Optometry Patient Care & Prescription Analysis

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Questions and Answers

What factors should be considered when comparing the final prescription to the habitual one?

The color and style of the existing glasses

Increased cylinder power only

Sphere changes, cylinder axis differences, and changes over time (correct)

The patient’s age and lifestyle changes

Which type of glasses would most likely be recommended for an office worker who is a presbyope?

Single vision glasses

Prism control glasses

Occupational glasses (correct)

Bifocals

During a three-way handover, what role does the dispensing optician (DO) play in the discussion?

To independently determine the final prescription without patient input

To provide only technical details about the glasses

To give a final recommendation without patient involvement

To summarize what is required and engage in a discussion with the patient (correct)

What common change_over_time issues should typically be monitored in a patient’s prescription?

Gradual increases in cylinder and myopic shifts Signup and view all the answers

Which statement best describes 'thinking refraction' during the assessment process?

It refers to evaluating whether the prescription outcome fits with habits and visual acuity. Signup and view all the answers

What is a primary factor to consider when deciding upon a prescription for a patient?

The patient's lifestyle Signup and view all the answers

Which of the following best represents an aspect of effective communication with patients?

Listening to the patient’s concerns about their visual welfare Signup and view all the answers

When considering how to dispense eyewear, which factor is least important?

The frequency of fashion trends in eyewear Signup and view all the answers

Which statement best reflects the concept of patient-centered care?

Concentrating on the individual needs of the patient Signup and view all the answers

What should take priority when recommending eyewear options to a patient?

The patient's specific visual needs and preferences Signup and view all the answers

Which factor does NOT contribute to determining the effectiveness of a prescription?

The status of the patient's insurance Signup and view all the answers

How can a practitioner assess whether to recommend spare pairs of glasses?

By evaluating the patient's daily activities and tasks Signup and view all the answers

What aspect is least relevant when discussing a patient's fears and anxieties about eye examinations?

The medical qualifications of the practitioner Signup and view all the answers

What is the primary focus of person-centred care in clinical decisions?

Guiding decisions based on patients' preferences and values Signup and view all the answers

What should be included in the final summation of an examination?

Relating findings to presenting complaints and offering further advice Signup and view all the answers

When comparing the new prescription to the old one, which response is most appropriate to ensure patient understanding?

Let’s compare my prescription with your old glasses and discuss any changes. Signup and view all the answers

In which scenario would it not be advisable to dispense a new prescription?

The patient expresses satisfaction with their current prescription. Signup and view all the answers

What should be considered when a patient requests a change in prescription despite having a stable condition?

Assess if they are symptomatic or have any concerns affecting their current glasses. Signup and view all the answers

What is an effective way to reassure patients who have received significant changes to their prescription?

Inform them that it will take time to adjust to the new prescription. Signup and view all the answers

What should be considered when deciding to provide a modified prescription for a patient?

A negotiation process between the practitioner and patient is important. Signup and view all the answers

What key aspect should be evaluated when considering new lenses for a patient?

The specific needs and lifestyle of the patient Signup and view all the answers

Under what circumstances might a small prescription change be beneficial?

When the patient has a Type A personality. Signup and view all the answers

In what scenario might it be acceptable to duplicate a patient’s old prescription?

When the patient has stabilized vision and prefers familiarity. Signup and view all the answers

Which of the following is NOT a recommendation when considering a partial correction?

Review in a lengthy time frame. Signup and view all the answers

What is a key factor in deciding whether to prescribe glasses for over contact lenses?

Assessing if the glasses will provide significant improvements. Signup and view all the answers

What does altering the binocular vision status typically involve?

Adjusting only one lens to accommodate specific needs. Signup and view all the answers

What is indicated by the term '12-year-old girl syndrome' in prescribing?

It highlights a common trend in young female patients seeking change. Signup and view all the answers

Which of the following considerations is crucial when dealing with a subjective refraction?

Document the reasons for a small prescription adjustment. Signup and view all the answers

What is a key focus when prescribing for a patient who does a lot of detailed work?

Considering a small prescription change to possibly aid their comfort. Signup and view all the answers

What should be considered if a patient has central scotoma and requires assistance for near tasks?

High near add with BI prism for convergence Signup and view all the answers

What condition may cause differing cortical image size due to unequal spectacle magnification?

Aniseikonia Signup and view all the answers

Why might anisometropia not necessarily require correction in some patients?

Patients may have a good eye that is near-plano and asymptomatic. Signup and view all the answers

Which lens design change can help reduce the difference in spectacle magnification?

Changing the index of refraction Signup and view all the answers

What type of lens may be used to provide better cosmesis while offering less spectacle magnification?

Aspheric lenses Signup and view all the answers

In what circumstance should a patient be reassured about symptoms that do not have an ocular basis?

If headaches are not a result of an eye problem Signup and view all the answers

What is an important consideration when advising a patient on when to wear a new prescription?

