THE HUMAN EYE

W HEN YOU look at a person's eye, one of the first things that
lay people think of is the color of the eye. That is only one
part. The eye consists of many parts. Notably, you will need to know
several terms:

ciliary muscles optical nerves

cornea Presbyopia
conjuctival pupil
emmertropia pupilary distance
hyperopia refractivel error
iris retina
lens sclera
limbus vitreous
myopia

Light enters the eye and is bent by the cornea. This is where most of
the correction takes place. If the cornea had no power (curve or

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ability to bend the light), the light would not be focused on the retina.
The cornea does, however, change the light so that it falls on the
retina, the cell layers at the back of the eye.

Refractive error is commonly used to describe what lenses a

person needs to see clearly in the distance. If a person requires no
correction, it is because the light falls properly in focus. Those
individuals are called emmetropic.

If the light falls short of the retina, the persons are called
myopic or nearsighted and if the light falls behind the retina
(theoretically), then the person is farsighted or hyperopic. The
farsighted person has the advantage over the myopic person, because
all humans can accommodate.

Accommodation is a contraction of the ciliary muscle. This

forces the lens of the eye to bulge forward, which in turn allows us to
focus clearly on objects that are near us. Thus a farsighted person
may spend a lot of energy by keeping things in focus by

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accommodation. As far- sighted people get older and begin to lose
their ability to accommodate, they may complain of not being able to
see clearly after a long day's work. Small amounts of concentrated
reading will increase their difficulty in accommodating.

Presbyopia is the age related loss of accommodation. This

process has already started at age one year, and generally becomes a
problem in the early forties. The ability to focus closely may be
completely gone by the age of sixty. The problem is simply that the
patient cannot focus closely enough and their arms are too short!
Supposedly, only 5 percent of the population does not lose their
ability to accommodate.

Around the cornea is the conjunctiva: cell layers filled with

blood vessels that swell with infections, with eye strain, and with
certain eye diseases. The sclera is a layer of white tough cells beneath
the conjunctiva.

The iris is, of course, the colored part of the eye. At the
meeting place of the iris and of the cornea/sclera is an elaborate filter
system that keeps the eye pressure in balance. If the filtration system
is not working properly or too much fluid is being produced,
glaucoma may develop.

The retina is the magic part of the eye. There are millions of
cells (rods and cones) which contain chemicals that translate light into
impulses which the brain can organize and make meaningful: "I see!"
The photoreceptors (rods for night vision and cones for day/color
vision) talk to other cells (about 6 layers worth of cells) and then
group themselves into cables called nerve fiber layers which plug into

3
the optic nerve. The optic nerve looks like a whitish/yellowish crater
with blood vessels. The optic nerve which is seen by the eye doctor
has distinct features and changes with increased pressure (e.g.
glaucoma) and also with unusual pressure from the fluid surrounding
the brain. The optic nerve leaves the retina and connects directly in
the lower part of the brain, where more electronic switching occurs,
and then follows highways of nerve fibers to the back of the brain
where the visual center (visual cortex) of the brain sits.

Papillary distance (pd) measures the distance between the

centers of the pupils. Distance pd is measured when the eyes are
focused at infinity, and near pd is measured when the eyes are
focused at something close (about 16 inches from the face). The near
pd is always smaller than the distance pd.

PLUS LENSES

F ARSIGHTED persons (hyperopic) need (+) plus lenses to correct

their refractive error. This is measured in sphere power.

Plus lenses have these characteristics:

4
1. They magnify: the patient's eyes will look bigger with the
lenses. When you hold the lenses above a piece of a
newspaper the print will be enlarged.
2. The center is thicker than the edge of the lens.
3. Optically, the plus lenses converge light.
4. They correct hyperopia and presbyopia, and are used for
patients who cannot focus closely (e.g. accommodatively
stuck children)

MINUS LENSES

N earsighted persons (myopic) need(-) minus lenses to correct

their refractive error. This is measured in sphere power.

Minus lenses have these characteristics:

1. They minify (make things smaller): patients' eyes will seem
smaller with these lenses. If held above a newspaper the print
will appear smaller.

5
2. The center will be thinner than the thick edges. The bigger the
lens size, the bigger the edge thickness. This can be
unattractive.
3. Optically minus lenses diverge the light.
4. They correct myopia.
Care must be given to patients who have "too much minus" If
a patient receives too much minus power in his or her prescription,
the patient will notice this unwanted power in terms of stress. The
stress will cause visual fatigue, especially when doing near tasks like
working on the VDT (visual display terminal of a computer) or long
periods of reading. The stress of "too much minus" is caused by the
lenses making the eye accommodate through the extra power.
Bifocals are often prescribed to relieve this near point stress, even on
young people!
A farsighted person receiving not enough plus power is the same as a
person receiving too much minus power.
Relaxation of the accommodative system can also be accomplished
by enforcing visual rest periods during an intense work session of
using vision at the near point work.
Myodisc Lenses are used for people with high minus (more than -
10.00) prescriptions. This high minus lens is placed in a "carrier"
which helps reduce the weight of the total lens. Without a carrier lens
the edge thickness would be very thick and weighty.

ASTIGMATIC LENSES

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Lenses that correct for astigmatism are shaped like a cylinder. This is
not a sphere power. A sphere power measures the same power in all
directions from the optic center. A cylinder lens (or toric lens) has
power in one direction only and is weaker in power at any other
direction.

This is sometimes difficult for people to conceptualize. One easy way

to define astigmatism is by the following illustration. If you are
looking at a fence with boards that are parallel and perpendicular to
the ground, with one kind of astigmatism the boards parallel to the
ground look in focus and the boards perpendicular look out of focus.

Another way to think of astigmatism is to imagine looking at a

point of light. With astigmatism, this point of light will look like a
line of light in a specific direction. In fact, astigmatism means
"without mark" and some optics books interpret this as "without
point" Here again, if you shine a point of light into an astigmatic
correcting lens (cylinder lens) a point will not form. The light will
become a line.

Cylinder lenses have a direction of power and a direction of axis.

In writing prescriptions, the axis direction is the important direction

7
to re- cord. The axis direction uses degrees much like the protractor
you used in fifth grade math. Most optical manufacturers and doctors
use minus cylinder lenses. Plus cylinders are used and may cause
patients trouble if they are switched to minus cylinders. They will
complain of a "distortion that is hard to describe" The cylinders and
sphere powers can be con- verted from minus to plus cylinders by a
method of Transposition. (See the transposition section.) Most
cylinder lenses are used together with a plus or a minus lens.

THE CYLINDER LENS

The axis direction goes from 0 to 180. The 0 mark is always on your
right side as you face the patient. The patient's right eye has the 0
mark next to patient's nose, and patient's left eye has the 0 mark next
to patient's left ear.

8
 ASTIGMATISM TYPES
There are two major and one minor types of astigmatism: “With the
Rule,” “Against the Rule” and “Oblique.”
With the Rule: This kind of astigmatism has the axis direction
near the 180 degree meridian.
Against the Rule: The axis is located near the 90 degree
meridian.
Oblique: The axis is located near the 45 or 135 degree meridians.
This is a minor and less frequent type of astigmatism yet the
consequences of not being corrected will lead to irritation. This kind
of astigmatism is generally noticed by patients and may be
responsible for disturbing the visual clarity.
Most often the anatomy of the eye is responsible for creating
astigmatism. The cornea is generally the culprit in causing the
astigmatism, but the lens and unknown retinal or neurological factors
may also contribute. Great amounts of astigmatism or rapid onset of
astigmatism may indicate eye disease. Contact lenses fitting of these
patients require a skill and an art to yield success.
THE PRESCRIPTION: LENS POWER

9
Just as the curve of the cornea gives the eye a certain power, tne back
and front curves of lenses gives each prescription lens a particular
power. The power is measured by the Diopter.

The Diopter is the reciprocal of the distance from the lens to the
point of focus from a light at infinity entering the lens. If you had a 1
Diopter (D.) magnifying glass (Plus lens), it would focus the sun's
light into small point at one meter from the piece of wood you are
1
about to set on hre. If you had a 2 D. magnifying glass, the distance
required would be 1/2 meter. The proper formula is

Diopter = 1
[Distance required to focus the light]

With minus lenses the description is more abstract. Minus

lenses cause the light to diverge AS IF the focus was from an
imaginary point in front of the viewer. For example, a myopic woman
can see sharply (20/20) when a card is 1/2 meter in front of her. She
wants to look at something in the neighbor's yard across the street.
She will need a lens to cause the far away image to be sharp at 1/2
meter from her eyes. This is a minus lens that causes the light from
far away to be in focus at about 1/2 meter from her face.
Diopter powers are measured in 1/4 units: 0.25, 0.50, 0.75, 1.00, etc.
Minus lenses use the [-] sign and plus lenses use the [+] sign.
Examples of sphere power (no astigmatism) are written as follows:

Myopic. Hyperopic
-0.50. +0.50
-1.00. +1.00
-2.75. +2.75

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 -11.00. +11.00

If a person has both myopia and astigmatism:

[-2.00-0.75 x 045] this equals [sphere - cylinder x axis]
The prescription for this person means: a -2.00 sphere lens plus an
astigmatisn lens of - 0.75 with an axis of 045 degrees will correct the
pa- tient's refractive error as best as possible.
Other examples:
-1.00 means low correction for a myopic patient with no
astigmatism
+2.75 means moderate correction for a hyperope with no
astigmatism
-5.75-0.75x 180 means high correction for a myopic patient and low
correction for astigmatism: With the Rule
+1.75-1.50 x 090 means moderate correction for hyperope with high
astigmatic correction: Against the Rule.
pl-1.50 x 065 means astigmatic correction only in the oblique
direction of 65 degrees. Note the use of "pl" which
stands for plano. And notice that 065 uses a "0" as a
place holder.

OTHER LENS NOTES

Plano lenses can be ordered in sunglasses or in regular glasses
such as for safety glasses or sports glasses.
The right eye power is always written first or above the lefa power.
Latin abbreviation is used for labeling each eve as well:
OD is the Right Eye. OD stands for Oculus Dexter.
OS is the Left Eye. OS stands for Oculus Sinister.
OU stands for both Eye. OU stands for Oculi Uniter.
For example:
Patient A. Patient B. Patient C
OD -2.50. OD +5.75-0.75 x 090 OU+2.50

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OS -2.25. OS +3.00-2.00x 085

It is best to write "sphere only or "sph in the cylinder column if no

cylinder is ordered. This indicates that you checked the prescription
and verified that there is only a sphere prescription request.
TRANSPOSITION

This is a minus cylinder prescription (Rx):

-1.00- 1.50 x 180
This is a plus cylinder prescription (Rx): -2.50+1.50×090

Guideline
Transposition
Transposition allows change from one cylinder form to
the other cylinder form. The cook book:
1. Add the cylinder to the sphere and place in the
sphere position.
2. Change the sign of the cylinder power and leave
the cylinder power alone.
3. Add or subtract the 90 degree to or from the axis
so that the axis is a positive number less than 180
degree.

Transposition Examples
A. Minus cylinder is transposed into a plus cylinder
If the Original Rx is -1.00 - 1.50 x 180 degrees, to transpose into a
plus cylinder form:
1. Add cylinder of -1.50 to the sphere -1.00 and place in the
sphere position:
- 2.50 - cylinder x degrees.

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 2. Change the cylinder power sign and leave the cylinder power
the same as before:
-2.50 + 1.50 × XXX degrees.
3. Add or subtract 90 degrees so the axis is less than 180 degrees:
180 -90 = 90
The new transposed prescription is:
- 2.50 +1.50 x 090 degrees

B. Plus cylinder into minus cylinder

If the Original Rx is +2.50 + 1.00 x 085 degrees, to transpose into a
minus cylinder form:
1. +2.50 and + 1.00 equals +3.50 sphere power
2. +1.00 becomes -1.00
3. axis becomes 175 (adding 090 to 085 equals 175; whereas :-
Subtracting 090 from 085 is -005 and not usable)
The new transposed prescription is:
+ 3.50 – 1.00 × 175 degrees
Transpositions:
Minus cylinder Plus cylinder
A. - 4.25 - 0.75 x 45 = A. - 5.00 + 0.75 x 135
B. + 0.75 - 2.50 x090 = B. - 1.75 + 2.50 x 000 (or 180 )
C. + 1.50 – 0.75 x 160 = C. + 0.75 + 0.75 x 070
D. – 3.00 – 3.25 x 060 = D. - 6.25 + 3.25 x 150
E. Pl – 2.00 x 090 = E. - 2.00 + 2.00 x180

The difference between minus and plus cylinders lies in how the
lene is shaped. With minus cylinders, the cylinder is placed on the
patient side of the glasses. The plus cylinder lenses have their
cylinder on the front surface.
Generally, optical laboratories will transpose all plus RXs into
minns cylinder lenses. As mentioned previously, even though the
numbers are the same, sensitive patients will notice a difference in the

13
distortion and apparent magnification. Some patients will adapt; some
will not.
If the patient has a true front cylinder lens then a note is generally
made on the prescription and order form.
If the prescription is in plus cylinder form, check the patient's pre-
vious lens by the lens clock (see lens clock section). Keep the new
pre- scription in the same cylinder form as the previous cylinder form.

PRISM

The eye is moved by six muscles. The muscles are fast and accurate
in finding something in a visual position. If the muscles do not
respond together, the eyes become strabismic. Strabismus means that
while one eye will be fixed on what the patient wants to see, the other
eye may be positioned toward the other eye or away from the other
eye. An eye that 1s tropic is the eye that is turned in some way that
does not give good "binocular vision to the patient.
An inward pointing eye is called esotropic.
An outward pointing eye is called exotropic.
Opward and downward pointing eyes are called hypertropic and
hypotropic, respectively.

14
 Optical Corrective Lenses

Figure 12. Normal and strabismus eye postures.

When the eyes first turn in or out, diplopia occurs. This means that a
person sees double. Eventually a person will suppress information

15
from one eye and favor the other eye. This leads to a condition of
amblyopia, which is diminished vision in one eye. The good eye may
have a vision of 20/20 and the amblyopic eye a vision of 20/80 or
worse.
Young children who have eyes turned inward or outward need vision
care.
Prism may often be prescribed in conjunction with regular lenses in
order to keep the eyes positioned together. Eyes that turn inward can
Often be corrected by using a high power of plus lenses. Surgical
intervention should only be suggested if the training are inadequate.
Vision training can enhance people’s ability to have their eyes work
together, can improve vision accuracy, and can establish vision as a
functional part of learning.
Another, more subtle, condition happens when patients have their
eyes together. Phoria is the tendency of the eyes to position
themselves when the binocular when fatigue sets in, or when stress or
illness is present. Phorias can be large and can interfere with a
person's visual performance. And in response to their presence the
eye doctor may prescribe prism with high phorias, the patient is
always expending energy to keep his or her eyes together.
When binocular conditions are interrupted:
Eyes that tend to move toward each other are called esophoric.
Eves that tend to move away from each other are called exophoric.
Eyes which move up or down are hyperphoric or hypophoric,
respectively.
Eyes that do not deviate from the straight ahead position are called
orthophoric.
Prism can be commonly prescribed by two methods:
(a.) the prism diopter and

16
(b.) decentration of the lenses.

