eyecare professional magazine february 2012 issue

February 2012 • Volume 6, Issue 50 • www.ECPmag.com

ECO-FRIENDLY EYEWEAR / PAGE 6 THE LOWDOWN ON HIGH INDEX / PAGE 30

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ECO-FRIENDLY EYEWEARDo your part for the environment and offer your patients the latest in Eco-Friendly Eyewear and Sunwear.by ECP Staff

FUTURE OF OPTICIANRYOnly through an increase in education and licensure can Opticianry reach its full potentialby Warren G. McDonald, PhD

EYEWEAR ICONSThere has been a huge range of eyeglass and sunglass wearing icons over the years.by Laura Miller

GLASS HALF EMPTY OR HALF FULL?Maintain a positive outlook about things you can directly control and become a better ECP.by Anthony Record, RDO

HIGH INDEX 101High Index lenses have become the lens of choice for high powerprescriptions and rimless mountings.by Dee Carew, ABO/NCLE, LDO, MLS

GENDER IN OPTICSWomen have come a long way from the days when female ODswere sometimes referred to as “nurse.”by Elmer Friedman, OD

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EDITOR/VIEW .....................................................................................................4INDUSTRY PROFILE........................................................................................22MOBILE OPTICIAN .........................................................................................26MOVERS AND SHAKERS.................................................................................28PATIENT CARE..................................................................................................34OD PERSPECTIVE ............................................................................................40ADVERTISER INDEX .......................................................................................42INDUSTRY QUICK ACCESS ............................................................................43LAST LOOK .......................................................................................................46

FEBRUARY2012

Vol. 6Issue 50

On The Cover:US OPTICAL LLC 800-445-2773www.USOPTICAL.com

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Publisher/Editor . . . . . . . . . . . . . . . . . . . . . . . Jeff SmithProduction/Graphics Manager. . . . . . . . . . . Bruce S. DrobDirector, Advertising Sales . . . . . . . . . . . . Lynnette GrandeContributing Writers . . . . . . . . . . . . . . . . . . . Judy Canty, Dee Carew, Paul DiGiovanni, Gary Fore, Elmer Friedman, Lindsey Getz, Ginny Johnson, Jim Magay, Warren McDonald, Laura Miller, Anthony Record, Jason SmithTechnical Editor . . . . . . . . Brian A. Thomas, P.h.D, ABOMInternet Coordinator . . . . . . . . . . . . . . . . . . . . Terry Adler

Opinions expressed in editorial submissions contributed to EyeCareProfessional Magazine, ECP™ are those of the individual writers exclusively and do not necessarily reflect the opinions of EyeCareProfessional Magazine, ECP™ its staff, its advertisers, or its reader-ship. EyeCare Professional Magazine, ECP™ assume no responsibilitytoward independently contributed editorial submissions or any typographical errors, mistakes, misprints, or missing informationwithin advertising copy.

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EyeCare Professional Magazine, ECP™ is published monthly by OptiCourier, Ltd.Delivered by Third Class Mail Volume 6 Number 50TrademarkSM 1994 by OptiCourier, Ltd.All Rights Reserved.

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MagazineEditor / viewby Jeff Smith

THE ATTITUDE you bring to the dispensary and your process of dealingwith patients profoundly affects your ability to provide the best in care andservice. You can use all the techniques ever written about sales & dealing

with patients, but not bringing some excitement and fun into the process is completely missing the point. Eyewear and lenses have changed from being drabprosthetics to eye-catching accessories, so the sales approach must be altered toreflect these changes.

Can you imagine a sales clerk at an upscale clothing boutique handing a customerone of the latest fashions and saying, “Here, this is the latest fashion; try it on ifyou think it looks nice.” More likely they will say, “Look, here’s the latest fashion...isn’t it stunning! It would look so good on you, why don’t you try it on and see.”The same type of approach, or at least a modified form of it, should be used in thefashion business of eyewear.

You are providing the benefit of making sure the frame the patient chooses isappropriate for the prescription and their lifestyle, while at the same time reducingthe cost of having to wear glasses by guiding them to fashionable frames they willenjoy wearing. If the cost of wearing glasses exceeds the benefits of better visionand fashion, some patients won’t perceive the value of wearing glasses and may notwear them when they need to. You are not “selling” anything, but rather offeringguidance so they will choose stylish and functional frames that provide real value.

When showing frames, be aware of the personality of the patient. Try matching theframe style, and your approach, with the patient’s personality. If they seem moreconservative minded, then you might have to calm your approach and presentmore conventional styles, while still maintaining an undercurrent of enthusiasm.

With a more extroverted patient, you can really have some fun. Don’t be afraid tohave them try on some of the more outlandish frames ... you never know. At thevery least it will often get them thinking in a different fashion direction and is agood way to move the patient off the same style they’ve had for the past 10 years!

You might even find that a frame style you thought no one would look good inreally does work for them. If you are excited, your infectious enthusiasm will mostcertainly rub off on the patient, hopefully creating a satisfied and “chic” customerfor life.

EEYECAREPROFESSIONAL

4 | EEYECAREPROFESSIONAL | FEBRUARY 2012

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1. Crocs™ EyewearAll styles in the Crocs™ Eyewear adultcollection include eco-friendly polarizedlenses. Crocs™ Eyewear’s polarized lensesare made using cellulose, the most common, organic compound on earth.Cellulose is a natural resource and isextremely renewable. www.eyeking.com

2. Eco by ModoThese design-forward frames aremade from 95% recycled plasticand hypoallergenic/non toxic stain-less steel. The collection is certifiedrecycled by UL Environment (ULE),case is made from recycled PET, andfor every pair sold, a tree is plantedwith a community through Trees for theFuture and Mezimbite Forest Centre.Unwanted frames can also be mailedback in the recycled packaging to theOneSight Charity. www.modobiz.com

3. Rolf SpectaclesThe model “Primus” isavailable in four differentwood combinations – bogoak, bog oak/maple/bogoak, oak and robiniesteamed. The unique wooddesign combined withROLF innovation, meansthat each frame is a one-of-a-kind piece of eyewear.www.rolf-spectacles.com

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Eco-FriendlyEco-FriendlyEYEWEAR & SUNWEAR

Going-Green

Closer to NatureIn today’s tough times,

people are becoming more in touch with nature.

Consumers are looking fornatural colors and designs

that are comforting and environmentally friendly.

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6. Anni ShadesCommitted to create fromwhat nature has made, AnniShades was founded on thebelief that one can contribute tothe well being of the environmentin a fashionable manner.Continuously inspired by both theurban and rural world, we are passionateabout building one of a kind woodenframes in Ohio, USA.www.annishades.com

4. DRIFT EyewearDRIFT Eyewear turnedheads last year with theirTimber Collection andthe introduction ofreclaimed wood to eyewear. ThisChicago-made brand will continue topush the eco-envelope this spring byincorporating Mazzucchelli M49 bio-plastic, groundbreaking designs, andan evolution of their classic meetsmodern appeal.www.drifteyewear.com

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EnvironmentallyResponsible

5. Blue Planet EyewearBlue Planet Eyewear is a line ofsunglasses and reading glasses fortoday’s eco-conscious consumerfeaturing recycled or reclaimedmaterials and first quality lenses.The manufacturing processincludes non-toxic finishes thatare lead free and nickel free.All products are shipped with eco-friendly recycled hangtagsand packaging, and reclaimedwood display units complete the package.www.blueplaneteyewear.com

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Natural LookIn simpler times, frames can have a sleek, nature

inspired look. In an effort tohelp the environment, some

companies may also be planting a tree for frames purchased.

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A-Look Optics

Tony Morgan Eco-Sheek A3208 is perfect for men and womenwho seek eco-friendly eyewear in a trendy, retro design. Theframe features an acetate front with wood temples and spring

hinges. Available in size: 53-17-145. www.alookoptics.com

ICU Eyewear

Featured is the eco-friendly metal hinged oval bamboo reader inLime Green. Also comes in Dark Brown if you prefer somethinga little more subdued. They are handcrafted and a perfect shapefor any face. www.icueyewear.com

Wooden SpecsWooden Specs stop an artistic, style-conscious clientele in itstracks. Design elements (earth-toned paints, wood-burneddesigns, mother-of-pearl inlay) and handmade details (remarkable steam-bent curves, handmade brass hinges) impart value well beyond the frames’ unique, natural material.Styles in the collectioncover a range of sizesand are designed forreasonable durability,repairability, adjustabili-ty and glazing.www.woodenspecs.com

Gold & Wood

The new B20 sunglasses for women from Gold & Wood are madefrom a mixture of refined materials and influences: made ofprecious, contemporary ideas of Gold &Wood, and sophisticatedglamour from the elegant and feminine 50’s. Based on hand-crafted marquetry decors, the temples are made of mixed precious woods from sophisticated patterns.www.gold-and-wood.com

Kenmark

The Timex – T261 is made from a biodegradable acetate, whichis created from renewable natural resources: cotton lintels, woodpulp and a non petroleum based plasticizer – the latter being the“eco-friendly ingredient” that differentiates this material / framefrom others. The plastic will also fully decompose in the sameamount of time it takes a leaf to biodegrade in soil.www.kenmarkoptical.com


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Luxottica

The Stella McCartney’s eco-friendly eyewear collection featuresinjected bio-plastic made from 54% castor-oil seeds, a renewableresource that helps limit the exploitation of petroleum. SM3009is a round oversized shape that features a steel frame and anultra-feminine profile with thin temples on a step design. Therecognizable yet subtle Stella logo is applied on the temples.www.luxottica.com

iwood ecodesign

All frames are made from luxurious veneers reclaimed from business jet interior jobs. The veneers are “micro laminated” to 9 layers for strength using formaldehyde-free glues. A hand-applied protective coating emitting no VOC’s is added for durability. Temples are stainless steel imported from Italy.All frames can be Rx and all species of woods are FSC certified.www.iwoodecodesign.com

Sires EyewearSire’s Crown – Using innovative technology to create one of akind functional wearable art. We are taking part in a growing

demand that requires less cookie cutter manufacturing and morehandcrafted individualism. Our frames are comprised of

reclaimed, sustainable, and FSC woods. www.sireseyewear.com


Viva International Group sales associates gatheredrecently for the company’s annual North AmericanSales Summit at the Westin La Cantera Resort in SanAntonio, Texas. The four-day meeting included 176members of Viva’s North American sales force, asupport team from Viva corporate and executivesfrom parent company HVHC, Inc. The agenda includ-ed professional development training sessions,

brand and product presentations, achievementawards and a charity team-building event.

