By Palmer Cook, O.D.
Photos by Nedjeljko Matura

Last month in 20/20, it was explained what it takes to become a “Specs Expert”—a dispenser who can confidently recommend attractive, comfortable high-performance eyewear based upon their knowledge of frames and an understanding of a patient’s facial anatomy, complexion and preference of style (Spec-ulating, May, 2004). To illustrate these dispensing techniques, 20/20 introduced two male characters, Chubby Cheeks Charley and Long Nose Tom, and presented solutions to their eyewear needs.

In this month’s follow-up, we profile two female characters: Flashy Floretta and Lawyer Lil. Each presents a different set of challenges for “specs experts.” Perhaps you’ll recognize them.
Flashy Floretta
Rx: OD -5.00 = -3.75 x 090, O.S. -4.75 = -3.25 x 090. Floretta has high, prominent cheek bones, long lashes and a tiny, recessed bridge that swoops down to an up-tipped nose. Her facial shape is a classic base-up triangle. Her maximum facial width is 115mm and her PD is 68mm.  

Floretta loves makeup and her face is a mélange of color because of her liberal use of lipstick, lip liner, lid liner, blush, mascara and eye shadow.
By day she is a secretary and part-time agent at a real estate agency. By night Floretta is studying art history at a local community college. Her old lenses have groups of tiny posterior surface scratches near their lower, lateral corners. 
Thoughts & Suggestions
Floretta doesn’t want contacts. She likes to incorporate eyewear as part of her “look.” She is a candidate for a dramatic design. Floretta uses makeup to emphasize her wide PD so if your dramatic design enhances her already wide PD too much, you may give her a “bovine appearance.” Try a frame with gentle rounding of the lower, lateral portions of the lenses and some upsweep toward the temple attachments to emphasize her high cheekbones and base-up triangle facial shape. Her lens power is -8.00 in the horizontal meridian. A zyl frame with a lot of eyewire width, especially laterally, will help minimize the facial inset of high myopia as well as minimizing lens weight and edge thickness. AR lenses with an edge tint will minimize the bulls eye rings of myopia.

There is mystery and fun in wearing sun lenses and Floretta knows it. Those little scratches on the old lenses are a giveaway. She has been “economizing” by using clip-ons with wire hooks. Let her know about the advantages of adding real prescription sunwear to her wardrobe. Some clip-ons are clunky and don’t have the better optics of prescription sunglasses. Give her polarized lenses. If her old clip-ons were polarized, her new non-polarized prescription may not measure up as well. Most folks keep their eyewear for two to three years, about 1,000 days, so even an extra $400 for top quality sunwear will only cost her about 40 cents a day—less than the cost of her morning cup of coffee.

Checking Out Floretta’s Lashes
Long Lashes Can Be A Problem: Floretta’s recessed bridge and long lashes make her a prime candidate for problems with lash relief even if she curls them. Use your thumb as a fixation point at a distance of about 16 inches and view them from the side. Moving your thumb up and down slowly will allow you to position the lashes at the straight-out position. This permits a good estimate of how much lash relief is needed. In an extreme situation such as this one, Floretta will hear a “curl them or clip them for best results” discussion.
Thoughts & Suggestions
The small lens size that reduces lens weight and edge thickness will also have a shorter sag depth than a larger lens. Using a frame with a smaller bridge or adjustable pads may increase her vertex distance sufficiently and, if the B measurement is not too small, the lab may be able to move the bevel of her minus lenses back a bit. Consider a frame with low temple attachment for better lash relief through pantoscopic tilt.

Lawyer Lil
Rx: OD -1.75 = -0.75 x 179, OS -2.00 = -0.50 x 002 with a +1.50 add.
Lil has a classic oval facial shape. She has a right (2.5mm) hyper eye. She is wearing a dark maroon business suit and is carrying a matching cordovan mini-briefcase. In addition to her law degree she has a degree in industrial engineering.
Lil specializes in representing plaintiffs in industrial injury cases. Her responses during the vision exam were precise. Her present eyewear is well cared for aside for some teeth marks near the end of the left temple. She gestures with her glasses toward the frame displays. She is a skilled racquetball player. She takes notes swiftly as you begin your lens discussion. Her facial width is 115mm and her PD is 56mm. Lil has a short upper lip, high forehead and long chin.

Thoughts & Suggestions
Lots of lens shapes and frames look good on the classic oval face. Lil may lean toward a heavy power-frame look (dramatic design), but be careful. Her facial features make her look “vertically bunched” in the center of her face. A balanced design will be the best choice. She will probably look best with a clear bridge in zyl or a very simple bridge with slightly more complex temple attachments in a metal frame. A short B measurement could help disguise the vertical bunching of Lil’s features, but it also could make her hyper eye more apparent. Because she obviously has the habit of gesturing with her eyewear, she would probably not find a drill-mount very satisfying.

Even though she can still remove her eyewear for short-term reading, suggesting a spare pair for prolonged reading would be a good idea. Lil will understand the concept of having an eyewear wardrobe to complement her clothing wardrobe if you take the time to explain it. Her low Rx will make her prone to “headlight ghosting” when she drives at night and she will understand the importance of good eye contact in communication. AR lenses will help with her appearance, communication and night driving. The good optical properties of PPG’s Trivex material with its relatively low reflectance and high-impact resistance make it a good choice for Lil.

Discussing break-resistance and special eyewear for racquetball is especially important for this patient. Ask if she ever has occasion to visit industrial plants. If so she may be interested in having her own custom-designed safety eyewear.

If the doctor did not compensate for the hyper eye when he did the muscle balance testing, you may induce unwanted vertical prism if you order unequal distance MRP heights. If the hyper eye was compensated for, then the distance MRPs should be unequal with the right 2.5mm higher. Lil is a critical observer who knows quality and wants the best technology has to offer. Do a great eyewear design for her and she will be your patient for life.
Anatomy and Eyewear Design
Rules That Are Made To Be Broken—With Caution

• The top of the front should generally follow the brows.
• The eyewear should be about as wide as the widest part of the face.
• Tightly grouped facial features generally require simple bridges.
• Wide-set features do better with more complex bridges and very simple temple attachments.
• Head tilts and head turns may require special MRP placement.
• Hyper eyes and hyper ears may require special design considerations and
special MRP placement.
• Long noses can be shortened by a low bridge.
• Short noses can be lengthened by a high bridge.
• Optimum B measurements tend to mimic facial lengths.
• The anatomic PD should be about the same or a little less than the frame PD.
• Ask for a smile. If the cheeks strongly touch the frame, you may want to

Palmer R. Cook, OD, is director of education for Diversified Ophthalmics in Cincinnati