Dispensing: Prescription analysis – Case #8

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 #8

Habitual Rx:

Right Left
+1.00 DS Distance +1.00 DS
+6.00 Near +6.00

Prescriber’s comments:

  • Bifocals required
  • VA: RE & LE: 6/60 N24

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

  • How would you describe this patient? Review the VA.
  • What is the possible pathological reason for this prescription?
  • Why is such a high reading addition required?
  • What are the practicalities and potential disadvantages of dispensing this high reading addition?
  • How would you manage the patient’s expectations? Discuss the use of terminology to explain the condition to the patient and how to manage their expectations in terms of what they will actually be able to see.


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  • This is a low-vision patient whose prescription is likely a result of age-related macular degeneration
  • Increasing the reading print size means words will be easier to make out
  • The patient’s expectations of the high reading addition will need to be managed

Possible recommendations:

  • A high addition bifocal may be useful but the patient may not be steady on their feet and may prefer single vision pair. The bifocal line may also cause issues when walking due to the increased effect of the jump.
  • Ensure the patient’s expectations are managed:
    • Advise them of the short working distance
    • Advise them of the reduced field of view
    • Advise them that the vision achieved will not be 100% clear, even with spectacles
    • Discuss optical aids such as magnifiers and stand magnifiers so that the patient can write and does not have to keep their hand steady
    • Advise on non-optical aids such as apps, talking watches, talking books, large-print papers, etc. and low-vision agencies that may be able to provide extra support


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

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