3D D I S P E N S I N G.c o m
Discovery, Design, and Delivery
Opticianry is ultimately defined by how well the eyewear makes contact with
"Most people think the optometric examination is important. It is, but
Teaches the principles of excellence in the Discovery,
Improved job security for prescription Eyewear Professionals
Discovery, Design, Delivery
It's time for three-dimensional dispensing, a time honored craftsmanship that includes:
. Why do we so often consider Consumers mere customers
POINTS TO PONDER
"Handcrafting prescription eyewear to fit the consumer
"For the last few decades our collective mindset has manifested as,
"More than half of all people in the United States use some type of lens
"It's time for Opticians to receive practical form-fitting training,
"The real challenge for any Optician is to take a symmetrically 4-point-squared
"When Opticians relate to Consumers as customers, it often has an adverse
"If you will recall, Opticianry is ultimately defined by how well
as Hairstylists cannot practice without tactile contact with a consumer,
retail optical paradigm needs to be upgraded to that of serving
ARE YOU A GENUINE OPTICIAN
POINTS TO PONDER
Consumers deserve a pleasant experience.
What do Manicurists, Hairstylists, Dentists, and
When Opticians do not touch the Consumer at the time
is no right or wrong way to dispense eyewear.
is ultimately defined by how well the eyewear makes
Dentists, Manicurists and Hairstylists make direct contact with the
1950s Optician-assisted frame selection
"Opticianry is defined by how well the eyewear makes contact with the patient.
Many dispensers practice four-pointing eyewear on a flat surface as
Handcrafted frame-fitting, i.e., touch and feel, hands-on dispensing,
retail optical paradigm needs to be upgraded to that of serving
customized fitting of eyewear involves more than just adjusting a nose
Opticians are highly skilled Healthcare Providers.
Any ophthalmic dispenser who is not practicing basic guidelines as described at DispensingGuidelines.com is a mere eyeglass merchant, not an Optician. And this is the major reason why many of today's PRESCRIPTION eyewear consumers purchase their eyewear online. See GlassesOnlineWarning.com. See Letter To Eye Care Professionals. See The Danger Independent Opticians Face. See EyewearGenie.com. See My Two Sense.
If you are not practicing Opticianry with the application of 3D Dispensing, Discovery-Design-Delivery, skills, i.e., a) Discovery of the consumers REAL eyewear needs in an unbiased Comprehensive Lifestyle Interview, b) Using yesteryear skills in both the Design of eyewear, and Tactile, Touch and Feel Hands on the Consumer Delivery of prescription eyewear, let’s be honest, you are a big part of the cause of today’s proliferation of online sales. And only you can restore market share to the ECP industry, more skillful professional services for consumers, and lost art-craftsmanship skills to the Opticianry profession. See 50 Things On Line Sellers Simply Cannot Do.
Also, we recommend across-the-board-charging of a realistic fee to Web-based consumers who seek follow up attention for ill-fitting eyewear. (This is addressed in some detail elsewhere.) Of course, we must see to it that we have the hands-on skills to warrant our fees. Opticians have historically offered free lifetime service, but with the advent of the Internet, lifetime services can only be realistically offered to full-fee consumers. Again, we must have the hands-on skills to warrant the fee. And for many Opticians, even many senior Opticians, this could be a real challenge.
Where there is NO DIFFERENCE between the service offerings of a brick-and-mortar merchant and an online vendor, other than price, many consumers understandably choose the online source. Online providers are 7/24 accessible, cheaper, and offer the same absence of direct human contact as a majority of today’s dispensaries. What’s not to like? Note: Keep in mind that 7-11 stores are successful even though their prices are high. Why? Because consumers mostly get the Service and Quality they want. See The Danger Independent Opticians Face. See OpticalViews.com.
There are only three things the optical industry can offer the prescription eyewear consumer, SERVICE, QUALITY and PRICE. But most latter-years dispensaries currently ever offer ONLY TWO of these, simultaneously. Why can’t we offer SERVICE, i.e., 1) HANDS-ON THREE DIMENSIONAL DISPENSING, 2) QUALITY PRODUCTS, and 3) FAIR PRICING, all three simultaneously, like we used to do? This leaves the online providers with only their cheaper prices with no custom fitting skills for that segment of the market, and leave the remaining market (we’re talking mostly about full-time-wear prescription-wearing consumers, not those looking for plano sunwear or readers) to Eyewear Professionals. A big challenge now, is that the industry has devolved to the point of being extremely deficient of Multi-Dimension Dispensing Opticians.
