Eyewear dispensing is always enjoyable, but the real fun happens when you are faced with a unique challenge.
The true test for an ECP comes when it’s time for innovative thinking and clever use of lenses and frames. Here are some real-world examples from around the country.
“I live in an area full of bow hunters that have some unique needs when it comes to releasing that arrow,” says Dave Gilman, LDO, of Rutland Optical in Rutland, VT. “Hunters need to see their prey, but they also need to see the sights on their bow, usually in the 36-in. range. To accommodate that, I use a flat-top 28 mounted vertically on the very nasal edge of the right (or left) lens, 10mm or less from the rim. Don’t forget to swing the axis 90° when ordering. I usually use an add that’s 50% of the normal add, or maybe 60% if they are under 5 ft. 8 in. If you switch the bifocal back to normal position, this works well for handguns too.”
‘MINUS’ READING ADDITION
One of my patients presented with the following Rx: O.D. -3.50- 0.75 x 40 O.S. -3.00 -1.00 x 72, add O.U. -5.00D, executive bifocals, glass. This patient had anterior lenticonus, causing the anterior section of the crystalline lens to bulge forward and downward, which precipitated the need for the -5.00D add. The prescriber confirmed the -5.00D add and noted: “I want an executive.” The most logical option was an upside-down executive bifocal, but no lab would touch it. My employer suggested, “Let’s do a Franklin!” He dug up some Canada Balsam cement (Franklins are made from two single vision lens halves cemented together) and we got to work. Differences in lens curvatures can be problematic, but the patient was satisfied with the result. She wore them until she had intraocular lens surgery for cataracts.
NECK MOBILITY ISSUES
Mary Ann Hargrove, ABOM, of Empire Optical in Tulsa, OK, reports, “A man presented this prescription: +1.00 sph/add +2.50 OU. He had a progressive multifocal and was a prominent petroleum engineer who lectured internationally. His work included using two large desktop monitors. He had a severe neck injury that made his head immobile, and he could only scan his computers by twisting his body at the waist. He couldn’t move his head up or down without pain. He also used notes when lecturing, drove a car, and was sensitive to bright sunlight.”
Following a search, Hargrove found a magnetic frame with a full rim and made a pair of distance/intermediate (+1.00D/+1.25D) eyeglasses with an AR-treated executive bifocal. The measurement of the seg height was very carefully adjusted to consider podium height and auto instrument panel height so the patient could see them without pain. Hargrove ordered a spare magnetic clip-on that she re-glazed with AR-treated single vision +1.25D lenses. This gave the patient computer/reading eyeglasses (+2.25D/+2.50D) for working, also with a minimum of neck stress. The second pair of clip-ons were already polarized, and he was able to drive comfortably in bright sunlight. Hargrove recalls, “This was one happy fella!”
SHOOTERS AND POLICE OFFICERS
Howard Jadofsky, LDO, of On-Sight Optical in Stanardsville, VA, had a state police pistol instructor who wanted glasses that he could use to focus his pistol, use his in-car computer, keep an eye on a person outside during traffic stops, and drive. With so many uses for one pair of glasses, he finally settled on a Gradal‘ RD by ZEISS from Carl Zeiss Vision, Inc. “The RD is a room-distance lens, and the key is knowing the lab adds +0.50D to the top and -0.25D to the add (sometimes -0.50D),” he says. “Also, the fitting reference point is in the corridor.” Jadofsky fitted the lens low, putting the eye above the fitting reference point and altering the ordered Rx so the top was the same as normal distance vision. It worked and other officers have also requested the same eyewear.
Sharon Leonard is a licensed optician and contact lens practitioner in the Syracuse, NY, area.