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A NEW ROLE FOR OPTICIANS / PAGE 12 PHOTOCHROMICS 101 / PAGE 16 November 2009 • Volume 3, Issue 23 •


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A ZEISS Premier Distributor using patented ZEISS technology To order call:1.800.4.GLASSES (800.445.2773) Or contact us at: www. usopt US Optical LLC 6848 Ellicott Drive | East Syracuse, NY | 13057



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Vol. 3 Issue 23

Features 6

Courtesy of Europa International

FASHIONABLE, “PREPPY” EYEWEAR Appeal to your more conservative customers with the latest in chic, preppy eyewear. by Amy Endo, ABOM, CPOT


REFRACTION AND OPTICIANRY Refraction skills can enable Opticians to evolve beyond their traditional dispensing role.


by Warren McDonald, PhD


Courtesy of Transitions Optical, Inc.



PHOTOCHROMICS 101 Photochromics provide the best in UV protection and visual comfort. by Carrie Wilson, BS, LDO, ABOAC, NCLEC


CHARITABLE EYECARE These ECPs donated their time to help those most in need of vision care. by Lindsey Getz



OPTICAL DISORDERS The modern, well-informed ECP should have a general grasp of the most common eyecare disorders. by Anthony Record, RDO


THE ARTIFICIAL EYE Prosthetic Eye Makers – or Ocularists – still have their place in the modern optical world. By Elmer Friedman, OD

On The Cover: US OPTICAL LLC 800-445-2773

Departments EDITOR/VIEW .....................................................................................................4 MOVERS AND SHAKERS.................................................................................19 DISPENSING OPTICIAN .................................................................................30 MANAGING OPTICIAN...................................................................................34 ADVERTISER INDEX .......................................................................................46 INDUSTRY QUICK ACCESS............................................................................47 LAST LOOK .......................................................................................................50




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Editor / view


by Jeff Smith

Publisher/Editor . . . . . . . . . . . . . . . . . . . . . . . Jeff Smith Production/Graphics Manager. . . . . . . . . . . Bruce S. Drob Director, Advertising Sales . . . . . . . . . . . . Lynnette Grande Contributing Writers . . . . . . . . . . . . . . . . . Thomas Breen, Judy Canty, Dee Carew, Harry Chilinguerian, Timothy Coronis, Amy Endo, Bob Fesmire, Elmer Friedman, Lindsey Getz, Jim Magay, Warren McDonald, Anthony Record, Ted Weinrich, Carrie Wilson Internet Coordinator . . . . . . . . . . . . . . . . . . . . Terry Adler Opinions expressed in editorial submissions contributed to EyeCare Professional Magazine, ECP™ are those of the individual writers exclusively and do not necessarily reflect the opinions of EyeCare Professional Magazine, ECP™ its staff, its advertisers, or its readership. EyeCare Professional Magazine, ECP™ assume no responsibility toward independently contributed editorial submissions or any typographical errors, mistakes, misprints, or missing information within advertising copy.

ADVERTISING & SALES (215) 355-6444 • (800) 914-4322

EDITORIAL OFFICES 111 E. Pennsylvania Blvd. Feasterville, PA 19053 (215) 355-6444 • Fax (215) 355-7618 EyeCare Professional Magazine, ECP™ is published monthly by OptiCourier, Ltd. Delivered by Third Class Mail Volume 3 Number 23 TrademarkSM 1994 by OptiCourier, Ltd. All Rights Reserved. No part of this magazine may be used or reproduced in any form or by any means without prior written permission of the publisher.

OptiCourier, Ltd. makes no warranty of any kind, either expressed, or implied, with regard to the material contained herein. OptiCourier, Ltd. is not responsible for any errors and omissions, typographical, clerical and otherwise. The possibility of errors does exist with respect to anything printed herein. It shall not be construed that OptiCourier, Ltd. endorses, promotes, subsidizes, advocates or is an agent or representative for any of the products, services or individuals in this publication. Purpose: EyeCare Professional Magazine, ECP™ is a publication dedicated to providing information and resources affecting the financial well-being of the Optical Professional both professionally and personally. It is committed to introducing a wide array of product and service vendors, national and regional, and the myriad cost savings and benefits they offer.

For Back Issues and Reprints contact Jeff Smith, Publisher at 800-914-4322 or by Email: Copyright © 2009 by OptiCourier Ltd. All Rights Reserved


Defining your Competition O JUST WHAT IS COMPETITION? Seems straight forward and simple: two or more businesses competing for the same customer or market. But are you? Are you really competing for the same customer as the major chains? Look at it from a demographic perspective: how many of your patients are simply seeking the cheapest prescription they can get? The least expensive eyewear? If those are the patients you’re competing for, then you are going to have a tough time surviving. Wouldn’t it be better to capture the patients who are looking for value, and who understand that quality, style, and personal attention are all part of the value equation.


The key to beating the competition is not to have any. If you are faced with a large discount chain, don’t try to keep up with them on price, simply out-flank them with outstanding service and unique products. Avoid offering identical products, which simply leads into a pricing war, since the patient has an easy comparison. Instead, offer different brands that feature unique styles or features. Don’t be afraid to price them fairly; remember, price is only one of several factors that determines value, and for many patients one of the easiest to overcome. Even if you are forced to offer many of the same products or services, the approach you take in how they are offered and presented can set you apart. After all, an exam is an exam ... right? Well, perhaps, but is your exam the same as the one offered at the big discounter down the street? Probably not, so it is your job to get the word out. Setting yourself apart is great, but it’s only half of the equation. The other half is making sure your potential patients know it. The very best advertisement is word of mouth and worth devoting significant resources to develop. Take maximum advantage whenever someone new walks in. If they are wearing glasses or contacts, they’ve certainly been to another ECP somewhere, and the fact that they are in your dispensary is a good sign they may be looking for something better or different. Pay attention to how they react when you approach them. A quick remark of, “I’m just looking” while they turn away is a clue that that person has experienced the sales pressure that is common in the larger discount retailers. Again, the key is to be different. Allow them time to walk around and get to know the dispensary. While it may be difficult to get them engaged in a conversation, it is well worth the effort. What can you do to limit competition? Give great service, don’t just mouth it. The large retailers have to limit their patient contact ... they simply cannot afford to spend time on a sale and follow-up; their survival depends on high volume. Basically, there are two ways of dealing with competition: hit’em head on with your best shot, or side step and differentiate from the others.



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PREPPY SPEAKS to a long list of distinctiveness, from a point of view of eyewear that defines a generation. This “preppy” fashion has been redesigned as each new generation emerges. It was originally the P-3 shape that has been a mainstay in eyewear, but now “preppy” could mean chic and fashionable.



1. Kliik:denmark Preppy is the new fabulous and KL-412 offers that clean and put together look that frame wearers are looking for. The patterned zyl designed with a combination of tweed and houndstooth adds a touch of modern prep to this stylish frame. For a more masculine frame, the rectangular eye shape and subtle detailing on the temples of model KL-295 handsomely shapes the face with style. 2. LINDBERG The new Strip 9500 is LINDBERG’s latest modern, fashionable eyewear design in titanium plate. The feel of the extremely thin, laser-cut titanium plate is impressive. The thin titanium plate is both flexible and stable, the discrete, screw less hinges are simple and elegant.


3. Free Form Eyewear The new RBT-Acetate collection adds a touch of nature to its techno and puristic design. Cruelty-free man-made tortoise, horn and natural stone pattern acetate materials are used on temples to give a premium look. The rest of the frame is still in its original super lightweight, super flex beta-titanium for maximum comfort.



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4. Morel Eyewear With the new TACK line, Ă–GA is launching a new product concept combining aesthetics with architecture. Like taut cables, two metal wires link the front to the twin-material injected plastic and stainless steel temples. This well-balanced product is available in 6 eye-shapes and 4 colors: blue, black, ruthenium and brown. All models are two-toned.


