Support Activities

Trouble shooting

When patients come with complaints of discomfort or poor vision with their spectacles, it is important to assure them that you can help them with the problem. If they have a complaint about their spectacles or the service provided, do not deny you made a mistake. Instead listen carefully to the patient’s problem as this serve as feedback for you to improve your dispensing practice.

  Often, the patient explains his experience with the spectacles and these are usually only symptoms of an underlying problem. One should try to be ready for handling the majority of the problems. A few problems which patients often complain of are discussed here. Possible ways to solve these are also suggested.

  Whenever a patient arrives with a complaint, the following steps can help one to arrive at the cause of the problem.

- Refer to the patient’s medical records to ensure that the spectacles satisfy the prescription details

- Make sure that the lens power and the lens design are dispensed according to the prescription.

- Observe the frame position and segment height when the patient is wearing the spectacles.Misaligned frames and improper frames size can cause the following problems:

- Vertex distance discrepancy which can affect the effective power of the spectacles

- Ill-fitting frames can slide forward

- Frames may be positioned awkwardly

- Too-tight frame temples cause uncomfortable pressure on the side of the head or at the ears

- Eye lashes touch the lenses

- Frame touches eyebrows

- Complaints of frame discomfort: Adjust the frame and check up the following

- Are both rims in level with each other : A - B level

- Nose pad is positioned evenly and does not press on the nose

- Facial wrap: the frame fits properly following the curved line of the face - but not excessively

- Pantoscopic tilt: angle between the front and temple should be comfortable – a tilt of 10º to 15º helps to avoid contact with the cheeks

- Inter-pupillary distance (IPD) measurement is correct

Temple grip:the temple is adjusted for a snug fit. Adjust length of temple to minimise sliding - comfortable but not tight

Complaints in vision: Check for the following:

- Prescription: Verify the spectacles against the prescription – power, axis, prism etc

- Previous spectacles: Investigate what type of spectacles were used previously; it might only need some practice to get used to the new pair

- Centering: the optic centre of the lens should coincide with the eye’s pupil – mark the centre of the lenses and check if it coincides with the corneal reflection when the patient is wearing the spectacles

- Segment height: Check if the segment is well below the pupil; otherwise the patient would be viewing distant objects through the near segment. Check that both segments are at level with each other

- The most common defect in dispensing is the wrong centering of lenses – the optic centre of the lenses is not aligned to the patient’s pupil. This can cause blurred vision.

- Decentred lenses can induce a prism effect that cause headache and giddiness

- An incorrect form of lens can cause discomfort and heaviness of the spectacle. Check the lens for proper thickness and lens curve. Shadow scope or Polaroid lens can be used to identify the lens defects.

- If all the above seem correct it is worthwhile to confirm the prescription by repeating refraction on the patient.

- If there is no technical problem found, gentle counselling can help to understand the real cause of the dissatisfaction with the spectacles. Other reasons like cost, poor counselling during delivery and miscommunication by staff can make the patient unhappy.

Some common symptoms and possible causes are given below

Symptom Patient complaints	Possible causes
Distance vision is blurred	- Incorrect prescription - Incorrect axis - Segment height is too high
Near vision is blurred	- Incorrect prescription - Segment height is too low - Large vertex distance - Incorrect PD - Insufficient pantoscopic tilt
Waves seen in distance vision zone	- Incorrect prescription - Incorrect axis - Large vertex distance - Insufficient facial wrap - Insufficient pantoscopic tilt - Segment height is too high
Difficulty in reading (excessive lateral head movements whenreading)	- Over correction in near vision zone - Incorrect PD - Segment height too low - Large vertex distance - Insufficient facial wrap - Insufficient pantoscopic tilt - Insufficient segment area; frame is too small
Distance vision is clear only when head is tilted back	- Incorrect prescription
Head has to be tilted back for reading	- Incorrect prescription - Fitting height too low
Head tilt forward at distance	- Fitting height too low
Head tilt forward at near & Intermediate	- Incorrect prescription

Inventory management

In an optical dispensing set up it is essential that all goods and consumables are accounted for and stocked in a manner that it is easy to retrieve, use and audit. This section deals with the maintenance of inventory. It discusses how to stock optimum quantities with control on receipts, issues and storage. The inventory items considered for this are frames, lenses and spectacle accessories only. The inventory system discussed here is only one method of handling optical goods there are other possible methods to stock these items. With the help of computers, today, we can manage the stock in a way that is more error-free and the information can be produced faster to enable quicker decision making.

A good inventory manager should:

- Be knowledgeable about all stock items

- Be up-to-date about the new products available in the market

- Be sensitive to the current preferences of the customers

- Be able to deal with the different suppliers – to appraise and select and negotiate with them

- Ensure that all entries are made in the stock register/computer

- Periodically perform an audit of the stock items

Frames and spectacle accessories

Maintaining an inventory of frames or spectacles accessories requires not only a disciplined inventory system but also a sense of fashion and the current trends in the locality. This is important as the models purchased should reflect the preference of the customers.

