Spectacle intolerance

Spectacle IntoleranceSpectacle Intolerance
& Its Management& Its Management
OPTOM FASLU MUHAMMEDOPTOM FASLU MUHAMMED

03:58 PM Spectacle Intolerance and its
Management
2
““Handing over of SpectacleHanding over of Spectacle
to the Customer is not theto the Customer is not the
end of the matter, may beend of the matter, may be
beginning of a problem bothbeginning of a problem both
to dispenser and customerto dispenser and customer”
Spectacle Intolerance & Its ManagementSpectacle Intolerance & Its Management

Management
3
What can be the causes of ‘Intolerance’What can be the causes of ‘Intolerance’
Vision not clear at arms length
Head ache, Eye ache
Reading Distance too short
Ill-fitting frames
Eyes pulls on wearing specs due to decentring and induced phoria
Distorted or tilted Image
Awkward head position
Diplopia
The Common ComplaintsThe Common Complaints

Management
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1. Cosmetic1. Cosmetic
Cosmetic IntoleranceCosmetic Intolerance
is mainly subjectiveis mainly subjective
and is best left to theand is best left to the
patient to decide.patient to decide.

Management
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1.1. Improper frame selectionImproper frame selection
2.2. Lens FittingLens Fitting
3.3. Wrong PrescriptionWrong Prescription
4.4. Anisometropia & AnisokoniaAnisometropia & Anisokonia
5.5. High Refractive ErrorsHigh Refractive Errors
6.6. Organic DiseaseOrganic Disease
7.7. HeterophoriaHeterophoria
2. Functional2. Functional

Management
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Management
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Parts of a FrameParts of a Frame
Improper Frame SelectionImproper Frame Selection

Management
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Rigid
Strong
Light weight
Best fit
Comfortable to wear
Frame SelectionFrame Selection
The Frame must beThe Frame must be

Management
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Temporal Hair Line Margin Distance
IPD
Shape of face
Physical features of face
Nose Bridge
Suitable Side arms (Temple)
Points to be taken into accountPoints to be taken into account

Management
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OvalOval
RoundRound
RectangularRectangular
SquireSquire
TriangularTriangular
Shape of faceShape of face
Approximately there are main 5 shapes

Management
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OVALOVAL
Lucky People! AllLucky People! All
types of frames suittypes of frames suit
them as long as theythem as long as they
are well fittedare well fitted

Management
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Round
Frames with Crisp , Straight
Lines will break up its
Roundness and give it a more
structured geometric look

Management
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Rectangular
Bigger, Longer frames are
appropriate as it tends to
make the face appear
shorter

Management
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Squire
Oval or Round
Frames is better to
de-emphasis its
squireness

Management
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Triangular
Rectangular frames or
frames with pointed edges
will suit.

Management
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Colour
Eyebrows
Shape of nose
Shape of cheeks
Physical Features of facePhysical Features of face

Management
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The frame size is noted on the inside of the
side arm like ‘54/18’
 54 Means size of Rim
 18 Means Size of nose bridge that varies
to 18-26mm

Management
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Properly fit frames touch the patient in only three
places; the bridge and top of the ear
“Fitting Triangle”

Management
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Don’t let ur glasses take over your faces!
Top of the frame should fall below the eye brows.
It should mask Eye brow
Sweating can fog lenses easily

Management
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Frame should not rest on on the apple of the
cheek. The patient should be able to move their
cheek without any frame slippage
It can cause
Ectropion
Epiphora
Scar on the cheek

Management
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Key hole
Thin nasal bridge
Saddle
Avarage size
Adjustable nospad
Suitable for most patients
Bridges of the noseBridges of the nose

Management
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Bridges of the noseBridges of the nose
Key hole Saddle Adjustable nose pad
Adjustable nose pad is Suitable for most patientsAdjustable nose pad is Suitable for most patients
Saddle or Key hole is Suitable for High powersSaddle or Key hole is Suitable for High powers

Management
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It should ideally conform to back of the ears-
Ears may be dissimilar.
The frame should rest on the face so that fitting
plane of lens should be perpendicular to the visual
axis.
Side arms or TempleSide arms or Temple
For High Myopes Smaller Frames, Converse in HyperopesFor High Myopes Smaller Frames, Converse in Hyperopes

Management
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Management
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2.Lens Fitting2.Lens Fitting

Management
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Pupillary alignment
Fitting plane of lens
Type of lens
Optic center
Lens FittingLens Fitting
What should one look for in lens fittingWhat should one look for in lens fitting

Management
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Both pupil should be close to OC (Optic Centre) of each
lens to take full advantage of refractive correction.
Pupillary AlignmentPupillary Alignment

