By Barry Santini

The rapid rise of telehealth and telemedicine has been one of the most remarkable developments to come out of the COVID-19 pandemic. Over the past year, growing numbers of doctors and other health care providers around the world have learned how to connect, diagnose, monitor and even treat patients remotely. Many health care observers and analysts predict that this new mode of interaction will remain important even when in-person doctor visits regain frequency.

In the optical industry, this trend has accelerated the growth of tele-optometry and tele-ophthalmology. Yet there hasn’t been much talk about tele-opticianry, even as examples of it have started to crop up. Is that because our profession, which has always been based on in-person fitting, fabricating, adjusting, repairing and maintaining prescription eyeglasses, has been unable to adapt to the way many consumers are now buying eyeglasses?

With the constraints imposed on everyone’s time and mobility by the COVID-19 pandemic, trying to interact with customers solely through an in-store channel is simply not possible. Opticians, like other professionals who provide needed services, are confronting the fact that face-to-face is not always the best way to connect with today’s informed eyeglass consumers. Consider this alternate scenario: As the process of selecting glasses is no longer being limited by retail store hours, it shifts to the comfort of the buyer’s home. In this relaxed environment, friends and family are nearby for real time consultation—avoiding the sidetrack created whenopinions on eyewear selfies go unanswered, or worse—given a quick thumbs down. Certainly, redirecting the typical services involved in purchasing eyewear, including assessments of vision, fit, style and comfort, away from the traditional store will be challenging. But during my research, I discovered a few visionary opticians who have discovered how to successfully pivot their passion to become tele-opticians—optical professionals who primarily connect with clients through non store-based channels. And there’s a nice surprise for us: They’ve found the appeal of eyewear products is actually heightened and enhanced when taken out of the store, and your expert advice is welcomed and gladly paid for! Connecting with customers as a tele-optician could even be the doorway to a new and brighter future.

TELE-TIME
The challenge of scheduling your day is the same for both consumer and professional: There never seems to be enough time. But what if the eyeglass buyer entered an online intake portal prior to choosing new eyewear, through a process where they were guided to reveal their wants, needs and fashion desires ahead of their first engagement with the optician? This might free up time that could be used better in the office. And this intake process wouldn’t have to be a boring or dry experience. Rather, it could be carefully structured and become an excellent opportunity to present a variety of topics for the buyer to consider, from blue light and computer fatigue to current eyewear complaints and even to style and fashion considerations, an area trivialized by the traditional canons of the profession. But making eyewear style—rather than visual need—first and foremost, will no doubt mark where the old way ended and the new age of eyewear began.

The sheer possibilities arising from connecting with a client outside of the physical store are endless. All it takes is to imagine buying eyewear from the consumer’s side of the computer rather than the dispensing desk side.

TELE-MEASURING
Especially in a try-on environment at home, getting proper basic measurements wouldn’t be difficult. After all, you’re sending them frames of known size and therefore scale, so interpolating frame-based measurements such as pupil height and pupillary distance from pics should be a breeze. Frame wrap angle is also easy, since you know the frame’s info before when you begin to order. Pantoscopic tilt could be determined using an overlay applied to screen shots of the patient’s profile while wearing the selected frames. Too imprecise you say? You could always revert to default values for position of wear, which are averages derived from large data sets. In fact, I believe that technology will create an app that might perform better than many opticians do today working in person. Imagining an optical tele-landscape like this only requires an open mind to entertain it. And there’s no doubt your customer will trust the new way if you do.

TELE-VISION
Choosing lenses as a tele-optician would be no different than in person. After a needs and Rx analysis derived through the intake process, recommendations would be made for one of more pairs, based on visual need. But after the eyewear is dispensed, the central question opticians had about performing as a tele-optician was: “How would you troubleshoot issues like vision complaints?” Here, a quick face-to-face conversation over a secure video connection, rather than a dispensing desk, would suffice. Privacy considerations, such as compliance with both HIPAA concerns and the need for personal information to remain secure, are easily met through the use of a secure video connection and a digitally-signed intake disclaimer. I now ask the opticians reading this: “Would there be any fundamental differences in the interview process if we troubleshot a vision complaint remotely?” I don’t think so, especially if we add the skill set of “remote assessment of visual satisfaction” within a structured learning environment. After all, we’re doing the same thing practically every day online in various optical forums. Are you listening, optical schools?

