Efficiency is a key to the success of any busy office. Efficiency is the
ability to get the job done well with the least amount of excess.
Excess can take the form of time, which is money, or effort, which
beyond the norm can wear negatively on all involved. That means
staff operates as a team, technology and equipment provides better
information faster and more accurately and everyone in the dispensary understands and knows the best products to use for each
patient. With the wonderful variety of products and suppliers available—how do you make the best product decisions for the office?
Effectively meeting the eyewear needs of the patient is the job
the dispenser must efficiently accomplish. This job should begin
with a needs assessment that states the patient’s visual solution. Once the goal is
clear the remainder
of the process will
require the dispenser
to educate the patient
through instruction
and demonstrations
leading to the best
choices for that
individual.
 As with any job,
efficiency depends
on the tools used to
accomplish the task.
A dozen four-inch
stainless-steel screws
could be driven into
a hardwood board
with a manual, bent,
broken-tipped screwdriver or with a 12
volt, high-speed, torque-controlled drill. Efficiency is defined by the
hour-and-30-minutes that job will take manually versus the 10
minutes it would take by using the drill. Tools are good when
matched to the task.
However, the problem
with tools is that they
can be bulky and heavy.
You need them when
you need them, but you
don’t want to carry your
whole tool collection to
the job when you only
need a level and a drill
(or in my case—a hammer, always a hammer).
In the case of dispensing, the tools we use to deliver vision solutions are lenses. When
categorized into the dispensing toolbox as designs, materials and
enhancements the problem becomes apparent—the toolbox is so
heavy and full it can’t be used efficiently. The dispenser can’t lift
the toolbox in order the take it to the patient. It is hard to get to
the items the patient needs when a whole gamut of other stuff is
piled in on top of them.
This article is meant to help you develop a streamlined toolbox
of the most useful lens choices needed for the highest fill rate. It
does not mean you won’t use the other options that you left back
in the “New Yankee Workshop,” but if the job requires hanging a
shelf, there is no need to carry a pipe bender, auto planer and
turbo pneumatic wrench. Just don’t forget the hammer.
START YOUR TOOLBOX/STREAMLINE DESIGN CHOICES
The message in this section is certainly not to pick one design and
use it for everyone regardless of need. The message is to fill each need individually with the best products the industry has to offer
while limiting the choices to a workable grouping of lenses.
As professionals you make decisions everyday as to which products
you support. Those decisions are no doubt based on your past successes and failures. If it works you use it again. If the product results
in dissatisfaction you abandon it. Before you know it you have a hierarchy of recommended products based on their frequency of success.
The first area where design comes to mind as a difficult choice
is in the area of progressive lenses. You may be familiar with the
Optical Laboratories Association’s publication “The Progressive
Lens Identifier.” Through the use of schematics this piece maps
out the unique markings and semi-visible engravings utilized by
each manufacturer to identify their particular lens. Years ago this
piece consisted of a handful of manufacturers and about a dozen
different progressive choices. In the current edition of the “Progressive Lens Identifier” there are over 300 illustrations. The current
and complete progressive toolbox is so cumbersome it couldn’t be
budged with a bulldozer. As dispensers selling progressives we
have to limit the choices to a right but workable few.
First, when selecting key progressives for a daily toolbox know
that the nature of progressive lenses has changed. In the past,
frames were larger so lens corridors only supported minimum fitting heights of 20mm or more.
Today specialization better meets an individual patient’s needs.
Progressives are designed for specific performance. Categories of
general purpose, small frames, computer, bifocal wearer conversion and individualized custom fits must be managed within an
office. A good toolbox won’t have over 300 different types of
screwdrivers, but it will have a selection of
specialized choices to get the job done.
By now everyone has probably found
the best progressive for their general
recommendation, but with frame styles
changing what was a general use product
yesterday needs to be a specific use product today. So the question is how do I
organize the choices? Here’s a start.
Define up to three general-purpose lenses
used. These are the standard progressives
that form the basis of the progressives
prescribed and are the foundation of the
pricing charged.
Choosing a progressive is a function of
brand—yours not the manufacturer’s.
Here are the key questions to ask. Does
the brand of lens support who you are as
a brand? Can you get the add-on treatments and materials that are
needed in that design for the variety of patient in the practice? Are
patients satisfied when fit with that design? Does the manufacturer
support and train staff to help make the office more successful?
Does the lab, the source of the progressive provide customer, technical and promotional support to make better everyday decisions?
