PREFACE
"Practiced at its highest level,
Opticianry is a healing arts* form."

What follows is a 'Bird's eye' view of today's Ophthalmic Dispensing practices; a critical examination of the decline of Hands-on Dispensing and Delivery and other long standing deficiencies; and some practical suggestions for their remedy.

While deficiencies exist throughout this country's healthcare system, this discourse is intended to be a critique as well as a primer and plea to those Optical Retailers who fail to recognize or who have chosen to ignore the need for a resurgence within the ophthalmic dispensing industry of a) the Art and Craft of Prescription Eyewear Assessment and Delivery, and b) the Full Discovery and Disclosure Patient Interview in the training of Opticians, these elements being increasingly absent in today's Ophthalmic Health and Wellness delivery system.

In addition, Part I is meant to be a resource for Consumers in the hope that they become more vociferous in demanding higher standards of practice and more personalized care in the delivery of ophthalmic products and services. (See a Consumer Guide to optical terms.)

Furthermore, this discourse is presented with the hope of stimulating some meaningful dialogue among Ophthalmic Industry leaders, i.e., Corporate Retailers especially, with the idea of encouraging them to provide more comprehensive and ongoing practical training, especially for Retail Managers and aspiring Opticians; training that goes beyond the usual on-the-job, learn-as-you-go training, reviewing testimonials of episodes of prowess in selling, or answering an array of test questions that have more to do with corporate sales goals and policy issues than they do with every day Practical Dispensing; quality-over-quantity training that focuses on one-on-one, Dispenser-Patient-Interview exercises, and especially the practical application of hands-on, in-place, on-the-face prescription eyewear assessment, design and delivery skills.

"For today's Consumers, the personalized fitting of eyewear
by a skilled, hands-on Optician is an unfamiliar experience."

Part II, Back To Basics Frame Fitting Course, which follows this discourse is a Continuing Education and Knowledge Review Course for Ophthalmic Dispensers. Some major points that are covered in this discourse are given some additional attention therein.

*The Florida Board of Opticianry is an entity within the Florida Department of Health.

OVERVIEW
America's Generation Gap

In an article appearing in the Orlando Sentinel, June 4, 2008, Harry Wessel reports that there's a generation gap in America's workplace that's serious enough to cause a big brain drain in coming years. According to Randstad USA, an Atlanta-based employment-services company:

"U.S. businesses risk a shortage of skilled labor -- not because of the lack of manpower in the wake of retiring baby boomers, but because of the limited transfer of knowledge.

According to a Harris Interactive survey, there is little interaction among the four Generations of U.S. employees.

It defined the four Generations as the Mature Generation (those born before 1946), the Baby Boomer Generation (born 1946-1964), Generation X (born 1965-1979) and Generation Y (born 1980-1988).

The different Generations rarely interact with one another and often do not recognize each other's skills or work ethic.

Employers (Ophthalmic Industry Manufacturers, Retailers, Professionals and Educators?) should help close the knowledge gap by instituting ways for each Generation to recognize the strengths and value of all colleagues."

The four Generations share the same objectives but not the same experience. Their respective perceptions have to do with diversities in background and life experience. Thus each of the Generations must simultaneously appreciate the skills, and tolerate the shortcomings of all colleagues in order to move forward successfully.

Ophthalmic Dispensers'
Generation Gap

"For the truly skilled Optician,
the standard of care must include
personalized design and hands-on
fitting of eyewear on each Patient."

It is apparent to many of today's senior Ophthalmic Patients and other industry observers that there's little connection between the applied dispensing skills, i.e., the 'hands-on' assessment, design, adjustment and delivery techniques of "Mature Generation" skilled Opticians of yesteryears, and the practices of many of today's Retail Dispensers and Managers.

Through no fault of their own, due to the absence of multi-generational connections, many of today's Dispensers, especially Retail Managers, are seen to provide and-or oversee only the most casual delivery of prescription eyewear as if it were ready-to-wear clothing or over-the-counter general merchandise, with little or no attention being given to the all-important Full Discovery and Disclosure Patient Interview, or to the subtler frame-fitting details as practiced by their hands-on-skilled predecessors. Unfortunately, their attention is now preoccupied almost entirely with quantity-over-quality issues, such as daily sales goals, sales reports and other marketing efforts to the detriment of Patient satisfaction, which of course, adversely impacts sales as well as referrals. Consequently, many of today's Ophthalmic Retailers are chronically struggling with high rates of returns and refunds.

"The most perfect ophthalmic Rx can be compromised if the
eyewear does not provide comfort and long-term wear-ability."

And if any hands-on skill is applied, it may amount to no more than a slight adjustment of the frame's nosepiece and-or a sharp and short ninety-degree bend of the frame's temples at the junction of the ears. In other words, no reshaping of the temples to follow the lines of the skull occurs, in the mistaken belief that it is the temples-to-ears contact that holds the eyewear in place. Of course, it's the temples-to-skull contact, NOT THE EARS, that actually holds the eyewear in place. See example here.

