What is this refraction technique called?

[Prentice Pro 9000]

I have a friend that is an OD and he told me that for a lot of hyperopes doctors will put a little more plus into the distance in order to make it so that the add power is not so high. I asked him if this is called anything and he said he didn't think so. And So I was wondering if there's a way to ask "is this the pure prescription or the ______ prescription"?

[Kwill212]

Ask him what his remake rate is. I wouldn't want a doc to do that for glasses meant for full distance, green balance is always happier. I've never met anyone who likes to be over-plused, unless they never leave their house.

[drk]

Kwill is almost right. That's an improvement for him. :)

The correct prescribing technique is indeed called "over-plussing". (It used to be called "hyperfocal distance" a thousand years ago...pupils and depth of focus and whatnot but forget I ever said this.)

And he's right: overplussing in glasses is stupid. (Overplussing in contacts is...smart, when you're desperate, because...multifocals ain't awesome.)

And he's right that the red-green balance/ bichrome/ duochrome is the ultimate way to get the final spherical endpoint.

But I take issue with overminusing. No, R = G is the preferred endpoint. (Do you want to underplus a dude like Kwill so he has to tilt his head even further to see his Bud Light can? I didn't think so.)

So Kwill is 3/4, which is very good.

[Prentice Pro 9000]

Kwill is almost right. That's an improvement for him. :)

The correct prescribing technique is indeed called "over-plussing". (It used to be called "hyperfocal distance" a thousand years ago...pupils and depth of focus and whatnot but forget I ever said this.)

And he's right: overplussing in glasses is stupid. (Overplussing in contacts is...smart, when you're desperate, because...multifocals ain't awesome.)

And he's right that the red-green balance/ bichrome/ duochrome is the ultimate way to get the final spherical endpoint.

But I take issue with overminusing. No, R = G is the preferred endpoint. (Do you want to underplus a dude like Kwill so he has to tilt his head even further to see his Bud Light can? I didn't think so.)

So Kwill is 3/4, which is very good.

And so over-plussing the distance is specifically meant to alleviate the add power? If so, what's the thinking behind this (as an optician I understand why keeping an add low is beneficial, but what's the thinking for ODs and MDs?)

[Kwill212]

I didn't say we should over minus people. But most people aren't going to give a "Yes, doc both sides of the red and green look exactly equal. I'll take green over slightly red every time.

[NAICITPO]

But I take issue with overminusing. No, R = G is the preferred endpoint. (Do you want to underplus a dude like Kwill so he has to tilt his head even further to see his Bud Light can? I didn't think so.)

He didn't say anything about over-minusing.

If you have dispensed glasses for any amount of time you can tell when someone's Rx got more plus power in comparison to their old Rx. Watch the customer put the glasses on and not see clearly. Look at their last Rx from 2 years ago and notice the doc bumped it up half a diopter plus. Tell them that doc increased their Rx a bit and it may take a couple days to adjust to, and that they are probably better off trying the Rx the next morning after they have had some time to rest their eyes.

IF they come back in a week, I use flippers over their glasses with -0.25 and -0.50 in them and when they say they can see so much better I ask the doc to pull them back for a quick refraction and get it fixed.

Over plus to keep the add down is a really bad idea.

[Prentice Pro 9000]

He didn't say anything about over-minusing.

If you have dispensed glasses for any amount of time you can tell when someone's Rx got more plus power in comparison to their old Rx. Watch the customer put the glasses on and not see clearly. Look at their last Rx from 2 years ago and notice the doc bumped it up half a diopter plus. Tell them that doc increased their Rx a bit and it may take a couple days to adjust to, and that they are probably better off trying the Rx the next morning after they have had some time to rest their eyes.

IF they come back in a week, I use flippers over their glasses with -0.25 and -0.50 in them and when they say they can see so much better I ask the doc to pull them back for a quick refraction and get it fixed.

Over plus to keep the add down is a really bad idea.

What is the doctor's thinking behind keeping the add down?

[NAICITPO]

What is the doctor's thinking behind keeping the add down?

I would guess they are trying to have less oblique astigmatism peripherally so their patient likes the glasses they make them better. Less add leads to wider fields of vision. But that is probably a better question for Drk.

[Prentice Pro 9000]

I would guess they are trying to have less oblique astigmatism peripherally so their patient likes the glasses they make them better. Less add leads to wider fields of vision. But that is probably a better question for Drk.

yeah waiting for his take

[drk]

I don't know why they're stupid.

"Which is better? 1. Best possible night driving vision and a +2.50 add, or 2. Punctum remotum at 13 feet and a +2.25 add?"

(Hint: the answer is "1".)

[drk]

I didn't say we should over minus people. But most people aren't going to give a "Yes, doc both sides of the red and green look exactly equal. I'll take green over slightly red every time.

You should have taken the win, bro.

I do RG bichrome on all patients with accommodation...most (like...90%) will see equality with the wheels of fortune at a specific 0.25 D position. For those that don't...there's always the dreaded +0.12 lens!

But yeah, I'll give it to you. Technically accommodators would do better with the greenie and non-accommodators would do better with the reddy. (But I don't do RG on anyone 60 and up, anyway, because their lenses are too cloudy to make it work right.)

[Becko]

This sounds like a misunderstanding to me.
"He puts a little more plus".. compared to what?
Many hyperops wear a weaker correction (compared to optimal) until they're 40. When presbyopia happens they suddenly realize they need a lot more for reading than regular people.
When you give them their first PAL, if you're doing it right, you have to give them the max + for distance.
Therefore, compared to their previous glasses, you give them "a little more plus"