DISPENSING THE HIGHER OR

UNUSUAL RX
FITTING, EDGING & DISPENSING

OAO
APRIL 2017

M A R I LY N S M I T H R O

Sponsored by the CAO/CCOA Program

 DO NOT BE AFRAID

• Often the higher the

Rx dioptre value, the
less lens choices
• Offer the best lens
choice and best
coatings possible
• Be meticulous with
measurements
 LARGE FRAMES CREATE
THICKER LENSES
As fashion change & may dictate larger
frames be aware:
-create thicker lenses despite high index lens
materials…warn patients!
- increase overall weight of glasses ED =
- may sit on cheeks! 49mm
Edge thickness increases
in minus lenses VS
Nasal thickness increases
in plus lenses ED =
64mm
Guide patient through frame
selection for fashion AND
Rx thickness BOX MEASUREMENTS!!!
 FRAME DEPTH & OC

• SV lens in lower Rx is usually set with OC @ 3mm above

Geometrical Centre (GC) with no vertical prismatic issue
• Larger frame = Deeper B measurement
• High Rx’s - measure pupil height for SV lenses to have
pupil centred at OC vertically (keep pantoscopic angle in
consideration!) & remove vertical prismatic issues
• Warn patient – lens will be thicker at lower edge (minus)
- thicker at upper edge (plus)

Smaller “A” measurement = less decentration

therefore less edge thickness
Smaller “B” measurement = less vertical
thickness
 POWER CROSSES – HOW THE LENSES WILL
LOOK IN THE FRAME
1. –2.00 – 4.50 x 180 2. +7.25 -1.50 x 044
-6.50 +7.25
+5.57
-2.00

3. PL – 2.25 x 137 4. +3.25 – 3.25 x

020
+0.00 -2.25 PL
+3.25

In a power cross, the SPHERE is attached to the AXIS direction

This is very beneficial when considering lens thickness in a frame design
 SPECTACLE MEASUREMENTS

• Always take monocular PDs

• Use pupilometer properly

• Adjust frame thoroughly before taking

measurements
• For single vision lenses record pupil height
• Multifocal measurements should be
precise & be compared to previous pairs
• Computerized devices can be helpful
• Take all measurements at least twice!
 MINUS VS PLUS

Minus Lenses Plus Lenses

Frame PD = Patient PD Frame PD = Patient PD
Rounded frame edges Rounded frame edges
Vertex distance Vertex distance
Hi Index Lenses Aspheric Design
Aspheric Design Hi Index Lenses
Temple hinges Nosepads
Nosepads
 FRAME SELECTION – HIGH RX

• regular shape, metal or plastic

• smaller eyesize best (PD = Frame PD)
• head clearance look for wider hinges
• thicker full eyewire can help cover edge thickness,
zyl frame?
• nosepad/guard arm clearance?
• discourage rimless

GOOD, ADJUSTABLE
GUARD ARMS A MUST!
 HIGH MINUS LENSES

Edge thickness of lens changes with smaller frame choice

Keep frame PD as close to patients’ PD as possible for
minimum decentration & thinnest lens
Larger frame choice Smaller frame choice

Frame PD/2 – Patients Monocular PD = Decentration per Eye

Effective Diameter (ED) + (2 x dec’n per eye) = Minimum Blank Size
Consider TOTAL power & where lens will be thickest!
THICKER
TEMPLES

Terrific for hiding edge

thickness for high minus!
Warn about limited
peripheral vision in
Rx frame or sunglasses!!