In fact, many of today's Dispensers only require the delivered eyewear to look straight or "cool," never mind that it does not fit the asymmetric facial or cranial contours of the Patient. It's as if they are fitting a one-dimensional, flat-surfaced counter top instead of a multi-dimensional, contoured human face and skull. Some have been known to go so far as to 'fix', i.e., remove, any previously applied skull-conforming configuration, albeit more comfortable for the Patient.

"In order to excel as a Dispensing Optician, one must first have
the attitude of a Healer, and then, the sense of a retail merchant."

Through no fault of their own, today's Dispensers are unaware of the decades-old decline of applied hands-on, in-place, on-the-face fitting skills. This situation has produced at least two generations, "Generation X" and "Generation Y" Opticians, including many latter generation Board Certified Opticians, who have never witnessed any demonstrations of these hands-on skills. Furthermore, it's uncertain if any of today's Schools of Opticianry are teaching dispensing skills to this same degree. And as a result, many latter day Dispensers have come to believe, after practicing a couple of years of their method of 'delivering' eyewear, that they are sufficiently skilled and are in need of no additional training in the art and craft of dispensing eyewear, and worse, that they have little to learn from more skilled colleagues.

As an example, a Patient recently reported their experience whereby they were just handed their new eyeglasses at an Optometrist's office by a Dispenser with 20 years of experience, whereupon no adjustments to the eyewear were offered and the Patient was forced to seek the appropriate service elsewhere. The Patient subsequently reported that she felt fortunate to find an Optician having the skills to relieve her discomfort after some considerable time spent searching. Unfortunately, similar episodes have become rather common throughout the retail optical industry.

"Hands-on dispensing is a soon-to-be-lost art. If we continue today's
trends to the narrow and strictly retail approach to ophthalmic services,
the marketing of ready-to-wear, over-the-counter eyewear will continue to
flourish, hands-on dispensing skills and services will disappear, Patients
will continue to suffer from substandard quality of service, and eyewear will
continue to be delivered by an increasing number of unskilled Dispensers.
The current retail paradigm for dispensing eyewear needs to be overhauled."

Placing The Frame Directly
On The Patient Is Important

"By placing the eyewear directly on the Patient, the Optician
can get a much better sense of how the frame fits the Patient,
whether too tight or loose, and what adjustments are needed."

Some portion of the Opticians' Generation Gap is explicable due to the current focus on Dispenser training by way of on-the-job apprenticeship programs, many of which are devoid of adequate Full Discovery Patient Interview training, and absent any Hands-on, In-place, On-the-face assessment, design and adjustment of prescription eyewear as practiced by skilled Opticians. But this gap is equally a result of today's over-emphasis on the corporate retail paradigm whereby the latter generations especially tend to become more skilled at parroting slogans, giving testimonials about sales prowess, and answering questions about company policy, sales goals and promotions from company executives, all of which afford them no experience in conducting a Patient interview or effectively assessing, designing, and then fitting prescription eyewear directly on the Patient. Unfortunately today's aspiring Dispensers tend to become merchants, peddling ready-made, over-the-counter merchandise, not skilled Opticians, dispensing customized, prescription eyewear.

"It's time for Optical Retailers to think outside the 'Big Box.'
Unlike other retail venues, the delivery of ophthalmic services, i.e.,
adjustments and repairs at no charge, often precedes a future sale."

This leads one to wonder whether board certification and-or licensing is really effective, since just about anybody can hand over a pair of eyeglasses or contact lenses and operate a cash register, as we see demonstrated in some of today's true-to-life TV ads, whereby the Patient and Dispenser never make direct contact. The Dispenser just hands the Patient their eyewear. The Patient puts the eyeglasses on, looks in the mirror, and leaves. This scenario is so commonplace today in the real world that many Patients never expect to have any form-fitting adjustments applied to a frame.

"A Surgeon must train for years in actual hands-on practice,
in residency, before being considered to be a qualified Surgeon."

In the eyes of the Consumer the hands-on custom fitting aspect of dispensing eyewear has become an exotic and unfamiliar craft, and the art has devolved to such an extent that many Consumers (even many Dispensers) now actually think that a hand-fitted frame is inferior to an off-the-board frame. For example, some Patients, having never seen or experienced a hands-on customized frame fitting, have been known to request that the skull conforming adjustments, having been applied by a skilled Optician of the hands-on-school, be removed from temple ends because "they don't look straight, flat and normal like other people's glasses." Unfortunately, the "other people's glasses" were more than likely never customized to fit either.

Ophthalmic Dispensing and
Hands-on Delivery Defined

"Just as a Dentist cannot practice
Dentistry without touching the Patient,
an Optician cannot practice Dispensing
without direct contact with the Patient."

OPHTHALMIC DISPENSING is herein defined as those activities performed by a skilled Dispensing Optician, which include, a) the fullest discovery and maximum consideration of the Patient's visual needs, b) the assistance and advice to the Patient regarding the appropriate choice of lens design and frame selection, c) the duplicating, measuring, inspecting, and verifying of prescription lenses, and d) any subsequent Gross Frame Alignment and Subtle Frame Adjustments, including the Final Fitting.

