I’ve always liked the old carpenter’s adage mentioned in the title above. With great simplicity, this statement describes the essence of economy and efficiency when doing a job right the first time. I’ve recently applied this axiom to the optical department in my practice.
Appalled by the number of remakes of glasses my practice does every month, I analyzed the reasons for the do-overs:
Seg height or PD measurement error by my staff
Rx error by our doctors or transposition error
Non-adapt by patient
Lab error or quality problem in fabrication
Warranty replacement of frame or lens (breakage or scratches)
The first reason noted above caused a large percentage of remakes and it is the easiest for us to control. I’m targeting PD and fitting height measurement accuracy with a staff training program and a new “measure twice; cut once” policy.
Let’s realize that not only are optical remakes expensive in staff time and material costs, but they also come at a high price in the loss of patient satisfaction and confidence. In many cases, we see multiple remakes occur with the same patient for the same pair of glasses, because the problem was not properly diagnosed the first time. This is extremely inconvenient for the patient and causes real harm to the practice reputation. The first remake due to a measurement error may be covered at no charge under a lab remake policy (with some limitations), but additional remakes are a significant cost to the practice.
Review of measurement methods
Basically, we have two methods for measuring glasses: digital and manual. The most critical measurements are PD and seg height, but digital devices add additional factors like vertex distance, pantoscopic tilt, wrap and other proprietary features.
From big, free-standing towers to desk-top units to iPad devices to cameras built into mirrors, I own and have tried many different digital measuring devices. Most of these work with a photograph of the patients face and eyes. I’ll conclude that some systems work better than others, but all of them are just tools and when used properly by a well-trained optician, they all can produce accurate measurements. These devices have undergone many improvements over the past five years to speed up and simplify the process.
Our old measurement standard, which has come under much ridicule in recent years, is a pupilometer and a Sharpie felt-tipped pen. While these techniques are definitely old school, years of experience tell us they are accurate. Perhaps the simplicity of this method is more important than we first realized.
A good test of your own opinion about optical measurement methods is revealed by how you answer this question: Assume your optician measured a patient for progressive eyewear using a digital photographic device and measured again with a pupilometer and dotting the center of the patient’s pupils on the demo lenses. Assume the measurements for the PD and seg height were different by at least 4 mm with the two methods. The patient already left your office. Which measurement method would you have more faith in?
I love the wow factor we get from the use of digital measuring devices and I’m well aware of the need to be perceived as up-to-date as we face competition from online vendors and new uses of technology. I also think the measurements we take for eyeglasses are important enough that we can do them twice. If they differ by more than 2 mm, we can redo them or get another opinion from another staff member.
I implemented a new procedure for ordering glasses in my office that requires my staff to measure the PD and fitting height by both a digital method and the old school method. Our optical order form now has a place for two measurements of the PD and seg height labeled digital and manual. The data produced by this is interesting to gather: how often are the measurements different and by how much? Interestingly, many of our technicians and opticians told me they were already doing the double measurements, but not recording them.
I believe this extra measuring step will significantly reduce our remakes.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.