Opticians are Eyewear Professionals. Opticianry
is ultimately defined by how well the eyewear makes
contact with the Patient, not by the number of Customers served.
For the truly skilled Optician, the standard of care must include a
customized design and handcrafted fitting of eyewear on each Patient.

This Free Online Course, includes Optical Guidelines and a Free Test. The Course covers a) the basic parts of the ophthalmic frame and a summary of its various measurement criteria; b) lens decentration, horizontal and vertical; c) the theoretical and actual minimum lens blank size based on pupillary distance; d) frame measurements along with required procedures for making hands-on, in-place, on-the-face visual and tactile assessment; and e) the all-important handcrafted final-fitting. ("If you do not touch the consumer at the time you dispense their eyewear, you are acting as an eyewear merchant, not as an Optician." See Service, A One-On-One Interview.)

Next, an outline of the various frame styles, and bridge and temple designs currently available with an emphasis on the importance of proper bridge and temple selection, using the shape of the face and head, placement of eyes and ears, and most importantly, the nature of the prescription as criteria. Some of the most common, and some of the more exotic frame materials will be covered in addition, with a brief mention of the general characteristics of each.

The last and most important item in this work, Final Fitting, will then be addressed with special emphasis on the necessity for the qualitative dispensing of eyewear using 1) Direct, hands on the Patient, in-place, on the face visual and tactile assessment, and 2) The most subtle and artfully handcrafted, touch and feel techniques of form-fitting eyewear. See Fitting Facial Asymmetries. See also Custom Frame Fitting, Up Close and Personal.

As indicated elsewhere, the Hands on the Patient tactile assessment is one of the most important, yet least implemented aspects in today's retail optical market. Although frame adjustment, especially the more subtle aspects, is an artful skill which must be acquired through practice and experience, this course presents some basic guidelines, which may be applied immediately. These will be covered only briefly along with a mention of the fitting triangle, the various frame tilts and face forms along with the reasons for applying them. A quick summary of the various types of frame fitting issues and their solutions is presented later. To those Eye Care Professionals in need of more practical training via workshop venues, please check out the Intermediate Workshop Overview, and the Advanced Workshop Overview. See also OpticalGuidelines.com, and 3DDispensing.com.

Special Notice: Optical Workshops offers ABO accredited practical hands on the patient training to improve your form-fitting skills. Learn the art and craft of old-fashioned, handcrafted form-fitting of eyewear at the hands of an old-school Optician. Contact us here, or 855-410-2700. You can also add your name to our mailing list here.

See also our Free Companion Course offering, Serving vs Selling; a listing of more Free Online Courses; and other Optical Training Resources. See also Service, A One-On-One Interview. Take the online Test here.

To those accustomed to working with ophthalmic terms, the following Abbreviations, Definitions, and Terms, may seem redundant. These can be used as a simple review in order to ensure a better understanding of the main subject matter, or they can be skipped. Click here to Skip Abbreviations, Definitions, and Terms. Terms.

'Professional Egotism' There are a number of conflicted forces at work within the ophthalmic dispensing industry, which keep us from making progress. The two biggest are: .) We have not yet effectively dealt with the reality that the majority of current dispensers are woefully under trained and extremely challenged when it comes to handcrafting prescription eyewear. For instance, I know senior Opticians who attend Optical Workshops who are unable to adequately customize eyewear directly on a Patient. (The number one complaint by prescription eyewear consumers is they are unable to acquire well-fitting eyewear.) .) There's also a lot of what I call professional egotism and shaktipad (see NOTES* below), whereby many 'Opticians' are unable to admit, either through ignorance or antipathy, that they really do not know how to adjust eyewear, i.e., handcraft eyewear directly on a patient. Many only think they know and take umbrage when challenged. They have convinced themselves that they need no more training because they've been adjusting frames for years, and they see no need to change. Regarding this 'professional egoism' issue, we suggest that we ask this question of those dispensers who claim they already know how to fit eyewear, and those who claim that they have been working as an Optician for several years. "Have you had any formal training in handcrafting eyewear directly on the consumer?" The problem is that many folks are self-taught, and most of those who came up as apprentices were taught by dispensers who have had no formalized hands-on the consumer, frame-adjustment training. This decades-old history is the main reason, not price, that Opticianry as a profession has lost, and continues to lose market share. Therefore it is incumbent on those who know to teach those who do not know. And it is incumbent on those who do not know to surrender their ego. OpticalGuidelines.com *NOTES: EGOTISM is the feeling or belief that one is better, more important, more talented, etc., than other people. SHAKTIPAD is a state of egotism in which an optical dispenser is far less experienced, knows far less than they think they know, and who fails to acknowledge it. The worst case scenario is the optician who falls into the trap of convincing themselves and others that only they know the best way, and that the old ways need to change. Beware of the 'tiger's bite'! Shaktipad is a consequence of 'riding the tiger' of pride. One must ever be alert to the signs of shaktipad in order to take appropriate action. In the case of an optical dispenser in the state of shaktipad, the remedy is to seek out practical training with the attitude of a perpetual student, i.e., one who surrenders their ego, realizes that learning never stops, and that one can always improve their skills. See Ego Eradicator.

Abbreviations, Definitions, and Terms

"A" is the Horizontal measurement of a box enclosing the lens area.

ASTIGMATISM is a blurred vision condition produced by a 'football-shaped' cornea, which is too steep in one meridian and too flat in another. An astigmatic cornea (see example here) focuses light in two different places in the eye, adversely affecting both near and distance vision. Also see "CYL" below.

AXIS corresponds to the orientation of the cylinder power in terms of degrees from 0 to180.

"B" is the Vertical measurement of a box enclosing the lens area.

BRIDGE is that part of the frame front that connects the eyewires and holds the frame in place at the nose.

BRIDGE TYPES: KEYHOLE BRIDGE is a type of bridge that fits only on the sides, and does not touch the top. Resembles a keyhole. SADDLE BRIDGE is a type of bridge that sits uniformly over the nasal crest.

"C" is the Width of the lens along the central datum line.

CATARACT is a clouding of the lens of the eye. Click here for more.

"CYL" is the abbreviation for CYLINDER and corresponds to numbers indicating the amount of astigmatism correction. See ASTIGMATISM above.

              

Left image, spherical lens with no cylinder.
Vertical and horizontal meridians are equal.
Right, lens with cylinder to correct astigmatism.
Vertical and horizontal meridians are unequal.

DBL is the Distance Between Lenses, the least distance between the two lenses, the bridge size.

DIOPTER is a measurement of lens refractive power equal to the reciprocal of the focal length of a lens in terms of meters, e.g., a 2.00 Diopter lens will bring parallel rays of light to a focus at a half meter, i.e., .50 meters. Also, the measurement of the degree to which light converges (a plus Diopter, +2.00D, lens will correct farsighted vision), or the degree to which light diverges (a minus Diopter, -2.00D, lens will correct nearsighted vision).