Management
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If IPD (inter pupillary distance) does
not tally with OC it will make
prismatic effect for which the
patient makes subconscious effort
to neutralize in the interest of clarity
of vision. This leads to eye strain

Management
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In the case of children who do not co operate or
Squint IPD is measured by finding the distance
between inner canthus of one eye and outer
canthus of other eye

Management
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Lenses should be plane perpendicular to the visual axis.
For Near since the eyes directed down ward they tilted
slightly (10-150
) towards the cheek this is called
‘Pantoscopic tilt’
Fitting plane of LensFitting plane of Lens

Management
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PANTASCOPIC TILT
50
- 150

Management
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The lenses should ideally be fitted 15.7mm in front of cornea
(VD- vertex distance) which corresponds to the anterior
principal focus of eye.
The effective power of lens will change with change in VD.
The effective power of plus lens will increases when les
moves anteriorly and inverse to the minus lens
Fitting plane of LensFitting plane of Lens

Management
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Fitting arc of LensFitting arc of Lens

Management
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Glass
CR
Univis
Trifocal
PAL
Executive
Photo chromatic ETC
Type of LensType of Lens

Management
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Geometric center is center of lens while
optic center is center of optical system.
Optic CenterOptic Center

Management
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Lensometer
By throwing torch light
By coinciding Cross line
How do you find optic center?

Management
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Optician’s Rule
How you Measure Fitting parameters?
IPD
Nose Bridge
Temporal hair line margin

Management
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BifocalsBifocals
Two portion should provide equally clear
vision free from aberration
There should no sudden change in prismatic
effect at the junction of two segment

Management
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BifocalsBifocals
Image displacement
Kryptock bifocal is best to Plus lens
Univis D-Bifocal is best to Minus lens

Management
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BifocalsBifocals
The centering of two portion should
exact for their different purpose.
Ideally top of B/F segment should
be at the level of lower lid.

Management
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BifocalsBifocals
Ranges of Vision
Working Distance

Management
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Management
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3. Wrong Prescription3. Wrong Prescription

Management
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Wrong PrescriptionWrong Prescription
Over correction
Inadequate correction
Incorrect or illegible correction

Management
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Management
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4. Anisometropia & Anisokonia4. Anisometropia & Anisokonia

Management
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Anisometropia & AnisokoniaAnisometropia & Anisokonia
Difference of 0.25D – 0.50% difference in retinal
size.
Eye can Tolerate upto 2.50D Difference.
No Diplopia at the time of refraction but Diplopia
after dispensing lenses means difference in base
curve of two lenses.

Management
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Management
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5. High Refractive Errors5. High Refractive Errors

Management
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High Refractive ErrorsHigh Refractive Errors
Peripheral magnification
& Distortion
Restriction of field
Weight of the glass

Management
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High Refractive ErrorsHigh Refractive Errors
Good centering of lenses
Hi index glasses
Small size frames
Separate glasses for distance
and near

Management
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Management
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6. Organic Disease6. Organic Disease

Management
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Organic DiseasesOrganic Diseases
Frequent changes of
spectacle necessitates a
detailed investigations to
rule out Diabetes,
Glaucoma and Cataract.

Management
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Management
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8. Heterophoria8. Heterophoria

Management
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HeterophoriaHeterophoria
If one has exophoria and needs minus lens give
him full correction, but if he needs plus lens he
should be under corrected and vice versa in
esophoria. This will enable him to overcome the
phoria with accommodative convergence

Management
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Management
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Conclusion
Do not change the glasses if asymptomaticDo not change the glasses if asymptomatic
Give same base curve as beforeGive same base curve as before
In high minus lenses specify hi-index glassesIn high minus lenses specify hi-index glasses
Proper counselling must be done if patient is wearingProper counselling must be done if patient is wearing
specs first time, shifting to bi focal, or changing framespecs first time, shifting to bi focal, or changing frame
size.size.

Management
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Conclusion
Be Patient and careful, when you prescribe glasses.
Spend some time in checking the glasses, otherwise the
patient will come back to you with most demoralizing
and embarrassing statement “ My earlier Spectacle
was better”

Management
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End of this topic

Management
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LensLens
EnhancementsEnhancements

Management
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What Lies Between You and Perfect VisionWhat Lies Between You and Perfect Vision

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For More Details and Technical Advice
Contact
Mr. Sarafudheen
Dispensing Optician
Al Salama Eye Hospital Ltd,
Perintalmanna
Ph: 04933 225524
K Mohamed Kunhi
Manager-Clinical Services
Al Salama Eye Hospital Ltd,
Perintalmanna
Ph: 04933 225524, 9895116363
Email: kmk@live.in

Management
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Thank You

Spectacle intolerance

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