A themed “Glam Night” showcased a host ofachievement awards, including the new inductees for Viva’s prestigious “President Club,” which honors the top 10 achieving sales consultants inNorth America.

Viva International Group hosts annual North American Sales Summit


Continued on page 14

Over the last number of months, my articles havebeen focused on management topics. I have writtenabout marketing, strategy, and a number of otherimportant topics, but felt that I needed to go off in anew direction this month.

I am a frequent reader, and former active participant in anonline forum called Optiboard (www.optiboard.com), and itprompted me to think about where opticians may be in thefuture.

It is a marvelous forum filled with very dedicated people fromthe eye care community who talk about anything under the sunthat is related to the optical industry and related professionsand sometimes things not related at all. In my reading of thesethreads, it is clear that the term optician can have a completelydifferent a meaning even within the field. So this month, I feltthat we should see if we could get some folks thinking aboutsomehow developing a national definition of what an opticianreally is and does in their professional life.

The Changing Face of the Profession

Opticians today have seemingly been relegated to the role of“spectacle peddler” in a retail or chain store environment, farremoved from the professional optician of the past that fittedcontact lenses, and other devices used in the correction ofvisual anomalies. The changing landscape of the eye care industry presents a quandary for the optician. Where do they fitinto this new environment? Should they expand practice roles

through additional education and training, or serve as technicians and assistants working for chains and eye doctor’s offices? What are the personnel needs for the futureand how will those needs be met?

Licensure/Certification Requirements

Twenty-two states require a specific state license to practiceopticianry. One other state (Texas) recognizes a national boardcertification they refer to as voluntary licensure, but it is notrequired to practice (hats off to those who undertake this professional designation!). The remaining states have little orno restrictions placed on the sale of prescription eyeglasses. Inother words, the primary requirement to practice as an opticianin those jurisdictions is a pulse!

Pass rates on state and national boards vary according to training and education of the student. Additionally, as the coreknowledge and skills required for opticians to pass their licensing board examination increases, it may necessitate anincrease in the qualifying level of education and/or experiencefor licensure. Should an increase in educational and experiencerequirements for opticians be considered unacceptable by theprofession, can opticians continue to work under the supervi-sion and direction of an ophthalmologist or an optometrist?Furthermore, if opticians only work under the supervision anddirection of other professionals, should additional education berequired prior to sitting for state board or national certificationexaminations, or are those examinations even necessary toserve the public as an optician? Obviously, these questions canonly be answered by the opticians involved and other eye careprofessionals in the states where it is an issue.

Just what is an optician?

There are some differences within the opticianry community as to the definition of “optician” in the United States. Some

2012:Reflections on theFuture of Opticians

The 21st Century OpticianWarren G. McDonald, PhD

Professor of Health AdministrationReeves School of Business / Methodist University

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within the profession view it as a retail business that demandslimited education, while others see the role of the optician asbecoming far more advanced, with an increase in the scope ofpractice to include refraction and more involvement in contactlenses and other specialties. Several questions must beanswered to gain a clear understanding of what the opticianwill be doing professionally in the future. These questions alsounderlie the problems facing opticians today as a profession.

For instance, what level of education and training should be required to safely and effectively utilize new and emergingtechnology in practice? An acceptable answer to this questionhas not been adequately resolved by opticians throughout theUnited States. This is important because some of the new technology available for opticians – and should within theirscope of practice such as advanced refraction systems – requireadditional training to safely operate them. These systems allowthe technician in the eye care professional’s office to accuratelyperform refractions to develop a prescription for spectacles orcontact lenses, so should opticians consider using them as well?Some opticians are currently using advanced refraction systemsin their practice; however, it is not known how their educationand training differs from that of other opticians that are notusing these systems.

Another key problem which has not been studied or addressedby opticians is to define the role they will play in the eye caredelivery system of the future. Opticians seem to have only two choices – become an assistant or a technician in an ophthalmologist’s or optometrist’s office or expand their current scope of practice, because today the independent isseemingly a dying breed. If we are to regain some independ-ence, we must advance. However, ophthalmologists andoptometrists view the optician’s potential advancement asencroaching on their territory. Optometry regularly fights theability of opticians in legislative arenas across the country.Opticians of today are seemingly at a crossroads. They willeither advance into new areas of activity or be reduced to aparaprofessional under the supervision of an ophthalmologistor an optometrist.

Regulatory problems also impact the optician. The issue whichhas a significant effect on the profession is the question oflicensure. States have the power to regulate and impose licensure for opticians under the state’s police power. The state’s

power to regulate opticians is an attribute of a sovereign government. In the United States’ Constitution, sovereignty isfound in state governments. However, licensing of opticianscan only be justified to protect the public’s health. This is animportant concept to understand because the issue of licensureis resolved by state government and not the opticians themselves.

The issue of licensure is further complicated by the fact thatsome members of the profession, particularly those from unlicensed states, as well as other eye care professionals do notsee the need for licensure or certification of opticians. So withall this confusion, where do we go from here?

Redefining the Profession

To adequately understand the role that opticians may fill in thefuture, a clear picture of the profession as it currently existsmust be presented. The profession is currently ill defined due tothe varied role optician’s play in different regions of the coun-try. In many states, opticians are licensed health care providerswith the right to fit contact lenses and other visual appliances.Those states require an examination, state licensure and variedlevels of education and training. On the other hand, manystates require no training at all. For example, Nebraska has nolicensing requirements, but the author’s home state of NorthCarolina has an extensive 2-day examination. This disparitycauses obvious problems in defining a future role, but theemergence of new technology could provide a measurementfor what the profession feels will be the level of education andtraining needed to safely and efficiently practice in the future.This new technology may expand the need for better-trainedpractitioners or eliminate the need for them completely. Thetechnology may be good enough that technicians trained at avery basic level could do the tasks that opticians do today.

Conclusion

As opticians, we all must look to the future. If we are nearingthe end of our careers, we want to leave the field better thanwhen we came. If we are just starting, we certainly want to maximize our potential. We need to be cognizant of who isleading our professional organizations, and take an active rolein seeing that we select strategic-minded leaders that can makea positive difference. We must assure that the future will bebright, and it is up to us. ■

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WHO SETS STYLE BETTER than celebrities who havelarge followings? Here is a list of some of the mostinfluential eyeglasses wearers who glamorized their

signature frames and popularized eyewear in pop culture. Canyou predict who will influence frame styles in 2012? Sometimes,the best way to look at the future is to study the past.

Benjamin Franklin – In 1784, Ben Franklin developed bifocalglasses. He was getting old andwas having trouble seeing bothup-close and at a distance.Getting tired of switchingbetween two types of glasses,he devised a way to have bothtypes of lenses fit into theframe. The distance lens wasplaced at the top and the up-close lens was placed at thebottom, creating early bifocals.

Bifocals are still popular and the oval frame he wore is still infashion today. Search for Benjamin Franklin glasses on theinternet and you will be bound to findmany.

Jacqueline Kennedy – Jackie Obrought style and sophistication toevery American home. Her signatureoversized, round sunglasses representthe impeccable taste of the formerFirst Lady. She was always seen wear-ing her sunglasses and helped to createthe luxury sunglasses market. Eachyear, many manufacturers come outwith a Jackie O look in their summerline. There is always a demand for them.

Sara Palin – Some called her the “Jackie Kennedy” of eyewear.The Alaskan governor came into national limelight when shechose to run for vice president in 2008. She was always seen

sporting her rectangular rimless frames by Kazua Kowasaki andpeople still ask for the Sara Palin look today. She caused a rim-less crave that inspired numerous frame companies to add rec-tangular drills to their collections, creating an affordable and

attainable look for all of her fans. Thoughher political views may have been polar-izing, her glasses were a firm hit on allsides of the political spectrum.

Websites by the thousands offer JohnLennon glasses. The rock legend’s mostrecognizable trait was his perfectlyround, metal frames. When the singerbroke out from the Beatles and startedhis solo career, he was hardly seen with-out Windsor eyeglasses. The frames sym-bolized Lennon’s ideas of peace, love andfreedom, which is one reason why theyare still popular today.

The Fashionable ECPLaura Miller

Icons in EyewearFashion provides a wonderful form of self-expression. It defines what one likes

and who they are. It represents periods, cultures, religions and ethnicities.

