Picture this: A young, female patient/customer is sitting at a dispensing table, awaiting delivery of her eyeglasses. The dispenser brings the glasses to the table, hands them to the customer, who places them on her head. The “optician” seems to ask a question of the customer, who smiles, shakes her head yes, stands up and makes her exit. That, apparently, is the end of dispensing process. But should it be?
When my wife, Andrea, graduated from Opticianry School in the 1980s, personalizing the fit and adjusting eyeglasses was a huge part of the curriculum. Likewise, while I was completing my three-year apprenticeship, more time was spent teaching me the intricacies of adjusting eyeglass frames than any other aspect of opticianry. Fast forward thirty years later and I am afraid that the approach to adjustments (in terms of schooling) has taken a back seat to nearly every other aspect of opticianry. Apprentice sponsors gloss over the topic. Saddest of all, before attempting any adjustment whatsoever, many eye care professionals feel the need to ask patients a question that no dentist, chiropractor, or other caregiver would even think of: “Is it okay if I touch you?”
I am also a big believer in giving credit where credit is due, so I would be completely remiss if I did not inform you of the inspiration for this article. It came from a dedicated colleague for whom I have much respect – Hari Bird, a proud, dispensing optician since 1958. The quote on the website he created says it all: “It is how well the eyewear makes contact with the patient that ultimately defines ophthalmic dispensing, whether it be spectacles or contact lenses.” I would encourage everyone interested in a good refresher course or for people who are studying the profession to check out his website and the home-study course he has created at www.opticianrytoday.com.
Unfortunately, an article of this nature cannot adequately address the problem, nor effectively teach the methods and techniques that must be mastered to be an effective adjuster and dispenser; but we can point out the various things that must be known and the problems that must be addressed on a day-to-day basis in the dispensing world. Ask yourself, are you and your staff members able to adequately deal with some of the following issues? The challenge/problem is listed and in parentheses are some possible causes.
• The glasses do not stay in place. (Temples spread too widely; temple adjustment behind ears is too loose or incorrect; pads spread too far; bridge too wide; doesn’t fit nose; eyeglasses are too heavy.)
• The frame sits too high. (Bridge is too narrow; distance between nose pads too small; pad arms too low; poor overall fitting.)
• The frame sits too low. (Bridge is too wide; distance between nose pads too far; pad arms adjusted incorrectly; angle incorrect.)
• The frame touches the eyebrows. (Temple angle is too retroscopic; poor overall fit.)
• The outer ear hurts. (Temple rides too high on ear; temple touches ear cleft; temple touches lobe of upper ear; temple tip touches outer lobe of ear at the bottom of the lobe.)
• The head hurts behind the ear. (Contact area is too narrow or small; temple tips “dig in”; temples too narrow or tight against head; temples are too short.)
• Temples wobble or flop open. (Patient has a screw loose {J}; rivets loose; rivets broken; internal spring mechanism broken or about to break.)
• The temples are too long or short. (Poor fit; lazy fitter.)
• Vision seems “off,” but was acceptable at initial dispensing. (Prescription filled incorrectly; prescription ordered incorrectly; error in vertex fitting in strong prescriptions; base curve incorrect; defective and/or warped lenses; pantoscopic tilt is incorrect; face form is incorrect; unwanted waves present in lenses; scratches.)
• Vision problems occur at near – especially with progressives. (Prescription incorrect; frame too high or low; O.C. placement incorrect vertically or horizontally; reading area is too small; fitting height incorrect; incorrect brand was chosen for patient; objects “swim” or move when wearer turns head.
• Wearer is having problems in adapting to the prescription (Incorrect prescription; fit does not match old eyewear.)
• Wearer is having problems adapting to the frame/adjustment. (Wearer is switching back and forth between the new glasses and the old; not wearing the glasses long enough to adapt; bifocals located in different place than old pair.)
• Vision is unclear at specific working distances. (Patient needs bifocal, trifocal, or progressive lenses; wearer’s visual needs have changed; glasses not being used for prescribed purpose; segment or fitting height is incorrect; the near addition power is incorrect.)
• Wearer is experiencing unwanted reflections and/or ghost images. (Glasses need more or less pantoscopic or retroscopic tilt; base curve needs to be changed; lenses are uncoated (AR), especially in polycarbonate and high-index lenses.)
• Wearer is experiencing “vague” problems and has unclear complaints. (Optical cause; wearer has changed his or her mind about frame selection; family members or friends do not like glasses; after finally seeing the glasses, the wearer does not like them anymore; patient is experiencing buyer’s remorse because of the high cost of the eyewear.)
These are just some of the challenges that face dispensers every day on the front lines of ophthalmic dispensing. Ask yourself if you and all your dispensing staff members possess the ability to professionally and effectively “diagnose” the cause of these problems and effectively and efficiently correct them. If not, there are many resources that can help in “hands-on” training.
For example, Hilco and Vigor both offer videos and DVDs that feature in-depth tutorials with many tools and their purpose, showing how they are to be used in a close up, hands-on fashion. While lenses evolve, and new frame and lens materials become available, some things never change. Many of the techniques needed with frame adjustments today are the same ones used a hundred years ago. System for Ophthalmic Dispensing by Clifford W. Brooks and Irvin M. Borish is still a great resource, as is the website I mentioned earlier. 02/16/09