# Optical Forums > General Optics and Eyecare Discussion Forum >  Lab Delays due to Prism

## KrystleClear

I wanted to see what your opinions are on this. I really appreciate your knowledge and wealth of experience!

We have a patient who has been prescribed a total of 20 diopters of prism secondary to an injury (10 base out each eye). He is a forklift driver and has been out of work due to this, and needs the glasses to get back to work, as he cannot safely drive the forklift with double vision.

We ordered his glasses 5/18/2021. The patient is a big and tall guy and thus had to go for a larger frame. Ten days after ordering, the lab calls and says they want to change the material. I say fine, we'll eat the cost. I get another call back saying, no, they don't want to change the material (I guess we heard them wrong or some miscommunication), but rather they are demanding he restyle to a smaller size. I mean, I understand why, but he is a larger man and it has already been 10 days (5/28/2021) and now we will be starting from square one. He also lives a distance away and has to have a driver bring him. So he comes back in same day, picks out smaller ones - the fit isn't ideal but this is a small as we can really go. I wish we could go with a smaller frame, but it just isn't feasible for his size.

We hear nothing until 6/10 and they say there is lens spoilage and are restarting. It has been in the prism block phase for several days if not a week, and no end in sight. Patient is getting upset and now his employer is too, as they don't want to keep paying out medical leave. We use an outside lab. They are going to still have to mail them to use when done via UPS.

I am at the point where if/when they come in, and the patient accepts them, I feel that I should refund him. He has been out of work for 5 weeks because there was a week or two before the doctor prescribed prism after the injury. I am just waiting for him to call or show up and yell at me. :( Does that seem reasonable? His glasses are not going to be cheap for him and I hate to collect that money knowing we have put him and his employer out like this.

Thanks!

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## Optical Roy

It's not your fault for the delay, or injury. It really doesn't matter if his company is tired of paying medical leave, they should also pay the expense for the glasses as I am assuming that his injury happened while working. Here in Texas, workman's comp pays everything. We have 1 individual that has received workman's comp glasses for the last 7 years due to injury on the job. I would advise him to look into this.

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## Uncle Fester

You have my permission to steal this apology:

"I'm going to ask that you _call on your better angels to forgive me_. I am so sorry that we are experiencing this delay for your complicated custom designed glasses and am doing everything I can to get them from the lab- but this is a prescription that often needs multiple attempts to get the finished lens accurate and mounted in the frame. Meanwhile- I can get a pair of Fresnel press on prisms that should work until the order comes in at no charge to you (explain a Fresnel yadah yadah)"

Don't do them no charge. If you must- offer a future credit/discount toward another pair.

Also- any future job like this would do well if you call the lab and ask them beforehand if the order is doable in the frame he chooses and how long will it take.

Hopefully he will be ok with this.

fwiw-We've all been there with jobs that if it can go wrong it does.

Like this one last week-

Had a chem clip job where the lens magnet fell out. Sent it back to the lab (poly- didn't want to risk crazy gluing myself) and said it should take a couple of days. I call 5 days later and get told it will go out "today" Next day comes no job. Assured today for sure! Next day job comes in. THE MAGNET WAS REVERSED!!! Now we need a new rx lens ordered on a rush- A Week later the lab calls saying they have the blank but need the frame. "WHAT! YOU HAVE THE FRAME AND CLIP!! I start hyperventilating until a half hour later- Oopps sorry we found it. We'll get it going rush rush. 

Bottom line a 3 day turn around turned into a 3 week fiasco. Thank goodness she was nice about it and came away realizing the importance of an updated, functioning spare pair of glasses.

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## Quince

Out of your control. When the problem is due to a difficult Rx, I do try and set expectations for a longer time frame but other than that, if you've done your best to communicate with the patient and be sympathetic, there isn't much more you can do. Most people are very understanding of this, so don't beat yourself up!

I absolutely would communicate with your lab rep that the situation could have been handled better on their end.