5. Jee Vice Sexier – These retro-inspired frames are a take on the classic cat-eye. The angle has been softened for a less severe look, but the glasses still maintain their smart, sultry air. Molded nose pads and tips at the end of the temples keep you in your comfort, while spring-loaded temples make sure this style is never bent out of shape. 6. MYKITA The first edition of the Lite collection is composed of six simple and classic forms for men and women. Their low-key design is ideal for everyday wear. The frames are available in five different metallic colors, ranging from brown to graphite, silver and gold. In short, MYKITA Lite comprises a range of refined and ultra-comfortable frames, with the added bonus of easy mounting and adjusting for opticians.





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The Persol PO2961S is a bold men’s frames with a keyhole bridge and is made using acetate carving to enhance the exclusive contoured shape. This model comes in black with polarized lenses (95058), burgundy (825/32), three tortoise shell versions (108/51-811/31-24/31) and transparent yellow (204/31).


The MontBlanc MB226s is a modified aviator shape that has a combination of shiny metals and rich acetate temple colors that give the style a modern and sophisticated look. The MontBlanc “star” logo has been discreetly incorporated on the temples as well as being laser etched into the lens for brand awareness.

Clariti Europa International

The new Michael Ryen MR-154 will appeal to both the trendy, fashion forward customer as well as the classic, conservative patient. The squoval eye shape is emphasized with contrasting acetate along the upper rim. Narrow block endpieces boast cigar band embossing in a diamond pattern that is carried through the entire length of the temples.

Modo Modo introduces two new styles to its core collection focusing on classic and sophistication with a modern twist. Model 3015 is the unique color texture concept adapted to the temples where shavings into the temple unveil layered colors. It will be available in warm shades such as black/tort, silver/grey and tort/green.

Work or play, Clariti offers a clear choice for every occasion. Konishi Flex Titanium collection offers something for everyone – this line offers over 100 styles in men’s, women’s, unisex and children’s frames.

lindberg 9500/19 路 PATENTED



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Baumvision has great, vibrant sunwear for the preppy guy and girl. The Blue Sky Revolution, in Aqua and Seafoam, is saucy and chic, and is available in Size: 54-17-140.

Silver Dollar Mitrean Collection frames are designed to easily make the transition from work to personal time. The Cozumel frame is a full rimmed combination style featuring a rectangular metal

front with modern zyl temples. Colors range from chrome/denim, ash/black and black/smoke with spring hinges and adjustable nose pads.

Aspex Eyewear The new EasyTwist ET904 offers comfort and durability, combined with a sleek modern look. The result is an amazingly light and ultra-resistant frame. It is also equipped with Turboflex™ spring hinges – the sleek pioneering spring hinges that flex with 360 of motion.

LBI Eyewear

Geek 101 is the frame that inspired a lifestyle, made famous by legendary Geeks from Buddy Holly to Woody Allen. Geek 101 can make anybody instantly hip, yet studious. From coffee shops, to executive board meetings, if these frames could talk, they would say “I am cool, in a manner that is irreverent.” Available in Black only, in two sizes: 45-21-145 and 49-21-145.

ProDesign ZENSE 7346 – Clever, advanced technology has not only helped to create an extremely functional piece of eyewear, it has also made it possible to create a perfectly streamlined design. The simplicity of soft, organic lines and elegant contrasts are combined with richness in detail – that simply must be seen and felt.

Continue with the trends, as preppy style will change from year to year. Keep a collection to satisfy your customers-they will love you for it. Amy Endo, ABOM, CPOT



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Smart Mirror introduces its new electronic dispensing system Smart Centration: The Ultimate dispensing tool that will revolutionize your business! Retain more patients & boost referral base Better and simplify the sales process Increase sales of premium products Enhance quality of service and patient satisfaction Differentiate your practice from the competition Take Fast, Easy, Accurate measuring of progressive lenses

Smart Mirror systems:

the best solutions for your optical business! ABS, Inc Smart Mirror • 1-888-989-4227 •



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The 21st Century Optician Warren G. McDonald, PhD Professor of Health Administration Reeves School of Business / Methodist University


A New Role for the Contemporary Optician

AS DISCUSSED in last month’s article, there are many things Opticians can do beyond the traditional dispensing role. We have talked about contact lenses and management so far, and this month we will be evaluating a bit more controversial role, that of Refraction, or as some people like to call it, Refractometry. We are not trying to make “junior eye docs” here, just teaching a skill set that can help Opticians serve in clinical roles with the OD and MD. It is a natural progression, and hopefully this article will provide some information that is useful. Basic Procedures Refraction is defined as “the act of determining the focal condition (emmetropia or various ametropias) of the eye and its correction by optical devices, usually spectacles or contact lenses” (Keeney, et al., 1995, p. 254). This article is designed to introduce the subject to those interested, and to provide some continuing education for others already involved in the process. While the process may seem confusing to some, once learned, it becomes almost second nature. Pre-Tests There are a number of pre-tests that can tell us a great deal. Included are: 1. pupil measurement 2. visual acuity with and without current Rx 3. pupillary reflexes 4. ocular motility tests (broad H test, etc.)

5. near point of convergence 6. range of accommodation 7. cover tests 8. stereopsis 9. color vision screening 10. observation of the external adnexa 11. pin-hole acuity I will not go into specific detail about these procedures, but I do want to call your attention to the pin-hole acuity test. As mentioned earlier, it is imperative to recognize when to refer. The pin-hole acuity test will clearly indicate whether or not a refractive condition is present, or if the blurred image is caused by something else. As you recall from basic optics, central light rays come to focus at a different place than peripheral rays (commonly referred to as spherical aberration). Placing a pinhole before the eye will cause a substantial improvement in visual acuity in someone with a moderate or greater refractive error. If a pin-hole shows no improvement, the error may not be refractive and needs to be referred. Continued on page 14




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Subjective Procedures There are many ways to find the refractive status of the eye. In the old days of refraction, everything was done totally on the subjective response of the patient. Today, we still depend a great deal on those subjective responses to help us arrive at the perfect neutralization. Refraction can be accomplished using entirely subjective means. Using a “guide” called Eggers Chart logic, one can gauge the rough amount of ametropia present, if any. Eggers Chart logic uses the premise that each line away from emmetropia on the Snellen chart represents approximately .25-.50 diopters of ametropia. Someone who reads 20/40 on the Snellen Chart will have a rough ametropia of approximately .75 diopters. Eggers Chart logic does not tell us what ametropia, merely how much. From that information we can readily judge whether the subject is a myope or hyperope by utilizing trial lenses. The world would be a wonderful place if that were all there was to it, but something called astigmatism is around to mess up our day. Astigmatism can be detected by using a couple of subjective techniques. The first we will talk about is the “clock dial.” This technique uses a plus lens to “fog” the patient to approximately 20/40, typically 3 clicks of plus power above best acuity with the “rough” sphere. A dial that looks like the hands on a clock is placed at 20 feet, and the patient is to report if one set of hands on the clock looks clearer. If all the hands on the clock are equal, no astigmatism exists; if one set of hands is clearer or sharper, then there is astigmatism present. The axis can be determined by multiplying the lower numbered hand on the clock by thirty. For example, if the patient reports the 2 and 8 o’clock positions to be clearest, then the axis would be 60 degrees. We can also find astigmatism subjectively by utilizing the Jackson Crossed Cylinder on the phoropter. The JCC is a lens with a spherical equivalent of plano (-0.25/+0.25; -0.50/ +0.50) used for a number of tests. It features a set of red dots, meaning minus power, and a set of white dots, plus power. By placing one of those sets of dots on the principal meridians, you can find the presence of astigmatism. It is difficult to adequately describe here; you need to see it and touch it to understand it, but for now, I want you to know it will work. Once a rough idea of what refractive error is determined, we must refine, or “fine tune,” our findings. To do that, we again utilize the JCC, but this time the dots are positioned at a 45degree angle to the axis. By simply bracketing around the axis, we can find the exact axis location. You cannot find the correct power without first finding the axis.


