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OVERCOMING THE BURDEN OF EXPERIENCE / PAGE 14 October 2012 • Volume 6, Issue 58 •



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HIGH-X 1.67 7x28 Lenses TM

kRx Range: -9.00 to +3.00 kAdd Range: 2.00 to 3.50 kMR-10 Lens Material

©2012 X-Cel Optical Company, all rights reserved. HIGH-X is a trademark of X-Cel Optical Company.

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Vol. 6 Issue 58

Features 6

Courtesy of Rudy Project



AFFORDABLE EYEWEAR Stay ahead of the challenging economic climate by offering affordable, quality eyewear. by ECP Staff


THE BURDEN OF EXPERIENCE Move your practice forward by letting go of the way things have always been done in the past.


by Anthony Record, RDO


ONLINE REVIEW WEBSITES Dispensers should make their presence known on fast growing websites like Yelp and Foursquare. by Corrie Pelc


INTERVIEW: EAR TECHNOLOGY Ear Technology Corp.’s Jim Barbarito discusses how TuneAmp can provide additional revenue for ECPs. by Paul DiGiovanni, LDO



DEALING WITH PATIENT FEAR It can be challenging to help some patients overcome their fear of going to the doctor. by Lindsey Getz


OPTICAL REMINISCENCES A long and storied optical career, from World War II until the present, is fondly remembered. by Elmer Friedman, OD



Departments EDITOR/VIEW .....................................................................................................4 DISPENSING OPTICIAN .................................................................................18 MOBILE OPTICIAN .........................................................................................28 MOVERS AND SHAKERS.................................................................................30 OPTICAL CASE STUDY ...................................................................................34 THROUGH THE LENS .....................................................................................38 INDUSTRY QUICK ACCESS............................................................................42 ADVERTISER INDEX .......................................................................................44 LAST LOOK .......................................................................................................46



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Sell is not a Four Letter World o matter what kind of practice you work at, you must achieve patient satisfaction to succeed, and whether it is a product or service, achieving that satisfaction is going to involve some type of selling.


The simplest – and most often used method – is comparison. If it is a new product or procedure, then a comparison is made between what it would be like without it and what it will be like with it, in other words the benefit to the patient. This usually involves educating the patient so that they will understand the difference. But be careful, they only need enough information to judge the value, and going beyond that point may at best bore the patient, or at worst make them more confused. A good approach is to state general principles and then relate them to everyday experiences. For example, you have determined that AR coating would benefit your patient. You’ve explained that the coating allows all the light to go through the lens resulting in much better aesthetics, but he’s still not convinced of the value. You might then explain that reflected light is lost and unusable, which is like sitting down to read and turning the lights down, while the coating makes all the light available, so contrast is much improved: a point easily understood by most people. Frame sales is a major area of potential patient satisfaction, and with the varying costs, makes frames more susceptible to price shopping. If your patient doesn’t understand the value difference between a $200 frame and a $50 frame, then cost is going to be the primary factor. While style is easily demonstrated, many benefits of premium frames are hidden and must be pointed out. Always start out showing the best quality frames that meet the requirements of the patient, and as you move down in price, the differences in quality will become apparent. When showing frames, always put the frame in the patient’s hands. Doing so not only lets them feel the material, weight, and quality, but also gives a sense of possession and ownership. For example, while the optician explained the benefits of titanium in a high quality drill mount frame, the frame was handed to the patient. When another frame of lesser quality was handed to the patient, she recognized the weight difference immediately. Enthusiasm is the key to successful selling. If you’re not excited about your products or services, how do you expect your patient to be excited and receptive? Know your products and know you’re giving your patient the best in quality and satisfaction.


Publisher/Editor . . . . . . . . . . . . . . . . . . . . . . . Jeff Smith Production/Graphics Manager. . . . . . . . . . . Bruce S. Drob Director, Advertising Sales . . . . . . . . . . . . Lynnette Grande Contributing Writers . . . . . . . . . . . . . . . . . . . Judy Canty, John Dick, Paul DiGiovanni, Gary Fore, Elmer Friedman, Lindsey Getz, Ginny Johnson, Jim Magay, Warren McDonald, Corrie Pelc, Anthony Record, Jason Smith Technical Editor . . . . . . . . Brian A. Thomas, P.h.D, ABOM 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 6 Number 58 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.

For Back Issues and Reprints contact Jeff Smith, Publisher at 800-914-4322 or by Email: Copyright © 2012 by OptiCourier Ltd. All Rights Reserved For Subscription Changes, email: Scan this barcode with your smartphone to go to our website.




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any Crizal Brand AR when applied to any Balester digital progressive lens design

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Affordable Eyewear 1. Rudy Project Designed with a half-rim lens and a frame optimized for the shape of the female face, Stratofly sx is for active women who appreciate stylish design. It was created with the unmistakable wraparound frame design for maximum protection from debris and sunlight, no-slide soft rubber temple tips and an adjustable Ergo IV™ nosepiece to facilitate air ventilation.



2. A&A Optical New Globe delivers lasting quality and classic styles at a price point to meet any family’s budget. L4047-P applies new rules to old school plaid – translucent, bright hues. The rectangular shaped acetate frame is available in Black, Blue, Brown, and Crystal. Available in Size: 53-16-135.

3. Renoma by J.F. Rey In 1980, the artistic path of Maurice Renoma crossed that of J.F. Rey. Renoma Eyewear was born to seduce a mixed, urban and very elegant clientele. Renoma Eyewear is modern styling with ready to wear collections. Renoma is focused on acetate and metal combinations that make for a match made in heaven.




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Value Eyewear can still be functional and fashionable.


4. Viva International Group

5. Morel Eyewear


Designed exclusively for women, Alpha 19 is a super lightweight frame which features discreet, clean lines. Stainless steel temples are inserted into rounded, injected, long endtips. Satin fronts paired with gloss temples create a high contrast for a unique trendy look. All models can be fitted with progressive friendly lenses while retaining an ultra-contemporary appearance.


The new CANDIE’S Eyewear Fall 2012 collection reflect the playfulness of today’s CANDIE’S girl infused with fashion glamour. Fun stripe detailing decorates the outside temples of model C Logan, while model C Lexie takes a subtler approach with a stripe pattern on the inside of each temple. Both styles are handcrafted in acetate and feature trendy oval front shapes.

6. Hilco The Element Rx Sunglasses collection features a lightweight, semi-rimless frame with an 8-base wrap styling with the processing ease, affordability, and optics of standard Rx lens mounting. Our newest Element style includes classic animal print with a rhinestone twist, sure to capture every female’s eyes. Fully Rx-able, in Size: 58-18.



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Studio Optyx

NW77th was launched for champagne tastes and the beer budget. These guys have all the right shapes and styles. Now you can have something that looks different that not everyone has. It is so new that it’s not on the website yet.

Les Pieces Uniques


Kaenon’s Kanvas offers lightweight clarity, comfort and impact resistance through the new, Brown SR-91 lens. TR-90 frames provide lifelong memory retention and durability. Also available in polarized SR-91 options.

Classique Eyewear

Les Pieces Uniques produces handmade frames from Italy that provide a unique style for every person wearing them. Characterized by elegant and refined details, the frames take a modern approach with enchanting forms and colors.

OGI Eyewear Using a blend of traditional shapes and a contemporary color palette, Seraphin introduces the Dale. Combining Japanese titanium with Italian acetate, the Dale offers a spark of color to neoclassical eyewear with options such as blue demi/antique silver and crimson/ antique gold. An intricate coining ridge along the Dale’s eyewires offers a subdued sophistication.

The flattering pillow eyeshape SuperFlex 366 has enough depth for a progressive lens while the intricate temple design and two tone coloring provides a modern look to this classic design. Spring hinge temples provide additional comfort and added durability. This model is available in Sizes: 52-18-130 and 54-18-135 and comes in Brown Gold, Purple Silver and Rose Burgundy.,



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Exalt Cycle


A lightweight aluminum temple coupled with classic acetate is the embodiment of style and technology that combine to form the distinctive Bora line from Exalt Cycle. With an understated logo and all the craftsmanship and quality you would expect from Exalt Cycle, the Bora is offered in several colors.

MA7309 – This stylish, full fitting acetate model is perfect for the mature woman. The frame includes metal end pieces in a satin finish and epoxy coating while the deep B measurement ensures the use of progressive lenses. Available in three colors (Black, Brown, Red) and two Sizes: 53 and 55.

Trevi Coliseum Eyewear

Clariti Eyewear

Cotton Club 288 is constructed from the highest quality Mazzucchelli Zyl with rubberized temple inlays for style and comfort. It defines the concept of fashion and beauty. Available in 3 colors Black/Gun/Black (shown), Tortoise/Blue/Silver and Havana/Gun/Purple. Made in Italy and backed by a two year warranty. Sold exclusively in North America by National Lens.

Revolution Eyewear Revolution Eyewear continues to raise the bar on magnetic clip-on styles. This classic look is now available with a magnetic clip-on. The Rev736 is available in Bronze Brown, Matte Gun, Matte Gold and Semi Matte Black. All Revolution Magnetic Clip-Ons can be special ordered for 3D Viewing and soon to come specialty lenses for specific sports as well.

