0.25 Cylinder?

[Stephanie Yee]

I'm a new user to this board, so I'm not sure whether this topic has been discussed before, but ...

Just out of curiosity, how do you all feel about Rx's with +/- .25 cylinder in them?

As an O.D. who does all her own refractions, I always measure the cylinder power and axis for each patient to determine their BCVA. When the time comes to write out the Rx however, sometimes I wonder about prescribing it, especially when it's only .25 and the sphere power is +/- 4 D or greater.

I'm aware that since .25 cylinder power is generally within tolerance for most Rx's, the lab technician may reasonably substitute a spherical lens for the prescribed Rx, and the job will still pass upon final inspection ... and the patient/customer will most likely never know the difference.

I'm also aware that some O.D.'s never prescribe cylinder unless it's .50 D or more, but currently I'm not one of them.

[QDO1]

I'm a new user to this board, so I'm not sure whether this topic has been discussed before, but ...

Just out of curiosity, how do you all feel about Rx's with +/- .25 cylinder in them?

As an O.D. who does all her own refractions, I always measure the cylinder power and axis for each patient to determine their BCVA. When the time comes to write out the Rx however, sometimes I wonder about prescribing it, especially when it's only .25 and the sphere power is +/- 4 D or greater.

I'm aware that since .25 cylinder power is generally within tolerance for most Rx's, the lab technician may reasonably substitute a spherical lens for the prescribed Rx, and the job will still pass upon final inspection ... and the patient/customer will most likely never know the difference.

I'm also aware that some O.D.'s never prescribe cylinder unless it's .50 D or more, but currently I'm not one of them.

the thing is that you came up with 0.25 because the patient subjectivly chose it, and because it falls neatly between 0.50 and 0.00. If infact the RX was 0.36, and you rightly opted for 0.25, and then the lab put in 0.12 or 0.00 the job will now be (not 0.25 out, but 0.36 out.

Labs try very hard to give you what you ask for. I have glazed jobs where the RX had +0.50(+) meaning go stronger not weaker

furthermore, from your point of view, the more accuratally you try to refract, the more accurate your prescriptions will be, and if the DO, and Glazer have the same attitude, the RX on the patients nose will be what you and the patient were expecting

Remember in the bad old days of maths class the teacher always used to say: "keep all the decimal places untill the answer is found, and then truncate" well this is a good example of why

[Happylady]

If it is part of the prescription then the patient prefered it. If I got a job back from the lab without it and it was ordered then I would send it back most of the time. I hedge here because if it was coming from the Davis lab and the patient had already waited over two weeks for the glasses I would probably let it go.

[Johns]

[QUOTE=HappyladyI hedge here because if it was coming from the Davis lab and the patient had already waited over two weeks for the glasses I would probably let it go. [/QUOTE]


This is the very reason that I am confident that I will always be able to make a very good living.

[Jacqui]

This is the very reason that I am confident that I will always be able to make a very good living.

Same here, if it's ordered I send it. Forget ANSI standards they aren't critical enough.

[Happylady]

This is the very reason that I am confident that I will always be able to make a very good living.

I am not sure what you are suggesting here. I am very picky about the glasses we do. However, if I have a strong rx and a -.25 cylinder correction is left off by the lab I know that with 99% certainty that the patient will not miss it. I also know that if I tell this patient that her glasses are going to be another 2 weeks that she will not be happy at all.

[fjpod]

When I find a.25 cyl objectively or subjectively, I almost never Rx. it. BUT, if a px has been wearing a .75 cyl, and now I'm finding no cyl, I might Rx a .25....or a px has been wearing .25 axis 180 and I find a .5 cyl at 90, I might Rx.25 axis 90

There are numerous other situations like this. In reality, I Rx .25 cyls a lot.

[chip anderson]

Gee: I remember this same debate 35 years ago, over .12 cylinders. Does this mean refraction is getting less accurate or refracters getting less concientious.

Back in the days when physicians were getting kickbacks from dispensaries they did not own, .12 cylinders were needed in welding goggles. Are we about to go through this in reverse?

[Jacqui]

I feel that if I can tell the difference with a 0.25 cyl then the patients can. I'll do it to make sure they get what is right for them.

