THERE'S A HOLE IN YOUR FRAME BOARD

By Preston Fassel

Release Date: Sept 19, 2017

Expiration Date: June 27, 2019

Learning Objectives:

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

  1. Understand the problem of a part of the eyeglass wearing population, those with flatbridged noses.
  2. Learn how some manufacturers have changed the way they make frames to better meet the needs of this patient population.
  3. Know how to better merchandise and communicate the opportunity about frames for all facial shapes and needs.

Faculty/Editorial Board:

Preston Fassel Preston Fassel, is an optician in the Houston area. His interests are in the history of eyewear and all things vintage. He writes for Pro to Pro and 20/20 Magazine and has also been featured in Rue Morgue magazine, where he is a recurrent reviewer of horror and science fiction DVDs.




Credit Statement:

This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Technical Level 1 Course SWJHI012

Ever think about what was missing from your inventory of available frames that would meet every demographic to which you might sell? As it turns out, the majority of frames are made for an average range of nose shapes and head sizes. That makes sense if you’re a frame manufacturer and want to have your frames appeal to and fit the most number of wearers possible. However, there’s a hole in your frame board when it comes to patients with very flat bridges.

GUY WALKS INTO AN OPTICIAN’S OFFICE…

Question: An Asian/African-American/small nose, flat bridge patient comes into your office to buy a new pair of glasses. He or she chooses a set of frames, you discuss lens options, and they leave. They come back a week later to pick them up. When the patient leaves, where do the glasses sit? Now, your knee-jerk, “I know this one” answer is probably “On their nose,” but ask yourself: Do they really?

A FRAME FOR ALL FACES?

For the past several years, zyl frames have dominated the market, and everyone has been eager to get in on the trend and keep up with the times. However, there’s no denying that until very recently, the majority of frames were designed with a particular facial topography in mind, one that excludes large parts of the U.S. population—and your patients.

While for most of the 20th century, Italy, France and America were the heart of the frame design world, it’s logical that manufac- turers considered the face types and shapes of those who made up the majority of those respective country’s populations, taking into account only those ethnicities with prominent nose bridges and missed the Asian and African-American portions of the population. The result was often a choice of frames with adjustable nosepads or a poorly fitting acetate frame.

Though it has long been an accepted ste- reotype that Asians and African-Americans tend to have flat bridges, a 2013 study conducted by the department of ortho- dontics at the University of Iowa found a link between the size of the maxillary sinus and the size of the nose, with the average African-American demonstrating 36 percent smaller sinuses than individuals of Western European descent. The study suggested that this sinus size would have been an evolutionary advantage to older populations living in a climate with high heat and humidity, but it isn’t exactly helpful when eyeglass design has long been the domain of Western European and Mediterranean culture.

As a result, for years, Asians, African- Americans—and opticians—have simply compensated by selecting frames that fit “pretty good,” often resulting in the patient having frames that fit poorly, were uncomfortable and didn’t afford the highest quality of vision. More often than not, patients’ plastic frames would rest on their cheeks or nostrils, requiring extreme panto in order to stay on the face. The result was a sort of social hierarchy of optical fashion: Disregarding specialty made frames or periods of time when metal frames were in style, patients with flatter or non-existent bridges were essentially relegated to a lower rung of the ladder, walking around with constant reminders on their faces that they were not a part of the norm. While patients with prominent bridges were able to cultivate an image in which every part of their wardrobe fit correctly and sent a message of well-dressed confidence, African- American and Asian eyeglass wearers were forced to compensate. It’s telling that two of the 20th century’s most iconic African-American glasses wearers, Malcolm X and Rosa Parks, both wore glasses with nosepads; and that another opti-icon, Ray Charles, purchased high- end zyl frames that more readily suited his facial structure (and even then, they didn’t always fit him properly)!

THE UNIVERSAL FRAME

In today’s more socially conscious world though, that no longer needs to be the case, and many frame designers are now offering alternatives that will allow your patients to keep up with modern trends while maintaining a high quality of comfort and vision.

If you had asked a wise old optician in years past what frames to fit for an Asian or African-American patient, the answer would probably be “metal.” After all, metal frames offer adjustable nosepads that can be tweaked to comfortably fit any type of nose, and which can be easily adjusted to push the frames away from prominent cheeks. Rimless glasses also offer the same options, while remaining lightweight and dainty for more sensitive patients. But what happens when you’ve got a patient with a -9.00 Rx? One with a nickel allergy who can’t afford titanium frames? What about that situation where the patient simply cannot and does not want to wear metal?

