Basic Dispensing Optics

Mohammad Salah Uddin

[Link]; MPH
Definition

An Optical Dispensing is subspecialty

of optometry of which includes all
procedures from the time the spectacle
prescription is presented to the
optician till the patients are on with the
pair the glasses satisfactorily
Frame Style and Cosmetic Dispensing
Frame selection is often a process of trial and
error can be time consuming
Proper assistance in frame selection is
especially important for the type of patient
who may be inclined to accept the first frame
presented
The best frame for a patient complements his
or her facial structure, requires minimal
adjustments and will securely hold the lenses
in place.
Frame Selection
Follow these steps to choose a best stylish
eyeglass frames
Determining Facial wrap
Broadly, there are six face shapes that we
observe around the world –
 Oval
 Round
 Square
 Rectangle
 Triangular
 Heart
Frame for Oval Face Shape
Oval face shape is the most common face
shape and is considered as an ideal one.
We recommend oversized or rectangular
frames
Frame for Round Face Shape
Round faces are usually proportional to width
and length that features full cheeks and a
broad forehead
We recommended rectangular or angular
frames for round face shaped persons.
Frame for Square Face Shape
Square faces are characterized by a broad
squares forehead and a strong jaw line.
we recommended Round or Oval shaped
frame.
Frame for Rectangle Face Shape
Rectangle faces are regarded as the elongated
proportion that means a longer, narrower face
and nose, along with the same strong jaw line
and squares forehead.
We recommended round or cat eye shaped
frame.
Frame for Triangular face Shape
Triangle face have a narrow forehead, but
wider cheek
These faces look the best in top heavy styles
which help balance out the jaw.
Frame for Heart Face Shape
Heart shaped faces have a broad forehead
and narrow jaw line or small chin.
We recommended deep vertical frame shaped
frame.
Frame Measurement
Datum System
Boxing System
Datum System
Previously used system for measuring lenses
was established as a system of reference point
for the frames and lenses so that position of
lens optical centers & bifocal segment heights
would be consistent.
Boxing System
In 1962 the optical manufacturers association
adopted the boxing system to provide a
standard for frame and lens measurement
that greatly improved upon the accuracy of
previous systems.
The boxing system is based upon the idea of
drawing an imaginary box around a lens
shape with the box’s sides tangent to the
outer most edges of the shape.
Frame Measurement Guide
“A” Measurement
It is measured as the horizontal distance
between the furthest temporal and nasal
edges lens shape of the box
This is measured in millimeters.
“B” Measurement
It is measured as the vertical distance
between the furthest top and bottom edges
lens shape of the box
Parameters of Box
Frame difference
Datum line
Geometric center
Distance between lens
Distance between centers
Effective Diameter
Segment height
Segment drop
Pre Dispensing Measurement
Facial wrap
Pantoscopic tilt
Vertex distance
IPD Measurement
 PD Ruler
 Pupillometer
 Pen torch
Facial Wrap – Facial
wrap the frame fills
properly following the
curved line of the face.
Pantoscopic Tilt –
Pantoscopic tilt is the
angle between the
normal to the temple
and frame front.
Vertex Distance –
Vertex distance is the
distance between the
front of the cornea and
back of the lens.
PD Measurement Devices
PD ruler
Pupillometer
Pen torch & marker
PD Ruler Method
Sit directly opposite the patient ( arm’s length)
Position yourself 40 cm in front of the patient.
Eyes are level
Place ruler on the bridge of the patient’s nose
Hold pen torch under your left eye directed at
the patient’s Right Eye.
The dispenser aligns the zero mark of the demo
lens with the center of the patient’s pupil.
The PD for distance is read as the mark fallng
on the left pupil.
The Pupillometer Method
Fast and accurate measurement for
monocular and binocular PD’s
The variation between the visual axes and
pupil center
Pupillometer - Procedure
Hold the instrument in both hands and rest
the pupillometer on patients face.
Ability to vary working distance from 20 cm
to infinity
Internal hairline moved until line and corneal
reflection are coincident
Corneal reflection typically located nasal to
pupl center (2 to 5 )
Direct Pupillary Reflex Marking
A pen torch will produce clear corneal
reflections
Position yourself 40 cm in front of the
patient.
Eyes are level
Hold a pen light under your left eye, aiming
the light at the patient’s eye.
Mark the patient corneal reflex in marker.
Layout Card Measurement
Measure monocular PD. The recommended
procedure is the use of a pupillometer.
Incorrect PD may cause difficulty in using
different zones through the lens.
Counselling
Lens materials
 Glass
 Plastic
 Hi-index etc.
Lens Design
 Single vision
 Bifocal
 Executive
 Progressive etc.
Counselling
Lens Coating
 ARC
 SRC
 UV or Polarized
Photochromatic
Tinted lens
Lens Material
Traditionally, people used to prefer glass
lenses. But they have become less popular now
due to the danger of breaking. They are also
heavier in weight than alternatives. These
days, CR-39 plastic lenses are the preferred
material for spectacle lenses.