Prism bends the light. The prism is constructed with a base on one
end and an apex on the other end. The light is bent toward the base of
the prism; the eye, when looking through the prism, moves toward the
apex. The prism base direction and power is needed for ordering
prism in a prescription. There are four directions that describe where
prisms are placed in front of the eye.

Ape
x

Base
Figure 13. Single Prism

PRISM: DIRECTION AND PURPOSE

BU = Base Up generally used for hypo eyes

BD = Base Down generally used for hyper eyes
BI= Base In generally used for exo eyes
BO = Base Out generally used for eso eyes
Power is determined with actual prisms in the examining room.
One prism diopter means that light from one meter away will be
bent by 1 centimneter. So if you look through a 2.5 prism diopter at

17
a straight pin which is one meter away, the position of the pin is
actually 2.5 centime- ters in the direction of the prism base.

LENS DECENTRATION

What happens when you put two prism bases together? A plus lens is
formed. What happens when you put two prism apexes together? A
minus lens is formed.

With a plus lens, one way to induce prism is to use the center of the
lens (where the bases meet) and position the base where desired. With
minus lenses, one way to induce prism is to use the center of the lens
(where the apexes meet) and position the center where you wish the
prism.

The amount of decentration of a sphere lens power will be able to be

predicted by Prentice's Rule:

18
 Prism Diopter = [Powersphere] [decentration]
provided the decentration is in centimeters

If the pupillary distance (see pupillary distance) is set incorrectly,

prism will be created. This is especially harmful for people with
strong prescriptions. Induced prism will occur.

INDUCED PRISM: INCORRECT

PUPILLARY DISTANCE
This example concerns a wrongly judged pupillary distance of 5 mm
(0.5 cm):
Prism = + 1.00 (0.5 cm) = 0.5 unwanted prism

19
 Prism = + 5.00 (0.5 cm) = 2.5 unwanted prism
Thus, the +1.00 prescription will barely notice the 1/2 prisn diop- ter;
the +5.00 patient with the 2.5 prism diopter may experience la tigue,
diplopia, or disorientation from wearing the unwanted prism.
The prescriptions should be written:

OD -1.00 -0.75x 180 5 BI

OS - 1.00 -1.00×180 5 BI
OD - 1.00 -2.00×180 2 BU
OS - 1.00 -1.75×180 2 BD
Note: With hyper and hypo conditions, the prism will be split
between the eyes in opposite directions. Always call the doctor if
there is prism indicated, but no direction prescribed.

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 BIFOCALS

Bifocals are dreaded by many in our society. Much of your work will
be helping those who need lenses for seeing clearly at different close
distances adjust to the new view. Your dispensing optician career will
turn into being a combination of Ann Landers, Dr. Ruth, and a friend
indeed.

21
 The bifocal lens is a plus lens built into the lower part of the
traditional bifocal or trifocal. We call them ADDs or SEGs on an
informal nature. Patients will not know them as ADDS
Presbyopia brings people into your office complaining that they
cannot see "up close like they used to". Their arms are not long
enough. Near the age of forty, this experience begins to surface. As
our society gets older and the youth culture greys, avoidance and
denial of need is often the major stumbling block in dispensing
something the patient needs. There are alternatives!

BIFOCAL ALTERNATIVES
Two Pairs of Glasses
One pair is for distance: sports, driving, etc.
One pair is for reading or for near work only. The reading onl:.
pair may be a full pair of glasses (which will interfere with the
person's vision if he or she has a job requiring greeting customers or
looking into the distance). Half glasses (lawyer's glasses) are
sometimes the perfect solution for someone who only needs
occasional correction for near see- ing yet needs to have clear
distance vision available without interruntion.

Contact Lenses

22
In Monovision, the doctor prescribes one lens in one eye for near and
one for far. The brain has to get used to switching one off when
reading the newspaper and the other off for driving, golf, etc.
New developments in bifocal soft and bifocal gas permeable lenses
are being approved rapidly. These will be widely available and will
re- quire skill by the doctor for successful fitting.

THE TRADITIONAL BIFOCAL

This is one pair of glasses which consists of multifocal lenses
(trifocals and bifocals) which include many types (executive,
straight top, round top, ultex, double segment, progressive, or no-
line) of ADD desigis.
The ADD is always thought of as an addition to the distance pre
scription. Thus a patient with -1.00 and a patient with +1.00 may have
the same ADD of +1.50. What happens if the patients take off their
glasses? In this case, both people still need reading glass up close: the
myope (- 1.00) needs + 0.50 and the hyperope (+ 1.00) needs a total
of + 2.50 for near work. (The myope will have the advantage over the
hyperope, as the need of +0.50 will only deteriorate best vision to
20/25 or 20/30 at the near position.)
The first bifocal ranges from + 1.00 to + 1.50. In the patient's late
sixties, a common ADD is + 2.50. Generally, the ADD is the same for
each eye. The lens prescription is written:
OD -2.50- 1.00 x 180
OS -2.25–0.50 x 160
ADD + 2.00 OU
BIFOCAL TYPES
Flat Top or Straight Top
The Flat Top (FT, ST) is the mnost common bifocal. The shape is
like a sideways letter "D" The width of the segment is variable and is
available in 25, 28, and 35 mm widths. The 25FT is standard; the

23
35FT gives a good wider field of view and may make the lens a little
heavier.
The advantages are in the availability, in the ease of viewing (because
the lens can be set at the patient's near pupillary distance) and in
allow- ing some peripheral vision (like for walking down the stairs).
With cos- metic appearance as a concern, the proper placement of the
top (if done well) will be little noticed.

Executive
The Executive (Exec) is perfect for people doing a variety of
desktop activities (bookeepers, CPAs, Writers) particularly for fast
readers who use their eyes to rapidly scan, this bifocal will work
without peripheral vision limits.

24
The disadvantages, however, are numerous:
1. The weight is significant in a plus prescription.
2. There is a thick line between the far and near vision part of the pre-
scription. This edge is easily chipped with normal use.
3. The difficulty of manufacturing increases the cost.
4. Maximum segment height is 28 mm from the bottom of the frame.
5. Some of the peripheral vision is distorted.
6. The optical center of the lenses is not moved inward. Thus, the
patient will always be viewing a little prism when working at near.

Round Segment
The round segment is less visible than the others. The width is
commonly 22 mm. Two other diameters of 24 and 35 mm are
available. The appearance will be a slight bubble formation on the
bottom of the lens. This tends to blur the presence of a line, making it
less visible. Dis advantages are the patient has to move his or her eye
through a larger area of distortion to get to the reading part of the
segment's reading por tion; some of the cheaper round segments
(Kryptok) may have color distortion; and the size of the diameter
produces a small reading zone.

25
These Segments may need to be placed 1 to almost 2 mm higher than
he straight top bifocals.

Ultex
The Ultex is an old bifocal lens design which is used for plus
cylinder prescriptions. Ultex is available as a "minus seg" for
placement at the top of the lens rather than at the bottom. This is
particularly appealing for those working in stock rooms, pharmacies,
and places that require reading for finding "what is on the top shelf"
The jump from far to near vision is disturbing for many wearers and
requires a serious positive attitude toward adaptation.

Double Segment Bifocals

The Double D is a pair of straight top segments separated by 13
mm; the Double Executive is a pair of executive bifocals adds
separated by 14 mm zone for distance vision; and the Double Round
is a pair of Round segments separated by 13 mm (sometimes called
the Baseball Bifocal). These are all successful for electricians, pilots,
mechanics, carpenters, etc.... people who are active with their eyes
and hands. The bifocals will have different powers: the top will be
about 75 percent of the bottom power, which is more appropriate for
the arm's length distance.

26
27
28
 THE NO-LINE BIFOCAL:
PROGRESSIVE LENSES
In keeping with the large number of baby boomers/yuppies who
hesitate at facing presbyopia, manufacturers have scrambled in the
late 70s and early 80s to produce the no-line bifocal, the cant tell it's a
t bifocal- bifocal"
As an historical note, blended bifocals were first introduced by
Younger in the 1960s. This seamless bifocal was a round segment
with a blurred circumference. It yielded fuzzy distortion and was not
popular. This is not a true progressive lens.
The progressive lens was originally introduced in the United States
in 1968. The modern evolution of the progressive has produced a
sophisticated design so that as a patient lowers his or her eyes from
the optical center the power increases in plus power. Things at
near be- come clearer gradually, and there is no jump from distance
clarity to near clarity. There are no lines! As a dispensing optician
you will be able to detect the presence of distortion in the side regions
of each lens as you see more and more of these lenses.

29
That distortion is a liability of the lenses. On each side of the clear
lane of vision are areas of distortion for the patient. When the head is
turned, objects will move in the wrong direction when seen" through
these areas. This will take a few hours or days for adaptation to occur.
This also means that the clear lane or alley of vision must be "aimed"
wherever the patient wants to see clearly.
If the patient is a fast reader, one who uses eye movements to read,
this may be frustrating as the eye sweeps into the area of distortion
and requires the head to move in order to clear the image.
With powers greater than +2.00, these experiences become
prohibitive for efficient eye movers to use the progressive lenses. The
small
ADD powers (+ 1.00, + 1.50, maybe + 1.75) and ideal for
progressives and first time wearers. Larger powered progressives for
individuals who do not use the bifocals much are also ideal
candidates.
Discretion and inquiry into finding out how your patients use their
eyes will help prevent having glasses returned and patients frustrated
at failure to adapt.

30
31
Progressive Placement Procedure
1. Adjust the frame so that it sits well on the nose and ears.
2. Adjust yourself so that you are absolutely eye-level with the
patient. You should be about one arm's length from the patient.
3. Close your right eye and have the patient look into your left eye.
Measure from the center of patient's pupil to the lowest portion of the
visible lenses. Add 1/2 mm for the lenses insert into the frame's bevel.
Then measure from the pupil center to the middle of the frame's
bridge. To measure the left eye, close your left eye and have the pa-
tient look at your right eye for the measurement.
Note: A simple way to do this is to place a piece of transparent tape
on the selected frame and mark the patient's pupillary center. Do both
eyes. Remnove the frame and make the two measurements for
monocular pupil heights and pupil widths.
4. It is written as
OD 25 mm Hi = pupil height
12 mm mono PD = monocular papillary
distance for the right eye
5. Errors are expensive and time consuming; follow the carpenter's
rule: Measure twice, cut once.
BIFOCAL ADAPTATION
Both progressive and variations of the traditional bifocals will
elicit uncomfortable results in some patients. The successful adapta
on to 34 bifocals depends on the agility of the patient to adapt to new
situations.
The adaptation also depends on your skill in fitting the proper
bifocal segment height.
People are very precise about where they like to read or work
at distance. Upon receipt of their first time bifocals if the reading
power is correct for their distance and eye position, you have won
more than half the battle of adaptation.

32
 If you are fitting a previous bifocal wearer, determine if the
bifocal placement has worked well for the patient. If yes, then find
where the segment line is in relation to the lower lid margin and
duplicate the posi- tion on the new frame. Remember to do each eye!
For the patient that has not had success, start fresh!

Guidelines :
AdditionalBilfocal Tips.
For rimless glasses the dummy lens may be included in the order
form with a precisely marked lens. Or, the segment height
indicated by "22 down/" may be given, which means it was
measured from the top.
For people with unique eyelids or unusually different anatomy, the
lowest point of the eye's limbus may be used.
Bifocals which are set too high will cause the person to have neck
aches, as they are always tipping their heads to compensate.
Bifocals which are set too low, will cause the person to have neck
aches, as well, and reduce the patient's reading time as they have
Suggestions for Alternative Bifocal Heights
to tip their head backwards.
Suggestion for Alterative Bifocal Heights
Lower Height than usual:
1. For bifocal sunglasses, if near work is infrequent.
2. First time bifocal wearer.
3. Patient keeps his head retracted or stiff.
4. A very tall patient.
5. Deep set eyes.
6. Large vertex distance (distance between the lenses and corneas).
7. Active person, with infrequent near activity (e.g. deliveryman).
Higher Height than usual:

33
 1. Full time reading as vocation or avocation.
2. Patient with kyphosis or tendency to keep head tilted down.
3. Short patients.
4. Round segments.
5. Children, where they "need" to be using the ADD.

Guidelines:
How DBL and Eyesize Affect the Bifocal Placement
When changing bridge sizes, you may have to compensate the
change of the bifocal height. A wider DBL will place the segment
lower.
If you fit a pair of glasses which have the eyesize too small, for in-
stance, a larger size is listed in the catalogue but not on hand in the
dispensary, here's what to do:
(a.) Find the difference between the two eyesizes.
(b.) Divide the difference by two.
(c.) Subtract the divided difference from the measured seg height if
a smaller eyesize is needed. 34
(d.) Add the divided difference to the measured seg height if a
larger eyesize is needed.
 SLAB OFF LENSES
If the right and left eye prescriptions are different by 3 or 4 diopters, a
prismatic difference may cause a vision imbalance. This can happen
especially at near through bifocals or trifocals. Slab off grinding
removes vertical induced prism from the more minus bifocal lens.

35
You can feel the point of juncture in between the top of the slab off
bifocal and the distance Rx.
TRIFOCALS
Trifocals are bifocals with an in between lens. The intermediate lens
helps when the bifocal power is too strong from an intermediate
distance. This may be frustrating to the patient who has to locate
things on his or her desk or things just out of reach of the fingers
which require sharp vision (like the table saw blade for a carpenter).

The intermediate power is usually 50 percent of the bifocal power.

The trifocal prescription is written: “ADD +2.50/tri or +2.50/1.25"
You will translate this into FT 7× 25 which means a straight or flat
top trifocal with a width of 25 mm.

