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The "...ize" Have It

By Mark Mattison-Shupnick, ABOM

Release Date: May, 2011

Expiration Date: July 31, 2012

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

  1. Learn how new optimized, customized and personalized lenses are different from traditional best form lenses.
  2. Understand the differences between optimized, customized and personalized lenses using the Optimization Pyramid.
  3. Communicate the benefits of "...ized" lenses to patients.

author Faculty/Editorial Board:
Mark Mattison-Shupnick, ABOM is currently director of education and training, program development for Jobson Information Services LLC, has more than 40 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 STWJM513-2


This program is supported by an educational grant from:
LUXOTTICA


"...izing" lenses is the best way to deliver the vision that was always intended by the doctor when writing the prescription and the optician when filling it. It's now possible because of the variety of free-form and digital surfacing technologies. I'm talking about optimizing, customizing and personalizing lenses. Believe me, if this had been possible 100 years ago, this is the way we'd be doing it now.

FROM ADEQUATE TO EXCELLENT

You might ask, "What's wrong with today's lenses, the ones I order every day?" That's the right question to ask since it appears that most wearers do well with their glasses. To quote another—it's a matter of providing lenses that are only adequate to those that deliver excellence. Traditional or ordinary lenses today are pretty good for low cylinder prescriptions at the center of each of the Base curve ranges. But as power and/or cylinder increases they only become adequate. That was the best we could do. To provide excellence, lenses should be designed for each Rx individually based on wearing conditions. Why?

When any lens is worn at different tilts, wrap angles and distances from the eye, the effective power of the lens and the design of the periphery change the way the lens works. In the exam room, the lenses used to determine the prescription have no tilt or wrap and are about 12 mm from the eye. This is certainly not the way that the lenses will be positioned by a frame in reference to the eyes. As a result, the effect of the prescription and the design and power of the periphery, when worn, is not what is intended. The result, depending on the Rx and the amount of tilt, wrap and vertex distance is anything from insignificant to blur, both for central and peripheral vision. It is true for both single vision and progressive lenses.

One might argue that the tilt and vertex changes for most Rx's are small between the exam and the frame so the effect on the central Rx is also small. This is true. However, peripheral design changes are more radical and the resulting peripheral blur and distortion reduces the effective field of clear vision. This affects mobility, an overall sense of lens clarity and ultimately how happy patients are with their vision.

Optimizing redesigns the lens from prescription to periphery using: the traditional measurements of PD and fitting height; the way the lens sits in front of the eye i.e., actual or default vertex distance, pantoscopic tilt and wrap angle measurements; asphericity, atoricity and/or complex surfaces; and in some cases, lens size and frame shape considerations. This data is used to redesign the entire lens individually for each eye, for binocularity requirements, for the frame chosen and the person wearing it.

That means two important things. First, the effective lens prescription that the wearer "sees" is the prescription that the doctor intended. Even though the power of the lens on a lensometer would be different, in the as-worn position on the patient, they "see" what the doctor prescribed. Anything else changes the prescription. Secondly, "...ized" lenses require a new manufacturing technology i.e., free-form or digital surfacing techniques that can cut any surface i.e., optimized, customized and personalized lenses.

Of course, free-form also includes the ability to cut ordinary best form design lenses. But don't be fooled into thinking that this new technique automatically makes better lenses just because they were free-form or digitally surfaced. To make a better lens, the design must be optimized. Lastly, traditional toric surfacing cannot cut an optimized design, only "...ized" lenses can be made with the new free-form techniques.

THE OPTIMIZATION PYRAMID

Like any other new technology, free-form and optimization allow new tiers of opportunities for wearers and opticians alike. The pyramid builds on best form lens designs, adds the correct asphericity for each principle meridian and optimizes the design from edge to edge using the actual way that the lens sits in front of the eye. The result is that there is an "optimized" lens for any budget.

img1

At the top of the pyramid are the most complex and sophisticated of lenses. Personalized lenses redesign each prescription using sophisticated instrument data plus the actual fitting and position of wear measurements. They might refine the prescription with wavefront measurements (higher and lower order aberrations), eye rotation center distance data or lifestyle input from the wearer. For the office that prefers to be able to deliver the best in the category, invest in new measuring instruments and recommend the most personalized of lenses. A lower cost option is to add monitors and soon iPad applications to the dispensing table to input lifestyle data.

Don't intend to invest in new specialty instruments yet? Customized lenses are your best option. Take actual vertex, tilt and wrap measurements, along with monocular PD and fitting heights. Provide these values when ordering lenses. This allows the laboratory's free-form software systems to cut each individual prescription and lens design for each individual order. Contact your lab or lens supplier for tools to measure vertex, tilt and wrap angles.