Adjustment Tip for Thick Temples:

Height of temple and pantoscopic
angle cannot be adjusted at the
front hinge…only by adjusting
temple end up or down!
 PRESCRIBING FOR HIGH MINUS RX

• High index
• 1.56,1.6, 1.66 for Rx’s up to -6.00*
• 1.67, 1.74 (both aspheric) for higher minus
• 1.8 & 1.9 glass
- no safety hardening
- thinner but heavier
- safety issues, can break
*Polycarbonate (1.589) is less expensive, safe & a
good choice for children/cost, but low abbe 30

Tribrid – Trivex material in a 1.6 index, abbe 41, 100% UV

protection, very safe, more $$$ than polycarb
 HIGH MINUS EDGE THICKNESS

Use charts or computer apps for thickness demo! Dot pupil

centre on chosen frame and hold over chart to show thickness in
each index or put info into app to show & compare.

Using the same frame/PD dimensions approximately:

1.6 = 20% less thickness
1.67 = 25% less thickness
1.74 = 30% less thickness
1.8/1.9 = less thickness but weight/safety issues
 COMPUTERIZED DISPENSING

• Patient wears adjusted

frame, picture uploaded
• Calculation shows lens
thicknesses in all meridians
• Can compare indexes,
show thickness variations, www.Essilor.ca

various frames
• Most companies have GREAT for helping choose
software, some for iPads frames too!!
 HIGH MINUS – BEVEL
• Split bevel so
thickness is
shifted towards
front of frame
• Hides thickness
of minus lens
• Reduces 20/20 Magazine

thickness &
keeps F2 away
from lashes/face Huvitz

Can also be helpful to split thickness in high prism lenses!

 HIGH MINUS – BEVEL
• Back bevel sharp
• Roll or feather
back bevel to
protect from
injury to px
• Polish edges 20/20 Magazine

choice of px
• Show sample,
sometimes too
“shiny”

Automated edgers are terrific…BUT!!

 LENS STRESS

• Seen thru polarized lens or

polaroscope
• Stress usually in corners or
around outside of lens
• Can cause lens warpage or
ill fitting lenses
• Low power/thin centres
• Mark stress & re-edge to
HOYA
eliminate
• Polarized sunglasses show
stress in windshields etc
 HIGH MINUS - LENTICULAR

• Lenticulated design for over

approx. -15.00D
• Myodisc - scooped out minus
aperture with carrier
• Blended Myodisc (Optilenti) -
aperture edges blended
• Rx aperture from 28 – 42 mm
available in 2mm increments
Noticeable edge Better cosmetics
• Aperture size changes lens
thickness (smaller = thinner
BUT less peripheral vision)
 HIGH MINUS - LENTICULAR

• To choose either minus style

lenticular (myodisc or blended)
design depends on Rx, frame
choice & patients’ expectations
• F1 (base curve) is plano or minus
depending on Rx
• Up to -20D can be ok in a full field
lens design if frame is small From Darryl Meisters’ OptiCampus website

enough
• Have samples to show patient
 HIGH MINUS - LENTICULAR

• Measure pupil height to “centre” the aperture vertically @

OC for best vision
• Measure height to pupil using
Box Measurements with adjusted
frame

• Carrier is thinned to outer edges towards frame for better

fit into frame and thinner outer edges
• Vision is limited by aperture size, no vision thru carrier
• Not all patients adapt if moving from Myodisc to Blended
Myodisc (blurred edges of aperture are noticeable)
HIGH MINUS - APERTURE

• Aperture size depends on

frame size, Rx & patient
preference
• Using “B” measurement
helpful for determination of
aperture size
• Smaller aperture = less
thickness but less peripheral
vision
 HIGHER PLUS LENSES

• Aspheric CR-39 for +2.00 to +4.00

• Aspheric design flattens front
surface, reduces thickness
& magnification
• Hi index + aspheric for above +4.00 an option
• Higher indexes 1.67/1/74 are automatically aspheric design
• Aspheric polycarbonate an excellent low cost hi index option
– very safe for kids
• Flat F2 can be a problem for long eyelashes
 HIGH PLUS LENSES - ASPHERIC