What is an Optician?

DISPENSING OPTICIAN, OPTICIAN, or LICENSED DISPENSING OPTICIAN (LDO or RDO): Opticians can be likened to Registered Pharmacists (Optical Pharmacists?) who dispense medications based on the prescribed orders of a physician. Opticians are Eye Care Professionals, ECPs, herein defined as a Board Certified and-or State Licensed Health Care Practitioners who specialize in the design and fabrication of prescription eyewear, i.e., lenses, frames and contact lenses, which includes the duplicating, measuring, inspecting, and verifying of prescription lenses, and any subsequent form-fitting frame Alignment or other Adjustments, which includes the Final Fitting, whereby the Patient's long term visual comfort and eyewearability is the primary objective.

Opticians are Eyewear Professionals who act within the vision healthcare industry much as
Pharmacists in the medical profession, i.e., Opticians translate, verify and fit eyeglass and
contact lens prescriptions prescribed by Ophthalmologists/MDs and Optometrists/ODs.

An expanded definition as defined by the U.S. Department of Labor, Bureau of Labor Statistics: "Designs, measures, fits, and adapts lenses and frames according to written optical prescription or specifications; assists with selecting frames; measures for size of eyeglasses and coordinates frames with facial and eye measurements and optical prescriptions; prepares work order for optical laboratory containing instructions for grinding and mounting lenses in frames; verifies exactness of finished lens spectacles; adjusts frame and lens position to fit; shapes or reshapes frames. Includes contact lens Opticians." See more.

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

See also Ophthalmic Dispensing, the Final Fitting, and our Consumer-Industry advisory at www.OpticianryReview.com.

DS is an abbreviation for "Distance Sphere."

DV is an abbreviation for "Distance Vision."

ECP or EYE CARE PROFESSIONAL: Any Health Care Professional who specializes in a) the medical examination or treatment of eye disease or injury; b) refracts the eye for the purpose of correcting vision error; c) designs prescription eyewear, i.e., lenses, frames and contact lenses, which includes the duplicating, measuring, inspecting, and verifying of lenses, and any subsequent dispensing or delivery, including form-fitting Alignment and other Adjustments, which includes the Final Fitting of prescription and safety eyewear, and contact lenses. See The 3 Os.

NOTE: The Florida Board of Opticianry is an entity within the Florida Department of Health, which has jurisdiction over Florida Eye Care Professionals.

ED is the Effective Diameter, twice the distance from the geometrical center of the lens to the bevel farthest away from it.

EYEWEAR: A medical prosthesis, i.e., an ophthalmic device which acts as a vision aid and-or eye protection for a dysfunctional or otherwise at-risk system of sight, inclusive of both eyeglasses and contact lenses. For the purposes of this Hands-on Form-Fitting Frame Course, the word EYEWEAR refers to any streetwear, sunwear, safety, athletic, or other occupational or avocational prosthesis, utilizing corrective or plano lenses, which are worn in combination with an ophthalmic frame.

EYEWIRE is that portion of the frame front into which the lenses are inserted or mounted and which is connected to its opposite by the bridge.

FLORIDA Board of Opticanry licensing requirements.

FRAME is that portion of a pair of spectacles that is designed to hold the lenses in the proper position before the eyes.

FRAME DIFFERENCE is the difference between the horizontal and vertical measurements of the eyewire.

FTB, or Front To Bend, is the distance between the plane of the frame front and the bend of the temple. Applies to frames where the endpieces of the frame-front wrap around and there is some distance between the frame front and the beginning of the temple.

HANDS ON THE PATIENT LENS DESIGN AND DISPENSING is herein defined as those procedures, which include a) Eyewear lens design using Trial Frame and Lenses to afford the Patient a real-world visual experience at variable distances with different lens styles, i.e., bifocal, trifocal, progressive, etc., b) Frame adjustments performed by a skilled Optician, which specifically include the visual and 'touch and feel,' hands on the Patient, visual-tactile assessment and handcrafting of the frame, while it is in-place, on-the-face of the Patient, in order to determine and correct any misalignment, and c) Any subsequent multi-dimensional hands on the Patient, '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 wearability. See Before and After photo.

Contrary to media reports, not everyone needs a progressive lens.
An unbiased and comprehensive lifestyle interview must
occur in order to determine the patient's real needs.

SPECIAL NOTE: Unfortunately, many of today's Dispensers make no tactile contact with either the Patient or their eyewear while in place, on-the-face, whereby it is impossible to make a significant assessment or subsequent multi-dimensional, handcrafted, form-fitting adjustments* to the frame. This practice is akin to a Dentist making no direct contact with a Patient while attempting to fit dentures. Sadly, latter generation Dispensers give little or no attention to fitting a new frame after it arrives from the lab, presumably four-point inspected on a flat surface by the lab technicians. Just as in the case of fitting a set of dentures, a frame must ultimately be handcrafted to the variable dimensions of the Patient, not the one-dimensional surface of a flat table. The lab only zeroes-out any frame misalignment in lieu of anticipated adjustments by the Optician. See Fitting Facial Asymmetries.

*Multi-Dimension Dispensing

What is Multi-Dimension Dispensing? An old fashioned concept, which includes a)
Discovery of the real needs of the Patient by way of an in-depth Lifestyle Interview,
b) Design of frame and lenses that fulfill the Patient's real needs, and c) Delivery of
eyewear, which has been handcrafted to create a multi-dimensional balance both in
relationship to the visual axis, the face and skull, and results in a skull conforming,
frame-temple fitting that precisely matches the topography of the Patient's skull.

Again, a properly executed hands-on, in-place, on-the-face, visual-tactile assessment, and handcrafted frame fitting procedure requires not only appropriate communications between the Dispenser and the Patient, but some direct physical contact must occur as well. A hands-on 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. The Dispenser cannot rush the procedure. Much time is actually saved in the long run when the fitting is done with sensitivity and patience whereby Patient return visits are minimized.

HEALING ARTS are those skillful health care practices, which contribute to the health and wellness of those to whom they are applied. See also Ophthalmic Health and Wellness.

HEALTH CARE PRACTITIONER is herein defined as one who contributes to making a person whole, a HEALER.

NOTE: Not all doctors are healers. Not all healers are doctors.

GCD, or Geometric Center Distance, also known as the DBC, Distance Between Centers, and sometimes referred to as the FPD or Frame Pupillary Distance, is the distance from the geometric center of one eyewire to the geometric center of the other.

NOTE: Theoretically, the GCD may be calculated by adding the "A" measurement to the DBL. In practice, however, there are often differences in the actual measurements and those marked on the frame. An experienced Optician is capable of taking accurate measurements, and this skill plays an especially important roll as it relates to frame dimensions.

