A Lecture-Workshop
Continuing Education Course
For Dispensing Opticians
Compiled by Hari S. Bird, LDO
Ophthalmic Dispenser since 1958

                   
                          

                          

"For many of today's Patients, the hands-on, custom
fitting of their eyeglasses is an unfamiliar experience."

PREFACE

What follows is one Optician's view of today's ophthalmic dispensing and delivery practices; practices which include some long standing deficiencies, along with suggestions for their practical remedy. This discourse is meant to be a primer as well as a plea to those optical industry members especially who have failed to recognize or who have even ignored the urgent need for the resurgence of a) The 'Full Discovery and Disclosure' Patient Interview, and b) The Art and Craft of Hands-on Assessment and Delivery in the practice of Ophthalmic Dispensing. And this work should also be viewed as a Consumer advisory.

Furthermore, this discourse is presented with the hope stimulating dialogue among Ophthalmic Professionals for the purpose of persuading industry leaders, the Manufacturers, Professional Organizations, Educators, and especially Retailers, to act quickly and more effectively to provide comprehensive and ongoing practical training for Dispensers, especially Apprentice Opticians, and Managers; training that goes beyond textbook and online reviews and-or simply answering questions that have more to do with company marketing goals and policy issues than with practical dispensing; training that includes one-on-one interviewing exercises, and the practical application of hands-on, in place, on-the-face assessment, design and dispensing skills.

Note: The 'Back To Basics Frame Fitting Course,' which follows this discourse is a continuing education exercise and knowledge review course for Ophthalmic Dispensers. Some major points of this discourse are given additional attention within the Course itself.

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 Mature (those born before 1946), Baby Boomer (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."

Opticians' Generation Gap

It is apparent to many of today's ophthalmic Patients and other industry observers that there's little connection between the applied dispensing skills, i.e., the 'hands-on' design, adjustment and delivery techniques of experienced, 'Mature Generation' Opticians and the practices of latter day Dispensers and Managers. Through no fault of their own, due to the absence of generational connection, today's Dispensers and Managers are seen to provide and-or oversee only the most casual delivery of eyewear as if it were ready-to-wear merchandise, with little or no attention being given to the all-important 'full discovery and disclosure' Patient interview, or the subtler frame-fitting details as practiced by their Mature Generation predecessors. Unfortunately, their attention is now directed almost entirely to retail sales goals and marketing efforts to the detriment of Patient satisfaction, which of course, adversely impacts the potential for increased sales and subsequent Patient referrals.

"Too little attention is given to the practical needs of Patients."

And if any hands-on skills are applied, it may amount to no more than a slight adjustment of the nosepiece or a sharp and short 90 degree bend of the temples at the junction of the ear with no thought of reshaping them to follow the lines of the skull. In fact, many of today's Dispensers only require the delivered eyewear to 'look' symmetrical or 'pretty', never mind that it does not fit any of the asymmetric facial or cranial contours of the Patient. They may even 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 an Ophthalmic Dispenser, one must first have
the attitude of a healer, and then the sense of a retail merchant."

Through no fault of there own, today's Dispensers are unaware of the decades-old decline of applied hands-on fitting skills, which has produced at least two generations, 'Generation X' and 'Generation Y' Opticians, including many latter day Board Certified Opticians, who have never witnessed any demonstrations of these hands-on skills. And as a result, these Dispensers have come to believe, after a couple of years of their way of 'delivering' eyewear, that they are sufficiently skilled and need no additional training in the 'dispensing' of eyewear, and worse, that they have nothing to learn from their more experienced and senior 'Mature Generation' colleagues.

"Placing the frame directly on the Patient will give the
Dispenser a better sense of what adjustments are needed."

This disconnection is understandable due to today's focus on training Dispensers mostly via on-the-job apprenticeship programs, most of which are devoid of adequate Patient interview with full discovery-disclosure, and absent any direct hands-on, on-the-face training in eyewear design, assessment and adjustment as practiced by 'Mature Generation' Opticians.

The deficiency is now even more acute due to the latter day emphasis on online instruction, which of course affords no opportunity for aspiring Dispensers to develop their Patient interviewing skills or hands-on assessment and frame-fitting experience. As a result, today's aspiring Opticians become skilled mostly in how to give the correct answers to test questions about company policies and sales promotions. Many end up with no experience in conducting a Patient interview or effectively assessing, designing, and then fitting eyewear directly on the Patient. Unfortunately they are just merchants, not real Ophthalmic Dispensers. This leads one to wonder whether Ophthalmic Dispenser certification and-or licensing is really effective, since just about anybody can hand over a pair of glasses and operate a cash register, as demonstrated in some of today's true-to-life TV ads, whereby the Patient and Dispenser make no direct contact. The Dispenser just hands the Patient their eyewear, and the Patient pays.

"A surgeon must invest years in actual hands-on practice
in residency before being considered to be a surgeon."

