Fix and Fit

The Slippery Slope

Alex Yoho, ABOM

How often do patients bring back eyewear they have bought from you that is now slipping down along their noses? One plus is that fixing their slipping eyewear can make you a hero. It also gives you an opportunity to dispel myths about what is causing it.

TYPICAL MISCONCEPTIONS

There are several things that a patient can speculate is causing their eyewear to slip. Here are the most common myths.

■ SPREADING PADS. The most popular myth is that the nosepads have spread out and need to be narrowed. This might make sense to a new dispenser as well; and when it’s tried, the glasses seem to be higher on the face because the nosepads will be riding the frontal angle up on the nose. However, the patient usually will return in a few days complaining of a sore nose. That’s because the nosepads are resting on the skin covering the septum and pinching between the nosepad and bone.

■ HOOKING TEMPLES. The next most common theory is that the temples need to be tighter against the back of the ears to “hook” the glasses on. If done carefully, this can help keep the eyewear from slipping by creating what I call a critical fit. One slight bump on the endpiece, however, and the eyewear will be out of balance—causing the temple on the opposite side to pull harder on the ear.

Poorly fitting, too-tight temples press against the head (top), resulting in “racing stripe” marks (bottom)

WHAT TO CHECK

Following are a few more reasonable adjustment options than the patient-preferred ones above.

■ RACING STRIPES. Created by tight temples, these are dents in the skin on the side of the head in front of the ears. Because the typical head is widest at the point above the ears, it is very important to adjust the glasses so that this area has no contact with the temples. If there is contact, it will create a wedging effect, forcing the eyewear to push down on the nose, particularly when the patient perspires.

■ BEHIND EARS. I like to leave a space of about 2mm from the temple to the back of the ears. This avoids that critical fit problem. As you adjust for that gap, be very careful to bend the temples to follow the back of the ears. Gravity will eventually pull them down the nose and against the back of the ears a bit, so it’s important to distribute the pressure over as much surface area as possible. Distribution of weight and pressure is, in fact, one of our primary jobs.

■ THE MASTOID. The same wedging effect that caused the eyewear to slide down is exactly what we will use to keep it up by ensuring that there is constant contact along the side, behind the widest part of the head. This area, known as the mastoid, is the key to prevent slippage.

If this area dips in or bulges out, the temple tip must be made to parallel the area. Following the taper of the head to the neck helps keep the glasses from riding up the back of the ear as gravity does its work.

With these techniques and a bit of practice, you can be the hero—and problem solver—to patients. EB