HANDS-ON DELIVERY is herein defined as those procedures, which involve eyewear adjustments performed by a skilled Dispensing Optician, which specifically include, a) the visual and hands-on, tactile, 'touch and feel' assessment of the frame, while it is in-place, on-the-face of the Patient, in order to determine any misalignment, and b) any subsequent multi-dimensional hands-on, tactile, 'touch and feel' handcrafting that is required to refit, align, adjust, reshape, bend, stretch, twist and sculpt the components of the frame in order to personalize the eyewear for maximum visual comfort and wear-ability.

"Where there's no touch, there's no hold."

The highest level of customized frame fitting, aligning, and sculpting, is achieved mostly with handcrafting skill and the trained eye, along with the aid of hand tools. Hand crafted multi-dimensional adjustments, including tactile, hands-on, 'touch and feel' procedures such as reshaping the temple ends to make direct and full, but light contact with the mastoid area behind the ears, while simultaneously avoiding direct contact with the pressure-sensitive ears, is one of the single most important considerations for long-term comfort and wear-ability. Full, but light contact with the bridge of the nose, along with the skull behind the ears, NOT THE EARS, are the two primary means of support and frame restraint. The ears must be seen as only a secondary or 'last resort' means of restraint.

Custom Frame Fitting
Up Close And Personal

Furthermore, a successful multi-dimensional frame alignment and fitting can be achieved only when the Dispenser 1) visually assesses the eyewear in-place, on the face of the Patient, and 2) simultaneously uses the sense of touch to determine any anomalies between the frame's temples and the Patient's skull. In most cases, the Dispenser cannot remain seated. The Dispenser must get up, and get close to the face of the Patient, otherwise neither a proper evaluation or fitting can occur. In other words, the Dispenser must stand and lean over the seated Patient in order to make the required observations at different angles to the front and rear of the Patient's head. The fitting-adjustment procedure itself also requires the removal and re-placement of the eyewear directly on the Patient as many times as necessary to complete, and the entire evaluation and fitting process requires sufficient time to execute properly, i.e., it should not be rushed.

Example of Old Fashioned
Hands-on Craftsmanship
"The temple-ends cannot hold an eyeglass frame
in-place comfortably if they do not touch the skull."

Every Patient deserves a sufficiently handcrafted,
multi-dimensional, personalized frame fitting, e.g.,
gaps and spaces are removed from between the frame's
temples and the skull behind the ears, in order to enhance
comfort, stability, and long-term wear-ability. Full contact, with
a light touch of the skull, NOT THE EARS, is the primary means
by which the frame should be held in place for long-term comfort.

Before    After

'Before' temple-end is in out-of-the-box condition.
As such, it makes little contact with this Patient's skull,
whereas the 'After' temple-end has been customized.
It now fits the mastoid bone like a glove since it has been
shaped to make full, direct contact with this Patient's skull.
The customized temple-end becomes invisible when worn
by the Patient and the resultant fit is extremely comfortable.

"Today's Ophthalmic Dispensing practices are
'out of touch' with the comfort needs of the Patient."

There are some industry observers who see the devolution of Ophthalmic Dispensing as the result of an overall corporate strategy perpetrated by some industry members to eliminate any reliance on competent, Licensed Opticians in order to better manage their labor costs and enhance their profits. But the Profession is mostly the victim of the perpetual tension and struggle between opposing market forces; the Company's need for control of inventory and labor costs, and the Patient's desire for choice and comfort. What many corporations don't understand is that giving the Consumer more of what they want is best for everybody. The last century's most successful entrepreneur, Sam Walton, taught that the Company must always favor the Consumer, first.

Ophthalmic Dispensing, within recent decades, has become so 'retail oriented' and subsequently dehumanized to the point that some Patients have been known to express a sense of surprise, even concern, at a skilled Optician's use of 'touch' while fitting their eyewear. This has occurred to the extent that some 'old school' Opticians now feel the necessity to request a Patient's permission before proceeding with any critical and necessary hands-on adjustments, which require touching the Patient.

Just as nobody can order dentures from a mail-order source because the
required precision and comfort is impossible without a hands-on fitting,
hands-on skills are equally required to fit prescription glasses properly.

Physicians and Dentists do not request permission to touch a Patient since it is an obvious necessity and a long accepted practice to use their hands-on skills. Sadly, Ophthalmic Dispensing has devolved for such a period of time that the Dispenser's use of touch is now no longer acceptable or even associated with the dispensing of eyewear by some Patients. Unfortunately this has subsequently led some Patients to turn to mail-order eyewear, their experience or logic being that the customized fitting of their prescription eyeglasses is either insufficient or unavailable.

"It is how well the eyewear makes contact with the
Patient that ultimately defines Ophthalmic Dispensing."