Mademoiselle Pure Titanium – MM9250 Antique Pink offers classical Parisian sophistication and style. A level of elegance at a reasonable price point without compromising a single flourish. The Mademoiselle collection combines a new level of intricacy with a stately European style. The material is hypoallergenic, non-corrossive and feather-light.



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REM Eyewear

J.F. Rey Eyewear Joins the Fight to Find a Cure for Breast Cancer

The new Converse Star Chevron “On Your Mark” takes conventional and kick flips it way past ordinary. A grip tape inlay and polarized lens push the boundaries on these street smart shades. Available in 3 colors: Black, Grey and Neon Yellow, all with grip tape inlay.

Global Optique

PB386 – It is made of 100% grilamid that makes the frame a lightweight model designed as a traditional ladies frame with a nice decorative piece at the temple.


Daisy Fuentes Valeria is a semi-rimless metal frame with an extended fit in a modified oval shape that is feminine and perfect for a variety of face shapes and ages. The metal temple features an intricate pattern of raised and cut out diamond shapes.

J.F. Rey Eyewear will unveil their branded Breast Cancer Awareness Eyewear frame at the Glam-A-Thon event “Lipstick Lounge” at the Broward Center for the Performing Arts in Fort Lauderdale on October 5th. This event will showcase the optical frame which features the Breast Cancer Awareness ribbons alongside the handmade French product that matches the high quality J.F. Rey products are known for. These frames are limited to 200 pieces and will be sold at the Lipstick Lounge through Optical Spectrum and 100% of the proceeds will go to help find a cure for breast cancer. “Our goal is to raise over $70,000 for the fight against breast cancer through the production of our frames,” says Jean-Francois Rey. Jean-Francois Rey is one of the most acclaimed eyewear designers in the world, and the Breast Cancer Awareness frame is produced in the same manner of all of our high quality frames, with a suggested retail value matching our regular frames of $450.00. During the Lipstick Lounge event, every V.I.P. will receive a complimentary pair of J.F. Rey or Boz Eyewear. “The idea is to hopefully get these V.I.P. attendees to open their hearts and minds and donate to this very worthy cause,” says Travis Chivers, Sales Manager of J.F. Rey USA. For more information, call Mr. Chivers at (917) 688-9779 or email



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Workplace Eye Injuries: A Closer Look at Prevention by JODI GROH Every day, approximately 2,000 U.S. workers receive some form of medical treatment for work-related eye injuries. That's a startling number, isn't it? Over the course of a year, nearly 800,000 workplace eye injuries will occur, which, as the Bureau of Labor Statistics points out, takes a staggering toll: •

$300 million in lost production time, medical expenses, and workers’ compensation

Almost $4 billion in lost wages and productivity

Untold human cost of vision loss

Here’s an even more troubling fact: three out of five victims weren’t wearing eye protection, according to the Bureau of Labor Statistics. Why safety eyewear mandates don’t work You are probably wondering why there aren’t government regulations to protect workers’ vision. There are. The Occupational Health and Safety Administration requires employers to complete a workplace hazard assessment and mandates “protective equipment, including personal protective equipment for eyes...shall be provided, used, and maintained...wherever it is necessary by reason of hazards.” Then why are injuries still high? Field experience suggests worker noncompliance is a significant factor. A study published in Accident Analysis & Prevention examined the causes. Researchers asked focus group participants to name reasons for not wearing protective eyewear. In 100 percent of the groups, fogging and comfort/fit were identified as the problems. Anti-fog: a surprising secret weapon for preventing eye injuries In the study, fogging was found to be the number one vision-related barrier to wearing safety eyewear in the workplace. More than half the respondents suggested an anti-fog solution could help increase compliance. Is it any wonder? A utility lineman dealing with 20,000 volts atop a sun-scorched power pole can’t work with steamed-up safety glasses. A steelworker pouring molten metal can’t afford obscured vision. A food processing worker driving a forklift in and out of coolers may trade eye protection for a fog-free view. Research by Nanofilm in partnership with Occupational Health and Safety magazine found corroborating results. Among the findings, 66 percent of respondents said fogging was a deterrent to wearing safety eyewear.

Twenty-eight percent reported fogging had contributed to injury in their workplace. A wide range of industries are at risk, including mining, construction, food processing, utilities, pulp and paper, and more. The causes are equally varied. High heat and humidity are frequent problems. Changing temperature is another. Exertion levels also play a role, since increased perspiration creates moisture that becomes fog. Workers in full-face or full-body gear are at higher risk, since moisture can’t escape. Jerry Daniels, authorized Occupational Safety and Health Administration (OSHA) outreach trainer, shared in a recent seminar that he would include fogging risks in a workplace hazard assessment and recommend anti-fog, if needed. It’s worth noting that OSHA guidance on personal protective equipment adds: “It is important that all eye and face protection be kept clean and properly maintained. Cleaning is particularly important where dirty or fogged lenses could impair vision.” Think SAFE to prevent workplace eye injuries As eye care professionals, we need to take an active role in protecting patients’ vision – and that responsibility doesn’t end when they walk out of our offices. Always discuss eye protection as part of lifestyle evaluation. This S-A-F-E process can help guide the conversation. •

Share the facts. Help your patients realize injury risk is real.

Ask about work hazards and safety eyewear. Do they need safety eyewear? Do they use it? If not, why not? Don’t accept “I forget” or "I’ve never been hurt" as an answer.

Find the barriers. Include fog, fit, availability and other factors.

Enable safety. Provide appropriate advice and products. That could include stocking professional grade anti-fog, non-prescription or prescription safety eyewear, or items like lanyards to help workers keep safety eyewear close at hand.

Remember, 90 percent of all eye injuries could have been prevented by using proper safety eyewear. Be sure you’re focused on assuring 100 percent of your patients are wearing it. Want more eye safety tips? Visit The Vision Council’s at



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Protect Their Vision. Diversify Your Revenue. It is estimated that 800,000 work-related eye injuries occur each year. By using the “Inquire. Inform. Introduce.” strategy you can help protect your patients’ vision while at the same time expanding your patient base and diversifying your revenue stream.  Ask: What are you doing to protect your vision?  Consider: Job-specific tasks and hobbies  Discover: Your patients’ daily activities Providing accurate information and solutions begins with asking your patients the right questions. Learn how to ask the right questions at

helping you to grow your practice



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The Burden of Experience I recently had the honor of participating in a collaborative brainstorming session with some executives at an educational organization which I have contracted with for more than a dozen years.

myself against being perceived that way that I began to hold back on what I thought were worthwhile and salient points. Perhaps sensing all this, I noticed the leader of the group, Gary, had started to smile. What he said next was intended, I believe, as a mild admonishment to me, and as a lesson to the rest of the group not to misinterpret my intentions. It was also, a bit profound. Gary said, “The problem here is, Anthony, you’re operating under the Burden of Experience.” What he meant was that despite the fact that I knew the company was taking a different direction, had made some key operational and staff changes, I was seeing everything through my paradigm of the past – the way things had always been done. I had no factual reason to believe that the things I were told would happen in fact wouldn’t happen; other than, of course, the Burden of my Experience. Once I was made aware of it, I was able to – at least a little bit – let it go. The proof is always in the pudding, so I will look back six or twelve months from now and say – wow, what a profound moment, or, God forbid, the Burden of my Experience will be even stronger. Only time will tell.

The people of the organization are some of the smartest, most ethical and professional people I have ever had the pleasure of knowing, and the work they do in the field of life-long adult learning is vital. Being associated with this group of highcaliber individuals has been one of the joys of my life. The goal of the day-long session was to come up with as many ingredients as we could as to what makes for the perfect seminar day – what we have come to refer to as a WOW experience for attendees to our events. As the morning session progressed, I began to have the realization that many of my contributions to the conversation began with phrases like, “Well, that will never work because...” or, “Yeah, but if...”, or “That’s never happened in the past, so....” In fact, despite my intention of offering constructive suggestions, I knew my words were coming across as negative or destructive. I was so worried about guarding

As I was flying home to Florida, I began to think about what Gary had taught me about the Burden of Experience and to ask myself, does this in any way apply to our world in the optical field? I think it does. Most of you are probably smarter than I am and have already thought about how your Burden of Experience may be holding you back as an eye care professional. Perhaps it’s holding you back in sales, patient relationships, furthering your education, or advancing within your organization. I would like to delve into how this Burden of Experience may be contributing to our loss of eyeglass and contact lens sales to Internet retailers. As you probably already figured out, we all operate under our very own burdens of experience. That goes for our patients as well. So how does this all tie together? Well, let’s take a moment to think about a typical client, and his or her own typical Burden of Experience as it relates to being an eye-care consumer. It seems to me that the typical experience clients go through in your practice is what will mostly determine whether Continued on page 16




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Experience performance and comfortable viewing in changing light conditions with KODAK TransitionsÂŽ Lenses. Two great brands from Diversified Ophthalmics, Inc.


Kodak and the Kodak trade dress are trademarks of Kodak, used under license by Signet Armorlite, Inc. Transitions and the swirl are registered trademarks and Transitions Adaptive Lenses is a trademark of Transitions Optical, Inc. 3KRWRFKURPLFSHUIRUPDQFHLVLQÀXHQFHGE\WHPSHUDWXUH89H[SRVXUHDQGOHQVPDWHULDOV Š2012 Signet Armorlite, Inc.