The trifocals available are the flat top and executive. The width of the
segment is predetermined: 7 mm. Additional segments of 10 mm and
14 mm may be available.
Guidelines:
Trifocal Placement
1. Adjust the frame so that it sits well on the nose and ears.
2. Adjust yourself so that you are 36 absolutely eye-level with the
patient. You should be about one arm's length from the patient.
3. Have the patient look straight into your eyes.
 APHAKIC LENSES

The human lens tends to become a cataract as we all become

older. There are many kinds of cataracts. Some are naturally yellow
or brunescent; some are dense white which lets no light through.
Some form in patients as early as the age of fifty and become ripe
enough to require removal; some start early and grow slowly over a
decade. Some form as a response to trauma to the eye, some as a side
effect of drugs used systemically (taken orally or intravenously), and
some develop as part of a disease (e.g. diabetes).
When the lens is removed, the patient is aphakic. This means
"without lens." Removing the lens removes part of the optical
correction of the eye. In fact, it removes about + 11.00 from the total

37
eye. If you needed a - 11.00 prescription, removal of your human lens
would make you almost Plano! If you needed a + 5.00, and had your
human lens re- you moved, you would need + 16.00 to see clearly.
Lens implant surgery uses an Interocular lens (IOL) to
replace the human lens that is removed. This practice is almost the
rule today for cataract surgery. A smaller than a dime size lens is
inserted behind the pupil and will help replace the refractive power
that was removed and perhaps compensate for the refractive error.
Sometimes, lenses are placed in front of the iris. With time, the new
implant can become "cloudy" and at this time a simple laser cleaning
treatment will restore the vision to its previous state.
Contact lenses are an alternative for those not receiving
IOLS.
These lenses give good vision and a better field of view. The liability
is that the patients generally need the lenses or glasses to put on the
contacts! Extended wear lenses are a possibility, but strict adherence
to lens care requires good follow through on the part of the patient.
Aphakic lenses are high plus lenses. They are thick and
make the patient's eyes appear enlarged. The lenses are heavy and
require accurate placement of the optic centers (via your pd
measurement) and the distance from the lenses to their eye (vertex
distance). Liabilities include peripheral distortions and a reduction of
the field. The sudden awareness of objects or events in the periphery
may startle the patient. (This is sometimes described as the Jack in the
Box phenomenon.)

38
 Guidelines:
Fitting the Aphake.
1. Accurately measure the pd. Monocular pds are best.
2. Measure the vertex distance and make sure no power is lost for
the patient.
3. Pick a frame with adjustable nose pads; this will help position
the frame to compensate for the proper position.
4. Plastic lenses and a small eyesize will help reduce the weight
of the lenses.
5. Make sure the lens has an ultraviolet (U) coating and/or a tint.
The human lens naturally absorbs UV light, and patients will re-
quire some protection if they are out doors a great deal.

39
 APHAKIC LENS TYPES

There are three types of aphakic lens:

1. AO Optical Full Vue is an aspheric and lenticular lens. The
manufacturers claim the lens provides a full field and minimizes
distortion in the periphery.
2. Aspheric Lenticular is a thin carrier" lens with a thick button which
provides the power. This design reduces the visual field, but provides
a lighter alternative than the full field aspheric.
3. Full Field Aspheric is a large lens that does provide a wider field
than the single aspheric lenticular, but with that advantage comes the
penalty of weight and peripheral distortion.

40
 LENS MATERIALS

T HERE ARE three major types of materials for lenses: Glass,

Plastic, and Polycarbonate.
Glass
Glass lenses are slowly being replaced by plastic. Some specific
qualities about glass lenses are:
1. The weight is about twice as heavy as plastic. For large
prescriptions in plus or large eyesizes in minus, suggest plastic.
2. Glass is more scratch resistant than plastic.
3. Glass is made of Crown glass, unless specified flint. Flint is thinner
easily than crown, has and denser than crown, scratches more
color distortion than crown, and may be advisable for Rxs greater
than -8.00
4. Bifocals will have no ledge or tactile sign of the segment top.
5. Chromatic (photogrey, photobrown, etc.) lenses only come in glass.

Plastic
Plastic lenses are the most common lenses used in frames. They
are made from a formula of resin. They may be referred to by CR 39.
CR stands for "cast resin" Some specific qualities are:
1. Plastic is one half the weight of glass lenses.
2. Plastic lenses scratch more easily.
3. Plastic lenses resist breakage.
4. Plastic lenses do not fog up as easily as glass when coming in from
the cold.
5. Plastic lenses will absorb and release dyes easily which make them
tintable and bleachable.
6. Plastic edges will be thicker than glass edges.
7. Plastic may warp and create astigmatism effects.

41
8. Plastic bifocals will have a ledge, which you will feel with your
fingernail.
9. Anti-scratch coatings work well with plastic lenses to improve their
Scratch resistance.

Polycarbonate
Polycarbonate lenses are another form of resin which is
extremely generally reserved for use in safety glasses tough. These
lenses are contact sports eye protection.
HOW TO TAKE CARE OF GLASSES
1. Always RINSE the lenses in water BEFORE wiping clean.
2. Wipe with soft clean cloths.
3. Silicon impregnated cloths are okay for glass lenses.
4. Store the lenses in a case when not in use. Or
5. NEVER set the glasses on their lenses. ALWAYS place the glasses
on their "backs," with the temples on the table and the lenses up
in the air!
6. All babies go through a developmental stage where they have been
known to eat and ruin glasses. Be careful.
Notes: Some dispensers use pledge or anti-static cleaners to help fill
"wax' in the small hairline scratches of plastic lenses. Some
use furniture polish to achieve the same results. These may
contain solvents which leave deposits or remove (in splotches)
the tint of the lenses. Experiment on a useless lens before
trying any of these or other's suggestions!

HOW GLASSES ARE MADE

Both glass and plastic are liquids when they are pressed into a blank
form. The blank has no prescription but is simply a chunk of each
material. Glass is made of silicon with traces of lime and soda
(baking type, not club). Plastic is made of long chained molecules of
carbon with other chemicals (variation of glycols).

42
The "chunk" is finished on one side: This finished and curved side 15
done to a specific curve or radius. The curve side is called the Base
Curve and the chunk" is called a semi-finished blank.
Bifocals are created at this step: a curved button is removed from the
base curve side. This leaves a depression in the base curve side of the
blank. A matching curved “segment" is glued or fused with heat into
the depression in the base curve. A plastic bifocal is ground to a
different curve (which creates that ADD power).
The other side of the semi-finished blank is “surfaced" This is done
by either creating the finished sphere power or by placing two
different curves which create the cylinder power. Now it is called the
finished blank.
The finished blank is marked for the optical center for the
proper frame and the requested pd and/or prism. The edging machine
grinds the lens to the correct frame eye size and shape. Smoothed:
this produces the "safety bevel."
Rimless lenses take a different route. Each lens is drilled and a
groove is cut in the lens edge. This forms the canal into which the
nylon guide wire is slotted.
All glass lenses are hardened to ANSI standards. Hardening helps
the lenses "strengthen" and protects the patient from splintering glass
or plastic into the eye. The hardening process uses the stresses of the
lenses to retain its integrity or break into large chunks. Either heat or
chemical treatments do this process. Heat treatment requires the lens
be heated for a few minutes at a high temperature (1320 degrees F)
and cooled quickly with forced air. The outside of the glass cools
more rapidly than the inside of the glass, and the tension created by
this differential in temperature creates a stress pattern that can be
checked by a colmascope.
The colmascope uses a back lit polaroid filter to analyze stress in
warped plastic lenses and in heat treated glass lenses.
Chemical treatment does a better job than the heat treatment.

43
Chemically treated lenses show no stress induced pattern in the
colmascope. The treatment is a hot salt bath. Sodium in the lens
surface is ex- changed for slightly larger particles of lithium or
potassium. This causes the outside of the lens to have a greater
tension than the inner portion of the lens. This process requires more
time. Photochromatic (glass) lenses require a separate bath for
chemical treatment.
After the hardening process, the lenses are tinted and coated for anti-
reflection, UV, or mirror "tints" They may have appliques glued, en-
graving done, or paint applied.
Glazing is the final step involving placement of the lenses into the
frame.
The lenses are then verified and inspected.
It is not uncommon for a pair of glasses to go through 17 to 18
people's hands from start to finish in an optical lab. Glasses are still
handcrafted items for each person. These are somnething that many
patients will appreciate knowing and increase the respect you may
receive when all goes well.
AVAILABLE TINTS

Tints are a visible color or invisible coating which absorbs part of

the light that enters the glass or plastic lenses.
When light enters the glass, part of the light is transmitted (goes
through the lens), and part of the light is absorbed or reflected (does
not go through the lens). These two qualities of absorption and trans-
mission are expressed as percents.
75 percent transmission is lighter appearing than 25 percent
transmittance.
75 percent absorption is darker appearing than 25 percent absorption:

44
The optical manufacturers have developed numbers which roughly
predict "which color is how dark."
Tint Equivalents
Grey A = light grey. Green #1 = light green
Grey B = medium grey. Green #2 = medium green
Grey C = dark grey. Green #3 = dark green
G-15 = dark green-grey
Single gradient tints are tints that change from one color to
another color or fade from one color to a clear color. There are
specific reasons for this fade: the tint that is darker at the top helps
reduce glare from overhead; the lighter shade at the bottom permits
easy reading or easier transition from light to dark places; and it is
fashionable or cosmetically appealing.
Double gradient tinting produces a lens which utilizes two
tints; each is darker at the bottom and top. Each tint fades to clear as it
approaches the middle. The colors can be the same or different.
Patriotie patients may want blue at the top and red on the bottom.
Those patients who like blush may prefer rouge and brown double
gradients.
With plastic lenses, all colors are possible. Bleaching can rem0Y
color or lighten a color. The darkest of tints may leave some residual
color when a complete bleach is attempted. After bleaching, the
lenses may be tinted again.
Flesh or pink tints are the most popular colors. These tints
are also helpful for patients who work in fluorescent lighting
environments. It is best to have patients choose the colors they desire
and include the color sample with the prescription order.

45
 GLASS TINTS

Glass lens tints come in two types: Color coating and absorptive
lenses.
1. Color coating is the more time consuming. A vacuum process
applies the color to the back of the lens after the lens has been
hardened. There will be a bluish color coated on the back surface of
the lens. Extra applications can be ordered to increase the darkness of
the color. Clean only with soap, NEVER acetone.
2. Absorptive lenses have the tint added to the original lens blank.
This tint is permanent and increases in darkness as the thickness of
the lens increases. With high prescription lenses of plus and minus,
the tint will vary with the thickness. Plus lenses will be darker in the
center, minus lenses will have a donut of darkness around the optical
center.
OUTDOOR TINTS

Glare and direct sunlight are often are often very irritating for
patients. Both standard sunglass tints and photogrey are solutions for
these problems. In sunlight there are wavelengths which are
potentially harmful. These are the Ultraviolet (UV) and Infrared
(IR) light. Neither is visible to the normal eye. The atmosphere
absorbs most of these wavelengths and the human lens absorbs
another portion of the UV light. In fairer skinned patients, there is a
reduction of pigment in the retina. Pigment is helpful in reducing
scattering of light or glare. It will be beneficial for light skinned
patients to use sunglasses if the glare is irritating. Extended periods of
sunlight exposure can harm the conjunctiva and cornea (This can be
sunburned just like other body skin.) Suntanning studios should use
proper eye protection for their clients.

46
Sunglasses should absorb about 75 percent of the light (transmit 25
percent). Most quality sunglasses block UV; only dark green glass
and grey block IR light.

Guidelines
Color Selection
When choosing colors, remember that blues and reds (with varying
pastels) are most pleasing as cosmetically appealing colors. When
choosing sunglasses, it is important to suggest a larger frame for more
sun protection and coverage.
Aphakic patients (after cataract surgery) need UV protection
Drugstore sunglasses generally have defects which include wave of
distortion or blemishes; furthermore, they do not provide adequate
UV or IR protection.
With constant use of sunglasses, a patient can develop a light
sensitivity and become reliant on their use.

THE COLORS

RED and PINK variations are the most pleasing due to their warming
effect on the skin color.
BLUE cools the skin color and gives an apparent contrast to white
and blue objects
YELLOW is a popular color with hunters because it absorbs blue
light, improves the apparent contrast, sharpens detail in the mist. It is
not considered a true protective sun tint.
BROWN protects against UW and IR (due to the slight mix of grey
and yellow/green), increases the apparent contrast, and is
cosmetically appealing.
GREEN helps protect against UV and IR, helps absorb red colors,
and cosmetically absorbs the red color of flesh.

47
GREY is good for protection of UV and IR and generally absorbs all
colors democratically (equally).

NOT COLORS BUT TREATED

AS COLORS
POLAROID is not a tint but helps absorb glare from the horizon,
such as road and water reflections. It is expensive when ordered in
prescriptions. It is available in grey, brown, and green. A colmascope
will reveal its presence in glasses by being completely black as you
rotate the lens.
MIRROR is metal applied to the surface of the lens. The chrome-
nickel alloy is a "tint" and has no protective value. It can be ordered
in single or double gradients.
PHOTOCHROMIC lenses are special, more expensive and,
generally, available in glass only. There are actual particles of silver
in the lenses which respond to light to produce darkness. The particles
also respond to cold by becoming dark. When light is removed, the
particles change the lens to become clear again. Chemical hardening
is suggested for these lenses. The lenses will require a breaking in
period. The length of break in time will depend on the strength of
light induced darkening and the number of clear-dark recycling times.
Placing the glasses in the cold can help induce the darkest cycle.

Guidelines:
Photochromic Tips
1. Thin lenses (mild prescriptions) will still be light.
2. When the patient is in a car, the lenses may lighten as they re-
quire direct sunlight to stimulate the darkness.
3. Bifocals will be a lighter, distinct colored shape unless the
segment is also photochromic.
4. Photogrey/Brown Extra can provide darker lenses.
5. Prolonged exposure to constant48 light can prolong the time the
lenses require to lighten up.
 ANTI-REFLECTION COATINGS

Reflections from the backside of the lens can be annoying to the

patient. The coating should be applied to both surfaces of the lens. It
is generally clear or slightly reddish-blue when the coating's
reflection is seen on surface of the lens.,
A second, helpful aspect of this coating is reduction of the awareness
of lenses. This is accomplished by reducing the reflections seen on
the front of the lenses and makes the lenses seem "clearer" This is of
cosmetic importance. Anti-reflection coatings reduce the number of
reflections on the front of the glasses and allow more of the skin and
eyes to show through without interference.
EDGE COATINGS AND POLISHING
The edges of a thick minus lens can look white. A neutral grey tint
can reduce the presence of the edge. An unpolished edge absorbs the
tint better. Polishing yields a transparent look to the edges. Beveling
enhances the edge, creating a "faceted" look which masks the thick
edges.
APPLIQUES

Engravings, decals, paintings, rhinestones, diamonds can all be used

to create a "personalized" pair of glasses. Be sure to draw the lens and
specify the placement of the decal, engraving, etc. Some patients are
surprised at how annoying the little "item" can be, but most adapt to
its presence within a couple of days of constant wearing.
SAFETY TINTS

49
Industrial tints help protect patients when they work in environments
which have potentially damaging lights. Welders are the most
vulnerable to IR and UV light. American Optical produces a
“Filterweld" tint which protects eyes from daily exposure to UV and
IR.
Lasers are very dangerous to retinal tissue. There are various lasers
which use "finely tuned" light to produce their effect. For this reason,
goggles or protective glasses need to be built for each specific laser
and its band of wavelengths. Manufacturers of the lasers should
provide in- formation about the proper protective eyeware for the
user. X-ray damage may be protected by use of Super Protex.
TINTS AND THE VDT
Some visual display terminal (VDT) users will inquire about
protection from the radiation emissions of their screens. Their
concerns are warranted. The science literature (up to 1985) states that
there are no harmful effects from present day screens; however, one
must remember that the atomic bomb tests in Nevada were claimed to
be free from damaging effects during the 1950s.
Manufacturers of lead glass screens claim absorption of low levels s
of radiation from the VDT. Recognition that long term and low level
radiation exposure may produce ill effects may substantiate in the
future claims by some manufacturers of the protective screens. The
screens may inhibit an amount of radiation that is considered
potentially harmful.
Screens may help increase the visual contrast depending on the
environmental lighting (the lights above the computer and in front of
the VDT user). Recent research shows that circular Polarized screens
yield the best contrast. A slight pink and/or UV protection is
generally satisfactory for the VDT user under fluorescent lights (the

50
 pink may be a slight single gradient). Factors influencing the VDT
user, periods of rest, proper back support, the proper optical
prescription and control of the lighting above and in front of the VDT
will all contribute or degrade the quality of work.
SPECIAL TINTS

American Optical has a listing of specialized tints which include co-

balt blue lenses (which protect against hazardous light from feldspar)
didymium (which protects from molten glass), and others.

