Doctor over correcting hyperopes.

[HarryC]

I am running into a rash of both my Optometrists and my Ophthalmologists over plus-ing (if that's even a word) patients.
I would really be interested in hearing opinions as to why this happens frequently and what the doctors are doing to cause the condition
resulting in corrections to the eyewear. When I ask my doctors its never their fault. :-)

[mshimp]

Mostly Ophthalmologist. Works well at 20 feet and closer but not in the real world.

[Kiwideb]

I had a rash of this when a doc changed when he dilated a patient in the course of his exam...

[Jarhead Daddy]

Short exam lane?

[harry888]

Short room.

I moved to a new location with 16 foot room and had three weeks of scripts that were off.

Now I add -0.25

It's harder to figure out unless you dispense.

Harry

[mshimp]

Even when the room is the proper size or corrected by mirrors Most ophthalmologist still over plus.

[gmc]

This is what the doctors are taught. It's called MPMVA. Maximum Plus for Maximum Visual Acuity.

It gives most patients their best vision. However some patients will not tolerate their full plus correction. I often see it with early presbyopes. It is the most frequent reason I see for Dr. Rx changes.

Here's a very good CE course on refraction by our very own Dr. Warren McDonald. Slide 23 specifically addresses MPMVA.

http://www.quantumoptical.com/CoursePage.asp?id=919

[Barry Santini]

Dilated pupils in a darkened exam room yields a corneal sample area that often results in extra plus.

B

[drk]

I second the suggestion that the exam room is too short. I swear a big percentage of ODs think they can get the digital acuity chart and calibrate it for any distance, and that's all there is to it.

Otherwise, I find no other source for overplussing than sloppiness. Any seasoned OD should know that overplussing distance is never going to to any good whatsoever...better to overminus if there is an error to make.

I really, really, really like the RG bichrome test and I do it on every patient that I can. It makes the endpoint very easy for the patient and the doctor.

[Barry Santini]

Otherwise, I find no other source for overplussing than sloppiness. Any seasoned OD should know that overplussing distance is never going to to any good whatsoever...better to overminus if there is an error to make.

I really, really, really like the RG bichrome test and I do it on every patient that I can. It makes the endpoint very easy for the patient and the doctor.

Good points, drk! And these are the underlying reasons why the current technology in "self-refraction" will be for many, fatally flawed.

B

[Paul Smith LDO]

I second the suggestion that the exam room is too short. I swear a big percentage of ODs think they can get the digital acuity chart and calibrate it for any distance, and that's all there is to it.

Otherwise, I find no other source for overplussing than sloppiness. Any seasoned OD should know that overplussing distance is never going to to any good whatsoever...better to overminus if there is an error to make.

I really, really, really like the RG bichrome test and I do it on every patient that I can. It makes the endpoint very easy for the patient and the doctor.

Drk, would not the addition of trial framing patients also assist in the reduction of over correcting.

[Barry Santini]

Drk, would not the addition of trial framing patients also assist in the reduction of over correcting.

Yes. But nothing is 100%.

B

[drk]

Drk, would not the addition of trial framing patients also assist in the reduction of over correcting.

I think it could...you could trial frame and look at a very distant object, like outside a window.

The only thing about trial framing is that it is time consuming to do on everyone. I do use it for special cases, a lot, especially modified prescriptions.