Optometric practice 3
DR. Ann Benedicto O.D. at ISOPTIK
Ophthalmic Dispensing- includes dispensing of eyeglasses and contact lenses to patients. It also requires skills in fitting frames, checking the frame alignment and tightening of screws/nose pads in the frame of the customers. The delivery of a pair of eyeglasses to a patient is a very important aspect of practice building, yet it is a part of our service that can easily under-perform because the optometrist is not often directly involved. The Rx delivery process should be reviewed frequently from an objective point of view. The tangible details of dispensing finished glasses are extremely important because optometry is a service "business" in which patients don't really understand the service or the product. They have no way of judging spectacle lens quality, or eye exam quality. With no basis for evaluating what was purchased, people use other clues to help them decide if a service or product was a good value. The physical surroundings play a huge role in this perception of quality - which influences future referral patterns.
Here are a few physical things to consider as you analyze your dispensing interaction :
Is it set up efficiently? It should look like this is a place that does glasses well. Are adjustment tools, and sink easily accessed? Can more than one patient be dispensed at one time if needed? Does it seem convenient to the patient?
How does the dispensing furniture look? The table or counter; the patient's chair; the tech's stool; the area where the patient looks straight ahead with the new glasses. Remodel this area and replace furniture before it is obviously needed.
Where are glasses stored? Where the glasses are retrieved from makes an impression as the patient watches. Invest in the storage cabinet and make it look efficient and properly sized.
How are the glasses packaged when they are brought to the patient? This is often not even looked at from the patient's point of view - but I believe it makes a huge difference. Avoid the "lab look" that is so common - such as glasses in job trays, lab ticket wrapped around them with a rubber band, lens markings still present, etc. We even remove the progressive lens markings when the glasses are verified in our lab, and we've had no problems fitting them. The glasses should look like fine jewelry. Consider presenting them in a beautiful tray, or bringing them in their case.
How is the case? The case speaks volumes - don't skimp and don't advertise on it. Make it something that the patient would be proud of. Obviously, match designer cases with designer frames.
Other give away? We like to dispense a complimentary bottle of lens cleaner and a microfiber cloth. In my opinion, these are good places to put your practice name and logo.
Is the frame already in standard adjustment? You want it to fit well and feel good upon the first wearing.
What does the reading material look like? Avoid dog-eared, worn acuity charts. Replace them often with high quality materials. Printed text is better than a Snellen chart. Is there an attractive, large mirror present? How is the lighting? As an expert in vision, we must have plenty of light to read comfortably, and pleasing illumination on the patient's face to make the first viewing in the mirror a success.
An optometrist demonstrating to a patient the proper way of keeping the glasses.
Tips on Dispensing glasses to customers
The dispensing visit may be the last interaction with the patient for some time and last impressions are just as important as first ones because they stick. Be sure to make this service special.
Greet the patient with a cheerful and warm statement. Use the patient's name and ask to be corrected on pronunciation if you’re not sure (it should be spelled phonetically in the chart).
Present and handle the glasses gracefully.
verbally review the features of the lenses and frame. For example, say: "Mr. Smith, I see you've ordered progressive lenses in a high index polymer. These are no-line multifocal, in the lightest and thinnest material available. You also have anti-reflective lenses to reduce glare and look better on your face. WHY do this? Two reasons: (1) Patients forget everything we tell them and they pay a lot for glasses; reminding of the special options builds value. (2) You want patients to talk to others about their new glasses and arming them with knowledge gives them something to say.
Make some adjustment, even if they fit perfect. This enhances the perception of professional, custom fitting.
Perform a final quality check of frame fit and that materials are free from defects. Acknowledge any problems you discover and propose a solution. You may wish to dispense the glasses so the patient can wear them while you re-order or re-make the correct part. Offer an apology without blaming co-workers and without becoming angry or upset. It should be very rare that a problem is found at dispensing.
Complement the patient or the new glasses in some way. Be sincere and natural.
Instruct the patient on use of the glasses, especially if this is the first time wearing this type of lens. Verify the quality of vision at appropriate viewing distances.
Instruct the patient on the care and use of the glasses. Try to keep this simple and easy.
State the balance due and ask how the patient wishes to pay. This requires a system to make this reliable and smooth.
Close with something positive, like "I'm sure you're going to get many complements on your new glasses! Don't hesitate to let us know if they should need any adjustment."
Free accessories for patient e.g. lens cleaner, lens spray, microfiber cloth, and spectacle case.
Checking the fitting of the frame.
Instructing a patient how to use the lens cleaner and lens spray
Vision therapy, also known as visual training, vision training, or visual therapy, is a broad group of techniques aimed at correcting and improving binocular, oculomotor, visual processing, and perceptual disorders Vision therapy encompasses a wide variety of non-surgical methods which some have divided into two broad categories:
Orthoptic vision therapy, also known as orthoptics (essentially includes strabismic visual therapy).
