# Optical Forums > General Optics and Eyecare Discussion Forum >  Why Cant We Get It Right After 724 Years?

## John@OWDC

“Around 1284 in Italy, Salvino D'Armate is credited with inventing the first wearable eye glasses.”

OK, here is a challenge for you: Name one other practice that has been with us for seven hundred and twenty four years and we still do not know how to do it right?

Seven hundred years is a very long time. Why can’t we get this right and why isn’t there a protocol for determining what is going wrong? I know that we see with our brains and not our eyes so maybe the answer belongs in a new area of research ophthalmic psychiatry? 

How can dispensing a pair of eyeglasses be this hard? 

After a careful examination, you put your patient in the latest and greatest lens design and in a frame made from space age materials. Their prescription changed a quarter diopter in each eye and they come back three days later saying, “I can’t see anything out of these new glasses, I like my old ones better”. 

Their old ones by the way are eight years old and one of the first progressive designs on the market. On the new pair the fit is correct, Rx is correct, height is correct, frame bends are correct, and the material is the same that they had before. 

I have been at this a long time now and this is NOT a unique occurrence. I know that I am not the only one who fights this battle everyday. 

How can it be that patient after patient after patient presents with visual acuity problems in their new glasses? We have had seven centuries to figure this out and we are no better off than we were one hundred years ago. 

We have computers, virtual eye charts, free-form designs, auto-refractors, pupilometers and we still cannot make a pair of glasses that people like. In many ways, to me it seems that we are going backwards instead of forward. It seems that we are more focused on asking, “can we do it” than asking, “does it actually work”. 

Do not tell me about any “adaptation period” for the new lens designs because that is a line of poop. These patients have really tried wearing them and cannot do it. 

It should be like rejecting your 1985 Toyota Corolla over your 1978 Chrysler K car! Well yes, my Toyota is much more powerful, more reliable, less expensive, more comfortable, and it actually starts in the morning, but I really would like to have the K car back… but it is not is it?

When I was a kid I loved jokes. One of my favorites went like this…

A guy walks in to a men’s shop to buy a suit. 

The salesman shows him a beautiful suit that the man loves.

He tries it on and notices that the one sleeve is a little longer than the other. The salesman says well if you just drop you shoulder a little it will look good. It really is a beautiful suit.

The man admires himself in the mirror and thinks it is a beautiful suit. Then he realizes the lapel is sticking up. The salesman says well just hold your chin down on your shoulder and it will flatten out, it is a beautiful suit. 

Last he notices that the one pant leg is a little short so the salesman says just lean down a little on that side and it will look fine, it is a beautiful suit. 

The man pays for the suit and leaves the store. As he walks down the sidewalk his head jammed against his shoulder, his arm drooping and walking with a limp he passes by two women heading the other way. They pass him and the one woman says to the other, oh that poor man, and the other says yes but that sure is a beautiful suit. 
____________________________________________

A guy walks in to an eyeglass shop to buy…

Sincerely, The Optical Curmudgeon

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## fjpod

Don't put so much faith in when a sales rep tells you he/she has the "greatest-newest-bestest lens out there"??

Give more weight to a persons habitual state, relative to what "...he should be".

We've gotten the science of optics right.  We just haven't learned the human lessons.

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## chip anderson

We as a society view _new_ as being synonomus with _better._ In some cases we out-tech ourselves. Like the new improved device that comes with an inch thick instruction book. We also as _salesmen_ have the incentives to sell the latest and greatest as profits and spiffs are higher. People see better with bifocals and trifocals. However they do _have a line_ which we have convinced them shows thier real age and has a jump when they look down.

We should pay a lot more attention to the whole person, if he fixes watches, or retinas he needs the best un-distorted lenses obtainable. If a straight top gives less distortion, use it, if he is a hyperope and needs needs to be in the near center as soon as possible, use a round top. There is nothing wrong with this no matter what the store manager that looks at the bottom line only thinks. A lens that worked well when the patient only needed a one and a quarter add may not cut it when the add gets to two and a quarter.

I think even those mathmaticly super bright people like the Meister and Chilly Harry will agree with this even though they may be employed by firms that are going higher and higher tech. True maybe when freeform has evolved a little more it may equal or surpass old designs, but we aren't quite there yet.

And before you ask, I am wearing Ziess individuals.
Chip

P.S. 
There is the point that very, very few of us have studied the accumulated history and math that others have persued for the last seven plus centuries. Perhas a bit more optical history in our training is indicated.   And yes you can mark this down, Chip came out in favour of more edumakation.

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## Michael I. Davis

> Their prescription changed a quarter diopter in each eye and they come back three days later saying, “I can’t see anything out of these new glasses, I like my old ones better”. 
> 
> Their old ones by the way are eight years old and one of the first progressive designs on the market. On the new pair the fit is correct, Rx is correct, height is correct, frame bends are correct, and the material is the same that they had before.


