渐进多焦点眼镜发明于五十年代末,经过更新换代,已日臻完善。渐进多焦点眼镜适用于中老年人远、中、近距离使用。近年来也可作为青少年预防、控制和延缓近视的发生和发展使用。

据报道,法国老年人中有48%人使用渐进多焦点眼镜,而我国老年人中仅有0.2%享受到渐进多焦点眼镜的福泽。究其原因不外乎有两种:

1、价格太贵,1-2千元一副眼镜的价位,离、退休的老年人难以承受;

2、验光配镜技术难度较高,许多中、小型眼镜店对这种眼镜的验配望而却步。

其实,配这种眼镜成功的关健部分,是验光和配镜。


一、渐进多焦点镜片的认识:

    渐进多焦点镜片上有四个区:1远用区。2近用区。3过度区。4像差区;如下图:两个光心:近用光心和远用光心。一个中心:几何中心(棱镜测量区)。一条参考线:水平参考线。加入度及品牌标记等。

水平参考线两端标记34毫米。

几何中心至上光心2-4毫米。

上光心至下光心:垂直距离17-19毫米。

水平距离(内偏)2。5-2。8毫米。

光度范围:单光≤±8。00DS,散光≤±2。00DC

加入度(ADD):+1。00D~+3。50D


二、渐进多焦点镜片的适应症和禁忌症:

1、适应症:

   (1)年龄在45岁以上,工作及生活中有远用、近用、中距离用眼要求的患者。如教师、医生、领导干部等。

   (2)青少年:远视力正常,可用作预防近视;近视患者,每年近视增加速度较快,可延缓和控制近视发展。

   (3)屈光不正状态:

单光≤±8.00DS;散光≤±2.00DC;垂直屈光参差≤±2.00D

   (4)配镜的最佳对象:

    A、年龄在45岁以上,有戴镜史,有近、中、远连续用视力的要求。

远用光≤±6.00DS,散光≤±2.00DC,垂直参差≤±2.00D。

重点是有戴镜史。长期戴眼镜的患者,对眼镜产生的像差早已习惯。而没有戴镜史的人即使戴平光眼镜也有不适感,如用多焦点眼镜,就更加不适应了。

B、青少年每年近视增加-1。00D以上,希望控制和延缓近视发展的,实践证明这些患者使用多焦点眼镜后,近视加深的速度会被控制或延缓。


2、禁忌症:

   (1)两眼垂直屈光参差>±2。00D散光>±2。00D患者。这类患者由于两眼屈光参差大,双眼调焦时形成不能忍受的棱镜效应。阅读时,两眼不但向内转,而且下端向鼻侧旋转,导致近用散光轴与远用散光轴略有不同,散光度太大,就会影响近用散光的矫正。

   (2)要求中距离、近距离有较大视场的患者,如驾驶员、图书馆管理员、会计等。不宜选配渐进多焦点眼镜。

   (3)远视力正常、从不戴眼镜、希望一副眼镜能任意看清远、中、近距离的物体,(即眼镜业常说的“上平下老”的多焦点眼镜)。这类患者配渐进多焦点眼镜的成功率较低。


三、渐进多焦点眼镜的验光:

    此类眼镜验光方法与普通眼镜验光方法略同。总原则:远光准,加光足。

1、远用光验光,采用标准程序:问诊、眼部检查、裸眼视力、原眼镜光度和矫正视力、电脑验光仪测试、检影复查、雾视法、双色试验、散光表法、交叉圆柱镜法、优势眼检查、双眼平衡。


2、近用加入光检查,采用交叉格子老视验光法或经验法。

(1)交叉格子法:

    远用光已矫正。33厘米注视交叉格子图。(组合验光仪、近用视力表或近用主觉验光图中均有)被检眼前置±0。50DC交叉圆柱镜。负轴置90º,正轴180º,观察交叉格子图。若横线清晰,有老视,添加正球镜片,直至横竖线。相同清晰。

所加正镜片的度数,并保持1/3储备调节,就是老视的加光度。

计算步骤:

A、调节步骤=1/测试距离(米)-添加正镜度。

B、储备调节=调节幅度×1/3。

C、可动用的调节:调节幅度-储备调节度。

D、老视加入度=+3。00-可动用的调节。


例:一位50岁的患者,远用光度已矫正,33厘米交叉格子试验,右、左加+1。50DS,横、竖线条等清,问加入度是多少?