Once that is accomplished we move on to refine the power. This refinement is again accomplished by placing the dots on the JCC on top of the axis. By asking which looks better – red or white dots – we can easily find the right cylinder power. Red indicates minus and white plus. Again, this is extremely difficult to get across in this fashion, but, if you have a phoropter at your disposal, you should take a look at it to gain a better understanding. There is still one more thing we have to do before proceeding on to the other eye; we must make certain we are not overminused; to give too much minus power can cause a problem with accommodation and convergence. Minus power will stimulate the accommodative reflex. We have a couple of different ways available to us to monocularly balance a patient. The first is the red-green or duochrome test. As you know, the red component in white light comes to focus at a different place than green. By showing the patient a 20/40 line and a colored slide with half the letter in green and half in red, we can determine if we are balanced. If the patient favors red, it indicates too much plus. If green is favored, too much minus. Either way we must adjust accordingly. The second monocular balancing technique employs a threeclick blue. We earlier presented Eggers Chart and described a 20/40 test line being approximately 0.75 diopters away from emmetropia. The same idea is employed here. If we dial in three “clicks” of plus power (each small movement of the large sphere wheel on the phoropter is 0.25) then the 20/40 line should be blurry. If it takes six clicks, then we have too much minus power. Go back three clicks, and you should be at the optimum monocular refraction. Remember, when doing refraction it is best to leave the patient at the maximum plus. MPMVA means Maximum Plus for Maximum Visual Acuity. That is a good acronym to remember. Once we have completed the balancing procedures on the right eye, all of the same steps must be done for the left, from rough sphere to red-green. When they are accomplished, one final step remains: binocular balancing. This is simply accomplished by fogging the patient, and splitting the two images with a dissociating prism (Borish, Vol. 2, 1970, p. 753). There is a 6-diopter prism on the phoropter that will move the right image down. By looking at the two images simultaneously, the patient is asked if both images are equal, or if one is better than the other. If one is better, we add +0.25 to that better image and ask again. Usually this will correct the balance and the basic refraction is complete. Once the fog is removed, the data collection is complete. An additional step some refractionists do is to complete a binocular 3-click blur, just to be certain we are at MPMVA. Next month we will continue with Objective Procedures and additional testing procedures. ■



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Through the Lens Carrie Wilson, BS, LDO, ABOAC, NCLEC

Shade of Color: The Way Photochromics Work Putting the Glass into Glasses The first photochromic lenses were invented by Corning in 1964 and were marketed under the term PhotoGray. Shortly afterward, PhotoBrown was introduced. Using a process called in-mass technology, glass lenses change by the activation of a combination of silver chloride and silver bromide crystals that were added to the lenses while the material was in a liquid state. The early lenses had an approximate 20% tint to the lens that darkened to about a 50% tint. The result was a lens that, although comfortable in a lot of lighting conditions, was still too light in bright light. Corning’s next step was a lens that would get as dark as a sunglass as the amount of sunlight increased. The result was the PhotoSun single vision lens that was developed in 1971. It was too dark in its unactivated state to be used indoors or at night, however. In 1978, the PhotoGray Extra lens was placed on the market. Combining the technology of the PhotoGray and the PhotoSun, it was as clear as the PhotoGray at 20% in the unactivated state and as dark as the PhotoSun with full activation at 75% tint. Today, there is the PhotoGray and PhotoBrown Thin & Dark. A thinner and lighter lens, it can be ground to a 1.5mm center thickness in the United States. Benefits to glass photochromic lenses include: • Better scratch resistance • Enhanced optics • UV protection Drawbacks to glass photochromic lenses are: • Weight

PHOTOCHROMIC LENSES ARE LENSES that change from lighter to darker due to exposure to ultraviolet coatings. The ultimate in comfort lenses, photochromics help the eye care professional provide clear vision indoors and out to his or her patients. Although not a replacement for sunwear, photochromics can fill most of the basic visual needs of the patient.

• Lighter colored bifocal segments. This is because the fused segment does not contain the photochromic crystals and any change in color occurs on the underlying lens. • Uneven color patterns in higher prescriptions. The thicker portion of the lens is a darker color than the thinner portion of the lens. Continued on page 18


Photo: Courtesy of Transitions Optical, Inc.



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The Future is Bright...


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Combining NuPolar® polarization and Transitions® Photochromic Technology, these lenses make the driving task safer and more comfortable for all your patients. Available in single vision, Image® progressive and now hard resin Flat Top 28 lenses.



For more information for your patients, look for the Drivewear Owner’s Manual with each prescription. Today’s best driving lens is Drivewear. One sunlens for driving, and for living. Visit

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now available in polycarbonate image


Drivewear, NuPolar and Image are registered trademarks of Younger Optics, Torrance, CA. Transitions and the swirl are registered trademarks and SOLFX is a trademark of Transitions Optical, Inc.



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• Loss of lightening ability as the lens ages (this is not the case with the Thin & Dark lenses). The World of Plastic Lenses Photochromics come in many different types of plastic substrates including CR-39, mid-index, high-index, and Trivex. What matters in the functioning of the different types of photochromic lenses is not the material itself, but the process that the lens goes through to become photochromic. The main ways in which a photochromic lens gains its color changing capabilities is through the imbibing process, en-masse process or a coating process. Imbibing Process Imbibing is when the photochromic substance is penetrated into the lens substrate. It was originally developed in the 1970s by American Optical for their glass Photolite lens and then improved upon by Transitions Optical in the 1980s. The first

En-masse is used with lens substrates that can uniformly dissolve photochromic dyes. These materials include low to mid-index resins. Once the resins completely dissolve the photochromic dye, the resin is then cast into a lens. The reason that the plastic lenses do not have the ring effect that is found in glass lenses is that the surface photochromic molecules of a plastic lens are all that is activated. This allows the lens to darken evenly. How long the changing capability lasts will depend on the material used, the amount of photochromic molecules placed into the resin and the amount of UV exposure. The average lifespan is one to two years. Lenses that are manufactured using en-masse processes are Corning’s SunSensors, Rodenstock’s ColorMatic Extra and Kodak InstaShades. Coating Process

Courtesy of Transitions Optical, Inc.

The coating process is used by many lens manufacturers, such as Vision Ease, for the lens substrates that do not take the imbibing or en-mass processes well. Manufactured in a clean room to prevent dust particles from depositing on the lens, a clean semi-finished lens goes through a coating process. Typically, a primer coat is applied to the lens to act as “glue” between the substrate and the photochromic layer. Next the photochromic layer itself is placed on the lens. Although the layers were traditionally applied as a dip coat, they are more commonly applied as a spin coat today. Spin coating enables the photochromic molecules to spread evenly across the lens surface ensuring even coloring. After the coats cure on the substrate, the lens is then hard coated to protect the photochromic particles. Into the Darkness

successful plastic photochromic lens was released by Transitions in 1991. How imbibing usually works is that a liquid photochromic solution is sprayed on the front surface of a finished or semifinished lens. The lens is then heated to enable the solution to penetrate the surface up to 200 microns. The lens is then hard coated to prevent the photochromic chemicals from becoming degraded from oxygen. The photochromic compound in the solution varies depending on the lens substrate that is being used. The process takes approximately 18 hours. Imbibing is commonly used in standard index and mid-index lenses. It is not used in harder lens materials such as high index, polycarbonate, or Trivex because the photochromic solution cannot penetrate as deep. 18 | EYECAREPROFESSIONAL | NOVEMBER 2009

All plastic photochromic lenses are activated by UVA and UVB rays. Glass lenses are also activated from UV, but this is in addition to the changes that occur from visible light. How dark the lens actually gets however, depends on many factors: • The intensity of the light – the brighter the light, the darker it gets. • Temperature – the hotter the temperature, the less effective the darkening molecules. • Age • The type of tempering process that glass lenses go through. • UVA spectrum changes that occur naturally throughout the day. • UVA changes that occur from location to location – example, mountains have less UVA than the beach so lenses will be lighter in the mountains.



