Back to School!

Within days (or weeks depending on where you live), the little tykes will be leaving the home, and heading back to school. Parents will gain back some small sliver of peace and quiet (only to lose evenings, helping with homework).  With the return to school, it’s important to think about the vision needs of your kids in a new way. There are many aspects of a child’s visual needs which can become more prominent as the school year begins.

Keep in mind, if a child’s vision is not properly corrected it can cause developmental delays and adversely affect their grades and enjoyment of school.  A child cannot tell you they don’t see well, if they don’t know how they should see in first place!

The Modern Classroom

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Today’s children face very different visual demands than we did as children. First and foremost amongst those changes are the prevalence of digital devices. Virtually all children, from every socio-economic demographic, face a much higher demand on their eyes because of this increase in screen time. Even much school work is completed on tablets in the classroom and many lectures are in PowerPoint, not to mention the increasing reach of Google Classroom for their homework. All of these things dramatically impact the exposure to Harmful Blue Light for kids today.  There have been numerous studies showing a correlation between exposure and the development of Age-Related Macular Degeneration (AMD) later in life.  AMD is an eye condition which is irreversible.  Once it begins, we can only slow it’s progress and the end result is blindness.  The Macula is the central portion of the retina with the highest concentration of cones (color sensing photo-receptors).

Children today, will have a much higher lifetime exopsure to Harmful Blue Light because they are growing up with digital devices and LED light bulbs, which both put out a much higher concentration of the blue light we are concerned with.

Modern lens technologies have ways for us to filter the harmful aspects of blue light, while allowing the “good” blue light to get through.

Glare From Screens

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In addition to the concerns of Harmful Blue Light exposures, all of those digital devices create a lot of eye strain from the glare reflecting off the screens as well.  Having a good Anti-Reflective (AR) coating can help to reduce the strain caused by reflections off of devices, as well as the reflections within the lens.  In addition, there are some AR coatings which can filter even more of the Harmful Blue Light (such as Crizal Prevencia from Essilor).
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Kids Play Outdoors Too

If your child plays outside, and needs a distance correction, you probably should consider Transitions lenses as well.  These lenses adapt to light (or UV) exposure to make a lens comfortable in most lighting conditions.  They also come in three colors, so they can be cosmetically appealing to your child, as well as provide the right kind of contrast for their favorite outdoor activities.  There are other brands of photochromic lens technologies available, so make sure you are choosing the right type for your child’s needs.  Transitions has more than one version, to fit all the different lifestyle needs.  For example, there are versions that respond to any visible light, or those that respond only to UV exposure.  This is one category where personal preference becomes the most important decision making factor, in my opinion.
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Don’t Forget Sports

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The beginning of the school year also often means the beginning of team sports season as well.  From basketball, football, hockey, and volleyball, having a good pair of protective sports eyewear is critical.  There are many manufacturers of sports glasses. I don’t really want to endorse any specific brand (though I do have the greatest experience working with Liberty Eyewear).  The most important things to be looking for when choosing a sports pair of glasses are:

  • Safety Thickness (Z95.1)
  • There is silicon or rubber padding around the bridge and eye socket

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Sharing a Link

I felt it important to share this piece which popped up on my feed today.  Much of what is said here is very valid for the vast majority of you.  I realize that not everyone is comfortable, or even able, to spend $1000 on a pair of glasses, but thereare reasons we, as opticians, recommend glasses that total in this neighborhood .

Thank you to Dr. Cathy Wittman for this piece.

Enjoy:

https://www.linkedin.com/pulse/why-spending-over-1000-glasses-worth-dr-cathy-wittman

Progressive Lenses…Continued

Progressive Lenses…Continued

There are quite literally several hundred progressive lens designs available on the market. Yes, you read that right. Looking at the Progressive Identifier book from 2015 (the most recent published), there are 348 designs. I know that there have been at least 60 lens designs launched since then. So, this means that there are approximately 400 different ways we can address the needs of a Presbyope (see definition in this previous article).

In this selection of lenses, there are designs which were developed close to 40 years ago, and ones that were officially launched last month. Newer isn’t always better, but the oldest are almost always worse.

