Ophthalmic Lenses

Injuries from ophthalmic lenses are a significant source of liability claims against optometrists.

The most likely cause of injury is breakage of a glass, high index, or allyl resin (CR-39) lens.

Frames are a less likely cause of litigation, but “safety” and sports frames have been involved in liability claims.

Liability claims most frequently allege negligence, but product liability may be alleged if lenses or frames are “defective”.

For an optometrist, there are three types of negligence claims involving lenses:

1--failure to prescribe an impact- resistant lens material 2--failure to warn of limited impact resistance 3--failure to inspect lenses

The materials of choice with respect to impact resistance are polycarbonate and Trivex.

Trivex is lighter than polycarbonate, more scratch resistant, has comparable uv attenuation,and has similar impactresistance.

The key error is failure to prescribe polycarbonate plastic (or Trivex) when protection is a key clinical consideration; the patients for whom protection is necessary include:

• Monocular persons• Athletes• Workers whose occupations place them at

special risk for injury (e.g., police)• Children• Individuals with compromised corneas (e.g.,

RK, LASIK, penetrating keratoplasty)

A policeman was struck by a drunk as he was entering a bar for a routine investigation. The blow shattered his spectacles, causing a piece of glass to be driven into an eye, thereby creating a permanent loss of acuity. He sued both the optical company filling the prescription and the optician dispensing the spectacles, alleging they were negligent for failing to provide him with lenses that were either more impact resistant or less likely to come out of the frame in sharp, jagged pieces (i.e., plastic lenses). A sizable judgment was returned in his favor.

The second error is failure to warn patients of the limited impact resistance of ophthalmic materials other than polycarbonate (i.e., glass, allyl resin (CR-39), high index).

This warning is especially important when a secondary use (e.g., playing baseball) makes wear of the lens material hazardous.

Example case: injury from shattered spectacle lens

• Myopic, physically active man in his 20s needs new glasses

• Optometrist performs an examination, writes a spectacle prescription

• While playing softball, one of the lenses is struck by the ball and shatters

• Permanent loss of vision in the eye results

Notice how skillful questioning causes the doctor to actually testify that he breached the standard of care by failing to take an adequate history and by not prescribing protective eyewear for secondary sports use.

CLAP Traps

• Patient histories should always include avocational use of eyewear!

• Make sure polycarbonate plastic (or Trivex) is specified on prescriptions when protection is a key clinical consideration

• For ametropic patients playing contact sports, eyeguards meeting ASTM F803 standards or contact lenses should be prescribed

The third error is failure to inspect and verify ophthalmic lenses and frames prior to dispensing (especially “safety” frames).

There are lens thickness requirements for “safety” lenses that must be verified by the dispenser. Failure to perform the inspection is negligence; the non-conforming lens is a “defective” product.

An 18-year-old man ordered safety glasses from his optometrist. Later the patient was in an automobile accident and suffered the loss of an eye when one of the lenses shattered. It was then discovered that when the original order was turned over to the optometrist's technician, she failed to mark the order as one for safety glasses. Thus, although the patient had ordered and paid for safety lenses, he had received dress lenses. The patient sued, alleging negligence, and the case was eventually settled in his favor.

Liability claims have also been brought alleging injuries from dress frames, industrial (safety) frames, and sports frames.

Dress frames are most frequently a cause of claims when they contribute to injury, such as dislodgement of a lens that strikes the eye; the failure of the frame to retain the lens is a contributing factor to injury in such a case.

Both a safety frame and safety lenses must be dispensed to patients requesting industrial (safety) glasses.

Failure to provide an approved frameeven if safety lenses are prescribedcan create liability.

Liability may ensue from failure to prescribe the appropriate frames for sports and recreational activities, if the risk of eye injury is significant.

Frames for athletes should offer reasonable protection for the sport. For participants of the racquet sports, polycarbonate frames with no hinges (and polycarbonate lenses) that meet the performance standards for impact-resistance established by the American Society for Testing and Materials (ASTM standard F803), must be prescribed. Although this standard was originally devised for racquet sports, it is now recognized as the applicable design for “hard ball” sports as well.

Although ASTM F803 was originally devised for racquet sports, it is now recognized as the applicable design for “hard ball” sports as well.

Ametropic patients who play baseball, basketball, football, soccer, and similar sports should be prescribed F803 frames.

The dispenser of eyewear is under a legal duty to be sure that ophthalmic lenses and frames meet standards for impact resistance. These standards are the same in all jurisdictions, and involve:

• dress lenses• non-prescription (plano) eyewear• industrial (safety) eyewear

There is no similar standardfor sports eyewear.

Standards for dress (Z80.1-1999) and non-prescription (Z80.3-1996) eyewear have been adopted by the US Food and Drug Administration and state that:

• All lenses shall be capable of withstanding the drop ball test (a 5/8 inch diameter steel ball weighing not less than .56 ounces must be dropped from 50 inches onto the lens).

• Exceptions: plastic lenses, laminated lenses, and raised-edge multifocals can be certified by the manufacturer, who must test statistically significant samples.

Standards for industrial (safety) eyewear (Z87.1-2003) have been adopted by the Occupational Safety and Health Administration and state:

– Basic impact prescription frames must contain the Z87 (or Z87-2) logo.

– Basic impact prescription lenses must be no less than 3 mm in thickness, regardless of lens material, and pass a drop ball test (1 inch diameter steel ball weighing 2.4 ounces is dropped from 50 inches onto the lens).

