Frame Woes

[TheRobotious]

Hi everyone,

I'm hoping to get some advice on what I might do next for this patient. She is an very elderly woman who is currently wearing progressives. She has no problems with her vision (thankfully!) but her frames are causing all sorts of comfort issues. Her Rx is around the +7 mark in both eyes, so the glasses overall are very front-heavy (even with thinning). The frames themselves have a plastic frame front with metal temples (see pic). The two main issues are the frames slipping down her nose and the temple ends pressing the sides of her head too hard. I should say she is a very fragile patient, so even the smallest things can cause issues.

I have already attached some stick-on silicone "nosepads" on the inside of the bridge to help with the slipping issues, and this has been really successful. Unfortunately, the temples are still causing some issues. At this point I have adjusted the temple ends to the point where they are virtually not touching her head at all behind her ear. This leaves the only point of contact just at the top of the ear where it meets her head. Now she still complains of headaches after long periods of wear because the temples are "squeezing too hard". Trouble is, if I make the temples any wider to reduce the pressure, the frames slip down her nose. If I attempt to widen the temples and compensate by better contouring behind the ear, she complains of discomfort or pressure behind the ear.

Are there any adjustments you could recommend that might help this situation? I've tried a marginally softer silicone temple tip cover is place of the original temple tip covers but the problem still remains. Are there perhaps other temple tips that might suit this situation? She is very fond of the frame and it is one of the lightest frames in our shop, so neither of us are keen on changing frames. Any advice?

Thanks very much,
Daniel

P.S.
These are the frames we're dealing with.

[Dr. Bill Stacy]

In my opinion the temples should not touch the sides of her head anywhere in FRONT of the top of her ears. The temples should bend down fairly sharply from just behind the top of her ears to rest just behind the backs of her ears, and should have light and EVEN pressure from the bend to the tips against her head and against the backs of her ears. Any pressure in front of her ears at all will push the glasses forward, due to the anatomical fact that human heads are usually convergent from the ears forward, causing a wedging of the glasses forward. This usually requires an "opening up" of the temples first ( by endpiece adjustment) to get rid of the wedge contact, then proceeding with the temple cover area behind the ears, in that order.

[Paul Smith LDO]

With that much plus the lenses may be creating too much face form, which might explain her comfort issues. The more you try to circumnavigate or curve the temples, to avoid contact on the side of her head, the more you may be increasing the temple tips curve inward to the back of her head. I might suggest trying to flatten the frame a little and see if that takes some pressure off the side of her head. Then try to keep the temples as close the side of the head with as little contact as you can, contour the temple tips to the shape of the mastoid plate, this can aid with slippage as it creates tension but not directly behind the ear.

[TheRobotious]

In my opinion the temples should not touch the sides of her head anywhere in FRONT of the top of her ears. The temples should bend down fairly sharply from just behind the top of her ears to rest just behind the backs of her ears, and should have light and EVEN pressure from the bend to the tips against her head and against the backs of her ears. Any pressure in front of her ears at all will push the glasses forward, due to the anatomical fact that human heads are usually convergent from the ears forward, causing a wedging of the glasses forward. This usually requires an "opening up" of the temples first ( by endpiece adjustment) to get rid of the wedge contact, then proceeding with the temple cover area behind the ears, in that order.

Thanks Dr Stacy, I've taken as much care as possible to do just as you say. From memory, the temples are not touching the head at any point until the top of the ear.

With that much plus the lenses may be creating too much face form, which might explain her comfort issues. The more you try to circumnavigate or curve the temples, to avoid contact on the side of her head, the more you may be increasing the temple tips curve inward to the back of her head. I might suggest trying to flatten the frame a little and see if that takes some pressure off the side of her head. Then try to keep the temples as close the side of the head with as little contact as you can, contour the temple tips to the shape of the mastoid plate, this can aid with slippage as it creates tension but not directly behind the ear.

Great idea Paul, that might be just enough to alleviate the issues. Thanks!

[Dr. Bill Stacy]

With that much plus the lenses may be creating too much face form, which might explain her comfort issues. The more you try to circumnavigate or curve the temples, to avoid contact on the side of her head, the more you may be increasing the temple tips curve inward to the back of her head. I might suggest trying to flatten the frame a little and see if that takes some pressure off the side of her head. Then try to keep the temples as close the side of the head with as little contact as you can, contour the temple tips to the shape of the mastoid plate, this can aid with slippage as it creates tension but not directly behind the ear.

Agreed, assuming you mean by flattening the frame heating the bridge to take out some or all of any "wrap" the front has, and heating the endpieces to angle the temples outward if needed until they (still factory straight) barely touch the side of her head in front of the ears, then applying your magic behind the ears, where it belongs. I'm not much of a fan of putting a reverse curve in the temples to clear the head except in extreme cases. Of course for fat heads, you have to put a little "wrap" in the temples themselves to align with all that head.

[harry a saake]

Agreed, assuming you mean by flattening the frame heating the bridge to take out some or all of any "wrap" the front has, and heating the endpieces to angle the temples outward if needed until they (still factory straight) barely touch the side of her head in front of the ears, then applying your magic behind the ears, where it belongs. I'm not much of a fan of putting a reverse curve in the temples to clear the head except in extreme cases. Of course for fat heads, you have to put a little "wrap" in the temples themselves to align with all that head.

have you thought of doing all of the above and then putting cable temple on the ends, i believe hilco makes an adaptar kit to do just that

[Dr. Bill Stacy]

Thought about it, never did it. Cables are a bit of a pain to put on and off, and they have to be very good quality to hold their shape and be shapable.

I tend to concentrate on weight and balance in frame selection when I can.

[smallworld]

There are also silicone temple tip covers that slide over the temple tip that is very soft and provides a little more grip behind the ears.

[TheRobotious]

There are also silicone temple tip covers that slide over the temple tip that is very soft and provides a little more grip behind the ears.

I've ordered some of these to give them a go as well. Hopefully they aren't too bulky.

[Uncle Fester]

If the silicone tip covers don't work then you've just about tried it all imo.

I've had a couple of patients like this where I fit the temple right up into the hair so it doesn't even touch the top of the ear. I pulled the temple tip out as much as possible and then bent the tip to form a hard angle (picture a boomerang) so much of the tip is well up and behind her head and well above the ear. Had to then crank the temple at the hinge to take away the extreme pantoscopic tilt the fit creates. Obviously a fit of last resort.

I'd also suggest a new pair as different as possible just to give her something different to put on when the headache/pressure gets to be too much to bear.

Good luck.

[TheRobotious]

If the silicone tip covers don't work then you've just about tried it all imo.

I've had a couple of patients like this where I fit the temple right up into the hair so it doesn't even touch the top of the ear. I pulled the temple tip out as much as possible and then bent the tip to form a hard angle (picture a boomerang) so much of the tip is well up and behind her head and well above the ear. Had to then crank the temple at the hinge to take away the extreme pantoscopic tilt the fit creates. Obviously a fit of last resort.

I'd also suggest a new pair as different as possible just to give her something different to put on when the headache/pressure gets to be too much to bear.

Good luck.

Best avoid that fit if I can! Good advice on offering a second pair, I think she might appreciate that idea. Cheers!