Thoughts and advice

[myownboss]

I have a patient who was previously wearing
+1.50 D.S.
+1.00 -0.25 180
+2.00 ADD in a FT-28

I received a new prescription today
Plano D.S.
+1.25 D.S.
+2.00 ADD
with 1 diopter base out prism OU

I checked with the OD's office and they confirmed this is the intended RX.

Patients age is 47

Thoughts and advice please.

[Hayde]

I see your concern; my first instinct would be to fish for more information from the patient. Catch up on his Hx of eyeglass satisfaction.

The new doc may have a very good reason to try this tact. Seen it more than once. I won't say it's not a remake/Dr's change waiting to happen. But at the end of the day, we can't try to do the doc's job to the degree of second guessing them.

Either way it goes, looks like a great learning experience!

[drk]

That's a cataract forming OD, and why someone is eso at this age is scary.

I wouldn't try that, as a prescriber, but whatever. Be sure you have a policy in place like this: "We will happily remake your glasses for no charge (or 50% off) one time within 90 days (or 60 days) due to a doctor's prescription change. Outside of that time period, lens changes will be regular price (or 20% off)."

[myownboss]

Thanks for the advice. I would normally think cataract as well, but patient is under 50. I was just wondering, from a prescribers perspective. Is there something else going on that I might be missing. Thanks again.

[CCGREEN]

DrK......I did not see anything in his post that said anything about age. But yes, if it is at a young age it could be frightful.......a bit. But it could very well be the norm if they have a history of taking steroids for what ever medical issue they have had going on over the years.
Or they very well could of be of "normal cataract age" and they may be post Sx now and had awesome results and need no correction distance OD.
One of the early things I learned about the optical field, everything is subject to change, what apply's to one person does not necessarily apply to the next person every time. Even the rules change in each case. Ya just got to love it.

[drk]

The patient has a +2.00 add, so I assumed the patient was 50+, and cataractous.

But if the patient is non-presbyopic, you probably have a binocular vision case on your hands.

The patient may simply be a convergence excess esophore and that explains the prism and the early add. It doesn't explain the myopic shift OD, though.

[chaoticneutral]

When I was a massage therapist, I approached everything from a much different perspective. We get so focused on eyes and fashion, materials and measurements. This might be laser gone wrong, or a degenerative disease. Perhaps a more thorough patient medical history would reveal the cause. Regardless, (irregardless) I love using that inappropriately, look at the patient as a whole and you'll find what your looking for.

[harry888]

Just throw a -1.50 blank over habitual od and tell him that this is new rx. See if he likes it.

Harry

[optilady1]

After confirming with the doctors office, This is a case for trial framing. And an honest talk with the pt that his rx changed dramatically. These two steps typically get the pt in the right frame of mind to give themselves an honest trial of the new rx.

[mdeimler]

After confirming with the doctors office, This is a case for trial framing. And an honest talk with the pt that his rx changed dramatically. These two steps typically get the pt in the right frame of mind to give themselves an honest trial of the new rx.

What she said