Ophthalmic Dispensing II

2014
Alemayehu

1
 At the end of this session, you be able to:

• Differentiated dispensing challenges of high myopia

• List factors affecting dispensing high myopia

• Explain how to solve challenges with dispensing high

myopia

2
These include:
• Care when selecting an appropriate frame in
order to avoid decentration.
• The prudent consideration of lens material and
form.

3
 Lens form
 Material of lens
 Field of view
 Optimum central thickness
 Resultant edge thickness
 Weight of the lenses
 Disturbing reflection
 Surface treatment
 Vertex distance
• They well influence the choice of frame

4
 High power lenses have several disadvantages
from the wearer’s point of view:
• Edge Thickness: most effectively reduced by reducing
the diameter of the lens.
• Increased weight: choose small eye size, symmetrical
frames. Avoid decentration.
 When lens diameter is increased from 40mm to 50mm, the
weight of the lens doubles
• Altered appearance of the wearer’s eyes
 A/R coating, high refractive index materials (not CG b/c of
chromatic aberrations) & aspheric design may improve
cosmetics.

5
 Therefore the lens design to be free from:

• Oblique astigmatism –point focal lens form

• Mean oblique error-Percival lens form

• Myope astigmatism cyl power on Back surface –toric

form

• Aspheric lens form-make edge thinner

6
 Glass or plastic lens
 Refractive index
 CVF-thickness
 Density- heavy
 Abbe value-optical property
 Hard coating
 Reflectance
 Tint

7
 Crown Glass:  CR39:
Index 1.523 Index 1.498
Density 2.5 (heavy) Density 1.3
Abbe value (V-value) 59 Abbe value 58
-the higher the v-value the
less transverse chromatic
aberration exhibited by Polycarbonate:
the lens. Index 1.586
 Color fringes or off-axis Density 1.2
blur
Abbe value 30

8
 Aperture field of view

 Real field of view

• Wider field than aperture diameter of frame size. How?

 To get wider field of view the lens has to close

to the eye and this at the same time increase
retinal image size

9
 Choice frame design not only cosmetical point of view
but consider prescription
• Central thickness
 Minimum central thickness 0.6
 Clinical simple method to estimate thickness is
 ranges 2mm to 1mm
 t=2.00+0.20xpower of the lens
 Thickness decrease as the power increase
• Sag factors
 To estimate the thickness sag x power of the lens
 NB. Lens diameter should be considered

10
 As refractive index increase central thickness remain
the same
 But the edge thickness changes inversely
proportional to refractive index
 Weight of spectacles:
• Rest on the nose bridge
• Spectacles frame and lenses
• Lighter like feather - titanium
• Heavy like - cellulose acetate
• Diameter of the lens
• Refractive power of the lens
• Decentration
11
 Small eye size
 Avoid decentration
 Choose small lens diameter
 Lenticular lens form –blended
 Eye size with horizontal diameter greater
than vertical
 Oval aperture
 Round aperture-less

12
 Increase as the refractive index increase
 Edge thickness

 Ghost image usually indoor / driving at night

 Caused by four reflection area.

 reflection factor (%) = ( n – 1)² x 100

( n + 1) ²

13
1) Vertex Distance
• The distance from the corneal apex to the
visual point of the lens (back vertex)
• The effective power of a spectacle lens used
for distance vision depends on its position
relative to the eye.
• All lenses become more positive as vertex
distance increases (plus lens becomes
stronger, minus weaker).
14
• Opposite for decreases in vertex distance.

• A vertex distance should accompany a

spectacle prescription if the power of the lens
in any meridian is ± 5.00 D and above,

• For example, -5.00/-1.00 x 130 at 12mm

where “at 12mm” refers to the vertex
distance of the trial frame

15
16
17
 Ensure that the chosen frame sits at the
prescribed vertex distance;

 Choose another frame, which fits at the

required vertex distance.

 Chose a frame that sits at a different vertex

distance, but alter the power of the lenses
accordingly;
18
 When + lens fitted further, BVP must be decreases and
with a - lens BVP must be increased
 In calculation, adjust focal length by the change in VD

• Example: -11.25sph at 12mm is to be dispensed

at 15mm (diff of +3mm)
FL= 1000/-11.25= -88.89mm PLUS 3mm = -85.89mm
So at 15mm: 1000/-85.89= -11.64D

19
• Example: +8.00/-4.00X90 at 12mm is to be
dispensed at 14mm (diff of +2mm)

20
 Decentration
becomes more of an issue when
high-powered lenses are
involved as the amount of
decentration required to achieve
correct centration can
dramatically influence lens
thickness and weight, resulting
in less than optimum cosmesis

21
 When faced with the challenge of dispensing
lenses for the highly myopic patient
• The three aspects immediately solution come mind:
- Selection of lens material;
- Special lenses for high myopia;
- Selection of a suitable frame.

22
 Special Lens Designs: High Myopia
 For very high myopic prescriptions, a reduced aperture
(lenticular) lens can be considered. This type of lens
employs various techniques to reduce the edge thickness
using smaller effective lens apertures while still maintaining
a viable overall lens size for glazing. The margin acts as
merely a carrier.

23
 Most designs can be produced in the workshop
using ordinary machinery (thus easy to obtain)
 The real field of view provided by a high-power
minus lens is much wider than the apparent field
(recall from ophthalmic optics course)
• Ex: a -15.00D lens made as a 28mm aperture lenticular lens
offers the same field of view as a +5.00D lens at 45mm
diameter

24
 Aspheric lens forms
• A flatter lens form means a smaller edge thickness but
sacrifices good off-axis vision if spherical surfaces only
are used.
• Incorporating a convex aspherical surface introduces
positive surface astigmatism that neutralizes the
negative oblique astigmatism
(you have learnt more about this in your Ophthalmic
Optics Course!!)

25
 Frames must be able to support thicker edges
of minus lenses
 Adjustable nose pads may interfere with nasal
edge of lens
 Choose smaller eye-size frames with wider
bridges
 A/R coating
 Special edge techniques (mini-bevel)

26
 Accurate horizontal centration (mono PDs)
 Vertical centration and pantoscopic tilt:
• For every 1º of panto lower the OC by
0.5mm)
 Reduce vertex distance as much as possible

27
 Compare and contrast aspheric lenses and spherical
lenses(2pts)

 Calculate the effective power of -12.00/-3.50 X 45

12mm when dispensed at 8mm. Then compare the
its effect at 12mm and 8mm?(2pts)

 Describe the relation b/n refractive index and TCA?

(1pt)
28
29