The speed with which new lenses are developing can be daunting to keep up with, even for the most seasoned of opticians. Every manufacturer likes to claim that their latest is the greatest for every patient we have. This is invariable not true. Sometimes the latest can be the greatest…but usually for a specific lifestyle or prescription type.

My Study

In order to better serve my patients, I began wearing progressive lenses much younger than the typical person. I put on my first pair at age 36, with the weakest reading addition possible. Since that time, I have worn 53 lens designs, continually testing both new and old technologies, different design concepts, and products from different manufacturers. In addition to all this personal testing, I also had coworkers evaluate the same lenses. Because each lens design doesn’t necessarily perform the same way for each prescription type, my colleagues who wore a different type of correction were used to get a more complete sample set.

Through this rigorous testing that I’ve done over the past 8 years I have developed a working knowledge of not only how different lens designs feel to wear, but also how to adjust the fit on a patient to get the most out of each lens design.

I will be the first to tell you, (as you can see from everything I’ve written above), I have not tested EVERY design available, but I’ve dipped into enough designs I feel I can give you a fairly well informed opinion on some of the lens designs which are best suited for different budgets, and different prescription types.

Recommendations

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The following recommendations are based on my own personal experience, and that of colleagues. Admittedly, there are certain brands I know better than others, and there are variables associated with lifestyle which are not entirely addressed here.

For those nearsighted in the distance (minus power), I have found that the following lenses work quite well:

  • Varilux Physio DRX
  • Zeiss Drivesafe (great for those who need larger intermediate-i.e. teachers, heavy computer users)
  • Shamir Autograph II
  • Kodak Unique (budget)
  • VisionSource TruClear

For the farsighted patient (plus power), I have found the following lenses are a better choice:

  • Varilux Physio W3+
  • Shamir Autograph II
  • VisionSource TruClear
  • Shoreview (budget)
  • Zeiss Drivesafe (again, great for those who need a larger intermediate zone)
  • Varilux Comfort (budget)

I actually have very little experience with Hoya branded lenses, so I am unable to recommend specific designs from their line of products.  Also, some lenses which have worked quite well for some patients, but seem less consistent in what they provide to each patient would be:

  • Varilux S Design (Fit)
  • Varilux Physio Enhanced (one advantage is a design specific to Asian fit)
  • Younger Image
  • Sola MAX (budget)

Addendum

While writing this, I helped a patient who had a bad experience with the progressives she purchased two years ago.  She never came in to discuss any problems she was having with them.  She just assumed that was how they worked.  Please realize that if you have any difficulty with your lenses after you pick them up, subtle changes to adjustment can have an amazing change in your experience.  If you have any struggles with your new lens, whether it was something I recommended or not, follow up with your optician.  They can often fix problems with reading or mid-range zone size/location with very simple adjustments to how the frame fits on your face.  If the problem cannot be resolved through this process, they should have access to a Progressive Non-Adapt redo through the lab they used to fix any problems you’re experiencing.

Please be aware that these non-adapt redos can only be completed within a brief period (1-3 months) after you pick up your glasses.  If you experience any problems, don’t delay seeing your optician to resolve them!

Take Away

Any troubles you may have had in the past with progressive lenses, are not indicative of your ability to wear progressives in general.  Any bad experienced is more likely a sign that you were fit in a bad design for your prescription or lifestyle.  Talk to your optician about your experience and they will be able to help you find the right lens for your needs.

Vision Insurance vs. Medical Insurance

Insurance can be a very confusing thing…even for those of us who have to deal with it on a daily basis. Defining what your coverage is, when it comes to vision benefits, can be a very loaded question. Moreover, knowing which insurance company you have, often tells us relatively little about what your coverage will entail.

First Things First

Probably the most confusing thing for most patients is understanding that your medical insurance is not necessarily your vision insurance. Most eye care professionals will take both medical and vision plans, but medical plans will only cover the examination–and ONLY if there is a medical diagnosis! So, I’m sure your next question is, “what is a medical diagnosis anyway?”

In order for an eye doctor to bill any kind of visit to your insurance, we need to use diagnosis codes, which define the reason for your visit. A prescription for corrective eyewear is not considered medical, believe it or not. A medical diagnosis, generally means a visit which requires a pharmaceutical treatment (but not always!). So, we can only bill your medical insurance if you’re seeing us for a foreign body in the eye, an eye infection, glaucoma, etc.