Yes, Chip, I remember making 0.12, 0.37, 0.62 cylinders, and if they weren't right we got to do them over.

[chip anderson]

Of course, Jacqui that was before we had ansi and the government to tell us how to do right and our tolerance was zero. When I first got into the contact lens business, if it was off a .12 in power, .02 in curvature, .01 in diamter, .02 in posterior optical zone, didn't have optics "good as plano" it was junk.

Chip

[DocInChina]

When I find a.25 cyl objectively or subjectively, I almost never Rx. it. BUT, if a px has been wearing a .75 cyl, and now I'm finding no cyl, I might Rx a .25....or a px has been wearing .25 axis 180 and I find a .5 cyl at 90, I might Rx.25 axis 90

There are numerous other situations like this. In reality, I Rx .25 cyls a lot.

fjod, I was scrolling through the replies to this thread, formulating my reply when I read yours. It seems we are on the same page with regards to prescribing. Did you by chance attend SUNY? :)

Doc

[Johns]

I am not sure what you are suggesting here. I am very picky about the glasses we do. However, if I have a strong rx and a -.25 cylinder correction is left off by the lab I know that with 99% certainty that the patient will not miss it. I also know that if I tell this patient that her glasses are going to be another 2 weeks that she will not be happy at all.

1. What is your definition of "picky"? I'm suggesting that your post is telling us that you're not that "picky" if you settle for a "close enough" rx based on convenience.

2. The patient will not "miss" a lot of things, but if they are paying you to fill the Rx properly, you are obligated to do so. What "creative license" do you have to determine what a patient will or will not "miss". Do you properly anotate the records to reflect you decided the patient doesn't need the full Rx ? If the lab had properly filled the Rx, then wouldn't the patient be over corrected ?

3. If the patient is unhappy with a 2 week delay, how unhappy would they be with the improper rx?

4. Why on earth would your Rx (high or low) take 2 weeks ?

[Happylady]

1. What is your definition of "picky"? I'm suggesting that your post is telling us that you're not that "picky" if you settle for a "close enough" rx based on convenience.

2. The patient will not "miss" a lot of things, but if they are paying you to fill the Rx properly, you are obligated to do so. What "creative license" do you have to determine what a patient will or will not "miss". Do you properly anotate the records to reflect you decided the patient doesn't need the full Rx ? If the lab had properly filled the Rx, then wouldn't the patient be over corrected ?

3. If the patient is unhappy with a 2 week delay, how unhappy would they be with the improper rx?

4. Why on earth would your Rx (high or low) take 2 weeks ?

I guess you don't do Davis insurance. If I have a Crizal Ar on a lens it often takes 2 weeks, especially if we send the frame.

I am answering a hypothetical question here. I said I would return it to the lab in most cases. I AM picky. However I have been in this business for 25 years and and I do know that someone that wears a -6.00 is not going to miss that -.25 cylinder 99% of the time. If this hypothectical situation ever came up I would run it by the doctor I work for because I obviously can't change the rx.

[Johns]

Regardless of what insurance (lab) is being used, the patient should get the Rx as the dr. prescribed it. I can't imagine going to the dr and saying, " The job has already taken 2 weeks, it came in wrong, so rather than wait longer, can I just give them what came in ?

[fjpod]

fjod, I was scrolling through the replies to this thread, formulating my reply when I read yours. It seems we are on the same page with regards to prescribing. Did you by chance attend SUNY? :)

Doc

No, PCO 1978. Although I havea son attending SUNY Optometry now. We'll have to wait and see what he would do.

[chip anderson]

Pehaps waiting 2 weeks and useing the crappy "Selected Frame Selection", and having to choose from the less prestigeous eye practioners will cause people to re-examing the silly "eye insureance racket" and eleminate the problem entirely.

I will stop seeing patients come in saying: "My insureance company made me buy my last contacts from thier eye doctor and I can't wear them, can you fix them."

[Johns]

Chip ,

...and they probably say, " And I even though it took them 2 weeks before I got the glasses, I still can't see out of them!"