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• UV blocks – items such as windshields and visors have UV screens incorporated in them, as a result, the lens will not get as dark. Once a dark lens is removed from a UV source, the bleaching process begins. Bleaching can take anywhere from a few seconds to a few minutes, depending on the lens substrate, photochromic molecules, temperature and light sources. On average however, it takes a lens two to three times longer for a lens to become fully clear than it does to color. To coat or not to coat? That is the question.

use with photochromics. The older AR coats contained UV blocker which inhibited the darkening process. This is not the case today. It is not only safe to place AR coatings on a photochromic; it is beneficial to the wearer because it minimizes the mirror effect of a dark lens. This is not the case with other coatings. When it comes to most coatings, less is more when it comes to photochromics. Photochromics provide the best in UV protection and visual comfort to the patient. With the wide range of materials and styles available, the visual needs of most patients can be fulfilled with photochromics. ■

In the past, Anti Reflective coating was not recommended for




Carl Zeiss Vision Carl Zeiss Vision has appointed Michael Hoffmann chief executive officer, effective Dec. 1, 2009. Hoffmann, who has German as well as Columbian roots, worked at Hewlett-Packard in several leadership positions. Prior to his Michael Hoffmann current responsibility as senior vice president and general manager worldwide graphics solutions business, Hoffmann served as senior vice president for HP’s imaging and printing business in Asia-Pacific and Europe, Middle East and Africa.

Pro Fit Optix Pro Fit Optix has expanded its management team with the addition of three experienced optical professionals. Steve Brewer has been appointed executive vice president of sales and business development. He brings 34 years of Steve Brewer optical industry experience as a senior level executive and industry consultant. Companies and clients that Brewer has worked with include Bausch & Lomb, CooperVision, Alcon, Essilor of America and United Healthcare. Bruce Winslow has joined as vice president of sales, independent markets. He brings more than 30 years of optical industry experience, including work with Bausch & Lomb, Unilens, and most recently Essilor Laboratories, where he has served as a strategic account manager. Bruce Winslow Tom Lyon has been named national director of business development, optical laboratories. Lyon’s 40 years of industry experience includes customer service, lab and sales management. He has worked for Rodenstock, Serengeti, Signet Armorlite and Zyloware.

Bausch & Lomb

R. Kerry Clark

Bausch & Lomb has announced that R. Kerry Clark and Robert J. Palmisano have joined its board of directors. Clark retired in September 2009 as chairman and CEO of Cardinal Health, Inc. Under his leadership, Cardinal Health acquired numerous medical technologies that helped the company expand its service to hospitals, pharmacies and clinicians across the U.S.

Palmisano is the president, CEO and director of ev3 Inc a leading global provider of technology Robert J. Palmisano for treating peripheral vascular disease and neurovascular diseases. Prior to ev3, Palmisano was president and CEO for IntraLase Corp., which designed and developed laser products for vision correction.

Revolution Eyewear Revolution Eyewear has appointed Steve Gintis as the company’s new worldwide director of operations. Gintis will be responsible for sales growth, as well as overall business development activities both domestic and internationally. He brings more than 30 years experience of eyewear industry experience, having worked at companies including Safilo, Diplomat Ambassador and B. Robinson. Most recently he was design, sales and manufacturing consultant to a few Chinese eyewear factories.

OLA The Optical Laboratories Association announced that its board of directors has selected Daniel Torgersen as the recipient of the 2009 OLA Directors’ Choice Award. Torgersen, who has served as the OLA technical director for 15 years, is vice president, MIS and special projects, for Walman Optical in Minneapolis, Minn.

Tom Lyon




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Optical Philanthropy Lindsey Getz

A Helping Hand her focus was primarily on learning and growing the business. In her second year (this past year) she’s focused more on getting her business name into the community and doing something positive for her neighbors. “There’s no doubt you’ll feel good about giving back,” says Gammon. “My community has been good to me and my business has grown since we’ve opened. So it’s a way to give back. But its also helped get our name out there.” Community Events

Harris Silverman, MD and his guide dogs

This holiday season why not consider doing something good for your community?

These ECPs did... There’s often nothing more rewarding than giving back to those in need. And with so many worthwhile charities out there, there are more ways to do so than ever before. In addition to national non-profits, your local community is likely filled with groups in need of help from local businesses and practices. It’s a way to do something good for your fellow neighbors...and what better time of year than the holiday season to consider it. Besides the personal fulfillment you’ll feel for your involvement, there’s an added benefit as well. Getting involved with community outreach programs or various service opportunities is also a wise business decision. It’s a way to get your name out to the public in a positive light. Dawn Gammon, OD, FAAO, CEO of The Eyewear Gallery in Reston, Va. says that in the first year she opened her practice, 20 | EYECAREPROFESSIONAL | NOVEMBER 2009

An easy way to get involved with the community is by linking with an event that already exists. Every community is packed with programs that are in need of supporters and sponsors. Gammon has gotten involved in a variety of walks and events in her community. This past October she was involved as a sponsor for the Creating Wellness Family 5K Walk/Run, an event that benefitted Reston Interfaith, a local non-profit that serves families in need of food, shelter, childcare and other services. The sponsors of the walk are other members of the community involved in health and wellness. “I like that this event is not only a way to reach out to community members but is also a way to get to know other medical professionals in the community,” says Gammon. “When I refer my patients to other medical professionals I like to know them.” This holiday season, Gammon became involved in a holiday trade-in event for the Lions Club. People can bring in their old glasses and they’ll receive a discount off their next pair. “We’re giving $50 off single vision and $75 off progressives,” says Gammon. “The Lions Club will then sort through the glasses, disinfect them, and distribute them to various missions programs and groups in need.” Emil William Chynn, MD, FACS, MBA, owner of Park Avenue Laser Vision in New York City, has gotten involved with existing charities by making some very generous donations. Every quar-



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ter he donates one LASEK surgery to an IRS-recognized charity which they can use in a raffle or auction to raise money for their charity.“Typically they raise several thousand dollars from each of our donations,” says Chynn. “The last donation we did was two months ago, when I donated a LASEK surgery to a charity that supports my former education professor at Dartmouth in his educational programs in Bosnia.” Because it costs Chynn around $1,000 in hard costs to perform the surgery, he asks the charities to set the minimum bid at $1,000 if it’s for an auction. “With a raffle, charities have the opportunity to make a lot more if they sell a lot of tickets,” he adds. More Amazing Efforts Besides existing charities, there are many incredible eye care professionals out there who have done some amazing charity work or founded programs on their own. Harris Silverman, MD, founder of The Eye Associates in Bradenton, Fla., is also a founding member of the Southeastern Guide Dog School, Inc., and has actively served as a member of its board of directors for more than 25 years. The mission of the Guide Dog School is to offer—free of charge—the use of professionally and humanely trained guide dogs to visually impaired men and women in order to help them achieve independent travel with safety and dignity.