In the eyes of the Consumer the hands-on custom fitting aspect of dispensing eyewear has become an exotic and unfamiliar craft, and it has devolved to such an extent that some people 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 an Optician of the 'old fashioned' hands-on school, be removed from temple ends because "they don't look straight and flat like other people's glasses."

A multi-dimensional custom
fitting with attention to detail.
All gaps and space have been
removed between the skull and temple.

Temple, right, has been customized.
Right temple now fits the mastoid
like a glove with touch at all points.
Left temple is untouched, making
little contact with the Patient's skull.
"No touch, no hold."

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 at a 'Mature Generation' Dispensing 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 the Patient's permission before proceeding with hands-on adjustments.

(Note: There are some industry observers who see the devolution of ophthalmic dispensing as an overall corporate strategy perpetrated by some industry members to eliminate any reliance on competent, licensed Dispensers in order to better manage their labor costs and enhance their profits.)

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

Ready-Made, Ready-To-Wear Gap

Whereas corrective eyewear that is assembled in an optical laboratory is, as a final step in the inspection process, inverted on a flat surface and made to fit squarely at the four points of contact, ready-to-dispense, it is NOT ready-to-wear. Instead of assuming that all newly made eyewear will require at least some minimal adjustment and realignment many of today's Dispensers assume and-or hope it needs no additional alignment. They apply the logic, "Well, the Patient chose 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 completely 'out-of-touch' with the real needs of almost every Patient.

"Successful discovery, dispensing
and delivery lies in the details."

Discovery and Disclosure

Some Refractionists make uninformed and presumptive entries on their prescriptions, e.g., "Progressive Addition Lenses," while many Dispensers ignore the actual visual needs of Patients, which results in an unsatisfactory outcome for all parties. Often times, for example, Dispensers promote only one particular lens type without any notion of whether the Patient's circumstances require more practical alternatives.

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 Interview so that all aspects of the Patients 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 greatly appreciate a 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.

        

    

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."

Dispensing and Delivery

Patients deserve a fully personalized design and fitting of their eyewear. The fact that the frame fits on a table squarely should never preclude fitting the frame directly on the Patient. This becomes obvious when after fitting a Patient who presents facial anomalies, the frame no longer fits squarely on a flat surface. Facial structure, the positioning of each eye and ear, the mastoid complex 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 multifocal lens design along with the appropriate advisory to the Patient?

Multifocal 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.

Eyewear can be considered to be successfully dispensed-delivered only after a) an adequate Patient interview with full discovery-disclosure occurs, b) the comprehensive fabrication of a lens-frame design is completed, c) a hands-on, in-place, on-the-face eyewear assessment is made, d) followed by Gross Alignment and Subtle Adjustments of the eyewear, using the Sense of Touch, at the hands of an adequately trained Dispenser, i.e., a qualified Dispensing Optician, or Optometrist, or their Professional Associate acting under their direct supervision.

PERSPECTIVE

Together with the decades-long corporate expansion of Ophthalmic Dispensing outlets, the marriage of eyewear to fashion, the 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 scarcity of experienced practitioner-teacher Professionals with hands-on skills, together with more and more Dispenser training occurring online and state licensing boards 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 'Mature Generation' Dispensing Opticians.

Some Contributing Factors*

Acting mostly in the interest of bottom-line numbers and cost-efficiency strategies, the ophthalmic industry itself is responsible for a good deal of 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 this practice for mostly inventory-cost considerations. This action marked the beginning of the decline in the made-to-order quality of ophthalmic services. Now, most frame styles are available in one or two sizes at most. As a result, Patients are unable to choose from as diverse selection of frames in sizes that fit, and for the more discriminating and conscientious Dispenser, this presents a daunting if not impossible task.

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 making 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 yesteryear, 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 experience with the custom designing of presbyopic golfers' glasses, which feature segs 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 seg, which is scarcely used anymore, but remains a first choice transitional lens design for some first-time, hard-to-fit Progressive Addition Lens wearers due to its ease of adaptation along with its cosmetic advantages? (Albeit the most popular lens for today's presbyopic Patient, the PAL may NOT be the ONLY first lens of choice for these Patients.) The list goes on and on.

    

And unfortunately, we see many of today's retail Managers who are inexperienced and sales-aggressive to the point of being overly critical of the time required to complete adequate Patient interviews and the hands-on dispensing tasks that Patients prefer, while overseeing their subordinate, albeit experienced 'Mature Generation' and experienced staff of Dispensers. This of course has helped lead to the further demise of these important skills along with the loss of the subsequent quality of service.

"Any action which genuinely favors the Patient
will always improve the bottom line."

Furthermore, untrained optical store Managers are known to obsessively push Dispensers for higher production thereby affording them less occasions for Patient interviews and design time along with increasing the pressure for high-dollar sales, e.g., the universal promotion of high-end, and more expensive PAL's, progressive no-line lenses, regardless of their demonstrable need, while at the same time allowing less time for consideration of the Patient's real needs. At the same time these Managers demand that customer satisfaction be maintained and minimal remakes-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 the appropriate Patient interviews. This results in more Patients becoming dissatisfied, while generating more returns-remakes, 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 fulfilled.