It is safer, cost effective and offers an

outstanding optical quality. Some people would
be satisfied with just that a chip good quality
lens which can correct vision
Lens Materials
People become more aware, they’ve started
realizing there is more to it than it appears.
Like UV protection, even lighter weight.
Lens Coating
Every good lens has 3-4 coatings
Each of a microscopic thickness.
Most common of coatings is for toughening
the lenses to make it break-resistant.
Then UV protection coating and scratch
resistant
Lastly, there is the anti-reflective coating –
Primarily helps in reducing the effect of
reflective light from bright objects such
lamps or car headlights at night.
UV Protection and Polarized Lens
This is one of the major deciding factors. UV
exposure has been clinically proven to be an
important cause of cataract because of its
oxidative effects on humans.
Photochromatic
A major breakthrough in the area of
absorptive lenses took place in 1964 with the
invention of corning’s photo gray photo
chromatic.
These lenses darken when exposed to light
Photochromatic are available in both glass
and plastic material.
The chemical component used in
photochromatic properties is silver halide.
Tinted Lenses
A tint is usually associated with a certain
quantity and depth of color, the depth of color
is described as density of lens.
Both glass and plastic lenses can be tinted to
achieve the desired color.
Ophthalmic lens fitting
Laying off
Before a lens is edged it must be marked so
that cylinder axis if any is set according to
prescription and its optical center is in
correct position relative to lens shape.
We use a Lensometer to mark three dots
indication optical center position and the
horizontal meridian.
This horizontally placed dots are used to set
the lens on correct axis.
In case of bifocals and trifocal, trifocals the
three dots should be parallel to top of the
segment.
Lens Cutting
Once the lens is layed off it must now be cut
into desired shape.
Edging Formers
Shanking tongs were then used to crumble
the edge away until it roughly resembles eye
shape
Lens Edging Formers
Flat edge
Bevel edge
Mini bevel edge
Grooved edge
Flat Edge
This is the simple form of edge.
It is mainly used for lenses fitted to rimless
mounts or as an intermediate stage in the
production of other edge forms.
Bevel Edge
The bevel edge is used for lenses to be fitted
in shall and full rimmed frames.
To avoid pressure on the peak of bevel and
attendant risk of chipping the lens.
Mini Bevel
The peak of a
normal bevel lies
approximately
midway between
the two surfaces
with strong minus
lenses and high
cylindrical power.
Grooved Edge
It is simply a flat edge with central groove.
Used mainly on lenses fitted to spectacles of
the nylon supras or semi rimless types.
Hand Edger
A hand edger is still indispensable piece of
equipment although new automatic are being
preferred. For starting ensure that the hand
edging machine in good working condition. It
should be set up with adequate water. Hold
the lens is both hands with convex side up.
Rest your hands on the dip tray and press the
lens against the revolving diamond wheel.
Make sure to hold the lens across the wheel
and at a slight upward angle. Now slowly
rotate the lens passing the grip of lens from
hand to hand.
Hand Edger
After edging match size of edged lens with
the frame. The lens is right when the shape is
exactly like that of the frame to be fitted.
Transpositi
on
Transposition
Definition: An application of changing
the lens form one to another. Usually it is
changed from ‘+’ form to ‘-‘ form.
Types
There are two types of transposition –
Simple Transposition – Applies to convert
the lens into different forms. and
Toric Transposition – Is applied only for
selecting the appropriate tools in
cylindrical lens surfacing. Different steps
followed in calculating the surfacing tools.
 Why we do the simple transposition?

Usually we change the lens ‘+’ form to ‘-‘.

To reduce the unwanted central thickness.
Minimize the peripheral aberration.
Light weight
Easy adaptation.
 Simple Transposition – Rules
Algebraic summation of sphere and
cylinder is a new sphere.
Cylindrical power is old one but
Sign and axis of cylinder will be in
opposite.
Example:
+2.50DS/+3.00DC@150*
a) +5.50DS
b) 3.00DC
c) – Cyl & 60*
Final Rx : +5.50DS/-3.00DC@60*.
Few Examples
-1.50DS/-4.00DC@105*
Ans: -5.50DS/+4.00DC@15*
+2.00DC@90*
Ans: +2.00DS/-2.00DC@180*
-1.50DS/+4.00DC@120*
Ans: +2.50DS/-4.00DC@30*.
 Toric Transposition
Objectives: To select the proper tools in cylindrical
lens
surfacing.
Rules
- Choose the base curve first for proper curvature
- Do simple transposition if sign of base curve &
cylinder not same.
- To find out the spherical surface power –
- Subtract the base curve from sphere
- To find out the cylindrical surface power –
- Fix the base curve at the right angle to the axis of the
cylinder
- Add the base curve with cylinder
- Both the spherical & cylindrical surface power
determines
the lens power.
 Example
# +1.00DS/+2.00DC@165* (-6.00 Base
Curve)
# +3.00DS/-2.00DC@75*
# +3.00 - (-6.00) = + 9.00DS
# -6.00DC@165*
# -2.00 + (-6.00) = -8.00DC@75*
+9.00DS
Final Rx: ---------------------------------------------------
-6.00DC@165*/-8.00@75*
Centring and Decentring effect in spectacle
lenses
What is Centring?
An optic centre of the ophthalmic lens is
aligned with the visual axis.
Proper centered glass provides the
sharpest, most distortion free image.
It is the goal of the opticians.