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or not they return and refer others to your office, or instead will decide to order their optical goods by using a few mouse clicks to navigate the web. Consider the following scenario: Upon entering your practice, a patient is politely and promptly greeted by a smiling, upbeat, well-dressed professional who sincerely offers to help and confidently guides the client through the check-in and medical history process. When completed, the patient is escorted to the waiting room area which is clean, comfortable and well-stocked with current point-of-purchase brochures and popular periodicals. On the flat-screen television, continuous loop videos offer information of all the new and exciting optical product that are available at your office – names that the patient is already familiar with (such as Crizal and Transitions) feature prominently, as do new and thought-provoking images of things like digital or individual lenses, something called Computer Vision Syndrome, golf glasses, Eye Sun Protection Factors, and many, many more. The patient is called in for her appointment on time or dare I say it, early. The examining doctor conducts a thorough, unrushed, caring examination, and actually listens to and answers questions both thoughtfully and thoroughly. As the client is “handed off ” to the optician, the doctor takes 30 seconds – in front of the patient – to communicate valuable information about things that were discussed in the exam room, and some of the features that will best serve the patient’s needs. The optician does a little lifestyle questioning, learning about additional patient activities and expectations. Based on all that information the patient agrees to whatever lens style and material is suggested by the ECP. The optician then suggests frame styles based on client feedback and cosmetic knowledge, and once the perfect frame is chosen, the order is entered and paid for, the patient is informed that the glasses should be ready in a week to 10 days and that a phone call will let her know exactly when they are ready for pick up. The ECP walks the smiling patient to the door, making small talk all the while, opens the door for the client, thanks her once again for her business and the confidence she has placed in both the optician and the organization. Smiling as the door swings closed, the optician offers a final goodbye, “Thanks again...have a great weekend...see you in a week or two.” Five days later (more than a week earlier than promised) the patient receives a phone call from the optician: “I know we told you a week to 10 days, but I knew you were anxious to get your new glasses, so I expedited them for the way...they came out great! Come in and get them whenever you’d like.” When the client comes in to pick up her glasses, she is greeted as enthusiastically as when she ordered them, and the dispenser asks the client to have a seat so that they can be personally 16 | EYECAREPROFESSIONAL | OCTOBER 2012

custom-fit to ensure perfect vision and comfort. The dispenser does a hands-on adjustment, carefully looking and touching behind the ears and on the sides of the client’s head, explaining every step of the way what is being done and why it is so critical. As a result, the patient receives hands-on, medicallike care, and the vision and fit is superior to anything she has ever experienced. You thank her for her business and proactively ask her to refer any friends and family members she thinks would benefit from your services. She says she will, and does. Now ask yourself, is this the kind of experience most of your patients are treated to? If so, I truly believe that their Burden of Experience would mean that they would never even consider purchasing eyeglasses online. On the other hand, if most of the elements of that scenario are only sometimes experienced by a few of the clients that walk through your bricks-and-mortar doorway...if hardly any clients experience all of the elements of that scenario, you can be sure that their Burden of Experience is what has and will continue to drive them through the virtually constructed doorway to the Internet that you have constructed. The choice is yours. Is it time to change the overall experience of patient who patronizes your practice? It’s not too late, but the clock is ticking. ■

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Signet Armorlite Welcomes Back KODAK Unique Progressive Lenses SIGNET ARMORLITE is pleased to welcome back KODAK Unique Progressive Lenses. Available in over 50 materials, KODAK Unique Lenses are digitallycreated full backside progressives designed with Vision First Design™ (VFD) Technology. The most significant benefits of VFD Technology to the KODAK Unique Lens include: a broad field of view in a clear distance area, smooth gradation of power across the surface of the lens to ease patient adaptation, gentle binocular balance for quick, clear object recognition and visual quality often compared to a single vision lens. KODAK Unique Lens continues to be easy to dispense with a full complement of lens materials to accommodate patients’ needs. Along with the relaunch of KODAK Unique Lenses, Signet Armorlite continues to evolve its designs with the release of KODAK Unique DS™ Lens. The KODAK Unique DS Lens is a digital dual-side progressive lens that offers significant improvement in the reading area

for many prescriptions, while providing excellent visual performance in the intermediate and distance viewing areas. “Along with the launch of the KODAK Unique DS Lens, we are incredibly excited to be able to welcome back the KODAK Unique Lens. We have built a loyal following for the KODAK Unique Lens since it was launched in 2006,” states Brad Staley, President of Signet Armorlite, Inc. “With these two lenses, Signet Armorlite continues its mission of providing highperformance lens options for all of our customers.” The KODAK Unique Lens starts at a 13mm minimum fitting height and offers 6 corridor lengths (13mm to 18mm). KODAK Unique Lenses will now allow the option for prescribed prism and is available in over 50 lens materials including multiple indices in clear, polarized and photochromic (with more material options coming soon).



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Adventures in Sales Prevention Yeah, you read that correctly. Example: Mrs. Smith brings you her new spectacle prescription. You fill it and, a few days later, she returns. She’s not happy with her vision through her new specs. You check them thoroughly, even though you did that before they were dispensed. You re-check your fitting measurements. Everything is correct. You ask Mrs. Smith to return to the prescribing doctor for a re-check. Instead, she sees a different doctor and brings in a change to her prescription. Your office policy is a one-time no-charge dr’s change within 30 days. What are your options? 1. Offer Mrs. Smith a discount on the new lenses, because she didn’t follow your instructions and chose to see another prescriber. Rules are rules and she should know that. 2. Remake Mrs. Smith’s glasses with the new prescription and bill the first prescriber for the new lenses. After all, you’re not running a charitable organization, you’re running a business. 3. Remake Mrs. Smith’s glasses at no-charge, regardless of the prescriber. Thank her for her continued patronage.

do you let her know how much you appreciate that opportunity or do you let the Sales Prevention Team control the situation? One option will almost guarantee the loss of Mrs. Smith’s repeat business and any referrals. One option will keep the customer and lose any referrals you may have gained from a prescriber. (Remember, if the new prescriber has a dispensary, you could have lost the sale and the customer.) One option will keep a satisfied customer and the additional opportunity to attract some more. Your decision? Example: Mrs. Smith gave Mr. Smith a gift certificate for $100 towards his next pair of eyeglasses. The Gift Certificate expires after 1 year. Mr. Smith is in your office and has chosen a top-of-the-line frame and lens combination. Mr. Smith will be spending large bucks in your office and wants to use his now-expired Gift Certificate. What are your options?

I am reminded of Lucy in the Peanuts cartoon strip. I can just see her screaming, “RULES ARE RULES!” to a hapless Charlie Brown as she yanks the football away. I can also see Lily Tomlin’s “Telephone Lady” reminding a caller that “the phone company is not in the habit of handing out free services willynilly.” Mrs. Smith came to your office for new eyeglasses because: • She is a returning customer, or • You were recommended by a friend or family member, or • She liked your frame selection, or • She trusted your reputation. Whatever her reason, she is now your customer and your job should be to make certain that relationship doesn’t change. So,

1. As politely as possible, show him the expiration date on the Certificate. You would really like to help him, but rules are rules. As a business man himself, he should know that. 2. Offer Mr. Smith a different frame and lens combination that is less expensive than the pair he has wants. 3. Honor the expired Gift Certificate; after all, you already have Mrs. Smith’s money in the bank. Mr. Smith is in your office because Mrs. Smith really appreciated your help with her glasses, so do you build on that recommendation or do you send in the Sales Prevention team? One option will not only make a liar out of Mrs. Smith, it will guarantee that neither Mr. Smith nor any of his friends will look upon your office kindly. Continued on page 20




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One option will simply make you look (condescending, greedy, cheap, slightly dishonest). Pick one. One option will make you a good business person, protective of your reputation for honesty and fairness. Your decision or do you turn it over to the VP of We Can’t?

to cement that relationship by offering a “family discount”, almost guaranteeing not only their future patronage, but also that of their other family members and friends. Your decision? Sales prevention is the offspring of office policies gone very, very wrong.

Example: Mr. and Mrs. Smith are very happy customers in your dispensary. Their son and daughter-in-law however are having some financial difficulties and the two grandkids need eye exams and new eyeglasses. You don’t have a “family discount” program and multiple pair discounts are only offered for the same prescription and patient. What are your options? 1. Allow the kids to choose from the discontinued, overstock, wouldn’t-wear-them-if-I-were-half-blind frame selection with the it’s-not-my-problem-if-theylook-like-pop-bottle lenses. 2. Allow the kids to choose frames that they like and will actually wear with lenses that are appropriate for their prescriptions. 3. Allow the kids to choose frames that they like and will actually wear with lenses that are appropriate for their prescriptions AND offer a “family discount” to lessen the financial burden for your very happy customers. This could be the Sales Prevention Team’s dream situation; the opportunity of a lifetime! A glorious win for the VP of We Can’t! One option assumes that Mr. and Mrs. Smith can’t afford to pay for whatever their precious grandchildren want and need and will appreciate your intuitive powers.