To understand visual tasks suited for the prescription Signup and view all the answers

How should the previous lens design be considered in cases of high prescription lenses?

It is essential to maintain similar lens form for better adaptation. Signup and view all the answers

What should be prioritized when prescribing for myopes to avoid over-plussing?

Ensuring maximum accepted plus Signup and view all the answers

In what scenario might a high myope not need near add until much later?

Due to a dropping down nose Signup and view all the answers

Which factor is essential for hyperopic prescriptions regarding comfort and acuity?

Understanding the patient's accommodation Signup and view all the answers

What is an important consideration when dealing with astigmatism in refractive prescriptions?

Binocular methods of refraction can help avoid errors Signup and view all the answers

Why are some asymptomatic hyperopes sometimes left uncorrected?

They may adapt to their condition without issues Signup and view all the answers

What is a common error made when assessing cylinder power in a patient's prescription?

Adding cylinders of 0.50DC to trial frames indiscriminately Signup and view all the answers

Which factor heavily influences the adaptation and explanation process for patients with new prescriptions?

The patient's habitual practices Signup and view all the answers

What should be checked when considering near addition for a patient with a high prescription?

The range compared to previous prescriptions Signup and view all the answers

Study Notes

Prescribing Tips

Learning Outcomes: Understand factors for final prescription, patient recommendations, and effective communication.

Core Competencies

Communication: Effectively communicate with patients, addressing fears and concerns about vision.
Examination and Record Keeping: Perform structured and efficient eye health assessments; maintain comprehensive, legible, and organized records with detailed information and grading.
Interpretation and Response: Appropriately interpret patient records and other relevant data.

Deciding What to Prescribe

Factors: Consider symptoms (visual, asthenopic, functional), patient age, lifestyle, occupation, and legal requirements.
Communication: Listen to patient concerns and evaluate how to improve visual well-being.

Deciding What to Dispense

Visual Improvement: Does the prescription improve visual acuity? Are lenses in poor condition? Will tints/coatings/new lens types help?
Style/Efficiency: Does the prescription fit the patient's style/consider new styles, spare pairs, holidays, special needs, sports wear, or fashion preferences?
Profit: Spare pairs, upgrades, sunglasses, additional pairs, and upselling related products (dry eye, magnifiers, etc).

Prescribing/Dispensing Considerations

Balance: Prescribing should consider best patient interest, clinical decisions, and practical offering/options to generate income.
Patient-Centered Care: Focus care on individual needs, preferences, and values, providing respectful and responsive care.

Asking for Trouble

Refraction Follow-up: At the end of refraction check how patient feels, compare new Rx to old glasses, and ask if there are any other concerns.
Prescription Changes: Communicate the importance of any prescription changes to the patient.

Prescribing/Dispensing Decisions: New Subjective

Prescription Decisions: Factors in prescribing/dispensing new subjective: VA improvement, patient desire for new glasses, including prism, tints/coatings/new lens types, and/or poor lens/frame condition.
Patient Considerations (Not Prescribing/Dispensing): Consideration not to prescribe/dispense: patient happiness with current glasses, no significant change, and/or latent issues (hyperopia, symptomatic issues, or future needs due to other issues).

What to Prescribe

Standard Practice: Generally provide a copy of the final subjective refraction to the patient (negotiation between the practitioner and the patient).
Possible Considerations: Duplicating old Rx, dispensing old Rx in new frame, providing modified Rx based on accommodation/BV status, partial correction, and changes to BAL lenses.
Significant Considerations: Assess if prescription changes are significant, and determine if an over-prescription should be avoided.

Small RX/Small Change

Prioritization: Only prescribe if the RX change will improve vision.
Considerations: Potential benefits of small RX changes include detailed work tasks, sensory sensitivities, and symptomatic relief.
Additional Considerations: Focus on addressing any compensation, potential BV interventions, and careful review within a sensible timeframe.

GOS Rules

Plano Lenses with Tints or Prisms: Not claimable with GOS vouchers.
Small Prescriptions/Changes: Maintain detailed records for reasons/supplements for issuing small prescriptions and monitor for any significant changes.

Considering the Previous RX

Recording/Tracking: Always record the habitual/previous prescription.
Patient Input: Ask the patient if they are satisfied with their current glasses/vision.
Comparison: Compare the final Rx with habitual Rx for changes/differences (e.g., large sphere, differences between R&L, changes in cylinder, ADD, and wearing position changes).
Physically Displaying RX: Physically display/show the new vs. old.

Does It Make Sense?

Outcome Correlation: Review the outcome/results of the refraction to match the eye examination, vision acuity, etc.
Consistency (Symmetrical, Stable, or Gradual): Normal refraction outcomes/results are typically symmetrical (i.e., same value/similar values for right/left eyes) or show stable values/gradual change over time.