• Aspheric designs flatten F1

• Reduce thickness & weight
• Reduce look of magnification
• Reduce peripheral aberrations
• Centre approx 10mm is original
spherical “base curve”
• Depending on Rx, CR-39 or hi-
index lens material
• Hi index less benefit with high
plus Rx – edges can only be
made to “knife-edge”
 ASPHERIC LENSES - MAGNIFICATION

• Aspheric lenses keep image

consistent across lens surface
• Reduces magnification of image
(and eye) in plus Rx’s
• Reduces minification of eye in
minus Rx’s
• Better vision and better
cosmetics
• Can be beneficial in high - Rx
• Consider pantoscopic angle &
OC height, must be precise for
aspheric lens design
 ASPHERIC LENS DESIGN

• How can you tell if a lens is

aspheric?
• Centre 10mm are the
“base curve”
• Gently place lens gauge
across F1 (don’t pull
across F1 – could scratch
lens surface!)
• If curvature changes from
centre – lens may be
aspheric design
 FITTING HIGH PLUS RX - FRAME

• Smaller eyesize (not as big a concern as minus –

sometimes helpful for thinnest edge!)
• Regular (more rounded) shape
• Little or no decentration
• Short vertex distance
• Adjustable nosepads with good guard arms (plus lenses
thick @ centre edge!!)
• Cable temples or snug fitting skull temples
• Rimless discouraged
 LENTICULAR
HIGH PLUS LENSES

• Lenticular design an option to reduce weight & thickness

• 40 mm lens Rx zone with plano “carrier”
• reduces weight & thickness
• fits into frame edge better than
• thick + lens edges
• looks like a “fried egg”
• high plus lenses over +12D
• no choices in aperture size
40mm

65mm
HIGH RX & F2 CONCERNS

Watch for:
-Long eyelashes
-Thicker Rx’s (especially plus prescriptions)
-Flatter bridged people
-Round cheeks & high cheekbones
-Frames with no nosepads
 HIGH PLUS WITH BIFOCAL
LENSOMETRY REMINDER

• High plus prescriptions

create thick lens issues
• Refraction & true power
of distance Rx on F2
• Lined multifocals are
created on F1
• Turn lens over, check
distance & near Rx
• Difference is true add
power
 BASE CURVE
(F1 OF LENS)

• Base Curve on Spectacles – lowest curve on F1

• Base Curve of lenses should stay consistent from
one pair of spectacles to the next
• Always record base curve in patient record
• Base curve cannot be duplicated if changing from
one lens index to another
• Counsel patient some adaptation may need to
occur when changing base curves
• Lens gauge readings can be incorrect if index is
unknown
 ADD POWERS WITH LENS GAUGE

• If lined multi-focal is
one-piece design
• Check add power by
comparing F1 curves in
distance and near
• Difference in curvatures
= approximate add
power
• Varies by index!
 LENS GAUGE VS LENSOMETER

• Lensometer bends light

= true power
• Lens gauge measures
surface power BUT
based on index of lens
• If lensometer ≠ lens
gauge (total power),
lens is a different index
from lens gauge
• Calculate to find true
index!
 HOW TO DETERMINE
LENS INDEX
• Lens gauge curves (Total Power = F1 + F2) will not be
equal to power from lensometer
• Lens gauge is calibrated to specific lens index

• Lensometer only bends light = true power of lens

• Some lens gauges have 1.49 AND 1.6 dials
 HOW TO DETERMINE
LENS INDEX
Take lens curve from lens gauge with known index value & determine
power of lens in one meridian
Neutralize lens in lensometer for true power in same meridian

n L
= index of the Lens
n LM
= index of the Lens Measure (lens gauge)
F V’ = power of the lens from Vertometer (lensometer)
FLM
= power of the lens from Lens Measure (lens gauge)

Will determine exact index of lens material

Based on thin lens design
www.opticampus.com – good reference for optics/formulas etc
 EXAMPLE