解:A、调节幅度=1/0.33-(+1.50)=+1.50D。

    B、储备调节=+1.50×1/3=+0.50D。

    C、可动用调节:+1.50-(+0.50)=+1.00D。

  D、老视加入度=+3.00-(+1.00)=+2.00D。


(2)经验法:

    用经验法公式(年龄-30)×0.1=加入度。60岁以上,按60岁计算。

例:53岁加入度=(53-30)×0.1=2.3=+2.25D老视加入度不能用少,否则会影响近用区的范围。


四、渐进多焦点眼镜镜架的选择和瞳距瞳高的测量

1、镜架的选择范围较宽,只要不是很特殊的大斜边镜架,或很扁的镜架,一般镜架的上下框缘≥34毫米即可。各厂家生产的多焦点镜片上光心至下光心距离是19-17毫米,如果近用区能在镜片内,又保持一定的远用视场,镜框上下缘之间距离不能小于34毫米。

2、瞳距测量:

    这种眼镜只要测量远用瞳孔距离。一些眼镜厂家提倡用瞳距仪测量单眼瞳距,但常常因瞳距仪使用不当,测量有误差。用瞳距仪测量单眼瞳距时,鼻梁的中线很难掌握,略有偏差,就会造成单眼瞳距人为的两眼不等。用常规的瞳距尺测量双眼瞳距,一般不会影响渐进多焦点眼镜的使用效果。远用瞳距测量要在两眼视轴平行的状态下进行。瞳距尺分别测出右眼颞侧(或鼻侧)角膜缘(或瞳孔缘)至左眼鼻侧(或颞侧)角膜缘(或瞳孔缘)的距离。要点是:远用瞳距测量不能偏小。

3. 瞳孔高度:

    为了避免测量时误差,验光技术复杂。特别推荐瞳孔高度的公式法。 h=(a-34)÷2+22

其中h为瞳孔高度,(即远用光心至镜框下缘距离)(mm);a为垂度。(上框缘至下框缘距离)(mm)。

例:一顾客选镜框的上框缘至下框缘距离为40毫米,瞳高应是多少?

h=(a-34)÷2+22=(40-34)÷2+22=25mm

所以该顾客的瞳高为25毫米。

实际配镜可参照下表:

                a(mm)       h(mm)            a(mm)       h(mm)

                 34         22               42          26

                 35         22.5             43          26.5

                 36         23               44          27

                 37         23.5             45          27.5

                 38         24               46          28

                 39         24.5             47          28.5

                 40         25               48          29

                 41         25.5             49          29.5

a垂度(mm) h瞳孔高度(mm)


五、渐近多焦点镜片加工:

    渐进多焦点眼镜的磨边加工不复杂,与普通眼镜加工基本相同。甚至比散光镜片加工还容易,只要把镜片的光学中心点放在相应的位置,注意两点:1。光心内移量,2。瞳高。水平参考线放在水平位置,即可仿形磨边。这时不用管散光的轴位,因为散光的轴位已在研磨镜片时设定准确。加工结束后,将镜片上所有标记保留。


六、渐进多焦点镜片检测:

1、核对处方。包括渐进多焦点眼镜品种、远用光度、近用加入度、瞳孔距离、瞳孔高度。

2、 远用光度检测。用焦度计检测镜片远用光检测位置,测量远光心、远光度、散光及光轴。

3、近用加入度检测。将镜片在焦度计上缓缓往前平移,直至下光区的光度显示,并核对。

4、测定瞳孔距离和瞳孔高度。


七、初戴眼镜的教育:

1、 将眼镜擦拭干净,帮顾客戴在脸上,观察镜片标记,看水平参考两眼是否一致?光心与瞳孔中心对准,瞳高位置恰当,如有不合,稍调整镜架、鼻托。

2、请顾客抬头正视前方,学会远用区的使用方法。

3、用面积较小的报纸或书籍,请顾客上下摆动头部,找出能看清文字的最佳位置,此位置是近用区。

4、将有文字的纸张远离顾客正前方约一臂长位置。调整头部姿势,找到中距离最佳区域。

5、请顾客眼向下并向两侧环顾,会出现视物变形、头晕现象。此区域测试不能使用的像差区。


八、使用注意事项

1、初戴渐进多焦点眼镜须逐渐适应,使用时应先静后动,先内后外。

2、戴多焦点眼镜观察物体,视野不如单焦点眼镜,应学会利用头部上下摆动来视物。

3、初戴时走路,最好看一米以外,不要低头看脚附近,下楼梯时一定要慎重。


九、投诉处理

1、根据顾客投诉内容,先核对眼镜与处方是否相同,(包括镜片品种、单光、散光、光轴、光心距、瞳高等)如有一项不符,应及时调整或更换。

2、如上述各项都正确,就调整镜架,可能因镜架变形,上下光心偏离瞳孔中心光轴偏离,调整镜架后,就能使用。

3、如一、二两条都正确,需重新验光。



    Progressive multiple focus glasses was invented in the late fifty's, after upgrading, has been improving. Progressive multiple focus glasses is suitable for the elderly, in the far and near distance use. In recent years, can also be used as a youth prevention, control and delay the occurrence and development of myopia using.

