performance on patient’s eye.

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Spherical versus aspheric design
• Upper portion of distance power was spherical initially.

• Later on changed to aspheric even in distance power.

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Symmetric versus asymmetric lens
• Both lenses were similar in symmetric lenses.

• So the lens rotation was needed to fit in right and left eye.

• Nowadays, separate lens for right and left eye is made so that there is less
distortion while looking in periphery with both eyes open called asymmetric
lenses.

• Prismatic effect and cyliderical effects are same for both eyes when looking
at periphery in asymmetric lenses.
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Aspheric/atoric design
• Aspheric design is good enough for spherical distance prescription but
atoric design is needed for cylindrical prescription.

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Free-form technology
• It is a new technology for manufacture of lens that shapes a lens to
unique form with varying curvature and polish the surface to give best
optics.

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Aspheric/atoric design
• Free form technology can be used to make aspheric/ atoric
progressive lens.

• Specially prescriptions with cylinder needs atoric design made by free

form technology because cylinder in prescription plus oblique
astigmatism aberration in lens itself + cylinder due to progressive
curvature all give too much distortion in peripheral view.

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Position-of-wear/As worn lens
• For the vertex distance and pantoscopic tilt, lens is adjusted
automatically with CNC(Computer numerically controlled) system
with free form technology.

• It is called position-of-wear lens or As worn lens.

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Short corridor progressive lenses
• Some frame have smaller B-dimesnsion but patient likes it.

• So we need to advise them short corridor progressive.

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OPL or occupational progressive lenses
• For particular occupation or task, progressive can be ordered with
special parameter called OPL or occupational progressive lens.

• Near variable focus lens for small room office where he passes
maximum time on monitor of screen might get benefited.

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Near variable focus lenses
• In this, distance power is added with half of add power and
progression starts from there.

• So add is divided between distance and near.

• It can not be used outside office.(small room office)

• E.g. BE plano, add+2.00 can be prescribed +1.00 distance with +1.00

add.
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Personalized progressive
• According to head and eye movement of individual person,
progressive can be ordered specially for him called personalized
progressive(Customized progressive).

• Vision printing system is an instrument used to measure head and eye

movement behavior.

• Varilux ipseo is example of this lens.

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Prism thinning
• For low minus or plus lens, the edge becomes very thin.

• To thicken it, whole lens is supplied with base-down yoked prism in

both eyes (probably 2PD).

• Then whole lens is sliced in such a way that lower part becomes just
enough thick and other part becomes thin.

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Photo: prism thinning

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