Standard progressive addition lens (PAL) prescribing derives add power from age-based tables that were not built for high myopic presbyopes and do not account for the geometric relationship between add power and intermediate zone position within the PAL corridor. This clinical perspective presents a first-principles prescribing framework for this population, addressing add power, corridor length, frame depth, and fitting position as interlinked variables to be optimised together rather than in sequence. The framework is derived from optical first principles and self-experimentation in a single high myopic presbyope, and is advanced as hypothesis-generating. Prospective validation is the gap it is designed to motivate.
Keerti Mundey (Wed,) studied this question.