Prescriptions — The Way They Were Intended By Todd Hasselius, Shamir Optical Release Date: July 2008 Expiration Date: July 31, 2011 Learning Objectives: Upon completion of this program, the participant should be able to: Understand new technologies developed to improve progressive lens fitting results. Learn the effects of tilt, faceform and vertex in the way that a prescription delivers its effective vs. refracted power. Develop a plan to provide all patients a well constructed series of progressive lens choices based on the benefits of newly added features. Faculty/Editorial Board: Todd Hasselius is the director of education for Shamir Insight, Inc. an ABO approved speaker and optical technologies graduate of Anoka Technical College. He has a BS from St. Cloud State University. Credit Statement: This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Course # SJMI193-1 This course is supported by an unrestricted educational grant from Shamir Optical Buying eyeglasses seems pretty straightforward. The patient gets an eye exam and receives a prescription, frames are chosen, lenses ordered, decentered, edged and glazed. The patient returns to pick them up, they get adjusted and the optician gets paid. Ca-ching! However, there are a few assumptions and you know what they say about assuming anything. Assumption 1 — A customer has to be selective about the frame they want, especially if they wear progressives. Assumption 2 — When the prescription and centering delivered equals the prescription prescribed and PD, the patient will see best. Assumption 3 — Your favorite progressive lens design provides the same great vision for virtually every patient (regardless of their prescription as long as you correctly chose the right general purpose or short corridor lens based on frame size and fitting height. Assumption 4 — In a tight economy, those things are just unaffordable. I know making it complicated is not what you wanted to hear. But this course teaches how the problems associated with these and some other assumptions have been simplified, and in fact, will make your life easier. BESIDES THE ASSUMPTIONS, CONSUMERS WANT… In a survey of 1,000 consumers (Shamir consumer survey, 2007), they found that consumers want more convenience when buying progressives i.e., convenience in the way they’re fit, ordered and gotten used to. They don’t want limitations on frame choices. Can the doctor and optician provide a clearly explained set of choices where the value of each is understood and appreciated? AN INTEGRATED APPROACH This course describes an integrated approach to allow a doctor and/or optician to uniquely and simply deliver progressives that better meet a wearer’s frame wants and lens needs. Then, using those learnings, improve the way other lenses, even single-vision lenses “fit.” This approach provides a way to integrate frame size and shape with lens choice. It allows the optician to answer the most common complaints using a variety of customization stages to deliver an arsenal of lens benefits and possibilities for patients (and opticians too). ASSUMPTION 1 — WHEN THEY WANT THOSE FRAMES We dispense style and fashion, and entice the patient with hot frame brands, great color and new textures. Patients pick out the best pair of frames they can afford; they fall in love with them and then find out the progressive lens of choice won’t work well in that frame. They return to frame selection, this time with their expectations reduced; they must choose second best or not their ideal. NEW FREEFRAME TECHNOLOGY Given a required fitting height and the frame size and shape, it is possible to analyze the available lower area of the lens. In this way, a calculation engine could re-design the shape of a progressive’s near zone to better fill the lower portion of the frame using the required fitting height. This calculation engine uses new FreeFrame Technology, a development of Shamir Lens. When select new Autograph designs are ordered, the progressive lens design is adapted to the frame itself. Based on the frame shape, this new feature dynamically and continuously adjusts the corridor length to move the reading zone to the most optimal position in the frame, retaining full reading power. This increases frame selection convenience. It means the consumer can now choose virtually any frame they pick when ordering an Autograph design. It also assures the optician they’re not going to compromise the reading zone by “squeezing” a progressive design into a smaller frame or “bumping-the-add” to ensure the addition is inside the frame shape. The software cleverly keeps the entire reading zone intact. It’s simply moved and reshaped to be within the frame. It is a logical next step to provide designs that fit the consumer’s frame choice and not make the lens choose the frame. This process also increases continuity by all staff since there’s no confusion with what to remember. Autograph lenses are simply redesigned to fit into virtually any frame. When there are fewer conditions and requirements to remember, ECPs and staff would recommend those products more often. ASSUMPTION 2 — THE EFFECTS OF VERTEX, TILT AND FACEFORM There’s a discrepancy between the prescription derived from the phoropter because of the way it is positioned in front of the eye and the way that eyeglass lenses are positioned. The distance from the back of the lens to the front surface of the eye (vertex distance) is typically different from the distance the doctor placed the refractor from the eyes. The same is true for the tilt of the lens (pantoscopic) and the faceform (panoramic angle) wrap of the lenses. The refractor’s lenses are positioned differently from the way that eyeglasses fit. These differences affect the effective power of the lens i.e., the lens has a different prescription in the way they are being worn than the way in which they