By Barry Santini

A fully rounded optician must wear many hats including optical scientist, frame-fitting phrenologist, fashion stylist, business strategist, cosmetician, politician and at times, even consulting psychologist. Mastery of these roles requires a deep and varied skill set.

On social media, there’s constant debate about exactly which skill sets matter most. Is it the hard type—such as optical scientist—which is typically taught by schools and tested for by the major certification bodies? Or is it the soft skills—those rarely taught in a structured school environment and are perhaps more organic in nature, like fashion stylist—that matter most?

Most eyecare professionals intuitively know which generally brings home the bacon, at least over the near term—the soft skills are the ones that create and sustain patient trust. But the optician who demonstrates a fully rounded knowledge of soft and hard skills has a very particular long-term value—one I might describe as near priceless. And nowhere else is this value clearer than when called upon to handle problems with someone’s glasses. The new challenge opticians face today is that those glasses were probably not purchased in your shop.

PUNCHING BACK ON DISRUPTION
The eyewear industry is certainly not immune to the disruptive changes brought by online. It is no longer the exclusive optical marketplace that transacted exam and eyewear sale in serial fashion in the same space. Today, the business of eyewear is rapidly evolving into a multi-layer, multi-channel delivery system. My friend and webmaster, Charlene Nichols, never stops reminding me that manufacturers and brand holders will continue to pivot their business models away from an exclusively B2B/wholesale channel, to also include an additional B2C/direct-to-consumer path. In reality, Charlene says, this is just one aspect of a greater transition to the new, expanding metaverse—a multi-channel virtual market driven solely by the consumer. But doesn’t this B2C pivot appear to place our B2B channel in direct competition for the same consumer? Appearances may be deceiving, and that what appears to be a conflict interest is actually the best opportunity for brick-and-mortar optical to finally differentiate their intrinsic value to the eyewear consumer. Only through the intimacy of a face-to-face encounter can eyewear consumer and optician fulfill their shared desire for a trustful long-term relationship. While online offers at-home and virtual try-on (VTO), with endless frame selection with powerful brand stories—things that sure look like they’ll fill every consumer’s optical desire—the reality is that online eyewear will eventually need the face-to-face service and problem-solving expertise of a skilled optician. So, no matter which channel a buyer buys their eyewear from, now or in the future, they’ll eventually need to have them adjusted, repaired and troubleshot to restore both clarity and comfort to their liking. And that’s where the local optician—armed with manifold skills and their proprietary punch list for problem solving—comes in: “We are here to help.”

THE SKILL SET OF A MASTER PUNCH LISTER
A carefully structured approach to solving eyewear problems is the most important skill opticians can possess in the new metaverse optical world. With buyers coming at you from every type of channel, let’s take a look at what is essential to the toolbox of a 21st century optician:

  1. Knowledge of Ophthalmic Optics, including:
    • Basic ophthalmic lens design, including corrective curve theory, image shell matching to far point sphere and its relationship to position of wear.
    • An encyclopedic understanding of progressive design, including corridor design, length and placement, along with the various aberration weighting disciplines.
    • A master-level understanding of ANSI standards and the various tools, instruments and metrics used to assess and guarantee accurate readings of all parameters.
  2. Knowledge of Binocular Vision
    • How to assess eye dominance and its role in evaluating the impact of prescription changes.
    • A working knowledge of managing anisometropia, iseikonia, prism and compound prism at all points in a pair of glasses.
    • Knowledge of exactly how to “do no harm” when designing a pair of glasses for optimal binocularity.
  3. Knowledge of the Refraction
    • Understanding of the straddling nature of subjective choices, with special emphasis on how the patient is always being asked to discern the ever finer differences of blur.
    • The nature of examiner experience and discretion, and how this can impact the prescribed Rx.
    • Knowledge of how common eye conditions such as glaucoma, cataract, diabetes and dry eye can affect the nature and fluidity of the subjective visual experience.
  4. Knowledge of Diagnostics
    • Learn how to differentiate between the different kinds of lens surface issues and the various causes of coating failure.
    • Master the methodology needed to accurately neutralize an unknown lens, even if that lens surface is significantly degraded.
    • Know how to assess the fitting height of a pair of lenses, including intuiting the difference between the intent of the fitter, the error of the lab and the preference of the wearer.
  5. Knowledge of Frame Fitting
    • What constitutes an ideal bridge fit.
    • What to do when the chosen frame does not fit:
    • Modifying the bridge and pads.
    • Modifying the temple...including length and bend.
    • Knowing how to tailor any frame’s fit to the wearer’s preference.