Ready-Made, Ready-To-Wear Gap

Whereas corrective eyeglasses that are assembled in an optical laboratory are, as a final step in their inspection process, inverted on a flat surface and made to fit squarely at the four points of contact, ready-to-dispense, they are NOT ready-to-wear. Instead of assuming that newly made eyeglasses all require at least some minimal adjustment and realignment, today's unskilled Dispensers assume and-or hope, due to lack of adequate training and tools, that they need no additional alignment. They seem to apply the logic, "Well, the Patient has chosen this frame, so it must be the right size, and the lab has already made their 'four point' adjustments, so the glasses are good to go." This hands-off approach is out-of-touch with the comfort needs of almost every Patient.

3-Dimensional Dispensing

"Successful dispensing requires the careful and thoughtful
process of Discovery, Design, and Delivery of eyewear."

LIFESTYLE DISPENSING
Full Discovery and Disclosure
Patient Interview

Some Refractionists, that is Optometrists and Ophthalmologists, make entries on their prescriptions such as "No-line Bifocals" or "Progressive Lenses," both of which refer to a Progressive Addition Lens or PAL. See below. Too many times this is a subjective entry on their part, which is made in the absence of any discussion with the Patient, and minus any explanation to the Patient as to why a Progressive Lens is better, or how the lens works, or what other options are available. Of course, these points are all better left to the Optician to give more complete coverage in their Patient interview, which unfortunately never occurs in many instances, today. See video here.

But any suggestions on the prescription notwithstanding, many of today's Retail Dispensers promote No-line Bifocals without any notion of whether the Patient's visual circumstances require more practical alternatives. And many Dispensers assume that a PAL is the Patient's informed choice since the reference appears on the Rx. This scenario all too often results in an unsatisfactory outcome for all parties, and it manifests by way of many unhappy Patients as well as high rates of unnecessary remakes and-or refunds.

"In order to adequately fulfill the needs of the Patient,
the Optician must ask appropriate questions and be
forthcoming with sufficient details and explanations."

A case in point:
This guide promotes only Progressive
Addition Lenses for all bifocal wearers.

Each Patient is unique, and presents different visual needs. In order for the Dispenser to recognize and fulfill these needs an adequate interview must occur whereby the Patient discloses any pertinent details. In other words, the successful design of eyewear requires that the Dispenser fully engage the Patient in a full discovery and disclosure interview, so that all aspects of the Patient's visual habits, both vocational and avocational are disclosed. For example, a presbyopic aircraft mechanic working under an aircraft engine or a presbyopic painter working on walls and ceilings, both of which require a fixed upward view for extended durations, will appreciate a Double D Multifocal (Double Bifocal) or even a Quadrafocal lens design. On the other hand, a Progressive Addition Lens, though preferred by a majority of Patients, or a regular bifocal, is most likely to be an inadequate lens design under such working conditions.

       

At the conclusion of the interview, the Dispenser needs to advise the Patient of the widest range of lens designs, frame styles, and prices that most appropriately fit the Patient's needs. This may well include the consideration of multiple pairs of eyewear, which can include special lens types such as extra-wide streetwear or occupational bifocals or trifocals, sunwear and safety, or golfing and other athletic designs.

        

    

    
Extra-wide Bifocal          Extra-wide Trifocal

When a Patient goes to a Physician for medical treatment the Physician first interviews the Patient to discover all relevant issues before designing a treatment. Likewise, a Patient in need of prescription eyewear requires a 'discovery interview' to determine the design of their eyewear, especially the lenses.

"The proper and successful practice of the art and
craft of Ophthalmic Dispensing lies in the details."

Hands-on Assessment,
Design, and Delivery

"A Patient's face and head are not
smooth, flat, one-dimensional surfaces."

Patients deserve a fully personalized design and fitting of their eyewear. The fact that the frame fits on a flat surface squarely should never preclude fitting the frame directly on the Patient. This becomes obvious when after fitting a Patient with facial anomalies, the frame no longer fits squarely on a flat surface. Facial structure, the positioning of each eye and ear, the mastoid-contour (see photo above) behind each ear, all of these differ with each person. The proper and successful practice of the art and craft of Ophthalmic Dispensing "lies in the details."

For example, some Patients have one EYE positioned higher than the other. Most of these Patients are unaware of this condition. How many Dispensers are aware of this somewhat common disparity? How many Dispensers compensate for this anomaly in their multi-focal lens design by vertically offsetting the respective reading segment along with an appropriate advisory to the Patient?

Multi-focal lenses are ordered today with the reading portion placed at matching heights because vertically-equal eye symmetry is assumed to be the norm and-or "it looks better" when the segments can be observed as vertically and horizontally equidistant, and because vertical eye asymmetry is not considered as a design factor, even though its consideration is important for the Patient's visual balance and comfort at the near and intermediate points. In fact, some Retailers don't allow for any disparate bifocal segment height or seg inset in their lens design software.

"The eyecare industry needs to strike a better
balance between retailing and healthcare delivery."

