Dispensing Eyewear is More than a Job Title

The reason we are called dispensing opticians, instead of “optical salespeople,” is because dispensing eyewear is at the heart of what we do. Yes, we sell frames and help patients choose lens products, but it is our role as dispensers that sets us apart from our peers in the field. Anyone can sell eyeglass frames. Anyone can hand a pair of glasses to someone. But not anyone can dispense them.

It takes an optician for that.

In a previous article (My Glasses Hurt!) I stressed the importance of good dispensing skills. A proper job at the dispensing table can make or break your practice. I even believe that the success of on-line optical is a direct result of wide-scale poor dispensing. Patients who haven’t been properly taken care of see opticians as salesmen. If the focus of our field is designer fashion instead of service our patients may decide to “bypass the middleman” (us) and get their glasses delivered in the mail.

We DON’T want that to happen! We, the opticians, are not the only show on the road these days, but we’re the only real Class Act. We have to get that message out to the public, one patient at a time.

The Steps of a Good Dispense

So how do we do it? What exactly is the protocol when the patient comes to pick up?

• Do a quick inspection of the job before you bring it out to your patient. It may sound like overkill because, in theory, if the patient has been called his job should have been final inspected, benched, and cleaned. But… unless you are the only optician at your shop, and do ALL the work yourself, you really don’t have complete control of what comes out of your lab. The possibility exists that the job might have flaws.

Check it again! One of you might have had a bad day. One time I opened the case for a patient only to have a lens come flying out of the frame! Some optician hadn’t checked sizing, OR the screws, before calling the patient, and I got stuck with it. All the finesse in the world won’t get the egg off your face in a case like that! Watch out!

LOOK at the glasses. Check bench alignment. Make sure the lenses are properly IN the bevels and are CLEAN. Check also for frame defects and stress fractures in the lenses. Stress fractures in poly lenses can develop hours after insertion. Look. Always look. We had a Zyl sunglass frame once that developed cracks after lens insertion which didn’t show up until hours after inspection. It took us three frames before we got the sizing right. Always look.

• Put the glasses on the patient yourself. There are two reasons for doing this. First, you establish control of the dispense. You demonstrate that you are in charge, you know what you’re doing, and that you are taking care of the patient. Most of the time they’ll let you do it. After all, YOU’RE the optician! The second reason we personally put the glasses on the face is so we can feel, through the fingers, the initial feel of the frame. An optician’s skill is in their hands. A properly fitted pair of glasses will sort of “click” when it goes on. There’s no other way to describe it. You have to feel it.

A well fitting set of glasses should not be tight as it goes on. It should just “graze” the side of the face at the temples and fit into the little hollow behind the ear. Most of the time, when frames haven’t yet been fitted, the temples will be bent inward and you’ll feel them putting pressure on the patient’s temples as you slide the glasses on. The patient may think that’s normal, but you really have to change that. You have to make them fit right.

A lot of patients try to “help” you by wiggling their heads as you put on their glasses. It’s irritating but it’s just a nervous a control issue. They’re probably afraid you’re going to poke them in the eye! Don’t poke them, by the way.

• Check the frontal adjustment first. Chances are the first thing the patient wants to do after you put the glasses on them is to check out how they work. They’ll look around the room or in the mirror to see if the frame looks as good as they remembered it. They’ll pick up whatever is handy to see if they can read it. You have to give them a chance to do this. Then you have the patient look at you so you can check the frontal fit.

Patients seem to come in three types. There are the newbees who have no idea that glasses have to be adjusted and, if the frame is in proper bench alignment, they think everything’s fine. Then there are the veterans who know that you have to adjust the frame and will tell you, or show you (by exaggerated pantomime) that you have yet to do your job. They think they are helping. Lastly, there are the people who don’t understand that glasses have to be adjusted but know that the ones on their face don’t feel right. They think there’s something wrong with them. “These are loose!” They take them off and hand them to you.

The first patient is easy at this stage because he’s still got the glasses on his face. The other two have taken them off. You have to patiently ask these patients to put the glasses back on again so you can see what is wrong. Then you ask them to look straight at you, and you check to see if the frame is level. Here is when you assess the vertical placement of the frame and get an initial idea of the vertex distance. You adjust the nosepads and, if you are one of those who leave progressive markings on the lens for the dispense, you check the OC height as well.

Some patients get a little impatient here. They want you to do the temples first! But it does no good to adjust the temples only to have to do them again if something you change on the front of the frame wrecks that adjustment. I have also found that in cases of “antsy” patients just keeping a calm, competent attitude makes all the difference. If you don’t lose your cool, they probably won’t either. And they’ll know better the next time! (we hope!)

