Dispensing case study: Navigating emotional challenges and patient preferences


by Audrey Govender DO, Specsavers Takapuna, NZ


A patient arrived with damaged progressives resulting from a fall. The glasses had been purchased from Specsavers following an eye examination 5 months prior.

Although their prescription was still valid, the patient reported gradually deteriorating near vision with the glasses on. They found removing them for reading was easier, but were disappointed as they wanted to be able to wear the glasses full time.

The extent of the damage to the glasses prevented adjustment to check fit, so a new eye exam was undertaken to check if there were any refractive or ocular health changes that could be contributing to the problem. The patient had glaucoma and was under the care of an ophthalmologist.

Habitual Rx:
OD: -3.25/-0.75X18 (6/6)
OS: -2.50/-0.75X29 (6/9)
ADD: +3.00
Near working range: 30cm

New prescribed Rx:
OD: -3.25/-0.75×15 (6/6)
OS: -2.25/-1.00X40 (6/10-2)
ADD: +2.75
Near working range: 20-45cm

The patient had a deterioration in the acuity achievable in the left eye and the optometrist found that half their visual field in this eye had been negatively impacted by glaucoma. The field loss was present in the inferior nasal aspect of their visual field. This was the same point as the reading area on their progressive lens, which explained why the patient favoured removing the glasses to read – to maximise the field of view available at closer working distances.

The optometrist recommended updating the progressives.

The patient was wearing a design with a 13mm corridor and the frame had a B value of 30mm. Lifting the reading zone would be imperative to moving reading to a usable part of their visual field, so the patient was advised to select a shallower frame. The patient disliked the idea, and chose a frame similar to their current frame in size and depth. A similar lens design with a shorter corridor length was chosen to allow for the reading zone to be lifted.

A SVN pair was also recommended as a solution for prolonged near tasks, however the patient was opposed to the idea; they asserted that the progressives should serve all functions of their visual requirements and was not interested in additional pairs. Their expectation was that the updated pair should resolve all previous challenges to reading.

After speaking with the optometrist due to concerns that the patient did not fully understand the changes to their visual acuity and field, it was revealed that the patient was in denial about the new changes and had become quite upset when they had first been explained. Managing the patient’s expectations about the new lenses’ performance without potentially upsetting them added a further challenge to the dispense.

The frames were carefully pre-adjusted prior to taking any measurements and comprehensive notes were taken to ensure that the completed pair mirrored the fit of the display frame at the time of dispense.

When the completed pair arrived in store, a fitting appointment was set up for the patient and all adjustments were made to the frame prior to the patient’s arrival. This made the collection appointment pleasant and stress-free for the patient as any concerns they may have been feeling about the new pair not performing were quickly dispelled when they put them on; the patient found they could read quite comfortably with the new glasses and left content and satisfied.

Learning outcomes

While it is a dispensing professional’s duty to educate and equip patients with as much relevant information as possible to aid them in making well-informed and judicious decisions relating to their ocular wellbeing, this must be done in a careful, considerate and tactful way.

It is up to the dispenser to listen carefully, recognise cues to possible distress and adapt their approach accordingly. Decisions regarding lens and frame choices made by patients must be respected. The challenge then is to make that chosen solution work as well as possible for the best possible visual outcome so that the patient leaves happy.