Does this scenario seem familiar? Your patient smiles, relieved to hear that the change in his near vision is natural. But, as you introduce him to your optical staff, he’s still confused about the concept of progressive lenses.
He looks down at the presbyopia brochure he’s holding, and it all seems abstract. The conversation turns to lens options. The patient is unsure at first, but after a little while, your staff member steers the conversation, and soon the patient is talking about himself, his interests and the details of his day to day—not lens designs or vision zones.
This relaxed, reassured approach stresses the use and benefits of progressive lenses. Because of the habits and policies in place in your practice, patients find themselves being handled carefully and confidently.
Situations like this seem to flow easily in your office, but in fact, it has taken hard work to get to your present level.
Present a Solution
The success of your office is very tangible, and the emphasis placed on clear intentions in our story ensures a more enjoyable outcome for patients and staff. Progressive addition lenses (PALs) are versatile devices, capable of correcting vision at a variety of distances. While an excellent, all-purpose lens, PALs also come in a variety of designs and materials for more specific functions and tasks.
By choosing the appropriate options, eye care professionals have an opportunity to provide many things to presbyopes with PALs, including better vision for safer driving, reduced eyestrain from computer use and the elimination of harmful UV rays (and blinding glare) through a pair of polarized progressives.
PALs are general-purpose lenses, but their best use often stems from eye care professionals’ tailoring each pair of progressives to a particular presbyope’s needs by choosing lens design, material and lens treatments best suited to that patient.
But, before these benefits can be passed on to the patient, proper lens options need to be furnished. Settling on and recommending the best lens options and treatments is a process in itself. The staff member in our anecdote identified the needs and options for the patient, resulting in a happy presbyope. He received a prescription, his needs and habits were uncovered, solutions were determined to fit his habits, and recommendations were made. In communicating this process to the patient, the ECPs demonstrated their expertise in treating the presbyope as an individual patient.
Refine the Selection
By refining the selection process, ECPs achieve a high patient satisfaction rate, successful use of PAL designs, a reduction in remakes or lens changes, and less chairtime for rechecks. Each of these is an important factor in any economy. Every factor influences the ability to do your job, contributes toward staff morale, and impacts the bottom line.
Let’s review a few key areas of this process:
• How to make good choices.
• How to customize language for each patient.
• How to present selected options.
• Polycarbonate has unsurpassed impact resistance, an abbe value of 30 (the higher the abbe value, the lower the chromatic aberration), and an index of 1.59. Most progressive designs are available in polycarbonate, making it the material of choice for sport or safety applications. At 1.59, it is lighter and thinner than standard plastic, which has a 1.5 index.
Initially, polycarbonate was considered a high-index option. As higher-index material became available, polycarbonate’s best feature became its impact resistance. The mass production of the polycarbonate CD led to purer polycarbonate, and compatibility with hard surface treatments.
Make Good Choices
Material Selections
Each material has unique qualities. It is important to choose lens materials based on what’s best for the job, not “cafeteria-style” from a slew of choices. Evaluate available options, then make the recommendations. Be prepared with your reason why one choice is the best in a particular case. Present this option first, and make sure the patient understands why this is your preferred option.
• Material with a higher index of 1.67 is thinner than polycarbonate. It has a greater tensile strength and better resistance to chipping at drill holes than polycarbonate, making 1.67 an ideal choice for most drilled rimless frames. Its abbe value is 34. Lenses with an index of 1.67 are thinner than polycarbonate (1.59), but also have lower impact resistance.
For high-power prescriptions, lens materials are available in indices as high as 1.71 or 1.74.
• The impact resistance of Trivex (PPG Industries) is similar to that of polycarbonate, and it has an excellent abbe value of 43. Its refractive index puts it in the mid-index range, at 1.53.
• Standard plastic is still widely available in most PAL designs. Standard plastic (CR-39, PPG Industries) is the most inexpensive lens material. However, it is not as impact resistant as polycarbonate, and at an index of 1.49, not as thin and light as other materials. Its abbe value is 58. Standard plastic boasts low cost, ubiquitous availability and the greatest range of tintability of all materials.
Success with lens options can be measured by presbyopes’ satisfaction with their PALs. Another measure of results: Whether or not presbyopes’ needs were identified, and if they received options specific to them. This can mean the difference between a job simply done and a job well-done.
For example, a well-chosen option could be an office progressive for the worker who spends the majority of his time on the computer. It fits with this presbyope’s visual needs and habits. Such a positive outcome results from the ECP’s ability to determine the presbyope’s needs and recommend the best option for them.
Other well-chosen options for a PAL include short-corridor PALs for smaller frames, wrap PALs for sport sunglasses, polarized PALs, or even PALs in safety frames.
Don’t forget to make the best use of lens materials. ECPs who suggest the best materials for a given job enjoy a greater likelihood of having exceeded patient expectations when the patient picks up the eyeglasses.
Every lens design and material option has advantages and disadvantages. They combine with other factors, such as the patient’s prescription, in contributing to the final form and success of the eyeglasses. Take care to avoid short-corridor PALs for presbyopes who work at many distances. Instead, these patients need a full-corridor PAL. Short-corridor designs feature smaller visual zones and more unwanted astigmatism.
Also, lenses and frames must be compatible, so that no part of the progressive corridor becomes edged off to fit the frame. And, measure from the point lenses will be de-centered for the patient’s pupillary distance.