If your office chooses not to use actual position of wear measurements yet, the lab will substitute a series of default values. This delivers an optimized lens. For example, one of the major lens manufacturer's labs will use a vertex of 14.5 mm, pantoscopic tilt of 9 degrees and wrap angle of 5 degrees for progressives.

img2

In each case for personalized, customized and optimized, the result is a lens redesign of both the lens power delivered and a peripheral design that reflects each manufacturer's design philosophy.

Next are the series of lenses we've been using until now, aspherics and best form lenses. Aspheric SV lenses improve lens cosmetics (flatter, thinner and less magnifying) while delivering vision similar to steeper lenses. Less common but available have been atoric SV lenses that have the correct asphericity for each meridian of a cylinder prescription lens. These have been very effective improving vision for prescription wearers with more than 1.00D of cylinder.

At the bottom of the pyramid is the way that our industry has delivered lenses for more than 70 years i.e., best form lenses. A range of powers is created from a small number of front surface curves, called Base curves. This in and of itself is a compromise. Since the front surface has a spherical Base curve, only one meridian of the prescription can be corrected in the periphery for off-center errors. In fact, the amount corrected is only for an average of errors since traditional surfacing or grinding limits any meridian to only a spherical curve.

img3

A representation of the Base curve charts (shown right) is now more easily understood. On the left, the original chart shows that there are different front curves used for a range of lens powers. However, vision is shown as being compromised by the changing colors. The farther from the targeted central power in sphere and cylinder power, the worse offcenter clarity the lens delivers. In an optimized lens, vision can be corrected for almost all powers in almost all Base curves. In fact, one can change from traditional Base curves and make an 8 Base wrap sunglass, and still correct for vision centrally and peripherally. It's really the right way to make lenses.

ONLY FOR PROGRESSIVES?

While the concept of optimizing a lens was made popular for progressive lenses, the technique is also especially good for single vision wearers. Lens position also affects the design of the lens' periphery in single vision. For high power and/ or high cylinder single vision wearers think optimized, customized or personalized lenses.

While optimized and customized progressives are increasing in popularity, there are less sales of "...ized" SV lenses. Yet this is in fact as large an opportunity as progressives, and for some offices SV may be easier. After all, the increased cost of optimized SV is less than progressives and it may be easier to get experience shifting patients to these better lenses.

IT'S A PROCESS CHANGE

Remember that the U.S. population is relatively young with an average age of about 32, and about half of all glasses sold are single vision. Therefore, thinking "...ized" lenses is a change to the process in the office. All patients are targets, not just progressive lens wearers.

That makes communication about the "... ized" lens benefits really important. First avoid the technical explanation since that will put all but the engineers asleep. Talking about this new technology should be just that. Words like "new" and "technology" resonate with today's consumer. Say "newest lenses, newest of technology, optimized, customized, personalized" and be able to explain the advantages of each. Agree with the patient that wants the "best in the category" that these lenses are just that—redesigned with all the latest technology used to their visual advantage, everywhere in the lens.

It's correct to say that "the patients I have fit see better, some notice very big differences, others smaller—after all it depends on the lenses worn previously and your own sensitivities." Many ECPs have found that describing "...ized" lenses as "high-definition" lets patients compare the experiences with high-definition television sets versus older analog models.

OPTIMIZATION PYRAMID PATIENT BENEFITS FEATURES
INDIVIDUALIZED OR
PERSONALIZED
• Best refines vision in all directions
• Creates the most individual of designs
using lifestyle, biometric and/or wavefront data
• Lifestyle data helps design the clarity and size
of viewing zones using direct patient input
• Incorporates new instrument data for refined Rx’s,
eye/lens position measurements or lifestyle input
• Includes actual tilt, wrap and vertex values to reconstruct
the Rx and lens design for the frame chosen
• Monocular PD and fitting heights
• 100 percent back surface or double-surface designs
• Lenses that can’t be duplicated online

CUSTOMIZED
• Best refines vision using actual
“position of wear” measurements
• Excellent vision in all directions
• Wrap and flat prescriptions effectively
“see” the same
• Includes actual tilt, wrap and vertex values to reconstruct the Rx and lens design for the frame chosen
• Opticians add to their skill level by taking vertex, tilt and wrap measurements
• The office adds to its technical and professional identity
• Monocular PD and fitting heights
• 100 percent back surface or double-surface designs
• Lenses that can’t be duplicated online
OPTIMIZED
• Improved vision in all directions when compared
to traditional lenses
• Includes default tilt, wrap and vertex values to reconstruct the Rx and lens design for the frame chosen
• Monocular PD and fitting heights
• 100 percent back surface or double-surface designs
ASPHERIC OR ATORIC
• Aspheric lenses improves the cosmetics of
traditionally steeper lenses but maintains the
vision of steeper lenses
• Atorics improve vision
• Traditional lens fronts
• Aspheric SV front surface lenses
• Aspheric for spherical Rx’s, atoric for cylinder Rx’s
BEST FORM • Adequate to excellent vision in all zones of the
lens, depending on the prescription and the way
that frame holds the lenses in front of their eyes
• Traditional and consistent with the lenses that the patient has typically worn
• Only excellent vision at the targeted design for each Base curve, adequate vision otherwise
• Monocular PD and fitting heights


Another good tool is to describe your office's experience with these lenses. Say, "Our experience has been...," or use your own experience as testimonial. Also say, "My experience has been..." That means you have to wear these lenses, whether they are SV or progressives.