As for cost- I wouldn't be inclined to not charge them, but instead you could offer an extremely reasonable 2nd pair (especially if your lab offers multipair pricing) or maybe some retail items- free lens cleaner/ extra cloths and whatnot. I wouldn't rush to take the blame because he most likely would have run into similar problems elsewhere.

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## optical24/7

Order a 20D Fresnel and put it on a pair Of his old glasses until the new order comes in. You can order them direct from the maker.

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## Kwill212

> Order a 20D Fresnel and put it on a pair Of his old glasses until the new order comes in. You can order them direct from the maker.


Of course the simplest answer is usually the right answer. Also one would have guess the Dr would have asked for a Fresnel prism before ordering 20D prescribed prism and crossing their fingers...

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## AngeHamm

> Of course the simplest answer is usually the right answer. Also one would have guess the Dr would have asked for a Fresnel prism before ordering 20D prescribed prism and crossing their fingers...


This. That's a hell of a Hail Mary RX.

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## KrystleClear

> Also one would have guess the Dr would have asked for a Fresnel prism before ordering 20D prescribed prism and crossing their fingers...


Yes! Funny thing is this whole started out with ordering a 20 diopter Fresnel. It came and just as I was about to call and let him know it came and he could come in at his convenience for me to fit it to his lens, the doctor said "nevermind," and to order ground in lenses. My coworker sent it back for credit, per the doctor's instructions, and I wish I could time travel and make sure we held on to it. Lesson learned! I should have just re-ordered it from the first sign of trouble. Normally our lab does tell us if a script is doable in a particular frame but there was a transcribing error on the lab's part when taking the order. I just placed an ASAP order for either a 20PD Fresnel, or two 10PD Fresnel stickers, whichever they can get to us sooner. 

Lab said this afternoon that the current ETA for the lenses is Monday if everything goes perfectly, which it may not, so either way we will have something to give him.

It apparently was not work related, so he is on his own for the glasses. I am going to comp the fresnel(s) for him. It's the least I can do.


I started at a chain optical that just threw us to the wolves with no formal training, left there, came back to the eye biz but as a receptionist for an ophthalmology practice for several years. I left there in October for a completely different field and they ended up offering me a significant raise to come back as their optician. That was January and since then I have been studying as my coworker is not really formally trained well enough to teach me anything I didn't already know. (No offense to her- she's great.) Thank you all for your kind answers! I really appreciate it!

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## Optical Roy

> It apparently was not work related, so he is on his own for the glasses. I am going to comp the fresnel(s) for him. It's the least I can do.


Get with your lab rep and see if they will comp a set of lens due to the delay, or credit that lens order if you want to give him a better credit. I usually go the 2nd set, they use a extra frame they have, or purchase a frame, so they have a backup, which I would say he does need a backup. The worse they can do is say no.

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## KrystleClear

> Get with your lab rep and see if they will comp a set of lens due to the delay, or credit that lens order if you want to give him a better credit. I usually go the 2nd set, they use a extra frame they have, or purchase a frame, so they have a backup, which I would say he does need a backup. The worse they can do is say no.


I actually did try that - explained the situation and that the patient has been greatly inconvenienced due to being unable to perform his job functions, but no dice. They just gave me the complex RX speech. I have no inner "Karen," but it would be handy right about now! I'll give it another go if it is still not finished next week. I understand it's difficult for them, though.

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## Optical Roy

I wouldn't just call the lab, call the rep, they have more pull. We all understand the complex RX speech, but the upfront honesty goes further than this restart, that restart, blah blah blah.

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## CME4SPECS

Don't give them to him, don't discount them to him.  Take this opportunity to educate your patient, that this will be the norm with a difficult prescription like his. Sell him a second pair so he won't have to miss weeks of work when he loses or breaks this very special pair of glasses, that have taken so long to get. Perhaps you can give him a break on the second pair.

