The most common adjusting error

April 15, 2009

The most common adjusting error that opticians make is temples fitted too close to the patient's head. When this mistake and others are seen it means that somewhere an optician has been improperly trained and is making the mistake on a daily basis.

Key Points

I always get a sinking feeling when I see someone wearing a pair of eyeglasses that has been improperly adjusted. I get that feeling because what I see means that somewhere an optician has been improperly trained and making the same mistake on a daily basis.

The most common mistake

The most common mistake I see is temples fitted too close to the patient's head. This has a number of consequences. First, it will create a deep indentation in the side of the patient's head, an indentation that not only can be seen but also felt. Often the indentation is so deep that it is clearly visible even after the patient takes the glasses off. Second, the inward pressure of the temples against the side of the head will make the glasses tend to slide forward. This will cause the patient to push the glasses back up constantly each time they creep down his or her nose.

In the chapter "The Fitting Triangle," Stimpson says that the first point of contact for a temple needs to be just behind the top of the ear. This will cause the temple tips, not the temple, to grip the head in such a way that the glasses will be pulled gently backward; as a result of the physics involved, the eyeglasses will want to creep up the patient's nose. Conversely, should the first point of contact be in front of the ear, the temples will constantly press into the head, forcing the glasses forward.

Spring hinges

The availability of frames with spring hinges only makes matters worse. Inexperienced and ill-trained opticians rely on them to hold poorly fitted eyeglasses in place. The springs only work when the frame is adjusted tightly enough for the spring to flex. This only increases the inward pressure of the temples against the head. When these temples are incorrectly adjusted, the springs only squeeze the glasses forward more forcefully than before.

The solution

The solution is for the dispenser to bow the temples so that they fit properly. I often test for this by taking a piece of paper and inserting it between the patient's head and the temple, about an inch in front of the top of the ear.

If the paper slides freely, the fit is correct; if I cannot insert the paper or slide it freely, the fit is incorrect. This also is a graphic and effective way of helping patients understand how their glasses ought to fit.

What you should do

I strongly recommend that you do two things. First, check to see if your optician understands how to adjust frames correctly. If not, see that he or she gets the training needed. Second, as you encounter patients, check to see if their eyeglasses are properly adjusted. If they are not, instruct them to go to your dispensary where they can have the problem corrected. If you and your optician are wise, you will use this as an opportunity to educate the patient about how a proper fit is part of the value of purchasing eyeglasses from a professional.

Arthur De Gennaro is president of Arthur De Gennaro & Associates LLC, an ophthalmic practice management firm that specializes in optical dispensary issues. De Gennaro is the author of the book The Dispensing Ophthalmologist, slated for release by the American Academy of Ophthalmology this summer. He can be reached at 803/359-7887, arthur@adegennaro.com
, or through the company's Web site, http://www.adegennaro.com/.

Reference

1. Stimpson R. Ophthalmic dispensing.Charles C. Thomas Publishing, 1979.

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