LENSMETER, Lensometer or Vertometer, is the instrument used to read the dioptric power of an ophthalmic lens and to locate the optical center of the lens. See also Using a Lensmeter.

LTB, or Length To Bend, is the distance from the center of the temple screw barrel to the middle of the temple bend.

NV is an abbreviation for "Near Vision."

OC is an abbreviation for "Optical Center." When looking through a lens at a distant point, the point image will not move when the lens is rotated slightly about the vertical or horizontal axis through this point. This is called the Optical Center. See LENSMETER above.

OD stands for Oculus Dexter, which is Latin for "right eye."

OPHTHALMIC means anything that pertains to the eye or is situated near the eye.

OPHTHALMIC DISPENSER is any health care practitioner who specializes in the design of prescription eyewear, i.e., lenses, frames and contact lenses, which includes the duplicating, measuring, inspecting, and verifying of lenses, and any subsequent Alignment and other Adjustments, including the Final Fitting of the form-fitting eyewear. See also DISPENSING OPTICIAN, Licensed Dispensing Optician, LDO.

OPHTHALMIC DISPENSING is herein defined as those frame adjustments performed by a qualified 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 lenses, and d) any subsequent Gross Frame Alignment and Subtle form-fitting Frame Adjustments, including the Final Fitting.

OPHTHALMIC HEALTH AND WELLNESS is herein defined as that state of well-being wherein a Patient's visual health and comfort is supported, and the long term wearability of their eyewear is provided and maintained.

OPHTHALMIC PATIENT is herein defined as one who needs or receives health related services having to do with their vision and-or eyewear.

OPHTHALMOLOGIST, MD or DO, is a State Licensed-Board Certified Health Care Practitioner who specializes in the diagnostic, surgical, and other medical treatments as well as the refraction of the eye in order to determine any refractive visual error and the means by which the error can be corrected. The steps taken by Ophthalmologists to treat a patient`s eye are the following:

1) Take a good history and listen to the patient and don`t miss or dismiss any complaint.
2) Ask about systemic diseases that may affect the eye as diabetes and hypertension and about drugs the patient regularly takes.
3) Ask if the condition is recurrent or this was the first time and if recurrent, what previous medications were taken.
4) After a good history you are supposed to have reached the diagnosis or a differential diagnosis that is to be confirmed with examination.
5) Do full ophthalmological examination including fundus and IOP (Intra Ocular Pressure) measurement.
6) If needed supplement the examination with one or two investigations specific to confirm the diagnosis or give clues for treatment or prognosis.
7) Explain for the patient his or her case fully including prognosis.
8) Explain the treatment given and how to apply it and its importance and the consequences of discontinuing the treatment without doctor`s order.
9) Give the patient dates for follow up and explain the danger of not coming in for the specified appointment times.
10) Let there be a way for the him or her to communicate with you if any problems or complaints occurred before the next follow up visit.
11) Finally and most important be kind to the patient and give him or her adequate time during the examination and if their case is out of your capabilities to treat or of another subspecialty, refer them to whomever can give them better service.

OPTICIAN, or LICENSED DISPENSING OPTICIAN (LDO or RDO): Opticians can be likened to Registered Pharmacists (Optical Pharmacists?) who dispense medications based on the prescribed orders of a physician. Opticians are Eye Care Professionals, ECPs, herein defined as a Board Certified and-or State Licensed Health Care Practitioners who specialize in the design and fabrication of prescription eyewear, i.e., lenses, frames and contact lenses, which includes the duplicating, measuring, inspecting, and verifying of prescription lenses, and any subsequent form-fitting frame Alignment or other Adjustments, which includes the Final Fitting, whereby the Patient's long term visual comfort and eyewearability is the primary objective. Also see DISPENSING OPTICIAN, LDO.

OPTOMETRIC PHYSICIAN, OPTOMETRIST, OD, is a State Licensed-Board Certified health care practitioner who specializes in the refraction of the eye in order to determine any refractive visual error and the means by which the error can be corrected. The refraction, i.e., the glasses determining Rx component of an eye examination, represents only about 20% of a comprehensive exam. The refraction ("Which is better, one or two?") portion of the exam contributes only this percentile to the overall determination of the prescription. The remainder of the comprehensive eye health evaluation requires additional evaluation, such as:

a) an external and internal examination and analysis of the structures of both eyes;
b) assessment of the oculomotor, i.e., eye pointing and coordination of the binocular system;
c) depth perception and use of the eyes in all positions of gaze, up, down, left, right;
d) reading tracking from left to right, ability to shift efficiently from near to far and back again;
e) ability to sustain easy focus

Refractionists, i.e., Optometric Physicians (Optometrists, ODs) and Ophthalmologists (MDs) are held accountable by individual state licensing laws and tort-malpractice attorneys to provide these services, or they can be subject to prosecution for sub-standard care or neglect.

OS stands for Oculus Sinister, which is Latin for "left eye."

OU stands for Oculus Uterque, which is Latin for "both eyes."

OVERALL TEMPLE LENGTH is the distance from the center of the temple screw barrel to the end of the temple tip.

PD is the abbreviation for Pupillary Distance, the distance between the Patient's pupils in terms of millimeters (mm). This measurement helps ensure that the OC is properly centered in the frame relative to the pupil.

POINTS TO PONDER

No two heads or faces have the same dimensions, so the
delivery of eyewear as if it's one-size-fits-all is NOT an option.

When adjusting glasses, you are fitting a human being
for comfort, not an inanimate table for square or for pretty.
You must touch and feel the glasses in-place on the Patient
and then take the time to adjust and align the eyewear to fit.

Patients deserve form-fitted prescription eyewear.

Can you spot any facial asymmetry in these photos?

How will anomalies affect the design of patient's lenses?
Does any facial asymmetry translate into ear-skull anomalies?
Can anomalies be overcome in terms of lens design and/or frame adjustments?

Although the Full Discovery Lifestyle Interview and Form-Fitting Frame 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, form-fitting 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 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.

The most perfect prescription can be compromised if the eyewear
does not provide the Patient with comfortable, long term wearability.

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 wraparounds 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. See GlassesOnlineWarning.com. See OpticalViews.com. See MySixSense.com.

PLANO is a term used to describe a lens with no corrective power.

PRISM is an element added to the prescription if the Patient's eyes need help working more effectively together, and-or to remain in proper alignment.

RX is an abbreviation of the word, Prescription, and refers to the document, which expresses the lens powers and other pertinent details, and is signed by the attending Refractionist, i.e., Optometrist, OD, or Ophthalmologist, MD.

SEG HEIGHT is an abbreviation for Segment Height, the vertical placement of the Reading Segment in terms of millimeters, sometimes called the Add, the Addition, or the Reading Addition.

SPH is the abbreviation for "Sphere" and corresponds to numbers that indicate the degree to which the Patient is near-sighted or far-sighted.