Using 1.49 index dial, lens curve from lens gauge is = - 4.50
Lensometry power value in same meridian = - 5.75

n = (1.49 – 1) x ( – 5.75 ) + 1
- 4.50
n = (0.49) x (1.27) + 1
n = 0.62 + 1
n = 1.62

The index of the lens material is 1.6

 HIGH ADD POWERS

Straight Top Bifocals

- Adds up to +8.00D
Round Top Bifocals
- Adds up to +30.00D
- +0.25 steps up to +15.00D
- +0.50 steps +15.00 to +30.00D
Progressive Addition Lenses
- Adds up to +300D in all designs
- Adds up to +4.00D in limited PALs
- Digital designs have unlimited possibilities!
 AR COATING A MUST!

• Use best AR coating

available
• Not an option (except for
young children when
expense for many Rx
changes is possible)
• Increases light into eye for
any Rx
• Better visually & cosmetically
 VERTEX DISTANCE

Distance from cornea to F2 of spectacle lens

Effective power can change noticeably

depending on Rx
Refraction with phoropter approx 13mm
Even 2mm shift in spectacle fitting can have
impact on rx’s over +/- 10D
Rule of thumb: take vertex distance for rx’s over
-8.00D or over +6.00D
MEASURING VERTEX DISTANCE

• Adjust frame on patient

• Use distometer to measure distance from
patients eye to F2 (with eye closed)
• Distometer automatically considers lid
thickness
• Arrow points to vertex in mm
(some hold the arrow in place, some don’t!)
• Include both measurements on lab order form
(vertex & refracted at)
• Lab will calculate new rx
• Remember to keep records of
new spectacle rx!
 EFFECTIVE/COMPENSATED
POWER CHANGES
Minus Lenses
• Effective power decreases as the lens
moves away from the eye
• ↓ power away from the eye
• ↑ power closer to the eye
• To compensate the Rx required for
shift in vertex distance
• ↑ power if further from phoropter
setting
• ↓ power if closer than phoropter
setting
Plus Lenses
Effective power increases as the lens
moves away from the eye
• ↑ power away from the eye
• ↓ power closer to the eye
• To compensate the Rx required for
a shift in vertex distance
• ↓ power if further from phoropter
setting
• ↑ power if closer than phoropter
setting
 EFFECTIVE POWER CALCULATION
Dl
• CAP – Closer Add Plus De = ---------------
• You can calculate the 1 + dDl
effective power (what
power the lens will be
when moved from the
phoropter vertex)
• OR
• You can calculate the Dl
compensated power Dc = ---------------
(what power is needed 1 - dDl
to create the same Rx at d = distance in metres
the new vertex distance) d is + if moved towards face
d is - if moved away from face
 NEW EFFECTIVE POWER CREATED

Rx is -12.50D
Vertex Distance on phoropter refracted at 13mm
Spectacles Vertex Distance fitted at 16mm
What happens to the power??
Dl = -12.50
d = .003m (3mm) away from the face = -0.003m
De = -12.50
1 + (-0.003 x -12.50) Therefore the effective power
created by the shift from
= - 12.50
the phoropter to the frame
1+ 0.0375 fitting is -0.50D less.
= - 12.04D
NEW COMPENSATED POWER NEEDED

Rx is -12.50D
Vertex Distance refracted on phoropter at 13mm
Spectacles Vertex Distance fitted at 16mm
What new power is needed to match Rx at phoropter??
Dl = -12.50
d = .003m (3mm) away from the face = -0.003m
Dc = -12.50
1 - (-0.003 x -12.50) Therefore the power
must increase from
= - 12.50
the phoropter Rx to the
1- 0.0375 fitted Rx by -0.50D more.
= - 12.98D
 CYLINDRICAL RX?

