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Thread: Digital Fitting in 2016

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    Digital Fitting in 2016

    My digitally compensated lens results have been fantastic and I have made believers of many many people who've walked through my door here. I still am doing them manually but I have a lot of people now asking about digital fitting systems.

    ABS Smart mirror, Optikam, Ifit, are these good? I know there is a thread like this every year it seems, but its a rainy afternoon and I'm taking CEs. Currently on one about the ABS smart mirror.

    Also will it help the less... experienced of my staff to take POW measurements confidently? What are the costs involved? Do you like them?

    Thanks and I really appreciate any and all feedback.
    Last edited by Tallboy; 07-28-2016 at 03:32 PM.

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    I'm eager to hear the responses as well. I have contacted Luzerne in regards to their iFDS. Seems like a solid deal with the rebates.

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    I take POW measurements for all of my patients irregardless of the lens design. I have done this many years prior to the digital or free-form lens designs or the digital measuring devices, personally I see no reason for such a device at this time. I understand the wow factor this technology is suppose to induce but I would encourage educational tools for employees so that they better comprehend the importance of such measurements for all patients along with promoting the office philosophy of optimizing all prescription lenses.
    I didn't attend the funeral, but I sent a nice letter saying I approved of it. Mark Twain

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    Thank you Paul that is how I feel as well. I don't think that any of these systems does better measurements than me with my tools. The results of the lenses speak for themselves. However I also don't want not use a tool at my disposal that may have benefit as well.

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    Where are the manual measuring devices sold? I couldn't find them at hilco or from shamir, who I thought made a kit.

    I certainly agree manual measurements can be just as effective.

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    Quote Originally Posted by pknsbeans View Post
    Where are the manual measuring devices sold? I couldn't find them at hilco or from shamir, who I thought made a kit.
    I got a few from Zeiss and a few from Unity VSP (These are the tilty things that are metal squares that take panto) I'm positive that you can get a plastic version from either Dynamic or Hilco. Call and ask them for a pantoscopic tilt measuring device. I use a small ruler for vertex or a distometer if you have one. As far as frame wrap I my favorite independent wholesale lab has a wrap measuring chart on the back of their centration chart. Or you can use a protractor and halve the angle found. There is some experience and estimation involved when frames flex on the patient's head and mastering this can lead to fantastic results.

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    Quote Originally Posted by pknsbeans View Post
    Where are the manual measuring devices sold? I couldn't find them at hilco or from shamir, who I thought made a kit.

    I certainly agree manual measurements can be just as effective.
    Haag-Streit makes a great distometer.
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    Confused POW measurements have very little effect on power of lens.

    I do 100% digital lenses and have for as long as they have been available, but the difference between the standard values used and the actual make almost no mathematical difference in the patient vision.

    The POW measurements are the least important of all the factors and I challenge you to call your lab and ask them what the power difference is when you use defaults vs your measurements.

    Barry is more on an expert than myself and wait to hear his input.

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    Up to what prescription do you speak?

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    Quote Originally Posted by pknsbeans View Post
    Up to what prescription do you speak?
    Anything over -5 or +4 might change slightly and is worth the energy, otherwise the math is the same and you are assuming the glasses stay in a perfect position or the measurements are off anyway. Fixed measurements only work on fixed objects and glasses or rx are not fixed so it is all a compromise anyway with not much measurable or perceived difference.

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    Quote Originally Posted by Craig View Post
    I do 100% digital lenses and have for as long as they have been available, but the difference between the standard values used and the actual make almost no mathematical difference in the patient vision.

    The POW measurements are the least important of all the factors and I challenge you to call your lab and ask them what the power difference is when you use defaults vs your measurements.

    Barry is more on an expert than myself and wait to hear his input.
    Craig I totally agree that for 90% of RX jobs the change in RX is is negligable from POW. I thought it was the variable asphericity of the sv designs and the location of the temporal blur/corridor length in PALs that changed from vertex and wrap. Who knows (not me) - I do know that I have made believers out of more than a few large nosed deep set eye progressive wearers who have always had trouble.

