Frame academy

The first ever Frame Dispenser of the Year award attracted applicants with varying levels of qualifications from all over the UK, with entries from independents and multiples.
Andrew Actman said that he was delighted with the success of the new competition: 'It's great for the industry that we can celebrate the individuals who make such a positive impact on patients' lives, making them look and feel better.'
Entrants had to submit two case studies of frame dispenses and the amount of 'work, time and effort which went into each entry was amazing', added Actman.
Three finalists attended a dinner at famous London restaurant The Ivy last month, where FMO chairman Malcolm Polley announced Frame Dispenser of the Year 2004 as dispensing optician Francesca Fulgoni of Fulgoni Optometrists, Abergavenny, Monmouthshire. Samantha Larder from Eye Deals of Bridgwater, Somerset, came second, with Sarah Thomas of Malcolm Gray Optometrists, Sutton Coldfield, in third.
'Francesca has set the benchmark,' said Actman. 'She shows great insight, has a natural flair for dispensing and is completely patient centric. Her product and technical knowledge is excellent and she's very confident of her ability. We believe Francesca genuinely wants to help patients and really seems to love her job.'

FIRST PRIZE: Francesca Fulgoni
Case Study 1
Mrs Stone: aged 53
Distance prescription only:
R -11.25/-0.75x80; L -12.75/0.50x50
Previous dispense: Hoya Glass 1.8 MAR to OWP 2237 - 54x15 659.

Mrs Stone has been attending the Fulgoni practice since 1993, and until she came in for an eye exam in April 2004, had not had new spectacles since April 1997.
I likened Mrs Stone's idea of choosing new specs to someone about to have their teeth pulled out. She was not too enthralled with the idea of choosing new frames as she suspected she would need the same heavy glasses in the same thick plastic frames as before, to hide her thick lenses.
The most important thing I had to do was reassure this lady that I would tell her if the frame did not suit her and, just as importantly, if they did not fit her. I needed to gain her trust. One of the ways of doing this was to teach her a little about lenses, so I sat her down with some paper, pens and some fresh coffee and demonstrated with a trial -10.00 lens how the smaller it is cut, the thinner the edge thickness.
With lens edge thicknesses explained, my next plan was to persuade Mrs Stone to go for plastic instead of glass. I explained the benefits of plastic, how they are lighter and safer and how the difference in thickness between a 1.8 Hoya and a 1.74 Nikon aspheric is negligible.
When selecting a frame, I was careful not to bewilder her by choosing more than necessary, so I selected a few frames only. I explained that I needed Mrs Stone's pupils to be as near to the centre of the frame as possible, to achieve the best lens performance on the edge thickness. Luckily for me, Mrs Stone has a nice wide PD of 66 which always helps.
Together with the patient and her husband, the chosen frame was an Oliver Goldsmith G5032 in Silver Ice. The pice de rsistance was that the frame had thick, chunky sides which I knew when the whole job was glazed would look fantastic.
When the lenses arrived, I carried out the most nerve-racking glazing job ever and then notified Mrs Stone that her spectacles were ready.
I sat Mrs Stone down for her fitting. I never let people look in the mirror until the spectacles are fitted and all fingerprints are removed. I adjusted, re-adjusted, looked and checked vision and then gave Mrs Stone the mirror.
She nearly broke down. I have never seen a reaction like it. I had, in her eyes, done something she never dreamed possible. Mrs Stone telephoned two days later to inform me that on that day she had made her husband drive so she could look at herself in the passenger mirror.

Lenses: 1.74 Nikon aspheric
Frame: Oliver Goldsmith 49/19 G5032 Silver Ice, by Pennine Optical.

Case Study 2
Mr White: aged 61.
New prescription: R +2.75/-0.50x90;
L +2.75/-0.50x85. +2.00 Add.
PD: R 31; L 31.
Previous dispense: Zeiss Gradal top 1.6 glass in full metal, grey monel material frames.