An effective communication technique is to approach the description by identifying a patient's pain (see Robert Bell's CE course "Selling's a Pain" at 2020mag.com/CE). That means you are identifying something the patient has been unhappy with, asking if they would like it fixed and responding with the option that "...ized" lenses can answer their dissatisfaction.

Try saying, "You wear your progressives successfully. If there is something about them that you could improve, what would that be—the reading area, distance clarity, width or computer?" In almost all cases, "...ized" lenses make a positive difference.

Ask, "Haven't you noticed, as your prescription for reading gets stronger, reading and/or arm's length vision seems narrower? These new customized lenses increase the size and clarity of all the areas in your lens—it will be more like going back to the size of the viewing zones of an earlier prescription."

Also say, "When you first received your progressives, you described the blur on the sides. It was different from right to left, vision in one eye was clearer than the other, and you didn't care for that. These new optimized lenses make lenses equally clear for vision as you move your eyes from side to side. That means you'll feel like everything is clearer."

MAKING “…IZED” LENSES
For single vision—The free-form process
cuts and polishes a new optimized/customized
surface on the back of a spherical
front surface semi-finished lens blank.
For flat tops—The free-form process cuts
and polishes an aspheric (for spherical Rx’s)
or atoric (for cylinder Rx’s) back surface on a
spherical front surface semi-finished lens blank.
For progressive lenses—Two general
methods are employed (depending on
manufacturer):
• 100 percent back surface - A spherical
front surface is combined with a back
surface that combines the progressive
Add, the Rx and the fitting and lens
shape requirements.
• Another method is to use a more complex
front surface like a progressive, partial
Add progressive or bitoric surface, then
free-forming a back surface to deliver
the design and powers as required.

“ARE YOU CHANGING THE RX?”
No. The power of an optimized, customized
or personalized lens is reconstructed to
deliver the prescription as the doctor wrote
it. Be sure to teach the patient why they
have two lens powers on the card with
their Rx. This will reduce any confusion
when patients return to another office to
have their lenses checked.



SOME RECOMMENDATIONS

These new technologies are beneficial to all wearers so that means a few recommendations are in order. First, tell every patient about the advantages of "...ized" lenses. After all, if we say nothing, the patient doesn't know, and they lose the opportunity for a better product.

Make it a plan to evolve all patients from older, only adequate vision to excellent vision. Describe the options available, allow the patient to manage their own budget and get all the benefits that optimized, customized or personalized lenses can offer.

Consider taking position of wear (vertex, tilt and wrap) measurements on every patient. Whyo? It sets your office apart from the ordinary and with so much practice, they become fast and easy to take. It then allows more time to focus on teaching patients about the benefits of their options, and helps you grow professional identity and revenue.

Lastly, get optimized or customized lenses for every prescription wearing person in the office. Then everyone can speak for their individual as well as the collective experience. It means a lot to the patient when there is a personal recommendation. Think about how you describe the benefits of polarized sunglasses after getting your first pair and experiencing how well they work.

I call for the vote. It's obvious. The "...ize" have it!

LENS SURFACES come in many forms, they can be any of the following and all can be free-formed or digitally created. But their effects on vision are very different. Lens surfaces are:
Spherical—Like a basketball, the surface has the same curve (radius) in all directions. Traditional spherical lenses, surfaced or stock lenses are used for sphere only Rx’s.
Toric—Like a football, a toric surface has two different spherical curves on the same surface, perpendicular to each other. Traditional toric or cylinder lenses are used for astigmatic Rx’s. Traditionally ground or supplied as stock lenses.
Aspheric—Not spherical, like sections along the surface of an egg, the curve flattens or steepens towards the periphery. Traditional aspheric lenses help deliver flatter, more cosmetic looking lenses with the vision of a steeper traditional design lens. Supplied as cast aspheric fronts with spherical or toric back surfaces.
Atoric—Provides two different aspheric curves (tuned to the power in that meridian), on the cylinder surface. These lenses are especially good for Rx’s with cylinders >1.00D and are supplied as molded stock lenses, or can be created using free-form techniques on demand in the laboratory.
Progressive—A lens that increases in plus vertically along a center line to produce an “Add.”

 


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