Adjusting or customizing glasses for poor facial symmetry?

[j.west]

I can never get a good answer to the question of adjusting glasses properly to an assymetric face, and whether there are methods of adding compensation to the Px. What if one eye is significantly off-center from the other, the nose is quite crooked, etc...yeah of course things can be adjusted so the OC's line up, but if one eye is significantly higher than the other, it seems to me this will throw off the astigmatic axes and cause lens distortions to be skewed. For those with purely spherical Px's, I assume it wouldn't be an issue, other than changing the boundaries of the field of view.

Thoughts on this topic? References?

[Chris Ryser]

I can never get a good answer to the question of adjusting glasses properly to an assymetric face, and whether there are methods of adding compensation to the Px. ...............................

There is NO such thing as a perfect face. Therefore the frame has to be ajusted properly ro the face.

A frame coming from a manufacturer will have been set for a perfectly simmetric face. Once a customer chooses a frame and is blessed with a lot of assimetric facial properties the optician has the duty to make a pre-adjustment of the frame and only then take all the necessary measurements so that optical centres and reading parts will fit properly where they should be.

[ikon44]

if you are dealing with a patient with facial assymetry, you need to supply a
frame that can be adjusted within a wide range of parameters, therefore good
quality frame needed. if the patient has one eye set higher than the other i would use prism to ensure correct centration.

[j.west]

thanks for the responses, keep 'em coming. i just went back for a recheck and the optical is exasperated with me....because I asked them why they didn't even dot my OC's, despite my numerous complaints of discomfort. Granted, I'm single vision, but I still have a fairly high Px and this should cut down on distortions..my OC's are well towards the top of the frame. My right eye is in fact more vertical. I knew I wasn't seeing things...they kept insisting the frame was straight. I figured I just had a dominant eye that was making me crazy. I kept doubting my judgment.

Once upon a time I got glasses from a decent shop, I was fairly happy and kept them for years. Then insurance changed, and now my parents can only go to two independent chains, Fraser Optical and Advanced Vision Centers. LTD. It's been so long I forgot that once upon a time my OC's were always dotted. This current place I deal with got angry when I suggested it was standard practice to properly fit a frame....especially because I know I don't have the facial symmetry of a supermodel. Then the optician got really angry and changed the subject when I asked her if she was licensed. I'm guessing that was a "no." :) It saddens me that so many people are subject to either ignorance, greed, or lack of caring. I would say ignorance, since it took 3 visits just to get them to dot my OC's, despite my constant concerns. Stay away from Advanced Vision Centers in the Detroit area.... Neither Dr. Lichota nor the staff would or could address my concerns. I had to be aggressive, research the 'net for hours and hours, and tell them what to do. And I probably didn't cover everything, I'm just a motivated amateur who is tired of uncomfortable vision. Well, at least it motivated me to learn more. And to appreciate the value of top-notch service.

I got a smaller plastic frame this time, with spring hinges. I'm inclined to believe that spring hinges are unnecessary and actually detrimental to the stability of a proper fit. Of course they said no, "it's a good thing." (Great, just like Martha Stewart...we all know her reputation). Not to be smug, but have I outsmarted the "experts" yet again?

Re: prism...of course prism would level the field of view, but perhaps one's brain is used to it, and it's better to leave that alone. Binocular vision depends on seeing slightly different images, anyhow. I'm sure there are differing opinions on use of prism and there's no "right" answer. I'm more concerned with the axis of astigmatism. If the nose is not perpendicular to the plane of the eyes, then the axis is going to be off. How does one determine whether one eye is actually "higher" than the other, or if it just appears that way due to nose and other facial elements being skewed? Is it safe to assume that the phoropter will sit on the face in the same fashion that the glasses sit on the nose, so therefore the prescription will in fact translate precisely, even to a skewed face-form (within a reasonable tolerance)?

[chip anderson]

You are not required to follow your insurance (if you check you are probably paying a lot more on dental and optical benefits than you are allowed to collect anyway. Shell out a few bucks (about the same as two pair of tennis shoes) and buy your glasses from the competent shop. Often insurance plans are serviced by places that have such poor reputations that they need the traffic insurance will bring in.

