DISPENSING PALs

AUTHOR
David Wilson: Brien Holden Vision Institute (BHVI), Sydney, Australia

PEER REVIEWER
Mo Jalie: Visiting Professor: University of Ulster, Varilux University in Paris

THIS CHAPTER WILL INCLUDE A REVIEW OF:

• Frame Selection
• Frame Requirements
• Frame Adjustment
• Facial Measurements
• Lens Ordering

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FRAME SELECTION

FRAME SELECTION

Figure 25.1: Comparison of frame parameters for PAL selection

Progressive lenses are best suited to regular shapes, round, oval, square and close
variations of these. They are least suited to aviator style frames, which cut off much of the
FRAME SHAPE
reading zone (Figure 25.1). It is important that the shape allow for the full use of all zones
within the lens.
All progressive lens manufacturers specify a minimum distance from the fitting cross to
the bottom of the frame (Figure 25.1). This is to ensure full use of the near zone. For most
progressive lenses this distance is around 19 mm, measured from the fitting cross to the
inner rim directly below the fitting cross. It is important to note, that this is not the point of
FRAME DEPTH
reference for measuring the height of the fitting cross. We will consider this issue later.
The frame chosen must allow for the manufacturer’s minimum depth. There is no
minimum height above the fitting cross; however, common sense should be used to avoid
selecting a frame where the fitting cross is too close to the top of the frame.
Most frames are required to be of adequate size for progressive lenses, with the possible
exception of depth as described above. The common problem with frame size is choosing
FRAME SIZE a frame that is too large. The smaller the frame the smaller the areas of unwanted
astigmatic power (Figure 25.1). Most modern regular frame shapes are ideally suited to
progressive lenses.

FRAME REQUIREMENTS

The three frame requirements are all closely related in that they all impact on the field of view. This will be discussed
further in the section on frame adjustment:

BACK VERTEX The best frames for progressive lenses are those that can sit comfortably with a relatively
DISTANCE small back vertex distance.

PANTOSCOPIC TILT The frame selected should have a reasonable pantoscopic tilt of at least 10° - 12°.

The frame selected should not be too flat in terms of its facial wrap. This allows for
FACIAL WRAP
optimal use of all three zones.

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FRAME ADJUSTMENT

The frames selected for progressive lenses will require adjustment:

• When the measurements are being taken: It is not possible to take accurate facial
measurements and particularly heights, if the frames are not sitting correctly on the
patient’s face. The frame should be positioned exactly as it will be worn when
finished.
• On final delivery of the spectacles: A good adjustment is critical not only for
FRAME ADJUSTMENT comfort but also to ensure that the lenses work to best effect.
The normal frame adjustment procedures should be followed when adjusting the frame.
This involves starting from the front of the frame and working back since any changes
made to the frame front will affect the length to bend.
Start with the facial bow and horizontal alignment of the frame, followed by the angle of
the sides, the pantoscopic tilt, the length to bend and finally, the angle-down and
anatomical bend. In addition to the normal adjustment procedures there are certain
special considerations that should be made with progressives:

Progressive lenses should be fitted with the smallest vertex distance possible. This allows
for an increase in the field of view through the various zones of the lens (Figure 25.2(a)).
VERTEX DISTANCE The benefits are particularly noticeable in the intermediate corridor and near zone. It
works much like looking through a keyhole, the closer the eye is to the keyhole the
greater the field of view through it.

Pantoscopic tilt works in the same way as reducing the back vertex distance. By
PANTOSCOPIC TILT increasing the pantoscopic tilt the near and intermediate zones are brought closer to the
eye and the field of view through the two zones is thereby increased (Figure 25.2(b)).

Increased facial wrap also works by bringing the various zones closer to the eye, moving
the troublesome temporal peripheral areas back out of the way of the line of sight
(Figure 25.2(c)).

FACIAL WRAP

Figure 25.2(a): Reduced back vertex distance gives a wider field of view
Figure 25.2(b): Increased pantoscopic tilt increases near field of view
Figure 25.2(c): Increased wrap increases near field of view

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FACIAL MEASUREMENTS

After choosing and adjusting the frame chosen for the progressive lenses, facial
measurements are taken for fitting of the lenses. This is a very important part of
dispensing progressives, as poor facial measurements are the cause of the majority of
FACIAL
adaption problems. There are various ways of taking these measurements but they can
MEASUREMENTS
be broken down into four basic methods. Whichever method is adopted, it is important
that it is carried out consistently and carefully. We will look at each method in turn before
comparing them.