MOVE FORWARD BY STEPPING BACK
The best way to begin to address a wearer’s problems with a pair of glasses is to take a step back: Even if your shop was the fabricator, and especially if you yourself were the person who performed the job’s final inspection, you must never assume all the work behind the scenes was correct. Get this first step wrong at your extreme peril. Anyone can make or miss a mistake. Only the best knows the importance of catching it early and being fully transparent about it. Begin by assuming there really is an issue to be uncovered and corrected. Next, listen to all the complaints while simultaneously looking at the glasses and how they’re being handled and worn. Remember: Human vision is dilemmatic in nature, being extremely attentive to change while also adaptable to it. The eye is alert to any novel change in the environment, while quickly adjusting to this change through adaptation. Therefore, asking a wearer to “get used to” a new pair of glasses can fix the problem while simultaneously obscuring the best solution. So always leave the door open to patients to return with problems. But instead of the well worn shop phrase, “If you have any problems” after delivery of the new glasses, try “If you need any attention with fit or vision.” The difference words make really does matter.

ALWAYS LEARNING
I’ve always maintained that you learn nothing from a client who never comes back between initial delivery and their next Rx change. Your first job is to assess the problem by gathering information, and then to sort what’s important by triaging the causes behind the complaint. Next, you create a hierarchal action plan—or punch list—by matching the most significant important complaints to the simplest solution.

STOP
First, never dismiss a patient with problem with a wave of your hand, or the throwaway line “you’ll get used to it.” Very few problems reside only in the wearer’s mind. But be careful: By suggesting adaptation as the solution, you may get your wish, and the wearer will adapt. But that doesn’t fix the problem—it just reduces or removes the complaint.

LOOK
When an eyewear client sits down in front of you looking for assistance, observe their glasses. Consider if they are tilted, skewed or out of balance. Ensure the nosepads are flush fitting and have symmetrical spacing. Take the frame and check all the screws for tightness. Next, ask them to try on the eyewear. Learn how to assess if the overall tension is proper through observation first. Then go on to check that both sides are clamping toward the temples and properly taught front to rear. Ask the client to try on the frames again and look for what appears too loose, tight or imbalanced. Ask for their preference in fitting by giving them a choice of “tight, medium or loose.” Then readjust their frame and reassess.

LISTEN
The old and sage business advice goes: “Listen to your customers. They’ll tell you how to run your business.” And the same approach is fundamental to getting clients back to satisfaction with their eyewear. Here’s a small sampling of what you’ll encounter:

These frames are always stretching out.”
Opticians hear this often, and there can be many reasons behind this issue. Frame quality, patient handling… even how the lenses were beveled, sized and inserted can all contribute to the causes of this complaint.

 

“I’m finding I have to move my head around a lot to read with my progressives.”
You should suspect frame alignment and position, for sure. But if the present Rx is at or near the two-year mark, their reading add may no longer be appropriate. With complaints indicating excessive head movement, you should also recheck the progressive height. If all checks out, then the patient should be advised to seek a new exam as soon as possible.

“I’m having a lot of glare at night.”
This is a commonly heard complaint, no doubt compounded by the newer LED headlights. First, check their eyeglass lenses for cleanliness. If the patient also complains they can’t keep their lenses clean, remove the lenses from the frame, clean their edges and clean around the lens bevel and inside the frame eye wire. Thoroughly clean the full lens surface, use a good lens polish and review them under an inspection lamp. Look for a crazed or defective AR surface. Crazed coatings may have been caused by exposure to excessive heat, so be sure to advise not to leave the glasses in the car during the hot days of summer.

“My eyes feel strained at the end of a day”
There can be many reasons underlying this complaint. But I feel amongst most common suspects to keep in mind is eye rivalry related to accommodative imbalance. When two eyes are not functioning as a team, the result can be all sorts of binocular problems. Therefore, you must be ever alert to symptoms observed after very small prescription changes, such as a monocular change in sphere or cylinder of 0.25D. On paper, the arithmetic Rx difference appears small or negligible. But in real life, minute changes like these can be insidiously impactful in both good and bad ways. Bottom line: You often have to sweat the small stuff to get your client back to 20/Happy.

STOP SETTLING FOR A 6 MM SOLUTION
When a patient returns with vision complaints, the first thing done is to reverify the Rx. When this is completed, the optician returns and states that the glasses are “correct.” But are they really? They may appear correct in the 6 mm area limited by the lens stop, but what about the area outside this verification point? Every optician must learn how to pass a lens in front of their eye to discern if there are unwanted irregularities or waves present. Routinely, this procedure should be done at initial lens or glasses check-in from the lab, but this optical check is often overlooked or neglected. Even if the optician sees no waves, it is still inconclusive because the next step must be completed first: Try the glasses on.