Dr. Paul Berman at the Special Olympics

It started out as a small effort and grew to be one of only 10 full certified guide dog schools in the entire country. “We now have a beautiful campus and dormitory where blind students come live for a month,” explains Silverman. “They get matched with a dog that meets their needs and learn how to care for the dog. We ultimately give them the gift of mobility, allowing people to get around independently. And the dogs, of course, become their best friends.” The school currently has more than 800 active guide dog teams across the country and continues to create more than 70 new dog teams annually. Continued on page 22



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The Guide Dog School has also recently joined forces with General Tommy Franks to offer the Paws for Patriots program. This new program is designed for veterans who have been injured during their service to their country. “It’s not just for veterans who have visual impairments, but any sort of physical impairment that a guide dog could help with,” explains Silverman. “If our dogs can help our patriots in any way, we want to be there for them.” Another equally as impressive organization that has grown from a small effort into something much larger is the Special Olympic Opening Eyes Program. Founded and directed by Paul Berman, OD, co-owner of Focus Eye Health & Vision Care in Hackensack, NJ. In fact, Opening Eyes is now a worldwide program that serves the visual needs of people with intellectual disabilities. With the help of the Lions Club, which provides funding, Safilo Group, which provides frames, and Essilor, which has donated lenses, this program’s mission is to improve the quality of life for the millions of individuals diagnosed with intellectual disabilities by optimizing their vision, eye health and visual skills through quality eye care. “It’s been one of the most gratifying experiences I’ve ever had,” says Berman. “The beauty of the Special Olympics is that it Dr. Berman helping a patient. makes you a better person for being involved. When you spend time with a Special Olympics athlete, you learn to accept and understand people who are a little different than you. And I think when you can get to that point, you become a better person. Most people that get involved with this program become ‘lifers’ and get their entire family involved as well.” The program is now in 46 states and 70 countries. Berman shares one of his favorite memories over his many years of involvement. “We were in Alaska at a world game and a track and field athlete that was very nearsighted came to see us,” he recalls. “I asked him how he was able to compete when he couldn’t see the track. He said he follows the blur in front of him. Because of this, he had always gotten the silver medal. A couple of days later he got his new glasses and that year he won the gold. That was a special moment for me.” ■



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EyeCare Disorders Anthony Record, ABO/NCLE, RDO

Opias and Itises and Phobias attempt to determine the refractive powers of the human eyes, or, in any manner, attempt to prescribe for or treat diseases or ailments of human beings.” Therefore, in no way is the information presented herein designed to facilitate circumventing these types of restrictions. On the other hand, it cannot be denied that dispensing opticians make up the greatest number of eye care professionals (ECPs), and that we represent the front lines of the profession.

Usually, there is one in every crowd. Someone who marches to the beat of a different drum – or doesn’t hear the beat at all. Sometimes he simply likes being contrary. Less often, he actually has a point. For example, the first time I presented a version of this article as a continuing education lecture, a hand popped up three minutes into the class. “Isn’t this stuff way out of the scope of Opticianry? We ain’t doctors, after all.” Despite the grammar...good point. Most states that license the practice of Opticianry have very specific restrictions when it comes to exceeding the scope of practice. Consider the following passage of Florida Statute 484.013, which specifically addresses this issue: “It is unlawful for any optician to engage in the diagnosis of the human eyes,


Every ECP working today has been asked by a concerned patient questions like, “Her ophthalmologist told my mother she has developed wet macular degeneration. What does that mean?” Similar inquiries regarding a variety of ocular ailments occur nearly every day. The question is, do we reply with some version of “that’s not my job?” Alternatively, do we reply with something like, “technically that is out of the scope of my practice, but if she was my mom I would...” and concluding our reply by sending them to a specific resource (book, Internet site, doctor), or by strongly recommending they seek further medical attention with an optometrist, ophthalmologist, or even an emergency room. As a 30-year veteran of this profession, I prefer the latter. With that in mind, here are some of the most common ocular maladies, their causes, signs and symptoms, and usual treatments. Age-Related Macular Degeneration (ARMD or AMD) is probably the most common ailment about which I am asked. Dry AMD is the early stage of the disease and is caused by the aging or thinning of the macula. Although there are a few in clinical trials, no FDA-approved treatment exists for dry AMD. In about 10-15% of cases, dry AMD progresses to the more serious wet AMD. It is called wet because new blood vessels that have grown beneath the retina begin to leak blood and fluid. No pain and a



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gradual loss of vision makes AMD seem almost symptomless. There is no outright cure, but some treatments may help to slow its progression and even improve vision. I think our best advice is for patients to be diligent about keeping appointments, and closely following doctor’s recommendations. Some researchers believe that certain nutrients like zinc, lutein, vitamins A, C and E help to lower the risk or slow down the advancement of dry macular degeneration.

“It is unlawful for any optician to engage in the diagnosis of the human eyes, attempt to determine the refractive powers of the human eyes, or, in any manner, attempt to prescribe for or treat diseases or ailments of human beings.” Sometimes called the silent thief of sight, glaucoma is something a front-line ECP should be able to discuss with her clients. I use it as a way to motivate patients to get an eye exam. Know that there are generally no symptoms of most forms of glaucoma – no symptoms until it is too late. During the eye exam, the doctor will measure your client’s intraocular lens pressure (IOP). If it is too high (doctors start to become worried if the pressure approaches or exceeds 30 mmHg, which stands for millimeters of mercury), treatment will begin. Untreated, this pressure can affect the optic nerve, eventually causing permanent, irreversible vision loss. Standard treatment usually involves eye drops. If that treatment is ineffective, lasers and surgery may be indicated. Sharing that information is usually enough for a patient to schedule an exam. Some medical researchers claim that upwards of 50 percent of Americans suffer with allergy symptoms. Of those, 75 percent demonstrate problems with eye allergies. The most common symptoms include red, swollen, or itchy eyes, sneezing, coughing, headaches, or runny nose. There are as many causes as there are symptoms. Pet dander, aerobic allergens, dust, pollen, mold, and reactions to certain drugs and cosmetics could all be culprits of the disorder. The most effective “treatment” is avoiding or eliminating whatever caused the allergy. Stay inside when a lot of pollen is forecast. Wear large, wraparound eye protection outside. Many over-the-counter medications help to alleviate allergy symptoms. Antihistamines relieve many of the symptoms of airborne allergens, while decongestants help sink swollen nasal passages for easier breathing. If your client has some type of unusual growth, or pimple-like body on or near the eye, he may have developed a stye, chalazion, pinguecula, or pterygium. A stye (also known as a sty or hordeolum) resembles a pimple, and grows on the inside or outside of the lid. The first signs are redness and pain, swelling and tenderness. A stye is caused by bacteria, and should never be “popped” like a pimple – it should be allowed to rupture on its own.

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Applying hot compresses for 5 or 10 minutes a few times a day will help facilitate its disappearance. If styes become recurrent, a doctor may prescribe an antibiotic ointment to help discourage their return. Sometimes mistaken for a stye, a chalazion is a blocked or enlarged oil gland in the eyelid. Chalazia also usually disappear on their own, though they may hang around for months. If that is the case, your doctor may introduce a steroid to shrink it or drain it manually. A pinguecula is a yellow lesion that has formed on the sclera (the white of the eye). It is slightly raised, and since they usually occur within the palpebral fissure (the opening between the eyelids), exposure to UV is considered the primary cause. A pterygium is a wedge-shaped, fibrous tissue with blood vessels usually on the sclera. It is benign. Large and advanced pterygia may start to grow over the cornea, causing or increasing astigmatism. While all of these growths are usually harmless and “run their course,” it is prudent to advise your clients to have the condition treated by an optometrist or ophthalmologist. Diabetic retinopathy is damage caused by the retina due to complications from diabetes. When the blood sugar gets too high, permanent vision loss can occur. Floaters or double vision may be a symptom, and any client complaining about these symptoms should be referred to a doctor for evaluation. Usually the inquiries a front-line ECP encounters come from patients or family members who are looking for help after the fact. While there are a couple of drugs that show promise for people in the early stages of diabetic retinopathy, no treatment exists to reverse its damage. After macular degeneration, questions about cataracts are the next most common thing asked about by patients. A cataract is simply a clouding of the eye’s lens. The lens is made of water and protein, and as we age, some of the protein starts to clump together and begin to cloud the lens. Cataracts may make sunlight too glaring, as well as headlights when driving at night. Colors may seem less vibrant. While no one knows for sure what causes cataracts, exposure to UV is thought to be a major contributing factor. Other minor contributing factors may include diets high in salt, pollution, cigarette smoke, and high alcohol consumption. As cataracts start to form, changes in the spectacle and contact lens prescription will help, but eventually IOL surgery will be indicated. In what is one of the most common surgeries in the United States, the ophthalmologist will remove the natural, clouded lens and replace it with a new one. Some of the other disorders that I believe ECPs should familiarize themselves with include, pink eye, ptosis, Acanthamoeba keratitis, amblyopia, Bell’s palsy, blepharitis, floaters, detached retinas, nystagmus, ocular herpes, and strabismus. Next month we will discuss how an Eye Care Professional can best discuss these conditions on the front lines of Opticianry. ■



