Effect of Tilt and Vertex Distance on Spectacle Lenses

If we investigate further, we may see that the above mentioned adjustments may be the culprits. Examining the effects of tilt, face-form and vertex distance in detail would be far too lengthy and complex for this article. Instead, we will demonstrate in a simpler way the effects that these adjustments can have on the finished product. Lenses are designed and fabricated with a certain assumption that they will be fit a certain distance from the eye and have a certain acceptable amount of tilt, either pantoscopic or created by the addition of face-form. When any of these adjustments are made beyond the designers expectations, the optical uality is then compromised. In wea!er prescriptions, the effects caused by the above adjustments are negligible" however, when the prescription has a power of over #.$$ to %.$$ diopters. care must be given to not allow any adjustments to compromise the optical uality of the lens. We will first discuss the effects of vertex distance. Vertex distance is the measurement from the bac! of the spectacle lens to the front of the eye. &he average vertex distance is approximately '#mm. (djusting the distance either further from the eye or adjusting the lens nearer will change the effective power of the lens. In the case of a minus or diverging lens, the further it is moved from the eye the wea!er it becomes and the closer to the eye the stronger it becomes. &he opposite is true in the case of a convergent or plus lens. &he further it is from the eye, the stronger it will be. (s mentioned before wea!er prescriptions will not be effected as much as those that are -#.$$ diopters. )ets loo! at our example. OD: -5.00 SP OS: -5.50 SP !his "atient c#$es in wearing g%asses that are sitting *$mm away from the eye instead of '#mm, so what is the actual prescription+ &o determine this we need to use the vertex compensation formula,

-c. /ompensated 0ower -l. 1riginal )ens 0ower d. /hange in 2ertex -istance in 3eters 4or the right eye we have a spectacle power of -%.$$ 506 sitting 7mm further from the eye than it should.

!he new s"here "#wer is -&.'5. &he best way to determine vertex distance is though the use of an instrument called a distometer. &his device places one arm on the eye lid while the other is placed on the bac! of the lens, and a small scale attached to the device measures the distance. 8ow lets ta!e a loo! and see what happens when tilt is added. (enera%%) s#$e "ant#sc#"ic ti%t and face-form is desired but when these adjustments are made too drastically, they can affect the optical uality of the lens. 9nli!e vertex distance, these two adjustments create something called marginal astigmatism. &his monochromatic aberration is the result of light passing obli uely through the lens, creating two focal points much li!e a toric lens designed for those with astigmatism. 4lat base curves and excessive tilt are the major causes of this. )et:s loo! at what happens to the above prescription when the pantoscopic tilt is changed from '#; to **;.

4ns. 8ew 5phere 0ower n. Index of <efraction =In this case '.#>?@ 4sph. 5phere 0ower

*#w we deter$ine the c)%inder "#wer. <emember that face form will have its astigmatic error in the >$; meridian, while pantoscopic tilt will have it in the '?$; meridian.

!his change $a) n#t see$ %i+e $uch t# us, but for the discerning patient such a difference may be noticeable. 0lus if we compound errors, such a $.'* diopter lab processing error can ma!e the situation even worse. -uring our troubleshooting process we often overloo! the effects of how the lenses are fitting and how this will ultimately effect the prescription. We need not go through a series of complicated e uations and measurements as the patient waits, but instead !eep these suggestions in mind while helping the patient during frame selection and during the dispensing process

Vertex Distance Compensation.

Remember when we were talking about having two lenses in an optical system, and I showed you that just by putting space between the two lenses we could change the total power of the optical system without changing the power of the lenses? Adding distance between the lenses increased plus power (or decreased minus power)

A glasses prescription represents the amount of power that needs to be added to the eye!s optical system at a particular distance from the eye in order to bring light rays to a point focus at just the right place "hether this refraction is done in a phoropter or an auto refractor, the distance that the test lenses are from the eye is the refracted vertex distance. "e are not going to go into the way the refractionist has of determining the refracted verte# distances "hen the wearer comes to us with prescription in hand, it is assumed that the glasses will fit at about the same distance from the eye that the refractionist used $or most prescriptions the verte# distance for the glasses can be off by several mm and not create a problem %he glasses would have to have more than &' ''( of power for a ) mm change to be noticeable to most wearers $or a larger change in verte# distance, such as converting from glasses to contact lenses, you need only have power over * ''( for a noticeable difference to occur I am told that some A+, review books indicate that verte# distance changes should be considered any time the refractive error is - '' or more