Don’t misunderstand me. Office policies and procedures are absolutely necessary for your business to function smoothly and efficiently. Slavishly adhering to office policies and procedures; denying your staff the ability to find some wriggle room to satisfy a customer is an uncomfortable situation just waiting to happen. Ivana Taylor, President of Third Force, a strategic marketing firm, offers this advice. • List all you customer policies and ask yourself the question, “Are these making it easier or harder for the customer to give me money?” • What are your customers purchasing? Are there products or services that they may not have considered that would improve their purchase and purchase experience? If they are buying clothing (eyewear)—are there accessories that can go with it? If they are buying services—are there complementary products that they can use to enhance the service experience? • Take a look at all your product offerings and look for simple ways that keep people from buying or buying more. • Create product bundles and train your staff on what things could go together.

One option assumes that because Mr. and Mrs. Smith are wearing the best eyewear your office could offer, they will want the same for their grandchildren.

I would add to that advice by suggesting regular meetings, weekly if possible, to identify opportunities taken and opportunities missed. A sort of brainstorming session designed to keep you and your staff focused on what you need to accomplish to maintain the reputation of trust that is the lifeblood of any business. ■

One option assumes that Mr. and Mrs. Smith will entrust their grandchildren’s eye care to your office and that you are willing

When a defining moment comes along, you define the moment, or the moment defines you. —KEVIN COSTNER 20 | EYECAREPROFESSIONAL | OCTOBER 2012



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Making the Most of Online Review Websites TEN YEARS AGO, if you wanted to find a business, you pulled out a copy of the Yellow Pages. And if you wanted a review of that business, you turned to your family and friends for their honest opinion. Now ten years later, although word-of-mouth still holds clout, it’s being upstaged by business rating and review websites like Yelp and location-based social networking websites like Foursquare, where patrons of a business can leave instant feedback – either good or bad – along with photos, videos, and more. Here’s further proof that rating and review sites are changing things up: • According to the Local Consumer Review Study 2012, conducted by BrightLocal, 72 percent of consumers surveyed said they trust online reviews as much as personal recommendations, and 52 percent said a positive online review makes them more likely to trust a local business. • As of April 2012, Foursquare says it has over 20 million users worldwide, with over 2.5 billion check-ins and nearly a million businesses using their Merchant Platform. • As of June 2012, Yelp says it averages 78 million monthly visitors and has accumulated 30 million reviews since its start in 2006. Review This So if online review and rating websites are the future of how businesses are to be found, should ECPs be jumping on this digital bandwagon? Yes, says Dr. Tommy Lim, who has been using Yelp for a few years now to help promote his practice, Berryessa Optometry in San Jose, CA. To date, Berryessa Optometry has 68 reviews 22 | EYECAREPROFESSIONAL | OCTOBER 2012

on Yelp, and they have used the review site to promote their business by placing photos and even a video about their practice. They also have a large button on the practice’s website,, to let both current and prospective patients know they are on Yelp. Dr. Lim says although word-of-mouth is still important, the way patients find an ECP is changing. While potential patients will still first look for providers that accept their vision plan, Dr. Lim says they are then turning to the Internet to check out websites and read online reviews of those practices on sites like Yelp. “That’s how they make their choices sometimes – patients now investigate more than they used to,” he adds. Dr. Nate Bonilla-Warford of Bright Eyes Family Vision Care in Tampa, FL, also believes online review sites are something ECPs should look into. He has been using Foursquare as a way to promote his practice since November 2009, and since then has had over 400 people “check-in.” Dr. Bonilla-Warford has been using Foursquare in different ways as a marketing tool. For instance, right now patients that check-in get a free Bright Eyes Family Vision Care coffee mug. Before that, he gave away bottles of hot sauce made by a friend’s company. “(That) was especially effective because it was so surprising – you don’t think about going to your eye doctor and getting hot sauce,” he says. “Even better, when they use the hot sauce they keep us in mind, so it’s a longer lasting thing – it worked out great.”



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Foursquare has also helped Dr. Bonilla-Warford get the word out about the practice’s location move earlier this year – he says the first official announcement about the move was done through a Foursquare check-in to the new location. He also used the website to keep followers updated on the construction of the new location. “I would go over to the new office and check-in and take pictures of the construction process and would share those pictures along the way to get people excited,” he says.

Additionally, both doctors have used feedback – both positive and negative – to help improve their office and staff. Dr. Bonilla-Warford says some feedback they have received has caused them to change policies in their office. And Dr. Lim says that knowing patients may be reviewing his practice on Yelp keeps him and his staff motivated to ensure each patient has a great experience. Plus reading reviews can help an ECP see problems with staff they hadn’t noticed. “If it’s a fair review you can learn a lot about your office,” he adds.

Thinking Positive One of the obvious downfalls of any online review site is users have the opportunity to not only post positive reviews, but also the bad, which can be a scary proposition. However, Dr. Lim says it’s all in how you handle it. Any Yelp reviews his practice receives that mention any issues in service, he promptly responds to them to try to resolve them. “Somebody writes something about your office, we have to be responsible business owners ...and respond to that person,” Dr. Lim explains. “You need to oversee everything so that when these things come through you can make the necessary response.” Dr. Bonilla-Warford also responds to any negative feedback – known as tips – on Foursquare by contacting the reviewer privately and trying to resolve the issue. “A lot of times if you listen and act quickly, you can actually turn what was formally a negative review into a very positive experience for the patient,” he says. He says not responding to patient comments may result in sending the wrong signal that either you don’t care what your patients think or that you are unaware reviews are being left, which are both signals small business owners do not want to send. “So if the experience was negative, professionally communicating and ... working with them privately to resolve the issue, sends a signal to prospective patients and current patients that while there may sometimes be glitches, you’re going to take follow-up seriously and professionally,” he explains.

Checking In If embracing review sites sounds like something you would consider for your practice, Dr. Bonilla-Warford suggests getting staff involved in the effort to help delegate monitoring and generate patient-level content. Additionally, he says it reflects badly if a patient mentions something they read online and the staff has no clue what they’re talking about. Before getting your practice an account on a review or rating website, Dr. Lim advises ECPs to sign up for an account and use the site themselves. For instance, Dr. Lim is an avid user of Yelp himself and even writes reviews for businesses he has used. “Doctors need to make a choice whether they want to get involved in it or not, but I think before you make a choice you need to understand how this thing works,” he says. Dr. Lim believes times have changed and if private practice optometry is going to continue to thrive and meet the needs of patients, ECPs need to understand how the new 40 and under generation thinks. “They approach things differently, and as we’re going to work with this new generation of people, we have to understand what drives all these different things if we want to participate,” he says. Dr. Bonilla-Warford agrees and says we’re at an age where businesses having a presence on review and rating sites is expected. “If you’re not using them, all of your competitors are – it’s sort of like where we were with websites ten years ago,” he adds. “I definitely think it’s going to continue to be an important part of marketing for eye care professionals all the way around.” ■




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Ear Technology Corporation Hearing New Revenue Streams for ECPs EyeCare Professional’s Paul DiGiovanni, LDO, speaking with Jim Barbarito, Business Development Manager, Ear Technology Corp. Jim Barbarito

Please provide a brief history of the company and explain how this new product, TuneAmp™ was developed. For over 15 years Ear Technology Corporation has been manufacturing and distributing innovative products globally, primarily to audiology practices. Dr. Daniel R. Schumaier, company president and holder of over 100 patents worldwide, saw the opportunity with advances in micro-electronic technology to develop a high quality digital sound amplifier for people not ready for a hearing aid. He also realized there was a large unmet need for Baby Boomers who want a simple to use and affordable technology to help them enjoy listening in various situations such as: conversations in restaurants, speakers at large meetings, introductions to new acquaintances, or something as everyday as birds chirping in the morning. So in late 2011 we began the manufacture of TuneAmp, which is a personal sound amplification product as defined by the FDA, or as we refer to them, PSAPs. How is it a good fit for ECPs to carry TuneAmp in their opticals? Many ECPs tell me they are looking for additional revenue streams as their business continues to get more competitive. Baby boomers have been going to ECPs when they begin to get tired of stretching their arms while reading the newspaper because they value the fashion and function of custom fit eyewear. So we believe it is an ideal fit for ECPs to carry TuneAmp to deliver the best quality, convenience and value for this new product category to their patients. Since they are approved to be sold over-the-counter there should be no issues with a practice offering TuneAmp for sale. They are so simple to sell that there is no need for additional staffing. PSAPs have been referred to as reading glasses for the ears. Do you need a license to sell these products? TuneAmp is a PSAP, not a hearing aid, and is not intended for individuals with impaired hearing. Because PSAPs

are not intended to diagnose, treat, cure or mitigate disease and do not alter the structure or function of the body, they are not devices as defined by the FDA. There is no need to get certified or licensed to sell TuneAmp. How is TuneAmp different from other PSAPs? TuneAmp is different because it’s ‘tuneable’ to what you like! Then it stays on that setting as long as you want. It remembers! No other premium PSAP does that. TuneAmp is available in a variety of colors and is packaged in a slim profile case with a thin tube. Not only does the small size give the user a comfortable fit, the instrument is barely visible. It has incredible technology packed into this tiny little device with the most advanced features. Automatic feedback control minimizes whistling while allowing the ear canal to remain open. Fast acting compression softens sounds that are loud so they are not uncomfortable. A directional microphone gives the user even more clarity in difficult listening situations. These are technologies used in high end hearing aids yet TuneAmp is available at a fraction of the cost. Does TuneAmp come with a manufacturer’s warranty and what if a customer is not satisfied with its performance? TuneAmp can be returned within 30 days of purchase. TuneAmp is covered by a limited warranty against defects in material and workmanship for 6 months from the date of purchase. A six month warranty extension is provided at no charge with the user’s validated purchase and regular use of a Dry & Store® appliance. What do you see as the trend in regards to optical practices offering hearing services? It’s estimated that that as many as 40% of Baby Boomers, the rock and roll generation, could improve their listening by having some kind of sound amplification device. That represents 26 million Americans that are age 50 and Continued on page 26




