What do you do?

[Jedi]

In the thread "problem new glasses", Chris brought up a situation that we all have dealt with, a previous dispenser makes an error on a measurement and now the client cannot wear a new pair with accurate measurements. I wanted to start a new thread to see how everyone tackles this issue. Do you match the previous pair and perpetuate the error, do you force them to adapt or do you meet them halfway and ease them back to the proper measurement. Personally, when it comes to segs I will match what has been worn (after a series of questions to assess that they are comfortable with that.), but I feel that PD's should be dead on. and monocular.

[Chris Ryser]

Personally, when it comes to segs I will match what has been worn (after a series of questions to assess that they are comfortable with that.), but I feel that PD's should be dead on. and monocular.

Jedi, that sounds very professional.......specially segs only give you maximum near vision when placed properly.

I still remember the times when out of 10 opticians maybe one had a pupillometer, and all the others measured with the little white ruler I used to send across Canada to my customers with Christmas card.

[For-Life]

Jedi, that sounds very professional.......specially segs only give you maximum near vision when placed properly.

I still remember the times when out of 10 opticians maybe one had a pupillometer, and all the others measured with the little white ruler I used to send across Canada to my customers with Christmas card.

Still can do that. Get a good layout chart and line up the frame.


Personally, I find that if you take the right monocular pd and split the pupil with monocular seg height they have no problems. Worst case scenario, drop the seg height to the bottom of the pupil.

[slaboff]

Personally i take all my own measurements and educate the patient as to what is going to be different... seems to work for me... btw i use a pupilometer as well wouldnt have it any other way

[rsandr]

I feel that PD's should be dead on. and monocular.

I agree, despite the fact that someone has got used to wearing incorrectly made glasses I see no reason why they shouldnt adapt to properly centred specs. If someone needs a size 10 shoe but has been wearing an 8, you wouldnt sell them a 9!
With segs however I think a lot is down to personal preference.

Rick

[Leo Hadley Jr]

Many years ago i took over a dispensary after the old owner and O.D. passed away. This particular small town optical shop had a solid customer base and at times did not take new patients!!! "circa 1989"

After working there a few days, I noticed that EVERY patient wearing FT's was measured 10MM Below the eyelid. I was baffled about how too deal with this. The few i measured correctly complained that they couldnt walk. I did not dare tell them that they have been wearing segs 10mm too low. Especially because they were measured by this Very highly regarded Doctor, and i was just an optician with only 3 years experience.

I decided to split the difference in the S.H.
I MEASURED THEM ALL 5MM too low. I figured in about 4 years i could get them all back too normal. This plan seemed too work very well as my patients were very happy with their new and improved reading.

As far as PD I would always make them right on, no matter what they are used too. Adapting too a correct PD is usually very easy.

[For-Life]

Well Flat Tops are important to leave where they are, because that is where the customer is used to it, but with a progressive moving it up and down can cause major problems.

I remember someone asking how to fit a round seg. I told them to fit them exactly where the customer is already wearing it.

[Rainstorm]

I will usually, after informing the patient of the issues I see, ask them what symptoms they may be noticing related to the error. Like for a PAL fit too high or low, are they noticing probs in the distance or do they really have to lift their chin to read small print.
Then based on the severity of their Rx (as far as how far off the PD and OC are) I will try to split the difference. I almost never fit a FT at textbook the first time I am trying to correct an issue.

[Ed_Optician]

If you have a large PD error and a strong RX I would most likely make a small change toward the true measurement and make notes of old PD and measured PD so that down the road someone else could pick up where I left off.
Progressive height I usually measure center pupil and lower it by 1mm almost no complaints about distance or reading difficulties
FT duplicate old height if close If way off split the difference...happier patients fewer redos

Ed

[Lewy]

Still can do that. Get a good layout chart and line up the frame.


Personally, I find that if you take the right monocular pd and split the pupil with monocular seg height they have no problems. Worst case scenario, drop the seg height to the bottom of the pupil.

Does this mean that you fit a FT through pupil centre? I can understand if it is a PAL but a seg I would place at the lower eyelid margin in 90% of cases.

I remember seing a lady many years ago from one of the big corporates, her mono pds were out by 7mm each eye horiz and 6mm vert! She was not happy with them, said she never wanted PALS again as they were awful. Once I had made her a correctly centred pair of specs on the understanding of a full adaption guarantee, she has worn PALS ever since to great delight. She then proceeded to send the whole family to us resulting in many £1,000's of business.

Lewy

[Chris Ryser]

Does this mean that you fit a FT through pupil centre? I can understand if it is a PAL but a seg I would place at the lower eyelid margin in 90% of cases.
Lewy

Actually there has always been a rule to fit the height of FT's at the lower eyelid. However a lot of people like the line higher, specially for desk work and then should be set at the lower edge of the pupil.

[rsandr]

I remember seing a lady many years ago from one of the big corporates, her mono pds were out by 7mm each eye horiz and 6mm vert! She was not happy with them, said she never wanted PALS again as they were awful. Once I had made her a correctly centred pair of specs on the understanding of a full adaption guarantee, she has worn PALS ever since to great delight. She then proceeded to send the whole family to us resulting in many £1,000's of business.

Lewy

Funniest thing I saw was a guy who had been wearing vari's (it was an oval shaped frame) glazed into the wrong eyes R<>L. His OC's were out as a result by about 4mm and obviously his corridors were back to front.
Startlingly he was happy with them! I wish all customers were like that!

Rick

[Lewy]

I was once called out by an Optician when I was a Varilux consultant working for Essilor. A lady couldn't get on with her VMD's at the time. 1. The lenses were Rodenstock and 2. One lens had been glazed upside down. I wasn't best pleased having driven for 2½hours to get to the practice.


Lewy

[slaboff]

I once had a guy come in with his ft28 splitting his pupil... he said the certified optician from walmart had told him that was where they were supposed to fit, wow... So i readjusted his frame to the lower lid to get him by till they could remake them.

when fitting bifocals I will match what they are wearing if the bifocal is lower than usual.... even if it is higher like chris said, but not splitting the pupil.

does anyone else do an oc with your bifocal height when placing the bifocal lower than usual?

[Alvaro Cordova]

I would make them an accurate pair of glasses and then have them tell me if they are having trouble adapting. Usually good visual acuity is accepted pretty easily. I don't have the power to guess which will reject what, and besides NJ law is very strict about this type of stuff.

[drballen]

Don't rule out the possibility that the patient actually requires prismatic correction before suggesting that the PD's are incorrect. He may have had some base in or out put in with decentration, and the doc who wrote the next script did not prescribe the prism(not all do a coprehensive binocular vision evaluation). Patients will also adapt to prism, particularly base in, and require more of it over time. Just a thought from reading the posts, of course this is obviously not the case if you are looking at PA's.
I agree with many on easing the changes in if needed.
Brent