Dispensing: Prescription analysis – Case #7

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 #7

Habitual Rx:

Prescriber’s comments:

• Px is 5 years old
• Bifocals required

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

• How would you describe this patient?
• Why would bifocals be dispensed for a child?
• What type of bifocals would you dispense? Why?
• Where would you position a child’s bifocal? Why?

Discussion

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• The Px is a myopic child with early onset myopia
• Myopic progression and the use of a reading addition should be discussed with the Px’s parents
• The benefits of round-seg versus D-seg should also be discussed
• Safety should be a consideration in the dispense
• There are different considerations when fitting a bifocal to a child. A child’s bifocal should be fitted between the lower limbus and pupil centre to encourage them to use the reading portion
• Don’t set the bifocals at the pupil centre as they may have difficulties when running around
• It is possible to dispense a PPL to a child; they often adapt better than adults

Possible recommendations:

• D-seg bifocals – either D35 or D45 – to ensure it covers the majority of the lens
• E-line would have been used in the past, but these can be unsightly and bulky
• Recommend a round frame to ensure the child looks through the lenses when looking up at the world
• Consider a plastics frame to help disguise edge thickness

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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