1:45 PM

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older, and that figure is expected to double by 2030. Based on recent articles, it’s a growing trend for ECP practices to have audiologists offering a full spectrum of hearing healthcare services which includes providing complete audiological evaluations. Some practices have found it to be a successful fit. But it doesn’t fit everyone’s business model. Meanwhile, the PSAP classification just came about in the last couple of years and sales of PSAPs have been growing rapidly. The recent September 11th article in the Wall Street Journal states, “a wave of new devices that are smaller, hipper, and sold over-the-counter are trying to win over consumers.” This is where the ECP can serve this growing market. What additional on-going revenue can ECPs receive once they start selling your products? A TuneAmp user will have on-going purchases every few months for batteries and tubes. If the user bought a Dry & Store appliance, they will need desiccants. You could expect there will be a resulting increase in foot traffic for the ECP practice as users are usually accompanied by friends or family when they come by to pick up their supplies and get any of their questions answered.

TuneAmp is not a hearing aid; rather, a personal sound amplification product (PSAP). The sophisticated sound amplifier utilizes innovative, patented technology to amplify sounds in the environment for non-hearing impaired consumers. 26 | EYECAREPROFESSIONAL | OCTOBER 2012

Additional traffic and referrals will mean more people coming into the practice who will get to see their products and services, which should lead to increased patient exams and optical sales. How much training is involved to be able to sell TuneAmp? It is really very simple to get started selling TuneAmp. We have a startup package that includes TuneAmps with the different colors, marketing materials for the sitting area and an accessories kit of batteries, cleaners, and tubes. There is an easy to use, four step quick start guide to show how to use it right out of the box. We have found that users like to have someone go over the instructions and help them set it up. We usually spend a couple hours on orientation with the ECP staff, showing them how it works. As a refresher they can also go to if they have questions or want to see what is needed. Otherwise they or their patients can always call our customer service 888.815.3240. ■


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Ginny Johnson, LDO, ABOC

Doctor Don’t Preach Doctor Don’t Preach Your prices sound too steep Doctor don’t preach I don’t want to pay a heap So I’ve made up my mind I’m keeping my glasses, oh I’m gonna keep my glasses AND ALL THIS TIME you thought she was a borderline material girl that was crazy for you and going to buy eyeglasses. What happened? Who knows? Maybe your approach was too much, too little, too late or too preachy. We can’t take back what we’ve said once we lose the patient’s desire to purchase eyeglasses from us. Tongue taming at the appropriate times during sales transactions takes gauging the patient’s comfort level with our best testimony. It’s a sin to lose patients we could have helped had we shown a little more patience and a little less ego. Today I’ll be preaching to the choir, the doctor, the staff, the reps, the labs and anyone else who needs revival from lost eyeglass sales. ECPs should be wearing and trying the different lens technology that is available today. Talk to the sales reps, lab reps and any decision makers to figure out how to get eyeglasses on the faces of everyone who works in the practice. Even those who say they 28 | EYECAREPROFESSIONAL |OCTOBER 2012

despise wearing eyeglasses might be pleasantly surprised with the latest lens and frame technology. It’s time to bring some live social media back into the practice. Get off of Facebook and get more face to face with patients. That goes for everyone in the practice. You don’t have to be licensed to share your opinion. The more ECP eyeglass testimonies your practice has to share, the more patients will buy the truth. What about the staff that doesn’t wear prescription eyeglasses? They should be wearing fashion forward frames with AR treated prescription plano lenses. No prescription to me means a frame that has the manufacturer’s demo lenses still intact. The cost of putting everyone in the practice in eyeglasses is minimal compared to the positive impact it can have on your eyeglass sales. It also helps when we are practicing what we preach rather than just preaching what we practice. I remember a phone conversation I had a few years ago with a customer service rep for my cellular phone service. The rep was trying his hardest to convince me to upgrade to a new phone which would renew my 2 year contract with his company. He said he was sure I would love the phone even though I had never handled one. He went on and on about all of the great features and the easy payment plan that was available. I asked if he owned the phone we were talking about and his unforgettable answer lost the sale and any chance of a contract renewal. He said he did not own the phone because he did not even have cellular service through his company. His phone and service were through a competitor’s company. An honest hypocrite is not always the best testimony. How much of an ECP hypocrite are you? Do you have regular eye health exams performed by an O.D. or an M.D. not counting yourself? Hopefully your answer is yes since you expect your patients to do so. Are your wearing your current prescription in your eyeglasses? If not then how can you get upset with patients who opt out of getting their new prescription filled? Are you wearing eyeglass frames that you sell in your practice? If the answer is no then remember you are wearing the wrong first impression when you wear those around patients. Do you edify staff in front of patients and then turnaround and beat the spirit out of them when patients aren’t around? Good luck at the pearly gates with that one.



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Do you wear sun/sports/safety glasses when necessary? If the answer is no then how can you genuinely stress the importance of sun lens protection and ANSI safety certified eyewear to your patients? The material girl has several hits that may help us preach better sermons and work on our human nature hypocritical tendencies. Express Yourself Encourage patients to unload their eyeglass concerns and questions on you. Help them vent. Humbly handle any competitor’s conversations without casting stones or bricks or cinder blocks. The way you handle every situation that they witness while they are in your practice reveals your true character. Practice allowing your patients to express themselves without passing judgment on any of their decisions.

Chairish Some of the most important patient decisions take place while they are sitting in a chair. Chairish is the word we can use to remind ourselves how we would want to be treated if we were in their seat. Here are some specific chairish times when we need to make sure our patients understand and are comfortable with their treatment: Patient paperwork – explanation of dilation, diagnostic imaging, referrals to specialists, fees and insurance responsibility. Pretest room – techs should explain the nature of each test as they perform them. Exam room – doctor/patient consultation and treatment plan should be in layman’s terms.

Like a Virgin These patients have never done this before so you have to take your time with them. They have never worn eyeglasses so they have no idea how they are supposed to fit or feel. They don’t know what they want. They have never had an eye exam and they might even think they were supposed to study for it. They need to be assured that cleaning their eyeglass lenses will not make the medicine fall out. Have a little extra patience and faith in these patients and they will be thankful you were their first.

Dispensing table – fit, measure, style, smile and forgive them for they do not understand. Live by the Golden Rule and let chairishing times take a front row seat in your practice. That’s what the best preachers do to attract believers and form large congregations. Can I get an Amen? ■



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Williams Group

James M. Caldwell, OD, EdM, FAAO, has been appointed dean of Student Affairs at Salus University. He will succeed Robert E. Horne, who is retiring after 36 years at the institution. A 1989 graduate of Pennsylvania College of James Caldwell Optometry (PCO), Dr. Caldwell completed an optometric residency at the PCO clinical facility, The Eye Institute. He began his career at PCO as an admissions officer; since then he held a variety of positions including director of Student Recruitment, director of Admissions and most recently, associate vice president of Academic Affairs.

Brad Rourke, CPA, has been promoted to chief executive officer of the Williams Group. He was previously the company’s vice president of finance and general manager of its software division, suppliers of Practice Director elecBrad Rourke tronic health record and practice management software for eyecare professionals. Brad Williams, OD, FAAO, who founded the company in 1987, will assume the role of chairman of the board. Rourke joined the executive team of Williams Group in 2003 as vice president of finance.

Zeal Optics NicOx NicOx S.A. has announced the strengthening of its United States business operations with the appointment of three senior commercial executives at NicOx Inc., its US subsidiary. Jason Menzo has been appointed Director of Jason Menzo Marketing, and will be responsible for leading the overall marketing strategy, including product positioning, branding, messaging and support for the sales team. Mark Puwal has also been appointed National Director of Sales, and Jason Werner has been appointed Director of Commercial Development & Strategic Alliances.

Nouveau Eyewear Nouveau Eyewear has announced the addition of two new officers to their marketing and business development teams, Les Rookstool as vice president of business development and John DeLuna as director of marketing. Les Rookstool Rookstool joins Nouveau with over 20 years of optical experience, most recently as vice president of the Retail Sun Division for The McGee Group. Prior to joining McGee, he served as vice president at Liberty Sport, and also held positions at Bushnell Performance Optics, as well as at Bausch + Lomb.

