Spectacle Spectacle Intolerance & Its Intolerance & Its
ManagementManagement
OPTOM FASLU MUHAMMEDOPTOM FASLU MUHAMMED
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““Handing over of Handing over of Spectacle to the Spectacle to the
Customer is not the end Customer is not the end of the matter, may be of the matter, may be
beginning of a problem beginning of a problem both to dispenser and both to dispenser and
customercustomer”
Spectacle Intolerance & Its Spectacle Intolerance & Its ManagementManagement
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
Vision not clear at arms lengthHead ache, Eye acheReading Distance too shortIll-fitting framesEyes pulls on wearing specs due to decentring and induced phoriaDistorted or tilted ImageAwkward head positionDiplopia
The Common ComplaintsThe Common Complaints
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1. Cosmetic1. Cosmetic
Cosmetic Cosmetic Intolerance is Intolerance is mainly subjective mainly subjective and is best left to and is best left to the patient to the patient to decide.decide.
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection
2. Functional2. Functional
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Parts of a FrameParts of a Frame
Improper Frame Improper Frame SelectionSelection
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Improper Frame SelectionImproper Frame Selection
RigidStrongLight weightBest fitComfortable to wear
Frame SelectionFrame SelectionThe Frame must beThe Frame must be
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Improper Frame SelectionImproper Frame Selection
Temporal Hair Line Margin DistanceIPDShape of facePhysical features of faceNose BridgeSuitable Side arms (Temple)
Frame SelectionFrame SelectionPoints to be taken into Points to be taken into accountaccount
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OvalOvalRoundRoundRectangularRectangularSquireSquireTriangularTriangular
Frame SelectionFrame Selection
Shape of faceShape of faceApproximately there are main 5 shapes
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Frame SelectionFrame Selection
Shape of faceShape of face
OVALOVALLucky People! All Lucky People! All
types of frames types of frames
suit them as long suit them as long
as they are well as they are well
fittedfitted
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Frame SelectionFrame Selection
Shape of faceShape of face
Round Frames with Crisp , Straight Lines will break up its Roundness and give it a more structured geometric look
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Frame SelectionFrame Selection
Shape of faceShape of face
RectangularBigger, Longer frames are appropriate as it tends to make the face appear shorter
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Frame SelectionFrame Selection
Shape of faceShape of face
SquireOval or Round Frames is better to de-emphasis its squireness
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Frame SelectionFrame Selection
Shape of faceShape of face
TriangularRectangular frames or
frames with pointed
edges will suit.
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Colour
Eyebrows
Shape of nose
Shape of cheeks
Frame SelectionFrame Selection
Physical Features of facePhysical Features of face
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The frame size is noted on the inside of the side arm like ‘54/18’
54 Means size of Rim 18 Means Size of nose bridge that
varies to 18-26mm
Frame SelectionFrame Selection
Physical Features of facePhysical Features of face
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Properly fit frames touch the patient in only three places; the bridge and top of the ear
“Fitting Triangle”
Frame SelectionFrame Selection
Physical Features of facePhysical Features of face
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Don’t let ur glasses take over your faces!Top of the frame should fall below the eye brows.
It should mask Eye browSweating can fog lenses easily
Frame SelectionFrame Selection
Physical Features of facePhysical Features of face
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Frame should not rest on on the apple of the cheek. The patient should be able to move their cheek without any frame slippage
It can cause
EctropionEpiphoraScar on the cheek
Frame SelectionFrame Selection
Physical Features of facePhysical Features of face
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Key holeThin nasal bridge
SaddleAvarage size
Adjustable nospadSuitable for most patients
Frame SelectionFrame Selection
Bridges of the noseBridges of the nose
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Frame SelectionFrame Selection
Bridges of the noseBridges of the nose
Key hole Saddle Adjustable nose pad
Adjustable nose pad is Suitable for most Adjustable nose pad is Suitable for most patientspatients
Saddle or Key hole is Suitable for High Saddle or Key hole is Suitable for High powerspowers
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It should ideally conform to back of the ears-
Ears may be dissimilar.
The frame should rest on the face so that fitting
plane of lens should be perpendicular to the visual
axis.
Frame SelectionFrame Selection
Side arms or Temple Side arms or Temple
For High Myopes Smaller Frames, Converse in For High Myopes Smaller Frames, Converse in HyperopesHyperopes
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame Improper frame selectionselection
2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & Anisometropia &
AnisokoniaAnisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
2.Lens Fitting2.Lens Fitting
2. Functional2. Functional
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Pupillary alignment
Fitting plane of lens
Type of lens
Optic center
Lens FittingLens Fitting
What should one look for in lens What should one look for in lens fittingfitting
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Both pupil should be close to OC (Optic Centre) of each lens to take full advantage of refractive correction.
