Optometry Patient Care & Prescription Analysis

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.

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.