|A low vision aid such as a Clip-on Magnifier is available from Eschenbach Optik.
It can be a profitable business for ECPs to offer special-purpose lenses.
While most of the eyewear that eyecare professionals (ECPs) design and craft for patients everyday are fairly routine, some require special eyewear for non-routine purposes. Special-purpose lenses can be defined as any lenses, in any power, and in any configuration for a specific activity.
Here’s an excellent example. A friend of mine is a competitive shooter. He specializes in a discipline known as bull’s-eye pistol shooting. This type of pistol shooting requires the use of open, fixed sights (so there are no optics, like a scope, on the pistol). The focus point for open sights is the front sight on the end of the pistol barrel, not the target. Since he recently hit his mid-40s, he needed some correction to get his front sight in perfect focus.
His eye doctor was understanding and let him bring his pistol to his eye exam. With his pistol in position, she used trial lenses to refract him to perfect clarity. This special-purpose prescription was used to create a special purpose lens for him. In this case, that lens was mounted in a special-purpose frame designed to hold one lens in front of his right eye and an occluder over his left.
Creating a special purpose lens is a three-step process:
- Need: The wearer, doctor, and optician must determine the exact need of the patient. This is not a casual conversation but a careful and thoughtful listening and discussion process.
- Prescription: This is created by the patient working with the doctor to use the information provided to meet the need, and then, with the patient’s ordinary prescription as a baseline, “tweaking” the Rx to meet the need.
- Choosing a lens: The optician works with the patient and the doctor to find a lens that can provide the proper prescription in the proper place.
|Vision-Ease offers a number of specialty lenses like its LifeRx trifocal lens.|
I like a challenge and I really love it when a patient says: “Another place told me that XYZ could not be done.”
A patient picked up glasses with the following Rx:
He proceeded to tell me how much he disliked progressives and that he could see at near much better without his eyeglasses. He then explained that what he really wanted was a pair of eyeglasses with his distance Rx at the top and nothing at the bottom. I confirmed that he meant nothing and he replied, “Yes, that is exactly what I want, but I have never found anyone who could understand what I was talking about, let alone make them for me.”
With some time, patience, and plain old hard work, I took four different lenses, and by hand, created an executive (Franklin-style) lens. I was able to give that patient exactly what he wanted: a distance Rx at the top and nothing at the bottom but clear plastic.
|LOW VISION AIDS Do not overlook low vision aids when trying to help your patient find solutions. Visor magnifiers, binocular specs, high plus readers, and clip-on magnifiers can all help those struggling to view the smallest of parts. Did you know that very high plus lenses for near work require prism to overcome the lens thickness and the eye’s convergence? Look to Eschenbach Optik of America, Inc. and Mattingly Low Vision, Inc. for answers. There are also a number of specialty lenses available from lens companies like Vision-Ease Lens and X-Cel Optical Co. that provide good platforms for specialty eyewear (See “Spotlight on Custom Lenses”). Make sure you’re up to speed on these options for creating specialty eyewear.|
ALL KINDS OF REQUESTS
A former student of mine works where they accept vision care insurance for the employees of a large wholesale jewelry factory. He sees all kinds of requests for near work eyeglasses, often filling add power requests of +5.00D. Did you know that Flat-Top 28 bifocals in CR39® lens material are offered in add powers up +8.00D? High adds are useful for a wide variety of intensive near vision tasks (see “Low Vision Aids,” at right).
We recently had a patient in her mid-20s who loved a pair of +0.50D readers. Her special-purpose lens was something as simple as a low-powered reader or magnifier for doing her needlepoint work.
You may have heard the term “piano eyeglasses.” This term can be applied to any set of lenses that needs to work in a range from arm’s length to near vision length. Attempting to make an intermediate/near pair from a written prescription with only full distance and an add power can be a little tricky. One simple method for providing intermediate vision is to add half the add power to the distance Rx. This is easiest to understand when using a lined bifocal as an example.
|Mattingly Low Vision can provide high plus and microscopic spectacles to help those struggling to view the smallest of parts.|
OD: -1.50 -0.75 X 78
OS: -2.25 – 2.00 X 89
This would make our single vision intermediate Rx:
OS: -1.00 -2.00 X 89
This would make our single vision reader Rx:
OS: +0.25 -2.00 X 89
If I want to create a multifocal lens with an intermediate Rx in the distance zone and the full reading Rx in the segment area (there’s no distance Rx in this bifocal; only near and intermediate), use an add of +1.25D instead of +2.50D.
This will result in an intermediate zone of:
OS: -1.00 -2.00 X 89
And a near zone of:
OS: +0.25 -2.00 X 89
While “half the add” method is convenient, it doesn’t always work well, especially with more mature patients with higher adds who have little accommodative ability. Often, there is no substitute for the real thing. Your best friends in these custom requests will be a doctor, a tape measure, and a set of trial lenses.
If the object that is to be viewed cannot be brought into clear focus (playing the piano, for instance), then have the patient sit in the exact position they do when they are working with that object, and have someone measure from the object to their eye. In this way, you can recreate that distance with a similar object, and after setting up a trial frame with their Rx, the doctor can trial lens in 0.25D or even 0.12D steps to find the perfect power.
It is custom work like this that sets you apart from other offices. All it takes is a little thought and creativity, often working with very basic lenses. Chances are excellent that your patient is not the first person on earth who needed this particular special-purpose lens. Specialty work like this can also benefit your profitability because patients who have special purpose needs are also usually willing to pay a premium for something out of the ordinary. That’s a nice plus for using your optical skills in creative ways.
WHERE TO FIND IT: