Prescription Analysis CW 2024 PDF

OPT505 Clinical Skills and Refractive Management: Prescription Analysis Claire Wright One Time Code Core Competencies 4.1.1 Ability to advise on, order and to dispense the most suitable form of optical correction taking into account durability, comfort, cosmetic appearanc...

OPT505 Clinical Skills and Refractive Management: Prescription Analysis Claire Wright One Time Code Core Competencies 4.1.1 Ability to advise on, order and to dispense the most suitable form of optical correction taking into account durability, comfort, cosmetic appearance, age and lifestyle. Learning Outcomes Learn how to analyse a spectacle prescription Ability to link frame and lens knowledge together to suit the needs of the patient Describe frame and lens choices for a range of patients Begin to develop a dispensing plan that is unique for each patient  Robert, 55 Right Left Sph Cyl Axis VA Sph Cyl Axis VA +2.50 -0.75 90 6/6 +3.50 -1.00 90 6/6 ADD +2.00 N5 ADD +2.00 N5 Robert Right Left Sph Cyl Axis VA Sph Cyl Axis VA +2.50 -0.75 90 6/6 +3.50 -1.00 90 6/6 ADD +2.00 N5 ADD +2.00 N5 Considerations: Robert Right Left Sph Cyl Axis VA Sph Cyl Axis VA +2.50 -0.75 90 6/6 +3.50 -1.00 90 6/6 ADD +2.00 N5 ADD +2.00 N5 Presbyopic patient, around 55 years old Multiple options including PPL’s, bifocals, two pairs of single vision lenses C or round segment due to hyperopia, C28 most common Would need to warn about jump Large range of frames, need to ensure that there is enough room for segment Thickness will be in the centre so a smaller frame (BC = PDs) will minimise blank size required and keep it thin CR39 suitable or could consider 1.6 – note this will increase reflectance (MAR) and the TCA (Abbe number reduced). Need to discuss these with the px. Anita, 50 Right Left Sph Cyl Axis VA Sph Cyl Axis VA -4.50 -0.75 10 6/5 -5.00 -1.00 170 6/5 ADD +1.75 N5 ADD +1.75 N5 BVD 11mm Anita Right Left Sph Cyl Axis VA Sph Cyl Axis VA -4.50 -0.75 10 6/5 -5.00 -1.00 170 6/5 ADD +1.75 N5 ADD +1.75 N5 BVD 11mm Considerations: Anita Right Left Sph Cyl Axis VA Sph Cyl Axis VA -4.50 -0.75 10 6/5 -5.00 -1.00 170 6/5 ADD +1.75 N5 ADD +1.75 N5 BVD 11mm Presbyopic patient, around 50 years old Multiple options including PPL’s, bifocals, two pairs of single vision lenses C or D segment due to myopia, D28 is most likely C less visible & used in Hi-Index Would need to warn about jump if first time wearer, E style could reduce this if a problem Large range of frames, need to ensure that there is enough room for segment – consider plastic Thickness will be on the edges so look for minimal size frame or increase index Best glazing will be if BCs match PD to maintain minimal edge thickness Recommend1.6 (or 1.67) – but this will increase reflectance and the TCA (Abbe number reduced) –will need to discuss with px Julie, 65 Right Left Sph Cyl Axis VA Sph Cyl Axis VA -3.00 -2.50 135 6/6 -4.00 -2.00 45 6/6 ADD +2.50 N5 ADD +2.50 N5 Julie Right Left Sph Cyl Axis VA Sph Cyl Axis VA -3.00 -2.50 135 6/6 -4.00 -2.00 45 6/6 ADD +2.50 N5 ADD +2.50 N5 Considerations: Julie Right Left Sph Cyl Axis VA Sph Cyl Axis VA -3.00 -2.50 135 6/6 -4.00 -2.00 45 6/6 ADD +2.50 N5 ADD +2.50 N5 Presbyopic patient, around 65 years old Multiple options including PPL’s, bifocals, two pairs of single vision lenses C or D segment due to myopia, D28 is most likely and common but C less visible Would need to warn about jump if first time wearer, E style could reduce this if a problem Large range of frames, need to ensure that there is enough room for segment Thickness will be on the edges so look for minimal size frame or increase index Best glazing will be if BCs match PD to maintain minimal edge thickness Recommend 1.67 or 1.74 – but this will increase reflectance and the TCA (Abbe number will reduce) –will need to discuss with px Will need to ensure that mono PD and heights of distance rx are met to ensure that astigmatism is fully corrected – a more sturdy frame to keep rx steady would be best  Samuel, 65 Right Left Sph Cyl Axis VA Sph Cyl Axis VA Dist +1.00 -2.00 70 6/6 +1.50 -1.50 110 6/6 N8 Inter +2.25 -2.00 70 WD 50-75cm N8 +2.75 -1.50 110 WD 50-75cm N5 Near +3.50 -2.00 70 WD 20-35cm N5 +4.00 -1.50 110 WD 20-35cm Samuel Right Left Sph Cyl Axis VA Sph Cyl Axis VA Dist +1.00 -2.00 70 6/6 +1.50 -1.50 110 6/6 Inter +2.25 -2.00 70 WD 50-75cm N8 +2.75 -1.50 110 WD 50-75cm N8 Near +3.50 -2.00 70 WD 20-35cm N5 +4.00 -1.50 110 WD 20-35cm N5 Considerations: Samuel Right Left Sph Cyl Axis VA Sph Cyl Axis VA Dist +1.00 -2.00 70 6/6 +1.50 -1.50 110 6/6 Inter +2.25 -2.00 70 WD 50-75cm N8 +2.75 -1.50 110 WD 50-75cm N8 Near +3.50 -2.00 70 WD 20-35cm N5 +4.00 -1.50 110 WD 20-35cm N5 Trifocals/varifocals or combination of Bifs or SV are all options Maybe asked to calculate Adds if Rx written out in full as above IP/RP Ratio D728 is most likely choice for trifocals – large ranges of lenses available Large range of frames, need to ensure that there is enough room for segment(s) Thickness will vary – vertically will be thinner edges than horizontally- Rx is moderate so large range of frames will be suitable. Rectangular frames may be best as will even out the edge thickness. CR39 suitable – not too thick and won’t have as many off axis issues as with higher index Will need to ensure that mono PD and heights of distance Rx are met to ensure that astigmatism is fully corrected – a more sturdy frame to keep lenses steady.  Suleman, 15 Discuss the most appropriate dispensing solution for the following prescription: Right Left Sph Cyl Axis VA Sph Cyl Axis VA -10.50 -0.75 90 6/6 -11.00 -1.00 90 6/6 Suleman Discuss the most appropriate dispensing solution for the following prescription (teenager): Right Left Sph Cyl Axis VA Sph Cyl Axis VA -10.50 -0.75 90 6/6 -11.00 -1.00 90 6/6 Considerations: Suleman Discuss the most appropriate dispensing solution for the following prescription (teenager): Right Left Sph Cyl Axis VA Sph Cyl Axis VA -10.50 -0.75 90 6/6 -11.00 -1.00 90 6/6 High myopia No BVD Thick edges, heavy lenses, minification Limited frame and lens choices 1.74 aspheric plastic to make it as light as possible MAR – reflectance will be higher TCA – discuss to see if an issue – small frame with low BVD will minimise Plastic, small frame, regular shaped with similar PD to box centre distance to minimise decentration – rectangle and large frames will look bad  Lucy, 21 Right Left Sph Cyl Axis VA Sph Cyl Axis VA +1.50 -0.75 170 6/6 +5.00 -1.00 180 6/6 BVD: 11mm Lucy Right Left Sph Cyl Axis VA Sph Cyl Axis VA +1.50 -0.75 170 6/6 +5.00 -1.00 180 6/6 BVD: 11mm Considerations: Lucy Right Left Sph Cyl Axis VA Sph Cyl Axis VA +1.50 -0.75 170 6/6 +5.00 -1.00 180 6/6 BVD: 11mm Anisometropia Aniseikonia Larger blank size RE or Aspheric lenses, Hi-Index in Left lens or Isekonic lens Smallest BVD possible Discuss with patient potential adaption issues Differential prism: - Slab off (base up introduced to the least positive eye) - Separate pairs of spex with different OC’s (distance and near OC’s) - Contact lenses Janice, 45 Right Left Sph Cyl Axis VA Sph Cyl Axis VA +4.50 -0.75 90 6/6 +1.75 -1.00 90 6/6 ADD +1.00 ADD +1.00 Janice Right Left Sph Cyl Axis VA Sph Cyl Axis VA +4.50 -0.75 90 6/6 +1.75 -1.00 90 6/6 ADD +1.00 BVD 11mm ADD +1.00 Considerations: Janice Right Left Sph Cyl Axis VA Sph Cyl Axis VA +4.50 -0.75 90 6/6 +1.75 -1.00 90 6/6 ADD +1.00 BVD 11mm ADD +1.00 Anisometropia Aniseikonia Px aged 45 years Differential Prisms – vertical, near problem – off axis viewing – esp reading Optical Solutions include- drop slab off/ diff seg sizes/ franklin bifocals – other prism controlled bifs (for differential prism) Anisometropia – apheric lenses to reduce magnification difference. Bigger blank for LE, smaller blank for RE – again to balance magnification. Cosmetic solutions: Aspheric/ high index RE, larger blank LE, reduce BVD Summary - Things to Consider: Rx to British Standards – BVD, no degree signs? BS 2738-3: 2004 +A1:2008 Prescription Type – Hypermetrope, Presbyope? Indications- Anisometropia, Aphakia, Keratoconic Tints/Coatings – Recommended & Why? Manufacturing process Lens Choices – Benefits/Issues? Frame Choices – Style, Material Measurements – What would you take and when Advice to Px? Dispensing OSCE This OSCE assesses three things: 1. Prescription analysis: identifying the type of prescription, suitable frame and lens choices, and any issues that may occur if it was dispensed. 2. A general knowledge dispensing question on the theory you have been taught. 3. Your ability to measure a pair of bifocal spectacles and write an order for a duplicate copy. Part 1: You will have 15 minutes to complete the following tasks: Analyse a written prescription Answer ONE dispensing knowledge viva question. Part 2: You will have 20 minutes to complete the following tasks: Focimeter both lenses of a pair of bifocal spectacles Include segment measurements and OCs.