[fjpod]

Pehaps waiting 2 weeks and useing the crappy "Selected Frame Selection", and having to choose from the less prestigeous eye practioners will cause people to re-examing the silly "eye insureance racket" and eleminate the problem entirely.

I will stop seeing patients come in saying: "My insureance company made me buy my last contacts from thier eye doctor and I can't wear them, can you fix them."

I love the ones who say, " I haven't been back because I lost my insurance, so I had to go buy my glasses/cls somewhere else.":hammer: When did I put up a sign that says," I only take insurance"?

[Johns]

I love the ones who say, " I haven't been back because I lost my insurance, so I had to go buy my glasses/cls somewhere else.":hammer: When did I put up a sign that says," I only take insurance"?

Don't you love that !?!

I stopped a lady in her tracks Monday (and made a $480 sale) when she said, "Oh I love the frames you have, but I have to get my glasses at Sears because of my insurance." I said ma'am, this is America, you're allowed to get your glasses anywhere you want! Buy the frames you really like here, and go to Sears and use the insurance for your back-ups you'll probably never use."

She did.
:cheers:

[harry888]

Stephanie,

Great question.

Personally I would think a -0.25 cyl over -4.00 should make no difference, but I've had multiple patients who were sensitive to it over a -6.00.

A local ob/gyn doctor went from -6.00 -0.25 x180 OD to -6.00 sph OD (her OS was -7.00 sph). She got dizzy.

If they've had it before, they keep it. But during a routine refraction if they are 20/20 with a -6.00, I don't go looking for -0.25 cyl.

Harry

[William Stacy O.D.]

Just out of curiosity, how do you all feel about Rx's with +/- .25 cylinder in them?

The same way I feel about prescribing and axis 7 or 44.

Give it your best shot. Just remember the lab tolerances fall on either side of what you PRESCIRIBE. If you err on one side of your finding (as in dropping the cyl by .25), the lab will make them on either side of that error, not on either side of your finding.

e.g. You measure -1.00 -.25 x 47

you prescribe -1.00

the lab makes -.75 -.25 x 144

Everything is in tolerance, but the patient loses, because the result is .50 off in the 144 meridian. And you lose because the patient can't wear your Rx.

[LENNY]

This is my favorite RX from a neghborhood MD:
OD -4.25-0.25X178
OS -4.50-0.25X171
I just love this!!!

[SpecialT]

I can basically see that most of the posts on this thread don't support prescribing a quarter cyl especially when the sphere is not a low power. My feelings are that you are less likely to cause issues by barely under-prescribing cyl than barely over-prescribing cyl. Because of my minimalistic approach, I do actually prescribe quarter cylinders because I feel that if it is in my phoropter at the end that it is the minimum needed. But remember, I don't have it in there unless the patient is explicit that it helps or they nearly accepted a half of a diopter of cyl. I guess what I am trying to say is that I do think it matters and if you give good instructions during a refraction, you can easily determine when the low cyl is needed and when it isn't. Not to be arogant, but my remakes are essentially non existant so I am only pointing out what works for me.

[QDO1]

its amazing when i send in a patient for a re-check how often 0.25 DC can make a difference

[medicalretina]

I'm a new user to this board, so I'm not sure whether this topic has been discussed before, but ...

Just out of curiosity, how do you all feel about Rx's with +/- .25 cylinder in them?

As an O.D. who does all her own refractions, I always measure the cylinder power and axis for each patient to determine their BCVA. When the time comes to write out the Rx however, sometimes I wonder about prescribing it, especially when it's only .25 and the sphere power is +/- 4 D or greater.

I'm aware that since .25 cylinder power is generally within tolerance for most Rx's, the lab technician may reasonably substitute a spherical lens for the prescribed Rx, and the job will still pass upon final inspection ... and the patient/customer will most likely never know the difference.


I'm also aware that some O.D.'s never prescribe cylinder unless it's .50 D or more, but currently I'm not one of them.

dear amiga,
in my experience, i've learned that a .25 cyl has made a difference for the young healthy eyes when viewing the 20/20 line.
however, now that i am refracting much older patients with poorer quality of vision, the .25 cyl doesn't really make much of a difference if any.

gracias,

gil