Ophthalmic Lenses

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Ophthalmic Lenses
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Injuries from ophthalmic lenses are a significant
source of liability claims against
optometrists.The most likely cause of injury is
breakage of a glass, high index, or allyl resin
(CR-39) lens.Frames are a less likely cause of
litigation, but safety and sports frames have
been involved in liability claims.
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Liability claims most frequently allege
negligence, but product liability may be alleged
if lenses or frames are defective.For an
optometrist, there are three types of negligence
claims involving lenses 1--failure to
prescribe an impact- resistant lens material
2--failure to warn of limited impact
resistance 3--failure to inspect lenses
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The materials of choice with respect to impact
resistance are polycarbonate and Trivex.Trivex
is lighter than polycarbonate, more scratch
resistant, has comparable uv attenuation,and
has similar impactresistance.
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The key clinical error is failure to prescribe
polycarbonate plastic (or Trivex) when protection
is a key clinical consideration the patients for
whom protection is necessary include

• Monocular persons
• Athletes
• Workers whose occupations place them at special
  risk for injury (e.g., police)
• Children
• Individuals with compromised corneas (e.g., RK,
  LASIK, penetrating keratoplasty)

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A policeman was struck by a drunk as he was
entering a bar for a routine investigation. The
blow shattered his spectacles, causing a piece of
glass to be driven into an eye, thereby creating
a permanent loss of acuity. He sued both the
optical company filling the prescription and the
optician dispensing the spectacles, alleging they
were negligent for failing to provide him with
lenses that were either more impact resistant or
less likely to come out of the frame in sharp,
jagged pieces (i.e., plastic lenses). A sizable
judgment was returned in his favor.
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The second clinical error is failure to warn
patients of the limited impact resistance of
ophthalmic materials other than polycarbonate
(i.e., glass, allyl resin (CR-39), high
index).This warning is especially important
when a secondary use (e.g., playing baseball)
makes wear of the lens material hazardous.
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Example case injury from shattered spectacle lens

• Myopic, physically active man in his 20s needs
  new glasses
• Optometrist performs an examination, writes a
  spectacle prescription
• While playing softball, one of the lenses is
  struck by the ball and shatters
• Permanent loss of vision in the eye results

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Notice how skillful questioning causes the doctor
to actually testify that he breached the standard
of care by failing to take an adequate history
and by not prescribing protective eyewear for
secondary sports use.
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CLAP Traps

• Patient histories should always include
  avocational use of eyewear!
• Make sure polycarbonate plastic (or Trivex) is
  specified on prescriptions when protection is a
  key clinical consideration
• For ametropic patients playing contact sports,
  eyeguards meeting ASTM F803 standards or contact
  lenses should be prescribed

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The third clinical error is failure to inspect
and verify ophthalmic lenses and frames prior to
dispensing (especially safety frames).There
are lens thickness requirements for safety
lenses that must be verified by the dispenser.
Failure to perform the inspection is negligence
the non-conforming lens is a defective product.
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An 18-year-old man ordered safety glasses from
his optometrist. Later the patient was in an
automobile accident and suffered the loss of an
eye when one of the lenses shattered. It was then
discovered that when the original order was
turned over to the optometrist's technician, she
failed to mark the order as one for safety
glasses. Thus, although the patient had ordered
and paid for safety lenses, he had received dress
lenses. The patient sued, alleging negligence,
and the case was eventually settled in his favor.
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Liability claims have also been brought alleging
injuries from dress frames, industrial (safety)
frames, and sports frames.Dress frames are most
frequently a cause of claims when they contribute
to injury, such as dislodgement of a lens that
strikes the eye the failure of the frame to
retain the lens is a contributing factor to
injury in such a case.
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Both a safety frame and safety lenses must be
dispensed to patients requesting industrial
(safety) glasses. Failure to provide an
approved frame?even if safety lenses are
prescribed?can create liability.
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Liability may ensue from failure to prescribe the
appropriate frames for sports and recreational
activities, if the risk of eye injury is
significant.Frames for athletes should offer
reasonable protection for the sport. For
participants of the racquet sports, polycarbonate
frames with no hinges (and polycarbonate lenses)
that meet the performance standards for
impact-resistance established by the American
Society for Testing and Materials (ASTM standard
F803), must be prescribed.
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• Although ASTM F803 was originally devised for
  racquet sports, it is now recognized as the
  applicable design for hard ball sports as well.
  
• Ametropic patients who play baseball,
  basketball, football, soccer, and similar sports
  should be prescribed F803 frames.

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The dispenser of eyewear is under a legal duty to
be sure that ophthalmic lenses and frames meet
standards for impact resistance. These standards
are the same in all jurisdictions, and involve

• dress lenses
• non-prescription (plano) eyewear
• industrial (safety) eyewear
• There is no similar standard
• for sports eyewear.

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Standards for dress (Z80.1-1999) and
non-prescription (Z80.3-1996) eyewear have been
adopted by the US Food and Drug Administration
and state that

• All lenses shall be capable of withstanding the
  drop ball test (a 5/8 inch diameter steel ball
  weighing not less than .56 ounces must be
  dropped from 50 inches onto the lens).
• Exceptions plastic lenses, laminated lenses, and
  raised-edge multifocals can be certified by the
  manufacturer, who must test statistically
  significant samples.

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Standards for industrial (safety) eyewear
(Z87.1-2003) have been adopted by the
Occupational Safety and Health Administration
and state

• Basic impact prescription frames must contain the
  Z87 (or Z87-2) logo.
• Basic impact prescription lenses must be no less
  than 3 mm in thickness, regardless of lens
  material, and pass a drop ball test (1 inch
  diameter steel ball weighing 2.4 ounces is
  dropped from 50 inches onto the lens).
• High impact prescription frames must contain a
  Z87 logo.
• High impact prescription lenses must be no less
  than 2 mm in thickness, regardless of lens
  material, and pass a velocity impact test (1/4
  inch diameter steel ball is fired at 150 ft/sec
  at the lens).
• The trademark of the entity fabricating the lens
  must be etched on the edge of the lens.

