case studies

Case 1

A male, age 73 years whose lens prescription showed:
RE +1.25Dcyl 180 6/18
LE +1.25Dsph + 0.75Dcyl 180 6/18
BE Add + 2.50Dsph N6
Lens Type: Executive Bifocal in Clear Crown Glass

Complaint: When he tilts his spectacle to one side down on the face, things look straight, otherwise things look tilted.

Initial Thoughts:
Initially when I received the complaint, it seemed to me that cylinder axis could be the reason. Keeping this in mind I proceeded.

On Examination:
It was found that
There is not much change in refraction
The wearer is not very sensitivity to changes in axis and power

Past Habits:
Lens Prescription:
RE +1.00Dcyl 9 degree
LE +1.00Dsph +0.50 Dcyl 179 degree
Add +2.00 Dsph
Past Lens Type: Photochromatic Glass Executive
Past Frame Type: Large size, Square shape plastic frame with large B measurement. The segment height was observed to be lower than lower lid

Solution:
It was decided to make a new spectacle with following changes;
Lens Prescription:
  • RE +1.25Dcyl 180
  • LE +1.00Dsph +0.75Dcyl 180
  • Add +2.50

Lens Type:
Executive Bifocal in Clear Crown Glass

Frame Type:
Focus was more on frame shape and size. I also decided to change the frame with larger size, square in shape and larger B measurement.

Fitting Issue:
I made the segment height lower than the previous spectacle, taking reference from his past habit.

Result:
The wearer reported immediate relief.

Impression:
There are theoretical and practical reasons for problem which can be understood by being flexible in the approach and careful listening to the wearer. A strong observation about the past habits is equally very important. This was also an evidence that while dealing with a complain we need to elicit the multiple causes and work upon all of them. Sometimes symptoms takes to one reason, i.e., in the above case cylinder axis but we have to dig more to look at more options.

Can I request more opinions on this from the readers?

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Case 2

A male, age 46 years whose lens prescription showed:
RE -2.00Dsph -3.25 Dcyl 170 degree
LE -1.25 Dsph -1.50Dcyl 50 degree
BE Add +1.75 Dsph
Lens Type: CR 39 Progressive with ARC

Complaint: When he looks through the corner of the lens, he sees more clearly than when he sees through the centre of the lens.

Initial Thoughts:
It was unusual complain. Usually with any progressive lens temporal corner carries unwanted astigmatism and prismatic effect that affect the visual performance.

On Examination:
The wearer told that there is no change in the lens power. He was already using another spectacle with the same prescription.

Past Habits:
Lens Prescription:
No change was seen in lens prescription when compared with the old glasses.
Past Lens Type: CR 39 Univis D Bifocal Lens

Solution:
It was decided to change the lens type with Univis D Bifocal Lens.

Result:
The wearer reported immediate relief.

Impression:
There are times when the customer is not ready to listen anything; we have to follow the course on which he insists as it will restore his satisfaction immediately.

Can I request more opinions on this from the readers?

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Case 3

A male, age 55 years whose lens prescription showed myopic lens power in distance with near addition Lens Type: CR 39 Progressive Lens

Complaint: He has to lift his glasses to read and vision on either side is not comfortable. Overall he was not very happy with spectacle.

Initial Thoughts:
All first time user of new lens type needs to break his past visual habit to really appreciate the advantage of new lens that take a short adaptation period. With this idea in mind he was advised to use the lenses for some days. After a few days he came back with the same complain.

On Examination:
Lens Prescription: The lens prescription was not an issue.
Past Lens Type: 
E – Style Bifocal Lens

Occupations:
Working on computers for more than 6 to 8 hours for data feeding from text document kept at the sides

Frame Type:
Plastic frame

Customer’s Psychology:
He selected the Progressive Addition Lenses as because he had seen his friends working happily on computer with the same lens. Hence he was not ready to listen the anatomical facts about progressive lens. He had his own ideas about the lens type which was formulated because of his friends.

Solution:
Since there was no issue with distance vision, I proposed him to change the lens type, he did not accept at all as he was too keen to use Progressive Lenses. Any talk against Progressive Lenses was not accepted by him. I was left with no option but to look at the frame and its fitting on his face.

On observation it was noticed that the vertex distance of the spectacle frame was quite larger because of high nose crest. With an intension to switch to a frame with nose pads, I advised him to switch to metal frame to which he agreed. We transferred the same lenses to the new metal frame by re-edging the lens. While dispensing the new spectacle, I again advise him to use it for some days to adapt. Additionally, I also stressed upon the visual needs of his data feeding occupation and limitations of Progressive Lenses and proposed him to make an Occupational Lens. In order to reestablish confidence in patient, I gave him my business card and assure all possible after care.

As expected three days later he came to us saying Progressive Lens was not working for him and requested me to change. I took back the glasses and made two spectacles for him - one spectacle with E- style Bifocal Lens that had lens prescription for Distance and near, another spectacle with E- style bifocal lens having lens power for intermediate and near distance.

Result:
He was given a desktop and asked to notice the difference. An immediate comfort was observed on his face.

Impression:
Understanding customer’s psychology and keeping patience are the key to successful management of complains. While lifestyle and occupational questioning, it is important that you dig deeper. A computer user can be benefited by Progressive Addition Lenses, but a data feeder who needs to move his eyes and head a lot would be benefitted either by Occupational Lens or specially design lens for the occupation.

Another important fact that I learnt a motivated customer for Progressive Lens does not listen against Progressive Lens as he has seen his close friends using the same comfortably. He takes time to break his opinion to accept your advice. I also learnt the importance of educating the customer and realized the fact that there is a big difference between informed customer and educated customer. If you do not educate the customer, he collects information from other sources.

Can I request more opinions on this from the readers?

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