If you’re coming to us for contact lenses or glasses, then only a vision insurance can be used.

So What is a Vision Insurance (Or Alphabet Soup)

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Typically, your medical insurance will contract with a secondary insurance which specializes in vision coverages. For example, if you have Aetna for your medical, then you almost definitely have EyeMed for your vision insurance. A vision insurance is about covering your routine annual eye exams, and any corrective eyewear you may need.

Amongst the major vision insurance companies, each company can have thousands of variations on the coverage available, all based on what your employer has negotiated as your coverage level.

How Vision Insurance Works

There is actually quite a wide variation on how vision insurance plans cover your materials. However, there are some overarching methods which apply to the vast majority of plans…

The Breakdown

Most plans have your coverage broken down by specific frame and lens components. For example, you may have $120 available towards a frame. And typically, you would pay only 80% of the overage. So, in this example, if you chose a frame that costs $250, we would subtract $120, leaving $130, and then we would subtract 20%, leaving a patient balance of $104.

The lens coverage usually has specific dollar amounts we are required to charge for each lens “option.” So, following through the example, let’s assume you need a progressive lens (see earlier post here). And of course, as mentioned here, you need anti-reflective (no glare). Also, as with most people, you are quite light sensitive so you decide you would like Transitions as well.

Below, I will use some assumed coverages, based on how VSP Choice works (probably the most common insurance type):

USUAL & CUSTOMARY PRICE           AFTER INSURANCE
Frame:              $250                             $104
Progressive:     $400                             $150
No Glare:          $165                             $95
Transitions:     $130                             $86     
TOTAL              $945                              $435

You’ll notice that the after insurance cost is roughly half the original cost.  This is a very common result for VSP Choice.  Other plans may have variations on this theme (some cover much less, some quite a bit more).

One of the most important things to take away from this, is that your coverage will be the same ANYWHERE you go that is within network.   We don’t set these prices, your insurance company does.  So “price shopping” very rarely does anything at all for you.  What you want to shop for is the experience, customer service, and accuracy of your eyecare provider.

Take Away

Vision Insurance is not Medical Insurance.  It’s confusing, I know.  You would assume that since your vision is part of your overall health, it would be covered by the same plan, but it’s always been treated differently.  Understanding how your coverage works can be confusing.  Understand that your eyecare professional is there to help you sort through it.

And most importantly, the price is the price is the price.  Wherever you go, this will be the same.  When selecting who will get your eyecare business, choose based on service, talent, experience, and accuracy, not price.

 

 

Dispelling Misconceptions

There are many patients who feel they completely understand some basic technologies in this field–they aren’t always ENTIRELY correct about this. In particular, Anti-Reflective (or No-Glare) and Photochromic (or light-changing) lenses have been around for decades. Whenever a technology has been around for a long time, there can be misconceptions about how it works, or even how different versions vary, simply because the point of reference from experience is with an older version of the technology.

ANTI-REFLECTIVE

The purpose of anti-reflective coatings is to minimize the amount of surface AND internal reflections. This can be mildly complicating to explain, but I think it’s possible to boil the benefit down to something digestible without injecting too much science. At the most basic, all anti-reflective coatings bend wavelengths of light so that reflections can be cancelled out, allowing more light to reach the pupil, and thus increase clarity of vision. This benefit applies to all prescriptions, but can be more noticeable with certain prescription types. Generally speaking, if you need glasses to see distance, or to work on any kind of digital device, you will notice the improvement in clarity.

Where Anti-reflective coatings vary is what they do beyond the removal of reflections, as well as how much reflection can they eliminate. Generally speaking, the more expensive the coating the more it does for you. This should be obvious, but as with so much in our field, many patients can believe there is essentially just one version and it’s all salesmanship and false promises to “upgrade.” I’m here to tell you that there is most definitely a difference amongst the coatings out there.

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A standard uncoated lens loses approximately 10% of all light to reflection. A portion bounces off the front, and this is what othere people see. It’s the cosmetic side of what AR does for you. But the greatest concern, from an optics perspective, is that a portion of the light enters the lens, bounces off the backside of the lens, bounces back to the front, and then continues towards your pupil. This “internal” reflection creates a ghost image on your retina. You see what you’re supposed to, as well as this faded, just off alignment, false image. When you are in a darker environment, with points of light, this ghost image is very hard for your brain to filter. So, when driving at night, for example, these additional reflections can be very distracting.