– High impact prescription frames must contain a Z87+ logo.– High impact prescription lenses must be no less than 2 mm in

thickness, regardless of lens material, and pass a velocity impact test (1/4 inch diameter steel ball is fired at 150 ft/sec at the lens).

– The trademark of the entity fabricating the lens must be etched on the edge of the lens.

Product liability claims involving ophthalmic lenses and frames may include optometrists (as the seller), but most frequently allege defective design or manufacture. Thus, optometrists are not usually the primary defendant.

Product liability law requires that individuals be warned if products are dangerous, and that products be inspected before they are sold. Optometrists may be liable in such products-related claims.

A high school baseball player was practicing for a varsity game when he misjudged a fly ball that tipped off his glove and struck his flipped-down plano baseball sunglasses. The lens shattered into sharp splinters that pierced his eye, necessitating the eye's removal nine days later. The sunglasses were advertised as "just perfect for active and spectator sports—world's finest sunglasses." They resembled ordinary sunglasses except for the flip feature. But their center thickness was only 1.5 mm, and they were not tempered for impact resistance. The youngster sued the manufacturer of the sunglasses under product liability law. The court held that the reduced center thickness made the lenses unreasonably dangerous and awarded the plaintiff significant damages.

Guarantees can be established by the words of assistants or employees of the doctor as well as by the doctor himself.

Careful instruction and supervision of office personnel is necessary to avoid ill-chosen remarks about the impact resistance of ophthalmic lenses: the word “shatterproof” should never be spoken or written.

Warranties are promises that some proposition or fact is true. There are two basic kinds of warranties:

• express warranties are those that are explicitly stated (“these lenses are made of polycarbonate plastic”)

• implied warranties are those that are derived by implication or inference from the nature of a transaction or the circumstances of the parties (optometrist prescribes glasses that are to be worn while playing sports, thereby warranting that they are suitable for that purpose)

A physically active young man sought the services of an optometrist, who performed an examination and prescribed standard, heat-treated dress glass lenses. While on a hunting trip the young man tripped and fell, and his head struck the ground. One of the prescription lenses shattered as a result of the impact and severely lacerated his eye. Although he sought treatment immediately, he suffered a series of complications and ultimately lost the use of the eye. He sued the optometrist who had performed the examination and the optical laboratory that had fabricated and heat-treated the lenses, alleging that the lenses were an unsafe product and that the optometrist had told him that the lenses were shatterproof. The jury found that the optometrist's remarks constituted a guarantee and awarded the young man substantial damages.

It is wise to have a form that explains lens and frame options to patients and that can be retained in the record for purposes of documentation.

Important Information About Your Glasses

Before you select the frames and lenses for your glasses, there are several things we need to consider. It is important that you describe to us the kinds of activities that you plan to undertake while wearing your glasses. If you will be wearing glasses at work, we need to know if there is a risk of injury to you from flying objects that could strike a lens and break it. If your job requires the use of safety glasses, you must tell us because special frames and lenses must be ordered. If you plan to wear your glasses while playing sports, please let us know so that we can help you select frames and lenses that will not create a risk of injury. In fact, if you participate in any activities that could potentially cause eye injury, you need to describe these activities to us so that we can advise you. Although no glasses are unbreakable, there are important differences between lenses and frames that make some glasses more protective when compared to others. We are here to help you choose the glasses that best satisfy your needs.

LensesA very important part of selecting your glasses is the choice of lens material. There are several different materials to choose from, and each has advantages and disadvantages, which are described below.

Glass—reasonably resistant to scratching and, as a photochromic lens, has good ability to darken in sunlight; in high prescriptions glass can be heavy; glass lenses may not withstand impact well.Plastic—scratches more easily than glass, but lighter, especially in high prescriptions; can change darker in sunlight, and makes excellent sunwear; impact resistance is similar to glass.High index plastic—used for high prescriptions because lenses are thinner and much lighter than other materials; withstands impact a little better than regular plastic; good for sunglasses.Polycarbonate plastic—a high index material that is very impact resistant, which makes it the best choice for ocular protection; scratches more readily than glass but like other plastic materials is light and thus appropriate for high prescriptions; makes good non-prescription sunglasses too.

FramesAnother important consideration is the frame you select for your glasses. It should fit properly, be comfortable, and compliment your appearance. It should also be safe. There are three basic categories of frames from which to choose.

Dress—these are the frames worn for everyday activities that do not pose a risk of injury; the great majority of frames serve this purpose, being suitable for wear at home, at work, and during play.Safety—some frames have been specially designed to provide protection in the workplace; they can be identified by a “Z-87” logo on the frame; lenses for these frames must be of a certain thickness and have a special design in order for them to meet the requirements for “safety glasses”.Sports—eyewear for high risk activities such as racquetball, squash, baseball, basketball, and football must meet special design standards and be made of polycarbonate plastic; frames must meet the standards of “ASTM F-803” to provide optimum protection.

Making Your ChoicePlease consider carefully your needs for both frames and lenses. Based on these needs, we will be pleased to advise and assist you in the selection of the eyewear most suitable for you, which will be marked below.

LENS MATERIAL [] Glass [] Plastic [] High Index [] PolycarbonateFRAMES [] Dress [] Safety [] SportsSPECIAL ORDERS [] Anti-scratch [] Anti-reflective [] Photochromic [] Sunglasses

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