SPRING HINGE is a type of hinge on eyeglass frames that flexes, making the frames more durable. Spring hinges also help keep the eyewear in proper alignment and help reduce the need for some adjustments.

TEMPLES can be generally defined as the hinged extensions on each side of the frame front, which when the frame is worn, extend along each side of the head, and in most styles, bend down behind the ears. Temples are made to be reshaped to follow the contours of the skull (see example) and avoid direct contact with ears, while resting evenly against the skull with minimum pressure, whereby they act to hold the eyewear comfortably in place. See variations on styles of temples below.

TEMPLE-END is that part of the temple that extends down behind the ear and makes direct contact with the mastoid portion of the skull. The temple-end is designed to be form-fitted to follow the topography of the skull whereby it acts to stabilize and hold the eyewear in place for long term comfort and wearability. The temple-ends, with all gaps and space removed, and making full, touching-without-pressing, form-fitting contact with the skull, NOT THE EARS, are the primary means of holding the eyewear in place.

TRANSPOSING a prescription is required when the Rx is written in plus cylinder form because of the equipment used by the doctor. Most optical labs process the Rx in minus form, meaning if a Rx is written in plus cylinder form it must be transposed to minus cylinder form before processing.

Can you transpose this Rx?

See Answer. 

See Consumer Guide To Optical Terms.

THE OPHTHALMIC FRAME

  

THE FRAME is that portion of a pair of spectacles designed to hold the lenses in the proper position before the eyes. Although ophthalmic frames come in a variety of styles, sizes,* shapes, and colors, they usually have basic parts in common. As illustrated above, the principal parts of a frame include the front and the temples.

THE FRONT consists of two eyewires which surround and hold the lenses in place, a bridge which connects the two eyewires, and a pair of frame-front endpieces to which the temples, i.e., earpieces, are connected.

THE TEMPLES consist of two hinged extensions of the front, which extend along the temples, and in most cases along the mastoid complex of the skull behind the ears. These can be divided into five basic categories:

Skull Temples, which are the most commonly used on prescription spectacles, bend down behind the ears and follow the contour of the skull, resting evenly against it;

Library Temples, which are generally straight and do not bend down behind the ears, hold the spectacles on the Patient, primarily by light pressure against the side of the head;

Convertible Temples, which can be used either as library or skull temples depending on the manner in which they are bent;

Riding Bow Temples, which curve around the ear and extend to the level of the ear lobe. They are often used mostly on children’s, athletic, and industrial safety frames;

Comfort Cable Temples, which are similar to the riding bow but are constructed from a coiled, metal, flexible cable.

*SPECIAL NOTE: Some of these styles may not be readily available due to the demise of multiple front, bridge, and temple sizes, which provided the Patient with made-to-fit options. See Part I, the previously mentioned, "Some Contributing Factors." It is especially appropriate to stress here that the Dispenser must fully disclose any adverse or ill-fitting qualities of any frame selected by the Patient, e.g., eye size too narrow, temples too short or too long, bridge too narrow or too wide, etc. Full disclosure during the frame selection process can work to minimize or even prevent the possibility of an unhappy Patient and the loss of the Patient's good will and future referrals, or even a remake, or worse, a refund.

Unfortunately, there are lots of people who are wearing ill-fitting, uncomplimentary and uncomfortable frames with either too long or too short temples, poorly fitting bridges, or too large or too small eye sizes. It is incumbent on the Dispenser to guide the Patient throughout the entire lens and frame selection process and to give expert counsel when appropriate.

Sometimes a plastic bridge, for instance, can be heated and manipulated, or the temples can be lengthened by slightly extending the temple cover to get more length. Or they can be shortened by removing the temple cover, cutting off the appropriate excess, and replacing the temple cover. These make-do efforts can mostly be avoided however, if the Dispenser anticipates the potential for any frame fitting deficiencies, and at least recommends more appropriate alternatives for the Patient to consider at the time of their frame selection.

FRAME MEASUREMENTS

Frames may be measured using the Datum System, or the Box system.

Datum System of Measurement

Box System of Measurement
(Note: N=Nasal)

When measuring an eye size using the datum system, an imaginary line is drawn through the middle of the eyewear both in the horizontal and vertical planes. The length of the lines correspond to the horizontal and vertical measurements of the eyewire. Given a shape such as illustrated above, it is easy to see how inconsistencies in measurement can result using this system.

The box system is more accurate and more widely used in the optical industry. In this system an imaginary box is drawn around the area to be measured. The distance between opposite, parallel sides of the box determine the length of the distance being measured. This system yields more accurate measurements even with unusual shapes.

Horizontal Lens Decentration

Example A

In the first example the OC, Optical Center, of the lens is in the same position as the geometric center of each eyewire. No decentration is necessary.

Example B

In this case the GCD is 4 mm wider than the PD, the lenses must be decentered 2 mm in on each eye. This will position the MRPs to properly correspond with the PD, Pupillary Distance.

The amount of decentration required in each eye is equal to the GCD - PD or 2 mm in.

In most cases the Pupillary Distance of the Patient will be narrower than the distance between the geometric centers of the selected frame. Less commonly, the PD will be equal to the frame’s geometric centers, and in rare cases the width of the PD will be greater than the GCD. In any case, to avoid unwanted prism, it is essential that the Major Reference Points (MRPs) of the lens correspond to the Pupillary Distance. In the first example above, the PD and GCD are equal to 64 mm and therefore no decentration is necessary. In the second example, the GCD is 4 mm wider than the PD. By applying the formula above, it can be seen that the amount of decentration required in each lens is 2 mm.

Minimum Blank Size and Vertical Decentration

The formula for determining the smallest possible lens blank, which will work for any given frame and PD combination, is as follows:

Minimum Blank Size (MBS) = (GCD - PD) + ED

In the examples below the ED is the same as the "A" measurement since the frame illustrated is round. Therefore, the theoretically smallest lens size that can be used in Example 1 is 44 mm. The theoretically smallest lens, which can be used in Example 2, is equal to 48 mm.

Example 1:
MBS = (64 - 64) + 44 = 44

Example 1

Example 2:
MBS = (64 - 60) + 44 = 48

Example 2

These Minimum Blank Sizes are considered to be theoretical for two reasons:

Two to three millimeters should always be added to the MBS to allow for imperfections such as chips or bubbles, which may exist along the periphery of an uncut lens.

Lens sizes are available from the manufacturers only in certain predetermined sizes, the diameters of which usually range from 60 mm to 80 mm, in 5 to 6 mm increments.

It is necessary to calculate vertical decentration when determining where the line of a bifocal segment is positioned relative to the datum line of the frame. This may be expressed in the following formula.

