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Progressive dispensing - getting it right

By James Gibbins
In the first installment of our new monthly dispensing column, JAMES GIBBINS explains the essential traits and skills dispensers need to possess in order to prevent adaption issues and unhappy patients.

The role of the optical dispenser is to provide outstanding service to patients, which in turn will produce outstanding results. One of our most important tasks is the dispensing of spectacles fitted with progressive lenses.

When compared with simpler lens designs, progressive lenses are more high-tech, expensive, and have greater potential for both wonderful and disastrous outcomes. Therefore you would expect that every dispenser who engages in this crucial role of dispensing would approach this task armed with excellent training, well-developed skills and attention to detail.

However, the feedback from our lens labs, and their records of warranty replacements and non-adapts would unfortunately suggest otherwise. How is it possible that despite the incredible advances in lens design today that we as an industry still struggle with progressive lens adaption issues?

"How is it possible that despite the incredible advances in lens design today that we still struggle with progressive lens adaption issues?"

The debate concerning possible reasons for non-adapts is extensive, but can be summarised in four main points:

  • Prescription

  • Lens design

  • Wearer resistance

  • Dispensing

Without going through the details concerning each of these points, the feedback and records of our labs would clearly suggest the bulk of the issues lie with this last point – the dispensing of the spectacles.

I would like to suggest a simple, step by step approach (coupled with excellent dispenser training, such as the Certificate IV in Optical Dispensing), as a pathway towards achieving the most reliable and successful outcomes for dispensing progressive spectacles.

7 Steps to dispensing progressives

1. Rx Interpretation

The dispenser needs to be able to read the written prescription and identify quickly where the principal powers lie, the potential appearance of the lenses, including thickness, and note any eye conditions and potential problems the prescription might contain. This understanding of the prescription is going to help guide both the lens and frame selection.

2. Customer discussion

The dispenser needs to engage the patient in a conversation that will indicate the expectations they have for the use of these spectacles. Lifestyle and particular visual needs will feature in this discussion, with the dispenser seeking all the information necessary to help guide the frame and lens selection.

3. Lens selection

Once the dispenser has a good understanding of what the customer expects of the new spectacles, then the discussion can move to specific lens design. Here the customer is more reliant on the expertise, experience and skill of the dispenser to make the right recommendations, keeping in mind lens features and cost.

4. Frame selection

Now, and only once the lens design has been settled on, can the discussion move to frame selection. Too often this order has been reversed, when the frame has been selected prematurely, and then the lens design selection restricted in order to match the frame, or often not even considered.

The customer will usually have something in mind, and will certainly have some personal preferences, and again the dispenser must call upon their skill and experience to assist the customer in making this crucial decision. Of course, the dispenser will be considering how the selected frame will perform with the lenses chosen.

However, they will also need to consider a huge number of other details, including how the frame shape can compliment the customer’s facial shape, how appropriate the frame size is for the customer’s physiology, and how the frame colours compliment the customer’s hair and skin tones.


5. Frame adjustment

The first point we must stress is this needs to be done before the facial measurements are recorded, as the final adjustment can impact a number of the measurements.

Inaccurate facial measurements are rampant and the most common reason for non-adapts would unfortunately suggest otherwise.
Inaccurate facial measurements are rampant and the most common reason for non-adapts would unfortunately suggest otherwise.

So often this is forgotten in practice and the frame adjustment is instead made on collection – after the lenses have been carefully fitted. This final adjustment of the frame itself can compromise both the lens positioning and lens performance.

Over the years we have noticed that the quality of the final adjustment is the result of both the skill and the care of the dispenser. Frame adjustments can be a challenging task, and for most of us it can take years of practice with multiple frame materials and styles, adjusting them for the huge variety we see in customer physiology, before we start to feel confident.

But in addition to this skill, the dispenser needs to have a healthy and committed attitude, because so often in practice we become aware of dispensers who will take short cuts and fail to show the attention to detail that these tasks require.

6. Facial measurements

According to the feedback from the labs, this is the area of most concern – inaccurate facial measurements are rampant and the most common reason for non-adapts. To combat this, the dispenser must be trained in the most reliable methods and also take the utmost care to take these measurements as accurately as possible every time.

For the basic, conventional progressive lens design the dispenser needs to measure for monocular pupil distances and monocular fitting cross heights. At the same time, they need to ensure the pantoscopic angle of the frame lies between 8–12°, the face form angle (frame wrap) lies between 6–8°, and that the vertex distance is kept to a minimum.

However, when dispensing a free form progressive lens design it’s important to provide more specific details on these “as worn” measurements, taking precise measurements for the pantoscopic angle, the face form angle and the vertex distance.

This will enable these high performance progressive lenses to be further customised at the time of manufacture for the patient and the exact final position of wear for the spectacles. Taking such steps ensures the peak performance of the lens and also maximises the wearer’s experience.

7. Collection

Take care and time to advise the customer on both the use and care of their new spectacles. Especially in the case of a first time progressive lens wearer, the appropriate guidance by the dispenser can go a long way towards helping the customer to adapt easily and quickly to their new spectacles.

The use of language here is vital, so therefore we keep the focus on the benefits of these outstanding new lenses and we ensure our language does not contain any negative, unhelpful or misleading comments.

This has been an extremely brief summary of the steps towards successful progressive dispensing, but if we keep them in mind for every dispense, resist the urge to take short cuts and maintain a high attention to detail, then we can be sure we will maximise the wearer experience and hopefully see an industry wide reduction in non-adapts.


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