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Dispensing Optician Timothy Coronis, ABOC-NCLE

The Pitfalls Of Easy AS YOU MAKE CHOICES regarding the efficient way to do things, you generally decide between simple and more complex options. Simple is usually better than complicated because simple options mean less chances for things to go wrong. When proceeding down a particular avenue in dispensing or edging, be aware of the pitfalls of easy. It can be tricky because sometimes the simplest solution is not necessarily the best. Matching the Tint in Plano Suns Suppose a patient looks at a sunglasses frame, and you are eager to show off the capabilities of your in house lab when it comes to getting a specific tint made. Materials do not all respond to tints in the same way. An excellent 1.6 lens does not have the range of tintability of standard plastic. It may become difficult or impossible to tint a lens material to the color of another material. This is not to take away the value of a custom tint. (See next example.) Imagine the patient simply wanted to know if they could get a brown tint. It’s possible to assign your lab staff a labor-intensive task such as matching a custom tint when it wasn’t necessary to do so. The suggestion that might have exceeded customer expectations was that of a brown polarized lens. Boundries Sometimes, the effective way to present the options is to offer the patient an either/or choice. You could offer a great high index lens material that could be tinted brown or a standard plastic material that can be tinted to almost any shade (rosebrown, amber-brown, orange-brown, etc.) Telling patients (where appropriate) that “we can either do this or that” can be an effective tool. “We can tint a clear lens to a custom color, we can tint standard plastic polarized to a lesser extent, or we may be able to get you a super thin 1.67 material in one of a variety of colors.” Lots of choices, each having limits.

Base Curves Even a casual consideration of base curves will help you rule out some pitfalls in choosing frames. You’ve no doubt seen base curves treated like variables in a long equation, and that is a shame. Before telling yourself you are about to get bogged down in complex techie stuff, just remember that base curves are numbers telling you the front curve on which an Rx belongs. Keep in mind that the Rx can be understood as the difference between front and back curves of the lens. If the front curve (base curve) is a +8.00, and you are questioning whether or not to use the frame for a –5.00 Rx, a casual evaluation tells you that this combination would result in a back curve of –13.00, something to be avoided for good optics. Digital PALs On one hand, the public seems to be pre-conditioned to dread hearing about things being “new and improved”. On the other hand, the public has high expectations about the lenses and service we provide them. Sometimes this leaves ECPs in a difficult place. The public is often expecting the best. When describing the benefits of new, digital designs, it is important to have sorted out lens properties beforehand. “Digital” PALs may be digital, conventionally surfaced, or hybrids. They may be back-surfaced, or front and back. “Digital” may refer to the manufacture of the lenses themselves, or to improvements made in the molds that produce the front surface. Just as a mechanic knows the difference between a 4 cylinder engine, a V-6, and a V-8, we need to be familiar with the differences between the lenses we sell, or face the pitfall of presenting two different lenses the same way to two patients, who in turn talk to each other and compare notes. Bike Glasses

Color This is where language can get sticky. A patient asking for a lens or frame in another color may be asking for another shade of the same color. 30 | EYECAREPROFESSIONAL | NOVEMBER 2009

Patients sometimes evaluate us based on our ability to provide options they can use. More than one dispenser has launched into a list of suggestions for “biking glasses,” only to find out there was some confusion between bicycle and motorcycle Continued on page 32



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glasses. Patient confidence can be lost if the patient feels we don’t understand them. How many other conversations involved eyecare professionals and patients being out of sync? The lesson is to proceed carefully, so that you are always sure you and the patient are talking about the same thing.

factors determining how thick the finished lenses will be in the frame. Just remember that other factors besides a high index of refraction material greatly influence lens thickness. By minimizing the amount lenses are decentered to match the PD, you will be more often using the thin center of minus lenses, as well as keeping thick centers of plus lenses better centered

“Even a casual consideration of base curves will help you rule out some pitfalls in choosing frames.” One PAL Lens The doctor in your office has written an Rx for a first time patient, who wears progressives. There is change in only one eye. You conscientiously identify the manufacturer, progressive design, and lens material. How much trouble could one lens become? A potential pitfall is avoided by measuring the amount of prism thinning in the existing lens, and matching it in the new one. The prism point is the point between the reference dots. Those dots are usually 4mm or 2mm below the fitting cross. Prism thinning is base down prism added in order to thin out some PALs. (Add power makes PALs steeper at the bottom.) It’s important for the amount of prism thinning to remain the same for both eyes, or vertical imbalance will result. When verifying a pair of PALs, the amount of prism thinning (vertically) should match right and left. When changing one progressive lens, it is essential that prism thinning match the other lens. Lenses Only It would seem that the cost of lenses only (as opposed to frame and lenses) is a bargain. In times of economic uncertainty, patients may want to spare expenses, and feel more secure. But how secure is the patient’s own frame? Depending on the age of the frame, lenses-only may be something of a risk. If the patient’s own frame shows signs of finish wearing off the metal, it may make more sense to suggest a new frame to hold the new lenses. Your office may offer a discount and a frame warranty to patients buying a complete pair. When you factor in the inconvenience and cost of the return trip to receive the new lenses, you may begin to see that encouraging lenses-only leaves some patients under served. Thin Lens Material Choice of a thinner lens material is one of the most influential 32 | EYECAREPROFESSIONAL | NOVEMBER 2009

in the frame. Greatly decentering lenses means thick temporal edges for minus lenses, and thick nasal images for plus powers. Why stop there, if there are other choices you can make? Aspheric lenses will flatten the curves of the eyeglasses, and improve optics. Combined with high index material, and minimal decentration, a pair of aspheric lenses will work wonders. Glass Lenses From time to time someone will enter your office, confident that glass lenses are the best choice. A Trivex or polycarbonate lens with the best available hard surface treatment is a safer option, and that hard surface treatment comes with a great warranty. For some patients, there may be no getting around the fact that glass has the hardest scratch resistance of any material. Sometimes these patients are builders or machinists, wanting lenses appropriate to their work environment. Be sure to remind them that hot particles from a grinder will stick to glass, which is cooler because of its heavier specific gravity. Don’t compare other materials to glass in terms of scratch resistance, or you won’t be successful. Instead, explain your warranty, your experience, and in particular how to clean eyeglasses properly with the correct tools. The Compromise An Optician friend of mine described a triangle diagram used by carpenters. It was an equilateral triangle with sides marked “Fast” “High Quality,” and “Low Price.” He explained a two out of three rule to me. Something could be fast and high quality, but not at a low price. Likewise, something could be high quality and low price, but not fast. And of course fast and low price will not get you good quality. In the world of Opticianry, we try to do as much as we can, all the time. Perhaps something could be learned from this triangle when avoiding pitfalls of over promising. ■



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Managing Optician Hari S. Bird, LDO

Opticians are Healthcare Providers, Not Merchants “Opticians are healthcare providers. An Optician’s first function is as a highly skilled health and wellness professional, not as a mercantile vendor or clerk.” THE OPINIONS AND CONCLUSIONS that follow are based first, on my direct observation and experience, and second, on the first hand testimonials of patients with whom I have had the opportunity of serving. And they are presented optimistically with the hope that owners and managers, whether they are private practitioners or corporate retailers, are inspired and motivated to make appropriate changes to their business model in order to advance the status of Opticianry as a profession while enhancing their own objectives. “Opticianry is ultimately defined by how well the eyewear makes contact with the patient. Therefore, a conscious, precise, and personalized process of frame selection, lens design, and in-place, hands-on fitting is required.” Main Issues 1) Many optical retailers are well positioned in the marketplace, but few can be called true vision care providers. Most of them employ a business model that works well for marketing general merchandise. But an Optical Dispensary is different. Like a Pharmacy or Health Clinic, an Optical Dispensary is a healthcare facility where prescription eyewear is designed and dispensed. It is not a mercantile sales facility. The comparison can be likened to the difference between a retail outlet where stuff is sold to customers, versus a Health and Wellness Center where prescription eyewear is designed and then fitted on patients.


