This document discusses various techniques for adjusting eyeglass frames and lenses to improve comfort and prevent skin irritation, especially for aging patients. It describes choosing lightweight frames and materials, adjusting nose pads for proper size and position, modifying bridge contours, and more advanced techniques like Usden crutches or saddle conversions that redirect pressure away from fragile nasal skin. The goal is to properly fit spectacles and modify them when needed to avoid issues like redness, infection, swelling or erosion on the nose and skin.

1. -ANURAG SHUKLA
FELLOW OPTOM
SHROFF CHARITY EYE HOSPITAL ,DELHI

2.  Frame Adjustment and Modification
 Fitting Parameters Of The Frame
 Lens Material and Quality
 Spectacle Comfort and Discomfort due to
ageing
 Treatment Plan

3.  Type of frame should be chosen
 Ways to reduce the weight of spectacle
lenses
 Types Of Lens Material
 How to handle it safetly

4.  Strong light weight
 Frame PD should coincide with IPD of the
spectacle lenses
 Adjustable bridge, with DBL as small as
Possible
 Cable type of temple is the temple of choice

5.  Correct size
 Adjustable pad
 Eye wire posioned lower to eye brow

6.  High Impact Resitance Lens
 Light Weight
 Scratch Resistance
 Unwanted reflection avoided with anti
reflection coating
 Multilayer coating with protective coating

7.  Changes Occur in the skin
 Skin becomes fragile and loss tonicity and
easily prone to get inflammation
 Fitting Of Spectacle needs to be proper to
avoid unwanted incidents

8.  Redness
 Infection
 Irritation
 Swelling and erosion of skin
 Improper positioning of the spectacle lens

9.  Reduce pressure on the nose/weakened area
 To make sure healing works first
 Temporary or permanent attachment on the
frames to reduce the weight bearing surface

10.  Pad size , material,shape, may reduce the
weight on the nose pads
 Soft, flexible and polyvinly pad
 Stick on cushions made of foam may give
temporary relief

11.  Modify the bridge contour, particularly in
fixed bridge frames
 Custom design and construct a frame that
meets the specific requirements of a
particular patients

12.  Foam stick on nose pad cushion may relieve
the discomfort caused by a previously worn
ill fitting frame
 Not an permanent mode of correction
 Relieve the discomfort by the masking the
portion with cushion pad

14.  Pad size shape and texture are also very
important
 Small hard and plastic pads should be
replaced with soft flexible and polyvinly pad

15.  Size of the pad depends on the factors
relating to the spectacle weight and typeof
the nose to be fitted
 As a general rule we should use a pad size
that will distribute the bearing load over as
great an area as possible

17.  Usden crutch technique is used for extreme
or advanced case where the skin and tissue
have become serious damaged
 Usden crutch is easily attaches to the
patients spectacle
 Simple attachment consist of two 1.5 inch
long extension bars that are fastened to
underside of the each temple hinge

18.  On end of the each bar is a large polyvinly
pad
 The pad can be positioned so as to rest on
the cheek result in slight vertical elevation
of the entire front portion of the spectacle
 The regular nose pads will be clear of skin
contact

20.  To increase the weight beraing surface of the
spectacle load to an complete rest
 Individual nose pads are replaced with one
piece poly vinly strap that froms a U shaped
bridge
 Major contact over the crest region rather
than at the side of the nose
 Redirecting the weight from side tissue to
the nasal crest which lessen the strain

22.  It act as temporary aids to overcome the
irritation due to spectacle
 Temple grips slipped over the ends will
prevent slippage and also add to overall
comfort
 Temporary aid for frame alignment

23.  Final treatment where temporary measures
are not effective
 After basic fitting arrangement of the nose
piece
 Saddle Conversion
- Adjustable pad bridges
- Non adjustable bridges

24.  Nose pads have been removed
 Adjustable arms must be straightened and
rebent into horizontal position
 Arms should meet and overlap in the centre
of the bridge
 Adjustments to the metal core over the crest
of the nose will regulate the frontal
positioning of the spectacle

25.  Vertex distance and vertical position ofbthe
spectacle front are the two important
adjustment to be completed
 Jet Acrylic mixture is applied over the metal
joint area
 Saddle DESIGN is shaped ACCORDING to the
nose crest
 Final phase of filing, sandling and polishing
and saddle piece

27.  Adjustable is not possible with the fixed
bridge design frames
 So the metal pin must be implanted across
the bridge area to from the reinforcing bar
for the saddle
 With the frame , bar and nose crest locations
are marked
 Two small nasal holes are drilled on the nasal
edge of the eyewire

28.  Metal part of the saddle should cut long
enough so it can be forced between the
opposing holes
 Procedure for finishing the plastic portion of
the saddle will be same as it was for the
adjustable pad bridge saddle conversion
technique

29.  Astro spec is a unique design
 Absolute free from nasal contact
 Principal of using headband that uses the
brow region as asupporting portion
 It requires minimal pressure of the side
 Pantascopic tilt and multifocal posioning
arecdifficult in this technique