Three Dimensional Design
From Individual Custom Eyewear Frames
The majority of prescription eyewear consumers relates to and seeks customized Discovery, Design, Delivery, including Quality Products, IF and WHEN these are available. What has prompted the migration of consumers to the Internet is that Multi-Dimensional Dispensing skills have become more the exception than the rule. We, for instance, have served consumers in recent years that were literally shocked to experience a tactile, hands-on, touch and feel frame fitting, having never seen nor experienced such service. Sad! -- Opticians For Change
WHAT DOES IT TAKE?
Sustained and conscientious emphasis on
the following procedures is necessary for the qualitative dispensing of prescription eyewear.
See Custom Frame Fitting Up Close and Personal. See Final Fitting. See Serving vs Selling.
IT'S TIME FOR THE CONSCIOUS DELIVERY OF PRESCRIPTION EYEWEAR
No two heads or faces have the same dimensions,
so the delivery
"Patients deserve custom-fitted prescription eyewear.
Can you spot asymmetries in these photos?*
ALWAYS FIT TO THE ANOMALY
is no right or wrong way.
Although the Full Discovery Lifestyle Interview and Frame Fitting Techniques are not the only aspects of what we call Ophthalmic Dispensing, today they are much underrated, even subordinated skills. Frame design and fitting skills can be acquired only through direct, practical experience that must include a) Visual-Tactile, Hands-on Assessment, b) Gross Frame Alignment, i.e., correcting the most obvious frame and lens misalignments, and c) Subtle Frame-Temple Adjustments, i.e., hand crafted multi-dimensional adjustments that include 'touch and feel' procedures such as reshaping the temple ends to make direct but light form-fitting contact with the skull and mastoid behind the ears, while simultaneously avoiding any direct contact of the frame components with the pressure-sensitive ears, is one of the single most important considerations for the Patient's long term comfort and full-time wearability. Full but light contact with the skull, NOT THE EARS, along with the bridge of the nose, are the primary means of alignment and support for the frame. See example. NOTE: The ears are used as a means of frame alignment.
most perfect prescription can be compromised if the eyewear
Not only is a poorly fitted frame likely to cause discomfort, and inconvenience to the Patient, but in cases of higher lens powers and high astigmatic corrections it can even adversely impact the effectiveness of the prescription, thus creating additional visual problems. And a poorly fit frame will most often result in the Patient broadcasting an undesirable image of Ophthalmic Dispensing, as well. Get the rap on wrap-arounds here. See advisory on frame selection here.
*SPECIAL NOTE: Multi-focal lenses are routinely 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, eyewear merchants don't allow for any disparate bifocal segment height or seg inset in their lens design, even in their software. Skilled Opticians however, compensate for the Patient's structural disparities by way of frame and lens designs and-or handcrafted frame adjustments.
is how well the eyewear makes contact with the
THE DYNAMIC DUO
A well-fitted frame will come into physical contact with the wearer at only three points, namely the bridge of the nose, and on each side of the head including behind each ear. These three points form a triangle known as the fitting triangle, as illustrated above. The temples should not touch the side of the head before reaching the ears. Should this occur, it creates a constant tendency for the eyewear to slip forward and down resulting in an unacceptable displacement of the lenses, and unwanted pressure on the Patient's nose and behind the ears, often causing soreness.
Also, great care must be taken to ensure the temple ends-tips do not touch the sensitive cartilage behind the ear. The frame is held steadfastly as the result of only a slight touching pressure on the side of the head behind each ear. The temple ends should be crafted to follow the contours of the mastoid complex. When executed properly, this procedure produces a multi-dimensional balance both in relationship to the ears and in relation to the skull, resulting in a skull conforming, 'like-a-glove' fitting that completely matches the topography of the Patient's skull. To the inexperienced Dispenser the results can look severe (see example) but it all blends in, unseen and unnoticed, when worn by the Patient. This is perhaps the least understood and least applied of any of the artful, more Subtle Frame Adjustments, which of course 'Mature Generation' Opticians are accustomed to providing.
NOTE: When completed, the temple ends may even look crooked, bent and misshapen. But how do the temples fit the Patient? Dispensers are hereby cautioned against making subjective judgments as to frame appearance, especially the temples, following the application of any Subtle Frame Adjustments since the objective is to make the Patient comfortable while wearing the eyewear full-time, and not just to satisfy the Dispenser's personal aesthetic sense of the frame, especially for the temples to look straight, squared, and 'pretty' while 'four pointed' on a flat, 'one-dimensional' surface. A PATIENT'S FACE AND SKULL IS NOT A FLAT SURFACE. Given the numerous anomalies of human facial and skull structure, a 'frame-squared' fitting can be, and in most cases is, the antithesis of Patient comfort. "You are fitting a Patient for comfort, not a flat surface for square or for pretty." See example.
