Welcome to question of the day #255

Eyetools question of the day #255

I’ve just opened my first practice. I know that poor frame choice for a patient is likely to lead to a complaint and a remake with a different frame. How can I make sure my staff help patients choose the right frame the first time?

Frame choice is almost as important as the accuracy of the prescription. I have colleagues who tell me frame choice is more important than the accuracy of the prescription.

Here are a few tips from my experience of advising hundreds of patients when choosing a frame.

It is common for the eye specialist who determined the prescription not to be involved in frame selection and this disconnection sometimes leads to poor frame choices.

Frame size and shape influence the nature of the lenses that go into them.

Communicate with the fabricating optician about any frame change issues. We comment on the prescriptions themselves with suggestions such as “minimize frame dimensions, as able,” or “note computer monitor position in selecting a progressive design.” These simple comments have resulted in better communication that can dramatically limit remakes.

Take the patient’s lifestyle into consideration to understand how he or she wants the product to perform. Some people will want spectacles purely for the office and home. A lightweight frame will work for them. Others want spectacles to use during sport or manual labour. A heavy, strong, sturdy frame will work better for them. Ask about hobbies and work to allow you to best advise the person.

Some older people may need a lightweight material because of thinning skin around the nasal area.

Some people may need a hypoallergenic material because of skin allergies.

Be careful if you want to move a presbyopic person from a large frame to a smaller framer. You may need to change to a short corridor progressive lens, which can change how and what the customer can see and make the lenses more expensive.

If the person had a small eye size in the previous glasses be careful in recommending a large frame as this is likely to lead to peripheral distortion.

Advise the first-time progressive lens wearer not to select a frame that requires a short corridor design. This limits vision and may create adaptation problems.

Pre-adjust frames before taking measurements. Once the patient has put on the frames, ask if that is where they will be wearing them. Make sure temples are long enough and that the bridge fits well. Check the pantoscopic tilt of the frame before measuring.

If a patient chooses a frame that you know won’t work, be honest and tell them why it’s not a good choice and give them better options.

If a person goes against your recommendation, make a note in the clinical records of what your advice was.

If you are the prescriber but not the person assisting with frame selection then make a note of your frame advice and speak to the dispensing optician about your suggestion.

Don’t tell the person to avoid changing frames, just be sensitive to these issues in frame selection.