I will have to disagree with your premise; all is not correct.  

Is the quater diopter for distance or near?  Did this overminus or overplus them at near?  Did you change diesign to solve a problem or because this was the newest and greatest.  If one design solved everyones problem there would be only one design.

I know you know this.

My point is what did you expect to change by changing the progressive design and why?

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## Happylady

Yes, this happens sometimes. Try holding a pair of trial lenses over the new glasses that will adjust the prescription back to his old glasses. This can tell you if it's the prescription or something else.

A lot of the newer lenses are very soft in design and people who are used to a harder design can have trouble adapting. The solution after checking everything out carefully to make sure it's not something else, is to put them back in the old design.

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## optical24/7

> Around 1284 in Italy, Salvino D'Armate is credited with inventing the first wearable eye glasses.
> 
> OK, here is a challenge for you: Name one other practice that has been with us for seven hundred and forty two years and we still do not know how to do it right?
> 
> How about brain surgery. There's supporting evidence that suggests considerable success rates as early as 7000 B.C. Have we perfected it yet?
> 
> Seven hundred years is a very long time. Why cant we get this right and why isnt there a protocol for determining what is going wrong? I know that we see with our brains and not our eyes so maybe the answer belongs in a new area of research ophthalmic psychiatry? 
> 
> Exactly. We see with our brain. A lot goes into our visual perception, most of it neurally. Vision is fluid and can fluctuate, just like your BP and your biochemistry. (Just one; we all know about blood sugar issues with vision.) Ophthalmic psychiatry could be a worthy pursuit. ( How many here have used the *magic drawer*?)
> ...


 John, I see where you're coming from. But there are too many factors to the equation. HOA's, fluidity from bio-functions, pupil size...the list goes on. Eye exams are subjective simply because of there has yet to be a know all prescribe all system, and very well may never be. Custom CL's (like FF PAL's today) and refractive surgeries will dominate the future of front line visual correction, not eyeglasses. (It's the only realm that can do this. IMHO)

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## Barry Santini

Short sound bite: optical is like food...there's no absolute right. And even if you get it right, after a while, right is boring (like food).

I'd add tear film issues/changes, pupil-sampling and neuro-adaptation to the other items cited by optical24/7.

My whole ABOM paper was based on the idea of ceasing to use "right or wrong" to describe visual satisfaction. It's more about degree, aka "fuzzy-logic". Make 'em happy, and they'll be back...just like in restaurants.

B

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## Uncle Fester

> How can dispensing a pair of eyeglasses be this hard? 
> 
> After a careful examination, you put your patient in the latest and greatest lens design and in a frame made from space age materials. Their prescription changed a quarter diopter in each eye and they come back three days later saying, I cant see anything out of these new glasses, I like my old ones better. 
> 
> Their old ones by the way are eight years old and one of the first progressive designs on the market. On the new pair the fit is correct, Rx is correct, height is correct, frame bends are correct, and the material is the same that they had before.


Don't fix what isn't broken.  :bbg:

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## Mizikal

+1 for all. You can check and make sure everything is correct  but what if comes down to is how the patient sees through the glasses.

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## Chris Ryser

Have we really progressed ? For the sake of cosmetics and appearance we are now selling lenses with worse optics for more money and the public has gone for it.

No line multifocals full of distortion and high powered lenses in high index materials with curves that would make an optical engineer from the 50s shudder and shake their heads. All in the name of progress, beauty and cash register.

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## Barry Santini

> Have we really progressed ? For the sake of cosmetics and appearance we are now selling lenses with worse optics for more money and the public has gone for it.
> 
> No line multifocals full of distortion and high powered lenses in high index materials with curves that would make an optical engineer from the 50s shudder and shake their heads. All in the name of progress, beauty and cash register.


No more, Chris. Optimized Free Form, especially Sv, allows us not only to break alot of ther old rtules about curves, it can and does often deliver better optics than *anything* ever offered to the eyeglass wearer in the history of corrective lenses.

Too bad refraction has lagged behind.

B

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## Craig

> Have we really progressed ? For the sake of cosmetics and appearance we are now selling lenses with worse optics for more money and the public has gone for it.
> 
> No line multifocals full of distortion and high powered lenses in high index materials with curves that would make an optical engineer from the 50s shudder and shake their heads. All in the name of progress, beauty and cash register.


You need to move to the modern era!

We put the optical engineer from the 50's in a new progressive and a Maybach frame; they love it and send friends.

Don't knock what you have not tried.  I will build you a real pair of non-cheapo glasses  and you can see the difference.

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## Judy Canty

> Don't put so much faith in when a sales rep tells you he/she has the "greatest-newest-bestest lens out there"??
> 
> Give more weight to a persons habitual state, relative to what "...he should be".
> 
> We've gotten the science of optics right. We just haven't learned the human lessons.