    According to reports, the elderly people in France have 48% of people using Progressive multiple focus glasses, and old people in our country only 0.2 percent enjoy Progressive multiple focus glasses of blessings. The reason is nothing more than two:

1, the price is too expensive, one or two thousand dollars a pair of glasses price, retired old people unbearable;

2, the optometry technology is difficult, many small and medium-sized glasses shop on the glasses fitting out.


In fact, With the key part of this success is the glasses, optometry and glasses.


One, the understanding of Progressive multiple focus lenses:

    Progressive multiple focus glasses has four districts: 1 far zone. 2 in the area. 3 transition zone. 4 aberration area; picture is as follows: two light: near and far light with light. A center: the geometric center (prism measurement area). A reference line: horizontal reference line. Join and brand etc..

Both ends of the horizontal reference line mark 34 mm.

The geometric center of first light 2-4 mm.

On the light to light: the vertical distance between 17-19 mm.

Horizontal distance (internal deviation) 2. 5-2. 8 mm.

Photometric range: single light less than 8. 00DS, astigmatism less than 2. 00DC

Join degree (ADD): 1. 00D ~ + 3. 50D


Two, Progressive multiple focus glasses indications and contraindications:

1, indications:

(1) more than 45 years of age, work and life are far and near, in the distance with an eye to the patients. Such as teachers, doctors, leading cadres, etc..

(2) young people: far sighted, can be used for prevention of myopia; myopia patients, the annual increase in the rate of myopia, can delay and control the development of myopia.

(3) ametropia:

Single light less than 8.00DS; astigmatism less than 2.00DC; the vertical anisometropia is not more than 2.00D

(4) best glasses:

A, more than 45 years of age, a history of spectacles, nearly, and far continuous vision requirements.

Far less than 6.00DS with light, astigmatism less than + 2.00DC, vertical stagger less than 2.00D.

The key is a history of spectacles. Wear glasses for a long time with glasses have already used aberration. Without wearing glasses history even wearing spectacles have discomfort, such as the use of multiple lenses, more not to.

B, adolescent myopia increased 1 year. Above 00D, hope to control and delay the development of myopia, the practice proves that these patients with multifocal glasses, myopia can be controlled or slow speed.


2, contraindications:

(1 eyes) vertical anisometropia > + 2. 00D astigmatism > + 2. In patients with 00D. This kind of patients with anisometropia, the formation of the prism effect can not stand the eyes when focusing. When reading, not only his eyes turn inward, and the lower end to the nasal side rotation, resulting in nearly by far and astigmatism axis of astigmatism axis is slightly different, astigmatism is too large, it will affect the near astigmatism correction.

(2) requirements in the distance, near a large field of view of patients, such as drivers, librarians, accounting etc.. Not matching progressive multifocal lens.

(3) of far sighted, never wear glasses, hope can a pair of glasses in the any of the Qingyuan, near distance objects, namely eye mirror often says "on the old multi focal glasses). This kind of patients with progressive multifocal lens of low success rate.


Three, Progressive multiple focus glasses lens:

    And such glasses and ordinary glasses optometry optometry. General principles: beam, light foot.

1, far light refraction, using standard procedures: interrogation, eye examination, uncorrected visual acuity, original glasses photometric and correction visual acuity, computer optometry instrument test, retinoscopy review, fog method, double color test, astigmatism method, cross cylindrical lens, ocular dominance checks, binocular balance sheet.


2, with the addition of near ray, the intersection lattice presbyopic refraction method and experience method.


(1) cross grid method:

Corrected far light. 33 cm at the intersection lattice graph. (combination of optometry, near vision table or near the main sleep were optometry in the figure) tested eye front + 0. 50DC cross cylindrical mirror. The 90&ordm positive, negative axis; axis 180&ordm, observation of cross grid graph. If the line is clear, presbyopia, add ball lenses, until the horizontal and vertical line. The same is clear.

The positive degree of lens, and keep adjusting the 1 / 3 reserves, is presbyopia and luminosity.

The calculation steps:

A, adjusting step = 1 / test distance (m) - add positive dioptric.

B, reserve adjustment adjustment range * 1 / 3 =.

C, available regulation amplitude and reserve adjustment degree.

D, adding additional = degree of presbyopia. Regulation of 0 0 - - available.

Case: a 50 year old patient, has corrected distance by spectrophotometric, 33 cm cross grid test, right and left with + 1. 50DS, horizontal and vertical lines clear, ask how much is the degree of join?

Solution: A, adjustable range = 1 / 0.33 (1.50) = 1.50D.

B, reserve regulation = + 1.50 * 1/3 = 0.50D.

C, can use regulation: + 1.50 (+ 0.50) = 1.00D.

D, added 3.00 (= presbyopia + 1.00) = 2.00D.