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FEBRUARY 2012 | EEYECAREPROFESSIONAL |17

While John Lennon wore the small round wire frames, HarryPotter is best known for his large, round frames. They are alsoa huge web phenomenon with thousands of sites offering theHarry Potter look for costume and for vision. The questionremains….Why does Harry Potter have to wear glasses if he hasmagical powers? Why doesn’t he just correct his vision? Author

J.K. Rowling never addresses these questions but without histrademarked glasses, he simply would not be Harry Potter.

Bono has made sunglasses acceptable for night. His sunglassesgive him a distinct “rock star” look that is often imitated. Theshades, usually Bulgari, helped to create his signature style buthe wears them out of necessity rather than for fashion. Bono isknown to have very sensitive eyes that get red and irritated fromthe constant flashing of cameras. He started the trend for newermusic stars such as P Diddy and Kanye West, who are bothknown to sport their shades indoors. Fans usually follow thefashion of their favorite stars and now indoor sunglass wear ismore acceptable.

Elton John is not only known for his vast quantity of glasses,but also for the outrageous styles that he has been known towear for his stage shows and public outings. His crazy spectacleswere what actually started his reputation for wild, off-the-wallfashion. His most famous were the ostrich feather festoonedglasses that accompanied his feather boa outfit on the Captain

Fantastic Tour. Another pair of glasses made famous on verysame tour was comprised of 57 individual lights that whenignited, spelled his name and were bright enough to be seenfrom the end of the concert hall. Any outrageous trend in eyewear today can be credited to Elton John’s crazy and indi-vidual style. Fans may not have the money to replicate an entire

outfit, but can easily find a pair of affordable Elton-likepair of eyeglasses if they want to imitate his style.

Sally Jessy Raphael is known for her signature red,oversized plastic frames. The 80’s talk show queen confessed to Oprah that she needed large glasses to readthe teleprompter and she wanted a pair of $19.95 framesshe saw advertised, though they tried to show here some-thing fancier. Her talk show that had a 19 year-run,inspired millions of women to imitate her look with redframes. People still think of Sally Jessy when they see ared frame.

Malcolm X has famed browline glasses that became popular in 1950’s. The human rights activist was always seen inthese glasses that are a combination of colors, with the darkcolor on the top of the frame fading to a clear color towards thebottom. Companies still make combination frames in their collections, imitating Malcolm X’s bold and strong style.Celebrities such as Kanye West, Jay-Z and Justin Beiber have followed this unique trend.

These are just a few of the biggest trendsetters of fashion in theeyeglass world. Fashion is relative and nobody knows what thenext big trend is going to be. Younger celebrities such as JustinBeiber, are creating the Geek-Chic craze. Smart, sexy actressessuch as Anne Hathaway dispel the old saying that “boys don’tmake passes at girls who wear glasses”. Will she be the next bigtrend setter? What about Justin Timberlake? These days he israrely seen without eyeglasses, though he has not decided on hislook yet. It is about time for another big icon in eyewear.History shows it happens every decade or so. It is always fun to try to predict what is coming next. Your guess is as good as mine. ■

Bono’s Bulgari sunglasses

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Managing OpticianAnthony Record, ABO/NCLE, RDO

RANDY WAS A PROFESSOR of computer science andhuman-computer interaction at Carnegie MellonUniversity in Pittsburgh, Pennsylvania. In September

2006, at the age of 46, he was diagnosed with pancreatic cancer,and less than a year later, he was given a terminal diagnosis.He was told by his medical team that he had “3 to 6 months ofgood health left.”

On September 18, 2007 Randy did something that many professors have done. He gave a lecture imagining that it wasthe last lecture he would ever give. Traditionally during theselectures, professors are asked to think about their demise and toruminate about what they have learned and what matters mostto them. It is usually the intent of these lectures and the professors to impart whatever insight and wisdom they can ifafter the lecture, that’s it, they’d be gone.

The only difference here was that, given his diagnosis,Randy didn’t have to do much imagining. In a few shortmonths he knew he would be dead. In fact, less than a year later,on July 25, 2008, Randy passed away. But during his lecture hedid what he had done most of his life – focus on the positive.He shared all of his tips and insights on how to stay focused onthe bright side. Here’s the thing: No matter how bad a dayyou’re having...no matter how challenging your last patientwas...the perfect antidote for it all is simply reading Randy’sbook: The Last Lecture.

I won’t give it all away, only to say that Randy doesn’t use theglass half full or half empty metaphor. Instead, he defers to A.A.Milne, the creator of Winnie the Pooh and the Hundred AcreWood. Pausch says we all need to decide which Pooh characterwe’re going to be. He poignantly asks the question: Are you anEeyore or a Tigger? As eye care professionals (ECPs) that is a

fundamental decision we all have to make. In case you forget itfrom your childhood, Eeyore is an old, grey donkey who lives inthe southeast corner of the Hundred Acre Wood, in “Eeyore’sGloomy Place, rather boggy and sad.”

He has a poor opinion of all the other animals, describing themas having no brain at all. His favorite food is thistles. He seemsconstantly depressed and has an uncanny ability to see the greycloud within any silver lining. Tigger on the other hand, is atiger-like character who is always smiling. With his distinctiveblack and orange stripes, he bounces from one adventure to theother, bringing out the best in those around him. There is nogrey cloud big enough or dark enough that Tigger can’t wrap ina silver lining. He sees the best in every opportunity.

In more than thirty years in the optical profession, I have nevermet a truly and wholly successful person who is rotten and miserable – never. That says a lot.

Is Your Glass Half Empty or Half Full?Is Your Glass Half Empty or Half Full?All of us must eventually decide.At least that’s the opinion of the late Randy Pausch.


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Essilor Acquires CSC Laboratories, Second

Largest Independent U.S. Wholesaler

Essilor International has acquired CSC Laboratories,the second largest independent laboratory company inthe U.S. The purchase price was not announced.

Based in Watsonville, Calif., CSC Laboratories wasowned by the Kim family which retains a minority share.The company is headed by D.K. Kim, who founded the company in 1967. CSC Laboratories, which alsooperates a lab in San Jose, Calif., generated net sales of $34.5 million in 2011, with Rx sales of $32.8 million,produces about 1,860 jobs a day and has 170 employ-ees. In addition to being a major producer of ophthalmiclenses and coating, CSC distributes an extensive line ofprivate label ophthalmic frames. CSC serves the U.S.market, Central and South America and the Caribbean.Kim will remain with CSC for the next three years,according to sources close to the company.

Clariti Eyewear Announces

ECP Magazine Cover Winner

The cover of the December 2011 issue of EyeCareProfessional Magazine had a little something extra special on it. No, not the model in the cool retro ClaritiKonishi frames, but a small and well hidden Clariti logothat could win a lucky reader a pair of those frames plusa $50 Macy’s gift card! Readers were asked to find thelogo and submit its location to be entered to win.

And the winner is... Stephanie Yee of Guber Opticalin Winter Park, FL!

Congratulations Stephanie!

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So imagine the following scenario – one that plays out hundreds of times in optical dispensaries day in and day out –all across our country: A patient walks into your dispensary,complaining that her lenses have become so scratched that shecannot see out of them at all. As you examine the glasses, youquickly determine that in fact it is the AR coating. The momentthat client walked through your door, it could be said that sheinitiated an EVENT (E). Although most of us usually don’tthink in these terms, we all experience dozens, perhaps hun-dreds, of Events every single day.

From this point on, let’s consider how this optician handles thisparticular Event. For the sake of reflection (no pun intended)let’s assume that this client had purchased her glasses out-of-state, and that any warranty on the lenses has long sinceexpired. One possible response from the ECP is this: “Well...youknow...it’s really not your lenses that are scratched. What youhave are lenses that have been treated with what’s called anAnti-Reflective, or AR coating. That’s what’s really scratched.You have to be really careful with what you clean them with.They’ll scratch if you look at them the wrong way. Really all youcan do is purchase new lenses.”

Once the ECP informs her that new lenses would cost $275, theclient recoils. “I can’t afford nearly $300. My insurance doesn’tkick in for another three months. I’ll have to struggle with themuntil then.” To which the ECP (and in this case the E in ECPmight just stand for Eeyore) replies, “Sorry I couldn’t helpyou...have a nice day.” What you have just read is this particulareye care professional’s RESPONSE to the Event.

What if the ECP had been more of a Tigger and instead had responded like this: “Wow! You’re really lucky. You havewhat are called AR lenses – that stands for anti-reflective. Youprobably remember when you first got them how crystal cleareverything was, especially at night. It’s probably what was usedto clean them that scratched them. Anyway, like I said you’relucky. First of all, they’re usually warranted for a year or two. Ifthe warranty has expired, I can strip the AR layer off and thenthe lenses should be good as new. Now of course, lights at nightwill bother you a bit, but you should be able to function a lotbetter without all the scratches. And remember, whether you

get your next pair from me or somebody else, make sure youalways insist on AR or anti-reflective lenses. They’re the onlylenses that we can remove scratches from...they’re just the best!Come on back in 20 minutes and I’ll have all those scratchesstripped off for you.”

I think we can all agree that each of these two separateResponses would result in dramatically different OUTCOMES.The Outcome of the first scenario is a frustrated, disillusionedclient who will never – and I mean never – want to have anything to do with AR lenses.

On the other hand, after the second Response, that client willbenefit in that she will be able to see clearly until her “insurancekicks in,” making herself and all the people around her safer.Additionally, even if it means shelling out more money, you canbet that she will always insist on AR lenses. What a radically different result! The thing that most affected the outcome ofeach scenario was what? Of course...the Response of the ECP to the Event!

