Spectacle intolerance

Spectacle Spectacle Intolerance & Its Intolerance & Its

ManagementManagement

OPTOM FASLU MUHAMMEDOPTOM FASLU MUHAMMED

09:07 PM Spectacle Intolerance and its Management

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““Handing over of Handing over of Spectacle to the Spectacle to the

Customer is not the end Customer is not the end of the matter, may be of the matter, may be

beginning of a problem beginning of a problem both to dispenser and both to dispenser and

customercustomer”

Spectacle Intolerance & Its Spectacle Intolerance & Its ManagementManagement


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What can be the causes of What can be the causes of ‘Intolerance’‘Intolerance’

Vision not clear at arms lengthHead ache, Eye acheReading Distance too shortIll-fitting framesEyes pulls on wearing specs due to decentring and induced phoriaDistorted or tilted ImageAwkward head positionDiplopia

The Common ComplaintsThe Common Complaints


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1. Cosmetic1. Cosmetic

Cosmetic Cosmetic Intolerance is Intolerance is mainly subjective mainly subjective and is best left to and is best left to the patient to the patient to decide.decide.


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1.1. Improper frame selectionImproper frame selection2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria

2. Functional2. Functional


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1.1. Improper frame selectionImproper frame selection



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Parts of a FrameParts of a Frame

Improper Frame Improper Frame SelectionSelection


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Improper Frame SelectionImproper Frame Selection

RigidStrongLight weightBest fitComfortable to wear

Frame SelectionFrame SelectionThe Frame must beThe Frame must be


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Improper Frame SelectionImproper Frame Selection

Temporal Hair Line Margin DistanceIPDShape of facePhysical features of faceNose BridgeSuitable Side arms (Temple)

Frame SelectionFrame SelectionPoints to be taken into Points to be taken into accountaccount


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OvalOvalRoundRoundRectangularRectangularSquireSquireTriangularTriangular

Frame SelectionFrame Selection

Shape of faceShape of faceApproximately there are main 5 shapes


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Shape of faceShape of face

OVALOVALLucky People! All Lucky People! All

types of frames types of frames

suit them as long suit them as long

as they are well as they are well

fittedfitted


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Round Frames with Crisp , Straight Lines will break up its Roundness and give it a more structured geometric look


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RectangularBigger, Longer frames are appropriate as it tends to make the face appear shorter


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SquireOval or Round Frames is better to de-emphasis its squireness


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TriangularRectangular frames or

frames with pointed

edges will suit.


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Colour

Eyebrows

Shape of nose

Shape of cheeks


Physical Features of facePhysical Features of face


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The frame size is noted on the inside of the side arm like ‘54/18’

54 Means size of Rim 18 Means Size of nose bridge that

varies to 18-26mm




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Properly fit frames touch the patient in only three places; the bridge and top of the ear

“Fitting Triangle”




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Don’t let ur glasses take over your faces!Top of the frame should fall below the eye brows.

It should mask Eye browSweating can fog lenses easily




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Frame should not rest on on the apple of the cheek. The patient should be able to move their cheek without any frame slippage

It can cause

EctropionEpiphoraScar on the cheek




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Key holeThin nasal bridge

SaddleAvarage size

Adjustable nospadSuitable for most patients


Bridges of the noseBridges of the nose


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Bridges of the noseBridges of the nose

Key hole Saddle Adjustable nose pad

Adjustable nose pad is Suitable for most Adjustable nose pad is Suitable for most patientspatients

Saddle or Key hole is Suitable for High Saddle or Key hole is Suitable for High powerspowers


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It should ideally conform to back of the ears-

Ears may be dissimilar.

The frame should rest on the face so that fitting

plane of lens should be perpendicular to the visual

axis.


Side arms or Temple Side arms or Temple

For High Myopes Smaller Frames, Converse in For High Myopes Smaller Frames, Converse in HyperopesHyperopes


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1.1. Improper frame Improper frame selectionselection

2.2. Lens FittingLens Fitting3.3. Wrong PrescriptionWrong Prescription4.4. Anisometropia & Anisometropia &

AnisokoniaAnisokonia5.5. High Refractive ErrorsHigh Refractive Errors6.6. Organic DiseaseOrganic Disease7.7. HeterophoriaHeterophoria



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2.Lens Fitting2.Lens Fitting



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Pupillary alignment

Fitting plane of lens

Type of lens

Optic center

Lens FittingLens Fitting

What should one look for in lens What should one look for in lens fittingfitting


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Both pupil should be close to OC (Optic Centre) of each lens to take full advantage of refractive correction.