%he verte# distance for contact lenses is .ero %his is the distance from the front of the cornea to the back of the contact lens $or glasses, the measurement is not so simple

,pticians basically have three ways of measuring the verte# distance

%/0 R120R3 if you stand facing the wearer!s side and hold your ruler against the temple and the side of the frame, you can appro#imate the distance from the front of the cornea to the frame 4ou are basically guessing where the back of the lens at the optical center is with respect to the frame And, since the distance will probably be 56&5 mm, and you would be doing this with one eye, the change in angle that you would have looking at the side of the ruler would also give you an error (called paralla# error ) %his is the low tech, cheap, least accurate way to take the measurement

%he ne#t best way to take this measurement is with the corneal refle# pupilometer 7ome pupilometers come with two scales on the top for each eye, only one of which you use when you take the 8(, and a fi#ed line near the outside edge in the viewer 7tand to the wearer!s side and hold the pupilometer up to the temple, in the same position shown for the ruler, but with the pupilometer where the ruler is 9et the fi#ed line aligned with the front of the cornea, then move the other line to where the frame is %hen you read the verte# distance off of the scale that you have been ignoring 66 the one that starts at & mm 4ou are still guessing where the back of the optical center of the lens will be with respect to the frame, but this is more accurate than using the ruler And, once you get the hang of it, it is relatively easy to do %he third method is the distometer, which is described in the Optical Formulas Tutorial on page (:; < -5) If there is no lens in the glasses you will be using the demo lenses to appro#imate where the back of the lens will be If the lenses are to be edged normally this will probably be ade=uate If you are changing bevel placement or increasing curves to control image si.e then you will have to adjust your verte# distance for those changes %his is the most accurate way we have of taking this measurement, and is also easy once you have practiced it a few times

,>, read through pages (:*6-' < --65*) ?y recommendation3 read it through once for basic understanding, then go back and read it carefully following the e#amples %hen come back here before you try to do the e#ercises "hile you are reading please ignore the

appro#imation formula It was important back in the days when we did not have calculators because it was mildly easier to do than the e#act formula if you were using paper and pencil @ow that calculators are easy to come by you do not need the appro#imation 8lease learn the e#act formula

(one reading? (id you follow the e#amples through? 8lease go back to the top of page (-' < 5A) and reread the @otes, particularly the second one %his is I?8,R%A@%BBBBB And what you need for real life is in the C"hat you really need to knowC table on page (:D < 5A) 2ets try a few & %he R# reads3 ,( 6&; ''(7, refracted verte# distance &' mm %he glasses fit at 5 mm verte# distance "hat effective power will the wearer e#perience if you order a 6&; ''( lens? "hat power would you order instead to compensate for the change in verte# distance?

$irst, decide what 7/,12( happen It is a minus lens moving toward the face, so the lens looses plus power or gains minus power %herefore the effective power should be stronger than 6&; ''(, and the compensated power should be weaker than 6&; ''(
o

0$$0E%IF0 8,"0R %he change in verte# distance is ) mm, which e=uals ' '') m %he lens moved toward the face, so d is positive (l is 6&; '' "hat is (e? (l (e G 666666666666666 & H d(l 6&; '' (e G 66666666666666666666666666666666666 & H (H' ''))(6&; '') 6&; '' (e G 66666666666666 ' D(e G -15.46 %he wearer would be e#periencing about one6half of a diopter to much minus power ("hich only a A;6*; year6old myope would object to ) ("hich does not e#cuse doing it )

