Barry, do you compensate adds when you compensate for distance?
Barry, do you compensate adds when you compensate for distance?
I have known a lot of "excellent" refractionists who over correct routinely (especially on young patients) by 1/4 ot 1/2 to allow for the eye being more myoptic in low light. The young ones can easily accomodate for this in bright light.
Chip
Depends on the intended use. For instance, for Wrap driving eyewear, no, unless there's gonna be alot of beachside reading.Originally Posted by drk
Barry
Quote:
Remarks: Filling this prescription constitutes an agreement to make spectacle lenses at the doctor's discretion for a period of ninety days without further charge to the doctor or the patient.
Now back to our regularly scheduled thread. You two, take it outside!;)
- It also depends how much you fog a patient and whether it is under monocular or binocular conditions.
- For instance, if you fog the patient to worse than 20/40, then accommodative spasm to correct for target blur will often defeat the purpose of the fog.
- If the fogging is done in accordance with the Humphriss technique, the fogged eye should only be 1.00D to reduce central fusion but create a peripheral fusion lock. If it is fogged to create vision less than 20'/40 then the peripheral fusion lock will be lost and then accommodative spasm will occur.
add another hi-jacker.Quote:
Remarks: Filling this prescription constitutes an agreement to make spectacle lenses at the doctor's discretion for a period of ninety days without further charge to the doctor or the patient.
Now back to our regularly scheduled thread. You two, er, three, take it outside!;)
It is obvious I have much to learn. For me, who has to deal with so many Rxs presented that, when routinely made as written, fail to satisfy and/or cause asthenopia, I feel it is my mission to learn what I can about refraction, in order to understand the possible *why*s behind the end points I see.
Refraction, done write and with the present tools and procedures, is a skill and an art.
And so is what we committed dispensers do at our professional dispensing tables each day.
I'm a life-long learner. Thank you, Dr.s and others who contribute here, to helping me improve my understanding of the art and subtelty of refraction.
Barry
The problem with fogging by only +1.00 is that the Rx has likely changed by at least +0.50 since the previous exam, and you are only fogging by +0.50.
I use the +1.50 ret lens on the refractor to blur the eye not being refracted. It seems to control accommodation well and does not seem to cause problems. I may be wrong but it has worked for me for the past 13 years.
Also, I tend not to push plus too much for older longsighted people.
ie. With the other eye blurred by +1.50
better +0.50 or +1.00 ? - (Px says +1.00)
then better +0.75 or +1.25 ? (Px says +0.75)
I give +0.75 for the prescription - not +1.00.
Sometimes I may put +0.75 in a trial frame and have them look far away - out of the room, and see if an extra +0.25 improves things - usually it makes it worse.
Can you believe the nerve of these guys?
Sheesh......................I NEVER HI-JACK threads!
;):cheers::cheers::cheers::cheers::D
Hey Fezz,
What kind of beer do you have in your fridge?
Sorry OBX, couldn't help it!
A lack of planning on your part DOES NOT constitute an emergency on mine!
Which fridge?
The one at work, duh!!
A lack of planning on your part DOES NOT constitute an emergency on mine!
Was interested to read everyone's comments about "Dr. Re-do's"
and yet not see anyone address the fact that in many ophthalmology offices the doctors are not doing the refractions...their "technicians" are doing the refractions. I have watched the number of remakes skyrocket because the doc delegates much of the exam to an underpaid and overworked tech. 2 years ago we began to charge $35.OO for RX remakes. This charge amounts to a restocking fee which barely covers the administrative and labor costs of "doctor" remakes. None of our clients has complained, except one who felt that the doctor should pick up the tab for his/her error. Is anyone else out there in optical land tired of giving away his or her expertise???
Give me an opthalmologist that doesn't dispense and I'll eat all his mistakes. For the merchant doctor type, yeah I resent the H*ll out of it.
Chip
I had a lady in today that I made bifocals for not too long ago, but long enough to be out of warranty. She comes in and says: "I gave these a good long trial, but I end up reading with my old glasses."
After I listen for a while the dear lady reads just great but at 14". She says she has always read at arms length or with her reading material on her knees.
Now after a call to the good doctor we are reducing her add (at my expense of course) by .50 dio.
Shouldn't the good doctor ask the patient what they want in a pair of glasses (of course if I were any good I would have checked in advance too) and where they want to see what before prescribing?
I know that 14" to 18" inches is concidered the norm, but some folks ain't normal.
Chip
It's not that easy, Chip. Sure, I know many doctors who "ask" how/where their client reads at. But, even a carefully worded question will often engender a non-qual response.
This is often the case with chronologicals whose new add reaches 2.50 or more.
I like to think of them as my generation's version of "no child left behind."
FWIW
Barry
Virtually all optometric RXs in BC have the "Drs change at no charge" disclaimer on them, despite repeated requests to remove them. Although our policy was to remake the lenses with a Drs change or error anyway, we would take credit for the change. If a client told us we were obligated to change the lenses anyway, because the Optometrist said so, I simply told them that if the optometrist had printed on the rx that I had to hand over the keys to my car, I was not under any obligation to do so. That usually put it into perspective for them.:bbg:
"Chronologicals" is very good!
Chip, I'm going to guess that the add exceeded +2.50.
One thing I've learned is never exceed +2.50 except in cases of reduced acuity, and then with caution (and a TF).
Nope. Add was two fifty. Reduced to 2.00. Two fifty was appearently correct for 14-18". But too strong for 26".
I might mention that this is far from the first time I have had this situation occur in my 50+years career. I just happened to get bitten again, Friday. I have had this occurr both ways, too close and too far.
Chip
Last edited by chip anderson; 07-07-2009 at 04:22 PM. Reason: second paragarph
Agreed. Although there are vocational and hobby indications for exceeding a 2.50, unless you become somewhat adept at calculating prism to aid in convergence, I would rarely use it binocularly.
I choose -2.12. Was that a choice?
I thought you refracted to 0.03D?
Even pseudophakes?
especially pseudophakes! They should have better visual quality than their phakic cohorts and thus should not need higher adds. (unless for some reason they have reduced acuity).
There are two main indications for adds higher than 2.50: Pt needs relative distance mag (ie closer distance) because of reduced acuity that cannot be corrected (think ocular disease of some sort), and those that have an occupational/avocational working distance <16"
Or a high myope that had cataract surgery and was very used to holding things a bit closer than usual. (I have a 2.75 add)
DragonlensmanWV N.A.O.L.
"There is nothing patriotic about hating your government or pretending you can hate your government but love your country."
The one fly in this soup of logic is that often new pseudophakes were, preoperatively, hyperopic. By this I mean that they may have had Rxs of +1.50 DV combined with a +2.50add. If they are older, say > 70, they'll often report back to me after getting their new +2.50 "readers" that their "old" eyewear let's them read better ( this means read the low-contrast obits in the local newspaper).
Refractionists should be aware of this occasional phenomenon. It would be nice if the optician wasn't always the "go-to" person when a patient thinks they have a problem with their vision and their eyewear.
FWIW
Barry
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