Eyewear can be considered to be successfully dispensed and delivered only after 1) an in-depth, full discovery Patient interview by the Dispenser occurs, 2) an in-place, on-the-face eyewear assessment is made and the resultant measurements are noted, 3) the laboratory processing of the eyewear is completed, 4) all elements of the eyewear are inspected for accuracy and validated by the Dispenser, and 5) Gross Frame Alignment and any Subtle Frame Adjustments are applied by the Dispenser upon delivery of the eyewear to the Patient using the sense of touch.

PERSPECTIVE

"It's necessary to recall the past
in order to insure a better future."

Together with the decades-long corporate expansion of retail outlets, the marriage of eyewear to fashion, the expanded marketing of multiple pairs, the proliferation of lens types, add-ons, and frame materials, the dawn of the computer age and the resultant visual issues, the unfortunate advent of mail order contact lenses and eyeglasses, the scarcity of experienced practitioner-teacher Professionals with hands-on, in-place, on-the-face skills, together with more and more Dispenser training occurring online, and state licensing boards, some of which are absent adequately trained members, a steady decline in the art of fitting eyewear with applied hands-on, in-place, on-the-face assessment and fitting skills has occurred almost to the point of its disappearance. These skills now reside mostly in the hands of a dwindling number of skilled Opticians.

How We Got Here
Some Contributing Factors

During the first half of the 20th century the American Optical Company and Bausch and Lomb, dominated and actually monopolized almost all of the Ophthalmic Manufacturing, Wholesale Laboratory, and Retail Dispensing Industry. Most dispensing skills were literally and figuratively in the hands of AO and B&L Laboratory-Dispensing Opticians. After the government anti-trust break-up of AO and B&L in the early 1960's, which separated their manufacturing and laboratory operations from any dispensing activities, the Ophthalmic Industry began to take the form we see today.

Prior to their break-up, AO and B&L dispensed eyewear directly to the public in what the government ruled was a monopolistic business, which exclusively served their wholesale laboratory clients, i.e., Opticians, Optometrists, Ophthalmologists and other Dispensers. After the break-up, the retail dispensary paradigm began to shift from one of Patient care, with the focus on Health and Wellness to that of merchandising. Thus, began the evolution from hands-on, 'healing' related, ophthalmic dispensing to today's dehumanized, over-the-counter, ready-made, hands-off merchandising. As a result, latter day Dispensers do not easily relate to the practice of hands-on dispensing nor does the Retail Optical Industry as a whole.

Then, acting mostly in the interest of cost-efficiency, the Ophthalmic Industry itself accelerated the decline. For example, in the years preceding the 1970's, frames were made in a multitude of sizes, i.e., eye sizes, bridge sizes and numerous temple lengths and styles, in order to satisfy the diverse needs of Patients. Since then, Ophthalmic Manufacturers have gradually eliminated multiple sizes. This has resulted in the decline of the quality of ophthalmic services. Now, most frame styles come in one or two sizes at most. As a consequence we see many Patients with ill-fitting prescription eyewear to wit it is now even more important for Dispensers to be skilled in Dispensing Opticianry, i.e., skilled in custom fitting frames in order to accommodate the absence of variable frame sizes. Instead, each succeeding generation of Dispensers is less skilled, and the downward spiral of decline appears to continue unabated.

Furthermore, today's frame manufacturers, which are now based mostly overseas, produce frame materials that are inferior to the products of yesteryears when gold filled metal, for instance, was the dominant material. Many of the plastics and metals used today are too brittle and do not respond well to heat or bending. Today's frames are not capable of being reshaped or adjusted quickly and easily, such as changing the length of temples or applying mastoid-fitting bends.

And ophthalmic lens manufacturers no longer provide experiential visual aids such as Progressive Addition Lens demonstrator kits whereby a Patient can actually experience the advantages and disadvantages of advance design PAL's as they apply to their specific needs before finalizing their choice of lenses.

Another indicator of the devolution of Dispensing Opticianry is the trend in the design of dispensing tables to wit Dispensers can just barely reach Patients. The design seen in most Dispensaries today actually discourages Dispenser-Patient contact since the proximity of the Patient to the Dispenser is well beyond arms length. Today's Dispensers are unfamiliar with the kidney-shape designed tables of yesteryears, which positions the Dispenser and Patient within easy reach and which affords the easier performance of hands-on fitting. Today, as a result, hands-on Dispensers must stretch and strain or circumvent the use of the offending table altogether in order to do their thing.

"An overly aggressive emphasis on optical retailing has
caused the current touch-free, dehumanized delivery of
eyewear, and the subsequent demise of old fashioned
hands-on, in-place, on-the-face dispensing skills."

Many important tools of the trade along with the knowledge of their use have disappeared due to the industry's shift away from any sufficient emphasis on Patient interview, relevant eyewear design, and hands-on, in-place, on-the-face dispensing-delivery skills. For instance, how many latter day Dispensers know how to lengthen or shorten and refit a plastic covered, metal temple end piece? How many have seen or even heard of numerous dispensing aids such as hot salt-bead pots, zyl-bridge stretching or shrinking pliers, nose pad removal pliers and Progressive Addition Lens demo kits?