TELE-FIT
Helping people choose frames they’ll love has not been easy. The typical guides we’ve favored—the ones using facial shape and traditional frame measurements, are difficult to classify and apply for both optician and consumer. Here’s why:

1. Classing a person’s facial shape originated in the early film industry—where the harsh lighting needed to compensate for slower speed film stock of limited contrast—became important in applying makeup to faces in the most complementary way for the camera. It was never originally designed for or meant to help people pick frame shapes.
2. The frame measurements we use today—derived from the boxing system—were not meant for sizing a frame to a face or evaluating its fit. This system was an idea designed to address blank cutout challenges presented as frame shapes evolved from gender-neutral, symmetrical shapes of the 1930s, to asymmetrical—think upswept, harlequin and CatEye shapes—of the 1940s and 1950s. By 1961, when the American Optical Manufacturers Association, predecessor to the Optical Lab Association and now part of The Vision Council, codified the boxing system into the standard we use today, Rx fabrication back then was still centered around glass lenses, which came in a limited number of smaller diameters. Today, using freeform technology, lens blank size limitations are a thing of the past. And with the end of frame options for different bridge and temple sizes, perhaps it’s time to create a new standard for sizing frames, one that more clearly and directly relates to the way a frame actually fits a face. This would make it far easier for the consumer to sort through styles they desired, without the need for an optician “midwife” to ensure the frame that’s chosen fits as expected.

So what would such a new system look like? I’m not completely sure, but perhaps more like the dimensional drawings manufacturers use to program the equipment that makes the frames. The following would be at the top of my list for inclusion:

1. Inner Width Between Temples—This would be the foundational value for assessing how the frame fits the sides of the head.
2. Temple Tension Value—This would be a value that assesses how much clamp force the temples supply against the side of the head. It would be a quotient between the frame front and temple material kinesthetic interaction, along with the subtractive or additive impact on tension force added by any type of clamping-relief mechanism present.
3. Effective Bridge Fit—This would be a value integrating the following:
   1. Actual Width at Point of Contact—This would result in a numerical dimensional value.
   2. Pad Splay Depth—A value that assesses both how much pad depth is present, as well as the splay angle of the pads. Interaction between these two parameters would calculate a quotient indicating percentage of frame contact to skin area.

A buyer questionnaire revealing wearer fitting preferences should also be used:

1. Preferred Frame Fitting Height—High, Medium or Low, and reasons why, if any.
2. Preferred Frame Closeness—Related to frame fitting height and illustrating buyer preference for closeness to face, brow or cheek.
3. Preferred Overall Frame Fit—Tight, medium or loose. When I fit frames on a new client, I ask this at dispensing to know better what level of temple tension and wrap would be most satisfactory.

Combing all of the above would result in something I call Overall Comfort Factor. While I don’t think the average buyer typically goes into an optical shop thinking, “I hope my new glasses fit right,” I do think every purchaser inherently expects their eyewear to fit. And when it doesn’t, it can become a great source of unhappiness. So I think the best way going forward to engineer a frame for best fit would be to use data from literally thousands of wearers (See Sidebar: Eyewear Master Tom Davies Takes a Bespoke Approach). Once we’ve mastered how to use big data sets to get frames to fit better, all that would be left is for styling to move front and center.

“The better it fits, the better it looks.” –Julia Gogosha, optician /optical style expert.■

Read Part 2 of Brick to Click »

Contributing editor Barry Santini is a New York State licensed optician and contact lens fitter with Long Island Opticians in Seaford, N.Y..