Troubleshoot RX

[Mrmessi]

Hello, just need some help on what you would do:


Patient OLD RX

OD -1.50 -4.25 x004
OS -2.00 -4.75 x180


Patient NEW RX

OD -1.50 -3.75 x005
OS -2.00 -4.00 x180


The patient doesn't see to well from his NEW rx, he is happier with his OLD rx. That being said the axis in both eyes of his new rx is off by 2. The cylinder in his next prescription is lower than his old rx.

Would you correct the axis in the new prescription even though it's only off by 2 or would you give the older prescription?

What is more likely throwing the customer off, a few degrees in the axis or the drop in the cylinder or can it be both?

[Paul Smith LDO]

Was the patient seen at your local? If so, I would trial frame both Rx's (when allowable by State or Providence) I would also trial frame old cyl with new axis, as well as new cyl with old axis. If not, request the patient go back to the refracting party. Of coarse you should always first pursue the usual suspects, lens design, material, IPD, fitting height, BC, etc.

[EyeCare Rich]

Need more information! Were the glasses checked out to spec? I disagree with the statement that the axis is OFF by 2, unless you mean they were made 2 off from the written RX. PD's, OC's, lens material comparison, Lens design comparison, how the frame is fitting comparitively, etc.....

[Mrmessi]

It was done in patient own frame, pd's are the same, lens material and index is also the same, frame is fitting the same as well.

I would assume OC's would be the same as well? Base curve was not taken into consideration but when should it be when there is a high power or wrap in the frame?

It was made 2 off written from the rx.

[Robert Martellaro]

Hello, just need some help on what you would do:


Patient OLD RX

OD -1.50 -4.25 x004
OS -2.00 -4.75 x180


Patient NEW RX

OD -1.50 -3.75 x005
OS -2.00 -4.00 x180


The patient doesn't see to well from his NEW rx, he is happier with his OLD rx. That being said the axis in both eyes of his new rx is off by 2. The cylinder in his next prescription is lower than his old rx.

Would you correct the axis in the new prescription even though it's only off by 2 or would you give the older prescription?

What is more likely throwing the customer off, a few degrees in the axis or the drop in the cylinder or can it be both?

Old sphere equivalent
OD -3.62 D
OS -4.37 D
New sphere equivalent
OD -3.37
OS -4.00

.25 D less minus in the right, and .37 D less in the left. Initially, a young myope might not like it, but should try the Rx for some period of time. Check if they like -.25 over, after adaptation.

The change in cylinder could also cause a similar amount of blur, if incorrect. Two degrees off-axis is equal to about .25 D of power error- try to turn the lens to minimize this error.

Base curve and/or surface design changes can effect the vision off-axis and possibly cause a general sense of unease. Don't assume that the OC position is optimal.

[Happylady]

Are the axises at 178 or 2?

[drk]

Hello, just need some help on what you would do:


Patient OLD RX

OD -1.50 -4.25 x004
OS -2.00 -4.75 x180


Patient NEW RX

OD -1.50 -3.75 x005
OS -2.00 -4.00 x180


The patient doesn't see to well from his NEW rx, he is happier with his OLD rx. That being said the axis in both eyes of his new rx is off by 2. The cylinder in his next prescription is lower than his old rx.

Would you correct the axis in the new prescription even though it's only off by 2 or would you give the older prescription?

What is more likely throwing the customer off, a few degrees in the axis or the drop in the cylinder or can it be both?

Hey! I have an idea. Talk to the doctor. What's so hard about collaborating when the patient fragments their care and there's an adverse outcome? You're ethically obligated to do so.

Would you seriously substitute someone's old Rx for a new one? Where do you find that you have the authority to do that?

If you did that to one of my patients, I'd come over and put a boot up your butt and tell the patient to never go to you again.

[optical24/7]

Hey! I have an idea. Talk to the doctor. What's so hard about collaborating when the patient fragments their care and there's an adverse outcome? You're ethically obligated to do so.

Would you seriously substitute someone's old Rx for a new one? Where do you find that you have the authority to do that?

If you did that to one of my patients, I'd come over and put a boot up your butt and tell the patient to never go to you again.

3 chew-out posts in a row...Stop trying the de-caf and go back to regular coffee!

[Tallboy]

3 chew-out posts in a row...Stop trying the de-caf and go back to regular coffee!

[braheem24]

Would you seriously substitute someone's old Rx for a new one? Where do you find that you have the authority to do that?

If you did that to one of my patients, I'd come over and put a boot up your butt and tell the patient to never go to you again.

Is that after they get the patient smiling by matching the old rx?

Guess what? By then patient no longer cares what you think.

Admit this, If it was your money being wasted on remakes for a 0.5D cyl increase non adapt you would neutralize and give the patient 20/happy too.

Now quit being grouchy.

[Barry Santini]

Luv u too, drk. But...getting back in touch with an OMD re the Rx the wrote is a week long process around these parts. This situation only points up how inadequate the current refraction format is.
What an rxperienced optician needs is the full and complete end points for DV and NV. No discretion. No treatment plan. Too many other layers/factors enter into wearer satisfaction, so i dont need to begin with a fudged starting point.

With all due respect.

B

[drk]

Is that after they get the patient smiling by matching the old rx?

Guess what? By then patient no longer cares what you think.

Admit this, If it was your money being wasted on remakes for a 0.5D cyl increase non adapt you would neutralize and give the patient 20/happy too.

Now quit being grouchy.

I'm a tad less grouchy today.

But what if the whole point of the Rx was to improve vision, based on a complaint the patient had? Just because they get a little wimpy on adaptation is no reason to bail.

Now, granted, if it was just one of those "I want new glasses" things, they had no complaint in the first place, so the Rx is quite superfluous. (Unless they could not see to drive, and you changed them back to illegal.)

[drk]

Luv u too, drk. But...getting back in touch with an OMD re the Rx the wrote is a week long process around these parts. This situation only points up how inadequate the current refraction format is.
What an rxperienced optician needs is the full and complete end points for DV and NV. No discretion. No treatment plan. Too many other layers/factors enter into wearer satisfaction, so i dont need to begin with a fudged starting point.

With all due respect.

B

I know where you're coming from. I understand that ophthalmology doesn't do vision care, and you're trying to do vision care to pick up the slack facing sub-optimal circumstances . I understand you have coordination of care issues.

This is why optometry is supposed to be a better solution for vision problems: we have integration built in. (Now, we may well have many other problems, but integration isn't it.)

But the bottom line is integrated care!

[Jarhead Daddy]

Integration! I am a licensed optician working for a licensed optometrist, and we have a licensed optician running a great lab on site. Communicate, communicate, communicate. The OD probably knows what he/she is doing. Mrmessi, I would bring the OD in on the situation unless they are hostile to your practice.