How many present-day Dispensing Opticians have any knowledge of, or experience with the custom designing of presbyopic golfers' glasses, which feature bifocal segments designed to the golfer's specifications, in either one or both lenses, which are placed anywhere the Patient prefers, for the purpose of avoiding interference while aiming their golf shots?

How many current Dispensers are aware of the round segment bifocal, which is scarcely used anymore, but remains a first choice transitional lens design for some first-time, hard-to-fit, prospective Progressive Addition Lens wearers due to its ease of adaptation along with its cosmetic advantage of having a nearly invisible segment? (Albeit the sales leader for today's presbyopic Patient, the PAL may NOT be the first or ONLY lens of choice for these Patients.)

And what about the trifocal lens, which is no longer considered an alternative to the PAL by many latter-day Dispensers because of its visible segment? Even when Patients are less concerned with the vanity aspect of the 'no-line' feature as opposed to the superior functionality that a trifocal offers over the PAL or Computer Continuum lens, in some visually challenging environments especially, the PAL is too often the only option offered to them.

    

The Progressive Addition Lens (PAL)
A multifocal lens whose corrective powers change
progressively throughout the lens. Each area of correction
is blended invisibly to the next, so these lenses do not have
the lines typically associated with bifocals or trifocals. Affords
most “natural” vision for all distances: near, far, and intermediate.

Unskilled And Unchecked
Retail Optical Managers

Unfortunately, today we see too many Retail Managers who are experienced in marketing but under skilled in the art and science of Opticianry. Many of them are too fixated on policies and procedures and-or overly sales-aggressive to the point of obstructing the delivery of acceptable ophthalmic services. (Remember the AIG debacle where the overreach for profits and bonuses caused an eventual financial calamity?)

"Success always follows good service.
Any action, which genuinely favors the
Patient, always improves the bottom line.
We need to focus on caring for Patients."

Furthermore, the untrained optical store Manager who obsessively pushes a Dispenser for higher production of high-dollar sales, e.g., the universal promotion of high-end and more expensive Progressive, "No-line" Lenses, regardless of their demonstrable need, thereby affords less occasions for adequate eyewear design time and full consideration of the Patient's needs. At the same time inexperienced Managers unrealistically demand that customer satisfaction be maintained and minimal remakes or refunds be sustained.

"Pushing Patients into Progressive Addition Lenses without
full disclosure is akin to the now criticized and over zealous
medical practices of circumcision and tonsillectomy."

As a result of these conflicted goals, Dispensers are discouraged from conducting the appropriate Patient interviews. This results in more Patients becoming dissatisfied, while generating more returns, remakes or refunds, which leads to more frustrated Managers and Dispensers. It's as if nobody can figure out that this unfortunate cycle, along with its adverse karmic impact on the bottom line, will end only when the Patient's genuine needs are considered and fulfilled.

"To serve is to succeed. When it comes to dispensing eyewear,
it is not possible to provide the Patient with too much service."

Now, after several decades of dealing with this conflicted and downward spiral, with its resulting focus away from previous generations' people friendly, 'take your time,' hands-on practice of dispensing to today's ready-made, one-size-fits-all, 'get them in, and get them out' attitude, and with bottom-line sales the industries' main goal in spite of much hype to the contrary, a litany of complaints from Patients, such as the following, are being heard with ever increasing frequency.

"They just handed me my glasses and asked me, "How do they feel?"

"She didn't take the time to fit my glasses."

"They just told me to bend down and shake my head to see if they fit okay, but they never adjusted my glasses."

"I told him my new glasses looked crooked and then he asked me what I wanted him to do about it."

"I was told that I needed a progressive no-line bifocal instead of a regular bifocal, but they didn't explain why, or what the difference would be. Now, at work, I have to raise my head and bend my neck way back in order to see my computer monitor. These progressive lenses don't work for me. I want my money back."

Sadly, optical dispensing has declined to the point that many Patients over the years have developed an attitude whereby they no longer have any expectation that their prescription eyewear can ever be fitted comfortably. Some Patients are even heard to express a sense of dread in making an eyewear purchase. And some Patients even describe their experience as akin to buying a new or used car, i.e., getting the big sales pitch, and then paying for the promised or implied high quality of service, none of which is received.

The 'Booming' Eyecare Industry

"Of the over 67,000 Opticians designing,
manufacturing and dispensing eyewear -
less than half have any formal certification
or licensure." U.S. Dept. of Labor

Furthermore, the eyecare industry in America is booming. The rapid growth, fueled by the ageing "Baby Boom" generation, and the dwindling number of hands-on skilled Opticians has created what is becoming a shortage of adequately trained Opticians nationwide. This large segment of the population, those born between 1946 and 1963, are entering their fortieth year and beyond. At approximately age 40, corrective lenses for reading and other near vision activities are commonly prescribed. This condition, known as presbyopia, is a normal function of the ageing process and affects nearly the entire population. See Presbyopia, before and after correction of photos. The result: an increasing number of people are requiring the services of Eyecare Professionals each year, a trend that will continue well into this century. According to a study conducted by the U.S. Department of Labor, the number of Opticianry jobs is predicted to increase by some 35% during this period of unprecedented growth. See before and after correction photos of Astigmatism, Hyperopia and Myopia here.