An experienced skillful Dispenser is able to 'take charge' of the dispensing process and anticipate adverse visual and fitting issues before the Patient has to endure them, thereby avoiding the necessity and inconvenience of return visits and-or a possible redos, or worse, a refund.
TOUCHING AND FEELING
"The Optician must touch and feel
After placing the frame (See OpticalGuidelines.com) on the Patient and making a hands-on, in-place, on-the-face, tactile-visual assessment, a careful adjustment of the nose piece along with handcrafted sculpting of the temples at all points of contact is extremely important so that any frame contact is caressing, i.e., not pressing, pinching, rubbing or grabbing. One principle to remember in three-point fitting is, "No touch, no hold", i.e., at any point of the fitting triangle where the bridge and temple ends do not touch the nose and head, there is a reduced ability for the face-head to support the eyewear and thus hold it comfortably in place.
Gaps and spaces are obvious when observing poorly fit frames, especially while touching and feeling the frame while it is in-place on the Patient. The idea is to remove ANY gaps or spaces between the Patient's skull and respective points of frame contact behind the ears. Again, where there's no touch, there's no hold. The displacement is usually too subtle to be seen, and if there is no direct touching-feeling by the Dispenser while the frame is in-place, on-the-face, there's almost no way to perceive the subtlest points of no-contact.
The complete frame fitting procedure, when it is fully applied, involves three distinct steps:
Visual-Tactile Assessment of the frame's contact with the skull at all points of contact,
Gaps between the frame temples and the skull can be easily felt behind the Patient's ears using the Sense of Touch. When the temple ends are hand crafted and contoured to fit the mastoid complex, they may resemble something akin to a segment of a pretzel, such as in the case of a 'wavy' mastoid bone or a mastoidectomy. But when the treated temple-ends are placed on the Patient, even the most radical reshaping becomes invisible to an observer and the resultant fit is extremely comfortable. See photo below.
OLD FASHIONED MULTI-DIMENSIOMAL
there's no touch, there's no hold.
Patient deserves sufficiently handcrafted,
Form-fitted for actual patient
But when worn by the Patient, as shown in the photo above, the temple ends look, feel, and fit like a glove, no space or gaps. This kind of custom fitting utilizes the contact surfaces to their maximum. The removal of the space and gaps however, requires Subtle Frame Adjustments, reshaping, even 'sculpting' of the temples with a bit of artistic skill. The eyewear will now fit only that person for whom it was intended, and provides a truly customized, balanced and comfortable fit. See Letter To ECPs.
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. A successful multi-dimensional frame alignment and fitting can be achieved only when the Optician 1) visually assesses the eyewear in-place, on the face of the Patient, and 2) uses the sense of touch and feel simultaneously to determine any anomalies between the frame's temples and the Patient's skull. In most cases, the Dispenser cannot remain seated.
That is to say, the Optician must get up, and get close to the face of the Patient, otherwise an appropriate evaluation cannot occur. In other words, the Optician 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 including any touch-feel fitting procedure requires sufficient time to execute properly, i.e., no procedures can be be rushed. Haste makes for waste. See more Hands-on Fitting details here.
A: Incorrect fit.
this: Bring the temples out at the end piece and bend
the temples in toward the skull and behind the ear line if necessary.
this: Bring the temples in at the end piece and remove
the bowing if necessary.
The Basic Frame Alignment, being the most obvious, begins even before placement of the frame on the Patient with the squaring of the 'x' frame axis or plane, as illustrated here, followed by the Hands-on Assessment of the nosepiece-bridge while in-place, on-the-face, then continues on to the squaring of the 'y' and 'z' planes, and ends with the reshaping of the temples, always working from the front-to-rear, face-to-mastoid, of the Patient's head.
THE X, Y, Z AXES
coordinates for optical system analysis:
In most cases frames are fit so that the pupil is positioned several millimeters above the optical center of the lens. When this occurs some Pantoscopic tilt is desirable as shown in figure A, above.
commonly, when the pupil is positioned directly behind the optical
center, an Orthoscopic frame tilt is recommended. In the very
unusual situation where the pupil is positioned below the optical
center of the lens, a Retroscopic angle is called for as in figure
In instances where the GCD and the PD are the same, no face form is best.
the very unusual instance where the Patient's PD is actually wider
than the frame PD, negative face form should be employed. However,
the need to apply negative face form can usually be avoided with
a more appropriate frame selection.
As mentioned earlier, care should be taken during frame selection to insure a good fit for the bridge. When using non-adjustable bridges, little can be done to alter the fit at the time of delivery. When fitting frames with adjustable nose pads, the main issue is to be sure the entire area of the pad is resting on the nose. If the pad is angled in such a way that only a portion of it is resting on the nose, there's a tendency for it to “dig in” and cause soreness.