E,?80@7A%0( 8,"0R

%he change in verte# distance is ) mm, which e=uals ' '') m %he lens moved toward the face, so d is positive (l is 6&; '' "hat is (c? (l (c G 666666666666666 & 6 d(l 6&; '' (c G 6666666666666666666666666666666666 & 6 (H' ''))(6&; '') 6&; '' (c G 66666666666666 & 'A (c G 6&* ;: %he correct lens to order is -14.50DS I would call the refractionist first to make sure that this is acceptable and to have this recorded in the wearer's records. /aving trouble getting my answers? 2ook at the first one %here are a lot of ways to punch this into the calculator, some of which work correctly all of the time If some of your answers are close to mine, but some are not within ' '& or ' '), then here is the way to punch it in3 6&; '' (e G 66666666666666666666666666666666666666 & H (H' ''))(6&; '') 8unch ' ''), C#C, &; '', C C, CGC, CHC, &, CGC, and write down the denominator @ow punch &; '', C C, C C, the denominator, CGC %his will give you the right answer for effective power "hen you do compensated power there is just one more plus<minus in there3 6&; '' (c G 666666666666666666666666666666666666 & 6 (H' ''))(6&; '') 8unch ' ''), C#C, &; '', C C, CGC, C C, CHC, &, CGC, and write down the denominator @ow punch &; '', C C, C C, the denominator, CGC %his will give you the right answer for effective power

o o o

change in verte# distanceI if lens is d, [ ] moved away from the wearer!s eye times original powerI if power is x Dl, [ ] negative if finding what the new lenses should be [ ]

o o

&<#K
o

add & +1 write it down, save it in memory, Jor press [1/x] x Dl [ ]

original power times what you wrote down or saved in memory, if original power was negative

%he R# reads3 ,7 H&) ;'(7, refracted verte# distance D mm %he glasses fit at &) mm verte# distance "hat effective power will the wearer e#perience if you order a H&) ;'( lens? "hat power would you order instead to compensate for the change in verte# distance?

$irst, decide what 7/,12( happen It is a plus lens moving away from the face, so it gains plus power %herefore the effective power should be stronger than H&) ;'(, and the compensated power should be weaker than H&) ;'(
o

0$$0E%IF0 8,"0R %he change in verte# distance is A mm, which e=uals ' ''A m %he lens moved away from the face, so d is negative (l is H&) ;' "hat is (e? (l (e G 666666666666666 & H d(l H&) ;' (e G 66666666666666666666666666 & H (6' ''A)(H&) ;') H&) ;' (e G 66666666666666 ' D:); (e G +12.99 %he wearer would be e#periencing about one6half of a diopter to much power

E,?80@7A%0( 8,"0R %he change in verte# distance is A mm, which e=uals ' ''A m %he lens moved away from the face, so d is negative (l is H&) ;' "hat is (c? (l (c G 666666666666666 & 6 d(l

H&) ;' (c G 66666666666666666666666666666666666 & 6 (6' ''A)(6&) ;') H&) ;' (c G 66666666666666 & 'A-; (c G H&) '; %he correct lens to order is +12.00DS I would call the refractionist first to make sure that this is acceptable and to have this recorded in the wearer's records. A %he R# is ,( 65 ;' 6A ); #&5', refracted at D mm 4ou dispense the glasses A week later the wearer comes back to you complaining that the street signs look the same as they used to in his old weaker glasses, and the (octor has assured him that they would be much clearer "hat do you do? After checking everything else you determine that the glasses were made perfectly, the 8(!s are correct and the ,E!s are A mm below his pupil center where they were on his old glasses 4ou used the same base curves, the pantoscopic angle and the face form are all as they should be or as they are in his old glasses %he only real difference is that the new glasses fit at &A mm, where the old ones were at the same D mm as the refraction J"hat you really want to do is get him into something that fits closer to his face 7uppose that, for some reason, he does not want that ?aybe his eyelashes have grown?K 2ets look at the effective power that he is seeing, and then decide what you should order for these glasses that fit too far away from his face $irst, you must notice that the power in this lens is 65 ;'( on the &5' meridian and 6&& -;( on the D'th meridian 4ou have to determine the effective power in each meridian, then create an R# again