• Calculate each individual meridian

• Ie +13.00 – 275 x 180:
• Calculate +13.00 and +10.25 meridians separately
• Cylinder value is still the difference between the powers,
at the same axis
• Compensated power is usually calculated to compensate
for frame fit vs phoroptor refraction distance but could be
due to frame movement or Rx comfort
• Darryl Meisters’ OptiCampus website:
http://www.opticampus.com/tools/vertex.php
• Samples questions/answers will be posted to LEARN
 HIGH RX’S - CONSIDERATIONS

Things to always consider with high Rx’s

- Frame selection – frame pd = patients pd, rounded shapes,
nosepads with good guardarms, add nosepads?, wider hinges for
minimum eyesize and best fit
- Lens selection – hi index and/or aspheric, AR a must!
- Photochromic, a good option – check availability
- Measurements – monocular PDs, pupil height, refracted
distance, vertex distance, base curves
- Counselling – even small changes are an issue: change of frame
size, lens index and vertex should be discussed when ordering
not on delivery
- Listen to client concerns, be realistic and honest
 LENS MATERIALS
MATERIAL INDEX ABBE VALUE

CR-39 PLASTIC 1.49 58

TRIVEX 1.52 44
PLASTIC 1.56 1.56 37
POLYCARBONATE 1.589 30
PLASTIC 1.60 1.60 42
TRIBRID 1.60 41
PLASTIC 1.66/67 1.66/67 32
PLASTIC 1.74 1.74 33
CROWN GLASS 1.523 59
GLASS 1.7 1.70 30
GLASS 1.8 1.80 25
GLASS 1.9 1.90 31
 IN-HOUSE EDGING

• Edging equipment in the

practice
• Best to have an employee
who has experience
• Money made on SV lenses
(less on surfaced & digital waterloo-optometrist.ca

multifocal lenses)
• Excellent client care
• Redo’s are your
responsibility!
 IN-HOUSE EDGING

• In-house lens selection choice of the practice

• 1.6 with AR if only one lens as stock, other choices only
if viable for patient base!
• Polycarb is “dry edging”/1.59
• Envelope shows Rx, BC, index,
lens blank size
• Photochromics?
• Larger blank size to fit frame sizes,
larger decentration etc
 EDGER MAINTENANCE
• Follow manufacturers guides & have technician service
once a year
• Follow daily automated calibration
• Have calibrated frame
Trace, PD, size, wrap,
Bevel, Rx accuracy
• Replace water every 100 lenses
• Use debris “sock” or cheesecloth
• Dispose of lens debris, recycle if possible
• Water can be re-used if no glass edging
• Clean out machine if not running efficiently, unclog hoses
WHEN IN DOUBT…
• www.framesdata.com
• Quarterly book or on-
lind with all up North
American frames &
Lenses
• Quarterly Lenses book
or On-line
• All info Rx range,
photochromics, blank
sizes, add range in
EVERY lens sold in
North America!
 DIGITAL LENS DESIGN

• Can be advantageous, depending on Rx

• Customized F1, F2 or both can minimize
peripheral distortion & create best visual
points across lens surface
• Single vision & PALs
• Now ST bifocals
• The future of surfacing moving away from
conventional semi-finished blanks & will allow
inventive customization!
• Keep copies of lab orders – will not match
refracted Rx in file!!!
 FRESNEL PRISM

• Fresnel Prisms
• Adhere to lens with water
OS Prism
• Usually on F2
• Temporary use to check
prism value
• High prisms to reduce
OD Upper Add
lens thickness
• May solve field loss
• Also spheres & “add”
fresnel prisms available Field loss
PTOSIS CRUTCH

- Added to frame, mono or bilateral

- Soldered to metal frame (must be
sure frame can be soldered)
- Embedded into plastic frame
- Metal moulded to fit under orbital
bone to hold up eyelid(s)
- Causes dry eye easily
- Surgery possible
- Rare now
 HIGH RX’S

Questions?
Thank You!
marilyn.smith@uwaterloo.ca
All slides are the property of M Smith & may not be duplicated without specific permission