Rx Red Flags

[drk]

Wes: does experiment with n=300 this morning, analyzes results and posts.
Me: irons shirt, spills coffee.

[Wes]

Wes: does experiment with n=300 this morning, analyzes results and posts.
Me: irons shirt, spills coffee.

Did you spill it on the freshly ironed shirt?

[icmor]

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.

Hey! That wasn't me! That was our contact lens specialist! (That was an inside joke, but you can see it on youtube under "Dana Hill office prank: Harlem shake".)

[Robert Martellaro]

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.

It was 1974, Union Eye Care, Muncie In., while picking the brain of the on-site age 60 optometrist. He said "have you noticed how the axes commonly add up to about 180 degrees? I didn't think he was a genius, but he did like to chase skirt, especially one of my coworkers, which caused plenty of trouble for everyone. It was my job to keep the peace, and I failed miserably. Unfortunately, she got the worst of it. It was not the best of times.

[sharpstick777]

Certain hairstyles and heavy eyeliner are major red flags!

Your pool of dating candidates is a different discussion from potential RX problems.

[IhaveSpecialEyes]

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.

Actually there are good reasons for Yoked prisms. We see a large number of TBI patients along with Vision Therapy Patients. Yoked prism may be the only thing that get's a patients quality of life back.

[sharpstick777]

Sadly, I worked in a couple of MD practices where the scripts were so bad, that I went through the entire exam for every patient to compare the subjective, objective and auto refractions with the final RX, all with the previous RX. The techs hated me, but we had a Drs RX change of over 30%, which was attrocious. We did manage to cut that in half but with a lot of grief.

But I had one pt, 8D prism in the new RX, ZERO prism last year. Auto refraction was +2.25 sphere, written RX was -2.25. Previous pair read +1.75 sphere. In all she had 6 refraction in 2 years and only 2 of them were consistant. The other 4 were all over the map.

The trouble with many big and busy MD practices is the speed at which they have to work. We had one MD who saw over 100 pts a day! Some techs can do a decent refraction, some can't, but NO one can do a decent refration in 30 seconds. The second problem is accountability, the Techs never had to deal with the redo or the unhappy pt., when we had a bad RX no one went back to the tech to complain, they came to the Optician.

So if you have a good tech team, just fill the RX as written, if you office is crushed and the techs don't care, start with the chart. If there is a discrepency, I would walk the pt back, explain the lead tech that the refractions were all over the map, and asked her to re-refract herself. She got annoyed, but over time, she began checking the charts and we ended up with better refractions.

As well, I am a firm believer that any pt with first time prism should be trial framed before filling that RX.

[gmc]

Actually there are good reasons for Yoked prisms. We see a large number of TBI patients along with Vision Therapy Patients. Yoked prism may be the only thing that get's a patients quality of life back.

Of course there are good reasons for yoked prism. It still doesn't hurt to ask if it is correct or if it is a transcription error. Takes just a minute to ask and can prevent an upset patient, delays and costly remakes.

[Wes]

Of course there are good reasons for yoked prism. It still doesn't hurt to ask if it is correct or if it is a transcription error. Takes just a minute to ask and can prevent an upset patient, delays and costly remakes.

Agreed. In my experience, prescribed prism for fusion is much more common than yoked prison for vision therapy.

[optilady1]

Sadly, I worked in a couple of MD practices where the scripts were so bad, that I went through the entire exam for every patient to compare the subjective, objective and auto refractions with the final RX, all with the previous RX. The techs hated me, but we had a Drs RX change of over 30%, which was attrocious. We did manage to cut that in half but with a lot of grief.

But I had one pt, 8D prism in the new RX, ZERO prism last year. Auto refraction was +2.25 sphere, written RX was -2.25. Previous pair read +1.75 sphere. In all she had 6 refraction in 2 years and only 2 of them were consistant. The other 4 were all over the map.

The trouble with many big and busy MD practices is the speed at which they have to work. We had one MD who saw over 100 pts a day! Some techs can do a decent refraction, some can't, but NO one can do a decent refration in 30 seconds. The second problem is accountability, the Techs never had to deal with the redo or the unhappy pt., when we had a bad RX no one went back to the tech to complain, they came to the Optician.

So if you have a good tech team, just fill the RX as written, if you office is crushed and the techs don't care, start with the chart. If there is a discrepency, I would walk the pt back, explain the lead tech that the refractions were all over the map, and asked her to re-refract herself. She got annoyed, but over time, she began checking the charts and we ended up with better refractions.

As well, I am a firm believer that any pt with first time prism should be trial framed before filling that RX.

This. This. This. This. This.

I lived this for the last 3 years. It was extremely frustrating. It got to the point where you have no confidence in any rx you're filling.

The only positive is that I got really good a problem solving.

[Uncle Fester]

Agreed. In my experience, prescribed prism for fusion is much more common than yoked prison for vision therapy.

You will need an OD near you who practice's VT and doesn't have a dispensary. It's an emerging field of practice.

[IhaveSpecialEyes]

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

So if I am a 180/179 axis was my egg defective?

[tdj]

SpecialEyes, think of it this way -- you could also say your axes are 0 and 179.

[sharpstick777]

I know your pain, and your gain. Yea, I did get really good a problem solving too.... after solving 20 problems a day.

This. This. This. This. This.
I lived this for the last 3 years. It was extremely frustrating. It got to the point where you have no confidence in any rx you're filling.
The only positive is that I got really good a problem solving.

[becc971]

Certain hairstyles and heavy eyeliner are major red flags!

how about the "duck butt" hair cut? or if girls are taking duck face pictures while trying the glasses on in the store?

[kat]

When the Rx isn't filled out completely. If the Pt only had Cat Sx in OD, please write Rx out for OU and leave the option of a complete pair of lenses or pairs of glasses to the patient. It will save staff time in the long run.

[harry888]

Surprised no-one brought this up already....but high adds.

Retinal specialist will give the mac degen patient a +3.50 add and tell the patient the extra mag will help. It doesn't help, and the dispenser is the bad guy.

Local big box store optical won't do adds over 3.00 Smart.


Harry

[IhaveSpecialEyes]

SpecialEyes, think of it this way -- you could also say your axes are 0 and 179.

+1

[manoj_verma]

We do have A damm Famous Ophthomologist in here in Dubai,Who never forget to mention on his Rx's ''Pls Follow the IPD'' and do mention IPD himself.
No Problem in this ,we do most of the time but When he do this with Prescriptions of -0.50 DC @ 180 ,even -0.25 DC @ 180.
If the Patient complains with Prescription........He Simply send them back to us asking ''Please Recheck The IPD and Redo The Glasses''