The scene: A waiting room in an ophthalmolgist’s office. The characters: Two ladies, both in their seventies and me.

Lady Number One: I have such trouble with these glasses.
Lady Number Two: What’s wrong with them?
Lady Number One: They’re always getting twisted and I can never get them to fit properly. I’ll show you. (Takes glasses out of handbag and shows them to Lady Number Two.) See, they’re the rimless kind.
Lady Number Two: Why did you get them?
Lady Number One: Everyone was talking about how great rimless is, so I thought I should get a pair. But they’re so flimsy! See? (Puts on glasses, then takes them off, tangling right temple in her hair.) Also, my dog likes to chew on them.
Me: May I see them? (She hands me her glasses.)
Me: I see you have progressive lenses. Those lenses need to be accurately aligned with your eyes and the position in which you wear them in order for you to get the most out of them.
Lady Number One: So I would do better with a plastic frame?
Me: Yes, or a lightweight metal one like mine. (I hand her my stainless-steel frames to inspect.)
Lady Number Two: Why didn’t the optician recommend that?
Lady Number One: I don’t know. But I don’t think I’ll be getting my glasses there again.

As this true story illustrates, dispensing a three-piece mount with a PAL probably isn’t the best choice for a mature presbyope whose coordination is slipping and who treats her glasses roughly. Know enough about your patient and their lifestyle to recommend appropriate eyewear and know the limitations of the products you dispense. That’s the value you bring to the dispensing process and it can distinguish you from your competitors.
—Andrew Karp