Vertical Decentration = Segment Height (1/2 "B" measurement minus desired vertical segment position in mm's)

In this example, since the "B" measurement = 50 mm the datum line is 25 mm from the bottom most portion of the lens. The desired vertical seg position is 22 mm. Subtracting the desired seg height from half the "B" measurement results in : 25 - 22 = 3. Therefore the segment line is decentered 3 mm below the datum line. This would be commonly referred to as seg = “3 below.” If the desired seg height were at 28 mm, the result will be + 3 mm, positioning the seg line 3 mm above the datum line, or “3 above.”

Frame Selection

When presented with a prescription of higher powers, the
Optician must draw upon many of his-her skills to achieve a
satisfactory fit and a satisfied Patient. Proper frame selection is
of utmost importance. The frame size must be kept to a minimum,
and the fit and style of the bridge takes on added importance due to
additional lens weight-thickness. The eyes should be well centered
in order to minimize decentration. If the lens power exceeds ±7.00
diopters, vertex distance must be considered as an important factor.

FRAME MATERIALS GUIDE

PLASTIC

Cellulose Acetate - Zyl
The most popular material for plastic frames. Nonflammable, durable, color fast, and available in large quantities. For the colors of the rainbow, zyl (Zylonite, or Cellulose Acetate) is the material. Zyl is a very cost-effective and creative option for eyewear and is extremely lightweight. Particularly popular in some areas are laminated zyl frames that have layered colors.

Multi-Colored Zyl Frame

Plastic frames do have some drawbacks. They are easier to break than metal frames, they will burn, but are not easily ignited, and aging and exposure to sunlight slightly decrease their strength but do not affect color.

Plastic Zyl Frame

Optyl
Relatively new epoxy material. Light in weight, cannot be overheated or burned, will not shrink. Optyl's “memory” will cause it to revert to original shape when heated.

Cellulose Propionate
Durable material. Molded rather than cut from a flat sheet like acetate.

Metal

Gold
Made of gold in combination with other materials such as nickel, copper, beryllium, and chrome. Frames may be gold filled, or gold plated. Some solid gold frames are available, but aside from the high cost, the softness of the material makes them difficult to work with and keep in adjustment.

Some companies make gold eyewear, typically gold plating rather than solid gold. Like silver, gold can also be used for accenting plastic or metal frames.

Metal Frame

Silver
Silver itself is not used in the manufacturing of frames due to its softness. Instead, white gold is used.

Solid silver or sterling silver is not commonly used as the primary frame material because it doesn't make very wearable or comfortable frames. Silver is sometimes used as a trace element in metal alloy frames, and is often used as a jewelry-like accent on plastic frames.

Stainless Steel
Non-corrosive, strong, and light weight. Qualities of stainless steel frames include light weight, low toxicity and strength; many stainless steel frames are also nickel-free and thus hypoallergenic. Stainless steel is readily available and reasonably priced. It's an alloy of steel and chromium; it may also contain another element. Most stainless steels contain anywhere from 10 to 30 % chromium, which imparts an excellent resistance to corrosion, abrasion and heat.

Aluminum
Light in weight, long lasting, may be anodized allowing for many variations in color. Frames made from aluminum are highly corrosion-resistant. Aluminum is used primarily by high-end eyewear designers, because of the unique look it creates. Aluminum is not only the world's most abundant, but also the most widely used, nonferrous material. Pure aluminum is actually soft and weak, but commercial aluminum with small amounts of silicon and iron is hard and strong.

Beryllium
A steel-gray metal, is experiencing increased popularity as a lower-cost alternative to titanium eyewear. It resists corrosion and tarnish, making it an excellent choice for wearers who have high skin acidity or spend a good amount of time in or around salt water. It's also lightweight, very strong, very flexible (making it easy for an optician to adjust the spectacles) and available in a wide range of colors.

Titanium
Relatively new material. Light weight, durable, and available in a variety of colors and styles. Frame manufacturers are coming out with more and more titanium styles these days; titanium is a silver-gray metal that's lightweight, durable, strong and corrosion-resistant. It has been used for everything from the Gemini and Apollo space capsules to medical implants such as heart valves. Titanium eyewear can be produced in a variety of colors for a clean, modern look with a hint of color.

Titanium Frame

Not all titanium frames are 100 % titanium. Some are made from an alloy that is a combination of titanium and other metals, such as nickel or copper. In general, titanium alloy frames cost less than 100 % titanium frames.

Relatively new to the eyewear market, Ticral is an alloy of titanium, copper and chrome. It is nickel-free and thus hypoallergenic. It's also extremely lightweight and offers many of the features of titanium without the high cost. It can be cut a bit thicker than titanium, which enables it to have the popular look of a thin plastic frame while still offering light weight. The material is also strong, durable and available in a variety of colors.

Flexon
A titanium-based alloy. This unique and popular material, which is proprietary to the eyewear manufacturer Marchon, is called a "memory metal" because it can go back to its original shape if damaged. Frames made of Flexon come back into shape even after twisting, bending and crushing. Flexon frames are lightweight, hypoallergenic and corrosion-resistant.

NYLON

Synthetic material made from coal, water, and air. Light weight and very strong. Often used in children's frames and industrial safety eyewear. Requires a good deal of heat for lens insertion and adjustments.

Eyewear made of nylon was first introduced in the late 1940s. Because of brittleness and other problems, frame manufacturers switched to blended nylon (polyamides, co-polyamides and gliamides). Today's blended nylon frames are both strong and lightweight.

Nylon is also a premier material for sports and performance frames - typically made of gliamides, which are very resistant to hot and cold and are more flexible, yet also stiff. Nylon is also easily molded into today's popular wraparound styles, as well as other shapes that are difficult to produce.

WOOD AND BONE

These frames are usually handmade, one-of-a-kind pieces that satisfy a specialty niche. Although stiffer and less adjustable than other frame materials, and much more expensive, wood and bone redeem themselves as frame materials because of their unique look and beauty.

Bamboo Wood Frame

LEATHER

Often used on temples or even across frame fronts, leather is not as durable or practical as other materials used for accenting, but it provides an interesting and fashionable look.

SEMI-PRECIOUS OR PRECIOUS STONES

These are sometimes used as accents in frames, especially in the temples. Popular choices are onyx and turquoise, but even diamonds can be used, for a luxurious touch. Such designs are usually worn in a formal office or on dressy occasions. Rhinestones are a less expensive alternative and are often used to create a flashy or retro look, especially in upturned cat eye frames.

FRAME STYLE GUIDE
See video here.

Ophthalmic frames may be divided into two broad categories of materials, plastic and metal. As indicated in the diagram above the basic frame styles used today include the full frame, combination frame, half eye, rimless, and semi-rimless.

Rimless

Semi-Rimless

The styles we commonly called rimless are actually semi-rimless designs since there is a bar connecting the endpieces of the frame-front to the bridge. The lenses of a semi-rimless frame may be mounted in several different ways. These include the screw mounting, where a screw is placed through a drilled hole in the lens then attached to the frame. One type of screw-mounted design is called a Numont mounting where each lens is held in place by only one screw.