Are lab costs, handling of redos and warranties and the delivery of
product keeping the office efficient and effective. If all these criteria
meet yours, that is the design for you. Now add it to a decision table
so its patient benefits can be described in relation to pricing.
Fill in a table like this. In the “good” column add two or three
general-purpose choice designs that you dispense. We’ve added
some lenses as an example. Then, in the “better” column, add in
their improved or evolved designs, thin and light materials and
treatments like Transitions, Trivex or polarized. Include the
increased sell prices of each. Now step back and review what
you’ve added. The designs for “better” and “best” should be
improved designs over the standard general-purpose lens normally used; the increase in sell price should match the increased value
of that design. The same is true for materials and treatments. For
example, “in polycarbonate or 1.6 high index, an extra charge of
about $89 will make your lenses about 25 percent thinner and
lighter than they are now.”
Next, add in the lenses used for small frames, short corridor lenses with minimum fitting heights of 16mm or less, then add the
designs for large near and computer. In each case, fill in the design,
material and treatment upgrades and the sell price in every box.
Choose at least two designs for each box but probably no more than three to four. In this way, the number of designs used is
reduced and more manageable.
If your toolbox only holds general purpose designs you will find
that a lot of your patients will have difficulty since it is estimated
55 percent of frames have a B-measurement of 35mm or less.
Therefore, most general use progressives have longer corridors
and require higher fitting heights. New generations of small frames
require shorter corridors regardless of prescription.
Examples of short corridor, high-performance
progressive designs are the Essilor Varilux Ellipse
and Ellipse 360º (14mm minimum fitting height),
SEIKO Proceed III Super Short (16mm),
SOLA Compact Ultra (13mm). More
than just general progressive designs,
these lenses better fit the needs of a growing population of small frame wearers.
Another growing special needs area and
tool for the progressive lens fitter are variable focus lenses for computer users. The
American Optometric Association has
identified the condition known as Computer Vision Syndrome, the complex of
eye and vision problems related to near work
that are experienced during or related to computer
use.” Symptoms of CVS are eyestrain, blurred near or
distance vision, headache, dry or irritated eyes, neck and/or
backaches, light sensitivity and double vision (diplopia).
Many of these symptoms are caused by the computer user’s eye
movements and head postures that are not directly addressed with
a general use progressive. Enter the computer specific progressive
that expands the usable areas where needed while paying particular attention to the specific head postures of computer users.
Examples of computer specific progressives that expand the near
and mid range of vision are Access by SOLA, Interview and Nikon
On-Line from Essilor, Tact from HOYA and Office by Shamir.
These designs de-emphasize distance vision. Their use is specialized for near and mid-range distances so they are computer specific
for patients. There are a couple of lenses that offer a greater range
from distance to near while still offering improved computer necessary intermediate and near vision—the Technica by AO and the
Tact lens by Hoya, which can be ordered for distance vision.
The newest emerging technology for a high-tech addition to the
toolbox comes in the form of progressive designs personalized
using the patient’s prescription and, in some cases, additional fitting measurements. In these cases, the existing design is modified
using prescription and fitting data. The results are a personalized
Varilux Physio that becomes Varilux Physio 360º (also consider
Varilux Ellipse 360º and Varilux Comfort 360º). Manufacturers like
Zeiss combine the prescription and fitting data and frame information
to place the entire progressive design as well as its optimization on the
back surface of the lens. Examples of individualized progressive
designs are the Zeiss Individual, SOLAOne HD and CompactUltra HD from Carl Zeiss Vision, SEIKO Succeed,Shamir Autograph and the Varilux Ipseo fromEssilor. These high-end options are not for
everyone, but they sure make a nice
addition to your toolbox. 
A variety of equipment manufacturers have developed optical generators and polishing machines that
can cut a progressive surface directly
to the lens blank. Therefore, it is possible to create a back surface progressive
on a spherical front lens. The result will
be progressives that can be customized
to enhance certain lens designs and deliver
a unique visual fit for individual prescriptions.
New design flexibility and inventory reduction may
bring better lens solutions for your patients.
So now if you are looking for a great progressive toolbox
you can forget lugging around 278 different designs in favor
of a streamlined six to eight designs that will handle all the normal
jobs plus those jobs that require some specialized handling.
