Years ago I was presented with a customer who had several
problems to be solved. She suffers from neurofibromatosis
and a mild Proteus Syndrome condition, so she has a very
uneven head. She had a large tumor growing from her brain
through her temple, making the left side of her head larger
and more swollen than the right side of her head. This
swelling started at the bridge of her nose and wrapped all
the way around the side of her head. Periodically, she
underwent surgery to remove excess tumor growth. Her right
lens was -6.00 -2.75 X 17 and the left was -8.00 sphere.
This presented a problem due to the thickness of her left
lens rubbing against her eyebrow.
In addition, her skin was very sensitive behind her ears
due to the multiple surgeries. So the first frame I made for
her was a metal frame, as we wanted as much airflow around
her eye as we could get. In order for the lens to clear her
eyebrow, I unsoldered the bridge and added a couple of
thicknesses of eyewire metal on the front of the left
eyewire, then resoldered the bridge back on so the left side
of the frame extended about four mm farther away from her
face than the right side. This gave us the extra clearance
we needed for her lenses. During final fitting it took many
trips to get the temples exactly right so they were firmly
fit and free from disturbing her scars behind her ears. She
was apologetic about causing me so much trouble and I
hush-hushed her, saying, "Sometimes the smallest
adjustment makes the biggest difference."
Much to my surprise, she adopted that saying and
correlated it to her own life, writing several inspirational
books and stories as well as some medical texts concerning
neurofibromatosis, a subject that interested her both as a
sufferer and as a nurse. Later on she wanted a plastic
frame, so I did something similar with an Optyl frame,
heating it in the center of the bridge and moving the left
side forward. Recently she returned with a new Rx and we
found a nice frame that was stylish with the wide temples
that did a great job of hiding her swelling, which now has
receded some due to her doctors finding a new drug that
worked better than any previous one. As a hedge against the
frame discontinuation, she purchased two additional frames
to have just in case.
I also had a man come in who had been a boxer in the Navy
and had the flattest nose I have ever seen. This was a real
challenge, as he only wanted a plastic frame, not a metal
one. His nose looked like someone took a PD stick and molded
the nose to the flat side of the stick, From the side, his
nose was very, very flat, and from the front, his bridge had
been smashed flat and was about 22 mm wide. What I had to do
was to take the lenses out of a frame he liked, heat the
bridge and bend it around until it fit his bridge. This
shaped the frame quite differently than the original shape,
so I then cut a pattern from the modified frame and cut the
lenses to fit, and he had a customized frame that fit his
nose perfectly.
Other problems that can arise are facial deformities of
various factors. If someone has greatly uneven eyes, either
vertically or horizontally, special measurements must be
taken. We had a customer whose right eye was 10mm lower than
his left eye, and displaced temporally. Obviously, monocular
Pds were in order even for his flattop bifocals, as well as
separate segment heights. Be sure to specify the optical
center heights for each lens above the segment line so the
risk of diplopia is eliminated. When checking the final
glasses, be aware that there will be in this case a large
amount of vertical imbalance shown in the lensometer, but on
this particular customer they worked perfectly.
I also had a customer who came in and was very hunched
over. He explained he had a neck problem that prevented him
from holding his head up in a normal manner and fortunately
he knew that this made his normal progressive lenses
worthless until his later scheduled surgery would restore
his posture. His problem was getting clear enough distance
viewing through the top of his lenses. So we made him two
pair - the distance pair had the optical centers moved up
10mm and his near pair decentered up 5mm. These worked well
for him and he should be back later this year after surgery.
When the first woman I mentioned came in to pick up her
glasses she told me that when she had come to me the first
time 30 years ago, she was planning on killing herself. I
was shocked to find that out, since she appeared so
extraordinarily adapted to her problem. But she told me that
since her glasses had worked out so well, she found the
strength to go on and thanked me profusely for saving her
life.
So when someone comes in with a facial disfigurement,
some tender loving care and special attention is required.
You may be giving them something more than the gift of
sight.