|
Get Used to It!
Adaptation Issues Happen - How
to Prevent and Resolve Them |
I just can’t get used to these.
I have to tilt my head down to drive.
I can’t find a spot to read.
I can see better out of my old pair!
WHAT EYE CARE PROVIDER doesn’t cringe when he or she
hears these words? Although these statements are
opportunities to improve patient care, they can create a
sense of guilt, failure and confusion for the ECP. To help
eliminate these problems for both the patient and the ECP,
there are some steps that can be followed.
When are adaptation problems more likely to occur?
One of the first things an ECP should be aware of is what
factors may cause adaptation issues to occur. Most patients
will be able to put on their glasses and be fine, but there
are those who will require an extra amount of time and care
to see as well as possible. It will be helpful to know when
the extra adaptation time is more likely to occur and plan
for it.
Multifocal Lenses
A common adaptation issue for patients is when a new
presbyope has to wear a multifocal for the first time. Many
first time presbyopes are already feeling some stress over
the natural aging process, and do not enjoy the fact that
they are losing their near vision. Now, they have to wear
glasses that either have a line that they believe shows
their age and may cause “image jump” or a progressive
which may cause unwanted distortion. Either way, it is not a
happy time for the wearer.
Prescription Changes
Every ECP has had the patient with a lot of change.
Although the situation may cause prayers to come from the
ECP, there are many reasons for a sudden change. It could be
that the patient has not had a refraction for many years; he
or she may be developing cataracts or another medical issue;
or, the patient may have a change in medications. Whenever a
large prescription change has occurred, common side effects
may be headaches, eyestrain, blurred vision, and
disorientation.
Lens Design Changes
Many factors in lens design are up to the optician,
unless certain parameters are specified by the optometrist
or ophthalmologist. It is important to note on the patient’s
records their current pupillary distance, optical center,
base curve, progressive lens design and lens material. This
way, if any changes are made to better serve the patient,
the ECP can be aware of the adaptation issues that may
arise. For instance:
-
Pupillary distance - In theory, the PD should remain
the same from one pair of glasses to the next. However, the
previous pair of glasses may have been made incorrectly and
unwanted base in or base out prism may have occurred. When
this situation is corrected, objects may appear sloped for a
short period of time due to the patient's previous
adjustment to the unwanted prism.
-
Optical center - Since the patient has become adjusted
to this unwanted prism, when it is taken away, the patient
may view vertical items as too short or too tall, or may
view the world as either from being on top of a hill or from
the bottom of a valley.
-
Base curve - Not as relevant today due to the increase
in the number of aspherics, base curve can still play an
important role in certain prescriptions and frame designs.
Base curve problems may occur with patients that have a
large prescription change or when patients select a frame
with a large amount of wrap. Common adaptation issues with
base curves are chromatic aberrations and distortion when
viewing items out of the corner of the lenses.
-
Lens material - The most common adaptation issue with
lens materials are chromatic aberrations and it most
commonly occurs when changing from a higher abbe value
material to a lower abbe value material.
Solving the problem before it starts
Taking Accurate Measurements
By taking measurements properly, a lot of adaptation
issues can be resolved before they start. Measurements
enable the circle of least confusion, or the clearest
portion of the lens, to be placed in the appropriate area
for the patient. When taking measurements it is important
to:
-
Adjust glasses before taking measurements. This is
critical and often not performed by the ECP. The glasses
should fit comfortably and in the location that the patient
will wear them. Not where you think they should be. If the
patient likes to wear his or her glasses at a certain
location on their nose, adjust for that.
-
Watch the patient’s posture. When talking to the
patient, the ECP should be aware of the patient’s normal
and relaxed posture and adjust the measurements for this.
For example, when a patient sits or stands with the chin up,
or if he or she is exceptionally tall or short, the segment
height may need to be adjusted accordingly.
-
Take note of previous measurements, but use your own.
As stated earlier, it is important to document previous
measurements, but be sure not to rely on them. The previous
measurements may have not been done correctly. Now, this can
be exceptionally tricky when a lot of change is noted from
the previous measurement and the current measurement.