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## lensmanmd

We are going through something similar, except it's 11^ BO OU.  This is outside of our bread and butter, so we outsourced them.  We got rid of our toric surfacing line, and are now a STP/FF platfrom.
Lab calls and says that they cannot get a thick enough blank for 11^OU, but can do 10^ OU.  But, the lab did not take 3+ weeks to communicate with us.
I call the clinic and gave them the FRP or 10^ option.  They called the PT, trialed the PT and the OD agreed on the 10^.  
Moral here, communicate with the lab, clinic, PT and the OD/MD.  Give them options.  Give the PT a realistic timeframe.  

10^ OU is not overly difficult to grind on a manual platform, but most pucks are not thick enough.  Then there is the edging.  Most edgers do not have wide enough wheels to handle the added 4-5mm thickness that this amount of prism adds to the edge.

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## optical24/7

Note to Fresnel users; Do Not use 2 Fresnel’s! You will reduce vision on BOTH eyes if you put one on both lenses, due to VCA’s that prisms induce, especially hi prism amounts. The proper way to utilize these is to put the full amount of prescribed prism on their non-dominant/least acuity eye. If it’s compound prism ( horizontal and vertical) you still only put it on one lens by mathematically finding the axis to put the base to induce both.

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## Uncle Fester

> Note to Fresnel users; Do Not use 2 Fresnel’s! You will reduce vision on BOTH eyes if you put one on both lenses, due to VCA’s that prisms induce, especially hi prism amounts. The proper way to utilize these is to put the full amount of prescribed prism on their non-dominant/least acuity eye. If it’s compound prism ( horizontal and vertical) you still only put it on one lens by mathematically finding the axis to put the base to induce both.


So I know we need to adjust the PD 1mm for each 3^ of prism in a progressive but what is the effect of 20^ on an existing lens?

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## optical24/7

> So I know we need to adjust the PD 1mm for each 3^ of prism in a progressive but what is the effect of 20^ on an existing lens?


Yep, adjust the Decentration for prescribed lenses (particularly PAL’s), but a Fresnel is usually used for trial/temporary/diagnostic reasons. Another reason to use only one Fresnel when you’re utilizing them.

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## jefe

> You have my permission to steal this apology:
> 
> "I'm going to ask that you _call on your better angels to forgive me_. I am so sorry that we are experiencing this delay for your complicated custom designed glasses and am doing everything I can to get them from the lab- but this is a prescription that often needs multiple attempts to get the finished lens accurate and mounted in the frame. Meanwhile- I can get a pair of Fresnel press on prisms that should work until the order comes in at no charge to you (explain a Fresnel yadah yadah)"
> 
> Don't do them no charge. If you must- offer a future credit/discount toward another pair.
> 
> Also- any future job like this would do well if you call the lab and ask them beforehand if the order is doable in the frame he chooses and how long will it take.
> 
> Hopefully he will be ok with this.
> ...


Why didn't you just pop out the magnet in the clip and reverse it?

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## KrystleClear

> Note to Fresnel users; Do Not use 2 Fresnel’s! You will reduce vision on BOTH eyes if you put one on both lenses, due to VCA’s that prisms induce, especially hi prism amounts. The proper way to utilize these is to put the full amount of prescribed prism on their non-dominant/least acuity eye. If it’s compound prism ( horizontal and vertical) you still only put it on one lens by mathematically finding the axis to put the base to induce both.


I did not know that! I was going off of our optom's recommendation to do 2 separate Fresnels if we could not get a 20PD. Good to know, thank you.

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## KrystleClear

> We are going through something similar, except it's 11^ BO OU.  This is outside of our bread and butter, so we outsourced them.  We got rid of our toric surfacing line, and are now a STP/FF platfrom.
> Lab calls and says that they cannot get a thick enough blank for 11^OU, but can do 10^ OU.  But, the lab did not take 3+ weeks to communicate with us.
> I call the clinic and gave them the FRP or 10^ option.  They called the PT, trialed the PT and the OD agreed on the 10^.  
> Moral here, communicate with the lab, clinic, PT and the OD/MD.  Give them options.  Give the PT a realistic timeframe.  
> 
> 10^ OU is not overly difficult to grind on a manual platform, but most pucks are not thick enough.  Then there is the edging.  Most edgers do not have wide enough wheels to handle the added 4-5mm thickness that this amount of prism adds to the edge.