Some lenses are tension mounted where clips attached to the eyewire fit into notches in the lens and are held it in place with tension. Tension mountings are sometimes referred to as Balgrip mountings.

RIMLESS SUNWEAR

Nylon mounted frames are the most popular semi-rimless design currently used. In this design, a nylon cord attached to the eyewire fits into a groove located around the periphery of the lens. A nylon mounted semi-rimless design is safe, durable, relatively easy to work with and fashionable.

NOTE: It is a common habit for Patients to remove their eyewear with one hand only. Patients should be advised to remove their eyewear with two hands in order to avoid undo pressure on the lenses, frame-front endpieces and temples. This is especially true with rimless and semi-rimless mountings.

FRAME SELECTION BY FACE

                  
     Oval           Oblong         Round     
                  
  Square      Triangular      Diamond

While most faces are a combination of shapes and angles, there are seven basic face shapes: Oval, Oblong, Round, Square, Triangular base-down, Triangular base-up, and Diamond. Here is a further description of these face shapes and which types of frames work for each. By considering these three main aspects and the seven face shapes that follow, the Dispenser can give Patients valuable guidance in the selection of their new eyewear.

The frame shape should contrast with the face shape. Rounder faces look best in frames with some angles. Angular faces look best in frames with some curves.

The frame size should be in scale with the face size. Frames should be selected in proportion to the face size, e.g., a petite woman with delicate features will want a smaller, lighter weight frame.

Eyewear should repeat the Patient's best features, e.g., a blue frame to match blue eyes.

Oval-Normal Face - Most shapes will be suitable. The oval face is considered to be the ideal shape because of its balanced proportions. To keep the oval's natural balance, look for ophthalmic frames that are as wide as (or wider than) the broadest part of the face, or walnut-shaped frames that are not too deep or too narrow.

Oblong-Long Face - Deep frame preferably with low temple attachment. Frames with a lot of depth, such as aviator frames, suit oblong faces. A low nose bridge will shorten the nose, too. The oblong face is longer than it is wide and has a long straight cheek line, and sometimes a longish nose. To make the face appear shorter and more balanced, try frames that have a top-to-bottom depth, decorative or contrasting temples that add width to the face or a low bridge to shorten the nose.

Round-Wide Face - Relatively narrow frame preferably with a high temple attachment. Round faces look good with angular narrow frames that lengthen the face. A round face has curvilinear lines with the width and length in the same proportions and no angles. To make the face appear thinner and longer, try angular narrow frames to lengthen the face, a clear bridge that widens the eyes and frames that are wider than they are deep, such as a rectangular shape.

Square-Wide Face - Same criteria as round face. Needs frame that softens the face angles, such as narrow ovals. A square face has a strong jaw line and a broad forehead, plus the width and length are in the same proportions. To make the square face look longer and soften the angles, try narrow frame styles, frames that have more width than depth, and narrow ovals.

Triangular-Inverted Base-Up (Heart) Face - Lighter looking frame is recommended such as metal or rimless or lighter colors in zyl. Faces in the shape of a base-up triangle need frames that are wider at the bottom, with very light colors. Rimless frames and semi-rimless frames are also good choices. This face has a very wide top third and small bottom third. To minimize the width of the top of the face, try frames that are wider at the bottom, very light colors and materials, and rimless frame styles, which have a light, airy effect since the lenses are simply held in place at the temples with screws.

Triangular-Erect Base-Down Face - Width of frame should approximately equal lower widest part of facial area. Darker colors work well. Faces in the shape of a base down triangle look great with eyeglasses, which have color accents, details on the top half of the frame, or cat eye shapes. The triangular base-down face has a narrow forehead that widens at the cheek and chin areas. To add width and emphasize the narrow upper third of the face, try frames that are heavily accented with color and detailing on the top half or cat-eye shapes.

Diamond Shaped Face - Looks well with frames that have detailing or distinctive brow lines. Diamond-shaped faces are narrow at the eye line and jaw line, and cheekbones are often high and dramatic. This is the rarest face shape. To highlight the eyes and bring out the cheekbones, try frames that have detailing or distinctive brow lines, or try rimless frames, or oval and cat-eye shapes.

FRAME COLOR GUIDE

There are three key elements in the choice of frame colors.

Everyone has either a cool (blue-base) coloring, or a warm (yellow-base) coloring.
Everyone looks best in his or her personal color base.
Eyewear color should complement personal coloring.

The best frame color depends on the look the Patient is interested in creating:

The "Look, ma! No glasses!" look -- try rimless or semi-rimless mountings in colors to blend with the skin tone, light frames for fair skin, darker frames for darker tones.

The "Please notice my eyes" look -- try rimless, semi-rimless or full front (fully rimmed) mountings-frames, and match the frame color fairly closely to the skin tone.

The "Hey, I'm wearing GLASSES!" look -- for this bold look, go for contrast, with dark frames for fair skin and bright or light frames for darker tones.

Try several colors in the shade range to find the best one. For example, if considering dark frames, try the same frame in dark blue, dark green, dark purple and black, or any other available dark color, to see if one of those is better than the others for their skin tone.

The main factors to determine the best color palette are the colors of the skin, eyes, and hair.

SKIN
Skin tone is the prime element in determining coloring. All complexions fall into one of two color bases - blue (cool), or yellow (warm).

A cool complexion has blue or pink undertones, and a warm complexion has a "peaches and cream" or yellow cast. Olive skin is considered cool because it is a mixture of blue and yellow. In the United States, cool, blue-based, complexions are more common than the yellow-based, warm, complexions. About 60 % of the population, are "cools."

EYES
Eye colors are usually a secondary element in determining coloring because of the wide range of eye colors.

Examples: Blue eyes can range from a cool, almost-violet, to a pale blue-gray, which is warm.

Brown eyes can vary from a light cider shade, warm, through a medium-brown to a cool, almost-black.

HAIR
Hair colors are also considered warm or cool.

Strawberry blond, platinum, blue-black, white, salt-and-pepper, and "dishwater" brown are cool.

Warm hair colors include golden blond, flat black, brown-gold, "carrot" and "dirty" gray.

Frame Colors

Once it has been determined the Patient has "warm" or "cool" coloring, find the frame colors that will suit them best.

Some examples of frame colors best for warm coloring are: camel, khaki, gold, copper, peach, orange, coral, off-white, fire-engine red, warm blue and blond tortoise.

For cool coloring, the best frame hues are black, rose-brown, blue-gray, plum, magenta, pink, jade, blue and demi-amber (darker tortoise).

Bridge Selection Guide

Selecting the proper bridge size and shape for any given Patient is a crucial part of frame selection both from a cosmetic, and purely practical perspective.

Since a “high” bridge such as a keyhole style, tends to accentuate nose length, it should be avoided with longer noses, and recommended with shorter, stubbier noses. The opposite holds true with “lower” bridge designs, such as a saddle bridge.

