1. Ophthalmic Lenses

2. 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.

3. 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

4. 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
impact
resistance.

5. The key 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)

6. 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.

7. The second 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.

8. 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

9. 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.

10. 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

11. The third 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.

12. 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.

13. 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.

14. 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.

15. 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. Although this standard was originally
devised for racquet sports,
it is now recognized as the applicable
design for “hard ball” sports as well.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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
sports—world'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.

22. 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.

23. 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)

24. 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.

25. 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.
Glass—reasonably 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.
Plastic—scratches 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 plastic—used 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 plastic—a 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.

26. Frames
Another 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.
Dress—these 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.
Safety—some 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”.
Sports—eyewear 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 Choice
Please 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 [] Polycarbonate
FRAMES [] Dress [] Safety [] Sports
SPECIAL ORDERS [] Anti-scratch [] Anti-reflective [] Photochromic [] Sunglasses
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