Centration of the Lens

An ophthalmic lens is said to be centered
when its optical centre is aligned with the
visual axis.
 What is Decentring?
An optical centre is not aligned with the
visual axis.
The displacement of the lens optical
centre from the wearers line of sight
induces a prismatic effect.
Prism can be obtained in lens either by
grinding or by decentration.

Decentration of Lens
An ophthalmic lens is said to be
decentered when its optical centre is not
aligned with the visual axis.
 Prismatic effect in “+” lens
Explains the characteristics transverse movement due
to the decentration.
Let us assume that a cross line is viewed through ‘+’
lens
- As the lens moved downwards, the cross line is
appeared to move upward towards the apex.
- An upward (base down) effect, i.e. AGAINST
movement is introduced.
 Prismatic effect in ‘-‘ lens
As the ‘-‘ lens is moved downwards –
A downward (base up) prismatic effect is
introduced.
Displaces the cross line towards the base,
i.e. upward ‘WITH’ movement.
Example – 1
A -6.00 D myope having a decentration of
2 mm outwards in RE, then the
prismaticeffect would be –
P = 0.2 x (-6.00) = - 1.2 ∆ B In
‘ – ‘ indicates that the base of the prism is
in the direction opposite to that of the
decentration.
 Example – 2
If a myope requires 2 ∆ B out in each eye
then the required amount of decentration
will be
D = P/F = 2/-5.0 = - 4 mm.
‘ – ‘ indicates that base of the prism is in
the direction opposite to that of the
decentration.
 Conclusion
< 0.50 ∆ dioptre prismatic effect does not
have much effect.
If a +2.00 D lens is decentered 2 mm,
then the prismatic effect would be –
2 D x 0.2 cm = 0.4 ∆ dioptre.
Tolerable range : Horizontally – 1.0 ∆
dioptre & Vertically – 0.75 ∆ dioptre.
Optical Counseling
Generally Patients Thinks…….

Spectacle is not a scientific device

Can be choose easily like others, i.e. dress
Spectacle not plays the important role in
vision correction
No scientific procedures followed
Why counseling is important?

To make understand the needs of spectacle

To choose the appropriate lens and frame
To know the cost of standard lens and
frame
To convince/motivate the patient
To fulfill their visual needs and expectations
To maintain the good relationship.
 Lens and Frame Selection
Listen & understand the
patients problem
Verify the glass if used
See the patient’s
refractive power
Advice the appropriate
lens design depends on
visual needs
Consider the patient’s
affordability.
Quality and Cost
Explain about –
Lens materials and its harmful effects
Limitations of lens
Frame materials and side effects
Make the patient aware about scientific
dispensing
Differentiate the cost of standard items.
Motivations

Instruct the patient about-

The lens optical inherent defects
Uneasiness with multifocal lenses
Adaptations and duration
Special guidelines for vocational glass
users.
Good Relationship

On-time delivery
Patient care after delivery
Individual attention in specific cases
Personal Qualities
Be a mediator between refraction and
optical
Good communication skills
An adequate experience in clinical
refraction & optical dispensing
Up to date knowledge about latest design
Genuine approach
Neat dressing and style.
Patients Satisfaction
Why Patients Satisfaction?
Health care is generally becoming
competitive
Providers must not only maintain high
clinical standards but also service that
satisfies the patients
To meet the dual challenge, providers
must have an understanding of what
constitutes both clinical excellence and
patients satisfaction
What are the Patients Expectations?
Friendly welcome and reception
Wants to know what is going on
Feeling of security and safety
Preserve their self respect
Control over the decision
Achieve their needs.

Expectations = Experience = Satisfied patient

Expectations > Experience = Dissatisfied
patient
In This Race Followings Are To Be Involved
Receptionist
MLOP
Refractionist
Technician
Optometrist
Ophthalmologist
Counselor
Difference in perception

We may judge ourselves by our

“efficiency”
Patients may judge us by our
SINCERETY.
Problem solving Modalities

Cut down prices

Catering staff need to be more polite
Change the menu
This is a hospital, not a hotel
We should run the catering services ourselves
We can’t satisfy each and every need.

Real reason could be – If only the food was

served HOT and CLEAN plates
Approach to the Patient
Friendly gesture
Listen with your eyes
Listen when you listen, write when you
write.
The way we talk matters more.

Lesson – Involve patients to

understand the problem better
and develop solutions.
How Are Our Patients Today?
Well informed
High expectations
Instant results.
Complaints
What hurts?
- Lack of attention
- Lack of transparency.

What they expect?

- To listened
- Prompt and appropriate response
- Attempt remedy if possible (cure).
SATISFIED PATIENTS ARE OUR WEALTH.
DISSATISFIED PATIENTS ARE OUR BEST
TEACHER.
END