Troubleshooting - you’ve got a problem… Fix it Once and Fix it Right

Attitude Your attitude Confident Scared Defensive Rushed

First Step Take a deep breath Calm attitude Speed is not the issue be methodical Act like a professional - listen

PERSONALITY TYPE Competitor – Fight with the patient Fun Lover – Play with the patient Respectful – Analyze with the patient Peacekeeper – Please the patient

Emotional issues Did you properly prepare the patient for the differences from previous pair ? Is the product right for the patient? Does the patient understand adaption? Policies 60 day Desert island

Check for your errors Was it ordered correctly? Check the doctors notes on the chart. Was it received correctly?

Check the history Previous prescription versus new prescription Is there a change? Where? How much? Determine total power change? Previous: OD -2.00 -1.00 x 050 New: OD -2.50 -1.25 x 055 New RX Change in progression of power? Previous: OD +0.75 -2.00 x 135 ADD +1.50 New: OD +1.25 -2.25 x 136 ADD +2.00 How much is too much?

Changes in history Measurement differences PD Pupillary Distance (PD) Seg height Optical Center (OC) PD Trifocal Bifocal Progressive OR Optical Center

Changes in history Base curve Pantoscopic distance - Vertex distance

Check the history Lens material Poly to High index High index to Poly Patient might experience Images appearing different in size Reflections Decrease in sharpness of acuity 13.8 mm 11.6 mm 10.3 mm 9.8 mm CR-39 Poly 1.66 1.70

Change in history Lens design Patient might experience Single vision to progressive Patient might experience Peripheral blur Frustration with need to move head Difficulty walking, reading in bed

Change in history Progressive design change How long was the patient wearing the previous design? What are the design changes? How long to adapt?

FRAME Fit Adjustment Differences in Pantoscopic angle Vertex distance Too far away? What happens? Plus lens? Minus lens?

PHYSICAL HEALTH Discuss medications Ocular side effects Heart medication: blurred vision, color distortion Tetracycline & steroids: swelling of the optic nerve Involve your doctor

PHSYICAL HEALTH Systemic changes Hypertension Diabetes Hemorrhages Involve your doctor

PHSYICAL HEALTH Ocular changes Halos – acute glaucoma Cloudy veil – retinal issues Sudden lose of vision or double vision Involve the doctor

Troubleshooting Checklist Double check all parameters are as ordered Sphere, cylinder power in each lens Axis Base curve Distance and near PD’s Optical centers Prism as ordered – Is it unwanted prism Multifocal segment – style, size, height, differences Segment alignment – even or crooked Add power

Troubleshooting Checklist Lens materials Lens coatings or tints Lens thickness Lens surfaces – scratches, imperfections Lens mounting

Troubleshooting Checklist Frame received as ordered? Differences from previous pair Frame style, size, metal, plastic Frame condition – torn pads, loose hinges Frame alignment

Closing Stay calm Work through problem solving step by step Discuss patients options Inform patient of practice policies

QUESTIONS