    I'm familiar with the default measurements because they are based on averages - more often than not my measurements are the same as a default 5 wrap, 9 panto, 13 vertex.

    Ian

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    Wrap and Vertex are guesses.

    Quote Originally Posted by Tallboy View Post
    Craig I totally agree that for 90% of RX jobs the change in RX is is negligable from POW. I thought it was the variable asphericity of the sv designs and the location of the temporal blur/corridor length in PALs that changed from vertex and wrap. Who knows (not me) - I do know that I have made believers out of more than a few large nosed deep set eye progressive wearers who have always had trouble.

    I'm familiar with the default measurements because they are based on averages - more often than not my measurements are the same as a default 5 wrap, 9 panto, 13 vertex.

    Ian
    I know nothing about the sv logic you mentioned; out of my area of knowledge.

    The problem with the vertex and wrap is you don't know what it is until the RX is done! You can measure to the plano but not to the back curve of the lens on a high plus that is much closer to the eye and the wrap angle is much different and not know until the glasses are already made.

    We are actually going to be able to account for this in our lens designs since we will have all the data but now it is a guess.

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    Prescribed astigmatism, even at low levels, is enough to deform the progressive optics, especially when the axes are oblique (see the illustration below).

    High refractive index lens materials have very steep best form base curves, resulting in increased sag depth, magnification or minification, and weight, not what we would want in a premium ophthalmic lens. For example, my sphere equivalent Rx is about -3.50 DS. Placed on a +2 BC 1.74 index lens results in more than half of a diopter of marginal astigmatism and off-axis power error. Best form would be on a +6 BC (no thanks). A +5.00 DS 1.74 index on a +8 BC results in .75 D marginal astigmatism. Best form would be on a +12 BC (double no thanks)! The only remedy, when using flatter bases curves, is to correct for the increased levels of marginal astigmatism and power error by using capable software on a free-form manufacturing platform.

    Position of wear optimization adds another of layer of optimization that results in additional aberration reduction, both on and off-axis. Inset optimization, by power and IPD, along with other refinements, tend to be additive, where any one optimization might not be significant to the wearer, but multiple areas of refinement are more likely to be noticed.

    Our job is to sort his out for the individual, matching the quality of the optics to the needs of the wearer.
    Attached Thumbnails Attached Thumbnails Optimized PAL Cyl plots.jpg  
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Quote Originally Posted by Craig View Post
    I do 100% digital lenses and have for as long as they have been available, but the difference between the standard values used and the actual make almost no mathematical difference in the patient vision.

    The POW measurements are the least important of all the factors and I challenge you to call your lab and ask them what the power difference is when you use defaults vs your measurements.

    Barry is more on an expert than myself and wait to hear his input.
    Craig,
    The idea of taking POW measurements are two fold; they can be applied to both Digital and Conventional Lens Designs. The execution is what matters most, I have always taken Center Pupil measurements, with the addition of the Panto measurement and utilizing Martins formula for tilt. Vertex is important in maintaining equi-distance from the eye to the ocular surface of the lens. None of these are new to you as I am sure that you are well aware of each one's usage but there are many new to the industry that have no idea as to POW measurements application and their importance to optimizing prescription lenses whether our patients are wearing a compensated FF lens or not, our customers deserve the best we can deliver.
    I know some may say that Martins formula applies to aspheric lenses, and that is what I sell.
    I see that Robert has added his two .02 and his conversion rate is equivalent to $50.00 to the .01. (Not kissing your a@# Robert but you deserve a bone with a few accolades)
    Last edited by Paul Smith LDO; 07-29-2016 at 04:02 PM.
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    why not just take pow measurements by hand, then take a 'digital' measurement with you 'super technical' ipad on camera mode? I bet you can even upload the photo to your EHR and have a record of what they picked out for the few who insist the frame isn't what they ordered? The patients get the wow factor, and you can say I told you so. Win-win, right?

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    The on line stores will soon have disposable paper cut outs. Maybe copy and use those.

