There's one adjustment issue I've always had and was looking for some advice on. It's when the patient complains that one side of his or her glasses sit too close to the face. It's not an uncommon issue and I always feel like I'm poking around in the dark trying to correct it. Does anyone have any tips or pointers on this? It's the one adjustment I've never gotten completely used to doing and it feels like a gap in my expertise.
In my experience, as long as the pantoscopic tilt of the eyewire is the same on both eyes (the first thing you need to check) it is because one temple is angled in more than the other.
The temple with the greater angle towards the side of the patients head will push the front of the frame out and away on that side, in turn torquing the opposite side in towards the face. Basically turn the temple in to create more space in the front, turn it out to let it rest further in. Often problematice with people who have had orbital/skull reconstructive surgery and have uneven temples placement on their heads because of the surgery.
Also make sure one ear isn't further forward than the other, or if the ears are even - that one temple arm isn't curved more sharply around the ear than the other one.
This is much easier to show than describe, if you have any questions with my descriptions please just tell me I am confusing.
Side closer = Temples are flared out on that side or too tight on opposite.
Educate your patient not to remove their eyeglasses with one hand, yanking them off the fellow ear. That yanking motion induces an outward temple splay which results in that side of frame coming closer to cheek. Demonstrate 2-handed removal technique to all patients.
Top view of the patient is essential when fitting properly. While the patient is sitting, stand up, ask the patient to tilt their head down slightly to gain a better view. What you are trying to achieve is equi-vertex. If the left lens is forward from the face, apply splay to the left temple to bring the left lens inward. If the right lens is forward, apply splay to the right temple to bring the right lens inward. Of coarse these adjustments should be made prior to measuring the patient for lenses.
As a side note, do yourself as well as your patients, a favor and purchase; Systems for Ophthalmic Dispensing by Brooks and Borish. It is the optical equivalent of Huckleberry Finn in American literature.
Last edited by Paul Smith LDO; 05-19-2015 at 01:54 PM.
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The problem is that correcting a severe example of this results in a table alignment that that same wearer says is wrong: "Why do my glasses look like that? They never looked like that before!"
B
Because we fit the glasses to your head, not the table. If you were a block head, we would fit them to the table.Originally Posted by Barry Santini
Nosepad alignment can cause this too.
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One other (very unlikely) cause is that the length to bend on one side is different from the other, allowing one side to slip a little, moving one lens further from the eye.
Yup, when aligned improperly, or when asymmetrically aligned to match an asymmetrical nose.
An asymmetric orbit structure may extend one eye forward or recessed relative to the fellow eye. I would not recommend correcting for this with the frame alignment, but there may be optical considerations that could influence lens power and design.
In general though, angle x should equal angle y, with the temple clearing the side of the skull, touching only when it reaches the top of the ear.
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Here's the best advice. Look over the top...
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