Lens FittingLens Fitting
Pupillary AlignmentPupillary Alignment
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If IPD (inter pupillary distance)
does not tally with OC it will make prismatic effect for which the patient makes subconscious effort to neutralize in the interest of clarity of vision. This leads to eye strain
Lens FittingLens Fitting
Pupillary AlignmentPupillary Alignment
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In the case of children who do not co operate or Squint
IPD is measured by finding the distance between inner
canthus of one eye and outer canthus of other eye
Lens FittingLens Fitting
Pupillary AlignmentPupillary Alignment
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Lenses should be plane perpendicular to the
visual axis.
For Near since the eyes directed down ward
they tilted slightly (10-150) towards the cheek
this is called ‘Pantoscopic tilt’
Lens FittingLens Fitting
Fitting plane of LensFitting plane of Lens
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PANTASCOPIC TILT
Lens FittingLens Fitting
50 - 150
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The lenses should ideally be fitted 15.7mm in front of cornea (VD- vertex distance) which corresponds to the anterior principal focus of eye.
The effective power of lens will change with change in VD.
The effective power of plus lens will increases when les moves anteriorly and inverse to the minus lens
Lens FittingLens Fitting
Fitting plane of LensFitting plane of Lens
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Lens FittingLens Fitting
Fitting arc of LensFitting arc of Lens
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Glass
CR
Univis
Trifocal
PAL
Executive
Photo chromatic ETC
Lens FittingLens Fitting
Type of LensType of Lens
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Geometric center is center of lens while
optic center is center of optical system.
Lens FittingLens Fitting
Optic CenterOptic Center
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Lensometer
By throwing torch light
By coinciding Cross line
Lens FittingLens Fitting
Optic CenterOptic Center
How do you find optic center?
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Optician’s Rule
Lens FittingLens Fitting
Optic CenterOptic CenterHow you Measure Fitting parameters?
IPD
Nose Bridge
Temporal hair line margin
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Lens FittingLens Fitting
BifocalsBifocals
Two portion should provide equally clear vision free from aberration
There should no sudden change in prismatic effect at the junction of two segment
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Lens FittingLens Fitting
BifocalsBifocals
Image displacementKryptock bifocal is best to Plus lens
Univis D-Bifocal is best to Minus lens
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Lens FittingLens Fitting
BifocalsBifocals
The centering of two portion should
exact for their different purpose.
Ideally top of B/F segment should
be at the level of lower lid.
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Lens FittingLens Fitting
BifocalsBifocals
Ranges of Vision
Working Distance
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
3. Wrong Prescription3. Wrong Prescription
2. Functional2. Functional
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Wrong PrescriptionWrong Prescription
Over correctionInadequate correctionIncorrect or illegible correction
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
4. Anisometropia & Anisokonia4. Anisometropia & Anisokonia
2. Functional2. Functional
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Anisometropia & AnisokoniaAnisometropia & Anisokonia
Difference of 0.25D – 0.50% difference in retinal
size.
Eye can Tolerate upto 2.50D Difference.
No Diplopia at the time of refraction but Diplopia
after dispensing lenses means difference in base
curve of two lenses.
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
5. High Refractive Errors5. High Refractive Errors
2. Functional2. Functional
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High Refractive ErrorsHigh Refractive Errors
Peripheral magnification & Distortion
Restriction of field
Weight of the glass
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High Refractive ErrorsHigh Refractive Errors
Good centering of lenses
Hi index glasses
Small size frames Separate glasses for distance
and near
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
6. Organic Disease6. Organic Disease
2. Functional2. Functional
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Organic DiseasesOrganic Diseases
Frequent changes of spectacle necessitates a detailed investigations to rule out Diabetes, Glaucoma and Cataract.
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
8. 8. HeterophoHeterophoriaria
2. Functional2. Functional
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HeterophoriaHeterophoria
If one has exophoria and needs minus lens give him full correction, but if he needs plus lens he should be under corrected and vice versa in esophoria. This will enable him to overcome the phoria with accommodative convergence
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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’
1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria
2. Functional2. Functional
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ConclusionDo not change the glasses if asymptomaticDo not change the glasses if asymptomatic
Give same base curve as beforeGive same base curve as before
In high minus lenses specify hi-index glassesIn high minus lenses specify hi-index glasses
Proper counselling must be done if patient is Proper counselling must be done if patient is wearing specs first time, shifting to bi focal, or wearing specs first time, shifting to bi focal, or changing frame size.changing frame size.
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Conclusion
Be Patient and careful, when you prescribe glasses. Spend some time in checking the glasses, otherwise the patient will come back to you with most demoralizing and embarrassing statement “ My earlier Spectacle was better”
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End of this topic
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Lens Lens EnhancemenEnhancemen
tsts
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What Lies Between You and Perfect VisionWhat Lies Between You and Perfect Vision
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For More Details and Technical Advice
Contact
Mr. SarafudheenDispensing OpticianAl Salama Eye Hospital Ltd,PerintalmannaPh: 04933 225524
K Mohamed KunhiManager-Clinical ServicesAl Salama Eye Hospital Ltd,PerintalmannaPh: 04933 225524, 9895116363Email: [email protected]
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Thank You