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Above are some examples of how different coatings can appear. You’ll notice that there is one coating with a slightly blue hue. This particular version is designed to maximize light transmission to the highest level possible. But this isn’t the only thing that varies amongst coatings. In addition to removing reflections, they can also improve scratch resistance, repel water, and oil, or even add an anti-static layer so that you need to clean your lenses less often (because dust is repelled). The coating process is quite involved, and can take as long as 24 hours to complete in a vaccuum chamber.

PHOTOCHROMICS

The technologies involved in creating photochromic lenses have evolved in significant ways since the first plastic versions were created in the early 1990’s. The earliest version was only available in one type of material, and it’s responsiveness was less than ideal. The older versions never got fully clear, and didn’t get particularly dark in the sun…unless it was cold out. As a native of Northern California, and one of the earliest guinea pigs for this original version, I discovered those limitations in a profound way. I got my first pair just as I was leaving for college in San Francisco. The relative chilly weather in the City left my lenses permanently around 50% tint. Too dark for most activities, but not dark enough in the sun.

Since that first version almost 30 years ago, things have improved dramatically. The lenses can now reach 80% or more in bright sun, and are virtually clear indoors. On top of that, there are many versions…some are light sensitive, some are UV sensitive, some become polarized, and there are many color options as well.

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Far and away the most well known version of photochromic lenses are called Transitions, but there are other technologies out there.  It’s important to have a discussion with your optician about what you want your lenses to do, to make sure you’re choosing the right one.

TAKE AWAY

Anti-reflective treatments are important for pretty much every pair of glasses.  It’s always going to make your vision sharper, and most often the complaints associated with Anti-reflective coatings are about earlier versions, or cheaper versions.  The best versions reduce smudging, as well as scratches.

Photochromic lenses aren’t necessarily for every patient, but the advancements in the technology has taken them much closer to hitting that mark.  Even if you’ve had a negative experience in the past, it’s worthwhile to discuss the changes with your optician to see if they can be a good solution for your needs now.

Cylinder Samples

A quick follow up to yesterday’s blog post.  I was finishing lenses for a patient today and wanted to share a great visual representation of what astigmatism looks like in a pair of glasses.

Below are two images, one is a front view of a lens, in which you can see reflections from the fluorescent lights.  You’ll notice how one reflection is “square” with the frame and the othere is on a sharp angle, almost 45 degrees off the first.  The first reflection is from the front of the lens, where there is no cylinder/astigmatism correction.  The second, severely angled reflection is from the backside of the lens where the cylinder is ground into the lens.

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Cylinder in Reflection

The second image here, shows a side view of that same lens where you can see the variability in lens thickness, which matches the angle and severity of the astigmatism correction.

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The “Cylinder” of Astigmatism

 

I hope you’ve enjoyed this update…

Explaining Your Prescription

Your prescription drives everything we do for you, as an optician. It steers us through which lens design might be best for you, which frame is suitable for you, and when you should wear your glasses. But, we often make assumptions in our field, that you understand what the numbers and terms mean. I’m hoping to clear the air and help you understand what it all means.

Demystifying the Mystery

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Explaining your Rx

The names used for the different parts of the prescription can be confusing to the uninitiated but, there is no need to be afraid or confused, with a little bit of tender guidance. The terms can actually be quite self-explanatory, once you have a grounding in some basic facts about how lenses work. In the end, it all comes down to how Light is bent by the shape of the lens, and how this corrects for the wrong shape of your eye.

Basically it all comes down to correcting the fact that an eye that needs glasses is the wrong shape. We put a prescription lens in front of the eye to help bend the light towards the correct path.

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Hyperopia vs. Myopia

If you are corrected for Myopia, or nearsightedness, you wear a “minus” power lens. This indicates that your lens is concave (i.e. relatively flat on the front surface and steeply curved on the inside surface). This means, in practical terms, that your lens will be thickest on the outside edge.

Conversely, if you are corrected for Hyperopia, or farsightedness, you wear a “plus” power lens, indicating that your lens is convex (i.e. relatively steeper curve on the front surface of lens than on the inside surface). This means, in practical terms, that your lens will be thickest right in front of your eye.

