Rx. Interpretations and Recommendations

[TheRobotious]

Dear Optiboarders,

I know most of you are incredibly knowledgeable when it comes to recommendations for patients based on Rx as well as troubleshooting a wide variety of problems. I'm currently trying to learn as much as I can to get to a point where I can confidently interpret potential problems based on Rx or patient lifestyle/preferences/needs as well as troubleshoot more confidently. I work casual, usually 1 to 2 days per week, and so I don't get a huge amount of exposure to a variety of Rxs, particularly the more complex ones.

What I'm hoping for is whether anyone would be willing to post a 'mock' Rx with some details about the patient or doctors recommendations as a kind of "what would you recommend?" or "what would you do?" practice exercise. It could be as simple or complex as you want. Alternatively you could make up a troubleshooting scenario that I could try and solve or suggest solutions for. It could be complete fiction or based off of your own experiences. Anything you can come up with would be a huge benefit in terms of applying my knowledge in more 'realistic' scenarios so that I can handle similar situations in the workplace with more confidence.

Getting different opinions and tips on how everyone handles different patients and Rxs would really make a huge difference to my own knowledge, and maybe help out a few others as well?

Thanks everyone!
Daniel

[Robert Martellaro]

Daniel,

Here's one that I run into routinely. Nuclear sclerosis, 1.00 D or so less plus or more minus distance O.U. At first glance, the optician will declare that there will be significant improvement in the distance vision, but at dispense, they complain that you (the dispenser), look blurry, and the distance looks about the same. They may also complain of decreased near vision.

Old Rx
Two years old
+2.25 DS
+2.25 DS add +2.75

New Rx
+1.50 DS
+1.50 DS add+3.25

Vision is compromised due to changes in the media. Slight recovery is possible with a Rx change, typically only few letters, maybe 20/40 to 20/30-2 or 3, for example.

The increase in minus that is needed to improve the distance vision, takes away some built-in intermediate help with the old, overplussed distance Rx. Even reading, when held close, seems worse with the new Rx.

The sudden change in Rx and the change in vision is alarming when compared to the slow, gradual change in Rx over two years. They adapted to the extra plus at near by holding the object fractions of an inch closer every couple months or so, over a two year period, and the extra plus increased the intermediate utility, which was also taken away abruptly by the Rx change.

When presented with this type of Rx change and eye health, inform the client of the above at the time of order, and when possible, show the difference with trial lenses. It's almost always best to fill the prescription with all of the above caveats, primarily to improve the vision when driving and for TV, and to make subsequent Rx changes less dramatic. Exceptions might be for non-active, elderly, maybe short-armed folks, who have comfortable vision with their present eyeglasses (and have a spare pair of the same).

[TheRobotious]

Thanks for taking the time to lay out that example in detail Robert, I can't say I've seen anything like that before.

When you mention that the intermediate utility is reduced with the new Rx, is that due to an abrupt need for greater accomodation at intermediate viewing distances when compared with the old Rx?

[Robert Martellaro]

Thanks for taking the time to lay out that example in detail Robert, I can't say I've seen anything like that before.

When you mention that the intermediate utility is reduced with the new Rx, is that due to an abrupt need for greater accomodation at intermediate viewing distances when compared with the old Rx?

Your welcome. The loss of vision at intermediate is due to the decrease in plus on the distance Rx. It's somewhat of a rob Peter to pay Paul scenario.

[drk]

Cataracts are a doozie.

I simplify it this way:

• 20/20: cataracts don't really count.
• 20/30 (lost one line): cataracts are a problem, but not generally ready for surgery. (This is where you get them with the newfangled Rxs.)
• 20/40 (lost two lines): Don't do anything other than surgery. Don't even change their Rx.

So, I think it's incumbent on that 20/30 insipient cataract group to understand that they are too blurry to be happy, but not blurry enough for surgery. This should last about a year or two at most, and no heroics are going to do a whole lot of good. (I.e. lower the expectations.) Then do what you can for them with new lenses.

Anyone into tinting lenses for incipient cataract patients?

[Tallboy]

Kalichrome yellow are a relief to some cataract patients, but its hit or miss.

Between the fogies and the gun nuts I keep a pot of the stuff hot.

[Barry Santini]

Robert M is the Master!