With all that in mind, I (and I think Randy Pausch) wouldencourage you to always keep the following algebraic-lookingformula in mind – consciously in mind: E + R = O. That’s right,always remember that Event + Response = Outcome. And of allthose three things, the only one that you are completely, 100%in control of is your Response to each and every Event thatoccurs each and every day. Choose wisely. ■

Progressivelenses.com

Here’s the thing: No matter howbad a day you’re having...no mat-ter how challenging your lastpatient was...the perfect antidotefor it all is simply reading Randy’sbook: The Last Lecture.”

FEB2012.qxd 1/26/12 1:19 PM

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APR2011_PPG.qxd 4/1/11 1:38 PM Page 1

Marco has been in business 40 years. What are thebiggest changes you see facing the industry?The biggest changes we’re seeing today are not someevolutionary series of changes, but revolutionary, whole-sale changes in the way practice’s function. Product andprocess changes are now colliding.

For a long time, the goal of Optometry has been toachieve the true status of ‘gatekeepers’ of eyecare – notsimply dispensers of corrective hardware. To do so, theprofession needs to institute a clinical, medical model inpractice – becoming diagnostic screeners of glaucomaand retinal disease, and more sophisticated in com-bined wavefront assessments in refractive examinations.

None of us know all that the future holds, but we allknow a few simple truths about the future of health care.Doctors will be seeing more patients, many more...buthow, when the hours of each day are already con-sumed? This is an unavoidable truth that requires a solution. GREATER EFFICIENCIES is the only answer.

ROI becomes a combined formula of seeing morepatients daily, providing ‘appreciably’ higher levels ofeyecare, and finding greater total efficiencies. Everyproduct purchased needs to fulfill this mission— both asthe technology itself, and in the services that supportevery purchase.

At Marco, that’s what we deliver every day.

Do doctors understand what changes will becoming...and will be necessary to make?Most do not fully grasp the magnitude of the issue, andmany still are not feeling the pain needed to move outof harm’s way. For some, life just goes on, as is...but the‘head in the sand’ approach needs to be replaced withsearching for available data ‘in the cloud.’

Many don’t recognize that control is slipping away fromthem, with potential patients lost to competition. Butthe ground is moving beneath our feet, quickly. Doctorsneed to become more efficient, and find more consulta-tive time with their patients— who are demanding it.Internet educated patients demand more...and Angie’sList tells them what practice to entrust their families eyecare to. Doctors need to learn how to market theirservices to patients...and elevate the patient experience... this cannot be underscored enough.

What are the hurdles for practices to address the needed changes?• The belief is that delegation of refraction is impossiblewithout compromise. While it may have been true inthe past— not so today with existing automated tech-nology. So there is a need to TRUST automation toaccurately standardize refractive results...consistently—among many staff members. The subjective patientdecisions between time-lapsed ‘1&2’ presentations...that are then further subjectively interpreted byDoctors or staff create far greater errors than necessary,given what technology offers today. With the ability topresent old and new Rx, #1 and #2 options together,and differences in patient’s day/night vision, any variability in testing BETWEEN staff is negligible compared to the benefits gained by reducing subjective patient responses.

• Knowing what questions to ask to purchase the correctautomated equipment.

• The fear of EMR implementation and technology integration. Disruption is daunting...especially for larger practices.

What are companies like Marco able to provide doctorsto succeed?First, there honestly are not many companies likeMarco— that provide the services we do...and that havedone so for more than 40 years.

22 | EEYECAREPROFESSIONAL | FEBRUARY 2012Continued on page 24

EyeCare Professional’s Paul DiGiovanni, LDO, speaking withMichael Crocetta, Excecutive Director of Marketing, Marco.

MARCOGreater Efficiencies

In the 21st Century

Marco_0212.qxd 1/26/12 2:18 PM Page 2

Healthcare is demanding that you change the way you practice. Sure, change, at some level, always involves adjustment, but it need not involve wholesale disruptions to your practice. The TRS-5100 refractive system integrates smoothly into your daily routine and EMR program. You’ll only be challenged to figure out what to do with all that extra time in the day. We’ve got a few ideas on that also.

Contact Marco for your free practice assessment, and learn how we can make a measurable difference in the life of your practice at www.whosincontrol.info.

www.marco.com800.874.5274

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you KNOW how tothrive amidst change

TRS-5100 Total Refraction System

FEB2012_Marco.qxd 1/26/12 5:29 PM Page 1


Of course you need to deliver the best technologies tocustomers...and robust technologies that meet the rigorsof real-practice use...but the key is in the support services,knowledge base of clinical and technical support, and alifelong partnership commitment for a practice.

What does Marco do differently for practices?We do a lot of listening to what you want to accomplish.We provide education, assessment, and metrics of patientflow and worksite efficiencies. We transcend the ‘consult-ing of the 80s and 90s’...to roll-up the sleeves ‘reengineer-ing’ needs of this millennia. We don’t just tell you what wethink you need to do...we work with you to actually implement what YOU want to achieve. It’s about YOURspecific objectives...and one size just doesn’t fit all.

We provide a 3-step solution:

• We help you develop a solid plan

• We show you specific, prioritized ways to regain greatercontrol of your practice, patients, and profitability

• We forge a strong and lasting partnership with the practice

Within this process, we offer a full staff of product managers and specialists, 24/7 on-line training, and GoTomeetings to resolve issues and to utilize 100% of instru-ment capabilities (that few practices utilize in the first year).Marco Area Managers are trained practice flow expertsand our Technical support services are unrivaled.

How critical do you think it is that practices embrace necessary changes— NOW?

It is an essential realization— but only the first step.

Accepting a plan and hitting the ‘NOW’ button iscritical...but in fairness, many doctors have never been presented with an achievable roadmap that doesn’t requiretearing down walls...and major overhauls to the practice.

You can believe that efficiency and quality cancoexist...and they do so in thousands of Marco practicestoday. Sure— practices are businesses— and success firstrequires survival...but the reality is that, while so manypractices are flailing while being buffeted by new magnitudes of change...Marco practices learn how toTHRIVE amidst change.

The practice of the future is NOW. The combination ofNidek technology and Marco ‘Tech-Knowledge-y’ providethe needed tools to find measured success.

Marco offers free practice assessments...and so manyautomated instruments and workstations, that we don’tforce square pegs into round holes, we don’t need to. Wedeliver the custom solution for your practice today...andagain for tomorrow...however the practice changes.

Bottom line:

• Practices need to make an honest assessment aboutwhat’s working and what isn’t

• Create a needs wish list

• Contact us to observe flow and process in the practice

• Let us record and document activity, and provide realisticmetrics concerning your unrealized potential

• Prioritize what changes you need to tackle first

• Equip the practice with the necessary technologies

• Begin to elevate best patient care and satisfaction

• Control the realization of your vision and experienceyour ‘WOW’— NOW ■

TRS-5100 Total Refraction System. One of numerous, fully automated, refraction solutions.

Marco_0212.qxd 1/26/12 2:12 PM Page 4

EXPAND YOUR FIELD OF

THE COMPLETE EYECARE EVENT

EDUCATION: MARCH 22–25, 2012 | EXHIBITION: MARCH 23–25, 2012New York, NY | Javits Convention Center | www.visionexpoeast.com

LENSES & PROCESSING TECHNOLOGY

MEDICAL & SCIENTIFIC

EYEWEAR & ACCESSORIES

CONTINUING EDUCATION

BUSINESS SOLUTIONS

DEC2011_VEE.qxd 12/2/11 2:15 PM Page 1


The stress of traveling is apparent on many faces while someshow little concern. There are a few aggravated travelers work-ing to remain calm while complying with the requests of thesecurity staff. Some passengers are holding back tears as they getcloser and closer to the gate.

As we board the plane it hits me that my safety for the next 3hours is being placed in the hands of commercial pilots that aretotal strangers to me. I’m tempted to ask them how well they getalong and if they feel they are a good match for making quickjoint decisions. I could have bought a limited edition pair ofdesigner prescription sunglasses for what I paid for this flight.Seems like it would have been less expensive since the plane isnot new and actually looks vintage. The person behind me tapsme on the shoulder and asks where my final destination is goingto be today. I tell him either Charleston or heaven, I’m just notquite sure yet. He laughs.

This is the final boarding call for Flight 20/20, ECPs please takeyour seats in first class as we prepare for takeoff.

First class treatment and going the extra mile takes placethroughout the duration of the flight (appointment). First andforemost the entire crew needs to treat each other and the passengers (patients) with respect. You can’t have first class anything if half of your crew is on standby. Getting everyone onboard with being and doing their best requires having fun finaldestinations every single day. Make up your mind to get rid ofthose jet lag thoughts and that terminal seriousness. Start atyour arrival time and decide to have fun throughout the daywith every passenger.

Our special agents (front line staff) assist the passengers before,during and after their flight. They are in charge of traffic control and can tell us what’s working fine and what’s not. Thiscan be extremely valuable information for improving first classperformance. Pilots need to know things like the check inprocess is too taking too long, when scheduling issues come upor that the system keeps crashing. Prompt attention to thesetypes of matters is needed to keep the special agents fromexploding or being blown up. Make sure that they have all ofthe tools necessary to do their job in an upright position withconfidence. Passengers should not feel uneasy or skepticalabout the way your airline does business.

To soar above those low lying optical shops or fly by night DIYeyesight websites, ECPs have to be prepared to hear about nosedive offers that some passengers fall for. As much as you mightwant to fly off the handle, remember that’s not the best way tosteer the passengers back to your airline. One pilot (doctor) thatI work with tells his passengers that he wants to help them takegood care of their eyes for life. He can’t do that for them if theydecide to go elsewhere.