Thankfully, today, several manufacturers offer what is called a universal fit or Asia fit bridge. This is a unique type of zyl frame that has a much more prominent, “built up” bridge on the back of the frames which slightly protrudes backwards from the eyewire and serves to compensate for a flatter bridge by creating one of its own. Nosepads are also splayed out further. The good news is that this allows for African-American and Asian patients to be able to wear zyl frames comfortably; however, it also means learning a unique fitting paradigm.

FRAME WARS, EPISODE IV: A NEW FIT

In a traditional zyl frame, the bridge will fit comfortably around the patient’s bridge, with the inner edges sitting flush with the patient’s nose. This serves to evenly distrib- ute the weight of the frame across the nose and allows for the highest level of comfort. Considerations, of course, must be made for the depth of the frame (patients with rounder faces or more prominent cheeks will not fare so well with deeper B mea- surements that will strike their cheeks when they speak or smile).

In a universal fit bridge, you’ll be apply- ing a similar principal, though the frame will be doing part of the work for you in “creating” a bridge on the patient’s nose. What you’ll primarily be looking for is whether the extra zyl on the back of the frame conforms comfortably to the space around the wearer’s cheeks and nostrils. You’ll also want to make sure that the eyewire sits far enough away from your patient’s cheeks that they aren’t bumped when he or she smiles (that may require the ability to add some retroscopic tilt), and that they aren’t resting there in the same way they would if the patient were wearing a non-universal fit frame.

You’ll also want to make sure that the frames fit on either side of the head; especially with frames that have temples which are thicker near the front and taper toward the ear, frames that set too closely to the face may splay outwards or other- wise be uncomfortable for the patient. It’s easy to hand an Asia fit frame to a patient with a flat bridge and consider the dis- pense a success. Just because it fits the nose doesn’t mean it fits everywhere else. Check, too, for the right panto; just because the frame has compensated for your patient’s bridge, universal fit frames make no “self adjustments” for panto- scopic tilt, and you may have to tweak the angle of the hinge so that the eyewire is moved away from the patient’s cheeks. Remember, though, that this will also move the bridge forward, potentially affecting fit on the nose.

If this sounds frustrating, don’t worry. Many opticians are inexperienced with universal fit bridges, owing both to their newness on the market and to many prac- tice’s lower volume of patients with flatter bridges. A lot of getting used to working with them will be a matter of time and experience. If you have long-time, loyal patients with flatter bridges, you might even ask if they’d be willing to help you experiment with fit and adjustment for universal fit frames, perhaps in exchange for a reduced cost on their next set of frames or some other “goody.” It’ll help you get experience and also demonstrate to your patients that you’re aware of their unique eyewear needs.

HOW MUCH STOCK SHOULD A FRAME STORE KEEP?

The question now arises, of course: How many universal fit frames do you need?

Much of the answer to this question will rely on your own unique patient demo- graphics. If you live in an area with a very high population of African-American and/or Asian patients, and they tend to be younger, trendier and more inclined to want to wear zyl frames, it may be worth considering making a sizable percentage of your stock universal fit frames. You may want to invest in some contemporary fashion magazines geared toward your target demographic to see if what’s cur- rently trendy in mainstream culture is also desirable among their community. You might be pleasantly surprised to learn that particular fashion trends are differ- ent and may even see some future trends in the making. (The currently fashionable “monobrow,” for example, started its latest iteration as a fashion trend amongst the African-American community).

Be careful, though, about making assumptions about your patients. Even if a sizable portion of your business comes from African-American and/or Asian patients, they may not necessarily be of the social demographic that wants to be trendy, fashion forward and “hip.” More conservative or older patients may well be very happy with metal frames, and gearing too much of your stock toward younger, trendier patients may alienate them. Again, it’s all a matter of knowing your patient base.

COLOR ME PINK…
AND RED… AND GREEN…

When selecting your new universal fit frames, remember that you’re working with a whole new schema in terms of color palettes. While you may have con- sidered different complexions in the past when it comes to helping patients select zyl frames, this may be a good opportunity to reconsider what you hold as basic knowledge in terms of what colors look good with what skin tones. African-Amer- icans, for example, can generally wear a wider variety of colors and still be flat- tered—remember, contrast is pleasing to the eye. I generally prefer to avoid frames that match skin tone too closely and appear to “blend in,” which creates a cosmetically unappealing effect when viewed from a distance.