The first thing I noticed about Mr White when he first walked into the practice were his glasses, I had never seen a pair of glasses perched so high. The pads were pinching his nose like old fashioned pince-nez. They were sitting high up and there was about 30mm from the base of the frame to his cheek.
I asked him if he was looking for anything in particular and what type of lenses he was using. He said he would like something more modern and move away from varifocals as he found them no good for reading and his distance vision was not very clear.
After examining his spectacles I asked if there was a reason why they were glass. He said his previous optician had advised him that the only way to get his 'thick' lenses thinner was to use high-index glass.
It makes me so angry when patients are put into lenses that are completely unnecessary. And frames that do not fit. I don't mean frames that don't fit just because the sides have not been adjusted or pads slightly angled, I mean frames where the bridge is too narrow (as in Mr White's case), where the length of bend is ridiculously short, or pantoscopic tilt is now retroscopic tilt. I explained to Mr White how he needed a wider bridge and soon convinced him this was the case simply by trying such frames on.
As with Mrs Stone, I then persuaded Mr White of the benefits of plastic lenses - particularly the safety benefits as he drove a lot - and he soon understood that his prescription was not as 'awful' as he thought and that if his glasses fitted, he would be be looking through the right area of the lens.
Mr White agreed to plastic lenses, and then said: 'Everyone's wearing rimless, even Sven-Gran Eriksson! Do you think I would be able to wear rimless glasses with my prescription?' I told him he could look even better.
From chatting to Mr White it was apparent that he has a young, modern outlook and wanted to have stylish frames. He told me he does a lot of photography so it was important for him to be able to see clearly through the camera lens, as well as looking at negatives close up.
I selected frames that I knew would fit correctly. Together we eliminated the frames I had chosen either for reason of colour, shape, size and we were left with just one rimless frame by Gold & Wood. The high-index plastic lens choice also proved useful to accept the drilling required for the rimless mount.
Looking directly at him he looked symmetrical and my pupilometer agreed: R and L = 31. I dotted the centres on the new frame, measured with a ruler and the heights were Right and Left = 22 decentred. Wonderful! Plenty of depth for the Essilor Comfort Ormil, a lens I favour for quality and design.
Two weeks later a very excited Mr White arrived at the practice and I removed his heavily 'perched' glasses and placed the new pair on him, made a couple of adjustments and checked he could see distance clearly. Then the all-important reading, which had caused him so many problems before. He could now read N5.
I then passed him the mirror and was greeted with what was one of the broadest smiles I've ever seen. I can't explain how good it makes you feel when someone has trusted you and they are really pleased with the outcome.

Lenses: Essilor Comfort Ormil
Frame: Gold & Wood S03. Colour 8 (bronze). Sides: 116 (brown with slight curves), distributed by Caseco.

SECOND PRIZE: Samantha Larder
Case study 3
Mrs Hewart: aged 54
Prescription: R +8.75; L +8.50. +2.25 Add
BVD = 7mm. PD = 62.

When Mrs Hewart first called in we had just received information from Essilor about the new AS Fusio 1.74 lens that was going to be made available in June. I consulted with Mrs Hewart and established that she only wanted single-vision distance spectacles, as her current reading spectacles would be OK. Her main aim was to have more fashionable frames, but also thinner, lightweight lenses. I explained at this time only 1.67 index lenses were available in her prescription but if she was prepared to wait until June a new thinner lens was being launched and was available in her prescription. I showed her the possible difference this index lens would make in comparison with the 1.67 and she mentioned she was in no hurry. I took her details and said I would contact her in June. She was happy to wait as long as I did not forget about her.
I assured her I would not forget and made an entry in the diary to contact her to confirm the lenses were available. I contacted Mrs Hewart to confirm lens availability, whether she still required a new pair of spectacles and if so would she like to come in and choose a pair as we had some new styles in? A few days later she called in and the task of choosing spectacles began. I advised which shapes would be more suited to accommodate the lenses, round or oval.
Mrs Hewart began to choose large, round plastic frames. At this point I mentioned she could choose smaller metal frames thanks to the lens type we were going to use. She was a bit shocked and asked me to recommend some styles. I picked out two I thought would suit her face shape and colouring and, of course, the lenses. She could not decide and as both frames were slightly different in shape and size I suggested I send both frames off and find out which of the two would give the least substance. As it turned out both frames would give the same. I advised Mrs Hewart of the result. I did comment that I preferred the shape and colour of the French Connection pair. She agreed and placed the order. On collection she could not believe how light they were and how different she looked. I checked the spectacles were fitting comfortably and the BVD measurement was correct and she expressed how pleased she was.

