Progressive Troubleshooting Triage [Katie Lauver]

Progressive lenses are a wonderful advancement in lens technology. The ability to allow a patient to see at multiple distances in one pair of glasses, while also making them cosmetically attractive with no lines on the plane of the lens, allows individuals to complete tasks more efficiently while looking stylish! 

Although freeform progressive lenses are an amazing addition to the lens world, they can sometimes be the cause for patient complaints. Knowing how to effectively troubleshoot a visual complaint with a progressive or any lens design is crucial to maintaining a patients trust. Instead of passing the patient who is having visual complaints on to the doctor, you can troubleshoot lenses and see if you can save your doctor some time and conquer the problem yourself.

In our office, I have developed a troubleshooting triage form that allows us to troubleshoot lenses efficiently and effectively so that we can get our patients seeing sharply if they are experiencing difficulty seeing through their new lenses. 

Typically when a patient is having trouble seeing out of their progressives, it is the result of one or a few things:  

  • The frame could be poorly adjusted.
  • The lenses could be mis-measured with the incorrect pupillary distance or seg height measurement, making the patient have to tilt their head up and down or side to side to get clarity.  
  • There could be a defect on the lenses in the treatment making the patient have foggy or blurry vision. 
  • The base curve could be different between the old and new pair of glasses.
  • The patient's prescription could be off and the patient may need to see the doctor again in order to be re-refracted. 
  • The patient may have unrealistic expectations.
  • The patient may be a non-adapt to progressives.

You want to start your troubleshooting by asking the patient what their chief visual complaint is.  You need to find out if the visual issue is in one eye or if both eyes are effected. Pay attention to what the patient is saying. Sometimes key words will tell you exactly what the problem is with the lenses.  

Next, you want to look at how the frame is adjusted on the patients face. If the frame is not sitting properly, the patient could be looking out of the wrong portion of the lens and in turn will cause the patient difficulty seeing. If the adjustment looks ok, you will then want to compare the patients old lenses with their current pair. Is the base curve different? Is their seg height in a different spot? Is there a vertical imbalance? All of these are good questions to ask yourself when comparing the new and old lenses. After this, you will want to go ahead and read the new lenses and verify the prescription and measurements. We are all human, and sometimes during the lens check in process, we can miss things. We want to be sure that everything we ordered on the lenses, came back properly from the lab and that an incorrect measurement is not the reason for the patients inability to see.  

After everything has been verified you are then able to ask yourself is the patient has any medical issues that may be affecting the patients vision. Do they have diabetes, cataracts, macular degeneration, or dry eye? All of these conditions can affect how a patient see's out of their lenses.  

Once you have troubleshot the lenses in every way you can, if there is still an issue, you can then pass the patient on to the doctor. This way you will have good notes to pass on to the doctor, so that they know that you have done everything you can to assess the lenses. At this point, it may be a prescription or medical condition that is not allowing the patient to see properly, and the doctor can properly diagnose the issue.  

Make a triage form with all of these tips to help prompt you on what to look for when troubleshooting lenses in your office.  It will help you be quick with your session and asses the lenses properly to ensure your patients trust your judgment when it comes to their eyesight! 

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