Ginny Johnson, LDO, ABOC

The Mobile Optician

“I Believe We Can Fly”While standing in line at the airport recently waiting for my flight to board,I was noticing the different ways that passengers handle the ground rules.

FEB2012.qxd 1/26/12 1:20 PM

ECPs should constantly be working on different approachestowards going the extra mile to insure that every passenger hasa rewarding experience. Offer fun frequent flier incentives ormaybe showing up on time passenger programs. Remind passengers to stop in every 5,000 miles for an eyewear checkup/adjustment.

If your airline makes adjustments on eyewear purchased elsewhere be sure to tell the passenger about any concerns youmay have regarding their frame before you begin working on it.There may also be a base fare that you charge for that service.Passengers don’t like fee surprises so if your time zone is notcomplimentary then make sure you let them know thatupfront.

Handling the bumpy parts of the ECP flight is not always the most comfortable seat to be in. Rising above the negativecarry-ons and ascending in a more positive direction is mandatory. Some days you will need a higher altitude to reachfor if your attitude has turbulence. There may be days when youneed an oxygen mask or feel like another crew member needsone so go ahead and offer to help them out. Take a hit for thewhole crew. Deal with that obnoxious passenger. Put the brakeson letting him/her ruin the flight for everyone. For some passengers first class isn’t even good enough. They expect nonstop free flights. If every time these passengers stop over theyhave an air rage tone then you might have to take the finalapproach. Have the captain thank them for the times that theyflew with your airline. It has gotten to the point of no returnnow so it is probably best for everyone if they get into theircargo and drive off into the sunset.

From time to time passengers will get lost when it comes toinsurance. Insurance can certainly turn out to be a trip you’drather not take. The sooner you can help the passengers betterunderstand the difference between vision insurance and medical insurance the easier the flight will be. Our crew tells thepassengers that vision insurance is used for routine eye careonly (nearsightedness, farsightedness, astigmatism). Medicalinsurance is typically used for emergency visits, eye injuries oreye infections. Medical insurance may also cover a comprehen-sive eye exam if there is no separate vision insurance or if theeye exam is due to diabetes, glaucoma, cataracts, maculardegeneration, among others. For safety regulations remind thepassenger that proof of their identity and insurance informa-tion is required at time of check in.

You can’t discount first class treatment. Passengers have thechoice of flying with any airline they choose to. There are noshortcuts you can take if you plan on having passengers for life.I believe ECPs can fly every single day. Heaven only knowswhere we could end up. ■

FEB2012.qxd 1/27/12 1:46 PM

PixelOpticsPixelOptics has appointed Brett H. Craig aspresident and chief executive officer. Craigbrings nearly 14 years of experience in theoptical industry. He joined Transitions Opticalin 1999 as general manager/managing directorfor Transition’s Asia/Pacific operations. He

became the company’s chief operating officer in mid-2006,taking over day-to-day leadership for Transitions’ global busi-ness at that time. Craig was named president of Transitions in2008 and resigned from the position in June, 2010.

Modo EyewearModo Eyewear has announced the appoint-ment of Pierre Fay as CEO for North America.Fay brings over 25 years of experience in theoptical industry to Modo Eyewear. He held topmanagement positions at leading companiessuch as the Luxottica Group where he headed

the North America wholesale division from 2005 to 2010with direct responsibility for strategies in the sale, marketingand distribution of the group’s extensive brand portfolio.

Transitions OpticalTransitions Optical has appointed SherianneJames director of North America marketing.James is responsible for the development andimplementation of organizational marketingplans in the U.S. and Canada. James has beenwith Transitions Optical since February 2011,

when she began her tenure as the director of global con-sumer and professional insights and was responsible forleading global research for ECPs and consumers.

Essilor Vision FoundationThe Essilor Vision Foundation has appointedtwo longtime Essilor executives to leadershippositions. Bob Colucci has replaced JacquesStoerr as chairman of the Foundation, andStephen Shawler replaced Ed Fjordbak as president. Colucci has spent the last 22 years

with Essilor serving in several senior sales and managementroles, and will assume this position in addition to his currentrole as president of Essilor’s Independent DistributorDivision. Shawler has 30 years of vision industry experience;the last 11 years have been with Essilor serving in a numberof executive positions.

Zeal OpticsZeal Optics has appointed David Borbon asDirector of Sales. He joins the company afterholding the Key Accounts Representative/Accessories Manager position at O’NeillClothing. He also spent years as an optical,apparel, footwear and accessories representa-

tive for Oakley, and helped the company launch numerousproducts and stage innovative marketing events that pro-pelled the brand’s success.

Optical Women’s AssociationThe Optical Women’s Association (OWA) hasselected Shirley Platzer-Stocks as the 2012Pleiades award recipient to be honored at theOWA’s annual event in New York in March.Shirley is the owner/partner and owner/con-sultant of two companies, The Optical VisionSite LLC and SPS Associates. She joined the

OWA in year one of the organization and became a boardmember soon after. She created the mentoring program forthe OWA and launched the first Professional OpticalWomen’s Workshop.

ZylowareZyloware Eyewear has announced the promo-tion of Jennifer Derryberry to the position ofsenior vice president of corporate accounts.Derryberry has more than 18 years of experi-ence in the optical industry and had mostrecently been the company’s vice president ofcorporate accounts. Derryberry joined

Zyloware in 2002 and has directed and managed the imple-mentation of corporate marketing initiatives, created brandawareness and brought new brands to market.

Welch AllynWelch Allyn has announced that Julie Shimer,president and CEO of the company for thepast five years, will retire at the end of 2012.The company said its board of directors hasappointed a search committee and hired anoutside executive search firm to assist in

securing a new CEO. Shimer’s career at Welch Allyn began in2002 when she joined the Welch Allyn board of directors.In 2007, the board asked her to become president and CEO.

Brett H. Craig David Borbon

Shirley Platzer-Stocks

JenniferDerryberry

Julie Shimer

Pierre Fay

Sherianne James

Bob Colucci

Movers AND Shakers


FEB2012.qxd 1/27/12 10:24 AM

FEBRUARY 2012 | EEYECAREPROFESSIONAL| 29

Alain Mikli internationalGuiseppe La Boria joins the Alain MikliInternational Group as sales and marketingdirector. For 8 years, Guiseppe worked forSafilo as sales manager for Italy, he worked for9 years for Luxotica as International SalesManager and about 2 years for the Allison

group as product marketing and sales assistant Director. Inthe Alain Mikli International group, his responsibilities willnotably include the development of field marketing and salesfor the company’s brands.

The Charmant GroupThe Charmant Group announced that GayleBennett has joined Charmant as RegionalSales Manager in the Southeast Region.Ms. Bennett’s initial focus will be supportingexisting business while identifying growthopportunities for the representatives in her

region. Having started in the optical industry with Optyl inthe early 80s, she was most recently aRegional Manager at L’Amy.

Coastal ContactsCoastal Contacts Inc. has namedGreg Lechner vice president ofbusiness development for the U.S.Lechner brings more than 18 yearsof senior marketing, brand andbusiness development experiencefrom Luxottica Group, where heheld positions of increasing respon-

sibility, including vice president of strategic partnerships,vice president of marketing for LensCrafters and vice president of strategy-internet/phone sales and service.Lechner holds a BS in accounting and finance and an MBAin marketing.

Live EyewearLive Eyewear expands its sales force with therecent hire of Bob Zappia. He comes to thecompany with 30+ years of sales and customer service experience derived from theintensely competitive wholesale Food andBeverage sector. Mr. Zappia will focus on

developing and supporting Live Eyewear’s accounts in theoptical and specialty channels to ensure they are reachingtheir full potential in the OveRx® category. President of LiveEyewear, Kieran Hardy says,“We are very pleased to welcomeBob to the sales team. Over the past 10 years, our OveRx®

eyewear collections have helped us build an incredibly loyalcustomer base.”

Guiseppe La Boria

Gayle Bennett

Bob Zappia

FEB2012.qxd 1/27/12 10:40 AM

However, that does not mean that high index is a panacea.Good fundamental opticianry still needs to be maintained inorder to arrive at the best looking spectacles for your patient.That means watching sizing and frame shape. Keep the frameshape symmetrical with the A dimension within 2 mm of theED and try to match their pupillary distance whenever possible.

High index Glass

High index glass lenses come in 1.60, 1.70, 1.80 and 1.90indices. High index glass has excellent optics and scratch resist-ance and it is thinner as the index increases. However, becauseof the high specific gravity of these lenses, the weight increasesas the index gets higher (See “Specific Gravity” below). The 1.60index lenses can be hardened and will pass the drop ball test forimpact resistance, but the 1.70, 1.80 and 1.90 index lenses generally require chemical tempering. In some cases they maynot meet ANSI standards and may require a waiver from thepatient stating that he understands that the lenses will probablynot be impact resistant. The 1.90 index lenses are not availablein the United States any longer.

High index Plastic

High index plastic offers the biggest benefit to minus prescrip-tions, where the edge of the lens is thicker than the center andtherefore, easy for the patient to notice. Plus lenses can also ben-efit from high index materials but the benefit is not as obviousto the patient. However, many high index materials have anaspheric design, which gives them a thinner and flatter profileand reduces the magnification that conventional plus lenses areknown to produce. Minus prescriptions and astigmatism alsobenefit from the high index and aspheric combination becauseof the lighter weight and thinner profile characteristics, buthere again, the aspheric benefits are not as obvious to thepatient.