AND:

long term contracts, no lens returns, unlimited remakes, massive marketing, unrealistic warranties and low-ball pricing don't make a lens any better either.

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## chip anderson

O.K.    Darryl and Harry we waiting fo you  to tole us if today's lenses are optically better than  those of the past or just better than the progressives of the past.

Chip

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## Chris Ryser

Lots of distortion compared to old fashioned 
no distortion 


 

 :cry:  :bbg:

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## Robert Martellaro

> Don't fix what isn't broken. :bbg:


At a minimum, the client should see as well with the new pair as they do with the old pair, at both distance and near (but not necessarily the intermediate). 




> No line multifocals full of distortion and high powered lenses in high index materials with curves that would make an optical engineer from the 50s shudder and shake their heads. All in the name of progress, beauty and cash register.


Ophthamics optics, like life, is series of compromises. I put segmented and PAL multifocals on the table for every presbyopic client. A very large percentage opt for the PALs. 




> No more, Chris. Optimized Free Form, especially Sv, allows us not only to break alot of ther old rtules about curves, it can and does often deliver better optics than *anything* ever offered to the eyeglass wearer in the history of corrective lenses.


It's true. However, the quality and effectiveness of the average finshed product is much lower today than it was fifty years ago. *Consumer warning*- shop carefully for a competent optician, not an expensive lens design. It will save you time (they'll get it right the first time), money (the most expensive lens is not always the best lens!), with on average, better vision and comfort.

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## scriptfiller

I can fit the good ole Natural till the cows come home.  Some of the variable corridor designs can mess things up even when giving proper frame dims. and POW.  I've taken folks out of FF PAL's and put them in the Natural and they have seen better.  And my old 2G still cuts a good curve.  I agree it's more about doing your homework.  (How many of us put a little "work" in from the house?) Don't believe everything you hear the rep's. say.  When it comes to FF design, I'm a 100% backside kinda guy.  I had a rep. from a lense company tell me that a "hybrid" front and back design was better than a 100% backside FF design.  Balderdash!  You gotta know your pat and you gotta know your tech.

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## DragonLensmanWV

I'm somewhat a fan of the ID Lifestyle, and it's a hybrid. As you know the distortion in a conventional progressive at a 2 add is not merely twice as much as a 1 add, but more. So when you put a 1 add on front and a 1 add on back you only have twice as much.

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## uncut

In our quest for thinner, lighter, smoother, one-size-fits-all...............for the lowest possible cost,...... *re-inventing the wheel* has it's consequences!

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## John@OWDC

OK, so one person took up the challenge --- Optical24/7: Name one other practice that has been with us for seven hundred and forty two years and we still do not know how to do it right?

"How about brain surgery. There's supporting evidence that suggests considerable success rates as early as 7000 B.C. Have we perfected it yet?"

OK, I can go with that, BUT, it may offend many an OptiBoard user to point out that in reality optician is not really on the same level as brain surgeon.  

Thanks everyone, great replies, and some great information. 

I would point out that in most licensed states that placing a lens or a trial lens in front of the patient is actually considered practicing Optometry without a license. Yes, we do it, but it is not wise, and could even cost you your optician's license.

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## Barry Santini

> I would point out that in most licensed states that placing a lens or a trial lens in front of the patient is actually considered practicing Optometry without a license. Yes, we do it, but it is not wise, and could even cost you your optician's license.


I _never_ place a lens or trial lens in front a client's eye anymore, just to avoid the risk you cite.

I just place an "OTC" reader (or even minus, cause they're available now) instead.  Totally and legally fine, and very low risk of harm.

B

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## optical24/7

> OK, so one person took up the challenge --- Optical24/7: Name one other practice that has been with us for seven hundred and forty two years and we still do not know how to do it right?
> 
> "How about brain surgery. There's supporting evidence that suggests considerable success rates as early as 7000 B.C. Have we perfected it yet?"
> 
> OK, I can go with that, BUT, it may offend many an OptiBoard user to point out that in reality optician is not really on the same level as brain surgeon. 
> 
> John, you're changing the *rules*. :bbg: You didn't mention something on par with opticianry. As far as "Not getting it right (opticianry)". Okay, I'll give you one closer to our field; Prosthetics. The Egyptians pioneered the idea, yet we still can't create one that duplicates the intricacy of a human limb. The answer to your original question _was_ answered by me and others in this thread. Until we understand the human brain more fully there will always be complaints. Newer products continue to better address optical problems we've known about for years but didn't have the means to fabricate. (i.e. FF, atoricity/asphericity, POW comp's, ect.). With more to come!~
> 
> Thanks everyone, great replies, and some great information. 
> ...


As to the original gist of your original post: We *can't* get it right until the human brain is fully and completely understood. This goes with many thing in medicine and will for some time. (i.e. don't hold your breath for perfection everytime. In anything that involves neural use to *operate* we will continue to have challenges.)

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