• Check the fit at the side of the head. To get that “click” of a proper fit the temples should “graze” the side of the head and conform to the shape of the ear. But check the side fit first before looking at the ears. Too much pressure against the head will “push” the frame forward and cause a “pull” behind the ears. If you start out with a too tight frame your ear adjustment will be wrong. So, adjust the sides first, and it’s best to do this back in the lab. Even if you have tools and a frame warmer at your dispensing station, this sort of heating, bending, or plier work may make the patient think you are “mangling” their frame. Doing it out of sight in the back will make it look like… magic. It’s always good to keep the mystery, and the mystique!

Many patients wrongly believe that a frame should fit tight to the head. You’ll put the frame on them, feel through your hands that it’s too tight, but the patient seems to like it that way. Do you let it go? NO! Many of these patients will be back later complaining that: “It felt good when I got them, but now they’re all loose!” (and it’s all your fault…) In this case, either the excessive tightness actually caused the looseness by pushing the frame forward, or a little bit of tolerable tightness (without proper ear adjustment) didn’t last. Always do a proper fit.

It might be a good idea at this point not to use the word “tight” during the dispense. Just as there are those who want the frame to make deep grooves in the sides of their face (“I know what I know, Sonny!”), there are plenty who are very afraid that you’re going to make it TOO tight. These customers would rather suffer an “all right” fit than chance a bad fit. To them, tight equals pain. So, instead of saying “Let’s just tighten these up a bit,” say “Let’s just make these more comfortable.” They may still be wary, but they’ll let you do it.

• Adjust the temple end pieces behind the ears. The best way to do this is to LOOK behind the ear. Don’t do it blind. Don’t feel with the fingers. Look. If you are sitting across at a table, get up and walk around the patient. If both of you are standing, walk around to the side of the patient. It doesn’t even work to have them bend forward to you. Bending the head forward encourages gravity to pull on the frame. That’s the same as starting with a too tight frame. You have to get up, and you also have to touch the patient. You have to lift the hair out of the way and gently move the earlobe to see where the temple is in relation to the mastoid bone. Some dispensers give a courteous warning: “Let me just check behind your ears to see how these are fitting.”

Students at Optician School are taught that a good ear adjustment is a 45º angle. If you get a question about this on your ABO exam, that’s the answer you pick! In real life, however, 45º is a starting point. No two patients are exactly the same, and human heads tend to be more rounded than anglular. This means that a 45º dispensing angle is really more of a 45º curve. Heat the temple end piece and bend it gently around your thumb to keep that angle from being too sharply delineated. This helps prevent a space at the top of the ear lobe created by an angular bend. Truthfully, I think stressing the 45º angle is to keep students from using the 90º bend the “greenhorn” opticians do. If you see a 90º temple bend, you know a REAL optician didn’t do it! Ouch!

So, where do you put that 45º angle/curve? The crest goes at the top of the ear, but it is the spaces behind people’s ears that really vary. Some people’s heads slope backward sharply. Other bulge a little. Behind every ear there is usually a little hollow between the lobe and the mastoid bone, and the shape of this space is what the temple must conform to, gently fitting in that hollow neither too close to the head or too close to the earlobe. Most of the time the temple tips will start out angled inward and will be exerting some pressure against the head. This will cause the top of that 45º curve/angle to be pushed out from the head. It even may cause the entire temple to stand out and appear loose. Remedy this by carefully flaring it away from the head in what looks like an “S” bend. If you do it right it will follow the contour of the curves behind the ear. Think of it as applied geometry.

This last part, by the way, is the essential optician’s art. If you learn to do it this way you will be a master of the dispensing part of your trade. YOU will be the one patients come to. “Oh, I always go to John/Jane at ___ Vision. He/she always fits my glasses right!” You’ll bring in business and keep it. But if you don’t bother to master this technique patients may not come back to you. They’ll find an optician who knows their stuff, or worse than that, they’ll think all opticians are equally incompetent and buy on-line. The better you are, the better we all are!

• Ask patient for feedback on the fit. You’ve done everything you were supposed to and it’s a textbook fit. NOW is the point where you ask the patient: “How do they feel?” Most of the time the patient will respond favorably, but not every time. Textbook fit doesn’t always work. It’s the difference between theory and reality, and every patient is different. Some patients have extra sensitive ears/heads. A few patients will have had a bad experience in the past and be looking for flaws in the fit. Most of these will not spare any pains in telling you what’s wrong! But don’t let that bother you. At least they’re communicating. As long as the patient tells you what they think is wrong you can easily fix it. Happy patient!

There will still be patients who want the glasses tighter. If you don’t think you should, don’t do it. Explain to the patient that if the bend is too tight on the ears the temples will ride up and cause the entire frame to drop forward and slip down. If they bounce the frame front up and down on their nose (Look! Look! They’re loose!) gently show them the real test. Put your two index fingers behind the lower eyewire and “tap” them gently forward. The frame shouldn’t move. If the patient still insists you change something Take the glasses to the back and wait a minute or so. Then come out again and put them back on the patient. “Is this better?” It nearly always is!