"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 'em in, and get 'em 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.

SO, WHERE DO WE GO FROM HERE?

The industry challenge?
Bridge the knowledge gap.

Each generation of Dispensers has the potential to learn more and to become better at the practice of Opticianry. The challenge for corporate and professional ophthalmic industry members is to step up with their collective resources, to help close the 'knowledge gap' by instituting ways for each generation of Dispensers to "recognize the strengths and value of all colleagues," to improve the quality of service at all levels, and to educate, provide, protect, and preserve these important and increasingly rare hands-on ophthalmic skills for the future generations in the interest of serving the health and wellness of their base. To this end, a prospective model for an on-site Hands-on Workshop Training Course for Dispensers follows.

REMEDIAL TRAINING COURSE
This model is open-ended and may include additional subjects.

A) The Patient Interview, including full Discovery and Disclosure.

B) Dispensing and Delivery of eyewear using on-the-face assessment and hands-on skills.

C) A review of the unique challenges confronting the Manager of an optical dispensary.

A: Patient Interview
With Full Discovery and Disclosure

With full participation of the Patient and the Dispenser

First, each 'Dispenser' will participate in a role-playing episode in which the all important Interview, including Full Discovery and Disclosure, is conducted. Full Discovery-Disclosure means that the 'Dispenser' conducts an interview of the 'Patient' in order to discuss and discover ALL aspects of their visual habits and needs. The 'Dispenser' then discloses and advises the 'Patient' of ALL the available lens-frame options and costs. The interview concludes with the 'Dispenser' offering specific recommendations, while the 'Patient' makes a fully informed decision as to their purchase.

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

B: Dispensing and Delivery
Using On-The-Face Assessment
And Hands-on Fitting Skills

"You are fitting a Patient for comfort,
not a table for square or for pretty."

The 'Dispenser' will first OBSERVE a demonstration of a comprehensive visual and tactile assessment of eyewear while in-place and on-the-face of the 'Patient' by an experienced hands-on Dispenser.

The 'Dispenser' will then OBSERVE a demonstrated delivery of eyewear with the application of both the Gross Frame 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.

The 'Dispenser' will then APPLY these fitting procedures* to eyewear after making an assessment directly on the face of the 'Patient' under the guidance of an experienced hands-on Dispenser.

The 'Dispenser' and the 'Patient' will then REVERSE their respective rolls and APPLY the fitting procedures under the guidance of an experienced Dispenser.

*Hands-on Dispensing Defined

A properly executed hands-on, in place, on-the-face assessment, design, and fitting procedure will require not only appropriate communications, but some direct physical contact between the Dispenser and the Patient as well. A proper hands-on fitting will involve 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. The Dispenser must not rush the procedure. Time is actually saved in the long run when the fitting is done with sensitivity and patience. Click here to arrange for a demonstration.

"Almost anybody can just hand over a
pair of glasses and operate a cash register."

C: Managing An Optical Dispensary

The dispensing of eyewear involves numerous subjective experiences on the part of the Patient. The Patient's clear and comfortable vision and well-fitting frame are primary issues which require knowledge, sensitivity and a unique intimacy between the Dispenser and the Patient that also includes an attitude associated with healing on the part of the Dispenser. This places the business of marketing and dispensing eyewear in a different, special and more humanized class, i.e., a business, in several respects, unlike that of marketing and delivering groceries or general merchandise. It's important for a Manager, especially those with no background as an Optician, to acquire additional training in order to be aware and sensitive to these unique aspects for the sake of better service to the Patient, and in order to maintain a proper perspective, especially in dealing with subordinates.

A Special Note: The emphasis with respect to the importance of hands-on, on-the-face dispensing and delivery of ophthalmic services within this discourse may seem overstated, but Patients who experience the results are known to give testimonials as to the improvement to their long term visual comfort and wear-ability using words such as "significant," even "profound." This level of service has the power to transform any Patient into a lifetime Customer. (See Johnny's Story.) These Patients become the source of numerous referrals. And complaints, remakes and refunds are significantly reduced, as well.

Whereas service can be best defined as any human activity by which people's lives are made better, i.e., easier, happier and-or more comfortable, just as portrayed in the inspirational narrative of 'Johnny's Story,' happy Customers are the very best way of advertising. Their satisfaction proliferates, and the resultant advertising is free! See more specific details.

The Alternative

Hands-on dispensing is a soon-to-be-lost art, whereby sales of 'ready-to-wear', 'over-the-counter' eyewear will continue to flourish, hands-on dispensing services will disappear, and Patients will continue to suffer with substandard quality of service, and poorly fitted and uncomfortable eyewear delivered by an ever growing number of unskilled Dispensers. --

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