TRY THEM ON
Sometimes people present problems that are complex in nature, requiring the optician to spend a bit of time sorting it all out. One of the best resources to turn to can be their old glasses, including the pairs that work as well as the ones that don’t. Make your approach methodical, noting and recording information from the glasses and asking questions about each with the wearer. Sometimes, after assessing all the data, you might feel that some information remains missing regarding why some glasses are good and others not so good. At these junctures, I will ask the owner if I may try on their various glasses. Sure, your vision may be blurry—after all, they’re not your glasses! But what I have found is that despite the blurred view, I can often see firsthand the differences between pairs. Using this try-on technique, I have discovered all sorts of important stuff and noted potential suspects ranging from uncorrected astigmatism to the image-degrading effects of low abbe/lateral color error, to information on where to refit/move their progressives. There’s so much to be learned using this simple hands-on approach, that I often wonder why it’s not taught or discussed in any school curriculum.

CAN YOU HELP THE ONLINE BUYER?
In a word: Sometimes. But first notice that I didn’t ask should you help the online buyer—I asked if you would. The question of “should” is a business/political one and really has no skin in the game of professional opticianry, in my humble opinion. I know that many B2C eyewear vendors have created their own punch list for remote diagnostics to helping their prescription customers troubleshoot issues with their eyewear. Whether these customers will continue to buy future Rx pairs online depends on whether that business has found a way to partner with a local optical access point.

And that’s where you come in: With the ever expanding eyewear market being driven by online purchases, why not consider opening your doors to welcome all buyers in need who are searching for professional help? If you help them solve their problems today, you have effectively moved your business as a purchasing choice for their next pair, right alongside the other online choices. Whether or not you decide to charge a service fee and how much is your choice. But to best leverage the opportunity to develop a trustful relationship and a long-term customer, which is the ultimate transactional currency, you are cautioned to choose wisely.

A UNIVERSE OF OPPORTUNITY
The art of making an eyewear owner happy is quickly understanding what your short and long-term goals are. For patrons buying eyewear in your shop, only the highest standards should apply and enhancing every aspect of their total eyewear experience should be your overarching goal. For consumers seeking help off the street, the more situations you tackle, the more experience you gain, and the faster and more efficiently you can get anyone’s problems fixed and back to 20/Happy.

But don’t forget that no matter where people buy their eyewear—from your store, to down the street, to online—each and every pair is eventually going to need alignment, tweaking, troubleshooting and repairing. While most owners will naturally resist traveling to get a quick adjustment or screw replaced, many will seek out and pay for competent skill and care nearby, when they see it. For every business, this means there’s a universe of opportunity to introduce yourself to potential customers—whether they have a new Rx in hand or not. But you should prepare by first having three things: 1. The full skill set of a well-rounded optician, 2. A methodological, punch list-like approach to problem solving, and 3. Work in a business that appreciates the value of helping every eyewear consumer in need. If you can manage to position yourself in this way, you will become that rare optician who writes their own meal ticket.

PUNCHING THEM BACK TO 20/HAPPY

What follows is a cautionary tale, one that reveals how the Rx you’re given, together with an unusual Rx compensation and unfavorable ANSI tolerancing, can conspire to keep a pair of glasses from delivering that all important satisfaction metric called 20/Happy. (For an in-depth discussion of the 20/Happy concept, read “The New 20/Happy, Optimizing the Separate and Unequal Aspects of Binocular Vision,” a two-part series in the March and April 2022 issues of 20/20.) The logical flow of the detective work is a perfect how-to example of using a punch list to solve an eyewear issue.

HISTORY
The patient is a 72-year-old post-cataract senior. They have been using +2.50 OTC readers without “apparent complaint” for the last year or so. Patient says they have no DV Rx after surgery, declaring “they see fine.” But now they desire to purchase a pair of brand name/authentic prescription progressive sunglasses, in a wrap sport frame style. They deposit the following current Rx on my desk: OD +0.50 -1.00 x 90
OS +0.50 -1.00 x 90
Add OU: +3.00

RX ANALYSIS
“Wow,” I think to myself. That’s a bit of distance Rx to have post-op and feel “they see fine.” But I quickly realize that the above Rx reduces to a plano spherical equivalent—so no harm, no foul. Makes sense. But that +3.00 Add does not make sense—especially if we’re to believe they’re happy with +2.50 OTCs. So I decide to second guess the prescribed add power and reduce it to +2.75. I do this in view of the fact that the frame chosen is a sport style with a healthy frame wrap angle of 25.5 degrees, and that both steep wrap angles and high add powers can act in combination to reduce the utility of the progressive reading area.