Step 1
As mentioned earlier we must start by adjusting the frame to fit. When doing this,
remember to consider the back vertex distance, the pantoscopic tilt and the facial wrap.

Step 2
Use the pupillometer to measure monocular PDs. The pupillometer will give an accurate
and consistent reading of the distance between the visual axes (Figure 25.3). Where a
pupillometer is not available the best alternative would be a PD rule, using a pen torch to
show the corneal reflex. It is important to maintain the pupillometer and have it
periodically calibrated and checked for accuracy.

Note that, if corneal reflexes are not considered when using a PD rule, the distance
measured will be the interpupillary distance as opposed to the distance separating the
visual axes (as measured using the pupilometer). The pupillometer will therefore give a
reading that is marginally narrower than the distance measured using the PD rule due to
the visual axes lying slightly nasal of the pupil centres. The pupillometer reading should,
DISTANCE METHOD 1 however, coincide with the PD rule measurement if the corneal reflexes are exposed to
allow for measurement between the visual axes.

Figure 25.3: Measuring monocular PDs using the pupillometer

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FACIAL MEASUREMENTS (cont.)

Step 3
To measure the height, clip the Horizontal Measuring System (HMS) to the adjusted
frame (Figure 25.4A) and place it on the client’s face (Figure 25.4B). Move the frame up
and down a little and let it settle. Use a pen torch to obtain the corneal reflex and line the
top of the HMS scale with the reflex in each eye. Note, it is the white line at the top of the
plastic plate that is the reference point. Adjust the knobs on the sides of the HMS to move
the scales up or down and to position the top of the scale so that it is level with the pupil
centre (Figure 25.4C).

Figure 25.4A: HMS clipped adjusted frame Figure 25.4B: Placing the HMS clipped
adjusted frame on the client’s face

DISTANCE METHOD 1
(cont.)

Figure 25.4C: In progressives adjusting the knobs on the sides of the HMS

Step 4
Check the height measurement by having the client wear the frame with the HMS and
note the position of the graticule while engaging the client in conversation (Figure 25.5).
This ensures that they are sitting in their habitual position.
Once the final position is decided upon, remove the frame and note the line on the
graticule, which is tangent to the lowest point on the inside rim (Figure 25.5). Add half a
millimeter for depth of the bevel.

Figure 25.5: Checking the measurement by noting the position

of the graticule while the client is wearing the frame with HMS

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FACIAL MEASUREMENTS (cont.)

Step 1 and 2 as for Distance Method 1

Step 3
Using the boxing frame measurement system, mark the horizontal centre line (datum) on
the dummy lenses, using a parallel rule or layout chart and draw a vertical line at the PD,
marking every 2 mm above the HCL (Figure 25.6). Be sure you are finding the true
mid-point between the tangents to the top and bottom of the lens, especially if you are
using a parallel rule and clamping the outside of the frame. A frame with a thick top rim
and a thin bottom rim can create errors when using the parallel rule.
Remember, when using the boxing frame measurement system, the three horizontal
reference lines are the line tangent to the top of the lens (that is, the peak of the bevel of
the lens or the depth of the groove), the tangent to the bottom of the lens (again the peak
of the bevel) and the line mid way between them, formerly known as datum but now, more
correctly, known as the horizontal centre line (HCL).

Figure 25.6: Marking the horizontal centre line (datum) on the dummy lenses using a layout chart

DISTANCE METHOD 2
Step 4
Place the frame on the patient’s face and check that the point on the marked vertical line
corresponds with the pupil centre. Make sure that you are at eye level with your patient.
Ideally you should be using an adjustable stool or chair. You can check your relative
heights by looking into the wall-mounted mirrors in the dispensary and checking your
height compared to your patient’s.
Step 5
Check the height by talking to the patient (Figure 25.7). If the patient feels they are being
measured, as in step 4, they will not be sitting naturally. If they are engaged in a
conversation, though, they are likely to be sitting in a more natural position.
Some practitioners would argue that this measurement should be taken while standing;
however, it is unlikely that the practitioner and the patient will always be of similar height.
Therefore, sitting in an adjustable chair ensures that you are at eye level with your patient.
You may wish to observe the patient standing with the frame in position to see if their
head posture is noticeably different.

Figure 25.7: Checking the height by placing the frame on the client’s face

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FACIAL MEASUREMENTS (cont.)

Step 6
Order the heights as per step 5 and the PDs as per your pupillometer reading. You can
simply measure the heights with a PD rule or with the parallel rule. Before ordering the
lenses, double check that they will cut out by placing them on the layout chart and ensure
there is sufficient depth below the fitting cross (Figure 25.8).