Guidelines:
How to Tint
Dye manufacturers will supply either powder or liquid which will
need to be dissolved or diluted before using. Some individuals may
use RIT dyes (one small package to three cups of water). The final
dye solution requires heat for the tinting process to work. Dyes fade
over time and exposure to light. Re-immersion of lenses can
strengthen the amount of the dye absorbed by the lens.
Remove the lenses from the frames, and clean the lenses with water
or acetone. Solid tints are simply created by placing the lenses in the
tint bath (about 200 degrees F) for small intervals of time. 5 to 15
seconds may be enough to produce the light colored tint desired,
depending on the strength of the tinting solution. Be sure to stir the
dye bath if it has been sitting undisturbed for a long time. Gradient
tints are produced by immersing the area that is desired darkest first,
and then gradually removing the lenses. There are some machines
with timers and robot arms to do this. Rinse the lenses after tinting
and inspect for streaking.
BLEACHING
Bleaching is a hot tinting neutralizer and will remove the dye. If the
lenses are streaked, remove all the dye and begin again. Total

51
removal of dye from a dark tint will often leave a slight brown tint to
the lenses

CREATING NEW COLORS

Colors may be added for a new color:
Green can be created from blue and yellow.
Mauve can be created from blue and red.
Greys can be subtly made cooler with blue and warmer with red.
Frames can also be tinted, with varying success and failure.

FRAME MATERIALS
Frames are made of plastic or plastic-like material and/or metal.
Plastic or plastic-like include: zyl, Optyl, nylon, Xelex, Nylyt, and
Proprionate.
1. Zyl (cellulose acetate) is the most widely seen frame material.
It softens and bends and stretches with ease.
2. Optyl (an epoxy resin) does bend when heated, but may return
to its original bend when heated in a car's glove compartment
or the desert. Its memory will be a difficulty if the material is
not heated up to 180 degrees F. This material is often seen in
designer frames and is lighter than zyl.
3. Nylon is often used for sports and safety glasses as it is almost
indestructible (excepting young Rambos). It comes in all
shades of black.
4. Xelex is used in some children's frames. This material can be
adjusted cold. Nylyt is similar to Optyl but will be difficult to
adjust as it breaks, burns, and stretches too easily. Proprionate
(Rodenstock) holds adjustment better than zyl frames.
Metal frames come in a variety of materials from space age
titanium to nickel. The metals are usually a combination of metals or

52
alloys: aluminum, bronze, brass, gold, nickel, steel, and silver. Color
is dependent on the combination of alloy or paint.
Gold is measured by karats and is marked on the frame:
1. "1/10 12K GF" means 1/10% of the frame's weight is gold
alloy. The quality of the gold alloy is 12K (pure gold is 24K).
Gold filled means the frame is a gold alloy tube which is filled
with some other material inside the tube.
2. "RGP" means gold-plated material. The gold is deposited on
the frame material. This is subject to wear and will eventually
become worn to reveal the lessor grade of frame material.
3. "50/1000" means 5o or 1/20 of the frame is pure gold. Gold is
wonderful to work with in forming the frame to someone's
face. It is malleable and yet will retain its shape. There are
scrap houses that will buy discarded gold frames.
Metal frames can easily be bent and broken. Upon impact the
metal frame will generally give enough to keep intact but in a
distorted shape. Plastic frames will simply break on impact. Sports or
protective eyeware should never be in metal due to the lacerating
(cutting) ability of the metal material. Soldering may be done to
repair a frame temporarily. And plastic is always lighter than full
metal frames.
Combination frames such as rimless, polymil, rimway, and balgrip
are made of an assemblage of metal, plastic, fishline, etc.

53
 FRAME PARTS

The frame parts are:

1. frame front 2. temples
3. nose pads 4. hinges
5. rim or eyewire 6. bridge
The "boxing" system describes the horizontal and vertical
dimension of the frames.
Eyesize (The A dimension) is the horizontal distance between
the widest points of the lens design. It includes 1 mm of hidden bevel
(1/2 mm on each side of the eyewire).
The vertical dimension is the B dimension, which is from the highest
and lowest points of the lens design. This includes 1 mm of the bevel
hidden in the eyewire's top and bottom.

54
 Figure 26. The frame front description

The effective diameter (ED) is used by the optical lab to

determine the correct size of lens blank to use for a specific frame. It
is generally the longest line between the edges of the lens.
The distance between the lenses (DBL) is from the left lens
to the right lens at the narrowest point of the bridge. This distance
includes the 1 mm that is hidden in the eyewire's bevel of 1/2 mm for
each lens groove.
The eysize and DBL are paired numbers hidden on frames.
The larger number is the eyesize. Optical labs may charge more for
certain eyesizes, for example greater than 56 mm.
The frame pd is the A dimension plus the DBL measurement.

55
Figure 27. Minus lens edge thickness comparison

Note of Caution
Remember, larger eyesizes with high power prescriptions will yield
heavy, bulky lenses that will be uncomfortable glasses and have
peripheral distortions.

Frame Fronts
There are several frame fronts:
A. Plastic: Lenses are inserted by warming the front and gently
placing one edge in first, then the opposite edge. The lens will make a
dull
Snap into position. Do not use force; do not overheat the frame front
be- cause the eyewire or rim will roll and ruin the bevel in such a way
that the lens will not fit.
B. Metal: Lenses are inserted after unscrewing the eyewire screws.
The commonly lost and should screws are then tightened. These
screws are always be checked and tightened when patients come in
for services.

56
C. Combinations use the same eyewire screw/lens in the metal frame
front to retain the lens in position.
D. Rimless fronts have several methods of mounting lenses to
frames:
1. Screw-mounted rimless, lenses are drilled and mounted with a
pair of screws, bushings (washers to prevent chipping near the
hole), and nuts. Generally there are two screw assemblies per
lens. One variation on this is the Rimless, which has a temple
attached to the outside of each lens and a single bridge bar
between the inner parts of the two lenses. The Rimless is a
fragile frame, often in gold, which is very in obstructive to the
face. Another variation, The Rim way uses a lens arm which
extends over each lens generally small with connecting with the
bridge bar. Eyesizes are both these lenses and may even be 42
or 44 mm.
2. Nylon fish line supported frames are commonly called rimless.
The frame bar is connected to the bridge bar between lenses. A
fish line is suspended from the nasal and temporal portions of
the bridge bar and is drawn tight to retain the lens. Each lens is
grooved rather than beveled so that the line holds the lens in
position.
3. Two other types of rimless are the (a) Balgrip, which uses the
tension of a metal spring to retain the lenses in place, and (b) the
polymil frame front, which has a frame bar with cemented
cushion (rubber) which attaches to the lens. The lens may be
attached by glue and re- moved by knife. Make sure to scrape
all remnants of the rubber cushion before applying the new lens.

57
 figure 28. Rimless frame front

Guidelines:
Installation of the Rimless Lens
1. The tools needed for inserting the lens are a ribbon, a length of
nylon cord ("fishline'), a razor blade, and snipe nose pliers.
2. Cut the nylon cord so it will fit all the way around the lens.
Insert the cord in the lower hole on the nose side of the frame
bar. Then insert the cord through the upper hole and leave about
2 mm of the cord in the upper groove. Use the snipe nose pliers
to crimp the loose 2 mm end into the frame groove.
3. Insert the other end of the cord in the lower hole of the hinge
(temporal) side of the frame bar. Insert the lens into the frame
groove and pull the nylon cord moderately snug, making sure
the cord is in the grooveFrame Bridges
around the lens.
4. Cut the cord from the outside of the frame, leaving about 1 mm
There ofare
cordthree types from
extending of frame
the lowerbridges: saddle,the
hole. Remove keyhole,
lens. and
adjustable
5. nose pads.
Pull the cord about 1 to 2 mm hole and crimp into the frame's
Saddleand bridges are molded
place the lens topand
intothe
themost
framecommon type. It Place
front groove. does not
the
put but evenly
ribbon all the
around weight
the cord of the the
to stretch bridge
cordon onetheplace
over edge of
of the
patient's nose,and
lenses distributes
into the the weight
groove. Usealong the molded
the ribbon of thecontour.
lenses. Some
Once
metal the
frames
cord will
is inhave a separate
the entire groove, piece
slideoftheplastic which the
rib-through "form fits
second
onto the
uppernose.
bon This
out. may be detached and replaced when cracked,
dirty, or discolored.

58
The keyhole bridge is a variation of the saddle, but it places weight
on the top of the nose. The frame may be perched slightly higher on
the patient's face.

The adjustable nose pads have parts which suspend the frame from
contact with the face. The nose pad and the guard arm are very
maneuverable for those difficult noses. In addition, the position of the
glasses themselves can be moved in or out from the patient's face and
up or down in regard to subtle adjustment of bifocal heights. The
guard arm is soldered to the frame front and is movable and easily
broken. The nose pad is generally a plastic rocking pad which can be
replaced when it breaks or becomes worn or discolored. Most metal

59
frames have the adjustable nose pads, and plastic saddle bridges can
have adjustable pads installed by a hot insert method.

Figure 31. The adjustable nose pad.

Hinge Types
There are three types of frame hinges: riveted, hidden, and flex.
The riveted hinge is a strong, well-secured hinge.
The hidden hinge is the most common hinge attachment. It is re-
placed by heating up the metal hinge and gently wiggling out of the
"socket" of surrounding plastic.
Both riveted and hidden hinges have a certain number of prongs
which interdigitate with one another. Each prong is called a barrel.
Thus a three barrel hinge is formed by a two barrel temple part and a
one barrel frame front part. A stronger hinge would be the five barrel
hinge formed by a three barrel temple hinge and a two barrel frame
front hinge.

60
 Figure 32. Two and three barrel hinge parts.

The third type of hinge is the flex. This has a variety of tension
yielding devices which help keep pressure on the temple; this
Pressure in turn, helps keep pressure against the side of the patient's
head. This also allows the temple to "bend" outwards when the
glasses are removed from the head. Adjustment is simple as the
temple pressure helps. With some active sports frames, the inside
springs of the flex hinge may rust with sweat.
Frame Temples
There are three types of frame temples: skull, comfort cable, and
library.

61
The skull is the most common. It is sometimes called the spatula and
may be in plastic or metal with a plastic tip. The length is measured
from the hinge to the tip's end. The pd ruler is placed at the hinge end
of the temple and pivoted at the ear lobe's bend to measure the entire
length of temple along the curve.

The comfort cable and its cousin the riding bow temple have the
same shape: cach curves around the back of the ear. The comfort
cable is a flexible metal which moves gently yet securely to hold the
frame on the patient. The riding bow is hard plastic which must be

62
affixed to the head. Active little children are generally the recipients
of these, althoush some safety glasses are specified to include this
design.
The library or straight back temple is the simplest temple. It goes
on and off with ease and is the most popular for reading glasses.
Skull and Library size conversions:
125mm equals 5 inches
135 5¼
140 5½
145 5 3/4
150 6
160 6¼
Common comfort cable size conversion:
160 mm equals 6 ¼ inches
165 6½
170 6 1/3
175 7
SPECIAL FRAMES

Half-eye glasses: These are single vision reading prescription

glasses. They are intended to give the patient the freedom to look up
and see in the distance without interference. The width of the half

63
eyes gives the patient good width and allows an eyemover no
restrictions. These frames are to be fitted lower on the nose and NOT
on the bridge.

Make-up glasses: Each lens has its own hinge which allows that lens
to be flipped down. Make-up can be applied with vision from the
other eye when one of the lenses is in the "up' position. These may
also be useful in applying contact lenses.

Sports: Prescriptions can be ground into underwater and ski goggles.

Golfers may prefer their bifocal segments to be set to the side so they
can still observe their swing without interruption. These and other.
specialized optical modifications constitute sports eyeware, the most
important sports eyeware however, is the glasses which protect those
involved with contact sports (elbows from basketball) or sports with
high velocity objects (racquet balls). Individuals with only one eye
need to be cautious and maintain protection of the surviving eye.
Most protective sport frames are made of tough flexible nylon. These
do not obstruct the side vision, provide good ventilation, are secured
to the face by a large adjustable head band, and have good padding
around the bridge. When patients place themselves in fast moving
vehicles (snowmobiles, bikes, etc.) the eyelid blink may not be
quicker than the flying gravel or ricocheting branch. Participants in
these sports require eye protection.

Safety: Industrial protection of eyes is mandated by the government

through the Occupational Health and Safety Administration. This
includes protection from splashing chemicals to flying metal burrs

64
from a grinder to sparks from welding operations. Lenses are thicker
and must withstand the impact of a standardized large steel ball. The
minimum thickness is 3.0 mm; and the lens must bear a small mark
indicating that it is a safety lens. Polycarbonate plastic lenses are
acceptable. Special tints are considered depending on the
environment of the worker: dark tints are unacceptable indoors.
Subtle structural differences will include the eyewire being larger
behind the lens so that impact will be braced and force the lens to pop
out forward (away from the patient).

Riveted hinges will be required on safety frames. Side shields will de-
crease the peripheral view; some shields will be made of wire mesh
which allows good ventilation; others will be solid plastic which
protect against dust and chemicals. Comfort cables should be the rule
– they prevent the glasses from accidentally slipping off and falling
into adjacent machinery.

