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Reducing Progressive Lens Choices to a Manageable Toolbox

By Mike DiSanto, ABOM

Release Date:

March 2008

Expiration Date:

January 31, 2013

Learning Objectives:

Upon completion of this program, the participant should be able to:

  1. Understand patient characteristics to better understand the needs of active presbyopes.
  2. Explain why patients should have two pair of glasses.
  3. List some of the benefits of newer progressives.

Faculty/Editorial Board:

Michael DiSantoMichael DiSanto is an independent industry trainer, past president of the Opticians Association of Ohio, a masters certified optician and a graduate of John Carroll University.

A recipient of the Beverly Meyers Achievement Award, his articles have been published in a variety of trade journals. He is also active on the national lecture circuit.

Credit Statement:

This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO).
Course #STWJM014-2

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.

fig1As 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.

CATEGORY

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GOOD ($$)

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BETTER ($$$)

div

BEST ($$$$)

div div div div

General Purpose

SOLA Percepta
Varilux Comfort
Varilux Panamic
Kodak Precise
Shamir Genesis
Vision Ease Illumina

Varilux Physio
SOLAOne, Zeiss GT2,
Kodak Unique,
Essilor Definity
+ Photochromic
+ Polarized
+ High Index
+ Trivex

Varilux Physio 360
SOLAOne
+ Poly
+ 1.67, + 1.74

div div div div

Short Corridor

Varilux Ellipse
AO Compact
Shamir Piccolo
Zeiss Brevity
Polycore Micro

Definity Short
+ Polycarbonate
+ Photochromic
+ Polarized
+ High Index

 

div div div div

Large Near
and Computer

SOLAMax
Nikon On-Line
SOLA Access

+ Poly
+ 1.67
Shamir Office

 

Courtesy M. Mattison-Shupnick

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. fig2

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.

TOOLBOX CHECKLIST

Designs

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Materials

vdiv

Upgrades

vdiv vdiv vdiv

toolbox• Well-proven general
purpose progressive
• Short corridor progressive
• Computer progressive
• Custom personalized progressive

• Polycarbonate
• Trivex
• High Index and
Ultra High Index

• Aspherics
• Anti Reflection
• Photochromics
• Polarized

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