Commonly Required Basic Frame Alignment
lens is higher - Bend left temple up, or right temple
The list above may be partially summarized by the following: “in with in; out with out; up with up; down with down.” Which means if a lens too far in, bend the temple or endpiece in to bring it farther out; if one lens is too far up, bend the temple or endpiece up to lower that side, and so on. Manipulating the frame tilt has the effect of bringing the frame either farther away or closer to the cheeks and eyebrows. Manipulating the face form will also effect the distance the frame lies from the cheeks. The entire frame front may be lowered or raised by widening or narrowing the bridge, and as previously mentioned, this is most easily accomplished with adjustable nose pads. See Common Complaints and Causes.
Subtle, Personalized Frame Adjustments
as a dentist cannot practice dentistry without direct patient
The Subtle Frame Adjustment, (see example) is considered to be a more advanced and sophisticated aspect of the frame-fitting procedure, i.e., it is multi-dimensional, with most attention given to hand-crafting detail, along with sufficient time and patience to accomplish the tasks. It can be demonstrated only by hands-on-direct tactile instruction, and it can be learned only by direct experience. Therefore, this subject cannot be fully addressed within the confines of this Course. A workshop setting, whereby the related tools and materials are available to the participants, is required. These techniques cannot be taught virtually.
For instance, Subtle Frame Adjustment involves the conscious, and somewhat artistic hand crafting or contouring-sculpting of the temples to the Patients skull whereby any space or gaps between the skull and temples are removed. (See photo.) This is the most sophisticated aspect of hands-on frame fitting and requires some level of artistic skill. It is the least known and thereby the least practiced, even by many senior generation Opticians. The resultant effects are the least visible but most comfortable while being worn in-place by the Patient, yet it is given the least attention by today's Dispensers due to the subtleties involved. It is of great importance, however, in spite of its subtlety, for the Patient's maximum long term comfort.
POINTS TO PONDER
From an East Coast Optician.
"The good news is that this issue was addressed at the webinar, was it last week? To what I remember, the plan is to promote (for lack of better word) Opticians... I got really excited about the possibility, now we just need to see it come to pass and I hope sooner rather than later." --
I agree. However, we face an apparent daunting task. I mean, these issues have been 'discussed' at many levels of the industry for years with no real action taken.
My view: There are a number of conflated forces at work, which keep us from making progress. The two biggest are:
1) We have not yet effectively dealt with the reality that the majority of current dispensers are woefully undertrained and extremely challenged when it comes to handcrafting prescription eyewear. For instance, I know senior Opticians who come to my workshops who are unable to adequately customize eyewear directly on a patient. (There's also a lot of what I call 'professional ego' involved in that many 'Opticians' are unable to admit, either through ignorance or antipathy, that they really do not know (some only think they know) how to fit handcrafted eyewear on a patient. See DispensingGuidelines.com.
2) And even if we had plenty of experienced, skilled Opticians at the ready, corporate retail interests and their unskilled, inexperienced managers will not allow adequate time and space for appropriate handcrafted skills to be applied at the dispensing table. (As you well know, it takes sufficient time to handcraft eyewear directly on the patient. Of course, this can be done fairly quickly, but only by skilled and experienced Opticians.) They are too interested in numbers of sales and serving their stockholders interests ($) at the expense of the Consumer, their real base. Serving their consumer-base is when their stockholders are best served. Too many optical retailers don't get it, in that we are a genuine healthcare industry, and Opticians are Healthcare Professionals dispensing prosthetic devices, not ready-to-wear eyeglass merchants. (I could tell you some really interesting albeit disturbing stories based on my experiences since 1958.)
The task is not impossible and I remain an optimist, but I have not seen anything to indicate we've stopped the rhetoric to the point where we're really getting our 'edge and groove' back. Time is short!
This is the principle, which must be the industry's universal, personal and corporate theme. "Opticianry is ultimately defined by how well the eyewear makes contact with the Patient, not by the number of customers served.” Once adopted, the industry will once again excel in the art form and craft of humanized Opticianry. See Indivijual Custom Eyewear Frames.
And here's a follow up from a senior Optician.
"One thing I have run into is today's optical world works at the top of the bell curve only by being interested in or capable of serving 60% of the eyeglass wearing public. With the rest, it is hit or miss at best. I would say that the new optical people need to understand what an Ultex is and why someone might be wearing one today, how to build a Numount, a Balgrip, or fit an aphakic lenticular. In our onesize fits all world, one size really fits about half. You fit a person with an ophthalmic prosthetic so that they can function in their day to day life. This requires a human touch, not a used car salesperson." --
Lens Care and Compliance
Eyewear For Hard-To-Fit Patients
appreciation is hereby expressed to
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