DISTANCE METHOD 2
(cont.)

Figure 25.8: Re-checking and confirming the dot marks on the layout chart before ordering

Step 1 and 2 as Already Outlined

Step 3
Place the frame on the patient. Using a fine tipped marking pen, dot the dummy lenses at
the point corresponding with the centres of the pupils (Figure 25.9). Once again, you must
be at eye-level with the patient. A fine tipped pen ensures that the dot is small for
accuracy. A white inked pen is also useful since blue and black are difficult to see against
the black pupil.

DISTANCE METHOD 3

Figure 25.9: Marking dots on the dummy lenses at the point corresponding to the
pupillary centres with the frame placed on the client’s face

Step 4
Once dotted, check the height by talking to the patient. If they are engaged in
conversation they are more likely to be sitting in a more natural position. If the dots do not
appear to be at the correct height you will need to re-dot the lenses.

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FACIAL MEASUREMENTS (cont.)

Step 5
Order the heights as per step 4 and the PDs as per your pupillometer reading or
according to the position of the dots. Once again check that the lenses will cut out by
placing them on the layout chart (Figure 25.10).

DISTANCE METHOD 3
(cont.)

Figure 25.10: Re-checking the dot marks of dummy lenses on layout chart before ordering

This is also referred to as the “mirror method”

Steps 1-5
The first five steps are identical to the distance method 1. The only difference being that
instead of ordering the positions of the fitting crosses after step 5; we check the position
of the reading zones.

Step 6
We must first mark the distance and near visual point circles. These circles are drawn
around the visual points (Figure 25.11). They are not the same as the checking circles
marked on the layout chart. The distance visual point circle is a small circle (about 10 mm
diameter) centred on the fitting cross. The near visual point circle is a similar sized circle
NEAR METHOD 1 centred at the top of the near checking circle.

Figure 25.11: Marking the distance and near visual point circles around the visual points

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FACIAL MEASUREMENTS (cont.)

Step 7
Put the frame with the marked visual point circles on the patient (Figure 25.12). Place a
mirror on the table between you and the patient at the normal reading distance or have
the patient hold a mirror horizontally at that position. Look at the mirror, observing the
patient’s right eye with your right eye and their left with your left. You should see the
centres of the patient’s pupils in the middle of the near circles. Some manufacturers
produce mirrors with circular fluorescent tubes around them. These produce a small
corneal reflection, which can be seen in the circles. It is also possible to hold a pen torch
immediately under each eye as you observe the patient.

Figure 25.12: Placing the frame with the visual point circles on the patient.
The visual point circles are the white circles seen in this picture

NEAR METHOD 1 (cont.) Step 8

If necessary, move the circles horizontally to coincide with the pupils when viewing
through the mirror. If the pupils appear too high or too low simply have the patient tilt their
head more one way or the other. If they are at uneven heights then recheck steps 4 and
5, where an error must have occurred.
Step 9
When you have decided on the positions of the distance and near visual point circles for
each eye, place the frame over the layout chart with the near visual point circles centred
at the top of the near checking circles and mark the positions of the fitting crosses for
each eye (Figure 25.13).

Figure 25.13: Marking the positions of the fitting crosses on the dummy lenses using layout chart

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FACIAL MEASUREMENTS (cont.)

Steps 1 to 5 as for Distance Method 2

Step 6
Order the heights as per step 5 and the PDs as per your pupillometer near CD reading
plus the manufacturer’s inset (usually 2.5 mm each eye). You can simply measure the
heights with a PD rule or with the parallel rule. Before ordering the lenses though, double
check that they will cut out by placing them on the layout chart and also ensure that there
is sufficient depth below the fitting cross (Figure 25.14).

NEAR METHOD 2

Figure 25.14: Re-checking the dot marks on dummy lenses using a layout chart before ordering

Distance versus the near methods

The distance method is the traditional approach to fitting progressives. It is generally
quicker than the near method (especially the mirror method). The near methods were
developed due to a realisation that some people hold their reading material to one side
and convergence varies between patients and does not necessarily conform to the
manufacturer’s 2.5 mm each eye. These factors warranted consideration to ensure
correct positioning of the near and intermediate zones. The basic philosophy behind the
near methods is that it is important to get the more critical near and intermediate zones
correct and let the more forgiving distance area look after itself.
Mirror method versus near method 2
Near method 2 allows for variations in convergence but not variations in posture. Its
supporters argue that convergence is the most important factor and that a patient’s
posture will vary over time.
Pre-marking the dummy lenses versus dotting the lenses
COMPARING THE
METHODS Pre-marking the dummy lenses allows both hands to be free during the observation and
checking of the heights, while talking to the patient (Figure 25.15). It avoids the need for a
steady hand while taking the measurements and allows adjustments to be made to the
height without having to re-dot. It also avoids the problem of having to approach the
patient’s eyes with a pen. The patient will certainly not be relaxed if the practitioner is
poking a pen at their eyes.