Lenses: Essilor AS Fusio 1.74 Crizal coating, single vision.
Frame: French Connection OFC2304 col.061 50-18, from Inspecs.

Case study 4
Mr Jackson: aged 66
Prescription: R +7.2/+0.75x175.
Prism 1 up; 6 out. Add 2.25. L +7.25/0.75x30; Prism 6 out. Add 2.25.
BVD = 10mm
Optical centre R: 28; L: 29.5. Heights for chosen frame = 20.

Mr Jackson thought his current spectacles were the smallest, thinnest and lightest he was able to have. He was not happy with the weight and especially the style of the frames. He ideally wanted smaller more fashionable frames, but also wanted less weight.
I helped Mr Jackson choose a couple of frames: a Ralph Lauren pair and a Calvin Klein. Both were slightly different shapes, the first being more oval and the second more rectangular. I advised the Ralph Lauren oval pair would be the better choice, as the lenses would sit better within the frame and they suited his face shape and colouring.
Due to Mr Jackson's prescription we were limited on the lenses we could consider. After consulting many of the lens catalogues we have in the practice from various manufacturers and keeping in mind that Mr Jackson wanted thin and light, to reduce weight and thickness, I came across only one lens type available in his prescription: the Kodak Concise 1.6 varifocal with Kodak's Clear lens coating. Just to make sure that there was not another lens available I consulted our glazing laboratory, Waterside. It checked its database and came up another lens type - Genesis varifocal 1.6. As the practice is not equipped with the relevant tools, I needed to make a good analysis of edge and centre substance, I suggested to Mr Jackson that I send both frames to the lab and ask them to do the measurements for me, regarding both lens types in both the frames. I did mention I thought the Ralph Lauren frames with the Kodak Concise lenses would be the best option but would send them both off to make doubly sure.
As it transpired the best option to go for was the one I suggested. The Kodak Concise lenses would give a centre substance right = 5.1 and the left = 5.6.
I phoned Mr Jackson to advise him of the outcome and he placed the order. During our conversation I explained that he would have to adapt to the new pair, as there had been an increase in his prescription, the frame was also a lot smaller than his previous pair and he was also having a different design of varifocal. Mr Jackson mentioned he was not at all concerned and was confident and very happy with the advice and service he had received. And he offered to 'go around Bridgwater wearing a sandwich board advertising what a great service he had received'.
On collection of the spectacles, Mr Jackson was instantly impressed with the weight and the thinness of the spectacles. I adjusted the frame accordingly, checking the pupil was in the correct area and BVD was right. Temple adjustments were made to ensure comfort and tight fit. I then asked him to check his vision and he proceeded to look around at the cars parked down the road. I then handed him a reading chart and was amazed he could read N6 with no problems. He then decided to compare the new spectacles with his old and was extremely happy.

Lenses: Kodak Concise varifocal 1.6 with clear lens coating.
Frame: Polo Ralph Lauren stainless steel, Polo classic 205 3AE, 50-20 from Safilo.

THIRD PRIZE: Sarah Thomas
Case study 5
Mrs Willis: aged 84
Prescription: R Plano/-2.00x155
L +0.25/-0.75x67.5. +2.75 Add.
Centration: Distance OCs 62;
Near OCs 59.

