Rx Red Flags

[icmor]

I work in a large ophthalmology office where we have optometric techs doing the refracting for the MDs. On Friday, the MDs will be in meetings all morning, so I've been asked to speak to the Opt techs for some communication and education. I'll be talking about red flags that we see on some Rxs that come to the optical dept., and what to look for when writing a script. (ie: 70 year old patient being prescribed a 2.25 add power.) Our list goes on. So I would like to open this up to optiboarders; what weird Rxs have you "red flagged" in the past, that you could obviously tell that someone made a mistake in writing the script for a patient?

[Barry Santini]

Biggest RED FLAG I see:

0.25D sph change in ONE EYE ONLY.

YIKES!!!!!

Without uncovering symptoms of overt or covert asthenopia, DANGER WILL ROBINSON AHEAD!

FLIPPERS: DO YOUR STUFF.

B

[gmc]

Yoked prism. BU & BU, BD & BD or BI & BO

Increases in power in distance RX (more +) for hyperopes. Trial frame the new Rx. Not necessarily a mistake in writing the Rx, but potential problems none the less.

[icmor]

Yoked prism. BU & BU, BD & BD or BI & BO

Increases in power in distance RX (more +) for hyperopes. Trial frame the new Rx. Not necessarily a mistake in writing the Rx, but potential problems none the less.

Yeah, we've gotten the yoked prism on occasion. One time it was legit. The Dr. wrote it for a stroke patient who lost eyesight on one side only, so the prism centered what vision he had.

[icmor]

I just red flagged a script ten minutes ago. 46yr old with unequal add powers (1.75 and 2.75)! Turns out it was legit, though. The patient had an eye injury and cataract removal in one eye. An explanation at the bottom of the script would have been helpful.

[Uncle Fester]

Yeah, we've gotten the yoked prism on occasion. One time it was legit. The Dr. wrote it for a stroke patient who lost eyesight on one side only, so the prism centered what vision he had.

I've revized my thinking on this over time and realize that until I have an education equal to an MD or OD I won't question a yoked prism rx.

Vision Therapy is an emerging field that doesn't necessarily need an obvious physical condition for a patient to benefit from it.

I think even now chiropractic therapy is debated the same way.

I agree red flags are very big or very little rx changes

[Michael I. Davis]

- cyl from an MD + cyl from an OD

spheres of opposite signs

[Java99]

A presbyopic myope with a 20 degree or more axis shift from old pair.

[uncut]

A missing cylinder power.........with an axis position provided, makes me looks twice!


My radar goes nuts when blank spaces appear, also.

[drk]

Are you looking for refraction errors, transcription errors, potential non-adapts, or all of the above?

Probably the simplest way is to compare new Rx to old Rx. No method will be 100%.

[Fezz]

Certain hairstyles and heavy eyeliner are major red flags!

[fjpod]

Uh, what's an optometric technician? If the doctor is writing the prescription (as he or she should be) then talk over errors with the doctors.

[CME4SPECS]

I don't see it as questioning anyone...just confirming that you understand what they are prescribing

[gmc]

I've revized my thinking on this over time and realize that until I have an education equal to an MD or OD I won't question a yoked prism rx.

Vision Therapy is an emerging field that doesn't necessarily need an obvious physical condition for a patient to benefit from it.

I think even now chiropractic therapy is debated the same way.

I agree red flags are very big or very little rx changes

I know it can and does happen on occasion. Simply asking if it's correct is not questioning the doc's judgment or putting my education on par with theirs. There is a very good chance it's a simple transcription error.

Our docs have appreciated it the few times I've caught it. It has saved delays and expensive remakes.

[paulcr39]

Rx in OU for one eyed patient, plus for minus, Harlem Shuffle dancing on the dispensing table...oh wait that's something else I was thinking of. Nevermind. Carry on.

[anthonyf1509]

I agree with too much (+) added to hyperopes. But also will occasionally see MDs who change myopic patients distance (weaker) and no ADD change. This consistently over 2,3, even 4 years in a row with a new Rx.
Too often, they notice DVA "not as sharp as my old pair when I'm driving.."

[mervinek]

I agree with too much (+) added to hyperopes. But also will occasionally see MDs who change myopic patients distance (weaker) and no ADD change. This consistently over 2,3, even 4 years in a row with a new Rx.
Too often, they notice DVA "not as sharp as my old pair when I'm driving.."

I get this all the time. I always educate my patients about Rx adaptation when they go more plus. Saves me in the long run. Quite often it ends up being a redo.

[pseudonym]

Axis shift 10 or more degrees toward 180 rather than 90.

More than 2.5D difference between eyes AND a new presbyope.

People who relate every rotten pair of glasses they ever got and from whom, so now they're gonna try "us." (Not if I can help it.) Oh wait, that's a red flag of another kind.

[Robert Martellaro]

Axes that don't sum to about 180. 160/20, 70/110, 45/135 are generally expected, 90/180, and 45/45 should cause some concern and trigger a thorough review of their history, especially if the power is >.25 DC.

[drk]

In all these years I haven't realized that axes sum to about 180. Awesome.

[mdeimler]

Certain hairstyles and heavy eyeliner are major red flags!

The damn fake eyelashes. "My lashes keep rubbing my lenses. Fix them." Ok, remove the stupid lashes. Problem solved. Btw, what's with this recent trend towards fake eyelashes, anyway ? I'm ok with other fake parts, but eyelashes bug me.

[MakeOptics]

Axes that don't sum to about 180. 160/20, 70/110, 45/135 are generally expected, 90/180, and 45/45 should cause some concern and trigger a thorough review of their history, especially if the power is >.25 DC.

Symmetrical axis is a double check for me as well but to quantify it as summing to 180 is genius, makes it easy for layman and computers to understand.

[Barry Santini]

In all these years I haven't realized that axes sum to about 180. Awesome.

It is felt that axes are complimentary because of bilateral symmetry...related to the first division of the egg.

They are usually mirror images of each other

[Wes]

Axes that don't sum to about 180. 160/20, 70/110, 45/135 are generally expected, 90/180, and 45/45cially if the power is >.25 DC.

I've noticed this tendency toward mirror symmetry over the years. After reading these posts, I did an experiment this morning. I spotted up roughly 300 pair of lenses, and of those, 23 pair were off by more than 20°.
Ex:
Within 20° or less
165/15
18/2
90/70

Not within 20° or less
100/50
15/15
160/160

[MikeAurelius]

Plus cylinder in one eye, minus cylinder in the other.

Sloppy handwriting on Rx's that make reading 7's and 2's hard to differentiate.

Not writing the leading zero and decimal on an under 1.00 diopter sphere/cylinder power.

Specifying a base curve that obviously won't work with the prescription, much less the frame. (case in point, wanted 3 base progressive for a +4.50 OU Rx.

Same powers in both eyes except different signs: +2.00 -0.50 x 11 & -2.00 -0.50 x 169

PD's that wider than the Frame PD by more than 10 mm(*see note below). Seg Heights that are higher than the full B box measurement of the frame.

*Note: I've been doing a lot of Wiley X inserts lately, and almost ALL of those end up with at least 2-5 mm out decentration.