Figure 25.15: Dotting the dummy lenses while talking to the patient

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FACIAL MEASUREMENTS (cont.)

Pupillometer versus PD rules and dots

The pupillometer takes an accurate measurement of the distance between the visual
axes, as opposed to the distance between the pupil centres, normally measured by PD
rules and by dotting. A measurement of the distance between visual axes can be made
with these other methods by using a pen torch but there is still the problems associated
COMPARING THE with head movement and parallax error caused by the position of the torch and the
METHODS (cont.) respective sizes of the patient’s and practitioner’s PDs.
Care must be taken with pupillometers. As with any instrument, they will not give an
accurate reading if mistreated. They should therefore be checked and serviced regularly.
It is important to remember that the pupillometer will not agree with the PD rule
measurement (if made without obtaining the corneal reflexes with a pen torch), as they
are not measuring the same distance.

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LENS ORDERING

Progressive lenses must be ordered with monocular PDs (regardless of the method used
PDS
to measure them).

Like PDs, heights must also be considered monocularly. It may well be, due to facial
HEIGHTS
asymmetry that the heights are different in each eye.

Many laboratories prefer the height to be ordered relative to “datum” (Figure 25.16). The
reason for this is that its position is absolutely certain. All modern templates are cut with
their locating holes on datum. Datum tends to leave less room for error.

MEASURING FROM THE

HORIZONTAL CENTRE
LINE (DATUM)

Figure 25.16: Measuring height from Datum line

Unlike “datum”, there is less certainty about what is meant by the “bottom of the frame”.
Some believe it to be the bottom of the frame at the monocular PD, some believe it to be
at the centre of datum, some the bottom at the centre of the box (boxing frame
measurement system) and others believe it to be the absolute lens bottom (Figure 25.17).
It is the last that is most correct even though there are some countries and laboratories
that may use one of the other reference points. Heights referred to the bottom of the
frame should mean a line tangent to the bottom of the lens (that is, the peak of its bevel)
or the inside of the groove. This is the bottom line of the boxing frame measurement’s
“box”. Some newer edging machines require the distance from the bottom of the frame to
be entered into the machine during processing so it is important that it is measured
MEASURING FROM correctly. Remember that if you are measuring from the inside of the rim you must add
THE BOTTOM OF 0.5 mm for depth of the groove.
THE FRAME

Figure 25.17: Measuring height from the bottom of the frame

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LENS ORDERING (cont.)

As mentioned in the various facial-fitting methods, once the position of the fitting cross is
determined, it should be checked against the appropriate layout chart to ensure that it
cuts out (Figures 25.18A and 25.18B). This must be done before the patient leaves so
you won’t have to bring the patient back to complete the entire frame selection and
measurement process again.
Once this has been confirmed you will need to supply the laboratory with the following
information:
• Lens powers: Distance and Add
• Frame details
• Distance monocular PDs (regardless of the fitting methods you have used)
• Fitting heights and point of reference (HCL or frame bottom)
• Progressive lens design
CHECKING THE
CUT-OUT • Lens material
• Lens coating or treatments

A. B.
Figure 25.18: Checking the cut-out

BIBLIOGRAPHY

Jalie M. 2003. Ophthalmic Lenses and Dispensing. Butterworth Heinemann, London.

Jalie M. 1984. Principles of Ophthalmic Lenses, ABDO, London.
Wakefield KG and Bennet AG. 2000. Bennett's Ophthalmic Prescription Work, Butterworth-Heinemann.
Brooks CW and Borish IM. 2006. System of Ophthalmic Dispensing. Butterworth Heinemann.
Brooks CW. 2005. Essentials of Ophthalmic Lens Finishing. Butterworth-Heinemann.
Wilson D. 2006. Practical Optical Dispensing 2nd Edition. Open Training and Education Network, Sydney.
Wilson D and Stenersen S. 2002. Practical Optical Workshop. Open Training and Education Network, Sydney.

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NOTES

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