OPTICAL MEASUREMENTS
PUPILLARY DISTANCE”
THE pupillary distance is the interval between the centers of the
pupils. This is called the interpupillary distance (IPD) or pupillary
distance (pd). The lab places the distance between the optical centers
(DBOC) of the prescription to match the patient's far pupillary
distance. The near pupillary distance is used to match the near optical
centers of most ADDs (except the executive).
The near pupillary distance will always be smaller than the distance
pd. The eyes swing inward and move the centers of the pupils inward
when looking at a newspaper or close-up objects. The difference

65
between the near and tar pd will vary with each person: the near pd
will NOT simply be 4 mm smaller than the far pd. The variation may
range from 44/42 to 72/66 for far/near pds. Here's how:
A. Stand about 1'/2 feet from the patient at the same eye level.
B. Place a millimeter ruler (pd ruler) on the bridge of the patient's
nose.
Instruct the patient to look at your left eye. It may help to close
your right eye and use a finger to point to your left eye. The "0"
mark should be aligned with the nasal limbus of the patient's right
eye. The limbus is the part of the eye where the cornea (clear)
meets the sclera (white). (See limbus in the Index.) The nasal
limbus will be near the right side of the nose. Look at the patient's
temporal limbus of the left eye. For an average adult, this near pd
may be located near 60 mm. This is the Near pd!

C. Without moving the ruler, instruct the patient to look at your right
eye (you may need to assist the patient by closing your left eye
and pointing to your right eye). Watch the patient's left eye swing

66
 out- ward. The new position of the left eye's temporal limbus
(where the clear cornea meets the white sclera on the side near the
ear) is the measurement of the Far pd! Do not worry about the
patient's right eye placement. DO WORRY about movement of
your pd ruler.

Keep it steady.

NOTE: It is very important that you keep your hands very clean
and smelling neutral or fresh. Patients will appreciate not smelling
cigarette smoke, bleaching odors, tinting solutions, and Famous
Frank's French

Fries on your hands when you approach them to take this

measurement.
It is a courtesy to wash your hands as they wait for you. They will
appre-
Ciate your care. Hydrogen peroxide is used to clean ophthalmic
instru- ments that touch patients when there is concern of AIDs virus.
USING THE PUPILLOMETER
The simple pupillometer is calibrated for people even though
they are looking into a machine instead of at a distance object. Here's
how:
A. Set the fixation setting for the distance.
B. Turn the instrument on by placing it upright. Guide the forehead
rest to the patient's forehead, slightly above the "orbital ridges
or the eye brows.
C. Instruct the patient to look into the machine and look at the light
in the bull's eye."

67
D. You will look through the small pupil and align the small wires
directly onto the reflection you see. The reflection will be on the
cornea in the pupil area of the eye.
E. Remove the instrument from the patient's face and read the
monocular pupillary distances. Add up the number to produce a
single 1a pd. If the addition of monocular pds is different by
more than 2 trot the binocular pd, then record the monocular
pds. (For example monocular pds are OD = 30, OS 27 and the
binocular pd is 60.)
F. Reset the fixaton distance for a near setting: this may be marked
diopters (use the 2.5 D) or millimeters (use the 40 mm)
Repeat your instructions and observations of the new alignment. You
should observe a change if there is no difference between the far and
near pds, repeat unless the patient has a very, very small distance
between the centers of his or her pupils!

NOTE: Here again, monocular pds for the near vision may be very
important for your patient to have success in using the progressive or
no-line bifocals. Be precise and take your time in getting correct data.
You may want to calibrate your pupillometer. Measure the pds by the
traditional method and then set the near fixation setting for the proper
near pd measurement. You may find that the fixation setting is larger
or smaller than the near setting of 40 mm.
When strabismuic patients (whose eyes turn in or out) or patients with
a high phoria look into the machine, their eyes may naturally swing to
an inappropriate position. The pupillometer should have an occluder
which only presents one eye with the bull's eye light fixation. This
may improve the accuracy and also should alert you to the difficulty
the patient may be struggling with in keeping his or her eyes working
together.

68
When the pupillary measurement is incorrect for the patient, that
patient will be looking through unwanted prism. This extra prism will
force the patient to work harder at keeping his or her eyes together.
This extra work may cause visual fatigue, disorientation, double
vision, and even severe headaches.
Vertex distance is very important when the prescriptions are large (>-
8.00 or > +8.00). Movement of 1 to 3 mm may make the difference
between sharp and fuzz. Adjustable nose pads will help give you
potential to compensate for a frames vertex distance and the patient's
needs. Some pupillometers allow measurement of the vertex distance.
PRESCRIPTION VERIFICATION

When the patient comes in with a pair of glasses, the doctor will want
to know what power that person has been using. When the new
glasses are ordered and come back from the lab, you will need to
confirm that what you ordered is what you received. Verification
accomplishes these tasks.
1. Is the frame correct: Name? Color? Temple length and kind?
Eyesize and DBL? Any defects?
2. Verify the lenses: Are the powers correct? Is the axis correct for
the cylinder? Is the reading power correct? Is the bifocal/trifocal
style and size correct? Is the reading ADD placed properly?
3. Dot the optical centers of the lenses and verify the pd
measurement for the distance pd. Measure the bifocal segment
distances from the right nasal edge to the left temporal edge to
verify the near pd
Measure the segment heights.

THE ANSI STANDARDS

69
ANSI creates a series of limits for prescription tolerances. For the op-
tical industry they serve as a guide for accepting filled prescriptions
from the optical laboratory.

70
The procedure for mpact resistance: The lens must be able to withe
stand the impact of a 5/8 inch steel ball falling 50 inches. Exemptions
include slab off lenticular and myodisc lenses. Safety glasses require
a one inch thick steel ball for the impact test.

71
 THE LENS CLOCK

The lens clock is used to determine the power of the front and
back surface of the lens. To read the surfaces, place the center pin on
the optical center of the lens.
The front surface of many lenses today should have only one
curve on the lens. This means placement of the lens clock along any
axis radiating from the optical center will give a single base curve
reading.
The back surface, if the lens is a sphere prescription only, will
also re- veal only one base curve read by the lens clock.
The back surface will have two different base curves if the
lens has a prescription for cylinder. Some older or specially ordered
front surface toric lenses may have two base curves on the front
surface with a single back surface base curve. The toric powers
should be 90 degrees from one another: one power will be measured
at 12 o'clock and one at 3 o'cdock.

Or one measured at 45 degrees and one at 135 degrees. Remember

that the right ear lobe of the patient is the 180 degree mark and the 12
o'clock position is 90 degrees.

72
 The lens clock has a black scale for plus power and a red
scale for minus power. Use the plus black scale for the front surface
and the red minus scale for the back surface.
You can use a lens clock to verify the prescription:
Determine the front surface power. It has the same power (+6.00) in
90 and 180 degree meridians.
Determine the back surface power(s). This example has different
powers: -12.00 in the 90 degree and -12.75 in the 180 mneridian.
Make two optical crosses:

This means that a

person has a -6.00 power in the direction of the 90 meridian and a
power of -6.75 in the direction ofthe180meridian They have an
astigmatism of -0.75 x 090. This person's prescription is the -6.00 -
0.75 x 090.
The lens clock can be used simply to determine whether the front or
the back surface of the lens has the cylinder. Often, as mentioned
before a patient will complain of the glasses just not working like
their old pair or they may complain that everything looks tilted. Even
though the prescription is identical, the change from a front surface
toric to a back Slur face toric lens can irritate and disorient some
patients.
The lens clock can determine if there is warpage. The cylinder power
will be measured greater than the ordered cylinder power, the lens

73
will show cylinder power where there should be none, or the lens will
have the wrong cylinder axis position.
Another use for the lens clock is measuring the thickness of rigid or
semi-rigid contact lenses. Each diopter of measurement equals 0.10
mm thickness. First check that the surface registers Plano when the
clock pins are placed on the counter. Place the contact lens front
surface on the counter. Place the middle pin in the center of the
contact lens. Ii the lens clock measures 1.80 diopters, this registers the
contact lens thickness as 0.180 mm.
Most lens clocks are calibrated for plastic or glass. Each clock should
be marked for what material is to be measured. To translate a glass
leis clock measuring a plastic lens, multiply the power read by 0.925.
The pins from a lens clock can scratch the lens surface.

THE LENS CALIPER

The lens caliper is a gauge to measure the center thickness of lenses.
The optical center of minus lenses should be the point where the
thickness is measured. The minimum thickness is 2.2 mm for regular
glass lenses and 3.0 mm for safety lenses. Plastic lenses may be
slightly thinner. Some optical companies will create create thinner
lenses with stronger materials (polycarbonate) and with waiver from
the patient indicating no company liability for breakage or injury.
LENSOMETRY
The lensometer allows neutralization or verification of the power of
the lenses. The optics will reveal if the unknown lens has cylinder
power and its axis, if there is prism, and which direction the sphere
power, ism base lies. The lensometer incorporates a pen to mark the
optical centers of the lens.

74
A. Focus the eyepiece of the instrument so that the sharp lines are
clear.You may need to turn on the instrument and place a small
white pa- per to maximize the lines of the reticule being
clearest.
B. Place the right lens in the holder with the front surface toward
yourself.
The bottom of the eyewires should be level and resting on the stage,
which should be adjusted. The adjustment should be such that the
posi- tion of the crosshairs observed in the machine are centrally
located.

C. Always measure fromn the plus setting of the power wheel. Start
"in plus and gradually reduce the power while observing the
crosshairs in the machine.

D. Look for the sharpness of the crosshairs:

75
1. If you have a sphere only lens, you will see the PAIR or
SMALL lines be in focus or sharp as the TRIPLET (thre e PAIR
Or . LARGE lines at the only one position o of the power wheels
and axis wheels.

2. If you have a cylinder lens, you will not see the PAIR or SMAII
lines in focus at the same time as the TRIPLET or LARGE lines
One focus will be only the sphere power. The other will be both
the sphere and cylinder powers. How can you tell which is which

3. For minus cvlinder, find the SMALL lines and the more nl.
power. Do not be confused that you can turn the axis and focus
the large lines.

The rule is FIRST FIND THE MORE PLUS POWER.

Then sharpen the PAIR or SMALL lines in the machine.

Record this as the sphere power and axis. Next move the power wheel
toward more minus. If you do not see the other TRIPLET or LARGE
lines it means you missed the correct and more plus power: begin
again!

76
E. The interval between the (1) sphere power and the (2) sphere
and cyl- inder powers is called the minus cylinder power at the
axis deter- mined by the most plus sphere.

When you locate the more minus setting, make sure the axis is in the
best focus. You may need to refine the axis by a degree or two. With
all cvlinder, there will be a greater difficulty in discerning the correct
axis setting. Remember that -2.00 is more plus than -3.00.

BIFOCAL VERIFICATION

Place the glasses in the lensometer with the back surface toward
yourself. Find the optical center of the lens for the distance

77
prescription (not through the bifocal). Find the most plus sphere
power and PAIR or SMALL lines. Raise the stage that the lenses are
resting on so that the bifocal is at the lens stop. Focus the PAIR or
SMALL lines again. The difference from the distance sphere and this
number is the ADD. For example,
a. Lensometer reading of.
Distance sphere: + 1.00
Power through bifocal: +3.50 will yield an ADD= +2.50
b. Lensometer reading of
Distance sphere: -3.50
Power through bifocal: -1.00 will yield an ADD = +2.50
C. Lensometer reading of
Distance sphere: -1.75
Power through bifocal: +1.00 will yield an ADD = +2.75

NOTE: If you focus on the distance sphere and then drop down to
read the bifocal and cannot find the proper focus or the other mires
(reticule lines) in focus: Start Again.
When glasses are verified, a comparison is made of the optical centers
and the pupillary distance. If there is no prism the pd and the DBOC
should be the same or within guidelines of the ANSI standards. Mark
the center of each lens when the crosshair's center is in the reticule's
center. Measure from left to right lenses’ centers and compare to the
pd.
PRISM VERIFICATION
A. Vertical prism measurement.
1. Mark the optical centers of the lenses.
2. Average the sphere powers of the lenses.
3. Multiply the difference (in centimeters) of the two heights times
the average power. This will give you the prism.
For example:

78
OD-6.50 with its optical center 28 mm high
OS - 5.50 with its optical center 32 mm high
First, average the -6.50 and -5.50; this average is -6.00
Second, find the optical heights difference; this 4 mm which is 0.4
centmeters.
Finally, multiply 0.4 times 6 (the average) and arrive at 2.4 prism.
But which direction?
The prism direction or base direction depends on which eve we
specify to have the prism:
The prism direction or base direction depends on which eye
we specify to have the prism:
If it is the right eye it has 2.4 base down prism. This occurs
when the left eye has no prism because the correct vertical placement
is 32 mm.
If the left eye is to have the prism, then it has 2.4 base up
prism. This occurs when the right eye has no prism because the
correct vertical placement is 28 mm.
An alternative method is to use the concentric rings within the
lensometer. The center ring should indicate a 1/2 prism, the next ring
is the 1 prism mark, the third ring is the 2 prism mark, and the fourth
ring is the 3 prism diopter mark. Base Up is toward the nine o'clock
position and Base Down is of course toward six o'clock. (Base
In and Out depend on which lens is being viewed and will be
considered in the horizontal prism section.) Place the lenses on the
stage and center the optical cross or the center of the PAIR or
TRIPLET lines. Shift the frame to read the other lens. Note the
elevation or depression of the center of that lens's cross hairs.
Wherever the center falls is the determination of the prism, Base Up
or Down.

79
B. Horizontal prism.
1. Mark the optical centers of the lenses.
2. Average the sphere powers of the lenses.
3. Measure the distance between the optical centers (DBOO).
4. Find the difference between the DBOC and the pd.
5. Multiply the difference (in centimeters) times the average P power.
This will give you the prism.
For example:
If a patient's pd is b8, the optical centers are measured at 76.
The OD is + 4.00 0 and OS is +6.00.
First, the average power is + 5.00
Second, the difference between the DBOC and the pd is 76-68 =8 1
mm, which is 0.8 centimeters.
Finally, 0.8 8 times + 5.00 is 4.00 prism. Which way?
The base is determined by comparing the pd to the DBOC and
knowing the power of the lenses-
If the pd is smaller than the DBOC– with plus, it is BO.
with minus, it is BI.
If the pd is larger than the DBOC -with plus, it is BI.
with minus, it is BO.

80
Visually remember that plus lenses are two prisms with their bases
together at the optical center. With minus lenses the prisms forming
the lenses are on the edges. Just compare where the position of the
optical centers are in relation to the pd placement.
An alternative method is to use the concentric rings of the lens-
Mark the optical center of the right lens. Mark the pupillary distance
from the o optical center of the right lens to the proper pd point on the
left lens. Place the left lens in the lensometer so that the power is
being read through the pd point. This should indicate the of prism:.
If the optical crosshair's centers are to the left of the reticule, it is BI.