were tested. Some would say that for the average patient, the differences would be small. However, if our goal were to provide the option of the best vision possible, then we would want to adjust for the correct wearing positions. AS-WORN TECHNOLOGY As-Worn Technology is built into all new Autograph lens designs by adding three additional lens/frame fitting measurements. They are pantoscopic tilt, panoramic angle and vertex distance. By providing these additional measurements, they are used to further fine-tune the prescription. This ensures the patient gets the proper Rx for the frame in the way that it is worn on the face. So, the doctor’s prescription will be modified taking the additional fitting requirements into account. The lab will return the glasses with two prescriptions; the original prescribed Rx and the “as-worn” Rx. Use the as-worn Rx to verify the lens prescription in a lensmeter. Some opticians may be concerned they are changing the doctor’s prescription. However, if an Rx is altered by the way it is worn, compensating the Rx for the wearing effects ensures the final pair of glasses actually delivers the prescription the doctor wrote. The effects of position change powers. A powered lens moved away from the eye becomes more plus and more minus when moved closer. Lenses tilted change sphere and cylinder power. To test these, place a -4 sphere lens in an automated lensmeter and change the position up and down on the lens stop or change the tilt and watch the prescription change. As a result, to deliver the right prescription, lenses should be compensated to deliver the prescribed Rx. For example, a prescription of R -4.25 sphere, L -3.75 -1.00 x 90, add +2.00 with fitting requirements of PD 31.0/31.5, height of 17.5/17.0, tilt of 10 degrees, vertex 11.5mm (refracted at 13.5mm) and panoramic angle of 6 degrees would be returned as a R -4.12 -0.12 x 54, L -3.62 -1.00 x 93, add +2.00. Therefore, the compensated Rx will see as the prescribed Rx when worn in the frame. Clearly, those with higher prescriptions that need their glasses for full time wear benefit the most. In the Autograph series, when these measurements are not included (low prescriptions if the optician is not yet comfortable taking these measurements) the Prescriptor lab software implemented in Shamir partner laboratories is loaded with a set of average measurements for these three parameters. If no measurements are provided, the default measurements are used. The lab will still print two prescriptions and send them back with the lab paperwork, ordered and fabricated. The benefit to the consumer is more precise and perfected vision. It’s like wearing a suit purchased off the rack or one that was tailored to the precise nuances of a person’s body shape. ECPs also benefit because they provide patients with an improved vision that was never before available to them with the current tools they use. Since the changes are done automatically in the lab, there is an ease of use and staff at any level can be more of an expert. ASSUMPTION 3 — ONE PROGRESSIVE FITS EVERY LIFESTYLE Most of the progressive wearers we see believe progressives will work well in every situation but they learn one lens can limit their lifestyle. They look us in the eye and say, “Hey, we’re not getting older, we’re getting younger. If we want to go skiing, walk down the fashion runway or work in an office, we’d like to see the best we can in any situation.” In short, they don’t want to be told “No;” they want to know their options. Describing personal lifestyle-tuned lenses makes sense, especially when it delivers the right kinds and amounts of vision required. So, adding an offi/2020Exams/computer lens and sports targeted lenses to the Autograph technologies provides consumer and ECP with a full range of lenses for every patient’s real needs. The Autograph series of lenses includes five varieties of designs that provide everything from general purpose to those specially tuned for frame size, office distances or sports frames. They are customized, lab manufactured, back surface, freeform designs that are personalized for the patients lifestyle need. As a result, you can offer these lenses as the exact solution for the best work or sports performance. Lens Uses Design Features Autograph Custom made, personalized, back surface progressive General purpose Combines patients unique fitting requirements; vertex, tilt and panoramic angle Ensures comfortable and quick adaptation Provides about 20% wider fields of vision than front surface progressives Freeform manufactured FreeFrame Technology for variable corridor lengths based on frame size and shape, 11mm & up minimum fitting height Fixed designs available in 4 minimum fitting heights; 11, 13, 15 and 18mm CR39 (T, P), Poly (T, P), Trivex (T), 1.60 (T), 1.67 (T, P) availability, most in Transitions (T) and polarized (P) Fully aspheric back surface Lab created using Prescriptor Autograph Office Customized, back surface occupational lens Delivers wide intermediate and near zones when most needed Freeform manufactured Any Dynamic Power can be specified from 0.75D to 2.25D CR-39, Poly, 1.60 availability Lab created using Prescriptor software Fully aspheric back surface Autograph Attitude Customized, back surface wrap progressives Fits wrap frames, optimizes peripheral optics when a steep surface curve is needed to match frame curve Virtually eliminates peripheral distortion and power errors in the line of sight 6 and 8 base to match more highly curved wrap frames Freeform manufactured Fixed designs with 15 and 18mm minimum fitting heights Trivex (T), 1.60 (T), Polycarbonate (T, P) Lab created using Prescriptor software Fully aspheric back surface Autograph Single Vision Customized, aspheric/atoric back surface SV lens Virtually eliminates peripheral distortion and power errors in the line of sight Combines