Prescribing Considerations And Case Studies Flashcards
The process of prescribing is not only measurement, but
Problem solving
Goal is to prescribe a treatment
That satisfies the individual patients visual needs
Pilot vs athlete, know what they do on a day to day basis
What are some things you should do before you write a spectacle prescription
- show patient what you plan to give
- if patient is currently wearing glasses, ask them to compare what has just been measured to their glasses-the measurement in the phoropter versus their glasses
Factors to consider when changing a prescription
- does pt report difficulty functioning with their present glasses
- magnitude and type of measured change
- do they want new glasses bc of scratches or to get new frame?
- how long the patient has been wearing the present glasses
- cost
Importance of trial run
Put the contemplated prescription in a trial frame and have the patient take a short walk before writing the prescription. Walking with the Rx is more likely to identify a problem.
When should a trial run be done?
- large change in sphere
- change in cylinder power or axis
- first pair of glasses
- cyl is being prescribed for the first time
- amount of change cant be determined bc they forgot glasses
- any other concern about the new Rx
What are a couple myths about getting used to eye glasses?
- you should wear the glasses all the time, if you don’t, you are straining your eyes
- don’t start wearing glasses because your eyes will become weak and dependent upon them
Neither are correct
What do you always want to work towards when RXing optical correction
Work towards full correction, however the final choice must be tempered by the clinicians expectations and the patients tolerance
General RXing cautions
- avoid increasing subjective symptoms
- avoid large optical changes
- avoid poorly designed lenses and frames
- avoid ineffective communication
What is the goal when Rxing for patients?
Single, clear, comfortable, binocular vision and to reduce accommodative demand
When RXing each patient should be considered in terms of
- age
- degree of symptoms
- VA
- bino function
- efficiency during the performance of visual tasks
- presence of astig or anisometropia
- previous specs
A 37 y/o with a single vision hyperopic correction in their glasses is seeing well at distance, but is having difficulty reading
Weren’t corrected enough. Using accommodation too much. Do cyclo to see how much latent hyperopia is there
A 50 y/o who is successfully using OTC reading glasses is now beginning to have trouble with distance vision. Why, and what might you recommend
Uncorrected hyperope. Was using accommodation, but cant overcome now, turned into absolute hyperope. Bifocals needed
A 6y/o patient is examined and found to have a refractive error of +1.25 in each eye. Should glasses be given?
Make sure no ablyopia or strabismus, otherwise no RX, just monitor. Will be emmetropizing
37 y/o myope seeing well at distance with their glasses is having trouble reading
Overminused, educate them about taking minus away from them
55 y/o high myope presents for routine exam. You determine that they do not need a change in glasses and that their eyes are in excellent health. When discussing those results, what she’s should you tell them?
Back up specs.
New frames
Tell them about signs/symptoms of RD
30 y/o patient who has never worn glasses is examined and found to have a small amount of myopia. The patient says they do not feel they need distance glasses. Should you RX them?
Let them try a trial frame and make decision. Educate and document
35 y/o wearing glasses for myopia is examined and you measure a very slight increase in their myopic correction. Should you make it?
Do trial and let them decide
Educate and document
55 y/o patient for whom you perform a meticulous refraction two weeks ago, calls on the phone and says, ‘the new glasses you gave me ar not good. I cant see well with them.” What should you do?
Show them difference of RX
Make sure they are made correctly
Check Rx, PD, BC
Recheck refraction if the rest is correct