Prescriptions above +/- 3.00 sphere benefit most from highindex lenses. However, this rule will vary depending on theindividual characteristics (amount of decentration, ED, etc) of

each pair of spectacles. Following are general guidelines formaterials and Rx powers:

1.67 index Sphere below +/- 6.00 and Cylinder below +/-4.001.70 index Sphere below +/- 7.00 and Cylinder below +/-5.001.74 index Sphere +/- 8.00 or above and Cylinder below +/-6.00

Abbe Value

The Abbe Value of a lens is a measurement of the dispersion ofcolor in the lens as light passes through it. Lenses are basicallyconstructed of two prisms, base to base in plus lenses and apexto apex in minus lenses. As white light passes through theseprisms, it is separated into the components of the visible spec-trum made up of wavelengths which correspond to the variouscolors of the spectrum. This separation of the colors afterrefraction is called chromatic aberration. The higher the AbbeValue the less chromatic aberration. High index lenses tend tohave lower Abbe Values, thus producing more color dispersion.

Specific gravity

Specific gravity is the ratio of density of a lens material to thedensity of water. The higher the specific gravity of the lensmaterial, the greater its weight. The lower the specific gravity,the less the lens weighs. Specific gravity is measured in gramsper cubic centimeter.

There is a large variety of indices, Abbe Values and specific grav-ity in lenses. The following table shows the components ofsome of those lens materials.

(See “Table” bottom of 32)

While there are many advantages to high index lenses, includ-ing better ultraviolet protection than with standard plastic andglass lenses, there are some drawbacks as well.

High index lenses tend to have increased chromatic aberration.The flatter profile and poorer light transmission can causeincreased internal surface and backside reflections. Where

Through the LensDee Carew, ABO/NCLE, LDO, MLS

HIGH INDEX 101HIGH INDEX LENSES are often the lens of choice for high power prescriptions and rimlessmountings. The higher the index the more efficiently the light is refracted, requiring less lensmaterial to provide the same amount of correction as standard plastic or glass lenses.

30 | EEYECAREPROFESSIONAL | FEBRUARY 2012Continued on page 32

FEB2012_carew.qxd 1/27/12 11:11 AM Page 2

Marchon is proud to introduce a new eco-friendly folding case for all house brand collections, helping toreduce the global carbon footprint worldwide. The simple, effective and innovative design of each case

will reduce carbon emission caused by transportation,production and storage.

“The design of our new house brands’ case will resultin significantly reduced carbon emissions,” saidClaudio Gottardi, President and CEO. “Marchonships millions of frames and sunglasses everyyear and with this new case design, we canexpect to save significant energy, directly benefitting the environment.”

The foldable case, which is approximately one-tenth the volume of the average eyewearcase when shipping, offers wearers a sleek silhouette when closed. This functional, eco-friendly eyewear case is part of Marchon’s ongoing commitment to environmental protec-tion and worldwide social campaigns. Marchonplans to selectively extend the new case program to the designer brand portfolio. House brand case deliveries will begin in theSpring of 2012.

Marchon Introduces Eco-Friendly Folding Case

FEB2012.qxd 1/27/12 9:53 AM

CR-39 lenses reflect about 7% of light, high index lenses canreflect substantially more. Distortion can be caused by the lowAbbe values and off-axis viewing through a high index lens.The farther the gaze gets from the optical center, the more dis-tortion is created. Base curve selection can also cause issues formyopes. This is especially true with stock high index lenses.Manufacturers tend to make their stock lenses on flatter basecurves than corrective curve theory dictates to make themappear thinner. These flatter base curves can lead to distortionfor the patient.

Recommending high index lenses

When recommending high index lenses:• always recommend anti-reflective treatment. This will

cut down on the distracting reflections caused by thematerial and increase light transmission up to 99.5%.

• suggest the smallest frames possible to decrease theamount of lens material required. This will maximize thebenefits of the lighter, thinner properties of the highindex lenses.

• choose a frame where there will be minimal decentration.This will keep the eyes centered in the frame and reducethe center and edge thickness.

Finding the refractive index

The refractive index of a lens material refers to how much thematerial refracts or bends light as it enters the lens from air. Theindex is determined by dividing the speed of light in a vacuumby the speed of light going through the material. For instance,the speed of light in a vacuum divided by the speed of light inwater gives the index of refraction of water.

n = index of refractionspeed of light in air = 186,000 miles per second (mps)speed of light in a material = varies

n (water) = speed of light in air (186,000 mps) / speed of light in water

n (water) = 186,000/139,849n (water) = 1.33

Finding the edge/center thickness

Now that you know the index of refraction of a material,you can calculate the center or edge thickness of the lenses.The formula is:t = ((d/2)2 X D) / 2000(n-1)where t is thicknessd is diameter in mmD is powern is index

Using the formula for a -4.00 diopter lens and a 65 mm lensblank of 1.60 index:

t = (65/2) 2 x 4.00)/2000 (n-1)t = 32.52 x4/(2000 (1.60-1)t = 1056.25 x 4/2000 x .60t = 4225/1200t = 3.52 mm plus center thickness = edge thickness

High index lenses are considered a specialty lens because theirproperties are more complex and customized than standardplastic and glass lenses. They are an excellent choice for higherprescriptions in order to make cosmetically appealing eyewear.With anti-reflective and other lens treatments, such as roll and polish, high prescription lenses can be as light, thin andattractive as their low power counterparts. Now that you can determine index of refraction and lens thickness, you can provide to your patients the finest the eyewear industry has to offer. ■

With contributions from: Brian A. Thomas, P.h.D, ABOM

Lens material Index Abbe Specific Gravity

CR-39 1.498 56.8 1.32

Trivex* 1.53 44 1.11

Polycarbonate 1.586 30 1.20

High Index 1.60 1.60 36 1.22

High Index 1.67 1.67 32 1.35

High Index 1.70 1.70 39 1.41

High Index 1.74 1.74 33 1.46

Crown Glass 1.523 59 2.54

Glass 1.70 1.70 31 2.99

*Utilizes the green wavelength instead of yellow

Lens Reference Chart


FEB2012_carew.qxd 1/26/12 1:58 PM Page 4

FEA INDUSTRIES, INC.

(800)-327-2002 • www.feaind.com

Kodak and the Kodak trade dress are trademarks of Kodak, used under license by Signet Armorlite, Inc. CleAR is a trademark of Signet Armorlite, Inc.

Meet Our Hard Coat “Twins”!FEA has DOUBLED our Hard Coat Capacity

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• FEA has invested in a second CHC150 Hard Coat machine

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Remember

• 1 year unconditional scratch warranty (excludes processing and intentional damage)

• Non-tintable (the hardest coating available) applied to both sides of the lens

• Only $10.00 per pair

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Patient CareLindsey Getz

Working with

Older AdultsOlder patients may bring special challengesso make sure you’re up to the task

Working with older patients in your practice can bring specialchallenges. There are many normal changes that take place withaging which can affect the way patients act and react to their eyeexam or even their time in the dispensary. It’s important whenworking with the older population to pay special attention totheir needs. These patients are also more likely to have eyehealth problems so properly educating them on diagnoses andeye care is of critical importance.

Cognitive Changes

According to the US Department of Health & Human Services(HHS), aging results in normal changes in cognition—specifi-cally reduced processing speed, greater tendency to be distract-ed, and reduced capacity to process and remember new infor-mation at the same time (called “working memory”). WhileHHS reports that these normal changes can sometimes lead tofalse stereotypes or beliefs that older adults are cognitivelyimpaired, they are in fact just a normal part of the agingprocess. Still, these changes may mean modifying the way youeducate the patient on their diagnosis or even on what you’redoing as you go along with the exam.

“You definitely have to takeyour time and make surethe patient is clear onwhat’s going on and whatyou’re telling them,” saysSally Halim, OD, of VillageEyecare in Woolwich, NJ,who has worked with anumber of older patients ather practice. “Thingschange so quickly in ourindustry. The patient may

be used to older technology. I find that it’s important to explainwhat you’re doing as you proceed through the exam so that thepatient is not surprised or fearful in any way.”

Halim says she’s also found that older patients can be stronglyaffected by past negative experiences in the healthcare world.They may be less likely to let a negative experience go and mayharbor those bad feelings long term. If they had a poor experi-ence with a past eye doctor, they may be even more reluctantabout new technology or procedures.

“You have to assure older patients that have had a bad experi-ence that it doesn’t mean those things will happen again,”Halim says. “It’s almost like you have to win them over whichcan be difficult. But it’s important to be understanding of anydifficult medical experience they’ve been through and recog-nize that it may be affecting their current experience with you.Explain everything you’re doing and help walk the patientthrough the exam every step of the way. Taking that extra timewith them may be all it takes to make them comfortable.”

Health Literacy and Comprehension

Older patients also have a different level of health literacy thatneeds to be addressed. Not only may they not be familiar withnewer technology, but they may also have factors workingagainst them in their comprehension of medical information.According to the HHS, older patients’ comprehension of healthinformation may be impacted by any number of issues includ-ing vision and hearing problems, stress, fatigue, depression, andthe use of medication. They also typically have to manage mul-tiple medical conditions increasing their chances of being dis-tracted or forgetful, according to the HHS.