patients unique fitting requirements; vertex, tilt and panoramic angle Freeform manufactured CR-39 (T, P), Poly (T, P), 1.60 (T), 1.67 (T, P) availability, most in Transitions (T) and polarized (P) Fully aspheric back surface Lab created using Prescriptor software Fully aspheric back surface Autograph Single Vision Attitude Fits wrap frames, optimizes peripheral optics whena steep surface curve is needed to match frame curve Combines patients unique fitting requirements; vertex, tilt and panoramic angle 6 and 8 base to match more highly curved wrap frames Freeform manufactured Fixed designs with 15 and 18mm minimum fitting heights CR-39 (T, P), Poly (T, P), Trivex (T), 1.60 (T), 1.67 (T, P) Lab created using Prescriptor software Fully aspheric back surface Shamir Autograph virtually eliminates unwanted astigmatism and any “swim” sensations in the peripheral areas of the lens. The back surface design provides 20 percent wider fields of vision and precise optics to within 1/100th of a diopter. There are two lens series available; a fully customized design using FreeFrame and As-Worn technology or the fixed design series. The fixed design series has four standardized minimum fitting heights (11mm, 13mm, 15mm, 18mm). Autograph Office is a customized occupational lens designed for patients requiring wide intermediate and near zones, specifically for the visual needs required in a small environment setting, such as an office. By capturing the patient’s distinct measurements (including PD, prescription and the measured distances of the work zone) they can be personalized specifically for the use(s) intended. In this way, any Dynamic Range (power degression) can be specified from 0.75D to 2.25D. A perfect lens for the surgeon who needs a much larger “near zone” or for the stock trader with a screen distance of three feet who may want a larger “intermediate zone,” the lens can be customized to give larger areas where needed. In fact, one could order a lens whose degression results in distance power in the lens’ upper region. The “personal” dynamic power figured by Prescriptor is laser engraved into the final product for verification. For the best in fitting, three additional fitting requirements are needed; Gaze Direction (up, straight ahead, down), distance from task or computer, and whether they are standing (mobile) or sitting (stationary). In some cases, where the patient is standing or mobile, the degression is increased (reduced total plus in the distance) and actually create a distance zone in which to walk around. All with a significant reduction of peripheral aberrations and visual distortions while providing smooth transitions between power zones. Autograph Attitude is a six and eight base lens that works with very fashionable wrap frames. Wrap frames require steeper base curve lenses retain frame shape and allow a close fit for superb eye protection from the front and sides of the lenses. These frames are highly desired but labs often had difficulty creating comfortable prescriptions. Attitude is designed to virtually eliminate peripheral distortion and power errors in the line of sight. Autograph Single Vision and SV with Attitude provide the most advanced, precise, customized freeform optics on single-vision lenses. A fully aspheric, back-surface design lens is custom made for the wearer, even patients with high-powered prescriptions are able to experience edge to edge clarity by using personalized optics. ASSUMPTION 4 — THOSE THINGS ARE JUST UNAFFORDABLE Everyone prefers a lower price. However, progressives are more complex than traditional bifocals, have had constant investment, research and design improvements. As a result, they continue to cost more and that will be true for the Autograph series of lenses. However, Freeform has created an opportunity to also enhance standard front surface progressives by using its customizing ability. Here, the back surface is aspherized for the power (sphere and/or cylinder meridians) so every prescription in the standard Shamir line of progressives can deliver a wider and clearer field-of-view than previously possible. SHAMIR DLT Shamir DLT (Direct Lens Technology) is a marriage of old and new technologies. Very simply, a standard off-the-shelf, front surface progressive, semi-finished designs like Creation, Piccolo, Attitude or Office is used. An aspheric/atoric surface is ground on the back for the surface curves needed to deliver the power of the lens. This does two things; it offsets some of the errors (unwanted astigmatism and power errors) found on the front and it widens the clear field-of-view using asphericity tuned to the power in each prescription meridian. Because Shamir knows the front surface designs of their semi-finished lenses they can surface exactly the compensating surface on the back to optimize the lens to the extent possible. The result is significantly less astigmatism and therefore less blur and wider clear fields-of-view. The result is better vision at a better value. Everyone wins. The consumer benefit is a partially customized freeform lens at less than the cost of a true freeform lens. The benefit to the ECP is that now they can sell three categories of product, Good, Better and Best (example: Good = Creation, Better = Creation DLT, Best = Autograph). CONCLUSION Assumptions can get the optician in trouble. Knowing now that virtually every frame is okay for a progressive, the prescription can be delivered in its most precise form and these techniques are available in a variety of specially tuned lenses means the patient who wants the best can get it for the variety of vision needs they have. In fact, I think creating eyeglasses is more straightforward than ever before. A simple application of technology, added seamlessly by the lab, allows every dispenser to offer a new series of Better and Best for the best in eyecare.