Pupillary AlignmentPupillary Alignment


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If IPD (inter pupillary distance)

does not tally with OC it will make prismatic effect for which the patient makes subconscious effort to neutralize in the interest of clarity of vision. This leads to eye strain




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In the case of children who do not co operate or Squint

IPD is measured by finding the distance between inner

canthus of one eye and outer canthus of other eye




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Lenses should be plane perpendicular to the

visual axis.

For Near since the eyes directed down ward

they tilted slightly (10-150) towards the cheek

this is called ‘Pantoscopic tilt’


Fitting plane of LensFitting plane of Lens


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PANTASCOPIC TILT


50 - 150


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The lenses should ideally be fitted 15.7mm in front of cornea (VD- vertex distance) which corresponds to the anterior principal focus of eye.

The effective power of lens will change with change in VD.

The effective power of plus lens will increases when les moves anteriorly and inverse to the minus lens


Fitting plane of LensFitting plane of Lens


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Fitting arc of LensFitting arc of Lens


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Glass

CR

Univis

Trifocal

PAL

Executive

Photo chromatic ETC


Type of LensType of Lens


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Geometric center is center of lens while

optic center is center of optical system.


Optic CenterOptic Center


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Lensometer

By throwing torch light

By coinciding Cross line


Optic CenterOptic Center

How do you find optic center?


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Optician’s Rule


Optic CenterOptic CenterHow you Measure Fitting parameters?

IPD

Nose Bridge

Temporal hair line margin


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BifocalsBifocals

Two portion should provide equally clear vision free from aberration

There should no sudden change in prismatic effect at the junction of two segment


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BifocalsBifocals

Image displacementKryptock bifocal is best to Plus lens

Univis D-Bifocal is best to Minus lens


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BifocalsBifocals

The centering of two portion should

exact for their different purpose.

Ideally top of B/F segment should

be at the level of lower lid.


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BifocalsBifocals

Ranges of Vision

Working Distance


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3. Wrong Prescription3. Wrong Prescription



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Wrong PrescriptionWrong Prescription

Over correctionInadequate correctionIncorrect or illegible correction


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4. Anisometropia & Anisokonia4. Anisometropia & Anisokonia



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Anisometropia & AnisokoniaAnisometropia & Anisokonia

Difference of 0.25D – 0.50% difference in retinal

size.

Eye can Tolerate upto 2.50D Difference.

No Diplopia at the time of refraction but Diplopia

after dispensing lenses means difference in base

curve of two lenses.


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5. High Refractive Errors5. High Refractive Errors



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High Refractive ErrorsHigh Refractive Errors

Peripheral magnification & Distortion

Restriction of field

Weight of the glass


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High Refractive ErrorsHigh Refractive Errors

Good centering of lenses

Hi index glasses

Small size frames Separate glasses for distance

and near


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6. Organic Disease6. Organic Disease



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Organic DiseasesOrganic Diseases

Frequent changes of spectacle necessitates a detailed investigations to rule out Diabetes, Glaucoma and Cataract.


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8. 8. HeterophoHeterophoriaria



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HeterophoriaHeterophoria

If one has exophoria and needs minus lens give him full correction, but if he needs plus lens he should be under corrected and vice versa in esophoria. This will enable him to overcome the phoria with accommodative convergence


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ConclusionDo not change the glasses if asymptomaticDo not change the glasses if asymptomatic

Give same base curve as beforeGive same base curve as before

In high minus lenses specify hi-index glassesIn high minus lenses specify hi-index glasses

Proper counselling must be done if patient is Proper counselling must be done if patient is wearing specs first time, shifting to bi focal, or wearing specs first time, shifting to bi focal, or changing frame size.changing frame size.


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Conclusion

Be Patient and careful, when you prescribe glasses. Spend some time in checking the glasses, otherwise the patient will come back to you with most demoralizing and embarrassing statement “ My earlier Spectacle was better”


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End of this topic


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Lens Lens EnhancemenEnhancemen

tsts


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What Lies Between You and Perfect VisionWhat Lies Between You and Perfect Vision


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For More Details and Technical Advice

Contact

Mr. SarafudheenDispensing OpticianAl Salama Eye Hospital Ltd,PerintalmannaPh: 04933 225524

K Mohamed KunhiManager-Clinical ServicesAl Salama Eye Hospital Ltd,PerintalmannaPh: 04933 225524, 9895116363Email: [email protected]


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Thank You

Spectacle intolerance

Healthcare

Transcript of Spectacle intolerance