(2) the experience method:

By empirical formula (age 30) x 0.1 = join degree. 60 years of age or older, according to the age of 60.

Cases: 53 years old to join the degree = (53 - 30) 0.1 x = 2.3 = + 2.25D presbyopia added not less, otherwise it will affect the near area.


Four, Progressive multiple focus glasses measurement and pupil pupil height

1, frames a wide selection range, as long as it is not very special bevel frame, or a flat frame, general frames under frame edge is more than or equal to 34 mm can be. Each manufacturer production of multifocal lenses photocentric to photocentric distance is 19 17 mm, if the near area can in the lens, and the far field and frame between lower edge distance cannot be less than 34 mm.


2, interpupillary distance measurement:

This pair of glasses as long as the measurement of distance with the pupil distance. Some glasses manufacturers to promote the use of measuring monocular Centrometer IPD, but often due to improper use of Centrometer, measurement error. PD meter to measure pupil distance, midline on the bridge of the nose is difficult to grasp, a slight deviation, it will cause one pupil from human eyes ranged. For the measurement of the conventional PD PD ruler eyes, generally does not affect the use effect of progressive multifocal lens. By far the interpupillary distance measurements to be carried out under the condition of parallel eyes in los. PD ruler were measured right temporal or nasal) distance from the limbus (or edge of the pupil) to the left lateral nasal (or temporal) corneal limbus (or edge of the pupil). The point is: far too small not interpupillary distance.


3,pupil height:

    In order to avoid the measurement error, optometry technology complex. The formula method of the pupil height is recommended. H= (a-34 2+22).

Where h is the height of the pupil (i.e., distance from the lower edge of the frame to the optical center) (mm); a sag. (the distance between the upper frame and the lower frame edge) (mm).

For example: a customer margin box frame and the lower frame edge distance is 40 mm, the pupil height should be?

H= (a-34) / 2+22= (40-34 / 2+22=25mm)

So the customer's pupil height of 25 mm.

The glasses can refer to the table:

A (mm)     H (mm)     a (mm)     H (mm)

34         22         42         26

35         22.5       43         26.5

36         23         44         27

37         23.5       45         27.5

38         24         46         28

39         24.5       47         28.5

40         25         48         29

41         25.5       49         29.5


A sag (mm) H pupil height (mm)


Five, the Progressive multiple focus lens processing:

Grinding is not complicated Progressive multiple focus lenses, processing is basically the same with ordinary glasses. Even more than the astigmatism lens processing is easy, as long as the optical center of lens placed in the appropriate position, pay attention to two points: 1. The amount of shift light, 2. High pupil. The horizontal reference line can be placed in a horizontal position, profile grinding. At this time, no astigmatism axial, because the axial astigmatism in setting accurate grinding lenses. After the end of processing, the lens all tag retention.


Six, Progressive multiple focus lens detection:

1, check the prescription. Including the Progressive multiple focus glass varieties, far and near with photometric degree, pupil distance and pupil height.

2, far from the photometric detection. Far from the light detection position lensometer detecting lens, beam, beam, measuring heart astigmatism and axis.

3, with the addition of near detection. The lens in the lensometer slowly forward until the next shift, display light luminosity, and check.

4, the determination of pupil distance and pupil height.


Seven, early wear glasses education:

1, the glasses to wipe clean, help the customer to wear in the face, observe the lens marker, to see whether the two reference level? The optical center and the center of the pupil alignment, pupil high position properly, if substandard, slightly adjust the frame, nose.

2, ask the customer to look up look ahead, learn to use the far zone.

3, with smaller newspapers or books, please customer Bobbing Head, find out the best position to see the text, this location is near area.

4, writing the paper away from the customer in front of about an arm's length position. Adjust the head position and find the best area in the middle distance.

5, please look down to the customer's eyes, will appear as a distortion, dizziness phenomenon. This area can not be used in the area of aberration.


Eight, the use of matters needing attention

1, wearing progressive multi focal glasses should gradually adapt to the use should be static before moving, after the first inside the outside.

2, wearing a multi focus glasses to observe the object, not as a single focus glasses, should learn to use the head up and down to see objects.

At the beginning of 3, when wearing the best walk, see one meter away, don't look down at the foot near the stairs must be careful.


Nine, the handling of complaints

1, according to customer complaints, first check the glasses and prescription is the same, (including varieties of lens, a single light, astigmatism and axis, Halloween distance and pupil higher) if there is a discrepancy should be timely adjustment or replacement.

2, such as the correctly, adjust the frame may frames due to deformation, upper and lower optical decentration pupil center axis deviation, adjust the frame, you can use.

3, as one, two two are correct, the need to re optometry.


2015年02月04日

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渐进多焦点眼镜验光配镜法

作者:皇冠保罗眼镜  来源:www.crpolo.com   

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