The Confusing Part

 

Astigamtism takes a little more time to explain, so bear with me. Astigmatism, is essentially a lack of roundness to the eye. The eye is more egg, or football, shaped than someone who has good vision. But this is where it gets a little complicated. Think of it, more like the egg is standing on it’s end, rather than laying on a counter like you’re used to seeing them. It’s oblong, vertically, rather than horizontally.

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Which Came first the Chicken or the Astigmatism?

This lack of roundess to the eye is corrected with Cylinder. Cylinder is actually rather self-explanatory. A cylindrical lens is exactly that, a lens that is made by taking the side of a cylinder, rather than a end/sphere. This also explains the final column in your prescription. A cylinder can be set on different angles to correct for which angle your egg-shaped eye is standing on. So your astigmatism correction is both the Cylinder AND Axis. This explains the most common components of a Single Vision Prescription. There are other components, but I will save them for an addendum very soon.

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Take Away

I hope after this brief explanation of the three basic componenets of your prescription has helped you understand the basics of why we choose the frames we do for you, and how we can help make sure your glasses can look as good as possible.

 

 

You Pick Your Prescription

Most people are unaware of this basic tenet of the Optical Industry…You choose your own prescription!

I know it, it sounds preposterous to think this could be, but at it’s most basic that’s what’s happening.  Think about it.  You are asked to choose which you like better (1 or 2, A or B).

But even more important than this, your personal state at the time of the exam can have a significant impact on what prescription you choose for yourself.

Hard Day at Work?

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If you’ve just spent 6 or 8 hours staring at a computer screen, your eyes are tired and you have trouble focusing up close.  This means, during the exam, you will “choose” a prescription that is stronger for up close correction.  Even the amount of sleep you had the night before can have an impact.   Make sure you go into your exam with typical amounts of stress, sleep, and computer use to get a prescription most accurate for yourself.

Blood Sugar Feel Off?

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If you are diabetic and have had difficulty controlling your glucose levels, or worse yet, don’t manage it with diet or medication, then your vision is constantly fluctuating with the peaks and valleys of your blood sugar levels.  The higher your sugar levels, the generally more nearsighted you are.  So if you’re spiking when you have your exam, you will choose a stronger “distance” correction.

In addition, poor diabetes control can lead to Diabetic Retinopathy.  This is a condition which causes small, “dark patches” in your vision which will not go away.  This is an irreversible condition and should managed and monitored very closely to prevent it’s development and growth.

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Take Away

Remember, your exam is a “snapshot” of your life.  Your entire life and daily routine comes into play when finding your prescription.  Keep all of this in mind when coming in for your exam, or even when considering what day or time you want to schedule that appointment.

And remember, if you have any struggles with your prescription after picking up your new glasses, maybe it’s not the fault of the Doctor, maybe it had to do with how stressful your day was when you had that exam.

A Little Explanation on Progressive Lenses

There is a common misconception amongst patients which I’ve come across many many times.

The vast majority of patients are under the impression that there is only one progressive lens.  This has been in great part due to a failure amongst all eye care professionals to explain the choices for fit.  At this time there are several hundred progressive lenses.  There are laser etchings on the lenses which help the eye care professional to identify which of the several hundred lens designs you are currently wearing.

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All progressive lenses are not created equal.  The example I like to use with my patients, is that saying ‘progressive’ is like saying ‘car.’  There are different manufacturers (i.e. Toyota, BMW, Ford, etc.).  And each manufacturer has several models, each designed to suit a different budget, or function (i.e. Prius, Camry, Highlander).  One of the most critical jobs for an optician is to have the conversation with the patient to help identify which progressive lens is best suited to the patient’s needs.

Be Careful when Price Shopping

This diverse market of lens options can make price shopping for progressives very challenging.  Understand that not all shops and locations even offer all the options available.  Most offices work most closely with one manufacturer or another.  For example, some “big box” retailers will only work with one design, and it’s a much older technology with the necessary pitfalls associated with less advanced manufacturing.

How Progressives Work

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A progressive lens was developed to eliminate the hard “line” of a traditional bifocal, as well as to provide a large, comfortable intermediate vision zone.  Essentially, in a progressive lens, you can see clearly and in focus through a distinct “hourglass” channel.  Outside of this hourglass, generally in the lower periphery of the lens, vision is not as clear.