If the crosshair's center is to the right of the reticule center, with the
left lens, it is BO.

Common sense comparison of the pd and the optical distance

between the lenses is reliable and an elegant way to determine the
prism base direction as described above.

81
If your lensometer is an old or foreign model, the local Optometric
Society should be able to provide you with the name of a “senior”
member who may have experience with the lensometer.

OVERSIZED BLANKS

Large frames or large effective diameters cause an extra expense for

the patient. This is because of the large dimension requiring a larger
than normal lens blank. Normal lens blanks are 65 mm or less in
diameter. Generally the lab will indicate which eyesize requires an
extra charge for oversized lens blanks. Some optical companies
charge extra for eyesizes equal to or greater than 56 mm.

The lens blank has the "optical center" in the center. Usually the
optical centers are where the pd is placed. The pd is placed on the

82
frame and the lens blank may be shifted to one side or the other; the
farthest point must still be "covered by glass in the frame. This is
where the larger lens lne blank is required.

To predict the correct size of lens blank, a mathematical approach

dictates the following:

Lens Blank Diameter = Total Decentration + Eyesize

Total Decentration - Frame Pd - Patient's pd

Frame pd = A dimension + DBL

For example:

Patient has pd of 62 mm and desires a frame with an eyesize of 54

and
DBL of 15.
A. Frame pd = 54+ 15 = 69
B. Total Decentration = 69-62 =7
C Lens Blank Size = 54+7= 61... which is less than 65, no extra
charge!
For example:
Patient has a pd of 60 and wants the "Astonished Look Frame which
has eyesize of 58 and DBL of 20.

83
A. Frame pd = 58+ 20 = 78
B. Total Decentration = 78-60 = 18
C. Lens Blank Size = 58 + 18 = 78... which is greater than 65 mm,
and there is an extra charge!!
Laboratories can be creative if larger than normal lens blanks are
required; the lens blank can be resurfaced "off center" or decentered
from the original optical center. The lab will no doubt inform you of
the extra
Cost and time needed to produce this special very large or unusually
shaped lens.

THE FRAME AND THE PATIENT

F ACIAL FEATURES contribute to the success of the frame,

just as the frame contributes to the beauty of the face. Doctors
provide their best analyses of patients' needs for their best
vision. It is the province of the dispensing optician to provide a
translation of the doctor's prescription as well as the patient's desire of
a frame to create that person's look. This section will give you a
starting point for fitting frames for patients. Success will come from a
combination of inner mystique and simple common sense. As the
culture and styles evolve, you will have to update your own attitudes
to what is acceptable and what is ridiculous.

BEFORE YOU FIT THE FRAME

84
Before fitting any frame to a face, look at the prescription. Imagine
the power and bifocal or trifocal needs of the patient. Then, look at
three consequences of fitting frames.

THE WAY IT FITS

The Bridge
Start with the bridge does it fit, pinch, require adjustment? Are the
temples correct in length? Can they be modified? Do the eyewires
rest on the cheeks? Will the eyesize be appropriate for the
prescription?
The saddle bridge is the most popular. Noses that look like the Swiss

Alps may need adjustable nose pads. Keyhole bridges may work for
patients whose skin becomes irritated in reaction to saddle bridges.
The bridge should move about 1 mm from side to side. The bridge
should prevent the frame's eyewires from touching the cheeks. Ad-A-
Pads are "Dr Scholl's pads" for the nose. These may help elevate the
frame a little on a person's face and give irritated skin relief from
constant contact with plastic. With the keyhole bridge, the weight will
be on the sides of, not on the top. Sometimes in elderly patients the
skin becomes Paper thin and delicate, which may require a top fitting
bridge or adjustable pads with moleskin covers to prevent irritation.
The Temples:- Skull temples should follow the temple of the skull
ward; the bend should occur right above the ear's top and gently
follow the terrain of the outer ear hugging the skull behind the ear.
Have the patient turn his or her ear to you and gently fold the ear
forward, looking for redness from the pressure of the temple. The
comfort cable should wrap completely around the ear to within a
quarter of an inch of the ear lobe.
Eyesize :- Large eyesizes tend to make patients appear to be in a state
of perpetual astonishment. While some may wish that or feel that is

85
true, the shape of the eyesize may increase that appearance. Eyesize
can de- emphasize or enhance eyebrows, can make a square face a
little rounder, can help balance an oblong face by increasing the
width.

THE WAY IT LOOKS

After determining the optical restrictions, then determine how the

patient looks. Evaluate the shape, the color, the accent possibilities.
Do not be afraid to react to the patient's choice of color - is it
complimentary? Does it accent? Does it bring on a punk mood? Etc?
Then ask yourself, how suit- able is the shape of the frame-does it
cover the eyebrows? Does it make the face look too narrow, fat,
square, or oblong? To evaluate is to start with the general (gut)
feeling and work toward the specific (nits). Steer decision making
back toward the general evaluation when a roadblock occurs.
THE WAY IT'S USED

The function question is next. Will the frame be useful for what the
patient wants? Will the frame hold up from baby torture, from neglect
in the car, from the irreverence of the back pocket or the bottom of a
purse? Can the patient afford the designer name? Does it offer
protection if that is its purpose?
THE ATTITUDES
Recognize that each human is endowed with distinctive facial
features as well as fingerprints (excluding some twins). Each patient
will accept suggestions or will desire help up to a certain limit. Each
patient may wish or downplay) his or her unique- balance (e.g.,
minimize or some patients may wish to accentuate their appearance
toward an t2ginary desired look; and some people may simply wish to

86
accent what they've got! Interpretation of each patient's attitude
toward frames is recognition of personal philosophies.
Do not force one philosophy on another.
The Balance Attitude
Under this fitting philosophy, the shapes and lines of the face may be
mooted or homogenized into a more appealing affect. The shape of a
frame can help

Figure 39. the balance philosophy at work

The philosophy depicted in figure 39 says avoid frames which

emphasize the same shape. Avoid clashes

87
Within this guideline, color is used to coordinate with the patient's
hair color and with seasonal colors. Thus, light colored skin goes with
light colored glasses and yet a frame too light or too clear on a light
skinned individual may "wash out." Within this context, cool skin
tones should be complemented with warm frame colors and warm
skin colors should be associated with o, frame colors. Balance is the
rule.

The Accent Attitude

This is from the philosophy, "If you've got it, you might as well flaunt
it!" You will find individuals who enjoy the uniqueness of their facial
shapes. Do not impose the balance philosophy on them, but be willing
to allow them to explore and accent their own facial shape. Your job
is to provide a sounding board of experience and to provide
encouragement if the patient might want to take a little risk.

Guidelines:
What to Do with the
"The I Don't Know Attitude"
With this patient, start simple and keep the choices to three or less.
Never offer this patient a spectrum of choices concerning color,
shape, metal vs. plastic. Always keep eliminating one choice by
replacing it with another. Start simple with a good fit- ting frame,
then progress to color. If this is a blond haired person, try light
brown, gold, blue, red; if a brown haired person, try brown, gold,
copper, rose; if a red head, try red, gold, copper, light brown, blue;
if black haired, try anything, dark will work well; if grey haired
then try pastels, silver, grey. Keep the eye shapes small and slowly
enlarge the choices. Rimless will open up the face and show
smiles better than darker rimmed glasses. Try to match the "bulk'
of the frame with the general size88 of the person, e.g. thick frames
on a heavy set person.
 Guidelines:

For the Hyperactive Child

Sturdiness and insurance are desirable. Riding bows will provide

good snug fits; they need occasional checks to make sure the
frames are not causing irritation on the child's ears. Comfort
cables may be an alternative
OTHER as the young
FITTING patient matures.
NOTES

Myopes need to be cautioned in selecting large eyesizes. As the

eyesize becomes larger, the edge thickness grows, too. A -9.00 lens in
a 56 mm eyesize has an edge thickness of 9 mm; for the same
prescription in a 64 eyesize, the edge thickness is 15 mm. Even a -
4.00 goes from an edge thickness of 5 mm to 9 mm when changing
the eyesize from 56 to 64 mm. See page 54.

Aphakes need particular sensitivity with regard to their heavy

prescriptions if they have not received an IOL. The heavy lenses will
require precise placement of the vertex distance and pd. This requires
the choice of plastic lenses with a frame including adjustable nose
pads. The adjustment for vertex distance and up or down placement
for the bifocals will be utilized. Rimless frames will not work as the
large plus lens will have a "knife edge" thickness and would require

89
an even thicker lens center to accommodate the groove. A small
eyesize is advisable for these patients.

Patients with only one eye requires active protection for the
remaining eye. Plastic lenses or safety glass lenses are in order for
these vulnerable patients. The Rx for the non Seeing Eye receives a
balance lens. The lab Supplies a lens that has the similar look of the
power; it will not be an ex- act fit. Needless to say, monocular pds
and correct monocular segment heights are done only on the seeing
eye. A consideration of the frame which blocks the peripheral view of
the good eye is also a concern: Close low or high positioned temples
which obstruct a minimum amount of the view without sacrificing the
protective weight of the frame's bulk.

RESOURCES

Frames, a quarterly publication, is an excellent catalog of frames

currently available. The frame may be located by frame name,
manufacturer, or in sections labeled: Metal, Plastic, Rimless, or
Special. These are further divided into Women's, Men's, Children
(Boys/Girls). Each listing should include a sample black/white
picture, the eyesize/DBL, temple lengths, boxing diagram and ED,
the colors, and country and year of origination.

Two supplements, Frames Price Book and Frames Update come with
the subscription and may feature other items, such as dispensing
equipment, sports glasses, etc.

90
 Guidelines
How to Order the Glasses
1. Look at the prescription: Will it work in the patient's frame
choice? Does the frame really fit? Does the frame work with
the patient's features? Even though you have answered these
questions during the frame fitting process, don't hesitate to
ask yourself these questions again. You want your patient to
feel your confidence that the "glasses are them." This will
only come from you naturally when you yourself feel that
positive in answering these questions.
2. Select the lenses appropriate for the function of the patient:
segment type, size, glass/plastic, tinting, coatings, etc. This
may be the appropriate time to mention having a spare pair
or a pair of prescription sunglasses, having special
prescriptions for sports, driving, etc.
3. Measure the pupillary distance (pd). Measure the appropriate
segment height for the segment type.
4. Record
• the prescription
• the frame name
• the frame eyesize and DBL
• the frame color 91
• lens type
• the temple kind and length
 Guidelines:
Some Tips for Handling Awkward Situations
A. Patient Keeps Frames, Orders New Lenses
If the patient wishes to order new lenses for an old pair of frames,
record everything that describes the old frame (eyesize, DBL, frame
name, color or color number, temple kind and length, segment height,
box sizes, etc.). Explain to the patient that eyeglasses are still
handcrafted and that all lenses are fit into frames on a one to one basis.
It may be slightly difficult to fit the lenses properly if the frame does
not accompany the order.
B. Patient Orders New Lenses, Sends Old Frames to Lab
Again, write down all the descriptive data about the frames. This
allows replacement of the frame if the frame is destroyed or broken (it
happens!). You will be able to look up a comparable value. Reaffirm to
the patient that the lab cannot be responsible for old frames. Old frames
have an increased chance of breaking.
C. Patient Orders One Lens
Describe the frame as best as possible. Write down the
prescriptions for both eyes, draw a line through the lens NOT ordered.
Circle the eye that is ordered. Measure the Optical Center (OC) of the
lens from the nasal edge of the lens (monocular optical centers) and
measure the segment height, if any. You may wish to include the COC
distance from the segment height. If you 92 are to match the tint, you may
need to do the tinting when the lens returns from the lab and you have
the patient's other lens. If the new lens is a photochromic lens, remind
 (Guidelines continued)
A Cautionary Note
There are the people who are always trying to save pennies and
will argue to save money regardless of what they need and can
afford E pect this, But also realize that there is a significant part
of our society that needs vision care and does not have a week or
two week's worth of salary to pay for a new pair of glasses.
These people will be sincerely thankful if you can save them
money.

WHEN YOUR PATIENTS RECEIVE

THEIR NEW GLASSES..
When your patient returns to pick up the new prescription, offer some
common sense instructions for taking care of the glasses.
A. Plastic lenses need to be wet before cleaning. The water helps
lift off particles that will scratch the lenses if merely wiped
when dry. Use a soft clean cotton cloth. Avoid paper products.
Do not set the lenses on surfaces.

93
B. If the frame needs adjustment, return to your dispensary and
have the dispenser do it properly. Frames are broken easily by
patients who do not know their own strength!

C. If the new prescription is different, constant wear will help the

patient adapt. If the glasses are worn and taken off several
times during the day, the patient will never adapt. One week
to 10 days of sincere effort will be a minimum of adaptation
time. Older patients need caution if they are first-time bifocal
wearers, especially when walking up/down stairs with the new
bifocal placement.

D. First time bifocal wearers: Before asking the patient how well
they can see, MAKE SURE the bifocal is placed properly.
You are n charge of the dispensing. Before you ask the patient
to evaluate your job (Do my glasses work?"), you need to
evaluate whether the glasses are positioned properly. Confront
the issue of getting the bifocals. Also, inform the patient that
each time the patient pays attention to the distortion; he or she
avoids adjusting to his or her bifocals. When the bifocals are
placed on the patient, have the patient use to compare the ease
of view with and without the glasses when looking at small
type (e.g. a xerox of a phone book page). Have the patient
move his or her eyes in different positions. Have the patient
look at the floor from the standing position. Reassure the
patient that adaptation occurs rapidly. Tell the patient that we

94
 all adapt at different rates, but the more the bifocal is used for
what they need, the faster the bifocal will become easy to use.

E. Shift from bifocal to trifocal: Reassure the patient of success

with bifocals (hopefully). Request them to use their eyes
instead of the neck muscles (tilting down or up) to find the
right position and distant see clearly.

F. Photochromatic lenses: These lenses need a breaking in

period. The new glasses require good exposure to outside light
and good clearing or dark periods to enhance the recycling
time" from clear to dark. Sometimes placing the glasses in the
refrigerator to maximize the darkness and letting them be in
the dark over night (out of the refrigerator) will help.

G. Progressive lenses: Low powers will be easily adapted to by

first time wearers. Point out the clear "alley" or lane of vision
while the patient looks at the small print. Have them keep
their eyes centrally positioned, and place your finger where
distortion will be and then instruct the patient to turn his or her
head to bring the type into clarity.

FRAME ADJUSTMENT

Adjustment of the framne on each person takes a skill and art that re-
quires experience and observation. You will have to be alert to see
whether the frame is sitting properly so that it is functional; whether
the frame is creating new insults on the person's nose and temporal

95
skin areas; and what solutions will work to alter the poorly fitted or
abused frame to allow comfort and use of the glasses.

