Prescribing Flashcards
What are non tolls
patients who return because they are dissatisfied with their glasses
Might be issue with the dispensing, prescription or fit
Why do we not want rehecks
These cost the practice:
1) Recheck eye exam (at no cost to the patient) is needed
2) New spectacle lenses may need to be re-glazed at no cost
3) If not dealt with well, the px will likely tell friends and family, tarnishing practice reputation
How can we avoid rechecks
- Refract carefully
- Ensure changes in refractive correction between px specs and subjective refraction makes sense
- Do changes match symptoms?
o If no sxs would not expect increase in minus power or plus power in 55+ px who have no accommodation - Do changes correspond to changes in VA
o One line of VA improvement is -0.25DS (or 0.50DC) in young px - Use prescribing rules
Guildine 1: is change necessary
Show px difference between spec and subjective
If happy just don’t give
Guideline 2: use real world tasks
Show them change using real world tasks - looking outside window
Guideline 3: if it ain’t broke don’t fix it
If px comes in with no issues and VA good don’t change anything
Guideline 4: if it ain’t broke don’t fix it (dist specific)
Px comes in and says “I’m getting reading problems”
No sxs for DV but for NV only
Don’t change DV just change near add
Guideline 5: if it ain’t broke don’t off it much
Px has refractive correction change - currently no sxs but could within few weeks or months
Prescribe HALF of any change particularly spherical
Guideline 6: be careful reducing myope in happy young myope
Myopic px whose rx has plateaued and now starting to decrease
Used to slightly accommodating in their spectacles to obtain very clear distance vision
As long as reasonable amount of accom this can be ok
Guideline 7: cut the plus
Young hyperopes - 20/30s
Don’t give full plus rx
6m rx is 0.17D blurred so end up over plussing
Suggested to under correct by 0.25DS I.e if refraction suggests +2.25 prescribe +2.00
Allows pt wearer to adapt more easily without glasses on. Help the delay of dependence of px on their glasses
Guideline 8: be careful making large rx changes at near
Px who has correction of -4.00, add +2.50 reads through -1.50 at near not -2.50
So if px happy with their near vision but dist vision is reduced to -4.50…need to have the same near correction so need an add of +3.00
Guidelines 9 & 10: prescribe conservatively with astigmatism
If spectacle rx is -4.00 and subjective is -4.00/-2.00x90
Partially prescribe half the cyl change (-1.00DC)
To keep partial rx the same SE as subjective (-5.00) prescribe -4.50/-1.00x90
Guideline 11: prescribe astigmatic axis change conservatively
Partial prescribe cyl axis when axes are oblique and large changes especially in elderly