I find the best way to describe this for the layperson to understand, is to imagine a bifocal lens made out of clay.  If you wanted to eliminate the physical “lip” of the reading zone, you would put your thumbs down into the middle of the lens and “squeeze” the clay out towards the periphery to smooth out that lip.  In essence, this is what is happening with a progressive lens.  This means instead of having a blurry line in the middle of your vision, your have a blurry edge to the lens.  There are various different lens technologies amongst the larger family of progressive lenses to try and handle these inherent issues for no-line lenses.

A Word on the Technologies

OK, I’m just going to be straight up here.  Some of the technologies involved in manufacturing progressive lenses (or PALs in the parlance of the industry) are not easy to explain in layman’s terms.  To put it as simply as possible, older lens tech used to generate PALs involves molding the prescription into the backside of the lens only.  This is a less expensive method, and has the drawbacks you might suspect.  When you put all the power on one side of the lens, it means the “channel” for your best vision is necessarily smaller than when the power is shared across the front and the back of the lens.

Newer lens technologies digitally surface the power (using lasers to cut lens) on both the front and the back of the lens.  When the power is “shared” across the front and the back of the lens, it opens the channel of your vision up.  Giving more space for clear focus, and pushing the “distortion” further off to the sides, and out of your field of view.

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In addition, digitally surfaced lenses address the problem of the “blurry” periphery in a very different way as well.  The periphery in a PAL is blurry because it is actually unwanted astigmatism correction.  Astigmatism is correction that has not just power, but also angle.  In an older “analog” lens design that angle of the astigmatism is constantly shifting, which can create a sensation of “swim.”  Essentially, when you move your eyes around, you can feel like you’re riding on an ocean wave.  When a lens is surfaced digitally that unwanted astigmatism is all placed along a similar angle, or axis, so you don’t notice the “swim” as much and they are more comfortable for long term wear.

Take Away

Realize, that when your optician spends a fair bit of time explaining or discussing progressive lenses, it’s not because we’re going for a hard sell.  This is an advanced lens technology which takes time to accurately measure and fit.

If you have questions, you don’t feel were adequately explained here, please feel free to contact me.  Send an audio clip via email and I’ll answer them on my upcoming podcast.

The Doctor isn’t Always Right

Typically, when a patient is handed off to the optician, a conversation has already happened between doctor and patient establishing some detail on what type of visual needs are to be addressed with new glasses (or contacts) and what recommendations the doctor might have for the patient.

The vast majority of the time, this doctor/patient conversation hits the broad strokes of what the patient needs, and what is left for the optician is a conversation to nail down the details (i.e. which progressive lens, does patient need transitions as well).

Sometimes, though, a key component of the patients lifestyle, be it work or hobby, is missed and this is why a good optician often will rehash much of that conversation that already happened with the doctor.

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Sometimes the scenario is Deceiving:

Case in point, I recently helped a patient who is a helicopter pilot.  When I was given this patient from the doctor I was told the recommendation with progressives with anti-reflective.  This is a common enough recommendation for a patient who needs reading help, so I nodded along and prepared myself to ask my usual questions to pinpoint the best progressive design.

But the more I conversed with the patient, and realized he wasn’t just a pilot, but a pilot of helicopters I realized it was critical to get down to where his near vision needs were located.  As we talked through where he needed to look and at what distances, it became crystal clear that a progressive would be a terrible experience for him.  He had a need to see at full distance out of the lower corner of his eyes, where a progressive gives the greatest “distortion” and the clear vision is set at a closer focal length.

So what could have been a very quick session in the dispensary to help him find frames turned into a fairly long and involved conversation to really nail down his specific needs.  While he may have spent quite a bit more time than he intended, I was able to make sure he’ll have a pair of glasses that will function for his lifestyle

Take away Lesson

As a patient, it’s easy to be intimidated and expect that the optician and doctor know what’s best for you.  And for the most part this is quite true, but it’s ABSOLUTELY CRITICAL that you share specifics of your needs.  Even what you may assume is not important or trivial could be the difference between a pair of glasses you LOVE to wear and a pair you’ll LOVE to get rid of.