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Product liability claims involving ophthalmic
lenses and frames may include optometrists (as
the seller), but most frequently allege defective
design or manufacture. Thus, optometrists are not
usually the primary defendant.Product liability
law requires that individuals be warned if
products are dangerous, and that products be
inspected before they are sold. Optometrists may
be liable in such products-related claims.
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A high school baseball player was practicing for
a varsity game when he misjudged a fly ball that
tipped off his glove and struck his flipped-down
plano baseball sunglasses. The lens shattered
into sharp splinters that pierced his eye,
necessitating the eye's removal nine days later.
The sunglasses were advertised as "just perfect
for active and spectator sportsworld's finest
sunglasses." They resembled ordinary sunglasses
except for the flip feature. But their center
thickness was only 1.5 mm, and they were not
tempered for impact resistance. The youngster
sued the manufacturer of the sunglasses under
product liability law. The court held that the
reduced center thickness made the lenses
unreasonably dangerous and awarded the plaintiff
significant damages.
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Guarantees can be established by the words of
assistants or employees of the doctor as well as
by the doctor himself. Careful instruction and
supervision of office personnel is necessary to
avoid ill-chosen remarks about the impact
resistance of ophthalmic lenses the word
shatterproof should never be spoken or written.
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Warranties are promises that some proposition or
fact is true. There are two basic kinds of
warranties

• express warranties are those that are explicitly
  stated (these lenses are made of polycarbonate
  plastic)
• implied warranties are those that are derived by
  implication or inference from the nature of a
  transaction or the circumstances of the parties
  (optometrist prescribes glasses that are to be
  worn while playing sports, thereby warranting
  that they are suitable for that purpose)

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A physically active young man sought the services
of an optometrist, who performed an examination
and prescribed standard, heat-treated dress glass
lenses. While on a hunting trip the young man
tripped and fell, and his head struck the ground.
One of the prescription lenses shattered as a
result of the impact and severely lacerated his
eye. Although he sought treatment immediately, he
suffered a series of complications and ultimately
lost the use of the eye. He sued the optometrist
who had performed the examination and the optical
laboratory that had fabricated and heat-treated
the lenses, alleging that the lenses were an
unsafe product and that the optometrist had told
him that the lenses were shatterproof. The jury
found that the optometrist's remarks constituted
a guarantee and awarded the young man substantial
damages.
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It is wise to have a form that explains lens and
frame options to patients and that can be
retained in the record for purposes of
documentation.

Important Information About Your Glasses Before
you select the frames and lenses for your
glasses, there are several things we need to
consider. It is important that you describe to us
the kinds of activities that you plan to
undertake while wearing your glasses. If you will
be wearing glasses at work, we need to know if
there is a risk of injury to you from flying
objects that could strike a lens and break it. If
your job requires the use of safety glasses, you
must tell us because special frames and lenses
must be ordered. If you plan to wear your glasses
while playing sports, please let us know so that
we can help you select frames and lenses that
will not create a risk of injury. In fact, if you
participate in any activities that could
potentially cause eye injury, you need to
describe these activities to us so that we can
advise you. Although no glasses are unbreakable,
there are important differences between lenses
and frames that make some glasses more protective
when compared to others. We are here to help you
choose the glasses that best satisfy your needs.

Lenses A very
important part of selecting your glasses is the
choice of lens material. There are several
different materials to choose from, and each has
advantages and disadvantages, which are described
below. Glassreasonably resistant to scratching
and, as a photochromic lens, has good ability to
darken in sunlight in high prescriptions glass
can be heavy glass lenses may not withstand
impact well. Plasticscratches more easily than
glass, but lighter, especially in high
prescriptions can change darker in sunlight, and
makes excellent sunwear impact resistance is
similar to glass. High index plasticused for
high prescriptions because lenses are thinner and
much lighter than other materials withstands
impact a little better than regular plastic good
for sunglasses. Polycarbonate plastica high
index material that is very impact resistant,
which makes it the best choice for ocular
protection scratches more readily than glass but
like other plastic materials is light and thus
appropriate for high prescriptions makes good
non-prescription sunglasses too.
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FramesAnother important
consideration is the frame you select for your
glasses. It should fit properly, be comfortable,
and compliment your appearance. It should also be
safe. There are three basic categories of frames
from which to choose.Dressthese are the frames
worn for everyday activities that do not pose a
risk of injury the great majority of frames
serve this purpose, being suitable for wear at
home, at work, and during play.Safetysome
frames have been specially designed to provide
protection in the workplace they can be
identified by a Z-87 logo on the frame lenses
for these frames must be of a certain thickness
and have a special design in order for them to
meet the requirements for safety
glasses.Sportseyewear for high risk activities
such as racquetball, squash, baseball,
basketball, and football must meet special design
standards and be made of polycarbonate plastic
frames must meet the standards of ASTM F-803 to
provide optimum protection.

Making Your ChoicePlease consider carefully
your needs for both frames and lenses. Based on
these needs, we will be pleased to advise and
assist you in the selection of the eyewear most
suitable for you, which will be marked
below.LENS MATERIAL Glass Plastic
High Index PolycarbonateFRAMES
Dress Safety SportsSPECIAL ORDERS
Anti-scratch Anti-reflective Photochromic
Sunglasses_______________________________
_______________________ ___________________
__________________Verified By Date
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