• Ask the patient for feedback on the lenses. Here is when you ask: “How is the vision?” The reason we do this after asking about the fit is because often times the fit affects the vision. We want to fit the frame first and then evaluate the vision. Perhaps you have a chart on the wall for him to read. If the specs are multifocals hand the patient a reading card. Be prepared, though, to have to listen to the patient actually reading what’s on the card. They often think they have to recite!
  

A patient new to mutifocals may have to be taught how to use them. (this is where you explain how not to fall down the stairs…) You also watch for problems. All patients have to “get used” to their glasses, but some problems that you can fix now will never clear up. You may need to drop the frame or increase the pantoscopic tilt. Too high or low a seg height can sour the patient. “I tried bifocals once but I just can’t wear them.” Most of the time they CAN.

If the problem seems to be lens power there may be nothing you can do to fix it… right now. The doctor may have to re-examine them. But it is GOOD PROTOCOL to do some diagnostics. Check the lenses again to make sure they really are up to ANSI. Look for “waves” in the lenses. Pull the original script to make sure nobody on your end made a typo. Look at the patient’s old glasses to see the difference. Recheck patient measurements.

All this may seem like a waste of time, but the patient sees that you care. If you just tell them to “get used to” the glasses it looks like you’re passing them off. The patient may really have to get used to them, but Your little extra effort may give them more confidence in what you tell them. You’ll also have more information. You’ll be able to tell the patient that their new glasses are stronger/weaker than their old ones. Sometimes their eyes just have to relax a little or their brain has to “catch up” on what their eyes are seeing.

On the other hand, you just might find a problem. One of the axes might be 90º different from the old Rx. There might be a bizarre amount of new astigmatism that wasn’t there before. The doctor could have made a typo! Here is where you either CALL the doctor (which I recommend) or send them back to the doctor. It’s always good to let the patient know that you will redo the lenses in case of doctor change.

• Finish the Dispense. The patient’s been fitted and he can see. He can go now, right? Not so fast! Now’s the time you bring out your freebies! Smile at your happy patient and, if you haven’t already done it, offer to clean your “guilty fingerprints” off his lenses. SHOW him the best way to clean his glasses, and then present him with his own little cloth and cleaner with your practice logo on it. You can also hand him a nice, attractive eyeglass case. After that, thank him for his business and invite him to come back for any adjustments.

It’s also good, at this point, to go over the warranty policy. Let them know that you HAVE a warranty, and what it actually is. Having it in writing is helpful too. Now, I’ve worked with opticians who were reluctant to do this. Telling them about a warranty might encourage them to use it! They might come back.. with complaints! But if they really DO have a complaint, you WANT them to come back. You want to take care of them. Otherwise they’ll become someone else’s patients and you’ll lose business. You also don’t want a patient to come in too late with a problem because they didn’t know you had a warranty. You lose then too.

Some practices do a “courtesy phone call” a week or so after the dispense to see if the patient is still happy with his purchase. It’s a great idea if you have the staff and the time. Sending out courtesy Thank You cards works well too, and might even be better. You may not actually reach the patient by phone, and we ALL know how well patients listen to their phone messages! But they may just take the extra few second to read your card– if only to see WHAT it is and WHO sent it. You’ll send a clear message that you didn’t just take their money and forget about them.

Good Dispensing is Good Business.

An optical dispensary with good, caring opticians tends to thrive. The modern retail climate seems to be going toward automated, on-line purchasing, yet, even in such an impersonal, “do it yourself” world people really appreciate service. Perhaps the youth of today are sold on the idea that EVERYTHING worth buying should be bought on-line. But eventually… most shoppers learn that, for many items, there is just no substitute for the “brick and mortar” experience. Some clothes must be tried on. Some things must be picked up, felt. and examined by hand. And some things must be dispensed. Period. I mean, try getting your hair cut on line! Hah!

Sooner or later, we want the public to become educated to the fact that OUR product, EYEGLASSES, really must be shopped for in a store, with trained opticians at hand to help them, and must be carefully dispensed to them at the end of the whole process. The only way they will learn that is if WE DO IT. Handing patients their glasses and asking them “And how do they feel? Good!” without actually making sure they fit isn’t going to grow your practice.

No matter how busy your store is, make sure each patient gets a good dispense. And don’t worry too much if there are customers waiting. Those customers may be impatient, but they are watching how you treat the guys before them. If they see you giving consistent service to each and every patient, they will KNOW that when it’s their turn, they will get the same. A savvy customer will wait for that. And they will come back to you loyally. Hire some more staff if it gets too busy. It’s busy because you are doing your job!