Trouble shooting in problematic spectacles Faculty Aravind School of Optometry

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.

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.

Problems…. Patient may feel discomfort due to…., Clinical Errors, Technical Errors, Non-technical Errors Always refer the patient’s medical record first.

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.

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.

Technical problems At Optical shop At Optical lab

Lens defects -Optical lab Lens thickness Stress lines Distortions Abrasions Poor polishing Unwanted prisms.

Fitting defects - Optical lab Decentring Incorrect lens power. Scratches Inaccurate Axis Segment height variations lens chips at edges Fitting gaps Wrong lens (occasionally)

Frame defects Poor facial wrap Incorrect vertex distance Bridge size Temple length Earpiece Pantoscopic tilt. Style (occasionally)

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.

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.

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.

Patient complaints - Possible causes Symptoms (complaints) Possible causes Distance vision is blurred 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

Patient complaints - Possible causes Symptoms (complaints) Possible causes Difficulty in reading (excessive lateral head movements when reading) 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 Distance vision is clear only when head is tilted back In correct Prescription Head has to be tilted back for reading In correct Prescription Fitting height too low Head tilt Forward at distance Fitting Height too Low Head tilt Forward at near & Intermediate Incorrect Prescription

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.

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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