Patients with especially narrow bridges are generally successful with adjustable nose pads. Very often adjustable pads can be added to a zyl frame, which may increase the selection of wearable frames for the narrow-bridged Patient.

Saddle bridges and “comfort” bridges for metal frames are difficult to adjust, therefore care must be taken to insure the fit is suitable, right from the beginning, during the initial frame selection.

NOTE: Full, unbiased disclosure is important. During the frame selection process, the Patient should always be advised, by the Dispenser, of any critical fitting issues, i.e., too short or too long temples, too narrow bridge, too shallow eye size, if they should select a frame with these adverse fitting qualities. The Patient can then make a more informed selection. Full disclosure can help to avoid recurrent complaints and-or refunds.

Frame Selection and Prescription Considerations

High Minus Lenses
Smaller Eye Size
Heavier Frame Material
Rounder Shapes
Lightweight Lenses
Higher Index Lens Material
Antireflection Coating Lightweight Lenses
Edge Coating

High Plus Lenses
Smaller Eye Size
Sturdy Frame Construction
Rounder Shapes
Small Frame Difference
Adjustable Nose Pads
Lightweight Lenses
Higher Index Lens Material

When presented with a prescription of higher powers, the Optician must draw upon many of his-her skills to achieve a satisfactory fit and a satisfied Patient. Proper frame selection is of utmost importance. The frame size must be kept to a minimum, and the fit and style of the bridge takes on added importance due to additional lens weight-thickness. The eyes should be well centered in order to minimize decentration. Usually, when the lens power exceeds ±6.00 or ±7.00 diopters, depending on the Patient, vertex distance must be considered as an important factor.

Other considerations include higher index lens materials and special lens designs such as lenticular and myodisc which are designed to minimize thickness. The various lens coatings should be considered in an effort to enhance the functional as well as cosmetic value of the eyewear.

WEARABLE TECHNOLOGY

Do you see this technology in your future as an Optician? And are you
prepared to personalize similar high-tech eyewear? Send your thoughts here.

   
Google Glass...Start Here

"Hands on the patient dispensing is a soon-to-be lost art. If the trend to
the narrower and strictly retail approach to ophthalmic services continues,
a) The marketing of ready-to-wear, over-the-counter and Web-source eyewear
will continue to flourish; b) Hands on the patient dispensing skills and services
will disappear; c) Patients will continue to suffer from substandard quality of
service; and d) Prescription eyewear will continue to be delivered by an ever
increasing number of unskilled dispensers. The fact is that many of today's
eyewear dispensers require major improvements in their skills through training,
without which they will become increasingly irrelevant in the eyecare industry.
While Independent Optician's are focused mostly on doing everything to serve
the consumer, too many retailers are rigidly fixated on profit and reducing costs.
As a consumer, by whom would you rather be served?" See our Code of Ethics.
See more details at The Coming Humanization of The American Economy.

FINAL FITTING
The Conscious Delivery of Prescription Eyewear
No two human heads or faces have the same dimensions, so
the delivery of eyewear as if it's one-size-fits-all is not an option.

When adjusting glasses, you're fitting a human Patient
for comfort, not an inanimate table for square or for pretty.
You must touch and feel the glasses in-place on the Patient
and then take the time to adjust and align the eyewear to fit.

        

Consumers deserve handcrafted form-fitted prescription eyewear.

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-lens design and handcrafted fitting skills can be acquired only through direct, practical experience that must include a) Visual-Tactile, Hands-on Assessment, b) Gross Handcrafted Frame Alignment, i.e., correcting the most obvious frame and lens misalignments, and c) Subtle Frame-Temple Adjustments, i.e., handcrafted 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 complex 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 wearability. Full but light form-fitting 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. See OpticalWorkshops.com. See OpticalViews.com.

The most perfect prescription can be compromised if the eyewear
does not provide the Patient with comfortable, long term wearability.

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.

Opticians are Eyewear Professionals. Opticianry
is ultimately defined by how well the eyewear makes
contact with the Patient, not by the number of Customers served.
For the truly skilled Optician, the standard of care must include a
customized design and hands-on fitting of eyewear on each Patient.

THE FITTING TRIANGLE

THE DYNAMIC DUO
#1 Hands-on, In-Place, On The Face Assessment
#2 Handcrafted Touch and Feel Adjustments

A well-fit 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 slight and caressing pressure on the side of the head behind each ear. The temple ends should be crafted to follow the contours of the mastoid complex. See example. 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 long term, 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 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."

An experienced Optician 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
Handcrafting The Frame To Fit The Patient Is Essential

    

The Optician must touch and feel the eyewear
in-place, on the face in order for chronic discomfort issues to
be eliminated or at least minimized after proper adjustments.

After placing the frame (see OpticalGuidelines.com) on the Patient and making a hands-on, in-place, on the face, tactile and 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-skull 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. Again, if 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 no way to perceive the subtlest points of no-contact.

CUSTOMIZED FRAME FITTING
A Three Tiered Procedure

The complete frame fitting procedure, when it is fully applied, involves three distinct steps:

Basic Frame Alignment

Visual-Tactile Assessment of the frame's contact with the skull at all points of contact

Subtle Frame Adjustment

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, as in the case of a 'wavy' mastoid bone. 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.

THE NO TOUCH - NO HOLD PRINCIPLE

Temple-ends can never hold an eyeglass frame in
place comfortably if they do not touch the skull.

Note big gap between skull and temple-end.

"Where there's no touch, there can be no hold.
Temple-ends must fully contact the mastoid complex.
Temple-ends cannot hold eyewear in place for long-term
comfort if they do not make full contact with the mastoid.
Full contact does not mean pressure. Touch only is necessary."

Form-fitting the Mastoid Complex
With a Handcrafted Mastoid Dip and Wrap

Every Patient deserves sufficiently handcrafted,
multi-dimension, form-fitting frame adjustments, 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 wearability. 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.
Note: If you're able to teach this skill, contact me at LinkedIn.com.

    

BEFORE temple-end is in out-of-the-box condition,
i.e., it doesn't make contact with the Patient's skull,
whereas the AFTER temple has been form-fitted with
an added handcrafted mastoid dip and mastoid wrap.
It now fits the mastoid bone like a glove since it has been
shaped to make full, direct contact with this Patient's skull.
Custom-fitted by hand temples become invisible when worn
and the resultant fit avoids pressure and is extremely comfortable.
Note: This skill cannot be learned virtually, i.e., via lecture or online.
This skill is acquired only by handcrafting the eyewear using direct, face
to face, on the Patient, tactile, touch and feel contact with the Patient. The
availability, knowledge and skilled use of related handcrafting tools is essential.
Also, keep in mind that online merchants are incapable of providing this service.

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 handcrafted custom fitting utilizes the contact surfaces to their maximum. The removal of the space and gaps however, requires form-fitting 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 The Danger Independent Opticians Face. See OpticalViews.com and the real reason some folks buy their glasses online.