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    Quote Originally Posted by Craig View Post
    I do 100% digital lenses and have for as long as they have been available, but the difference between the standard values used and the actual make almost no mathematical difference in the patient vision.
    Quote Originally Posted by Craig View Post
    Anything over -5 or +4 might change slightly and is worth the energy, otherwise the math is the same and you are assuming the glasses stay in a perfect position or the measurements are off anyway. Fixed measurements only work on fixed objects and glasses or rx are not fixed so it is all a compromise anyway with not much measurable or perceived difference.
    You are correct, very small difference.
    Take a -7.00 and apply the formula's to 6.0 degrees face form and 9 degrees pantoscopic tilt your compensated Rx in a 1.5 is:
    -6.68 -0.24 X 56
    Now change pantoscopic tilt to 12 and 8.0 degrees of face form:
    -6.44 -0.48 X 56
    Not a huge change and like you said, they will not be exactly in the position measured

    That is a -7.00, now try a -3.00
    P = 9.0
    FF = 6.0
    -2.86 -0.10 X 56

    P = 12.0
    FF = 8.0
    -2.76 -0.18 X 56


    Quote Originally Posted by Tallboy View Post
    Craig I totally agree that for 90% of RX jobs the change in RX is is negligable from POW. I thought it was the variable asphericity of the sv designs and the location of the temporal blur/corridor length in PALs that changed from vertex and wrap. Who knows (not me)
    Knowing the vertex distance in combination with the eye's center of rotation will give you a great starting point when designing an aspheric lens. This value will help you determine the amount of oblique astigmatism and with that correct it on the back surface. This, of course, is not all aspherics This value will also determine the length of the corridor in a variable corridor lens. A hyperope will have a shorter corridor and a myope will have a longer corridor.

    Quote Originally Posted by Paul Smith LDO View Post
    Craig,
    The idea of taking POW measurements are two fold; they can be applied to both Digital and Conventional Lens Designs.
    i am not following how PoW measurements can be applied to conventional lenses in regards to compensating the prescription.

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    Smart Mirror from ACEP FRANCE is the best. Ifit is also supplied by ACEP France. Optikam needs you to charge kit separately and measurements are not very consistent. Smatt Mirror from ACEP needs you to keep only the iPad charged.

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    Quote Originally Posted by lensgrinder View Post

    i am not following how PoW measurements can be applied to conventional lenses in regards to compensating the prescription.
    I did not refer to compensating the Rx in a conventional design but referred to optimizing. The POW measurements provide the dispenser with far more accurate information than a simple IPD. Optimizing OC placement, equi-vertex distance, proper FBC for matching or readjusting the frame front for a better lens fit (flattening front to accommodate a flatter lens design) just to name a few. All I'm saying is that with these measurements we can deliver an optimized;to make as effective, perfect, or useful as possible, prescription lens to our patients without compensated designs. Knowing what the measurements are and why we want the information is far more educational/productive than sitting someone in front of a device and know what key to hit. When we sell that customer a compensated lens we have a better understanding of the POW measurements and their intended use for these designs.
    I didn't attend the funeral, but I sent a nice letter saying I approved of it. Mark Twain

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    I've always been skeptical of POW in calculating compensation for a given Rx. Everyone knows that patients may wear their glasses in a different position at different times, the frame may be bent as they wear the glasses and they get abused. Etc... Right "out of the box" I have no doubt it works, but have there been any studies that show this compensation holds up over time as being a positive benefit to the consumer? Over the years I have seen people tilt and twist their frames in some unbelievable ways, and I don't see how in those situations compsensation for POW has any benefit whatsoever, and could even be slightly detrimental if the distortion of the POW is in the direction opposite to the original POW measurement.

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    Quote Originally Posted by Paul Smith LDO View Post
    All I'm saying is that with these measurements we can deliver an optimized;to make as effective, perfect, or useful as possible, prescription lens to our patients without compensated designs.
    Optimizing the prescription means (to me) that we have altered the prescription in some way to create a better end result. Maybe I am misunderstanding something.

    Why not use a compensated design, price, insurance, etc.?