Mrs Willis was wearing a plain, gold coloured budget frame with CR39 bifocals. She did not dislike her spectacles but felt they were simply something to see through, rather than something that expressed anything about her as a person.
When I asked Mrs Willis if she would be one of my two entries for this award she was very surprised, thinking that a young person would be more suitable. She did, however, tell me that her 18-year-old granddaughter loves her glasses and her new look and she has also received many compliments from complete strangers. But fashion and style are not just for the young.
Mrs Willis has thick white hair (always perfectly styled), beautiful skin colouring and a spirited personality. She is an active lady and had decided that she would like a really nice pair of spectacles that would express her personality. Apparently she was 'a bit of a rebel', to quote her words, when she was younger. She is the sort of older person that many of us would like to be when we reach her age.
Mrs Willis has a rectangular face, a fairly high forehead but very pale, low, straight eyebrows and I felt that a warm colour frame that would give width while balancing the length of her face would suit her fair to pale colouring.
Mrs Willis prefers to wear bifocals so I suggested a Sola lens with UTMC anti-reflection coating would both improve her vision and the appearance of her new spectacles. I suggested a shallow Oko frame with supra edging at the temples as I felt that the rich purple colouring compliments Mrs Willis's skin and hair tones. The exposed temporal edges help balance the length of her face as they break up the vertical aspect of the frame and the upper and lower rims become two horizontals, giving width to a long face. The frame is also perfectly suitable for D28 bifocals.
When I fitted Mrs Willis's new glasses she said that with her unusual glasses (for an older person), she is expressing that she still feels young inside her elderly exterior, without resorting to inappropriate 'mutton dressed as lamb' clothes. She told me that she wished I could do the same for the rest of her and turn the clock back a few years.

Lenses: Sola CR39 1.5 D28 x 3 below x 1.5 in with UTMC coating.
Frame: Oko by Oko UC 20, 50 x 18, Purple.

Case study 6
Mrs Hyde: aged 45
Prescription: R: Plano/+0.25 x 90, 8 prisms base out; L: 0.25/+0.50 x 80, 8 prisms base out; Add +1.25 right and left, 3 prisms base out each eye.
Centration R 30 and 2 above HCL L 32 and 2 above HCL.

Mrs Hyde was wearing a small, oval, pink mottled, gold base coloured frame with CR39 single-vision lenses. The frame was very suitable for her complex prescription but she 'hated them' and her vision had never been very good with the spectacles. Mrs Hyde has physical health problems and felt her glasses, combined with her walking sticks, made her look and feel like an unattractive grandmother. She had a very specific requirement that her glasses should make her both look and feel better. A really nice pair of glasses can lift a person's spirits and give them confidence.
The mother of an eight-year-old son, Mrs Hyde is an attractive lady with thick, auburn hair, warm skin tones and a lively personality. Her activities are limited as she requires assistance to go out. She came to the practice with a hospital prescription for both distance and reading glasses as she has different horizontal prism requirements at distance and near. She had decided to revisit Malcolm Gray Optometrists, following a visit years previously, in the hope we could once again produce something that would make her feel happy with her appearance and vision.
To meet the hospital prescription requirements I dispensed distance vision spectacles to a metal Yves Cogan supra frame, near vision to a fashionable shallow, rectangular brown mottle plastic frame and Franklin Split bifocals to a fashionable shallow, rectangular blue plastic frame. It is the distance vision pair that are the subject of this entry.
Mrs Hyde has a fairly square face and arched brows. For her colouring, I felt a copper supra that would give width across the brow area while angling in at the lower edges to minimise the edge thickness of her prescription would be both suitable and attractive. As rimless and supra-style frames are currently very popular, I hoped that Mrs Hyde would feel happy with her appearance. With 8 prisms base out in each eye, I was aware that even dispensing a 1.67 index Transitions material the temporal edges of the lenses would be almost a centimetre thick. I therefore instructed the glazing lab to bevel the back edge of the lens, behind the supra cord to produce a soft, faceted appearance and minimise edge thickness.
When I fitted Mrs Hyde's new glasses she told me that she could not believe how much better she felt about her appearance. As Mrs Hyde is unable to attend the practice without assistance, she invited us to her home to take some photos. It was necessary to photograph her indoors as her Transitions lenses immediately darkened outside, therefore as flash photography caused reflections from her frame, the photos were taken in her conservatory and her lenses did darken slightly.

Lenses: Seiko SSV 1.67 AR-coated brown Transitions lenses, with back surface temporal bevel.
Frame: Yves Cogan 456, 54 x 16, Copper.

Acknowledgements
optician thanks all three entrants for allowing us to reproduce these edited extracts of their Andrew Actman Award entries and the case study patients who gave their permission to publish their images and prescription details.