HANDCRAFTED CUSTOMIZED FRAME FITTING
Up Close and Personal

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 and feel form-fitting procedure requires sufficient time to execute properly, i.e., no procedures can be be rushed. Haste makes for waste. See more Handcrafted Fitting details here.

BASIC FRAME ALIGNMENT

Most people have at least a few subtle
facial-cranial anomalies to be reckoned with.
The Dispenser must get up, look and feel behind
the ears, then look down over the top of the Patient's
head in order to acquire the above view of the fitting triangle.
Use of the hands to manipulate the head, the frame, and to
feel the temple ends relative to the mastoid complex is a
must-do for any comprehensive frame fitting assessment.

Example A: Incorrect fit.
The temples touch the side of the head before reaching the ears. This is a common fitting error and can be very uncomfortable for the Patient. It creates a constant tendency for the frame to slip forward resulting in additional pressure on the nose and behind the ears as well.

Do this: Bring the temples out at the end piece and bend the temples in toward the skull and behind the ear line if necessary.

Example B: Incorrect fit.
There is excessive bowing of the temples causing extra pressure behind the ears. In this case the eyewear frame should have been adjusted from the end- pieces first to allow for a straighter temple alignment.

Do this: Bring the temples in at the end piece and remove the bowing if necessary.

Example C: Correct fit.
Note how the temples go straight back toward the ears and come in contact with the Patient only at the three points of the fitting triangle. Also note that the equal and parallel distance of planes of the lenses to the plane of the face can only be observed from above the Patient. The Dispenser cannot accomplish this while seated.

Again, the Dispenser is greatly handicapped in the form-fitting process by a) Merely looking frontally into the Patient's face from across the dispensing table, b) Not visually assessing the lay of the frame from multiple angles, even from above the Patient, and c) Not touching and feeling the eyewear, in-place, on-the-face, which includes the frame temples where they make contact with the skull, especially the mastoid complex behind the ears.

Basic Frame Alignment, being the most obvious, begins even before placement of the frame on the Patient with the squaring of the 'x' frame plane or axis (a twisted bridge indicates lenses are not in the same ('x' plane), as illustrated below; followed by visual assessment of the nosepiece-bridge while in-place, on-the-face; continues on to the squaring of the 'y' and 'z' planes; and ends with the reshaping of the temples to follow the curvature of the skull. Always work from the front-to-rear, the face-to-mastoid complex, behind the Patient's ears. Getting the 'x' plane right from the very beginning of any alignment procedure is the single most important adjustment. NOTE: If the 'x' plane is misaligned, all other alignments are adversely impacted.

CONVENTIONAL COORDINATES
For optical system analysis

     X-axis - the horizontal
Y-axis - the vertical
                                    Z-axis - the optical axis of the system

Frame Tilt

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.

Less 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 C.

For every millimeter the pupil is positioned above the optical center of the lens about two degrees of pantoscopic angle should be applied to the front.

Ideally, for good cosmetics, there should be approximately 8 - 10 degrees of pantoscopic angle for most frames. With some unusual shapes, it may be even be necessary to specify the vertical decentration of the distance optical center.

Positive face form should be used when the Patient's PD is narrower than the GCD of the frame. Since this is usually the case, most frames will have some positive face form.

In instances where the GCD and the PD are the same, no face form is best.

In 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.

The Patient should always be advised of any critical fitting issues, e.g., too short or too long temples, too narrow bridge, too shallow eye size, should they select a frame with poor fitting qualities, which does not accommodate their features, there being no alternate sizes available. The Patient can then make a more informed selection. Get the rap on wrap-arounds here. See advisory on frame selection here.

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

Left lens is higher - Bend left temple up, or right temple down.

Right lens is higher - Bend right temple up, or left temp down.

Left lens is lower - Bend left temple down, or right temple up.

Right lens is lower - Bend right temple down, or left temple up.

Left lens is farther in - Bend left frame-front-endpiece in.

Left lens is farther out - Bend left frame-front-endpiece out.

Right lens is farther in - Bend right frame-front-endpiece in.

Right lens is farther out - Bend right frame-front-endpiece out.

Increase pantoscopic angle - Bend both temples, or frame-front-endpieces down.

Decrease pantoscopic angle - Bend both temples, or frame-front-endpieces up.

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 frame-front-endpiece in to bring it farther out; if one lens is too far up, bend the temple or frame-front-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. See Optical Guidelines. See MySixSense.com.

Subtle and Personalized Frame Adjustment

Just as a dentist cannot practice dentistry without direct patient contact, the
optician cannot effectively dispense without tactile contact with the patient.
An unskilled eyewear merchant routinely hands over prescription glasses
with no hands-on assessment, nor the appropriate touch and feel required
to form-fit the eyewear. When a skilled optician dispenses however, they can
determine for themselves how the frame feels in addition to asking the patient.

The form-fitting 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 addressing facial-skull anomalies and any subsequent hand-crafted, form-fitting details along with sufficient time and patience to accomplish the tasks. These can be demonstrated only by hands-on-direct tactile instruction, and it can be learned only by practical, direct, non-virtual experience. Therefore, this aspect cannot be fully addressed within the confines of this Course. A workshop setting whereby a skilled instructor and the proper tools and materials are available to the attendees is required. Again, these techniques cannot be adequately taught-learned virtually.

For instance, form-fitting Subtle Frame Adjustments involve the conscious, and somewhat artistic hand crafting or contouring-sculpting of the temples to the Patients skull whereby any space or gaps between the mastoid complex and temples are removed. See photo. This is the most sophisticated aspect of hands-on form-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 lack of training in the subtleties involved. It is of great importance, however, in spite of its subtlety, for the Patient's maximum long-term comfort. --

Can you transpose this Rx?

Answer:
O.D. +1.00 - 1.00 x 180
O.S. +1.00 - 3.00 x 180

Determine the amount of horizontal decentration for the following:

1. "A" measurement = 54   DBL = 16   PD = 62

2. "A" measurement = 42   DBL = 14   PD = 50

3. "A" measurement = 50   DBL = 16   PD = 66

4. "A" measurement = 58   DBL = 22   PD = 64

Determine the "theoretical" minimum blank size for each of the following:

5. "A" measurement = 58   DBL = 18   PD = 68   ED = 60

6. "A" measurement = 52   DBL = 20   PD = 60   ED = 54

7. "A" measurement = 56   DBL = 16   PD = 64   ED = 59

8. "A" measurement = 48   DBL = 14   PD = 50   ED = 50

Calculate vertical decentration of the bifocal segment for the following:

9. "B" Measurement = 52   Seg height = 23

10. "B" Measurement = 48   Seg height = 24

11. "B" Measurement = 50   Seg height = 28

12. "B" Measurement = 46   Seg height = 19

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