Fortunately there are some techniques you can try to help con-vey the correct information to patients and ensure they com-prehend it. The HHS says that repeating essential informationis important. But the HHS says that frequent repetition ofinformation that is “not true” may result in the informationbeing remembered as “true” simply because older adults are

Sally Halim, OD, of Village Eyecare in Woolwich, NJ

FEB2012.qxd 1/26/12 1:22 PM

more likely to interpret the increased familiarity of a message asbeing true. In other words if you repeat that the patient should“not take the medication with food” several times, they mayremember it as “take the medication with food. Therefore, theHHS advises emphasizing the desire actions, not the actionsthey should avoid.

When communicating, the HHS also recommends stayingfocused on important details and not letting too much unnec-essary detail creep into the message as this only leaves room forconfusion or for the patient to forget the vital details. The HHSalso suggests personalizing information whenever possible tohelp the patient remember it and also to minimize distractions.

And of course, be prepared to take your time. The HHS saysthat a slower pace may be needed and that means factoringextra time into your appointment depending on the patient.“Learning to communicate better and making sure the patientcomprehends the most important details may mean slowingdown,” agrees Halim. “Don’t insult the patient but also be careful not to rush through important information. Take thetime to make sure they understood what you’ve told them.”

In the Dispensary

Once your patient has moved on from their eye exam and intothe dispensary, they still have special needs that should contin-ue to be addressed. Every patient is different but older adultsmay be more likely to be unfamiliar with new lens technologyand may require more education on why you’re recommendinga certain product.

“You may need to take the time to explain why it’s better to gowith a different material—such as one that’s lighter,” saysHalim. “I have found that some older patients believe they’regetting more for their money by going with something heavieror bigger even if it’s not more comfortable. You may need toexplain why lighter weight lenses cost more but also how theycan make the patient more comfortable. Like any age group,you have to learn to speak their language based on their experiences and what’s important to them. Be careful not to dothis in a condescending way. Just understand that older patientsmay not be as up to date with newer technology and may havemore questions.”

Of course you always have to look at the flipside. Many olderadults have embraced the Internet and have read up on newtechnology. Some are into the latest fashion trends and willwant frames that are currently “in style.” The bottom line is thatyou have to be willing to work with each and every patient at their own level, says Halim. That can require some customization of your message. Be prepared to meet the needsof each patient that walks through your door and you’ll likelysee them back soon. ■

FEB2012.qxd 1/26/12 1:28 PM

36 | EEYECAREPROFESSIONAL |FEBRUARY 2012

My modem wassmoking with flashesof fire as he took upan issue that wasburning and trou-bling to him and had

need of expression in the most vehement of terms. Namely, hewas discomforted by the discovery and realization that womenin professions, particularly optometry, have become the newstandard bearers, having wrested the honor from males whohave suffered the indignities of such nefarious activity.

The subject comes up in our conversations from time to timeand has always been a hot potato. The majority has felt that aneasy peace now remains and ill will has been left behind. Butthere are some men who are diehards. Dr. Herbert Fingles(deceased), a Philadelphia optometrist, was the leader of a smallgroup in the 1980s opposing the idea of women optometrists.He was vociferous on the subject and received a good deal ofnegative notoriety and angry calls for his trouble. He wasstopped on the street and castigated publicly for his views. Inthe eighties, women were starting to realize their ambition inoptometry. At that time, the concept of meeting financialdemands required that both husband and wife join the workforce.

This is where my friend, Natty, takes issue. “At one time themale was considered the backbone of the nuclear family,” hesaid. “It was his income, for better or worse, that fed, housedand clothed the family. Soon, females were competing for seatsin optometry schools with the usual male entries. Thisdeformed approach to an increasing problem was also seen inlaw, medicine, communications, business, education media and

other venues,” continued Natty. “The strong, confident malealways associated with delivering important news to our homeshas been replaced by strong, confident and beautiful ladies. Italso exists in our practices. The male practitioner has alwaysbeen seen as knowledgeable and the experienced person ofchoice. That man has been replaced and his hopes for the futureare now in jeopardy as a female has taken his seat in optometryschool.”

Natty continued on his diatribe. “To add insult to injury, thefemale tends to accept lower wages plus maternity leaves andtime taken off since her husband can provide the monies shemay have lost. On my way to my office I often gauge the number of women drivers on or near my route of travel,” saidNatty.“Over 50% are women and I must conclude they are trav-eling to their own offices. In the meantime, the male who hasbeen superseded has taken on a second job to maintain his roleas the bone and sinew of his family. The final nail in the coffinof male dominance was the aggressive and skyrocketing push ofgovernment and private sectors as they forced the approval andacceptance of females in the domains that males once held.Elmer, I am sorry to be such a crab but I compare my attitudeof yesteryear to today’s slick, sophisticated, big business meth-ods. I have shared my feelings with some who threatened to sueme if I put my feelings in print. You wouldn’t believe the hatemail and calls I have received. What’s this world coming to?”

But the gauntlet had been thrown and womanhood was sur-prisingly adept at expressing her views and her rights. Maleopinions changed as female education and expertise rose toheights not heretofore imagined. It took a cigarette company totake note of the changes and gave birth to a slogan that said itall, “You’ve Come a Long Way, Baby.” Pressure from both

Elmer Friedman, OD

Second Glance

The Gender Question, RevisitedThe Gender Question, RevisitedThe Gender Question, RevisitedI HADN’T HEARD FROM MY FRIEND and colleague, Dr. Natty Bumpo, of Finster, N.J. for quite a while. When I sawhis email notice on my computer I knew he had something onhis mind that was as irritating as a wound from an opticalscrewdriver that missed its mark and pierced a finger.


FEB2012.qxd 1/26/12 1:29 PM

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females and males removed the condescending phrase from useat that time. Schools, fraternal orders and clubs that were oncethe mainstay of male dominance are now peppered with femalemembers; many of them serve on their board of directors andhold high leadership offices. May I point out to my fellowoptometrists that the President of the A.O.A. is Dori M.Carlson. O.D. Jennifer Smythe, O.D. is the dean of PacificUniversity College of Optometry. I will add that the femalespeakers ready to appear at the 2012 Convention of theAcademy of Optometry constitute approximately half ofthat group.

They are occupying important positions in optometry as professors, research specialists and clinical chiefs. Females arenow in command of some of the most successful offices in thecountry. Have you noticed the heavy concentration of womenat or near the top of school administrations, CEOs ofimportant companies and entrepreneurs in every field? Womenin sports have built enthusiastic fans to a level unheard of. Atone time a career in sports for a female was short lived. Todaythey receive salaries that are commensurate with men players.

My wife, Lillian, grew up in the era when newspaper want adswere labeled Male or Female Help Wanted. There was a definitedemarcation between jobs that were only suitable for one sex.When she enrolled at optometry school, there were five females

in the class and 26 males. In the clinic the patients referred tothe females as “nurse.” By the time she graduated there wereonly two females left, the others having dropped out of thecourse. Looking for a job took a daunting effort, and after manytrials and tribulations she was hired by an optometrist who wasthe sole practitioner in the practice. He gave her a white uniform and seated her at a desk where she could greet the patients as they came in. She never participated in theexamination, but had to remain in the reception area. Ofcourse, she came in handy when it was time to run to the lab topick up the day’s work. This was the extent of the opportunitiesavailable to her at that time.

She decided to drop out of optometry and concentrate on raising our two daughters. Later, when she made up her mindto enter the field once more the whole landscape had changed.Employment opportunities were available, and there was noproblem in obtaining work. Of course, at that time womenwere not paid on the same scale as men. Today she envies thefemale graduates who are so well educated, and working side byside with their male counterparts with equal opportunities inall realms. She sighs, “I was born 40 years too soon.”

And so, notwithstanding the attempts by the likes of a NattyBumpo or Herb Fingles to make male chauvinism credible, theladies have survived. They are stronger than ever and achievingtheir goals on the road to success. ■

FEB2012.qxd 1/26/12 1:31 PM

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AGE-RELATED CATARACTS create a clouding of thecrystalline lens of the eye, causing a variety of visual disturbances. These problems can include decreased

vision, blurry vision, glare, halos around lights, night drivingissues, color vision changes, monocular double vision, andpotential safety issues such as falling, tripping or driving concerns.

In the earliest stages, cataracts may only cause prescriptionchanges which can be improved with a new eyeglass or contactlens prescription. These prescription changes generally movethe prescription in a negative direction and are known as themyopic shift. Eventually, the cataracts may become so cloudyand dense that prescription changes will not help and cataractsurgery is the only viable alternative.

Most cataracts occur in seniors generally beginning around theage of sixty or later. Diabetics and steroid users may be moreprone to having cataracts that become a problem earlier in life.Occasionally, babies are born with cataracts that can be geneticin nature or may result from a traumatic delivery. Cataracts canalso occur in people who have experienced trauma or headinjuries. People who have been in car accidents can experiencea traumatic cataract as can happen to a boxer who suffers mul-tiple hits to the eyes or head. ECP’s can check for cataracts bydoing visual acuity tests and checking the anatomy of the eyewith a biomicroscope or an ophthalmoscope.

Biomicroscopes with cameras can photo-document thecataract as well as show it to the patient so that they have agreater understanding of their own health. A visual field test canindicate to the patient what they are not seeing. A better view ofthe cataract is obtained by pupillary dilation and the use of abinocular indirect ophthalmoscope.

A trial frame refraction will indicate a patient’s best correctedvisual acuities. These standards must meet minimum driving

standards, a patient’s own safety needs, and their minimum levels of acceptable vision for work and possibly, hobbies. Whendeciding if and when cataract surgery is appropriate or necessary, family doctors and family members will need to beconsulted. Risk factors, medical conditions, ambulatory condi-tions, and other vision problems must be thoroughly evaluated.What may be appropriate for a 70 year old who is still workingor driving may be different for an 80 year old who is in a nursing home.