REFINE YOUR TOOLBOX/STREAMLINE MATERIAL CHOICES
Luckily, there aren’t 300 materials to choose from, but there are
about four to six that require some careful planning. Issues of
wearing comfort and product liability have pretty much placed
glass lenses on the shelf. They are there when needed, but you
don’t have to carry them around to every job. Plastic lenses have
reached a point of maturity and while at about 50 percent of the
overall market, they are in decline. The main advantage of plastic
is that it is the lowest priced choice in all design categories but
includes a good mixture of vision and material properties. It
would probably be okay to leave plastic out of the toolbox, present the thinner, lighter and safer materials, then if price become
the issue you could always substitute it as the economy option.
Even though plastic is a lightweight material a toolbox full of
plastic options will weigh you down.
A well-organized toolbox might consider using polycarbonate as
a primary staple much like a carpenter would carry a saw and, of
course, a hammer. Polycarbonate makes up about 40 percent of the overall lens usage and it is still growing. Designs across the
board from single vision to progressives have embraced poly so
availability is rarely an issue. Polycarbonate addresses a large number of universal needs. It is strong, safe, thin, scratch resistant, UV
inhibiting and lightweight. (I like it because if you are careful you
can demonstrate it with a hammer.) It has earned its place as the
new industry standard.
In another issue relating back to frame styles, about 25 percent
of all frames today fit into the rimless and semi-rimless category.
Polycarbonate is great for drilling and grooving so it remains a
contender, but some eyecare providers prefer Trivex, a relatively
new material entry from Younger (Trilogy) and Hoya (Phoenix).
This new material is lightweight, impact resistant and lends itself
well to rimless mountings, safety and kids’ eyewear. Its advantage
is that is will not star crack.
Of course there is always the patient that requires the very best
or ultimate product. For those patients the thinnest of the thin
lenses are the 1.67 and 1.74 high-index material. They are thinner
than polycarbonate, available mostly in single-vision and progressive designs and obtainable from a variety of manufacturers. There
are other high-index materials, but the ultimate is the only one
worth carrying in your toolbox.
When it comes to materials the combination of polycarbonate,
Trivex and 1.67 high-index will cover most of your jobs. Remember if all else fails you tell the patient if they really don’t want the
strongest, thinnest, lightest, safest choice you have this plastic stuff
back in the shop that will do the job not as well but pretty good
and will save them a few dollars. That approach sounds like a
psychological manipulation, but it is really—just telling the truth.
COMPLETE YOUR TOOLBOX/ADD SOME UPGRADES
Even in a streamlined toolbox a few specialty items
fit nicely. In the case of eyewear these items
are known as enhancements or upgrades.They are not the lenses themselves, but
rather something that makes the lens better by adding to its performance. For any
optical toolbox, the three tools that come to
mind are aspheric design, anti-reflection
and photochromics.
Aspheric designs are available in the big
three materials of polycarbonate, Trivex
and 1.67 high index. The purpose of these designs is to enhance
already thin materials as they allow flatter, more attractive looks
and open up and widen a patient’s field-of-vision. These designs
look better and work better than standard products. The aspheric
tool deserves a place in the optical toolbox. Anti-reflection is an enhancement that is beginning to accelerate
in the upgrade category. Currently it is used on only about 30 percent of lenses sold, but as the public’s awareness of clearer, safer
vision grows so too will this tool.
Anti-reflective lenses are a definite keeper. Like most product categories there are many brands
competing for the ECP’s favor and while there are many bargain
entries into this area you would probably do best by sticking with
the industry leaders. Cheaper versions have been around for a long
time, but this is no place to cut corners. If the product performs
you will have a happy patient for life, if it fails you may not only
lose the sale you may lose the customer.
Photochromics have been available since the 1970s when
Photogrey lenses revolutionized the glass lens market. Since then
the last 35 years have been spent refining and evolving a product
that works with the new frontline materials like polycarbonate and
Trivex. And, in photochromic technology, the newest lenses are
sun lens dark in 30 seconds and in polycarbonate and high index
clear faster than ever before and two to three times faster than
standard plastic. Clear to sun dark in a single lens this enhancement allows for a tremendous range of versatility.
A STREAMLINED TOOLBOX IS THE RIGHT CHOICE
After considering all that is available, it should be apparent that a
dispenser’s toolbox couldn’t hold all the options. What an organized professional does is choose the best and shelve the rest. A dispenser should approach each patient with the experience tested
high-percentage products that have worked so well in the past.
They should keep all other products on the shelf in easy reach for
when the need arises and, like Tim “The Toolman” Taylor, they
should always be on the lookout for new and better, more powerful, high-tech options.
Now, there is a great toolbox that will fit into the back of your
pick up and enable you to bring the very best the industry offers
right to your patient’s doorstep. All I need to do to finish this off is
frame my byline… now where did I leave that hammer |