0$$0E%IF0 8,"0R %his is a minus lens moved away from the face It will be effectively weakened ("hich is why he could not see the street signs any better than before ) ,n the &5' meridian3 %he change in verte# distance is * mm, which e=uals ' ''* m %he lens moved away from the face, so d is negative (l is 65 ;' "hat is (e? (l (e G 666666666666666 & H d(l

65 ;' (e G 6666666666666666666666666666666666666 & H (6' ''*)(65 ;') 65 ;' (e G 66666666666666 & 'A* (e G -8.22 %he effective power on the &5' meridian is 65 ))(, not 65 ;' If all the (octor did was increase his power by a =uarter diopter of minus, moving the lens away simply gave him back his old powerB

,n the D' meridian3 %he change in verte# distance is * mm, which e=uals ' ''* m %he lens moved away from the face, so d is negative (l is 6&& -; "hat is (e? (l (e G 666666666666666 & H d(l 6&& -; (e G 66666666666666666666666666666666666666666 & H (6' ''*)(6&& -;) 6&& -; (e G 66666666666666 & '*(e G 6&& ))

%he effective power on the D' meridian is 6&& ))(, not 6&& -; %he &5' meridian is 65 ))(, the D' meridian is 6&& ))(, so the effective power that the wearer is e#periencing is -8.22 -3.00 x 180 @,% what the (octor orderedB E,?80@7A%0( 8,"0R3 he needs more minus to get what the (octor has intended ,n the &5' meridian3 %he change in verte# distance is * mm, which e=uals ' ''* m %he

lens moved away from the face, so d is negative (l is 65 ;' "hat is (c? (l (c G 666666666666666 & 6 d(l 65 ;' (c G 6666666666666666666666666666666666 & 6 (6' ''*)(65 ;') 65 ;' (c G 66666666666666 ' D:: (c G 65 5' %he power needed on the &5' meridian rounds to -8.75D

,n the D' meridian3 %he change in verte# distance is * mm, which e=uals ' ''* m %he lens moved away from the face, so d is negative (l is 6&& -; "hat is (c? (l (c G 666666666666666 & 6 d(l 6&& -; (c G 666666666666666666666666666666666666 & 6 (6' ''*)(6&& -;) 6&& -; (c G 66666666666666 ' D;A (c G 6&) AA

%he power on the D' meridian should be -12.25D %he &5' meridian is 65 -;(, the D' meridian is 6&) );(, so the lens power that could be ordered is -8.75 -3.50 x180 After having the new compensated prescription recorded in the (octor!s files "hy did I round the power on the &5' meridian to 6&) ); instead of 6&) A-, resulting in a cylinder amount of 6A :)? "ell, it was half6way in6between, and at that power I tend to round weaker when it could go either way It would be a good idea to ask the (octor which cylinder would be preferable for this wearer

,>, go back to the Optical Formulas Tutorial and do the e#ercises on pages (:and -' < 5'65& and 5A65*) Eheck your answers in the back of the book %hen read pages *&; 6 *&D (top left) in System for Ophthalmic ispensin! and do e#ercises &6on page *)* NOTE3 In Systems for Ophthalmic ispensin! (r +rooks refers to the adjusted power as effective power, both to determine what power the wearer e#periences based on the position of the lens and to determine what power to order to result in what the refractionist intended the wearer to see %his is because he uses the techni=ue of determining the adjusted focal length of the lens based on where it is positioned 0ither method is correct, and both result in the same answer "hen using the formulas shown in this lesson use the wording in the problem to determine what you should be finding3 if asked what to order (which is the only really important issue here) use the compensated power formula

"ant some more to do? ; %he R# is H&* '' 6) '' # '*; Refracted verte# distance is &' mm "orn verte# distance is - mm o "hat effective power will the wearer e#perience if you fit it as is? o "hat would you order instead? o If you fit this patient with a contact lens that is the spherical e=uivalent of the glasses lens, you will be starting with a power of H&A '' "hat effective power will the wearer be e#periencing? o "hat contact lens might you start the fitting with, instead of the H&A ''?

%he page with the answers is here If you are comfortable with this, and like the algebra, you may want to go to this page, which has the derivation of the formula %his is not re=uired reading, so if you don!t enjoy algebra, you have my permission to skip it