Dispensing: Prescription analysis – Case #3

This case was among a series presented by Miranda Richardson FBDO, Assistant Director of Professional Examinations for the Association of British Dispensing Opticians, for peer discussion at the second Specsavers Dispensing Conference (SDC2) in August 2018.

Case #3

Habitual Rx:

Prescriber’s comments:

• First time PPL

Looking at the above prescription, consider the following discussion points with your dispensing team:

• What lenses would you consider dispensing this patient?
• What problems can you foresee with this prescription?
• How will this affect your lens selection?
• How would you manage the patient’s expectations?

Discussion

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• Work through the appropriate lens types according to hobbies and occupations.
• First time PPL (progressive power lenses) for a myope: how do myopes cope with first time PPLs generally?
• How relevant is the reading Rx in this prescription? The near Rx is virtually plano.
• Will the patient realise the benefit of the PPL design? Consider the following:
  • They can take their spectacles off to read
  • They will have a very wide field of view at near
  • The progressive lens will narrow the near field of view considerably
  • They will probably struggle to adapt to the lens design.
• What will afford the widest possible field of view at near?
• Manage the patient’s expectations and be realistic about the initial impact of a progressive lens:
  • Advise them that they are able to read without their spectacles, so they can remove them for long-term reading
  • The progressives are required for everyday use to avoid the need to remove the spectacles throughout the day
  • Reading without the spectacles will be at a fixed working distance and impractical for technology.

Possible recommendations:

• After having a clear discussion with the patient to manage their expectations, suggest the progressive lens with the widest reading area.
• A longer corridor could be considered to potentially allow for computer use.
• A freeform design could possibly be used to give the best chance of adaptation.
• A distance lens and an occupational could be considered, depending on the Px’s occupation and hobbies.
• Be honest and advise that they can take the spectacles off to read from the very beginning of the dispense. Give reasons for the benefits of PPLs for everyday use but explain that prolonged reading can be done without the spectacles.

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More in the Prescription Analysis series
Case #1 and series introduction
Case #2
Case #3
Case #4
Case #5
Case #6
Case #7
Case #8