RECEIPT AND VERIFICATION OF NEW SUNGLASSES
The new sunglasses arrive in 10 days, with the following compensated Rx attached for verification purposes:
OD +0.64 -0.96 x 86
OS +0.64 -0.97 x 93
Add OU: +2.38

I find, however, the glasses end up neutralizing at these distance powers:

OD +0.74 -1.01 x 87
OS +0.74 -1.02 x 92

I verify the above power on both my trusted automatic Huvitz lens meter and a manual Topcon lens meter. Conclusion: Yes, they are “within” ANSI tolerance for sphere, cylinder and axis. But I don’t like where the final sphere power is falling—namely, to the “plus” side of the power tolerance. (We’ll uncover why I feel this way later in the story.)

DELIVERY OF NEW GLASSES
Patient comes to pick up glasses and is very excited: They had bought into the whole brand-performance aspect of these authentic lenses and were looking forward to getting their glare and reading issues addressed. They put them on, test the distance and reading vision, and pronounce them “terrific.”

They return a week later, now no longer 20/Happy. The distance vision is slightly blurred and reading requires them to look “too far down” into the progressive zone to see clearly. I verify the fitting height is correct and not too high or low. I also recheck the engraved add power. I then go to my handy Rx flippers to perform some over-glasses diagnostics. The following quickly becomes clear:

  1. The Distance Rx benefits from the addition of -0.25D to achieve clarity.
  2. The Reading Rx benefits from the addition of +0.50D to achieve clarity and comfort.

I subsequently trial frame the original distance and reading prescriptions, separately from the glasses. This takes the glasses out of the equation of what’s been fitted and dispensed. I discover that the distance is fine when the sphere power is +0.50, but not +0.25D more. The Reading Rx alone tests out to the prescribed +3.00 add (Sorry doc, for doubting this).

THE GLASSES ARE REDONE
I decide to return the glasses and order the following Rx based on my experience with the flippers:
OD +0.25 -1.00 x 90
OS +0.25 -1.00 x 90
Add OU: +3.25

The redone glasses arrive 10 days later with the following compensated values:
OD +0.35 -0.96 x 86
OS +0.35 -0.87 x 93
Add OU: +2.86

Neutralization reveals the following found distance power values:
OD +0.54 -1.01 x 87
OS +0.55 -0.89 x 93

I decide these values are what I was targeting and call the patient in to try the redone glasses. (Note: I rarely use my lens meters to verify the received add power. For this parameter, I will take the “manufacturer’s word for it,” unless there are strong reasons present to doubt the received add power values)

Result? The patient achieved clarity for both distance and reading.

GETTING EVERYONE TO 20/HAPPY
Any good prescription is the result of careful objective and subjective testing, mixed with a review of the patient’s visual history and the experience, expertise and discretion of the examiner. There is no doubt that the original Rx was a terrific Rx for overall use—but was also one that bordered on being a bit too much plus for use in a darkly tinted sunglass intended for outdoor distances much further away than the normal testing distance of 20 feet. When the slightly too strong original sphere powers collided with a compensated Rx that additionally went to the plus side of a plano spherical equivalent, and the glasses arrived with a fabricated sphere power that—although within ANSI tolerance—moved the spherical equivalent out of this wearer’s sweet spot for a pair of glasses intended for long distance vision.

Could this redo have been avoided? Perhaps. And perhaps not. Even though the patient initially revealed that they see distance fine without glasses and read fine with +2.50 OTC readers, it’s clear there was more to their actual state of vision than their anecdotal “20/Happy” summary.

My Rx recommendations for sunglasses:

  1. Prescribers should ensure that an Rx meant for sunglasses Rx is never to the plus side of 20/Happy because sunglasses are not used indoors. An Rx biased to the plus side of distance clarity would be a fine overall Rx for all activities except long distance, outdoor use.
  2. Although compensated Rx values should fall where they are calculated, the fabricated RX should never be allowed to tolerance in the same direction as the compensated sphere values when compared to the ordered Rx.

Are all these suggestions workable in the real world? Probably not. But it does make a strong case that the value of a trained optician is nowhere more apparent than when they help someone find their version of 20/Happy.

–BS


Contributing editor Barry Santini is a New York State licensed optician and contact lens fitter with Long Island Opticians in Seaford, N.Y.