OPT505 Clinical Skills: Prescription Analysis

OPT505 Clinical Skills and Refractive Management: Prescription Analysis

• Course name: OPT505 Clinical Skills and Refractive Management: Prescription Analysis
• Lecturer: Claire Wright
• Institution: University of Plymouth, School of Health Professions

Core Competencies

• Ability to advise on, order, and dispense the most suitable optical correction, considering durability, comfort, cosmetic appearance, age, and lifestyle.

Learning Outcomes

• Analyze a spectacle prescription.
• Link frame and lens knowledge to suit patient needs.
• Describe frame and lens choices for diverse patients.
• Develop a unique dispensing plan for each patient.

Patient Examples

Robert, 55

• Right eye: +2.50 Sph, -0.75 Cyl, 90 Axis, 6/6 VA, +2.00 ADD, N5
• Left eye: +3.50 Sph, -1.00 Cyl, 90 Axis, 6/6 VA, +2.00 ADD, N5

Considerations for Robert:

• Presbyopic patient (around 55 years old).
• Multiple options available (PPLs, bifocals, two pairs single vision lenses).
• C or round segment due to hyperopia, C28 most common.
• Need to ensure sufficient frame space for segment.
• Thickness in the center, so a smaller frame (BC=PDs) minimizes blank size.
• May consider 1.6 index or 1.67, but this will increase reflectance and TCA (Abbe number reduced), which needs to be discussed with the patient.

Anita, 50

• Right eye: -4.50 Sph, -0.75 Cyl, 10 Axis, 6/5 VA, +1.75 ADD, N5, BVD 11mm
• Left eye: -5.00 Sph, -1.00 Cyl, 170 Axis, 6/5 VA, +1.75 ADD, N5

Considerations for Anita:

• Presbyopic patient (around 50 years old).
• Multiple options available (PPLs, bifocals, two pairs single vision lenses).
• C or D segment due to myopia, D28 is most likely, C least visible.
• Need to advise patient about jump if first-time wearer.
• Consider E-style (could reduce the issue).
• Larger range of frames (need to ensure room for the segment).
• Consider thicker edges, or higher index (1.6 or 1.67, but this will increase reflectance and TCA (Abbe number reduced)). This needs discussion with the patient.

Julie, 65

• Right eye: -3.00 Sph, -2.50 Cyl, 135 Axis, 6/6 VA, +2.50 ADD, N5
• Left eye: -4.00 Sph, -2.00 Cyl, 45 Axis, 6/6 VA, +2.50 ADD, N5

Considerations for Julie:

• Presbyopic patient (around 65 years old).
• Multiple options available (PPLs, bifocals, two pairs single vision lenses).
• C or D segment due to myopia, D28 is most likely, C less visible.
• Need to advise about the 'jump' if this is a first-time wearer, consider E style for potential reduction of the problem.
• Consider larger range of frames, sufficient room for segment.
• Consider thickness on the edges, or higher index.
• Recommendation of 1.67 or 1.74 but this will increase the reflectance and TCA, which needs to be discussed with the patient.

Samuel, 65

• Right eye: +1.00 Sph, -2.00 Cyl, 70 Axis, 6/6 VA, +2.25 Inter, -2.00 inter, +3.50 Near (70WD 50-75cm/70WD 20-35cm) N8/N5
• Left eye: +1.50 Sph, -1.50 Cyl, 110 Axis, 6/6 VA, +2.75 Inter, -1.50 inter, +4.00 Near (110WD 50-75cm/110WD 20-35cm) N8/N5

Considerations for Samuel:

• Trifocals/varifocals or combination of bifocals or single vision lenses.
• Verify calculation of add.
• Recommendation of D728 for trifocals - large range of lenses.
• Need to consider the thickness on the frame and edges, for rectangular style frames(to even out thickness) or larger for higher index lenses.
• CR39 suitable frame to maintain minimal edge thickness with higher index.
• Need to ensure mono PD and heights of distance Rx to ensure astigmatism is fully corrected. Should use a stronger frame for steadiness.

Suleman, 15

• Right eye: -10.50 Sph, -0.75 Cyl, 90 Axis, 6/6 VA
• Left eye: -11.00 Sph, -1.00 Cyl, 90 Axis, 6/6 VA

Considerations for Suleman:

• High myopia
• No B/VD
• Thick edges and lenses, minification
• Limited frame and lens choices
• Increase usage of 1.74 aspheric plastic lens for possible reduction in lens heaviness and size.
• Need to discuss minimal edge thickness.
• Need to use smaller frame for minimal decentration, and avoid rectangular frames.

Lucy, 21

• Right eye: +1.50 Sph, -0.75 Cyl, 170 Axis, 6/6 VA, BVD: 11mm
• Left eye: +5.00 Sph, -1.00 Cyl, 180 Axis, 6/6 VA, BVD: 11mm

Considerations for Lucy:

• Aniseikonia
• Larger blank size and/or aspheric lenses in the right eye or isekonnic lens.
• Smallest possible B/VD as per the patient requirements.
• Patient may require adaption time, discuss possible issues.
• Consider differential prism, slab off(base up intro. to least pos. eye).
• Possible usage of contact lenses for alternative solution.

Janice, 45

• Right eye: +4.50 Sph, -0.75 Cyl, 90 Axis, 6/6 VA, +1.00 ADD
• Left eye: +1.75 Sph, -1.00 Cyl, 90 Axis, 6/6 VA, +1.00 ADD
• BVD 11mm

Dispensing OSCE

• The OSCE assesses prescription analysis, frame choice, potential dispensing issues, dispensing knowledge, measurement of bifocal spectacles, and ordering a duplicate copy.
• Part 1: 15 minutes for prescription analysis and dispensing knowledge viva.
• Part 2: 20 minutes for measuring bifocal lenses (focimeter), and recording segment measurements and OCs.

Summary of Considerations (General)

• British Standards for Rx, BVD, no degree signs (BS2738-3: 2004 +A1:2008).
• Hypermetropic, Presbyopic, Anisometropia, Aphakia, Keratoconic.
• Consider tints/coatings, and why. Lens manufacturing processes, benefits/issues associated with lens choices, frame style, material. Measurements and when, advice to patient.

Test your knowledge on analyzing spectacle prescriptions and developing suitable optical corrections for diverse patients. This quiz covers core competencies and patient examples to enhance your dispensing skills. Ideal for students in the OPT505 course at the University of Plymouth.