Asian patients, similarly, are flattered by a wide range of colors, though I generally avoid pastels, frames with very heavy yellow undertones and lighter browns. When selecting neutral colored frames, go for stark blacks and darker tortoise frames, avoiding lighter tortoise and grays.

WHAT’S YOUR SOURCE?

If you don’t already carry universal fit frames, you’ll want to do some research into what frame manufacturers currently have the style available and what demo- graphic they lean toward. Not every uni- versal fit frame is meant for every patient. Does your demographic want frames that make them look retro, trendy and haute couture? Ask your reps if they have any universal fit frames, and if so, what lines they’re available in. Review Oakley, TC Charton as well as others for the opportuni- ty within your practice. As time goes on, more and more manufacturers will probably begin offering them in a wider variety. Generally speaking, most manufacturers’ universal fit offerings are on par with the rest of their frames, so use that as a general guideline to their price and quality.

START KIDDING AROUND

Although we’ve largely discussed the benefits of universal fit frames for par- ticular segments of the population, there’s yet another demographic to con- sider: children. Many children will have flatter bridges that begin to develop as they age before reaching full protuberance in adolescence and puberty. Many, many (many!) parents want their children to wear plastic frames, both for style pur- poses and also because many kids are prone to breaking the nosepads off of their metal glasses. Here, the universal fit can be a potential blessing. The one issue here, of course, is that many universal fit frames are geared toward adults—with a disproportionate number being designed for women. (Seems to me that many frame manufacturers still hold to the out- dated maxim that “men don’t care what they look like.”) Because of children’s proportionately smaller heads, you may find that universal fit frames are too big for them overall—or that while the “A” may be appropriate, and the hinge-to- hinge width is fine, the temples may be far too long to curve appropriately. If you have a high percentage of child patients with flat bridges and parents wary of zyl frames, it may be worth looking into if any of your universal fit suppliers offer frames in smaller eyesizes and shorter temples. It’ll open up a whole new range of possibilities in terms of sales and parent satisfaction.

MEASUREMENTS: ANYTHING DIFFERENT?

Fitting the frame that also fits flatter changes the effective power of the lens. Lenses, in the absence of position of wear measurements, are designed for average fitting, i.e., 13.5 mm vertex, 9 degrees of tilt and 7 degrees of wrap. That’s true for finished stock lenses and directs the base curve chosen by the lab. Now what if the prescription is high minus or high plus? The result is a lens whose effective power is different from what was prescribed; and that is especially true in the periphery. As a result, fitting flatter eyewear and including position of wear measurements is an opportunity for excellence in vision.

The higher prescription myope has, because of edge thickness and the higher prescription hyperope, and because of center thickness and back lens surface flatness requires special attention when adjusting. Here, a judicious use of choice of lens size and shape plus the use of high index materials and aspheric lens designs can really help.

Is there anything special that the lab should know when you are ordering the glasses? If you do your own edging, then you probably have thought of the size and shape issues because you’ve become sensi- tive to the visibility of thickness and lens fit while creating eyewear. For your lab, discuss the order and the intended final shape of the frame front. They might rec- ommend a different lens bevel position or use of another lens design to help manage overall lens weight and shape.

DISPENSING FOR SUCCESS

Adjusting flatter fitting frames, if you haven’t used a universal fit bridge, can be challenging. As a result, first choosing the right bridge style up front and then describing what a good choice the patient made creates a memorable experience for the patient. It adds to the success of the pair of glasses.

A word of caution finally about those frames with very wide temples and/or those with more than a three-barrel hinge: For frames that need to be fit flatter and with less pantoscopic tilt—unless the patient’s ears are lower also, the frame may have too much pantoscopic tilt. And if you thought that you would adjust the frame once back from the lab, you’ll find that wide temple and many barreled hinges don’t allow much panto adjustment. That means you must choose the right frame right from the start. So choose wisely, and choose the vendors that provide your patients the right choices.

CONCLUSION

Though we tend to focus on advancements being made in lens technology, the intro- duction and popularization of the universal fit bridge represents a tremendous move forward in frame design. For the first time in the history of optics, patients with small, flat or non-existent nose bridges have wide-ranging access to frames that look, fit and feel good while also offering superior vision. Armed with the knowl- edge on how and when to fit a universal bridge, you can differentiate yourself from the competition by demonstrating your awareness of and concern for a unique issue faced by a large number of patients—as well as your ability to prop- erly address it.