Part of your job as an optician is to guide and assist your patient in the best frame selection for their face and prescription. Explaining your reasons for choosing or rejecting certain frames for consideration will create trust in your patients. You are the expert. They rely on you to give them sound advice. What you don’t want happening is your patient returning with complaints of poor fit and/or poor vision due to an incorrectly selected frame.

Having at least a rudimentary knowledge of prescription anatomy is vital to your expertise in this process. Does the patient have a strong minus prescription? A large or irregular shaped frame may result in unsightly, thick edges. Does the patient have a strong plus prescription and a narrow pupilary distance? Allowing them to choose a rectangular shaped rimless frame may result in a nasal edge so thick that it doesn’t allow adjustments with the nose pads. The first thing I’d recommend is knowing what prescription your patient has so you can visualize in your minds eye the prescriptions’ shape. This will give you the basis for creating the most functional and visually pleasing pair of glasses possible. 

With that knowledge in mind, guide the patient to the best eyesize that will fit their face while still accommodating their prescription. This may be challenging if they require a small eyesize but need a larger frame. Look toward those frames that have a generous end piece and bowed temples built into the frames’ construction. 

Once you’ve chosen the frame, always place the glasses onto the patient to see how well it fits their facial anatomy. Check whether the temples are either too long or too short behind their ears. If unsure, go ahead and adjust the temples to see where the bend will lie. The last thing you want is to be dispensing a patient's glasses and realizing no amount of adjusting will make them fit properly. 

The same goes for the bridge or nose pads. A solid bridge should never have gaps between the patient's nose and frame material, nor should it be digging into their skin. If you raise the glasses slightly off their nose, you should ideally see about a 1-2 mm space all the way around. If not, the bridge isn’t ideal. 

It’s critical to pre-adjust the nose pads for comfort as well as before measuring multifocals.

• Can the guard arms be adequately spaced in view of the possible encroachment of a thick nasal edge?
• Are the nosepads themselves either too large or too small?
• Would the patient benefit from soft silicone nosepads rather than the hard plastic?

It’s better to switch the nosepads before measuring multifocals and especially before dispensing. Changing the size of a nosepad may change how the frame is positioned and thus change the position of the lens optical center and the position of the multifocal. Switching them before they’re sent to the lab eliminates the possibility of accidentally scratching the prescription lens with a screwdriver that slips off the screwhead. (Trust me on this. I’ve ruined lenses by omitting this step beforehand.) 

Lastly, verify whether or not the chosen frame will accommodate whatever pantoscopic tilt their lenses require. Progressive lenses work ideally with around 8-12 degrees of pantoscopic tilt. Be aware if the chosen frame has an endpiece that won’t allow the correct tilt. 

Doing these steps before you send frames to your lab gives you and your patient the best chance of success with their fitting and visual needs. It also makes the dispensing process a happy experience rather than one fraught with difficulty and embarrassment.