Ophthalmic Lenses

Glass Works: 
An Untapped Niche

All kinds of high myopes can benefit from high index, glass lenses. But only doctors can prescribe them. Here’s a niche that many O.D.s overlook.

The contact lens wearer made an appointment with Dr. Witkin. Her refractive Rx was -15.75D O.D.,  -15.00D O.S. Dr. Witkin recommended 1.80 index glass progressive lenses with an anti-reflective coating.

On the day she picked up her new glasses, Dr. Witkin happened by the dispensary and spied the woman staring at herself in the mirror in disbelief. “I’m really not vain,” she told Dr. Witkin, “but this is the first time I’ve looked good in glasses since the third grade. Plus I’m seeing so clearly!” She’s been a loyal patient ever since.

That’s not unusual. Ultra-high index lenses have a way of inspiring loyalty in patients and dispensers. Apex Optical, with three locations in Washington, D.C., retains 98% of its ultra-high index glass wearers. Savvy doctors and dispensers say this lens category has helped them build a respected expertise, a loyal patient base, a constant referral source, and a better bottom line. And since only doctors may prescribe 1.70, 1.80 and 1.90 glass lenses, they’re an exclusive dispensing opportunity for O.D.s—with a few caveats.

What Is it?

Dispensers suggest AR coatings for all ultra-high index lenses. Turnaround time runs about a month, but you can get some orders within a week depending on the Rx and where the lenses are fabricated. At least one U.S. wholesale laboratory, Vision Systems of Virginia (VSOV) in Petersburg, Va., works with ultra-high index lenses. Several ultra-high index dispensers send work to Canada or to Carl Zeiss Inc. in Germany, where the lenses are more popular.

“This is a niche that provides a clear counter to optical chains, discount coupons, managed care and other retailers who can’t or won’t venture into this arena,” says Richard Hughes, VSOV president.

Getting Started

Audy Schwarts, manager at Visual Expressions in Ellicott City, Md., first experienced glass ultra-high index when he worked as an optician in Paris. When he moved to Maryland 8 years ago, he brought his expertise with him and capitalized on the ultra-high index niche. Visual Expressions works primarily with 1.80 PALs and 1.90 single-vision glass lenses, and finishes them in-house. “There’s no price shopping with ultra-high index lenses,” Mr. Schwarts says. “The patients belong to you.”

Apex Optical manager Paul Pinkham says it’s crucial to teach staff how to handle and work with glass before going into this niche, and to keep on top of developments in the field. “It’s also important to demand high quality and accuracy at a reasonable price, and supply the same,” he says. Mr. Pinkham has been dispensing ultra-high index glass lenses for more than 14 years.
Getting outstanding service from your lens supplier and laboratory is also key. Dispensers recommend forging close relationships. Dr Witkin’s supplier keeps him informed of new developments and holds in-office training and education for staff on a regular basis.

Justifying the Wait and Cost

The exclusivity and price of these lenses place them in the high-end category, typically retailing for $200-$400 for single vision. “With the proper explanation, we run into very little duty-to-warn or price resistance,” Mr. Schwarts says. (More on duty-to-warn later.)

Dr. Witkin’s optician prefers European standards for ultra-high index glass. He sends his orders to Germany, and turnaround time can be around 4 weeks. “Import-export is only a matter of filling out a few papers,” Dr. Witkin says. As for turnaround time, he says, “The wait is justified by the fact that this is a premium product. Someone with a high-minus Rx never gets his or her eyewear in one hour anyway. They’re used to waiting, so waiting a little longer for a far better product is acceptable to them in most cases.”

Duty-to-Warn Issues

Both you and your patient must sign a waiver, and you must submit the form to the fabricating laboratory. Keep a copy for your files as well. Dr. Witkin uses a release form he’s obtained from Carl Zeiss and that he’s “tweaked a bit.” He terms it an “informed consent,” much like that used with refractive surgery and other procedures.

Decide for yourself if it’s worth dispensing ultra-high index glass lenses in today’s litigious climate, even if you have the proper documentation. Dr. Witkin says that being overly concerned about obtaining a waiver and possible lawsuits is “way too myopic.” He adds: “If you’re not offering ultra-high index lenses to a patient base that can clearly benefit from these lenses, you’re not doing your best for those patients.” The people interviewed for this article don’t know of any such lawsuits in the United States.

Other Options

How to Fit Ultra-High Index Lenses

• Fit patients in eye sizes 48 or smaller if possible.
• Dispensers, not patients, must be in charge of the frame selection.
• AR coat all ultra-high index lenses for the best visual acuity and appearance.
• Pay special attention to vertex distance. If it’s off just a little on a high-minus lens, it can compromise the Rx too much.
• Invite patients to come in periodically for adjustments. “With a glass lens, if one little thing is out of alignment, it can cause big problems comfort-wise,” says Paul Pinkham, manager of Apex Optical in Washington, D.C.
• Stock a variety of nose pads to conform to all nose configurations and allergy tolerances. Apex Optical stocks 22 different styles and materials.
• Most dispensers recommend fitting myopes -6.00D and higher in ultra-high index glass. However, several advocate fitting higher than-4.25D in 1.70 or higher index, and lower than -4.25D in 1.60 index glass. Prime candidates are contact lens wearers who wear glasses because of appearance or discomfort, or as backup eyewear, or the eyeglass wearers who frequently scratch their lenses.
• If there’s any question about the Rx, make up a trial pair of CR-39 lenses for the patient to wear temporarily before going ahead with the ultra-high index order. That way if the prescription needs tweaking, you and your patient don’t pay for it.
• Take your time, present all the options, and let the patient make the final decision. Audy Schwarts, manager of Visual Expressions in Ellicott City, Md., typically spends 20-25 minutes demonstrating and talking about the product, using brochures and a variety of lens samples. “Impart confidence to the patient,” he says. Also discuss proper lens care.
• Remind patients that nothing can beat the visual clarity of glass. Car windshields and precision instruments such as cameras, binoculars and telescopes all use glass lens technology because of the undisputed clarity.
• Keep patients informed each step of the way. If the order gets delayed, tell them about it right away and be honest about how much longer it will take.
• Have ultra-high index demo lenses in stylish, small frames. Atlanta optometrist Ned Witkin’s office keeps -10.00D samples in CR-39 plastic, 1.60 and 1.66 plastic, and 1.70, 1.80 and 1.90 glass. “Once the patients see the difference, they sell themselves,” Dr. Witkin says. “I could talk myself blue in the face describing the features and benefits of ultra-high index glass lenses. But when patients see it, the sale is done.”
• Wear the product yourself. Visual Expressions has an ophthalmologist on staff who wears 1.80 glass lenses. “He’s a walking, talking demonstration,” Mr. Schwarts says.

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© Review of Optometry OnLine
April 15, 2000