For example, a -8.00 D patient has a previous PD of
binocular 58 and monocular PD of 29/29. When the current PD
is taken, the measurements are found to be binocular 61 with
a monocular PD of 29/32. After double checking the
measurement, the ECP now has to decide what to do. For the
left eye, if the measurement is kept the same and 2.4 D of
unwanted prism is induced. If the measurement is changed,
then the unwanted prism will be eliminated; however, the
patient may have an adaptation problem because he or she may
have adjusted to the previous unwanted prism and may have
difficulty adjusting to the new one. Another option is to
split the difference to try and make the adaptation period
easier. Whatever option the ECP uses, it is important to
note it on the patient’s record and explain the reasoning.
Helping the Presbyope
With lined multifocals, the most common adaptation
situation is “image jump.” This occurs when the patient
views things through the reading area and everything appears
to jump up at the patient. This is a normal occurrence and
is usually adapted to within a week or two. If the patient
cannot become adapted to a straight top bifocal due to image
jump, then a round or a blended bifocal, as well as a
progressive, may be a better option for the patient.
Progressives may also be a better option for the non-adapt
trifocal wearer.
When the issue is a progressive lens, the adaptation
becomes more complicated. This is mainly due to the corridor
width and length. A progressive is designed with a distance
portion at the top and a corridor that has progressively
more plus power that ultimately leads to the reading area.
This corridor is an hourglass shape with areas of distortion
on the sides. When a patient changes corridor designs, or
wears a progressive lens for the first time, the distortion
may be more noticeable and bothersome. To help minimize the
distortion, it is important that the ECP take accurate
measurements. It is imperative that the patient’s PD,
optical centers, and segment heights be taken monocularly.
Talk to the patient
Talking to the patient may seem like a simple task, but
on hectic days, the ECP may not feel as if he or she has the
time to explain everything fully. This is a mistake, because
making the patient aware of everything up front can
eliminate a lot of problems later. Explain to the patient
any changes that he or she may have had in his or her
prescription, the changes in lens design that may have
occurred, and what is common in multifocal wear adaptation.
Remember, when patients know what to expect, they will try
harder to get used to the prescription before coming back to
vent their frustration.
If all else fails…
Sometimes, it happens. A patient cannot get adjusted to
their new eyewear. This is the time for the ECP to really
shine for the patient. First, the ECP should remain calm and
listen. Although it may seem like a personal attack,
patients are just frustrated and nothing that they say right
now should be taken personally. Once the patient has vented
to the ECP, he or she should repeat to the patient
everything that was heard to prevent any miscommunication.
Once the problem has been determined to be an adaptation
issue, and not something else such as buyer’s remorse, it
is time for the ECP to rely on their experience and
knowledge to fix the problem. If minor adjustments such as
face form, pantoscopic tilt or nose pad adjustments cannot
resolve the problem, then the glasses will probably need to
be remade. This is where all the previous notations in the
patient’s records will come in handy.
If the problem seems to be due to a large prescription
change, contact the doctor and discuss the situation. Even
though the prescription may be correct, the amount may be
too large to get adjusted at one time and the doctor may
decide to cut back the initial prescription and then step
the patient up at regular intervals.
For multifocal wearers, a change in multifocal lens
design may be all that is needed. Sometimes switching to one
of the newer free-form progressives with wider corridors may
be all that is needed to fulfill the patient’s visual
needs. Or, a different style of segmented lens such as the
atLast! from PixelOptics may prove beneficial. If this is
not the case however, and the patient has tried numerous
multifocal options and still has adaptation issues, he or
she may need to switch to multiple pairs of single vision
glasses.
When lens design changes are the primary problem, there
are multiple options available to the ECP. The frame may
need to be restyled if the issue is too much wrap, a switch
to a higher abbe valued lens material may be in order to
reduce chromatic aberrations, or changes to the measurements
may be needed to help the patient adapt easier.
Adaptation issues are a common occurrence in the optical
field. Sooner or later, it is something that all ECPs will
experience. With a little patience and a lot of knowledge,
it can prove to be a rich and rewarding experience. It is
the non-adapt patients who will become the most loyal when
their problems are resolved and they leave the dispensary
happy.
|