SO, WHERE DO WE GO FROM HERE?

The industry's challenge is to upgrade
its identity and bridge the knowledge gap.

Now is the time for Optical Retailers to start thinking outside the 'Big Box.'

First, the Retail Optical Industry's business paradigm must be upgraded from its current RETAIL MERCHANT model to that of a true HEALTHCARE PROVIDER. The reality and importance of the SKILLED OPTICIAN'S role in the healthcare delivery system must be more clearly defined and nurtured.

Next, Ophthalmic Industry Members must step up with their collective resources, to close the "knowledge gap" with the ways and means for each generation of Opticians to "recognize the strengths and value of all colleagues," to improve the quality of service at all levels, and to provide, protect, and preserve the increasingly rare hands-on skills of "Mature Generation" Opticians in the interest of serving the health and wellness of their current and future base. To this end, a prospective model for an On-site, Hands-on Remedial Training Workshop for Dispensers follows.

REMEDIAL TRAINING
WORKSHOP MODEL

"LET'S GET BACK TO LIFESTYLE DISPENSING."

A) The Full Discovery and Disclosure Patient Interview.

B) Design and Delivery of Eyewear using in-place, on-the-face assessment and hands-on skills.

C) Managing an Optical Dispensary as a Healthcare facility.

D) Improving the Dispensary layout.

Full Discovery and Disclosure
Patient Interview

Each Attendee, in the presence of a skilled hands-on Optician, will participate in an alternating 'Dispenser' and 'Patient' role-playing episode in which the all-important Full Discovery and Disclosure Patient Interview, is conducted. Full Discovery and Disclosure means that the Optician conducts an interview of the Patient in order to discuss and discover ALL aspects of the Patient's visual habits and needs.

The Dispenser will advise the Patient of ALL the available lens-frame options and costs, and concludes the interview with specific recommendations, whereby the Patient can make a fully informed decision as to their purchase.

Note: It is the absence of such an interview and its subsequent disclosures that results in many unnecessary complaints, returns, remakes and refunds, and the loss of the Patient's good-will referrals.

Dispensing and Delivery
Using In-Place, On-The-Face
Assessment And Hands-on Fitting Skills

"You are fitting a Patient for comfort,
not a flat surface for square or for pretty.
Every Patient has different anomalies and
the area behind the ears is not flat or straight."

The Dispenser will OBSERVE a demonstration of a comprehensive visual and tactile, 'touch and feel' ASSESSMENT of a frame while in-place, on-the-face of the Patient in order to determine the proper frame and temple size and its relationship to the face and skull, by a skilled hands-on Optician.

The Dispenser will OBSERVE a demonstrated DELIVERY of eyewear with the application of both the Gross Alignment, and Subtle Adjustments, i.e., reshaping, bending, stretching, twisting and sculpting of frame components in order to personalize the fitting of the eyewear for maximum visual comfort and wear-ability. See example.

The Dispenser will APPLY the previously demonstrated procedures after making an assessment directly in-place, on-the-face of the Patient under the guidance of a skilled hands-on Optician.

The Dispenser and the Patient will REVERSE their respective rolls and APPLY the procedures with 'touch and feel' techniques under the guidance of a skilled hands-on Optician.

Chronic discomfort issues can be
eliminated or at least minimized.

"Opticians must touch and feel
the eyewear in-place, on-the-face."

A well executed hands-on, in-place, on-the-face assessment, as well as a touch and feel frame fitting procedure obviously requires some direct physical contact along with the appropriate communications between the Dispenser and the Patient. A proper hands-on frame fitting involves the repeated removal and re-placement of the frame on and off the Patient by the Dispenser until such time as the fitting is completed, which depends of course on the experience of the Dispenser, any asymmetric features of the Patient, and the type and design of the eyewear. See example here. The Dispenser must not rush the procedure. Much time is saved in the long run when the fitting is done with sensitivity and patience, thereby reducing the necessity for return visits. Click here to discuss a hands-on dispensing demonstration.

Note: It is how well ophthalmic eyewear, whether it be eyeglasses or contact lenses, makes contact with the Patient that ultimately defines Ophthalmic Dispensing.

"Just about anybody can casually hand over a pair of
eyeglasses or contact lenses, and operate a cash register."

Managing An Optical Dispensary
As A Healthcare Facility

"Many of today's Retail Optical Managers are skilled Merchandisers
but they are unskilled in the practice of Opticianry and therefore they
adversely influence the delivery of qualitative eyecare to Patients.
They formulate policies that are not in the best interest of Patients."

"When the Retail Optical paradigm is upgraded to that of
serving Patients as opposed to serving Customers, the
Optician is seen as a Healer as opposed to a Merchant."