Lenses

When a customer places an order for the lenses, we usually do not know the combination of the powers and thus we stock only those lenses whose power is of common occurrence. This range of stocked lenses or ready lenses is based upon the frequency of its occurrence in the orders; this range should change according to the changing demand patterns. These lenses can be bought readymade from any optical goods supplier. All other lenses are made-to-order: they are processed or purchased from an external supplier only after the customer places the order.

Purchase planning

While purchasing lenses and frames it is important to plan before placing the order.

- To get a estimate of the quantity to order, we can refer to previous sales figures. (For e.g., An indicator for the frames to order for this month, we can refer to frame sales in the same month, last year).

- The supplier should also be assessed. This can be based on our previous experience with the supplier:

- Overall performance in delivering the goods on time and in good condition

- Expertise in the optical field

- Support offered in replacing rejected goods,repair work and special order processing

- It is important to always check the goods received against the order placed and the bill invoiced. Also perform a quality check of the items

Return goods management

Remember that the longer the stock is held, frames tend to fade and tarnish; glass lenses are more susceptible to breakage and plastic lenses to scratch or turn yellow. When goods remain unsold over a long period of time, they can be disposed off in one of the following ways:

- Offer them on sale at a discounted price

- Suppliers usually accept return of these goods if they are in good condition and if the frame model is still in demand, so that he is still able to resell it to others

- To insure against this it is advisable to enter into an agreement with the supplier that he will accept returns within a certain period – this way both parties are not affected

The following flowcharts show the steps involved in routine inventory maintenance

Flowchart for maintaining inventory of frames and accessories

Flowchart for maintaining inventory of lenses

- The inventory should not be a fixed, static set of items. Instead, it should change constantly to stock the fast moving items – in such a way that any item does not stay shelved for longer than a fixed period. (slow moving stock may be kept in small quantities or purchased or order).

Reporting and reviewing

To effectively run the optical dispensing unit, as in any trade, it is important to record every transaction. More important, is to gather information from all the data collected and present it in a way that it illustrates performance efficiency. It should give feedback in a way that helps us take decisions for the future.

  Reports also serve to encourage or discourage a certain aspect among the employees. For instance:

- A report showing the quantity of lenses rejected by each staff will serve to make each employee aware and be more careful; whereas, in the absence of such a report the employee is not aware of his mistakes and may not take any steps to correct it.

- A report showing the quantity of orders taken by each staff will create a competitive spirit and encourage each employee to achieve more. Thus, it is necessary to study what results are desired and design the reports accordingly. Reports also help us monitor the performance of the set up against a set standard (such as the previous year’s performance).

  The use of computers can make data entry easy and fast. Data collating and reports can also be made quick and accurate. Calculations and extrapolation can be done faster too.

Here are a few report formats that are suggested

Example 1

No. of Out- Patients	No. of Prescriptions Issued	No. of Orders Taken
100	25	22

  This report shows the performance of the dispensing unit with respect to the overall patient visits. It also shows how many patients who received spectacle prescriptions actually purchased the spectacles. A modification of this report which compares performance with the previous year is given here.

  The use of percentages in reports helps the reader to quickly grasp the effect of the figures in comparison with each other. With such reports, predictions for the future can also be made by extrapolating with a conservative expected growth percentage. (Table : 1)

  This report shows the break up of the sales into relevant categories. This can help the management take decisions on planning inventory. The following modifications on this show employee-wise details which helps to create competitiveness and serves to

Table :1

No. of Out- Patients		No. of Prescriptions Issued		No. of Orders Taken
Yr.2003	Yr.2004	Yr.2003	Yr.2004	Yr.2003	Yr.2004	growth (%)
90	100	20	25	15	22	47%

Table :2

No. of Orders Taken	Glass lenses	Plastic lenses	Progressive Lenses	Special lenses	No of Undelivered Orders
22	3	19	5	4	2

Table :3

Staff Name	Orders Taken	Glass lenses	Plastic lenses	Progressive Lenses	Special lenses	Undelivered Orders
A B C	100 80 90	30 50 30	70 30 60	10 3 12	16 11 15	10 6 9

encourage those performing well. It is necessary however to communicate these reports to the employees in a suitable manner. The communication should explain the management’s desired results (e.g., increase sales of plastic and progressive lenses but reduce undelivered orders) (Table : 2).

  These reports correspond to sales performance. Similar reports can be generated to monitor inventory (non-moving items, rejections, pending purchase orders, payments pending etc), production (quantity produced, rejections, quality reports etc) and delivery (undelivered goods, delayed deliveries, complaints etc). For an effective reporting system it is essential to have a system to collect the data in a reliable manner. (Table : 3).

Teaching suggestions

- Have the MLOP observe an optician handling customer complaints

- Let the MLOP observe and assist in the different activities in the inventory section

- Have the MLOP collect data and prepare basic reports which measure different aspects of performance.

Practice questions

1. How do you handle complaints. How can you change your practices to avoid common complaints.

2. What is the role of the inventory manager.

3. How do you determine which lens power to stock as readymade and which to process on order.

4. How will you determine which supplier to purchase from.

5. What factors will you consider when purchasing frames.

6. Why should you have a recording and reporting procedure.

7. What reports will be relevant to your dispensing set up.

8. How would you record data in order to make reporting easier.