I am chalking this all up as a valuable learning experience. I have only been back in optical for about 4 ish months and some things I am learning the hard way. We only work one optician at a time (we split the week) and my coworker is not that much more experienced. 

I am not trying to put down our lab either - this was a mess from the get go, but I would just like better communication all around. I was never told he was out of work because of this until last week! Good grief.

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## Plausible

May I ask, are these lenses ordered with anti reflective coating as well?

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## KrystleClear

> May I ask, are these lenses ordered with anti reflective coating as well?


Yes to the AR. 

As of today, my coworker was told that they should ship Wednesday or Thursday. The fresnel came in in one 20D sticker, but the doctor is telling us NOT to call him to tell him it is in and to just wait until the glasses come, since it won't be much longer. (I get not that wanting to cut and place and fresnel for just a few days of wear but I'm willing to do it.) I am so stressed about it at this point that I dread the phone ringing, because I know he isn't happy.  :cry:  Waiting for the other shoe to drop drives me nuts!

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## jefe

> Yes to the AR. 
> 
> As of today, my coworker was told that they should ship Wednesday or Thursday. The fresnel came in in one 20D sticker, but the doctor is telling us NOT to call him to tell him it is in and to just wait until the glasses come, since it won't be much longer. (I get not that wanting to cut and place and fresnel for just a few days of wear but I'm willing to do it.) I am so stressed about it at this point that I dread the phone ringing, because I know he isn't happy.  Waiting for the other shoe to drop drives me nuts!


If you're getting the lenses as uncuts, be very careful to avoid slippage during edging due to the wedge shape.  The lenses will have a tendency to slip outwards when there's that much base out prism.  The AR will increase that tendency.

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## Uncle Fester

> If you're getting the lenses as uncuts, be very careful to avoid slippage during edging due to the wedge shape.  The lenses will have a tendency to slip outwards when there's that much base out prism.  The AR will increase that tendency.


even if I could you guys that edge this in house are way braver than me!!!

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## NAICITPO

> If you're getting the lenses as uncuts, be very careful to avoid slippage during edging due to the wedge shape.  The lenses will have a tendency to slip outwards when there's that much base out prism.  The AR will increase that tendency.


Would you put non slip film on front and back?

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## Optical Roy

> Would you put non slip film on front and back?


Yes

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## IIxIPariahIxII

Prism jobs, especially with that range, are difficult. Takes several tries usually, cause there's no room for error. And depending on his RX on top of that, yeah it's gonna be a hefty lens already. Had a couple of really difficult ones last year and just had to wait. Reassure him he is in good hands, it takes time and we gotta get this right to fix the double vision.

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## KrystleClear

We got the glasses in today. Halleluiah!  :Skip: 

The wedge is extreme but not as bad as I thought - I was expecting forced temple splay but all was well there. Patient is going to give these ago. Gave him a small courtesy discount after discussing with the doctor... Praying all goes well. Keeping the fresnel regardless until the coast is clear. 

He will still need to get RX safety glasses but we do not carry safety frames so I *hope* he ends up getting those through whomever his employer contracts with. Patient is off work until next month to allow for the adjustment period. It's been years since I have sold safety glasses (we don't carry them in this office as we are an ophthalmology practice with mostly senior/retired patients), so I am not sure if fresnel stickers are osha approved for safety glasses or not. I would only be able to order safety thick lenses - which.... please no.

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## Uncle Fester

Give this a couple of days Krystle and be pro active by calling him about what's coming. He needs to let his work know this could take months to be made "And a place that specializes in safety frames and not just ordered from a catalog is best."

I hope someone else will open that giant can of worms!!!

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## KrystleClear

So far, so good. He seems to be doing well, thankfully.  :Happy:

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## KrystleClear

Okay, so coming up on a month later from my last post. Nearly every order I place with prism is now taking 4-6 weeks. We got one in within a few weeks (it was a VSP job) however, the lab did not split the prism as we requested and ordered, and the patient is VERY particular. He has 14 total diopters of prism, so I have no idea how it slipped through so fast but will now have to do a remake.