Surgical Eye Expeditions International Surgical Eye Expeditions (SEE) International has named Randal Avolio its new president and chief executive officer. The 38-year-old nonprofit organization is dedicated to restoring sight and preventing blindness among Randal Avolio disadvantaged individuals worldwide. Avolio comes to SEE International after six years as chief operating officer at Bend Memorial Clinic, the largest multispecialty clinic in Central Oregon. His background includes positions at facilities such as Cedars-Sinai, USC and UCLA Orthopedic Hospital. 30 | EYECAREPROFESSIONAL | OCTOBER 2012

Zeal Optics has announced the appointment of John Sanchez to president. Sanchez started in the optical industry at Bausch + Lomb, where he rose from the manufacturing floor to supervisor and then to industrial engineering where John Sanchez he worked on a streamlining a global delivery program for the Ray-Ban business prior to its purchase by Luxottica. Following Bausch + Lomb, Sanchez joined Serengeti eyewear, where he worked his way up to vice president at Bushnell, Serengeti’s parent company.

REM Eyewear REM Eyewear has named Lisa Christie to the Brand Management team as Brand & Communications Manager. Christie brings several years of marketing experience with an emphasis in public relations. Prior to joining Lisa Christie REM, Christie worked at the nationally recognized nonprofit Downtown Women’s Center where she used her communications skills to benefit the homeless women of Los Angeles. There she honed her media expertise along with developing her artful brand of storytelling.

CNS Frame Displays CNS Frame Displays has announced the appointment of Mr. Michael Fazio as National Sales Manager. He is a veteran optical industry professional with over 30 years of experience, including responsibilities as wholesale division business manager at Viva Group International, Inc. and a number of retail management positions with leading optical retailers nationwide. “Mike brings a unique set of experiences and talents including expertise cultivated from multiple industry perspectives both in optical retail and wholesale.” commented Mani Vaghedi, President and CEO of CNS Frame Displays. “We are grateful to have the opportunity to leverage his expertise for the benefit of CNS’s newly created outside sales division.”



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Don’t Fear the Eye Doctor Why fear might be keeping some of your patients away A NATIONWIDE SURVEY commissioned by Lighthouse International, the world-renowned nonprofit organization in New York that seeks to prevent vision loss and treat those affected, found that 86 percent of those who already have an eye disease do not get routine exams. If patients who know they have a serious eye condition that needs to be maintained aren’t getting their regular check-ups, then what about the rest of the population? As a matter of preventative care and the potential for early diagnoses, these patients should be getting their eyes examined regularly. The big question is: Why aren’t more patients worried about coming in? For many, they are worried—but about the exam itself. Fear is a common reason that many patients avoid the eye doctor. We decided to explore this phenomenon and consider what might help change it. Fear from Children It’s certainly not uncommon for children to be fearful of the eye doctor. Just the word “doctor” alone may conjure thoughts of getting shots or taking medicine. Parents play a vital role in educating their children about the role of the eye doctor and the importance of regular exams. Eye care professionals can help encourage parents to talk to their kids about an exam. Perhaps the child can accompany their mom or dad to their own visit to see that there’s nothing to be afraid of. Many eye care practices also find that engaging with the child makes a big difference. Get them involved in the visit. Don’t just talk to Mom or Dad, but talk directly to the child. Also, encourage them to be involved in the eyewear selection process. While the final decision is obviously the parents’, the more the child gets engaged with selecting their eyewear, the more likely they’ll enjoy the overall experience.


Anything new is typically frightening for a child and one of the best ways to make them feel comfortable is to walk them through the exam. Taking a “Show and Tell” approach where you show the child what tools you’re going to be using, and tell them what they are, can really help alleviate some of these fears. It puts the child at ease. Fear of Diagnosis It may seem like a huge contradiction for a patient suffering from symptoms to not make an appointment with the eye doctor, but the truth is that a lot of patients actually avoid the doctor because of the fear of the diagnosis. Diagnoses like glaucoma or even cataracts can be frightening for a patient and some may take the approach of putting off the appointment or even avoiding it all together. Reaching these patients can be challenging but when they do make it to your office, be sensitive with the way you approach a diagnosis. Don’t overwhelm the patient with information and make sure you include resources that can help. Hand-outs that explain the condition can be particularly helpful as many patients are overwhelmed at the time of a diagnosis and may want to review the information later. On a lesser scale, some patients may actually be scared of the idea that they’ll need glasses. With all of the advances made in eyewear and lenses today, this can be an easy fear to alleviate. If patients are really opposed to the idea of wearing frames, they can be educated on options in contact lenses and also the lightweight frame materials available nowadays. Fear of the Process Some patients may avoid the eye doctor because they’re scared of the entire process. The bottom line is that some patients just



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get uncomfortable as soon as they enter a doctor’s office. For older adults, the bright lights used during the exam can be disorienting. Older adults often take a longer time to adjust to light differences so be sensitive to whether you’re turning lights on and off a lot during the exam and shining a lot of bright light in their eye. They may need an extra few seconds to recover or may even require some help moving from the exam chair to the waiting area. A lot of patients also report being fearful of the equipment used in the exam process. The best way to help patients overcome this fear is to take a similar show-and-tell approach that can be used with kids. Patients will feel more at ease if you explain what the equipment is and what you’ll be using doing with it. Oftentimes the equipment looks more intimidating to the patient than it actually is. Similarly, many patients may avoid the eye doctor because of their fears over glaucoma testing. Besides the potential for a scary diagnosis if the patient is having symptoms or the disease runs in the family, many patients also say they dislike the test itself. Eye care professionals that use the “puff of air” test may need to walk patients through it and give them ample warning. And even if you just dilate, that can still be an uncomfortable feeling that may make patients uneasy. Be sure to remind patients that the side effects will wear off relatively fast. And be prepared to help them around your office if they’re really struggling with blurred vision from the dilation. Squeamish Eyes Patients may also avoid the eye doctor because of the “squeamish” feeling they get when anything is close to their eyes. Surely you’ve encountered some of these patients. Their anxiety becomes obvious when anything gets close to their eye. These patients may have trouble keeping their eye open during the exam and often need to be talked through the process. This can be hard to overcome and in extreme cases, patients may need to be prescribed medication to be able to relax. This may be more likely if the patient is undergoing an actual procedure or surgery and doesn’t think they can handle their nerves on their own. These patients will require extra attention and again, can benefit from the show-and-tell approach. Try not to rush these patients as that can increase their anxiety. No matter what the case, there are ways to ease the fears of even your most anxious patients. Take your time and pay attention to patients’ needs to help them get through the exam. That will help ensure they keep coming back instead of being scared away. ■



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Issue Resolved I manage the optical dispensary at Outlook Eyecare, an Ophthalmology group in New Jersey. Being in the optical profession for some twenty-five years, I thought I had experienced just about everything this field has to offer. Whether it was from textbooks, professional magazines, continuing education courses or discussions with peers, I felt I had at least heard of a lot of different scenarios if not having actually experienced them.

+2.25. She purchased a pair of progressive glasses from our office at that time. We had not seen her again until her annual exam this past summer. July of 2012 is when I first met Mrs. S. She came into the optical office with a new Rx: ou-1.00/+2.50 add. She informed me of her unique eyes at this time. When Mrs. S. reads, she can only read with her right eye, monocularly, and when she reads her right eye actually diverges rather than the usual convergence. She also said she has never been happy with progressive lenses. Every time she reads, she describes a very small field of view. Obviously, this is due to her eye not aligning with the reading portion of her progressive since that eye diverges at reading. Looking at her medical records again, I noted that her left eye is amblyopic. With the newest correction she had visual acuity of 20/30 in the right eye and 20/70 in the left eye BVA.

Jeffrey Kravitz examining a patient at his practice.

However, early one recent afternoon, I actually had the opportunity to meet a very unique patient. Mrs. S, now 63 years old, knew her condition was difficult and she made sure I knew it also right from the outset. The optical office has full access to the patients Electronic Medical Records (EMR), so I was able to look through her chart. Her first visit to our office was in May, 2011. The EMR record matched what she had told me. She had strabismus correction surgery when she was five and six years old. She claims to be one of the first patients that this type of surgery was performed on by a Dr. Sheie in New York. Physiologically, her eyes were perfectly normal for her age from her cornea through to her retina and optic nerves. However, she was suffering from binocular exotropia. Her spectacle Rx was determined to be OD -1.50 sph, OS -0.75 with an OU add of 34 | EYECAREPROFESSIONAL | OCTOBER 2012

At this point my curiosity got the best of me and I wanted to try and improve her reading field of view. Luckily, Mrs. S. was willing to work with my questions and requests. My first instinct was to shift the right lens out 2 millimeters, which would give more of a reading area and still have her distance correction within prism tolerances. For some reason, I questioned myself if this would be sufficient. So I asked Mrs. S. to humor me and let me see her eyes in action. I handed her a reading card and had her look down to read. Sitting face to face, it looked like her eye dropped straight down. I asked her to stand up and do the same thing. This time I saw the definite outward turn of her right eye when reading. I then attempted to measure this with my P.D. ruler. Its was a 3 millimeter horizontal difference from her looking straight ahead into the distance to where her eye fell when reading. To reiterate, Mrs. S was diverging 3 mm as opposed to a more normal convergence of 2-3 mm. Thus placing her eye at 5-6 mm temporal of the normal reading position! She decided to utilize her old frame and wanted to continue wearing it so the order became a frame to follow.