It's not like you were having to pay our of pocket for a $10,000 surgery after all.
I hate it when people come in with glasses and contacts that: "My insurance made me buy them somewhere else and they don't fit, will you please straighten the problem out?" I never tell them this but my first urge is to tell them: "H*** No!."

[For-Life]

So in the US are all insurance plans like that where you can only go to certain places for coverage?

[chip anderson]

Most of them. Some require you to carry and dispense thier frames and use thier lab. Almost all restrict the amount glasses can cost. And ALL of them require you to have an in-house O.D. or M.D. Odd they used to disallow places that had an in-house precriber in a effort to promote ethical practice without a conflict of interest. Now we have a complete reversal. O.D. or M.D. must usually agree to preform exam at a reduced cost, which results in a minimum of attention to the patient. Sometimes resulting in test exclusions in order to make the time spent no more than commenserate with exam fee.

Compared to what it used to be, medicine in the U.S. sucks.

Chip

[For-Life]

that is just terrible. Most people here have a flat $150 to $250 that they can use on glasses.

[eromitlab]

I can totally understand your frustration, it's a shame that the profession has been cheapened like so many other things in this world (good food, stores, marriages and so-on), it's also a shame that you have had to go back so many times to your optician for problems that wouldn't ordinarily happen if the original "optician" had taken the proper steps to pre-fit you in the frame and properly take your measurements.

Chalk it up to whatever you want... because it would all apply (ignorance, greed or lack of caring), but this is a growing problem i've noticed with both the large mega-low-optical-mart chains down to some of the smaller groups in my area and I'm assuming it is the same elsewhere. Too many patients are not being properly educated or taken care of and the result it a bunch of people that are cheesed off and confused (because one place will tell you one thing and another will tell you something completely different).

Even with the company I work for in this territory, the training manual (which is quite informative, albeit out of date) is often ignored and thrown in a cupboard... associates are just thrown right out on the floor and left to asking us lab techs about how to do things (which ain't bad, but it's not our job to train people and some of our lab techs and lab managers are probably just as ignorant). My philosophy is that the associates shouldn't even be allowed to touch a frame or finished eyewear until they've passed the training manual tests, and can positively prove a practical knowledge of optical retailing (same goes for lab techs and optical manufacturing training)... and if they can't do that then they don't earn commissions (if offered) until they do pass, or go down the street to the Burger King and flip patties. This is a medical field we are in (more or less) and the people that work in it should be trained and treated like medical professionals, not like glorified cashiers or salespeople.

as far as medical care and insurance... I agree with Chip, it's all gone to the dogs in the US, and you don't have to stick to the insurance; even though it will probably cost you a lot more go back the shop that you had good luck with, you probably should... generally, you get what you pay for in this industry and to have a comfortable pair of eyewear I'd consider that money well spent.

[j.west]

I agree that money on vision is money well spent...if it's spent in the right place. That's why I have another thread asking for help in finding someone in Detroit. One place called All in Sight no longer exists. I've also had OK experience with the Visionary in Allen Park, but I never got glasses from them, only contacts, and although they are above the bottom of the barrel, I feel I can do better. Plus, I feel I would be treated unfairly because there is an ongoing feud between a staff member and my father. It came to a head and we never returned. I had already noticed I was not being treated as well. So far I've yet to be satisfied by any subsequent places. I'm able to pay now, but I will say poor insurance-specified shops are unfortunate for younger people who are dependent on their parents' insurance and really don't have another choice. I'm no longer covered by my parents' insurance, but I was able to take one of their promotional extra pairs for myself, that's why I gave this place a try. Now I'm trying to find the best, and my poor vision and comfort is ironically making my research very difficult. This situation just kind of snuck up on me from wearing soft, non-toric lenses and going through a long period of not doing much critical work. Now I really need a boost. My plan is to get rechecked and fitted for new contacts ASAP. I know that many members of this board are quite qualified and obviously caring and committed enough to spend their spare time in professional discussion, so hopefully someone will step up and show me how to get good references.


Anyhow, let's head back to the original topic. There are still a few unanswered questions.