Trouble shooting in
problematic spectacles
Faculty
Aravind School of Optometry
ARAVIND EYE CARE SYSTEM
Aravind Eye Hospital
& Postgraduate Institute of Ophthalmology
Madurai, India
Key to Problem solving is to:
 Listening the patient’s complaint carefully first to
understand the genuine cause of complaint.
 Identify the problem.
 Start a systematic approach & do the appropriate
correction depends on the symptoms /sign.
 Assure the patient of our best efforts.
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Approaches in Problem solving
 The more traditional, rational approach is typically used and involves,
 clarifying description of the problem,
 analyzing causes,
 identifying alternatives,
 assessing each alternative,
 choosing one,
 implementing it, and
 evaluating whether the problem was solved or not.
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Problems….
Patient may feel discomfort due to….,
 Clinical Errors,
 Technical Errors,
 Non-technical Errors
Always refer the patient’s medical record first.
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Clinical errors
 Inaccurate refraction.
 Wrong prescription.
 Poor communication
 Less priority to the patient’s main complaint.
 Inadequate information about recommended
lens/frame.
 Not so impressed approach.
 No differentiation the new prescription and
using spectacle.
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If suspect any Clinical problem,
 Check the PG power as in the prescription.
 Check the Rx is written correctly as in the case
sheet.
 Check the given prescription to correct patient.
 Check the vision with present glass.
 Repeat the refraction if need,
 Confirm the astigmatic axis as in the prescription.
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Technical problems
 At Optical shop
At Optical lab
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Lens defects -Optical lab
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Lens thickness
Stress lines
Distortions
Abrasions
Poor polishing
Unwanted prisms.
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Fitting defects - Optical lab
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Decentring
Incorrect lens power.
Scratches
Inaccurate Axis
Segment height variations
lens chips at edges
Fitting gaps
Wrong lens (occasionally)
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Frame defects
 Poor facial wrap
 Incorrect vertex distance
 Bridge size
 Temple length
 Earpiece
 Pantoscopic tilt.
 Style (occasionally)
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If suspect any technical problem,
 Check the lens quality.
 Verify the centring.
 Check the surfacing defects (thickness, unwanted
prism etc.,)
 Ensure that any other materials defect occurred.
 Reassure the frame alignments.
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How to identify the problem?
 Use only open –ended questions.
 Ask the patient to specify the problem.
 Do keen observation of use.
 Understand the possible cause of the problem.
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First approach…
 Refer the patient’s medical records to confirm the
prescription details.
 Ask a patient to wear the spec’s and Observe.
 Misaligned frames and improper frames size can cause the
following problems:
 Vertex distance discrepancy which can affect the effective power of
the spectacles
 Misaligned frames may be positioned awkwardly
 Incorrect size frames /temples cause discomfort to the wearer.
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Patient complaints - Possible causes
 Symptoms (complaints)
Distance vision is blurred
Possible causes
Incorrect prescription
Incorrect axis
Segment height is too high
 Near vision is blurred
Incorrect prescription
Segment height is too low
 Large vertex distance
Incorrect PD
Insufficient pantoscopic tilt
Insufficient facial wrap
 Waves seen in distance vision zone
Incorrect prescription
Incorrect axis
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Patient complaints - Possible causes
 Symptoms (complaints)
Difficulty in reading
(excessive lateral head movements when reading)
Distance vision is clear only when head is tilted back
Head tilt Forward at distance
Head tilt Forward at near & Intermediate
Possible causes
Over correction in near vision zone
Incorrect PD
Segment height too low
Large vertex distance
Insufficient facial wrap
Insufficient pantoscopic tilt
Insufficient segment area; frame is too
small
In correct Prescription
Head has to be tilted back for reading
In correct Prescription
Fitting height too low
Fitting Height too Low
Incorrect Prescription
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Always keep it in mind…
 If there is no technical problem found, gentle counseling can
help to understand the real cause of the dissatisfaction.
 Other reasons
 Cost factor
 Poor counseling
 Behavior
 Miscommunication by staff
can also make the patient unhappy.
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Key points to remember…
 Everyone may do mistakes but don’t deny.
 Final verification before delivery is always better.
 Ensure the patient’s satisfaction by doing
 on-eye verification
 Necessary frame alignments
 Vision check for both distance and near.
 Overall comfortness check.
 Patient’s relationship is highly important.
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