It’s Getting Personal
Your Lab and the Opportunity for Personalized Lenses

By Mark Mattison-Shupnick, ABOM

Release Date:	February 2010	Expiration Date:	February 28, 2011
Learning Objectives:
Upon completion of this program, the participant should be able to: Understand the difference between traditional, optimized, customized and personalized lenses. Learn methods to best describe them to patients. Determine how vertex, frame tilt and faceform are measured.
Faculty/Editorial Board:
Mark Mattison-Shupnick, ABOM, FNAO is currently director of education and training, program development for Jobson Information Services LLC, has more than 35 years of experience as an optician, was senior staff member of SOLA International and is a frequent lecturer and trainer.
Credit Statement:
This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Course #
This is sponsored by:
Three Rivers Optical and Zeiss

Individualization and personalization is happening all around us. In my case, I source information and news from various web sites daily, organized from select sources and by specific topic. By personalizing it, it fits my needs and the time that I have to devote. How have you have organized your desk, office, car, kitchen, and calendar? Regardless of the task, personalizing it adds definition, sharpness, efficiency and comfort. It’s the same with new personalized eyewear; they add efficiency and sharpness to every patient.

I know, we’ve made personalized eyewear before. After all every time you discuss a better frame size or shape, sunlens color or lens material’s advantages, you create a personal product for patients.

Now, however, the difference is the way in which the prescription is personalized. Regardless of frame, the Rx delivered will be just “what the doctor ordered”. So if a frame changes the position of lenses from the position of the lenses during the exam, (distance from the eye or tilt), that is taken into account and compensated for. There’s less for the patient to learn to use, in their new glasses.

Discussions of personalization tickle the patient too; it makes them interested in the solutions that are possible for the issues, wants or needs they have. Why now? Why should patients buy new lenses?

The Changing Lens Landscape

Using new lenses, as part of our toolbox, are not new. They have always meant new opportunities. However, today, lenses can be more personalized than ever before. The key to success is the design you choose and the lab that produces them.

New lens designs, the manufacturer’s science, results of testing and clinicals, new lab computing and math power and the terrific teaching materials available ensure success. However, why should patients buy new digital (freeform) lenses?

With these new designs, patients typically see better than they did with their previous lenses. That builds patient confidence and satisfaction. It adds to your professional identity and builds the practice.

Why Freeform? Remember, freeform is a manufacturing method only. By itself, it does not make a better progressive, single vision or multifocal. However, freeform allows a more precise and direct method of cutting a lens surface, front, back or both. The result combines vision science (design), fitting requirements (patient) and your lab (the software and equipment used to translate the design) into a more precise lens option. How?

Customized Lenses

Optimizing a patient’s progressive combines the prescription with the progressive design. The result is a customized lens. The lab’s software considers the specified base curve, corridor length and addition power, then iterates the design until it reproduces the ideal design progressive. Remember, a standard front surface progressive, when combined with a spherical or toric back surface creates the correct RX centrally, but changes the design delivered to the patient. It may also alter the add power (Fig 1. – Customization for Rx). This can explain why some patients see differently peripherally from each of their right and left lenses. Customized lenses are typically better – they deliver the ideal design, as intended by the manufacturer and more precisely reduce blur to deliver the power needed by the patient correctly.

Fig. 1 - Customized by Rx to deliver the target ideal progressive design (courtesy of Carl Zeiss Vision)		Fig. 2 – Effects of wrap and tilt on PAL design, customization results in ideal target design

Optimization improves the field of view in both meridians of an astigmatic lens also. It answers the single base curve issue of standard progressives. Prescriptions with cylinder power have a base curve chosen to best correct the stronger power meridian at the disadvantage of the other meridian. Optimizing the distance Rx while considering the unwanted front surface astigmatism bordering the intermediate and near, for each meridian independently, ensures that all patients with a cylinder Rx see better in all zones. This is especially evident in cylinders of 1D or more. (From “A Clear Perspective of Freeform”, 2009, 2020mag.com)

Customization can also be used to compensate for the effects of tilt and wrap. Figure 2 shows how tilt and wrap of 15 degrees each can be optimized to again produce the ideal target design in the patient’s Rx.

