While it has been many years since I have dispensed glasses, the memories of troubled patients are still fresh in my mind. I had the blessing of being trained under a master optician back in the days when this still meant something. I wish I could remember half of what he shared with me.
Through this training early in my career, along with hundreds if not thousands of calls working with dispensers over the last 18 years I've been with IcareLabs, I feel I have become pretty good at troubleshooting issues with a pair of glasses.
Much like a complex recipe, troubleshooting seems challenging from the outside. However, when broken down into individual steps it becomes effortless. In comparison with cooking, following each step in sequence makes even the most complex dishes seem easy.
Create Your Recipe
Having a difficult job will happen regardless of how hard you try to prevent it. Establishing a plan will prevent these issues from escalating further than they need to.
When you have a plan, you will be prepared and more confident when discussing the solution with your patients. This confidence will transfer to them and you will come across looking like a professional, steely-eyed, eyeglass dispensing master. As you know, there are hundreds of order takers to every pro. Your patients will appreciate the difference.
Yes, your first and most crucial step is to simply sit there with your mouth shut and ears wide open, completely engaged. Why is your patient grumbling? What is the main problem or complaint? Where is it that they are struggling? Their perception just became your reality.
Listen to what they are saying and then repeat it back to them to confirm you are both on the same page. Write some notes as you go through the information gathering. Questions like – "when did this problem start? Is it better when you…? Does it get worse when you…?"
Get all of your questions out of the way at this one point.
Get BusyYou now know the problem because you took the time to listen. You have all your notes and now it is time to find the “issue” that is causing your patient so much pain and trouble. Here is how we can break it down into six easy steps:
- Did you order the correct Rx? Yes, this happens often. You have an Rx from the doctor, you place an order with your lab, and the job comes back looking great. You check the order in with the paperwork from the lab - all looks good. Then the patient is called and arrives to pick up their glasses that they will never be able to wear, simply because of an input error. Always double-check that the lab power matches the original Rx.
- Mark the lenses back up.
- Recheck the Rx in the glasses.
- Verify the add power. Progressives will be verified using the add power engraving in the lens.
- Double-check that the PD is correct.
- If all of this checks out, you will need to mark the fitting cross on the progressive or the OC on SV or bifocal. Then place them back on the patient and make sure the frame is adjusted comfortably to the patient and verify fitting cross/ OC is in the correct spot.
If all of this checks out it is time to get even busier.
With today's digital processing it is very difficult to induce unwanted prism, but it's still possible. Your next step with a progressive lens is to check the prism reference point (PRP) for prism imbalance. Most progressives will have some sort of prism thinning in them; Thus resulting in some base up or base down yoked prism. If this prism is equal from OD to OS, all is good. Now you can move on to your next step.
Check for waves. Someone once said that a progressive lens is one big controlled wave. While this is not true, it sure can look like it when you hold the lens away from you and look around it. Do this with the lenses and look for waves in the distance, intermediate channel, or reading zone.
Check Out Old Glasses
At this point, you need to take a step back and check out your patient’s old glasses. Mark them up and compare the fit between the old and new. Were they wearing them low or high? Did they get used to a wrong PD?
Check the base curve. Did it change with the new pair? This is a very common problem as most patients don't do well with base curve changes.
Did they go from a short corridor design to a long corridor? This is a very common issue over the last few years as frame designs have become larger. Your patient will have to lift their glasses up to read if this is the issue.
Complaints - Probable Issues
Complaining about swim – Is your patient saying that they feel dizzy or that the world is spinning? This is very common for first-time PAL wearers. Most often this will go away after a day or two of constant wearing
Seeing rainbows – This could be two different issues. First, it can be the glare coming off of polished edges. Second, it could be chromatic aberration. This is a direct low Abbe value lens material with high curves.
Feeling like they are looking through a bowl or walking up a hill – If they are in single vision or bifocal check that the OC is over the pupil. Most often this is the patient experiencing base-down prism. If the patient complains of feeling like they are walking down a hill it could be them experiencing base-up prism.
The patient can't read in progressives – The patient says that they do better when lifting their glasses up. Double-check the fit. If all is good, you can try adding a little pantoscopic tilt. If this does not fix the issue, the only option left is to reorder in a short corridor design or with a fixed design that is shorter.
Troubleshooting doesn’t have to be challenging. By establishing a plan you will come to your patient as confident and competent. Own your plan of action and stick with it. You will come off as the optical rock star your patient is looking for. That is how you turn a customer into a stark raving mad fan of you and your business.