14 Rx Check

What follows is an approach for Rx checks.  It is by no means complete, and is intended only to provide a framework which you can alter to suit the particular task at hand.

1. History, history, history!
   • For each pair of glasses involved (I’ve had patients bring bags filled with 7 pair of glasses before), determine what the patient thinks about that pair.  Is vision good in the distance?  Up close?  Document what they tell you.
   • How much time have they spent wearing new glasses; i.e., have they adapted?
2. Verify all involved glasses, measuring base curves when necessary.  Changes in base curve can result in adaptation problems for the patient, even when the prescription is accurate (i.e., exactly as written) and acuities are good.

Measure distance and near acuities (DVA, NVA) for each pair of glasses as appropriate.

1. Perform refraction – with acuities – to guarantee that previous results are correct.  Include this as the last line of the table below.
2. Fit – do the glasses fit as they should?  Do eyeglass PDs align with the patient’s PDs?  Are PALs appropriately centered?  Are bifocals of appropriate height?
3. Perform trial frame as appropriate.  Remember, trial frame is not a refraction.  You should have refractive choices nailed down to 2-3; present each to the patient to see which they prefer.

The table below encapsulates the ideas above, and provides a a solid framework that allows you to solve the patient’s refractive issue…