    Quote Originally Posted by Lelarep View Post
    I've always been skeptical of POW in calculating compensation for a given Rx. Everyone knows that patients may wear their glasses in a different position at different times, the frame may be bent as they wear the glasses and they get abused. Etc... Right "out of the box" I have no doubt it works, but have there been any studies that show this compensation holds up over time as being a positive benefit to the consumer? Over the years I have seen people tilt and twist their frames in some unbelievable ways, and I don't see how in those situations compsensation for POW has any benefit whatsoever, and could even be slightly detrimental if the distortion of the POW is in the direction opposite to the original POW measurement.
    I have not seen any studies about whether they hold up over time.
    Although glasses are not in the same position soon after they leave if you use a lens that does not compensate for PoW then you are starting out with a prescription that is not what was intended. Granted in some prescriptions the compensation is small, but in regards to the overall design of the lens it helps to have the general position of the eyewear.

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    Quote Originally Posted by beejay View Post
    Smart Mirror from ACEP FRANCE is the best. Ifit is also supplied by ACEP France. Optikam needs you to charge kit separately and measurements are not very consistent. Smatt Mirror from ACEP needs you to keep only the iPad charged.
    Thanks for your input beejay, so you are a fan of the system?

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    Quote Originally Posted by Robert Martellaro View Post
    Prescribed astigmatism, even at low levels, is enough to deform the progressive optics, especially when the axes are oblique (see the illustration below).

    High refractive index lens materials have very steep best form base curves, resulting in increased sag depth, magnification or minification, and weight, not what we would want in a premium ophthalmic lens. For example, my sphere equivalent Rx is about -3.50 DS. Placed on a +2 BC 1.74 index lens results in more than half of a diopter of marginal astigmatism and off-axis power error. Best form would be on a +6 BC (no thanks). A +5.00 DS 1.74 index on a +8 BC results in .75 D marginal astigmatism. Best form would be on a +12 BC (double no thanks)! The only remedy, when using flatter bases curves, is to correct for the increased levels of marginal astigmatism and power error by using capable software on a free-form manufacturing platform.

    Position of wear optimization adds another of layer of optimization that results in additional aberration reduction, both on and off-axis. Inset optimization, by power and IPD, along with other refinements, tend to be additive, where any one optimization might not be significant to the wearer, but multiple areas of refinement are more likely to be noticed.

    Our job is to sort his out for the individual, matching the quality of the optics to the needs of the wearer.
    There's some POW wow in that post.
    Last edited by drk; 08-01-2016 at 01:12 PM.

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    Quote Originally Posted by lensgrinder View Post
    Knowing the vertex distance in combination with the eye's center of rotation will give you a great starting point when designing an aspheric lens. This value will help you determine the amount of oblique astigmatism and with that correct it on the back surface. This, of course, is not all aspherics
    I don't understand this, but accept it as truth. My concern: the eye's center of rotation has to be an unknown in just about every case. So, why bother?

    This value will also determine the length of the corridor in a variable corridor lens. A hyperope will have a shorter corridor and a myope will have a longer corridor.
    Oh no you dint! Robert.....!!!!!!

    i am not following how PoW measurements can be applied to conventional lenses in regards to compensating the prescription.
    We've been "wrap compensating" conventional lenses for years, now. Still do, for SV.
    Last edited by drk; 08-01-2016 at 01:13 PM.

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    Quote Originally Posted by Lelarep View Post
    I've always been skeptical of POW in calculating compensation for a given Rx. Everyone knows that patients may wear their glasses in a different position at different times, the frame may be bent as they wear the glasses and they get abused. Etc... Right "out of the box" I have no doubt it works, but have there been any studies that show this compensation holds up over time as being a positive benefit to the consumer? Over the years I have seen people tilt and twist their frames in some unbelievable ways, and I don't see how in those situations compsensation for POW has any benefit whatsoever, and could even be slightly detrimental if the distortion of the POW is in the direction opposite to the original POW measurement.
    I think this is generally right. The way I think it is best applied is to use the defaults and keep on adjusting the frame to "standard position".

    However, if you have a funky faceform frame (meaning wrapped) it makes all the difference in the world, but that really only seems to apply to wrap sunwear in the real world.

    In some rare cases of low ears and "unadjustable" temple angles, you may wish to have the lens powers modified for a relatively retroscopic tilt, I guess, but that almost never comes up.

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