The surgical options for patients include single vision IOLs(intraocular lenses), toric IOLs, and multifocal IOLs. Medicareand insurance guidelines provide certain IOLs at no cost andcover the cost of post-cataract single vision or bifocal glasses.The costs of “premium” bifocal IOLs or toric IOLs are not covered under Medicare guidelines as well as some other insurance plans. These IOLs can be an out of pocket cost of$1,900-$2,500. Toric IOLs can cost from $750-$1,400.

Bifocal implants include the AcrySof IQ Restor and AcrySof IQToric, the Crystalens, Tecnis, ReZoom, and the Array. TheRestor lens is convex on both sides and made of a soft plastic.It is folded and inserted into the eye through a tiny incisionsmaller than the optic diameter of the lens. After insertion, thelens gently unfolds to restore vision. The supporting arms (haptics) of the lens maintain proper positioning within the eyeby centering itself within the original lens sack. The AcrySofRestor IOL uses 2 terms called apodization and diffraction toachieve its optics.

According to www.supersightsurgery.com, “Apodization is thegradual reduction or blending of the diffractive steps from thecenter to the outside of a lens to create a smooth transition oflight between distance, intermediate, and near focal points. Theapplication of apodization to intraocular lenses is a patentedprocess by Alcon and can only be found in the AcrySof ReStorIOL. Diffraction is the spreading of light. It occurs when light

OD PerspectiveJason Smith, OD, MS

Bifocal Implants, Apodized Diffraction, and a Case Study

AS THE POPULATION in the United States ages, there will be anincreasing need for cataract surgery amongst this senior population.

FEB2012.qxd 1/26/12 1:36 PM

passes through discontinuities such as steps or edges. In anoptical system, light can be diffracted to form multiple focalpoints or images. On the AcrySof Restor IOL, the center of thelens consists of an apodized diffractive optic. This means thatthe series of tiny steps in the center area work together to focuslight for near through distance vision.”

There is still a significant debate in the literature concerningwhich bifocal implants provide the best vision. Some surgeonsuse 2 different implants. Clear distance and near vision is provided with one type of bifocal implant, and another typeprovides clear middle and near vision.

According to the Cataract and Refractive Surgery Journal ofMarch 2006, Dr. Kerry Solomon states, “there may be clinicalindications for mixing and matching lens technologies. Patientsdescribe blurring of their intermediate and near vision. Perhapsthey will experience improvement in time, as is often the casewith monovision. All of the patients say that nighttime halosare more noticeable in their ReZoom eyes, but none feels limit-ed by daytime or nighttime visual symptoms. There may beclinical indications for mixing and matching lens technologies.Until surgeons better understand the limitations, risks, and sideeffects of this approach, my advice is to implant the same presbyopia correcting IOL bilaterally.”

When opticians and optometrists refer cataract patients to anophthalmologist, it is important that they provide the necessarypre-operative information that help patients with their visualand medical decisions. These patients may rely on other familymembers who will make decisions on their behalf. Thesefriends or family members will also be required to go to an ini-tial consultation, be present for the surgical dates, and take thepatient to several post-operative appointments.

The hope is that no post-operative complications occur such asbleeding, glaucoma, lens dislocation, or retinal detachments. Itis important to educate your patients and their family membersabout potential risks. Be certain to include a discussion aboutthe available bifocal implants and their costs, risks, disadvan-tages and benefits. I continue to be amazed that many patientswho have Medicare or private insurance have no idea as tocosts, benefits, deductibles, co-payments, and coverage.Handouts and websites can also provide another source ofeducational information. The National Eye Institute(www.nei.nih.gov) will provide the patient with valuable eyeand eye health information at no cost and is available in Englishand Spanish.

Bifocal IOLs can provide some unexpected results, as I recentlyfound out. A 71 year old male patient recently returned to meafter having bifocal implant cataract surgery in 2007.

Mr. “Jones” had the Restor bifocal implanted in both eyes. Hisvisual acuity was OD: 20/25 and OS: 20/25+ for distance andnear. He was initially pleased with his results for three years. Butover the past year, he had noticed that his vision had becomeworse in the distance. His uncorrected distance vision in 2011was OD: 20/70 and OS: 20/50. He was also very concerned thathe was no longer able to track a golf ball when he was on thegolf course. The glare outside in the bright sun was now becom-ing a problem. His “golfing buddies” were also laughing whenhe said that he needed to use orange balls on the golf courseinstead of white ones!

This was the first time that I had a case where I was consideringdoing an over-refraction on a bifocal implant patient. I wasunder the assumption that if his vision was deteriorating, thenthe only options would be to either return to the ophthalmolo-gist for removal of the bifocal IOLs (explant), or to live with it.Neither option was one that I liked. I also ruled out any possi-bilities of neurological problems, retinal changes, ARMD,strokes, or corneal problems. Mr. Jones’ pre-operative refractionin 2007 was: OD: +0.50-0.75X120 ADD: +1.75, OS: +1.00-0.75X80 ADD: +2.00.

I took a few auto-refraction measurements in 2011 and decid-ed to do a trial frame refraction, not expecting any improve-ments. Was I surprised! A trial frame refraction provided thefollowing results: OD: +0.50-1.50X140 Va: 20/30 OS: +0.25-1.00X95 Va: 20/25. Mr. Jones was also thrilled that his closevision seemed crisper and clearer with this same single visionprescription. No ADD power was needed!

I prescribed a pair of Transitions polycarbonate lenses for himto use. When he picked up the glasses, his positive response wasimmediate. The large smile was something that his wife said,“was missing for too long.” I also bought him a box of white golfballs because he donated the orange ones to the driving range.

This experience with bifocal implants proved to me that this isan ongoing new technology that is neither applicable to everypatient nor beneficial to every patient. We are prudent in ourjudgments of who should be wearing progressive lenses compared to flat-top bifocals. We should also be prudent in suggesting bifocal IOLs to patients. And we should be comfortable with the ophthalmologists as well as their post-operative results.

For those ECPs who are doing refractions, use your auto-refrac-tor as a guide. The actual post-operative refractions may, ofcourse, not coincide with the auto-refractor. In my opinion, atrial frame refraction will provide the best results for thesepatients. And never be fearful of potential disappointment; theresults just may happily surprise you and your patient. ■

FEBRUARY 2012 | EEYECAREPROFESSIONAL | 41

FEB2012.qxd 1/26/12 1:36 PM

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Last LookJim Magay, RDO

The Twinkie PhenomenaBy the time you read this Mitt Romney will/will not be the Republican opposingPresident Obama in November. By then more important things will have been decided.

No, I’m not referring to Iran andtheir quest for nukes, nor am I

thinking about the titanic strugglebetween Jesus and God this Saturdaynight (of course that would be TimTebow versus Tom Brady in theplayoffs). Actually I’m referring to the fact that the icon of emptycalories, that unspoilable cellophanewrapped delicacy, the HostessTwinkie, may be on its way out!

You’ve most likely read the news thatHostess has filed for bankruptcy(again) as the demand for healthy (or at least what appears tobe healthy) snacks grow. In a country where obesity is now amajor health concern, diabetes a scourge, and white bread con-sumption down over 20% since the Millennium, snack makersare shifting to yogurt and granola bars. We are forsaking sugarydrinks for healthy (and expensive) bottled water.

But Twinkies...those harmless little fluffy things, they can’t bethat bad....can they? Each and every one has 150 calories,4.5 grams of fat, and what the heck is the sugary cream fillingmade of? My guess is recycled industrial waste, but that’s justme. We are testing the indestructible nature of Twinkies – 11years ago on the eve of the New Millennium we buried a timecapsule containing many artifacts of the day – including sever-al pristine packages of the sweet in question – we’ll check themout around 2025 and see how they are doing.

So, switching gears slightly – how will as a country we be doingby 2025? As imperishable as a Twinkie? If you listen to thepoliticians, they all have THE answer (each one different) tofuture prosperity. It would be nice to know which one is right,I’m sure they can’t all be wrong, can they?

Just like Twinkies, we are caught upin the global forces of our times. Themiddle class is being decimated asmuch by changing trends as by anypolitical ideology. The middle classis dwindling because middle classjobs have disappeared. Not justshipped overseas – although that issome of it – the jobs are just gone.There’s not a big need for buggywhip makers, typists, or bank tellersanymore. These used to be jobs thata person with a high-school educa-tion could do and make a pretty

good middle class living, and now those jobs are gone.

Historically, we’ve seen the same thing happening in the office.In the 19th Century, a person who had readable, attractivehandwriting and could do basic arithmetic could get a decentjob as a clerk. Then, starting late in that century, the handwrit-ing began to be replaced by typewriters, and later still the arith-metic started to be done by adding machines.

And the same is happening in retail. Cashiers and salesclerksand stock-boys and other apparatus of retailers are going to losetheir jobs, along with the folks who work at the mall OrangeJulius and video arcade. And that is seriously bad, and totallypredictable, and totally not affected by the yo-yo’s running forpresident.

So we ECPs need to innovate, innovate, and innovate somemore just to survive. Can we do it? Stay tuned, if Twinkies makeit ‘till 2025, maybe we will also. ■

FEB2012.qxd 1/26/12 12:07 PM Page 50

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eyecare professional magazine february 2012 issue

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