Your choices are almost as numerous as the choices today in traditional progressives. So understanding the options are important. Table 1 describes the categories of optimized lenses and a partial list of lens examples. Please refer to the full table located at the Opticianry Study Center at 2020mag.com. It will be updated regularly.

Not Just Progressives – Single Vision Also

All patients are interested in better vision and single vision is another opportunity, especially since half of all eyewear sold annually is SV (VisionWatch, a Jobson/Vision Council project). New personalized SV lenses offer a variety of patient benefits. They provide the moderate to complex Rx the crispest vision, prepares the patient for the benefits of personalized progressive lenses, can be sold at a reasonable premium over standard lenses and can’t be delivered through an internet provider.

Why are personalized SV lenses so much better? Over the last decade, lens designs have moved to flatter forms, transforming lenses to better meet cosmetic demands. In some way, I believe that we learned that the patient would accept somewhat more peripheral blur, given the acceptance and adaptation to progressives. As a result, more blur was acceptable than had previously been designed for.

Adding to the issue was the shift to thinner and lighter materials where an abbe between 30 and 32 now accounts for almost 60% of the lenses sold in the US. Chroma can add to peripheral blur.

In some cases, asphericity helped correct peripheral vision to be equivalent to the steeper forms of lenses (corrected curve). However, for the astigmatic patient, only one meridian was corrected since the lens front was a rotationally symmetrical asphere. Moreover, labs may not strictly adhere to the base curves that manufacturers’ recommend. Therefore, SV lenses optimized for the Rx, base curve and abbe results in a customized lens with superior vision and clarity for the wearer. How are they different and how can I describe them best to patients?

Describing the Advantages

As with any new lens and technology, it takes time to develop confidence and the right language to describe the benefits so a patient will purchase. It also means, in a still sluggish economy, that the patient must believe that there is real value in what you recommend. Let me suggest two approaches – both will resonate with the different patients in your practice.

Landed in Rx Limbo

Personalized lenses can make a difference when the varieties of tolerances we apply become additive and change the Rx delivered from what was intended.

Dissimilar Fitting Heights – Haven’t you had a patient complain that reading vision was clearer in one eye than the other? It may be because lenses weren’t ordered with dissimilar fitting heights.

When one eye is higher than the other and both fitting crosses are placed at the height needed for the lower eye, the lower eye reaches add power first and eye rotation downward stops. However, the higher eye still hasn’t reached the same add power. Always order dissimilar fitting heights for all progressives and in personalized lenses that means SV as well as progressives.

ANSI tolerances allow 1mm tolerance, in any direction, for the specified location of the Fitting Cross. It is possible that the error from not ordering dissimilar heights could be made 1mm worse if the lab needs to use the allowable tolerances. Personalized lenses reduce errors since more precision is used at all stages.

Round-off Errors and ANSI Tolerances – Personalized lenses are cut directly during the optimization process, then buffed to high transparency using a conformable pad. This means that surfaces are created in 0. 01D increments. This eliminates round-off errors for lenses, especially high index, where tooling would have chosen the nearest curve needed within 0.10 or 0.12D increments. One lens might be slightly weak, the other slightly strong, yet within tolerance. They would also read correctly in the lensmeter when using 0.25D steps to check them. However, they would see differently to the sensitive patient or difficult patients like the near plano Rx progressive wearer.

They Do Cost More...

Don’t be embarrassed to deliver these lenses at their right value – they are new, a product of years of research and expense by manufacturers and designers. Patients will understand.

Say, “They are more than your previous lenses, about $xx…” or “These lenses will be $xx more than our premium standard lens, they cost $$...” “That includes…” (It’s the best opportunity to bundle poly or high index and AR, etc.)