The dispensing of eyewear, which includes eyeglasses and contact lenses, involves numerous subjective experiences on the part of the Patient. The Patient's visual health and wellness, i.e., clearest vision, and well-fitting frame and contact lenses are primary issues, which require knowledge, sensitivity and a unique intimacy between a Dispenser and a Patient that also includes a skill set associated with healing on the part of the Dispenser. This places the business of dispensing eyewear in a special and more humanized class of commercial enterprise; a business that is unlike that of marketing groceries and-or general merchandise in several major respects. Therefore, it's important for Optical Retail Managers, especially those with no prior experience in the Ophthalmic Industry, to acquire adequate additional training.

"Due to their market share, 'big box' Optical Retailers are
in a unique position to lead the industry in the direction
of re-humanizing the deliver of eyewear to the public."

Special Note: The emphasis herein with respect to the importance of hands-on, in-place, and on-the-face, touch and feel dispensing and delivery of ophthalmic services may seem somewhat overstated, but Patients who experience the results of such skilled service are known to make more referrals and give testimonials as to the improvement to their long-term visual comfort and frame wear-ability using words such as "significant," even "profound." This level of personal service has the power to transform any Ophthalmic Consumer into a life-long Customer. And complaints, remakes and refunds are significantly reduced, as well. (See Johnny's Story.)

Whereas personal service can be defined as any human activity by which people's lives are made better, i.e., easier, happier and-or more comfortable, happy Customers are the very best way of advertising goods and services just as portrayed in the inspirational narrative of 'Johnny's Story.' Happy Patient's promote good will, and the serendipitous word-of-mouth-advertising is free! See more specific details.

Improving The Dispensary Layout

"Inadequate equipment and tools contributes to
substandard practices and loss of efficiency."

The manner in which an Optical Dispensary is configured can have a direct impact on the quality and efficiency of service.

The floor plan and workspace of many of today's Dispensaries are laid out in such a way that they do not support or encourage qualitative dispensing practices or Patient comfort. We see too many Dispensaries in which the pace of activities is so fast, and the environment so noisy and unpleasant that it is difficult for us to associate them with the health and wellness industry. In this respect, the training of skilled Opticians, the functional performance of Dispensers, and especially the delivery of healthcare services to Patients, is adversely affected, even discouraged.

Today, as mentioned previously (click here), we see dispensing tables that are not made with much thought of enabling close, direct contact between the Dispenser and the Patient. See Custom Frame Fitting here.

First, most of today's dispensing tables appear to be designed by traditional retail cabinet-counter makers in that little or no thought is given to the utility of the dispensing table as the point of direct contact between Dispenser and Patient and the subsequent delivery of rather expensive, high-tech, customized, handcrafted and personalized optical instruments, today's prescription eyewear. The kidney-shaped dispensing table of yesteryears is much superior and more accommodating.

Second, dispensing tools are far removed from the dispensing table itself. A conscientious hands-on Optician is forced to spend much time running back and forth to get commonly used hand tools, some located in another room. And many workstations, which accommodate hand tools, are restricted in that the tools are of inadequate number, and-or hard to get to.

Third, any Dispensary workstation design that impedes hands-on dispensing tasks and delivery activities is counter productive. Adequate types of hand tools and instruments and sufficient training in their use, is an imperative. Some Dispensaries are absent proper hand tools and-or display broken and damaged tools due to misuse. This is directly related to inadequate management and substandard training of Dispensers, which of course, adversely impacts the standard of care that Patients deserve and expect.

The Alternative To Inaction

Hands-on dispensing is a soon-to-be-lost art. If we continue today's trends to the narrow and strictly retail approach to ophthalmic services, the marketing of ready-to-wear, over-the-counter eyewear will continue to flourish, hands-on dispensing skills and services will disappear, Patients will continue to suffer from substandard quality of service, eyewear will continue to be delivered by an increasing number of unskilled Dispensers, and everybody will lose something in the real value, quality and satisfaction of life. The current retail paradigm for dispensing eyewear needs to be overhauled.

In Conclusion

The Golden Rule of Commerce
"When the interests of the Customer come first,
it's win-win. Otherwise, it's always lose-lose."

It is presumably the intention of all Ophthalmic Dispensers to conscientiously practice the art of dispensing and delivery of eyewear with the optimum of skill and service whereby both the gross and subtle aspects of fitting a frame are applied. But while the majority of today's Dispensers are familiar with Gross Frame Alignment, the subject of the more obscure Subtle Frame Adjustment fails to resonate in conversations with many industry members to wit, a rather blank, even puzzled facial expression is often visible in response to the broaching of the issue.

Hopefully, the views presented in this discourse will resonate with industry members as a call-to-action with the result that they will work jointly to avoid or discontinue today's all too common practice whereby a Dispenser casually, and absent any skillful attention to details, hands over prescription eyewear, and concludes the occasion with a statement such as, "How do they feel? Shake your head and see if they're loose!" Everybody deserves eyewear, which has been conscientiously personalized to their maximum benefit, comfort and satisfaction. --

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