Lecture ten

Prescribing for
Refractive errors
Gizachew T.
5/21/2017
 Outline
– Refraction recheck
– Guide lines for prescribing the prescription
– Time for modifying the prescription
– Risk of prescription for elderly patients
– General rules for prescribing spectacles for
different age group
– Advise to the patient
– How to writing the prescription
– Assignment

Gizachew T. 5/21/2017
 Refraction recheck
Before prescribing ask a person:
– Does your D/N vision looks clear with these
lenses?
– Do your eyes feel comfortable with these lenses?
– Do you notice difference b/n these lenses and
your old spectacles?
• demonstrate how the spectacles improve person’s
vision at certain distance but can worse for other
distance

Gizachew T. 5/21/2017
 Cont.….
General health problems can affect vision:
1. Diabetes
2. Pregnancy
3. medications

Gizachew T. 5/21/2017
 Prescribing spectacles
1. What prescription should be given?
2. Does a patient with a small refractive
correction need spectacles or contact
lens?
3. Is a small change in refractive correction
necessary to prescribe?
4. Demonstrate the change to the patient

Gizachew T. 5/21/2017
 Cont.….
The art of prescribing spectacles to a
person depends on :
1. Person’s case history
2. Person’s previous spectacles
3. Person’s sensitivity to visual change
4. Amount of refractive error and symptoms
5. Type of refractive error
6. Spectacles and lenses available

Gizachew T. 5/21/2017
What refractive correction should you prescribe?

• The patients input is the best source of

information when deciding what refractive
correction to prescribe.
• There are conditions where the prescription
may different from the subjective result

Gizachew T. 5/21/2017
Major considerations:
1.Compare against the patient’s spectacle
2.Progressive myopes
3.Hyperopes
4.Latent Hyperopes
5.Heterophoria in younger patients
6.Older patients
7.Presbyopes
8. Cylinder changes
9. Poor adaptors
10. Anisometropia
Gizachew T. 5/21/2017
Should we prescribe a small prescription?

1. If there are no symptoms related to use of the eyes,

first Rx should not be prescribed
2. Consider other ocular causes of symptoms w/c may not
be related to small refractive error
3. If Px has symptoms related to detailed vision tasks
prescribe small Rx.
4. If glasses are helpful, responses during subjective
refraction should be very certain and repeatable
5. The effect of Rx on binocular vision tests can be helpful

Gizachew T. 5/21/2017
 Should we make a small changes to the
Refractive Correction?
• If there are no symptoms, small change to refractive
correction is not necessary unless Px wants a new frame.
• If PX has symptoms w/c are related to detailed vision, it
is more likely to prescribe a small change.
• Even if there is no change in refractive correction, a
patient should always be asked if they want a new pair
of glasses with respect to other parameters.

Gizachew T. 5/21/2017
Prescribing for elderly patients risk of falling
• Not recommended to prescribe multifocal lenses
• multifocal lens wearers single vision lenses
• Avoid prescribing significant changes to the
refractive corrections in older patients

Gizachew T. 5/21/2017
 When to prescribe spectacles
General rules : Any visual improvement
• When a patient is unable to see at specific
distance adequately to perform their
normal activities.
• When patient is suffering asthenopic
symptoms.

Gizachew T. 5/21/2017
 1. Young people (<20 years)
• Hyperopes ( < +1.00) can be managed without
spectacles as they can accommodate to overcome the
refractive error

• +1.00 to +2.50 may need spectacles for close work

• +2.50 to +4.00 will probably need spectacles for close

work and perhaps for distance as well

• >+4.00 Spectacles for all the time wear: Risk of

esotropia
Gizachew T. 5/21/2017
• Do not give full plus prescription found by
retinoscopy for the 1st time
- e.g. Ret +6.00 EE. Initially give +4.00 and
maybe increase later
• Low myopes (<-1.00)
- Consider VA, pupil size, visual demands

• Myopes -1.00 to -2.00

- give full prescription to be worn as required

• Myopes above -2.00

- will probably wear their spectacles all the time.
Gizachew T. 5/21/2017
 2. Adults (20-35 years)
• Hyperopes (<+1.00)
- may require spectacles for close work

• +1.00 to +2.50
- may need spectacles for close work and perhaps
distance as well

• +2.50 to +4.00
- will need spectacles for distance and close work

Gizachew T. 5/21/2017
• Low myopes (<-1.00)
- consider VA, pupil size, visual demands

• Myopes >-1.00 to –2.00

- give full prescription to be worn as required

• Myopes >-2.00
- will wear their spectacles all the time.
• Close work may be more comfortable without
them

Gizachew T. 5/21/2017
 3. Adults (> 35 years)
• Emmetropes will require spectacles for reading

• Hyperopes > +1.00 may need two prescriptions

(distance and near)

• Myopes (-1.00 to –3.00) will require distance

prescription but may manage to read at near
without spectacles

• Myopes (above -3.00) may need two

prescriptions (distance and near)
Gizachew T. 5/21/2017
 When to prescribe for astigmatism
• Low astigmatism (<-1.00DC) Consider VA, pupil size,
visual demands
• Astigmatism (>-1.00DC) will make a significant
difference to distance and near vision
• For high astigmatism, do not give full prescription for
first time wearers.
– e.g. -2.00 / -4.00 x 180
– give –2.50 / -3.00 x 180
i.e. half to two thirds of the cyl
NB. adjust sphere if reduce cyl (-0.25 for -0.50DC)

Gizachew T. 5/21/2017
 Anisometropia
• Caution is required when prescribing for
individuals with high anisometropia

• Patient cannot fuse images of widely differing

sizes

• Prismatic effect varies with direction of gaze

• Unequal weight of lenses

Gizachew T. 5/21/2017
• Often little visual benefit as patient will tend to
suppress one eye

• Myopic Anisometropia use one eye for distance &

myopic eye for near (may not need to correct)

• e.g. RE –0.25 LE -2.75

• RE for distance & LE for near

Gizachew T. 5/21/2017
 Anisometropia
Example:
R +6.00 6/12
L + 2.50 6/6
Prescribe:
R +2.50( Balance)
L +2.50

(Or Contact lens for RE)

Gizachew T. 5/21/2017
 Writing the prescription
The standard format for writing a prescription is to
provide right eye details first followed by left eye:
Sphero Cyl Axis Reading add
RE + 2.50 / -1.00 x 80 Add + 2.00
LE + 1.50 / - 1.00 x 100 Add + 2.00

CD 64 (centration distance – usually PD)

Lens type, material etc - single vision lens, bifocal, plastics

lens etc

Gizachew T. 5/21/2017
 Explanation of eye examination results

When you have finished your eye examination,

you need to tell the patient:
– What you find
– What you can do for them
– Simple explanation of the person’s eye
problem (c/c, cause, treatment, futurity)
– Explanation of the spectacles that you
prescribe ( when to wear, not wear
,reassurance )
– Recall
Gizachew T. 5/21/2017
 Writing a spectacle prescription
Prescription must include :
1. Name of your clinic, hospital, optical shop
2. Date of the eye examination
3. Name of the patient
4. Distance prescription for right and left eye with their
respective signs
5. Reading addition (if needed)
6. PD (distance and near)
7. Type of spectacles recommended
8. Examiner name and signature
9. Prescription expiry date
Gizachew T. 5/21/2017
Any Question???

Gizachew T. 5/21/2017