3 Way Handover

Optometrist Introduction: The optometrist introduces the patient and the dispensing optician.
Summaries: The optometrist summarizes the necessary information like the evaluation/examination results and related recommendations/decisions.
Discussion with Dispensing Optician: The dispensing optician can now discuss the prescription/handoff items with the patient.

What Sort of Glasses?

Type Categories: Categorizing eyewear types: bifocals, varifocals, occupational, and separate pairs.
Specific Types: Describing each category's considerations (e.g., existing/new wearers, prism control, children, other occupations, existing/new/upgrade status, office workers, presbyopes, specific needs (small DV rx or additional pairs), and so on).

Myopes

Minus Focus: Myopes typically prefer minus lenses; be cautious about overcorrecting with plus.
Testing Considerations: Six-meter testing charts could lead to over-plussing in relation to real-world issues.
Prescription Changes to Watch for: Look for high rx slipping down and reducing the effective minus due to the BVD (trial frame/habitual frame), and shorter uncorrected distances and Add. Also, watch for pocketing issues (NVEE).

Hyperopes

Max Plus Considerations: Only use the highest possible accepted plus prescription.
Critical Considerations: Binocular and refraction should be the focus for considerations.

Astigmatism

Strong Cylinder Considerations: Stronger cylinder power indicates a stronger need for axis emphasis.
Refraction Errors: Review binocular refraction methodologies. Review whether there are any errors in refraction that could be causing the issues.
Subtle Changes: Be aware of potentially subtle changes in cyl value.

Adds

Non-Tols Cause: Large causes for non-tolerance include facial features, habitual practices, and so on.
Pathology: Consider possible pathology with additional checks, evaluation, and diagnoses.
Additional Needs: Evaluate patient needs (additional light, magnifiers, or more light support). Discuss needing more prism for convergence at high near add. Unequal additions with one eye pseudophakic/unequal age group can also occur.

Post-Cataract Prescribing

Timeframes: Review referral timeframes, refractive outcome discussions, post-op evaluations, and actions.
Important Considerations: Ensure appropriate considerations are made for temporary anisotropic changes, expected changes (i.e., for plano, sl myopic, and/or toric IOL), and potentially missing specifications, mag, or additional adds.
Key Considerations: Potential for additional needs at post-op, like reading glasses, will also need to be noted.

Large Rx Changes

Adaptation Considerations: Caution, adaptation, and the impact on reading needs (special magnification).
Potential Concerns: Evaluate if spherac changes are more common or prevalent.
Further Considerations: Evaluate if the large prescription change could indicate pathology.

BAL Lenses and Amblyopes

Diplopia Concerns: This focuses on minimizing diplopia with the selection of BAL lenses.
Initial Considerations: Do not assume amblyopia without proper justification throughout examination notes.
Amblyopic px Considerations: Be cautious with young amblyopic patients who may need a more adjustable lens to avoid peripheral vision issues in the weaker eye.

Anisometropia

Large Differences: Focus on potentially noticeable differences between the two eyes (e.g., greater than 2.00ish).
Unequal Lens Issues: Unequal lens prescriptions can affect visual comfort; provide additional lens support and/or additional testing to address potential problems.
Adaptation Considerations: If asymptomatic or nearly symmetrical/stable, this can sometimes be addressed without intervention.

High Rx

Matching and Selection: Important to match the lens design with previous considerations.
Considerations: Ensure proper frame fitting and BVD issues are noted.
Increase/Decrease: Manage increased/decreased magnification.
Potential Considerations: Note lens base curve, flatten base curve, and/or increase thickness/decrease.

Procedures for Determining Next Steps

Important Considerations: Reassurance if no explanation is found is important.
Further Considerations: Eye disease review/consideration, additional/related considerations (if needed), and the overall recommended steps.
Review: Review the recommended/required steps for proper handling and prescription creation.

Remembering Previous Optometrist

Potential Errors: Consider that the previous optometrist may have missed something important.
Important Follow-Up: Assess and make notes based on possible issues, and address necessary follow-up actions to ensure no critical problems are missed by the practitioner.

Discuss Recall

Timeframes: Patient recall times based on factors like age/childhood wearing status, diabetes, family history, or other factors and potentially other issues.
Additional Considerations: Include patient advice to make earlier appointments/contact based on potential/possible issues.

Considerations for Different Scenarios

Background Learning: Discuss various situations with hypothetical patients to plan for the potential issues.
Learning Resources: Read CET resources to create and discuss potential/possible scenarios to prepare for the practice.

Other Considerations

General considerations: Follow up on any potential considerations/recommendations.

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Description

This quiz explores essential concepts in optometry, focusing on factors influencing eyeglass prescriptions, effective communication with patients, and the importance of patient-centered care. Test your knowledge on the roles and responsibilities during the dispensing process and how to assess patient needs effectively.