Presenting Lenses
When done well, dispensing can be very rewarding; yet, dispensers often face an uphill task of determining the patient’s needs, considering options and simplifying matters for clear communication with the patient
When you talk to presbyopic patients, find out what they do and how they spend their time. Keep in mind their best options. Sometimes you might be able to “check items off a list,” and other times, you’ll have to go with the flow and glean any information you can.
When explaining the mechanics of PAL use, speak about scenarios specific to each patient: reading the newspaper, using the computer, driving, walking around, etc. It’s important your presbyopic patients understand several particular areas where their vision will be improved, not somebody else’s. You’re talking about that patient’s particular situation, so pick a near, intermediate and distance vision example based on his or her life, and give the patient an idea of what to expect in each example.
In this sort of situation especially, communication is more than an exchange of information. Communication is a skill involving speaking to each patient based on his or her individual level of understanding. It is not one size fits all. Effective communicators are thorough, unafraid to speak simply or slowly, and able to get their point across—no matter the audience.
What’s Your Goal?
If your aim is to reduce the weight and thickness of a high prescription, offer your highest index, be it 1.71 or 1.74, rather than 1.67. If you want a drilled rimless to look great, and you know 1.67 is more appropriate than polycarbonate, tell the patient that. If the presbyope’s lenses are to receive a customized tint, use standard plastic, or else agree on a simplified tint. If your presbyope needs a pair of polarized progressives for horseback riding, recommend a poly/polar material, and explain why this lens choice is superior.
Present options clearly, keeping your knowledge and vocabulary in check. Now is not the time to show off your ophthalmic jargon. Don’t speak condescendingly to the patient; separate the language used among ECPs from language used with the patient.
The art of dispensing lies in the ability of the ECP to provide sophisticated or simple options to patients, based on their needs.
Take this example: By investing a little time in conversation, an ECP learned that an emerging presbyope works at the reception desk in a busy dentist’s office. The prescription is PL -0.50D O.U., with a 1.50D add. Rather than recommending an all-purpose PAL, the ECP informed the patient there is a PAL made for work at “this” distance (motion to the computer monitor) and “this” distance (motion to the desk). The ECP explained that these are office progressives, and not for driving home. The patient smiled, saying, “That’s all I need them for, anyway.”
Notice that the ECP did not use words like “intermediate vision” and “near vision” right away. It was important to have the patient’s understanding before the terminology was introduced. The same goes for the corridor of progressive power, and hard and soft designs, as well. The ECP didn’t mention the corridor of power until after describing use and benefits of the office progressive.
Lens Options
• Customized PALs. PALs have developed from designs with clear and blurry zones. Modern PALs offer softer, more refined designs. The first wave of improved PALs featured an improved reading area, and a narrow intermediate; this was followed by designs that opened up the intermediate, and softened the overall PAL design. Today, most progressives are of an aspheric, soft design, although a few retain a spherical distance area.
• Office progressives. Office PALs provide the wearer with a very wide intermediate and near zone only. This specialized—and under-utilized—PAL is great for a large number of presbyopes. Instead of a longer, narrow corridor of progressive power, the office PAL widens the view, and corrects for near and intermediate only.
The next time a presbyope tells you they spend “a little time scrap-booking,” or use a computer for “part of the day,” you may want to dig deeper and find out exactly how much time. Patients working at near and intermediate distance for more than a couple of hours a day may greatly benefit from a lens option like an office PAL, which is made to correct vision at these distances.
• Digital. Progressives are currently undergoing a revolution and moving beyond traditional techniques of manufacture. Digital progressive designs use a computerized, numerically-controlled machining diamond tool to cut power directly into the surface of the lens, eliminating the tool drift of the conventional method, and delivering improved power to the lens surface.
Until recently, the best possibility was to offer a PAL design that was corrected for plus and minus powers in order to minimize peripheral aberrations. Manufacturers produce several base curves of semi-finished lens blanks, and each base curve requires almost a dozen add powers. Many excellent PALs are still made this way.
But, new technology improves this scenario. Software creates a virtual PAL for a particular prescription, corrects areas of imperfect optics specific to that patient’s prescription and customizes the design of the digital PAL to that prescription and frame shape. Corneal mapping technology applied to the measurement of the surface of a progressive lens allows for a point by point mapping of the lens surface in some instances. (There is some uncertainty about the meaning of this new technology: “digital” refers to software for machining, the lens designs and the lens surface that was measured.)
Digital PALs may be referred to as direct surface, or wavefront PALs. Sometimes the language may refer to the mold surface from which the PALs are produced, a front or back surface of the actual lens, and sometimes both surfaces. It is important to determine which technology benefits each particular design. So, sit down with your sales representative, ask questions, and prioritize the digital designs available to you. By doing this, you can offer the most uncompromising digital design to answer the most complex patient prescription.
Dispensing skillfully means presenting options well and omitting industry-specific language in conversations with patients. Proactive dispensing involves the consistent furnishing of options and always stresses lens benefits. The best dispensers skip a discussion of the various progressive lenses; instead, they speak confidently about what these lenses will do, and then they make the appropriate recommendations.
By using the right material the best way and by picking the design best suited to that particular presbyope, you can truly blend art and science on a human level, one presbyope at a time.
…But, what happened to our presbyope from earlier? He’s right where we left him, discussing his hobbies and lifestyle. Many things came up during the conversation—computer usage, walking his dog, commuting, riding his new motorcycle on weekends. You selected lenses for the frames he had his eye on, and on his way out, he thanked you and your staff for working with him.
Then, he laughed and confessed how he had been dreading the eye exam—now, he was looking forward to the new shades.
Mr. Coronis is an author, educator, and ABO-approved technical speaker. He can be reached at timothy@educationoptician.net.