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There was a lull of patient flow in the optical office after Mrs. S. left. I started relating Mrs. S’s situation to my colleague, Grace Danieles. I told her my plan to move the right lens out 2 millimeters to compensate for Mrs. S affliction. She mentioned that an optician she used to work with had success using flat top bifocals in opposite eyes to help patients with macular degeneration get a bigger field of view. This discussion with Grace fired my imagination and led me to change my strategy for Mrs. S. I was going to order two left progressive lenses for her glasses. By placing a left progressive in the OD, I theorized that the inset would literally become an outset and thus offer better alignment to the reading divergence of Mrs. S. Naturally, I was anxious to see if this would work. The next morning, Mrs. S. called wanting to cancel her order! She wanted to wait until her husband’s health plan benefits reset so she could use a vision plan. I explained to her that once we order lenses the processing starts immediately and that we will be charged for the lenses. She asked me to see what I can do. I decided to offer to change and charge her for the right lens only. This should be sufficient since the 0.25-diopter change in the left eye was not going to significantly improve her vision. I also took this opportunity to inform Mrs. S. of our unusual plan for her right eye reading issue.

Finally, the moment of truth arrived. Mrs. S. came in for her lens. I took her frame into the lab and blocked up the lens. It looked odd to me to say the least. I decentered the lens to her corrected distance P.D, but since it was a left progressive going into the right eye the cut-out was close, but it made it. I dispensed the glasses to Mrs. S and I asked her to first look through the distance. She said things were fine. Then I handed her the reading card and her reaction was astonishing. She was very animated and obviously thrilled. She shouted, “Wow! I can read everything. This is amazing. This is wonderful!” I asked her to walk around the dispensary to make sure that she would be comfortable all around. She was elated and so was I. This series of events concerning Mrs. S showed me that with enough thought and discussion just about anything is possible. A very unique situation required a very unique solution. It is situations like this that are the reason I tell my students at Raritan Valley Community College that Opticianry can be a rewarding and satisfying career and this was particularly satisfying to say the least! ■



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SECOND GLANCE Elmer Friedman, OD


Recently they have been badgering me to reveal all about my fledging days as a student at Pennsylvania State College of Optometry in Philadelphia and my early years as an OD. In order to avoid boring the reader into a comatose state, I will hit upon the changes that mattered to me. My memories extend over a period of three generations filled with activity and interest on the local, state and national levels.

during my senior year at high school and my freshman year at PCO and together with my parent’s help; I managed to pay my yearly tuition, which was in the neighborhood of $900. But remember, a gallon of gas was only $0.21. Many students paired up to study and Lillian and I did the same. However, Lillian was a quick study so we found ourselves hanging out the rest of the evening. I returned home and dove into the material that Lillian knew and I had to learn. Many of the students had just returned from the war and were very serious about completing the course without any “high school kid stuff frivolity”. Some were already married. Our class graduated only twenty two students.

PCO - now Salus University, in Elkins Park, PA – was located in a building that once served as an orphan asylum. I had just graduated from Central High School for Boys and had applied to PCO as a registrant for college there. The war was still raging and all my fellow graduates were clamoring to join some branch of the armed services. The patriotism of our Today, I feel shocked when I compare it to youth at that time was never more devout, the large classes graduating from our even in the event of being drafted. I and my Lillian and Elmer Friedman professional health provider schools. 5 diopters of myopia tried to enlist but was at a fraternity party in 1946. Lillian was one of three pioneer female rejected and asked to wait until called up in students in our class. The male interns were called “doctor” but the draft. I officially matriculated at PCO in Jan., 1944. patients referred to our female interns as “nurse”. Statistics Imagine my surprise and chagrin to learn that our four year today reveal that 70% or more of our classes today are course was changed by government mandate to a two year and dominated by females. At first, great resistance was expended in nine month course. We attended classes and labs from 9 AM an effort to snuff the interest of females in optometry and other until almost 5 PM each day. Holidays and spring breaks were professions. It was felt that their time worn roles as mothers limited to only a few days. The pressure was substantial and and family leaders would impede the direction and dedication some students could not keep up the pace. The great redeem- required from a health professional provider. Now we can see ing factor of those early days was that I met the woman who how much they added to our professions. was destined to be my partner in life. Lillian and I actually were acquainted in junior high school and then providence threw us Our clinic was in a semi-central location of Philadelphia near together at PCO. Lillian was a scholarship student. I worked the site of the Osteopathic clinic and Wills Eye Hospital. We




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were conducting a clinical practice as interns and hoped for many patients to build on our experience and were lucky to see five patients each week. We resorted to practice and experiment using each other as patients. The person who won the clinic award at graduation time was the lucky person who had a lot of friends, relatives and neighbors that lived near the clinic. During those days it was considered unethical to advertise for patients. We attracted patients who were on government relief and some who we suspected were homeless persons. Some presented themselves in an inebriated condition. We learned how to be diplomatic when we explained why we could not examine them on that day. We graduated in Nov. of 1946. I was underage to receive my license to practice. I had passed the boards in PA and NJ, and arranged to assist an optometrist in Camden, NJ. He signed all the prescriptions in order to comply with the legality of the situation until I reached the age of majority and received my license. When I finally gave the two week notice to my employer, he offered the following parting comment, “You’re going to fail within six months of your start.” The weather was warm, outdoors, but in the office I felt a freezing temperature. However, it was at that office that I received one of the most important lessons in my burgeoning career. Many offices at that time were small stores with window displays outside and cash registers inside. On one occasion I had examined a man who wore a seedy topcoat with safety pins instead of buttons. The rest of his appearance was seedy to match. When we discussed the frame selection he brought me outside and pointed into the window at a frame he desired. It was the “Duke” frame and was heavyweight gold filled. The average frame cost in the olden days would have cost a patient about eight or nine dollars. The Duke was priced to sell at $75. I was loathe to even broach the cost to him.

As for me, I felt that I would get a better start in a rural area. I was fortunate to have a friend who was a representative for Bausch and Lomb and who recommended an area in NJ. I needed to purchase equipment, so an optical supply house sold me some used equipment. It consisted of a hydraulic chair complete with a pump handle, a floor chart projector, a complete trial lens set with trial lens frame, a stand phorometer, (phoropters cost a king’s ransom) an ophthalmoscope, a Genophthalmic ophthalmometer, and a spot retinascope. I already possessed a mm rule and a variety of adjusting pliers which were issued to students during their sophomore term. The total cost was $650, which could be paid in monthly installments. I also purchased an impressive executive desk, the same size as the state of Rhode Island. After my starvation period was over, I gambled on purchasing new and more modern equipment. An optometrist who was known as an entrepreneur and a collector of old frames and equipment purchased my equipment from me. I could not guess to whom he might sell it. Some years later I visited The Franklin Institute. They had advertised an exhibit featuring early examples of medical and scientific instruments and how old time spaces were handled. I sidled up to the sign that said “Typical Optometrist’s Office in the ‘Olden Days’”. I was flabbergasted to find all my old equipment, complete to the last detail, as the main attraction. How does one react when other observers commented, “How in the world could any optometrist use this old and outdated equipment?” I guess the answer is that you had to be an old and outdated optometrist like me to understand those times compared to now. ■

However, when I did he quickly said, “I’ll take two pair and I’m paying cash.” At that point he delved into a side pocket of his seedy pants and could hardly remove it since it was so heavily stuffed with money. My mentor, having observed my surprising encounter said, “Never count your patient’s money.” I have heard that many times at practice management sessions in the years that followed. Competition in the big city was stiff. Several chains advertised glasses complete for $8.95. Many graduates returned home to practices already established. Others connected to the corporate or chain stores for work with the intention of assuming a private practice at a later date. Often, their good intentions were never fulfilled. Those who started “cold” often worked part time with a commercial company to help defray costs until established and on their own.

Elmer Friedman circa 1961, with an AO Phorometer and Reliance spring stand.