WHAT IS A GO0D FIT?

The frame should be symmetrical. It should be placed on the nose so

that the left and right eyewire are about the same distance from each
pupil. As the patient tilts forward, the frame front should be about the
same distance from the corneas. As you observe the frame from the
side of the patient, the tilt of the glasses toward the cheeks should be
the sanme for the left and right lenses. The tilt shoud not be excessive
or as- tigmatism will be induced. The bend in the temples near the
ears should temple not cause a Panama Canal to be carved in the
patient's skin. The temnl endpieces should gently follow the contour
of the head without digging into the skull.

When the frame is off the patient, lay the frame on the table top Does
one temple rise off the table; are both temples flat on the surface?

When you look at the side of the lenses, does one lens twist in a
different direction? Is the twist located at the bridge, or is one lens
simply bent in or out?

Some words are needed to describe what you observe:

96
 The Fit back Angle

This angle should be 90 degrees. It is best observed from above the

frame. It measures the angle between the frame front and the temple.

If the right (patient's) part of the frame is closer to the head than the
left side this is because the right fit back angle is more than 90 or the
left fit back angle is less than 90 degrees. First find the angle near 90
degrees. Then bend the more deviant angle near the 90 degree
position.

97
This angle is changed by bending the endpiece with the fiber jaw
plier. This plier has a wood-like fiber jaw which protects the plastic
or metal finish. Heat is used to warm the endpiece and move the
temple position toward 90 degrees. Be careful not to pull the hinge
out! Another method is to place the corrective bend after the hinge
barrels of the tem- ple toward the ear to correct the angle.

If there is an emergency replacement ternple which causes the fit back

angle to be too small (less than 90 degrees), the part on the tip of the
temple near the hinge may be reduced by filing the unwanted plastic
with a zyl file.

98
 The Frame Front

If one eye is closer to the one side of the frame, make sure the frame
front is straight. In these cases, it is the bridge which needs to be
adjusted. Shape the salt in the salt pan like a small hill just enough to
cover and warm the bridge. Do not warm the entire frame front. Be
careful not to twist the heat the bridge too hot. The heat may bridge to
the point of distortion or heat the cause a roughness felt on the
patient's nose. This can easily be filed with a small round file if you
get it too hot.

99
 The Temple Angle

Both temples should be at the same angle from the frame front. Place
the glasses on a touch the surflat surface. The top of the frame should
touch the face: the temples near the ear-bend points should touch.
This is called the four point touch system.

If one of the temples lifts up, this identifies a wobbly frame. The
wobbly frame will give the patient a frame that sits crookedly on the
face: one side of the frame will be higher than the other. This may put
pressure on the nose or on the ear; it may cause difficulty in using the
bifocals; and it may cause unwanted prism, visual fatigue, double
vision or headaches.

Use the pupils to judge the proper placement. Locate the temple on
the side of the frame which is lower. Angle this temple lower.
Replace on the patient or place on the flat surface and evaluate the
equality of the temple angles. Next, note which side is higher on the
crooked frame and angle the temple upward. The rule is lower the
temple on the side of the frame that is lower; raise the temple on the
side that is higher:" Do this in small adjustments. Do not try the super
adjustment move of one motion cures all. Use the pupils as the guide
for correct placement. With bifocals, the segment tops are excellent
guides to place the temple angles correctly.

Hinge gripping pliers allow you a good grip on the frame front's
hinge. Use the angling plier to change the angle of the temple.

100
Smooth, slow movements will prevent breaking the hinges. If you are
angling rimless temples: Be gentle. Stress can chip the lens at the
moun ting screw hole.

PANTOSCOPIC TILT

When the temples have a slight angle downward, this causes the bot-
of the lens to angle in toward tom of t the cheeks, rather than the
lenses sim- nlv hanging straight like laundry on a windless day.
Increasing the Dantoscopic tilt or downward angle of the temples may
raise the ap- parent height of the bifocal. This does not work in all
cases.

RETROSCOPIC TILT

101
The retroscopic tilt is raising the temple angle with respect to the
trame front. Some patients help increase their prescriptions by
bringing the bottoms of their lenses very close to their eyes.
Retroscopic angling Will return these lenses to their original position.

Figure 43 Retroscopic Angle

THE NOSE

"Goodness nose that only the patient's nose when the glasses fit their
noses."

The ideal nose pad position: The pad should be parallel with the
angle of the nose and with the frame front's pantoscopic angle.
The pads should contact the skin in a flat manner. If they are not flat,
redness and irritation will result. The pads should rest on the bony
portion of the nose and avoid the skin directly next to the eye's inner

102
corner (nasal canthus). The lateral movement should be about 1
mm. This gives the frame a little movement that prevents the skin
from being pinched.

Adjustments allowed by the pads include:

1, Vertex Distance

The pads are extended toward the patient to increase the vertex dis-
tance, and the pad's guard arm is compressed to reduce the vertex
distance.

2. Bifocal Segment Height

Moving the pads up will lower the segment placement. Lowering the
nose pads will raise the segment's position. Sometimes reducing the
distance between the wo pads will raise the frame.

103
3. Rocky's Nose

Individual pad placement allows a custom fit for each side of the
nose. Normally, the pads will be placed the same distance from the
center. With individual guard arms, placenent can compensate for the
constant left hook and consequences thereof.

Adjustment tools include:

Pad adjusting pliers which grips the pad guard arm precisely.

Snibe nose pliers which can reach into and grab the guard arm with
lever- age.

Round nose pliers allow the guard arm a "rolling surface on which to
bend the guard arm without cracking it. A nick in the thin guard arm
produce a broken arm instantly. Abused guard arms may require the
arm being straightened first, then recurved to the proper position.

Cheap alloys will break with bad breath. Gold will be a delight to
position.

Nose Pad Covers

The older a person becomes, the more susceptible the skin becomes.

The dry skin is sensitive to plastic rubbing on it and responds by first

be- coming red, then cracked, sore, infected, and then necrotic (dead).
You are responsible for stopping this progression at the observation
of red tissue. Larger nose pads help distribute the weight of the

104
glasses. Mole skin cushions can help soften the constant contact of
the pads to the skin.

Replacement should occur whenever the pads lose their sponginess or

become filthy. There are slip covers for pads which may increase the
pad Size as well as provide some cushioning.

THE IDEAL PLASTIC BRIDGE

POSITION

The saddle bridge or the keyhole bridge will gently follow or parallel
the lines of the nose sides. The weight of the glasses should be
displaced along the surface of the whole pad and should not pinch the
top of the nose (DBL is too small) or rock like a teeter totter (DBL is
too big).

Plastic Bridge Adjustment

If too small, heat the bridge area with a mound of hot salt, and gently
pull one side of the bridge away from you as you firmly hold the
other side. Do not pull the frame like a piece of taffy. If the top of the
nose is wider, simply heat the bridge and bend the eyewires outward
to widen the angle. If the nose is 1 like the empire state building,
bending the eyewires inward to keep the pads parallel may help.
Sometimes with this adjustment you may induce warpage in the
lenses, change the placement of the optical centers for high lens
bridge is fine, but the patient's powers, and change the lens cylinder
axis position.

105
If the bridge is too big, first try Ad-a-Pads. They are soft moleskin
pads with an adhesive backing. These may be the correct thickness to
reduce the DBL or raise the lenses for a bifocal which is just a hint
too low.

Some Ad-a-Pads glue on and have thicknesses varying from flat, thin,
medium, and heavy. All have a slight teardrop shape, except for the
flat pad. The thicker end of the pad is placed higher unless the boney
nose structure interferes.

Some saddle bridges have little half-moon shaped pads which extend
toward the patient. These may protrude into a patient's nose.
Modifying these small "rounded nibs" may be done by heating them
and flaring them away from the nose with a spoon's handle.
Remember to smooth the surface, which may be roughened by
heating.

Replacements for the saddle bridges on metal fra on metal frames are
available. Some simply snap in; some require a small holding screw
in the frame's bridge.

Guard arms and adjustable nose pads can be installed in saddle or

keyhole bridges. This may be the only solution if the patient
absolutely desires the frame but needs the adjustable nose pads.

THE EARS

The temple will cause irritation most often on the top of the ears or
behind the ears.

106
 The Ideal Fit

The temple should gently follow the curve of the ear as the temple's
tip curves downward. There should be another curve which hugs the
terrain of the head as the temple "wraps" around the skull. A com fort
cable or riding bow should parallel the ear's curve and the tips should
bend slightly away from the ear in order to avoid the temple end
digging into the ear.

The glasses will fall off if the temple is too long or the bend is too
gradual.

If the bend is too sharp the glasses hurt or "sit up" (the temples go up
and the lenses are tipped forward- much like to0 much retroscopic
angle).

107
Bending the temple endpieces is simple. Heat the temple and bend
with your hands into the shape needed. Avoid scorching the tip by
keeping the endpiece parallel with the bottom of the salt pan. Be sure
to cool the frame to avoid branding the patient.

The space along the side of the head above the front of the ear is the
human temple. There should be enough clearance - about 2 to 5 mm
between the human temple and the frame's temple. Too much space
ne- cessitates bending of the temples. Generally the temples should
have a slight curve which equals the curve of the human temple. If the
patient has "extra" flesh in the temple area, bend the temples so that
the temples do not indent the patient's temple.

The temple endpieces should have a little less than a finger width of
space when you gently press the frame against the patient's face. If
your finger easily inserts in the space, the endpiece may be too long
or require

Curving that is equal to the curve of the patient's ear

When you pull the frame forward, check that the frame gives a slight
but not more than 2 to 4 mm. You will encounter patients that
amount, vofer their glasses cemented to their skulls: fit the frame as
tight as they efer but instruct them that if they feel the framne
pinching anty irritating, they need to return for a slight adjustment.

108
The temple endpieces require a slight bend inward, that is following
the terrain of the skull. Too much of an outward angle will cause the
endpiece to rub on the outer ear. Too much inward angle will cause
the endpiece to jab into the patient's skull.

109
Temple covers can help soften the hardness of plastic endpieces or re-
place the covers on metal temple endpieces.

The folding angles of temples should be convenient for slipping the

glasses in and out of the lens case. If the temples are too low (the end-
pieces stick out, preventing the glasses from slipping into the case),
bend the temples at the hinge barrels. The temples are folded closed
while the bending occurs. Angling pliers are appropriate for this
technique. The pantoscopic angle should not be affected.

TIGHTENING FRAMES

1. Work on a solid surface. When you tighten screws, DO) NOT

PLACE your hand underneath you are tightening.
2. To tighten the temples: Avoid muscling the screw too tight:
the temples will move with difficulty and tightening may strip
the screws.
3. Always tighten all the screws. the temples are still loose:
remove the temple and squeeze (gently) the barrels of the
hinge together, so that the temple's barrels push in firmly.
Then replace the temple and screw.
If the screw is stripped, try the same size or replace with a nut
and bolt. Do not put in a larger screw.

110
The last resort trick with loose fitting frames is to increase the face
Wrap. Face wrap is the way the frame follows the front contour of the
face. Bending the frame at the bridge causes the frame to hug the face
and temples with a little more pressure. Be careful not to induce a fog
chamber around each eye.
Guidelines:
The Hot Salt Pan
The salt pan contains a mixture of tiny or high quality sand. Often,
adding baby static electricity which causes particles to adhere to the
frame.
Turn on the salt pan in the morning. Turn off the salt pan before you
go home. Using a timer will relieve you of this duty.
When you heat frames or parts of frames: pan.
1. Keep the frame moving when in the salt
2. Plastic burns, becomes rough, and can be pitted by too much heat.
Plastic covered temples can turn into burnt toast quickly.
3. Thicker parts take longer to heat. Older frames may require more
heat and may be brittle after heating (a no-win situation).

4. Rinse the frame after heating and bending, for two reasons:
cooling, so you do not brand the patient; and removing any lit- tle
particles which might fal. A gentle bristle toothbrush can re- move all
the salt.
5. A towel will protect your fingers from burning while you are
manipulating the frame. Be alert to metal trim on plastic frames.

111
6. Optyl requires the new shape to be held until the material is cooled.
Otherwise its memory will spring back to the previous ill-fitting
position.
If you burn or roughen the frame, you can file (zyl) the area and re-
smooth the area with acetone. Acetone is a user-friendly chemical
solution, but be cautious and clean your hands afterward.
A QUICK FITTING GUIDE FOR
FRAME FITTING TROUBLES
Ear Discomfort
Behind the ear
Temple is too short
Temple is bent too sharply
Temple is angled outward
Fitback angle is not equal
Temple is rough
On top of the ear
Crooked frame
Bad temnple bend (see Behind the ear)
Side of Head Discomfort
Fitback angle too small or not equal
Temples curved
Nose Discomfort
Nose pads not symmetrical
DBL too small or angles need customization
Small, rough, or worn pads.
Crooked frame pressuring one side of nose
Frame or lenses too heavy
Slipping Glasses
Temples too long
Frame or lenses too heavy
Bridge or nose pads need adjustment

112
Rims Touch the Cheeks
Frame front is too large
Decrease pantoscopic tilt
Ad-a-Pads
Reduce bridge angle
Reduce bridge size
Rims Touching Eyebrows
Increase pantoscopic tilt
Increase vertex distance
Eyelashes Touch Lenses
Reduce the distance between the pads
Increase the pantoscopic angle
Increase the vertex distance
Install adjustable nose pads
Reflections on Glasses
Anti-reflection coating
Tint lenses
Change pantoscopic angle
Different base curve
Bifocals Too High
Proper placement
Weight of lenses
Change from previous segment type/placement
Ad-a-Pads
Tighten frames to prevent slippage
Bifocals Too Low
Lower nose pads or widen nose pad width
Decrease pantoscopic tilt

VISION DIFFICULTIES

WHEN THE PATIENT RETURNS WITH

113
 VISION COMPLAINTS

YOU ARE the person who will be hearing about the difficulties that
patients are having with their glasses and their vision. It is important
to communicate the patient's concerns to the doctor. This may alert
the doctor about subjects that are not initiated by the patient in the
tion. This information may also allow the practioner to gear his or her
exam to finding out the root of the complain.

When the patient receives new glasses and returns in a few days with
a complaint that the glasses feel "different" or "not right," take a
moment and investigate:

A. Is the Prescription As Ordered?

Was there a large power change?

Is the cylinder axis different?

Was prism omitted?

Is there lens warpage?

Is the eyesize bigger/smaller than before?
Is the base curve different?
B. Is the Fit Correct For
pds, far and near?
facial alignment?
vertex distance?
pantoscopic tilt?

