Module 20 Section 3

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Module 20:

Section 3:

Instead of dreading the glasses complaint, embrace the challenge.  The more you do, the more you learn.  The more you learn, the better the refractionist you become.

Take care when reading glasses.  If using a manual lensometer, pay attention to the position of the optical centers in order to detect any prism correction. Auto-lensometers do improve accuracy, but know how to use the machine to check for the optical center and the presence of a prism correction.

Do lensometer readings yourself unless you are reasonably sure of the accuracy of the chart entry.

Be sure to read the distance correction of a progressive lens near the top of the lens.  Read the add near the bottom, nasal edge of the lens.

If in doubt about the add power needed, err on the side of a weaker add power.  Think twice about making huge changes in reading power, a +0.50 increase is sufficient in most cases.

Never give a patient a weaker add power than they currently have, unless the patient is complaining of having to hold reading too close.

It is hard to improve on no complaints.  A patient with no complaints regarding the current glasses should not be given a radical change in the glasses correction.

If your office routinely gives a glasses script to every patient who has had a refraction, be sure someone (you, or the doctor) is communicating with the patient about how much change there is in the Rx.  It is a very unhappy patient who just spent $400 on a pair of glasses she didn't need.

Do not make sphere power, cylinder power, or axis changes unless the vision is improved.

Always balance the correction of a patient with 20/20 vision OU.

Advise diabetics that vision can fluctuate with blood sugar level changes.  Advise contact lens wearers that vision with glasses may fluctuate depending upon how long it has been since contact lenses were worn.  Don't refract a patient with a lump in the eyelid (hordeolum, chalazion).

It sometimes helps to do a cyclo-refraction on a patient with very small pupils.  It is advisable to routinely cyclo-refract children under 18 and balance the cyclo-refraction.  Cyclo-refract any hyperope who does not see 20/20 (or struggles) on the manifest refraction, but has no obvious pathology.

Over-refract patients with high powered prescriptions if possible.

Have the patient try the prescription in a trial frame if you have doubts about how it will be tolerated.  Have the patient walk around the office with the trial frames on.

If there has been a large change in the prescription, specify on the prescription what the base curve should be in order to keep the ocular curve the same with the new glasses.  The Clinical Optics Calculator has a calculator that makes this easy to figure.

Listen to what the patient has to say about her visual needs.  Does she use a computer?  How often?  Does she never wear glasses for distance vision?  Does she take her glasses off to read?  Does she need a wide field of view?  You want to guide the patient toward the correct choice in eyeware so the patient does not come back with a pair of glasses that does not solve her particular problems.

Talk to the patient about glasses characteristics that reduce distortion.  Talk to him before he goes to pick out frames.  As you learned in the previous modules, smaller lenses are better, and frames that center the eyes in the lenses reduce distortion.

When writing out a prescription, slow down and write so that it is readable.  Double check the accuracy of what you have written.

Old fashioned retinoscopy is better than any auto-refractor (if you're good at it).  You can "see" the quality of the optics of the eye.  This gives you a heads-up on what to expect the refraction to be like.

If you have doubts about the amount of astigmatism a patient has, use a keratometer to find out what the actual corneal astigmatism is.   This is especially useful if the retinoscopy view is poor.

Do not buy a new auto-refractor that does not have auto-K.  Compare the Ks to the cylinder readings.  This gives you clues to the accuracy of the auto-refraction.  Most of the time they should match up.