Is anyone else experiencing longer wait times from prism jobs? I know prism takes longer but it's taking longer than ever before and it seems like we're getting more and more patients who have prescribed prism. :/ Is this due to the material bottleneck still? I am telling patients 4-6 weeks for their glasses to come in if they need prism, yet many are still calling every few days to check on them.

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## mervinek

I am at a loss as to why every order with prism would take longer.  That seems crazy to me.  I understand if it is a uniquely high amount and an odd order but every order with prism?  Something doesn't add up.  In addition, an order with 7 diopters of prism OU being changed to 14 in one eye seems crazy.  It would be in the lab's interest to split the prism.  To do 14 diopters in one eye vs 7 ou would be more difficult to cut.  I know it's been a while since I worked in the lab, but prism (unless crazy high amount) never affected our timeline.

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## Uncle Fester

> Okay, so coming up on a month later from my last post. Nearly every order I place with prism is now taking 4-6 weeks. We got one in within a few weeks (it was a VSP job) however, the lab did not split the prism as we requested and ordered, and the patient is VERY particular. He has 14 total diopters of prism, so I have no idea how it slipped through so fast but will now have to do a remake.
> 
> Is anyone else experiencing longer wait times from prism jobs? I know prism takes longer but it's taking longer than ever before and it seems like we're getting more and more patients who have prescribed prism. :/ Is this due to the material bottleneck still? I am telling patients 4-6 weeks for their glasses to come in if they need prism, yet many are still calling every few days to check on them.


Maybe pm some lab owning guru's posting here?

And how did a lab put 14^ on one lens without a question???

Be sure you are charging appropriately as prism patients are usually time consuming.

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## lensmanmd

> I am at a loss as to why every order with prism would take longer.  That seems crazy to me.  I understand if it is a uniquely high amount and an odd order but every order with prism?  Something doesn't add up.  In addition, an order with 7 diopters of prism OU being changed to 14 in one eye seems crazy.  It would be in the lab's interest to split the prism.  To do 14 diopters in one eye vs 7 ou would be more difficult to cut.  I know it's been a while since I worked in the lab, but prism (unless crazy high amount) never affected our timeline.


Short answer.  
Many labs are switching to an STP process to reduce labor costs.  Much easier to automate = less staff.  No one needed to pull laps, switch pads, clean and restock laps.  One person can run a 300 job line, instead of three.  
Downside is that freeform platforms have prism limitations.  Ours is 5^ total.  
Unless your lab also runs a full manual line, they will outsource high prism orders elsewhere.  
Another issue is that extra thick blanks are not readily available any longer.  
Hence the extra time.

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## KrystleClear

> And how did a lab put 14^ on one lens without a question???


Actually, I mistyped that. He actually has 17 total diopters. OD 5.5 BU, 3 BI / OS 5.5 BD, 3 BI (I can't remember which is base up or base down off the top of my head so that could be wrong). They did not put it all in one eye but they did put 7 of the vertical prism in the od and 4 in the OS. I had the optometrist double check my readings and he feels it should be remade.

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## Kwill212

> They did not put it all in one eye but they did put 7 of the vertical prism in the od and 4 in the OS.


That may be the best way to do it depending on the rest of the Rx, acuities and fitting parameters. I wouldn't say it's outright wrong.

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## KrystleClear

> That may be the best way to do it depending on the rest of the Rx, acuities and fitting parameters. I wouldn't say it's outright wrong.


I know he will be able to see just as well with him, but he may reject them if he notices the appearance of the lenses. I am guessing that is probably why they did it, but they also didn't tell us they did that. They just said they made them as ordered. Who knows. This is also a VSP job, so... there's that.

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## KrystleClear

I should also say, the first pair with just .5 less diopters of prism in each eye was done as ordered. Only now, after the dr's rx change did this occur.

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