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Honing Your Dispensing Skills: Turning Frustration into Satisfaction ADJUSTMENTS ARE AMONG THE MOST DIFFICULT OF SKILLS FOR A DISPENSER TO MASTER. A FEW ADJUSTMENTS CAN REALLY LEAVE US SCRATCHING OUR HEADS. It’s the head scratchers which really end up frustrating both the dispenser and patient alike, which may result in losing a patient if the dispenser does not handle the issue properly. In the optical profession, it’s important to remember knowledge is a vital commodity. Things to Consider During Frame Selection Taking into account the patient’s corrective needs should be one of the first considerations in frame selections. Is the patient significantly nearsighted? Farsighted? First time presbyope? Does the patient have narrow set eyes? Wide set eyes? Does the patient have long eyelashes which may brush the backside of their lenses? Does the patient have a wide bridge? Narrow bridge? Will the frame require a significant amount of pantoscopic tilt? Are the temples too long? Myopic Patients Preventing problems before they start begins with understanding optics and how it is utilized to correct vision. For example, a significantly nearsighted person will be corrected using a concave lens design. This means the lenses will be thicker the

farther it extends from the optical center. Essentially, for every two millimeters that we decenter a lens we are adding a full diopter of power to the lens edge thickness. It would be best to stay with the smallest frame possible to minimize this thickness as well as staying with a shape which is more rounded. Many frame styles have sharp angles which become fairly thick due to their distance from the optical center. Your goal is to keep the A dimension within one or two millimeters of the frames ED dimension. It’s important to remember vertex distances as well. If your patient was refracted at a vertex distance of 12 mm and the frame sits 14 to 15 mm away from the eye, you’re effectively taking correction away from the patient. This could account for blurred distance visual acuities, a swim effect when moving the eye away from the optical center and a fish bowl sensation when viewing objects at a distance. Remember to also stay with frames having temples that bend a little farther away from the frame front. Nothing is more embarrassing than dispensing a pair of glasses in which the temples won’t fold over because the lenses are too thick. Hyperopic Patients Farsighted patients require hyperopic lenses which will be convex meaning they are thicker in the center than at the periphery. If the patient is significantly farsighted, it’s important to try to match the lens with the frame. Although many frame styles are significantly smaller than in years past, once lenses are edged for a high degree of farsightedness lenses may have a fairly thick appearance unless the ECP matches the lens with the frame. This means to utilize the same standards mentioned for the minus patient and to then order the lenses ground to the specific frame dimensions. This will give the minimum of edge thickness which will also minimize the center thickness. Once again vertex distance is important. If the frame sits out too far from the patient’s eyes, you will effectively increase the power of the prescription presenting the patient with excess magnification and actually make them myopic! Continued on page 40



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To participate, sign up online at No other discounts apply. Use of Vision-Ease Lens voucher will not be applied. Lenses must be purchased through FEA industries to qualify. Promotion open to Eye Care Professionals only, and ends December 31, 2012. Payouts will be made once at the end of the entire promotional period, distributed by January 15, 2013. You must have permission from the practice owner to participate.



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You should always try to center the patient’s eyes with the geometric center of the frame horizontally. This is especially true as the prescription power increases. Always try to match the patient’s PD with the frame’s PD or at least get as close as possible. This is easily calculated subtracting the frame PD from the patient’s PD and dividing the number by half for a binocular PD. For example, if a frame has an eye size of 56 and bridge size of 14, then the frame PD will be 70 mm. If a patient has a distance PD of 68 mm and you subtract the two numbers you will arrive at a difference of 2 mm. Divide this value in half to compensate for each eye and you get 1 mm of decentration per eye. If you have monocular PD’s then you would divide the frame PD in half before subtracting from each monocular PD. We know from these numbers the optical center of the lens will have to be moved 1 mm to place it in front of the patient’s pupil. This will minimize the lens thickness especially if you have it ground to the minimum blank size of the specific order. Large amounts of decentration will only add thickness, weight and lead to disappointment. Given that most lab technicians will add at least 1 mm millimeter to ensure a good cut out, a frame with 4 or 5 mm of decentration or more will only lead to a disappointed patient at dispensing. Fitting Presbyopes


The most important aspect of successfully fitting presbyopes lies in the measuring. With the advent of customizable lenses, this has never been more important. Besides taking monocular PDs, it’s important to adjust the frame before taking measurements. Pantoscopic angle, vertex distance, face form (parabolic curve), and segment heights are all measurements which should be taken after the proper adjustments have been made. Adjust nosepads to ensure they are equidistant from and flush with the slope of the patient’s bridge. The frame should be level and increase tilt to the appropriate amount for the lens design. Check the vertex distance so that the frame sits just clear of the patient’s lashes. Remember to select a frame for the distance from the patient’s cheek to the bottom of the lens. You don’t want the lenses sitting on the patient’s cheeks by any means, but you need to strike a happy medium whereby the patient isn’t looking under their lenses when the gaze down to read. Increasing the amount of pantoscopic tilt so that when the patient drops their head from the primary forward gaze to their concentration at near will decrease the vertex distance at near which makes the field of view through the bifocal larger and clearer. Be sure the frame has at least 2° of face form (or parabolic curve) for every millimeter of decentration. This will assist in decreasing the swim effect experienced by patients as their eyes move laterally.



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The Adjustment Checklist In our office, we have an adjustment checklist taped to each dispensing table. This is simply a way to reinforce to new dispensers the basics of a proper fitting. 1. Check the frame front for “x-ing,” or “propeller.” Simply put, make sure the lenses are aligned in the same plane. You can easily accomplish this by closing one eye and making sure the rims of each lens top matches with the bottoms. If not, adjust the frame at the bridge to bring them back into plane. Since vision is a team effort, both eyes need to be viewing a singular object in the same way. 2. Check behind the patient’s ears and adjust the temples by creating a sharp bend starting at 1 to 2 mm past the root of the patient’s ear. Make sure the temples aren’t angled inward too steeply or they will not lie down properly at the ear. You want the temple to securely rest against the mastoid bone (the area protruding behind the ear) without being too tight. From the bend to the temple tip you want the temple to lie flush against the patient’s skull. 3. Make sure the frame is level and seated at the right height. If it sits low on one side, angle the temple down where it comes into contact with frame front to allow the frame to sit higher and level out on that side. If the patient is wearing multifocal lenses, make sure they are sitting in accordance with where they should be placed. For instance, bifocals at the lower lash line, trifocals at the midpoint of the lower iris, progressives at the pupil center, etc., etc. 4. Have the patient gaze down, and while you stand up, check the top of the frame to make sure each lens is equal in vertex distance. If one side appears to sit too far out or too close, examine the intersection of the temples and the frame front and adjust accordingly. If the patient happens to have an oddly shaped head, exaggeration of one temple may be required to achieve this equality in vertex distance. 5. Nosepads should be equidistant from the bridge and angled to the slope of the bridge. If the frame is sitting out too far, flare out the pads or adjust the guard arms by moving them closer to the frame front so the frame will sit closer to the face. Do the opposite if the frame is sitting too close. Keeping these few not so simple tips in mind will alleviate a lot of adjustment woes and just might instill a level of confidence in your patient which will keep them coming through the door – but not with complaints about the frame alignment! ■ With contributions from Brian A. Thomas, P.h.D., ABOM



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LUXURY lux •u•ry (lgzh-r, lksh-) 1. Something inessential but conducive to pleasure and comfort. 2. Something expensive or hard to obtain. 3. Sumptuous living or surroundings: lives in luxury. [Middle English luxurie, lust, from Old French, from Latin luxuria, excess, luxury, from luxus.]


thousand on fancy measuring devices to get the most out of the newest sophisticated digitally surfaced lenses – well, that’s a real luxury for us – the ECP. (Especially when HOYA has announced a $399.00 iPad “app for that.”) I’m reminded of a different kind of luxury when wealthy clients arrive in my store with designer sunglasses purchased at an airport shop on an international trip and ask for an adjustment – as nice as the frames are (names withheld to protect the innocent), mostly they are embarrassingly engineered and an effective adjustment can’t be performed without the danger of chipping a (glass) lens or breaking my adjusting pliers on a recalcitrant end piece. Apparently the designers (?) of these high-end status symbols aren’t familiar with the concept of pantoscopic tilt, one ear being higher than the other, other than perfect noses, or too much weight in general.

A lot has been said about the state of the economy during the current (never-ending) political campaigns. Fluctuating “consumer confidence indexes”, the peripatetic stock market going up and down, and of course, the outcry about the endemic unemployment this great country is enduring; yet, (cliché warning) “at the end of the day” we all go about our business and we are still selling pretty nice eyewear. Luxury still lives in the optical world (also lust). We provide eye care and the ever more sophisticated bits and pieces of plastic, titanium, and precious metals that make up modern eyewear. Think about the lenses we dispense – what could be more luxurious than personalized progressive lenses with your initials laser engraved on them, made to your exact specifications. Expensive? Well, unless you are one of the 1% we keep hearing about in the news, I guess you’d call them pricey but attainable. Consider the new electronic eyewear, now available across the country – early reports are mixed, but can anyone doubt that it is an ultimate luxury? And, of course, spending 10 or 12 46 | EYECAREPROFESSIONAL | OCTOBER 2012

Some critics of luxury might call it a case of the emperor’s new clothes. In many cases they would be correct, cynical marketers have been known to stretch the boundaries of credibility a bit, by labeling, or packaging very ordinary merchandise in fancy boxes with “designer” cleaning cloths and depending on the name of a celeb or designer – who in truth may have had little or nothing to do with the actual design of the product. In reality, I believe affordable luxury is within the reach of every eyewear consumer. What is more luxurious than a well fitted, well chosen, and carefully made pair of eyeglasses that garners you compliments from those who see you in them and allows you to see your best? I’ll close with a note about another kind of luxury – the headline in Gawker says “The World’s Most Expensive Paper Bag Will Cost You $290.00” for those who equate cost with luxe, this is an ultimate – Jil Sander’s Vasari bag, literally a paper bag like the one you might carry your lunch in for $290.00 – for once I’m speechless. ■



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Profile for ECP Magazine

EyeCare Professional Magazine October 2012 Issue  

October 2012 Issue of EyeCare Professional Magazine. A Business to Business publication that is distributed to decision makers and participa...

EyeCare Professional Magazine October 2012 Issue  

October 2012 Issue of EyeCare Professional Magazine. A Business to Business publication that is distributed to decision makers and participa...


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