114
avoiding reflections?
bifocal segment height?
C. Are the Lenses Scratched?
If the problem is not with the fit, and or with the mechanics of the
glasses, inquire:
D. Are Glasses Being Used For What Was Intended?
For example:
If the glasses are full reading glasses (no bifocal) and the patient or
see things across greet people or uses them at work where she has to
the room, the prescription may be wrong. She may have to choose a
combination prescription for far, intermediate, and near vision
distances. Or, for example, if the doctor only measured her for a
distance of 16 inches, but the patient is using a computer or playing
the piano at a distance of 24 inches, the power may be inappropriate.
E. Are the Difficulties Due to Adaptation ?
Have the glasses been worn constantly?
When are the glasses not working?
If the glasses are a newer, stronger power, the patient may notice
swimming and swirling in the peripheral vision areas. This may be rse
if the patient keeps turning his head to keep notice of the swirl. It
takes a week, or two weeks, of consistent wearing before the brain
reprograms and begins to ignore the new "prismatic motion" of the
outer edges of the lens. Sometimes patients need a strong, supportive
word from their friendly dispensing optician. This need usually comes
at the end of a day in which everything has gone wrong. Be strong!
If there are other complications which are interfering with the per-
son's vision, it will be helpful and appropriately be your responsibility
to inform the source of the prescription. Following are some serious

115
medical problerms which may tip off reasons for altered vision. These
symptoms warrant attention.
F. Are There Any Other Medical Changes Going On in Their
Lives ?
For example:
Diabetics' vision is influenced from timne to time by the disease. The
pre- scription may progress from farsightedness to nearsightedness.
This can render clear vision one day and fuzzy vision on another day.
Drugs which act on the accommodative system can cause focusing at
near to be more difficult.
Poisons (botulism) can act on the eye muscles and cause double or
blurry vision.
Retinal or vitreal detachments may cause a shower of sparks to
ocCur, and partial or complete loss of vision may occur.
Arteriol sclerosis and high blood pressure may cause temporary
ness and recovery within a few minutes or a few days.
Multiple sclerosis may cause double vision and difficulty following
or directing a line of vision (reading).

G. Is the Person's Vision Changing?

You should be able to relate to the doctor the following:
A. When the vision changes
B. To what degree the vision changes; what the patient sees or does
not see

116
C. Does anything else change? e.g. dizziness, sweating, and if pain-
where?
D. How long does the vision change last?
E. Does anything relieve the vision change?
H. Does the Patient Really Like the Frames?
Is it a game that the patient is playing, trying to get something for
nothing?

FRAME REPAIR

FRAME REPAIR will endear your patients to you. Frame repair re-
quires manual dexterity and some artful application of mechanics
save the frame from the garbage. Learning when a frame is beyond
salvation is important in utilizing your time properly,

117
 BRIDGE REPAIR
There are three methods of plastic bridge repair:
Hot Rod Technique
1. Clean the broken ends of the frame. Often patients attempt to glue
the broken bridge. Serape off all the old glue.
2. Cut a rod from a small diameter wire. Sometimes you may be able
to cannibalize an old wire frame. Sharpen the ends of the wire into
points.
Sharpened Wire

3. Mark the center of each broken bridge surface, so that the marks
meet when the bridge is put together.
4. Heat the rod and force half of the rod into the marked point of the
broken surface.
5. Carefully, without burning the plastic frame, heat the exposed rod's
end and force the rod into the other broken bridge part at the marked
point.

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6. Smooth by filing or using acetone on the surfaces that will come in
contact with the patient.

Sew-Sew Joint
1. Drill two holes in each bridge part.
2. Clean the bridge parts of old glue and drill shavings.
3. Use nylon fishing line (e.g. rimless fishing line) and string un the
glasses together. Use a cross stitch on one side and a parallel stitch
the other side of the bridge. Pull as tight as possible and tie a good
knot. Use some super glue adhesive to add some strength in keeping
the line in position. The glue will absorb into the fracture by capillary
action.

This is a terrific soldering gun which grasps staples and heats them to
a very high temperature. The staple melts its way into the two broken
parts of the bridge. The coordination in keeping the frame together
may require a second person or a vise holding the frame in its original
configuration. The staple is put in the bridge with the top in first.
After u staple gun is unfastened from the staple, the staple legs are
nipped ou and filed smooth.

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Repairing the Bridge of a Metal Frame
Soldering techniques and dexterity are required for repairing metal
bridges of frames. Flux is a caustic material that helps prepare the
metal's surface for accepting the new solder material. The flux needs
to be cleaned as this can irritate individuals and can stain clothing.
Using the micro torch or very hot soldering requires a heat resistant
surface.
1. Clean the bridge and remove any plastic part of the framne (accents
on the frame front, nose pads, and lenses).
2. Reshape the frame so that it resembles its original shape.
3. Flux the parts to be joined. Place a small amount of solder (may be
cut to length) near the joint-to-be.
4. Heat the parts and wait until the solder "flows." Hold the frame in
position. Be sure to use a vise and/or pliers. Metal conducts heat
rapidly. Wash off the flux after the frame cools.
5. Enamel paint from a hobby store may restore the color or cover up
the solder joints.
LOOSE LENS

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In plastic frames, loose lenses can be tightened by:

Shrink Therapy

Heat the frame and then rapidly cool in water. Some materials will
shrink just enough to keep the lens from rattling loose.

Rollers and Curlers

Sometimes the eyewire's bevel moves inward proper p poition.

Heating the eyewire only will allow the dispenser to reorient the
bevel so it will retain the lens. Heating up the eyewire too much will
create spaghetti out the plastic, and the beyel w will be past the point
of salvaging

Sticky Fingers

If the eyewire is broken, glue can be applied to the lens edge and
placed into the correct position. Be careful not to leave glue
fingerprints on the lens surface, The lens will generally become a
permanent part of the frane

In metal frames lenses, loose lenses may be a result of loose screws,

If tightening the screws does not help, then use an eye liner.

Eye Liners

Bent or stretched eyewires can be "illed in" with plastic liners. The
cye liners are about the width of the eyewire and can be cut to any
length, Use the minimum necessary to tighten the lens. It is not neces-

121
sary to completely wrap the circumference of the lens with the liner.
If only one side length is needed, place the liner on the top of the lens.
This helps eliminate any overhang which might interfere with
downward eye position. If two lengths are required, try placing the
material at the 3 and 9 o'clock positions. Gluing the liners to the eye
wire for easy coor- dination of lens replacement is recommnended.

Rebounding Rimless

Screws may need to be tightened on rimway glasses. The nylon line

on rimless glasses may fatigue and become loose. It is better to
restring the lens than to stretch the old line tighter.

1. Cut the nylon cord so that the length fits all the way around the
lens. Insert the cord in the lower hole on the nose side of the frame
bar: Then insert the cord through the upper hole and leave about 2
mm of the cord in the upper groove, Use the snipe nose pliers to crinp
loose 2 mm end into the framne groove,

2. Insert the other end of the cord in the lower hole of the hinge (tem-
poral) side of the framne bar. Insert the lens into the frame groove and
pull the nylon cord moderately snug, making sure the cord is in the
groove around the lens.

3. Cut the cord from the outside of the frame, leaving about 1 mm of
extending from the lower hole. Remove the lens.

4. Pull the cord about 1 to 2 mm through the second upper hole and
crimp into the frame's groove. Place the ribbon around the cord and

122
place the lens top into the frame front groove. Use the ribbon to
stretch the cord over the lens' edge and into the lens' groove. Once the
cord is in the entire groove, slide the ribbon out.

HINGE REPAIR

If the hinge has been broken, try rebending the hinge's finger" back
into the correct position. Snipe nose pliers can provide the best
leverage for this.

lows:

If the hinge has been disabled or amputated, replacement is as fol-

For Hinges in Plastic Frames

1. Heat the endpiece or temple and remove the hinge with the pliers.

2. Select an equal or greater size hinge anchor (the part of the hinge
that sinks into the plastic).

3. Heat the new hinge with the micro torch.

4. Quickly replace the hinge anchor into the endpiece's or temple's

cav- ity. Be sure to place the hinge upright!

If the hinge needs slight adjustment (rotation), place the soldering

Iron on the embedded hinge and heat until the hinge can be moved to
the desired position. Cool quickly.

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If extraction of the hinge has produced too big a cavity, fill in the
grand canyon with some shavings, filings, or chips of discarded
plastic trame material. Optyl material is uncooperative.

For Riveted Hinges in Plastic Frames

1. File off the old flattened rivet pins.

2. Punch out the rivet face or rivet shield.

3. Clean the endpiece or temple. There will be a collection of grime,

Sweat. and other biological debris lurking underneath the river face.

4. Push the rivet pins through the holes and squeeze the face flush
with the frame's surface. Place the hinge onto the pins and squeeze
flush 4 with snipe nose pliers.

5. Cut the pins leavìng about 1.5 to 2 nm extensions showing.

6 Place the rivet face on a hard surface with a cloth or chamois

protect.

ing the frame's surface. Use a mallet and flatten the two pin sions. Do
not flatten too severely or the frame will crack.

For Hinges in Metal Frames

1. Heat (micro torch) the old broken hinge and remove from the
frame

2. Use a file, and smooth any remaining solder or debris.

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3. Select an identical size replacement hinge, flux the parts, and
solder into position.

4. Clean the flux from the frame.

5. Enamel paint will cover the solder lines.

NOSE PAD ARM REPAIR

The Guard Arm Reattachment

1. Remove the plastic and lens from the frame and guard arm
(includ- ing the nose pad).

2. Clean ll the biological debris from the guard arm and frame's
eyewire.

3. Select a new guard arm or fabricate one by amputating a guard arm

from an old frame.

4. Apply the flux onto the guard arm and eyewire area for attach-
ment. Put a small section of solder on a heat absorbing surface (as-
bestos).

5. Heat the replacement guard arm and touch the solder. Heat the
solder so that the guard arm can pick up a small bead of solder.

6. Quickly touch the guard arm to the evewire attachment point. Heal
is needed to create the flow of solder, which forms a good union. Al-
low to cool.

125
7. Clean off the flux, reassemble, and re-fit to the patient's nose con-
tour.

NOTE: Aluminum, cheap metal alloys, and certain space age alloys
do not solder well.

NOSE PAD REPLACEMENT

Rocking Pads are easily replaced if they are either the clip-on or
screw-1n type. Many cheap frames s do not allow replacement of the
pads. To replace the cliP-On type, Simply use the snipe nose pliers to
re- rebend the new arms to the guard arm. move the clip-on side arms
and rebend the renlace the , slmply remove the screw and replace the
arm dnew screw. An effective method of replacement can utilize fine
cop- fishline in "re-tie-ing" the pad to the guard arm's at- per wire or
nylon tachment point. The fish line may tie the pad to the arm, and
then the extra line may be eliminated with a razor blade.

Other unique or antique pads available include those that snap in, a
hall and socket which twists in, and a rivet type (which is non-
replaceable).

126
 FRAME SURFACES

Plastic Frames

The surfaces of frame that have become scratched, burned, scraped,

etched, or cracked can be smoothed with acetone. Acetone has a
charac- teristic fruity smell and dissolves in water. Use a Q-tip to
apply and smooth the plastic. Excess use of the acetone will whiten
the material.

Materials become white from frequent washing in soap, from the salts
in sweating, and from exposure to heat (glove compartments of cars).
Oil will help return a darker color to the frame color. WD-40 and
furniture polishing oil may help.

Buffing will restore the lustre to frames. Rouge (waxy compound

used by jewelers) will aid in filling in scratches, especially with Optyl
material. Polyurethane (or, temporarily, clear finger nail polish) will
re- turn the shine to the frame material.

Metal Frames

The greenish discoloration of the frame and skin is generally a

chemical reaction to copper contained in the bronze or metallic alloy.
This can be re- duced or eliminated after cleaning by a coat of
polyurethane. Coat the areas where the frame will most likely come in
contact with the skin. Polishing the frame may remove the frame's
paint. Look at the hinge areas to determine if the paint is annodized
(mixed in with the material, not merely applied on top of the

127
material), Paint can be nearly matched with enamel paint (in a variety
of finishes: gloss, gloss, serni-matte, matte),

SCREW REPLACEMENT

Screws are often stripped. The rame is so loose and the patient Le
Comes frustrated and bears down on the screw with an effort as
strong as someone pumping iron.

First, try a similar screw. Often the threads of the hinge or frarne are
still intact. If this does not work, try a nut and bolt. The bolt may re
quire trimnming with a pair of cutting nippers.

A time consuming approach is retapping the screw hole. Thís re-

threads the damaged hole with a slightly larger screw thread size. Be
sure to have the tapper straight rather than angled. The use of a vise
helps eliminate misdirections.

If a screw head snaps off, there are two devices and two techniques
which will extract the remaining screw portion:

1. A screw extractor will screw on to the remaining threads and allow

a good grip to remove the screw. There are a variety of sizes.

128
2. Punch pliers can exert tremendous pressure and allow an exit of the
screw. File the screw so it is flush with the surface. If this is not done,
the screw may bend over and become a new rivet.

3. Drill out the remaining screw with a drill bit slightly larger than the
previous screw. The new hole may be retapped or a nut and bolt may
be used in place of a screw.

4. If there is some of the screw above the surface, file a place for the
screw driver. Rat tail files or screw head files will accomplish this.

However, if tightness or glued threads prevented the longer screw

from being removed, reslotting a smaller screw for removal will not
help.

NOTE: Some safety glasses and well nade frames have small plastic
sleeves which are inside the screw hole when the screw is first placed
in. This plastic expands as the screw enters and nep prevent the screw
from loosening. Another tool, the sleeve ex- tractor, is required when
removing the old sleeve. After the old screw is removed, the extractor
is screwed in the hole, and then pulled out. The replacement screws
already have the sleeve on them. Simply rescrew.

With rimless screws, it is important to replace the washer between the

screw head and the glass. This reduces the chance of chipping the
fragile and vulnerable glass hole rim,

129
Nylon screws may be used with rimless glasses. Replace- ment is
easy. The length may be reduced by a razor blade (put something
hard beneath the cutting point). Be sure to leave a small amount,
which is then heated to form a plastic rivet head.

TEMPLE REPLACEMENT

The temple can be replaced from samples or old frames. If the end-
piece is missing, sometimes a sports band can be attached to prevent
the frames from constantly falling off.

The main difficulty in temple replacement will be matching the bar-

rels of the hinges. With a file the thick single barrel can be reduced to
fit into a two barrel receptor. Breaking off one barrel from a three
barrel hinge may allow it to fit around a large single barrel. Drilling
holes in the temnple andnylon fish line can produce a union, at least
for the dura- tion of a weekend.

If the temple is too long and the hinges are correct, amputate! Cut the
endpiece the same length as the remaining temple, and file so that it is
smooth. Then reshape.

Some library temples may be used upside down if that is the only
temple you have. This kind of temple will require less heating and
bend- ing to recreate a new left temple from a right temple!

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REFERENCES

132