“Once today’s retail optical paradigm is upgraded to that of serving vision care patients, as opposed to serving retail customers, an Optician becomes a Healthcare Provider, as opposed to a merchant.” A true vision care provider must focus on a) ongoing practical training of staff, b) highest standards of care for patients, c) inclusion of qualified Opticians in upper management positions, d) sensitivity to patients’ eye care needs, and e) realistic sales goals. “When’s the last time you saw or heard a retail optical Ad promote the custom fitting of eyewear? Could this be because they don’t know how to custom-fit eyewear?” 2) There is an acute need for the staff of many dispensaries to acquire expanded and ongoing training that includes practical, i.e., handson-the-patient training, which includes a) the full discovery lifestyle interview; b) customized frame fitting and adjustment techniques; c) familiarity with both the lensometer and a wide range of dispensing hand tools; d) a working knowledge of optical laboratory operations, e.g., layout, surfacing, finishing and final inspection practices; and e) a working knowledge of the Ophthalmic Refraction. “Many retail optical executives and managers have no experience in Opticianry or Ophthalmic Dispensing. In one organization, only 1 of 43 regional managers is an Optician. In contrast, the CEO of Walgreens is a Pharmacist.” Continued on page 36



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3) Some corporate executives and managers within the retail optical industry, some with MBA’s as their only prior experience, tend to make decisions that adversely impact an acceptable standard of vision care. Some are focused only on their career advancement as managers, while obsessively promoting unrealistic sales goals and requiring interminable amounts of paperwork and reports from subordinates. This in turn interferes with the practice of Opticianry, and the delivery of quality healthcare. “The conflicted relationship between professional Opticians and retail management can be likened to the current relationship between Medical Practitioners and Insurance Industry HMO’s.” Retail managers who are absent Opticianry skills need sufficient training, possibly even in-house certification, in subjects such as the lifestyle interview, optics and lens design, and custom fitting and delivery of prescription eyewear before they assume any policy-making or supervisory roles. Currently, most get on-the-job training only, and their actions and decisions reflect their inexperience to the detriment of acceptable service. Again, providing professional vision care, i.e., designing, measuring, and custom-fitting prescription eyewear on patients requires much more technical expertise and people skills than what is required to service mercantile customers. “The most perfect prescription can be compromised if the eyewear does not provide comfort and long-term wear-ability.” Example: Newly purchased eyewear is routinely and casually handed over to patients without any custom fitting of the frame directly on the patient. (The number one patient complaint: “Nobody adjusted my glasses. They just handed them to me.”) “For many consumers, the personalized fitting of eyewear by a skilled, hands-on Optician is an unfamiliar experience.”

ers) and profitability (much reduced returns, remakes and refunds) of any Vision Healthcare Facility. Here is an actual Optical Retailer’s list of “essential” expectations as presented to prospective staff members. • Drive profitable store sales by fostering a retail selling culture by practicing and role-playing effective retail sales skills. • Develop professional business relationship with other staff. • Fill ophthalmic eyeglass prescriptions and fit and adapt lenses and frames, utilizing optical prescription. Notice that retail sales and retail skills rank #1 ahead of professional skills at #3 in the above retail model. In contrast, the ‘Premier’ model ranks Professional Skills as #1. And as a result, higher profits occur due to fewer returns, remakes and refunds, and more patient referrals are realized because of greater patient satisfaction. Some Optical retailers need to make significant changes if they hope to acquire the Vision Healthcare Provider title. Their business models fall short due to current deficiencies in practical training and depth of dispensing experience. An investment of resources needs to be made where it really matters ... people! For example, in-house training manuals are inadequate since they lack the practical aspects of hands-on-the-patient skills. The reliance on manual-only training is like trying to teach an aspiring surgeon with only a manual as a reference in the absence of a patient. “Due to their market share, the largest optical retailers are in a unique position to lead the industry in the direction of re-humanizing the delivery of eyewear to the public.”

Example: Experienced Opticians are required by inexperienced managers to reduce or even bypass the time necessary to conduct life-style interviews, design appropriate lenses, and custom-fit prescription eyewear directly on the patient.

I urge Optical retailers to invest more in the effective training of their Opticians and to support the certification and licensing of Opticians by providing or funding Opticianry training schools, and by expanding their wage scale in order to retain well-trained Opticians as professional Healthcare Providers.

“Just as a Dentist cannot practice Dentistry without touching a patient, an Optician cannot practice Opticianry without direct contact with a patient. Some of today’s Dispensers just hand over patients’ prescription glasses.”

“Of the over 67,000 Opticians designing, manufacturing and dispensing eyewear – less than half have any formal certification or licensure.” U.S. DEPARTMENT OF LABOR

Again, fitting a vision appliance on a patient involves a different level of technical knowledge and people skills. Dispensing prescription eyewear includes many elements of craftsmanship, artistry, and patient-dispenser interaction along with significant technical skill and finesse in their application. All of these are key to the success (satisfied, happy patients who refer oth36 | EYECAREPROFESSIONAL | NOVEMBER 2009

Some retailers have a long history of financially supporting all kinds of community events and philanthropic gifts. Investment of capital in the training and advancement of their Opticians is a gift that keeps on giving. ■



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Second Glance Elmer Friedman, OD

Understanding the Artificial Eye A few decades ago, many eye care providers were occasionally called upon to render a service to patients who experienced enucleation. Today, they are few and far between. The specialists who fit, design and make prosthetic eyes are called “ocularists.” At present, improved surgical procedures, preventative eye care techniques and improved safety measures in the industry account for a reduced number of eye removals. Joseph LeGrand Jr. is a prominent ocularist in charge of a firm that was started by his father in 1953. He explained to me that independent fitters are sought by surgeons and patients since they demand service from well-educated and trained personnel. The ocularists are a well organized, cohesive group and have not surrendered to external influences or control. The American Society of Ocularists has been the focal point for their group activity and is well supported. Some eye care professionals might find a valuable lesson in this.

HERE IS A FASCINATING HISTORY surrounding the artificial eye and its development. During Egypt’s ancient times, bronze and precious gems were placed upon the eyes of dead people of means and importance. Artificial eyes were also made of painted clay attached to cloth and placed over the socket.


Romans decorated statuary with silver artificial eyes. During the years of the 1500s the first description of an artificial eye prepared to fit an eye socket was revealed by Ambrose Pare, a well known French surgeon. They were made of gold or silver. One style was worn in front or under the eyelids. Enucleation was not a very popular procedure until much later so that the artificial eye was not implanted in the eye socket but placed directly over the blind eye.

