CONTINUING EDUCATION, 1 CE Credit � $9.99, 1 Hour, General Knowledge, Level 1, Release date: October 2007, Expiration date: October 31, 2012

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Fitting Difficult Faces

Special frames made for facially disfigured neurofibromatosis patient Roberta Messner.

Most experienced Opticians have had someone come in that presents unusual problems in fitting. Some have facial deformities, some have posture problems, and some just have a difficult Rx. Unfortunately, some have multiple difficulties, which can be addressed in a variety of ways.

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."

Roberta Messner's specially made frames.

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.

Mark H. Morris

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