Reassure them with “Our other patients have told us that they provide better vision and therefore better overall value, comfort and usefulness.” Be sure to tell them “These were not available the last time that you had your eyes examined and purchased eyewear.” Once the patient has agreed, stop talking and total the costs so that they understand the result. Add frame, insurance discount, co-pay and end with “Great, you’ll love this new pair of glasses, we take 50% as a deposit or all of the total price.”

Once You Set Your Pricing

Once the pricing for these lenses is set, all staff (including the doc) must be able to describe how they add benefits when compared to previous lenses. The doctor should prescribe or recommend from the exam room. Words like “Not off the shelf, precisely the need discovered during the exam, tailored to your Rx, etc…” can open the conversation that the optician will finish in detail. All staff should use very similar language and comments for continuity of message. Lastly, be able to relate personal or other’s experiences to add confidence to the patient’s decision.

Measurements – Here’s Another New Part

Add VTF to the measurements taken to personalize lenses. They are Vertex Distance (V), Frame Tilt (T) and Faceform (F). V=Back of lens to front of eye, T=Tilt angle of lens to eye (rotated at the endpiece) and F=Tilt angle of lens to eye (lenses are tilted from the bridge, temporal edge is moved towards the eye).

Technique is required, and it needs to be fast and accurate to ensure that the patient maintains their confidence in what you sold. So, practice on everyone in the office. If everyone in the office is within 1mm of each other’s measurements, you’re achieving good accuracy and consistency. Work with those that need practice.

Call your area lab or lens consultant for training. Ask them for the tools that help with taking measurements. Also, consider a digital camera measuring system.

Until the office is comfortable taking VTF measurements, consider using the default values that the manufacturer recommends. Don’t be lazy though, move to personalizing lenses with these values quickly.

Vertex Distance – Place a mm ruler or manufacturer supplied rule and determine the back vertex distance. Place the zero at the back plane of the eyewire and sight the distance to the front of the eye. If there is a lens in the frame, it might be easier to measure from the front of the lens to the front of the eye and then subtract the lens center thickness for the back vertex.

Frame Tilt – With the patient assuming a natural head posture, place the pendulum gauge parallel to the temple and in line with the eyewire. The needle will point to the Frame Tilt.

Faceform – The wrap angle of the lens is measured by placing one lens over and parallel to the reference line. Then sight an imaginary line for the other lens angle. See Figure 7.

Your Lab and the Role It Plays

Your lab is your partner in your success. By that I mean that the production of customized and/or personalized lenses occurs using the equipment and optimization tools in the lab at the time the lens is made. So, the quality of the lens and its faithful design replication is the result of their investment in the right lab components. First, the lab management system (LMS) and the software package installed create a math file that describes the surface needed. Next the LMS directs the freeforming equipment to exactly cut and buff the surface. Last, the lenses are sampled for faithful reproduction of the actual results vs. those intended. This system requires significant financial, technical and employee investment to be able to do freeform lenses. Their care of the system ensures your success.

Success and Being Effective

Knowing the technical stuff is only a part of the success of getting personal. Be able to describe the differences. That mean the attributes that you’ve identified that the wearer will benefit from and then the costs.

Take all fitting measurements with skill, speed and confidence. Make their experience special and personal. Then, once you have the completed eyewear dispense with confidence and talk about the improvement that the patient notices right away and that you’ll call them in a few days to review the other things that they like better about this pair of glasses than the previous pair. Be able to troubleshoot if necessary. Ensure that they know that they have new personalized lenses.

Remember, standing there next to you is the manufacturer’s science, their testing and clinicals, the sales and consultants and your lab, its people and the investment they made in this new technology.

Now, for the first time, technology exists that allows you to precisely personalize lenses for each patient’s frame, face and prescription to deliver their best vision possible. Get Personal!