Orthoptics aims to treat binocular vision disorders such as strabismus, and diplopia. This kind of visual therapy is commonly practiced by optometrists as well as occupational therapists under the guidance of some ophthalmologists; however, more specialized problems are co-managed between orthoptists and ophthalmologists also known as behavioral or developmental optometry, which is essentially non-strabismic visual therapy. Behavioral vision therapy or non-strabismic visual therapy is practiced primarily by optometrists who specialize in this field. It aims to treat problems including difficulties of visual attention and concentration, which may manifest themselves as an inability to sustain focus or to shift focus from one area of space to another. Vision therapy may also be prescribed to patients with eye strain and visually-induced headaches. However, not all such therapy is limited to disorders of the visual system. Professional athletes, for example, may use vision therapy to enhance sensitivity to peripheral vision on the playing field or increase responsiveness to fast moving objects.
Orthoptics (from the Greek words ortho meaning "straight", and optikas meaning "vision" is a discipline dealing with the diagnosis and treatment of defective eye movement and coordination (such as nystagmus), binocular vision, and amblyopia by eye care professionals. There are five areas of treatment for orthoptic problems:
corrective lenses (spherical, prismatic and Fresnel lenses
vision therapy (strabismic-related, not behavioral optometry), which can include eye exercises
pharmaceuticals, such as cycloplegics
However the term orthoptics is sometimes used to refer simply to eye exercises which are a component of strabismic-related vision therapy.
Your optometrist has given you exercises to help improve your eyes so that they work better together. Sometimes too much close work and/or sudden amount of close work (e.g. student preparing for exams) cause the eyes to tire. This can lead to symptoms such as sore eyes, headaches, and even double vision (worse at the end of the day).
In most cases, simply reducing the amount of close work one dose can help reduce these symptoms; however your optometrist may give you exercises to help. Exercises can be a very effective method of treatment however they must be done regularly for the period of time recommended by your optometrist.
EXERCISE 1 – PEN TO NOSE
Hold the first pen (red) at approximately 15cm from your nose.
Now look at a second pen (black) at approximately 30cm from your nose. While looking at the closest pen (red) you should notice that the further pen (black) has gone double (and is out of focus).
Now look at the second pen (black one) and notice that the red pen has gone double (and is out of focus). Make sure that you can see this double vision, if not consult your optometrist.
Bring the furthest pen (black) 2-3cm closer and repeat the test. A certain amount of effort is required to pull your eyes in to maintain a single image.
Push the closest pen (red) 2-3cm away from you and repeat the exercise.
Using two different colored pens makes these tests easier to appreciate which pen you are seeing double.
EXERCISE 2 – DOT CARD
Hold the dot card near your nose with the line vertical and facing away. Angle the far end slightly up. Squeeze the card very gently to keep it rigid.
Look at the far end spot, which should be single.
Notice that the line doubles to give an upside down ‘V’ whilst looking at the spot.
The idea is to try and look at each spot in turn and see it as a single spot. If your eyes are converging correctly, the viewed dot will be seen singularly (but not necessarily clearly) and the other dots and line will appear to form an X.
Try and bring your eyes in, and eventually to see the near spot singly
This should be done gradually. DO NOT try and pull your eyes in to see the near spot first.
Once you have reached the near spot and can maintain it as a single spot you will notice the line is now in a ‘V’ pattern. Hold each spot for 20 seconds and repeat 4 times.
Perform the exercise as recommended by your optometrist.
Orthoptists are Eye care professionals who specialize in the diagnosis and management of binocular vision problems alongside Ophthalmologists. Orthoptists are represented worldwide by the International Orthoptic Association.
Orthoptics is usually studied as a primary or master's degree, or as a 2 to 4 years post graduate training course. Orthoptists usually work in close cooperation with Ophthalmologists, pediatricians, and sometimes neurologists. Continuing professional development and registration is required in most countries
The eye exercises used in vision therapy can generally be divided into two groups; those employed for strabismic outcomes and those employed for non-strabismic outcomes, to improve eye health. Some of the exercises used are
Near point of convergence exercises (i.e. "pencil push-ups"),
Base-out prism reading, stereogram cards, computerized training programs are used to improve fusional vergence.
The wearing of convex lenses
The wearing of concave lenses
Double vision (diplopia)
What is double vision (diplopia)?
Double vision is when a person sees two images of the same object some or all of the time. The two images may be vertically separated (one on top of the other) or horizontally separated (side by side) or both (oblique). It generally occurs when the eyes, which have previously worked together as a pair, are no longer able to do so because a squint has developed and the eyes are now out of alignment with each other, resulting in double vision. This may happen suddenly or over a period of time.
What causes double vision?
Double vision is normally the resulting symptom when one or more of the eye muscles or nerves have been weakened or damaged. This weakness or damage can be caused by a number of conditions. General investigations may need to be carried out to try to find the cause of the double vision.
What action should you take?
If you have double vision you should visit your own GP or optometrist as soon as possible for a referral to an orthoptist. If the double vision has occurred suddenly, e.g. you wake up with double vision; you are advised to attend your local eye casualty department.
What treatment is available?
If the double vision is present most of the time, it may be possible to use a Fresnel prism on the person's own glasses to join the double vision. A Fresnel prism is a special transparent plastic sheet which can be customized to fit any pair of glasses. If the person does not wear glasses, it is possible to obtain a pair of clear glasses. Where Fresnel prisms are not successful, it may be necessary to cover one eye in order to block out one of the double images, at least temporarily. Double vision may gradually resolve with time. If full recovery does not occur, surgery to correct the double vision may be considered.