The background regarding creation of the modern era artificial eye is most interesting. Prostheses made of enamel (1820-1890) were not very durable but somewhat more attractive than those which preceded it. German and Venetian technicians were credited with inventing a formula for making a type of glass whose color was easily adapted for glass eye use. A tube of this special glass was heated at one end until a molten ball was produced and glass blowing skill was applied to achieve the desired effect. Various colors of glass were used in combination to imitate the colors of the eye to be matched. The process of creating artificial eyes was handed down as family secrets from one generation to the next. Germany records a special history of fabricating doll eyes, Christmas ornaments and prosthetic eyes. German craftsmen were so well advanced in this field that they were the first to be designated professionally as “ocularists.” These gifted artisans began to tour the United States and other areas throughout the Continued on page 40




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world. Once anchored in a location they proceeded to fabricate eyes and fit them to the patients in that particular area. They also fitted artificial eyes by mail order. Hundreds of premade eyes might be kept in stock so patients could be fitted right out of the drawer. The fitters were often referred to as “eye doctors.” In the 1850s several German founded companies made artificial eyes in New York City and sold eyes to local practitioners. Sometimes they would supply semi finished custom eyes to individuals. United States fitters continued to use glass for the artificial eyes until World War II. German imports were limited and German glass blowers were no longer touring the U.S. The U.S. army and national fabricators along with private practitioners began using acrylic plastic polymers and oil pigments. These basic concepts, with accrued improvements, have become the best choices for developments in the ocular prosthesis field. Plastic eyes are molded by the ocularist to provide the best cosmetic effect and excellence of comfort and fit. If the patient complies with the instructions regarding care and cleaning, it is possible for the artificial eye to last as long as a decade. However, Mr. LeGrand informed me that the average life is 5-7 years based

on possible cosmetic changes. The muscles and other tissues in the eye socket will adapt to the post operative circumstances. New developments with artificial eyes allow them to be left in place as much as possible. This includes sleep schedules. Some patients remove the eye for cleaning every few weeks. Others perform this task only every few months with no adverse results. An ocular implant replaces the removed tissue of the eye. The first record of an implant was in 1841. They have been made of many different materials, shapes and types over the years. They are made to aid the artificial eye to have some degree of natural movement. The surgeon, following the enucleation procedure, will attach the remaining musculature to the implant. Mr. Legrand reports, “Porous implants made from coral, newly developed plastics or other materials were introduced around 1987. They generally provide superior motility with fewer complications when compared to early plastics or glass spheres.” This allows the muscles to move the artificial eye in a manner that is similar to the action of a normal eye. The reader will be surprised to know that the new eye is not rounded in shape as Continued on page 42




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12:46 PM

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you would expect in comparison with your normal eye. It is shaped, more or less, like a bottle cap and is fitted over the implant. The fitting and dispensing of the artificial eye may take only one day. However, depending on the ocularist, it may require more than one or two sessions. The new eye is made in several steps. While it is not painful, it is tiring and may leave the eye socket a bit irritated. Once the wax impression is fashioned and finalized, the plastic insert is made. Further adjusting and smoothing may be necessary at this stage of the fitting. The ocularist is attempting to mold the impression in such a way that the eyelids will rest properly when the eye is open or closed. He merely removes it, adjusts it and reinserts it. Some ocularists use a special lubrication to help prevent the irritation that is sometimes caused by frequent removals and insertions of the impression. The ocularist will then draw a sketch on this implant to determine how the eye hole should be aligned. He will drill a hole in the material to meet the necessary alignment measurement. He will insert the colored area of the artificial eye via a “button� that closely resembles the alternate eye. This is placed over and around the implant in preparation for the painting process. The small red


blood vessels may be copied by attaching small strands of fabric on the plastic. In the hands of an expert the new eye should be a close match to the remaining eye. The patient must understand that as a result of losing the eye, the orbital tissues and muscles recede and change. The change is very profound from the first to the sixth week and no attempt should be made for a fitting before that period of time. The appearance of the new eye will match the opposite eye exactly. There are several solutions to the expected unequal movement of the artificial eye. Sunglasses or mildly tinted eyewear can be helpful to disguise the imbalance of movement. Recently reported developments regarding digitalized coloring of the artificial eye may help substantially in the manufacturing process, although Mr. Legrand does not endorse digitalized coloring since the long term results are not known at this time. The vanguard of ocularists is discovering how to use modern approaches to advance their profession and intend to ride the crest of the wave into the future. Eye care providers everywhere will wish them the best in their endeavors on behalf of the monocular public. â–



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Eyeego Launches Cutting Edge Eyeglass Screw Eyeego, LLC, based in Clifton Park,NY, is introducing an eyeglass repair kit that contains a new type of eyeglass screw designed to simplify repairs. Eyeego has signed a license agreement with FGX International, Inc. to sell the repair kit to the retail market. The screw, which is patent pending, features a feeder tab that allows it to be handled with ease. Users simply guide the tab into the hole in the eyeglass hinge, tighten the screw and snap off the feeder tab. Eyeego is in discussions with several international companies to distribute the screw to the optical industry. The kit can be ordered directly from Eyeego by calling (518) 487-1550, or by visiting the company’s Web site, A video demonstrating the screw can also be viewed on the site. Wholesale pricing for the screw is also available.

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To advertise please call 800.914.4322, or visit NOVEMBER 2009 | EYECAREPROFESSIONAL | 47



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Last Look Jim Magay, RDO




What could be a better pairing? From the OAM’s annual golf day to the new Definity Ground View Advantage by Essilor, not to mention Rudy Project’s great wrap sunwear with ImpactX Photochromic Golf lenses, Kaenon Sports (Davis Love’s favorite sunwear), Liberty Sports, Bolle, etc., etc. As a newbie to the world of golf – The first report in 1971 was from (I just started last year, and truth the town of Eucla, by kangaroo be told this coming weekend will shooters claimed to have seen a be my first time out this year), I’ve blonde woman amongst some struggled with progressives while kangaroos, and backed their story addressing the ball. Apparently the with grainy amateur film showing new Definity lenses allow clear a woman wearing kangaroo skins vision to the ground when your and holding a kangaroo by the tail. head is in proper position. I took After further sightings were the easy way out last year and got claimed, the story was reported Drivewear single vision lenses, I around the world, and journalists keep them in my golf bag and they descended upon the town of Eucla This hole is part of Nullarbor Links, the world’s longest golf course. are great. The polarizing feature which had a population of 8 peocombined with a unique blend of ple at the time. Transitions lens tinting make them comfortable in all light. The incident was eventually revealed as a publicity stunt. In non-optical golf news – unless you consider that you would The girl on film turned out to be a 17 year old model named need a good telescope to see from tee to green, The Nullarbor Janice Beeby. Plain in Australia’s Outback has become the home of the world’s longest golf course. 18 holes spread over 848 miles. Yes! Back to the golf course, it is the brainstorm of a group of local You read that correctly – 848 miles (1.365 km for you metric businessmen who got tired of watching tourists tear down the aficionados). Edward John Eyre described the Nullarbor as “a highway like Mad Max in search of revenge. Don Harrington, hideous anomaly, a blot on the face of Nature, the sort of place a leader of the group; speaking to NPR, said the idea was one gets into in bad dreams.” He became the first European to germinated, as many great leaps forward for mankind are, “over successfully make the crossing in 1841.This is not a course that a few bottles of wine about 5 years ago”. It is hoped Nullarbor favors golf carts, instead a fast car or small plane would work Links will become a tourist trail with the folks slowing down, well. The course is a par 72, and the 4th hole at Nundroo is savoring the charms of the outback – including golf ball stealing crows, kangaroos, koala bears, crocodiles! Over 600 golfers unique in that hairy-nosed wombats might disturb your play. have played the course even before the actual opening! You might keep an eye peeled for the Nullarbor Nymph, referred to in reports of sightings of a half naked woman living Let us hope they were wearing Ground View Advantage lenses, amongst kangaroos on the Nullarbor Plain, turns out was a I hear the sun is really blinding! ■ hoax perpetrated in Australia between 1971 and 1972. 50 | EYECAREPROFESSIONAL | NOVEMBER 2009



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EyeCare Professional Magazine November 2009 Issue  

November 2009 Issue of EyeCare Professional Magazine. A Business to Business publication that is distributed to decision makers and particip...

EyeCare Professional Magazine November 2009 Issue  

November 2009 Issue of EyeCare Professional Magazine. A Business to Business publication that is distributed to decision makers and particip...