Now consider the following two cases.

Case study 1

Mrs. FM (52 years of age) attended for a routine eye examination. She mentioned that both her distance and reading acuity were not as good as they used to be with her spectacles (which were approx. 2 years old). In particular, her eyes became more tired and strained when reading towards the end of the day. She wore bifocals and had no other concerns. Her general and ocular health were good. She was working full-time as a grocery store assistant (cash till mainly), and was a non-driver. She also enjoyed reading and social networking on her tablet.

New Rx

RE +1.75 / -0.50 x 80 (6/5) Add +2.00 (N5) DOC’s: R33, L32

LE +1.75 / -0.75 x 95 (6/5) Add +2.00 (N5) NOC’s: R31, L30


Previous Rx

RE +1.50 / -0.50 x 85 (6/7.5) Add +1.50 (N6) DOC’s: R32, L32

LE +1.25 / -0.50 x 95 (6/9) Add +1.50 (N6) NOC’s: R30, L30

Dispensing details

Following the eye examination, she was dispensed with the following to the new Rx:

Bifocal type: D25 (as before)

Bifocal heights: R-4 & L-4 (below HCL)

Bifocal inset: R2 & L2

Lens material: Plastic

Lens coatings: HMAR

Frame material & style: Metal, full rim

Frame size: 51[]19, side length 135

Blank size: 65 R&L

Comments

After collecting her new bifocals, she returned to the practice the following week complaining of ‘eyestrain and headache’ when reading with the new spectacles. She reported that the symptoms were less severe when reading at home, and that reading her tablet was much easier with the new spectacles. She had no visual complaints regarding the distance vision with the new bifocals.

Case Study 2

Mrs. CP (51 years of age) attended for a routine eye examination with no visual complaints. However, her spectacle frame was in poor condition and she was interested in choosing a more modern frame design as well as a second pair for work purposes. She was working full-time as an Insurance Agent, mainly in the field, and was also a car driver.

Rx from Eye Examination

RE +5.75/-1.25 x 80 (6/6) Add +1.75 R&L (N5)

LE +5.00/-0.50 x 110 (6/6) (BVD = 12mm)

No change from previous Rx

Comments

She was dispensed with two pairs of progressive power lenses which were the same design as she had been wearing previously. Shortly after collection the patient returned complaining of ‘reduced DV and distortion’ with pair 2. She had no complaints regarding pair 1. On re-checking, both pairs of spectacles were found to be identical. In addition, the refraction was checked twice over a period of time and ‘no change was found’.

The dispensing optician advised that nothing could be found to explain the symptoms with the new spectacles and that a new order would be sent for replacement lenses in case there were any optical lens flaws that could not be confirmed. At this point the patient asked if she could select a different frame as new lenses were being ordered!

Now consider the following two cases.

Case study 1

Mrs. FM (52 years of age) attended for a routine eye examination. She mentioned that both her distance and reading acuity were not as good as they used to be with her spectacles (which were approx. 2 years old). In particular, her eyes became more tired and strained when reading towards the end of the day. She wore bifocals and had no other concerns. Her general and ocular health were good. She was working full-time as a grocery store assistant (cash till mainly), and was a non-driver. She also enjoyed reading and social networking on her tablet.

New Rx

RE +1.75 / -0.50 x 80 (6/5) Add +2.00 (N5) DOC’s: R33, L32

LE +1.75 / -0.75 x 95 (6/5) Add +2.00 (N5) NOC’s: R31, L30


Previous Rx

RE +1.50 / -0.50 x 85 (6/7.5) Add +1.50 (N6) DOC’s: R32, L32

LE +1.25 / -0.50 x 95 (6/9) Add +1.50 (N6) NOC’s: R30, L30

Dispensing details

Following the eye examination, she was dispensed with the following to the new Rx:

Bifocal type: D25 (as before)

Bifocal heights: R-4 & L-4 (below HCL)

Bifocal inset: R2 & L2

Lens material: Plastic

Lens coatings: HMAR

Frame material & style: Metal, full rim

Frame size: 51[]19, side length 135

Blank size: 65 R&L

Comments

After collecting her new bifocals, she returned to the practice the following week complaining of ‘eyestrain and headache’ when reading with the new spectacles. She reported that the symptoms were less severe when reading at home, and that reading her tablet was much easier with the new spectacles. She had no visual complaints regarding the distance vision with the new bifocals.

Case Study 2

Mrs. CP (51 years of age) attended for a routine eye examination with no visual complaints. However, her spectacle frame was in poor condition and she was interested in choosing a more modern frame design as well as a second pair for work purposes. She was working full-time as an Insurance Agent, mainly in the field, and was also a car driver.

Rx from Eye Examination

RE +5.75/-1.25 x 80 (6/6) Add +1.75 R&L (N5)

LE +5.00/-0.50 x 110 (6/6) (BVD = 12mm)

No change from previous Rx

Comments

She was dispensed with two pairs of progressive power lenses which were the same design as she had been wearing previously. Shortly after collection the patient returned complaining of ‘reduced DV and distortion’ with pair 2. She had no complaints regarding pair 1. On re-checking, both pairs of spectacles were found to be identical. In addition, the refraction was checked twice over a period of time and ‘no change was found’.

The dispensing optician advised that nothing could be found to explain the symptoms with the new spectacles and that a new order would be sent for replacement lenses in case there were any optical lens flaws that could not be confirmed. At this point the patient asked if she could select a different frame as new lenses were being ordered!

Instructions

To gain your CET point you are required to discuss the cases with another GOC registered practitioner and, for each, decide the following:

  • What do you feel is the main cause for the non-tolerance?
  • How could you have avoided this situation arising?

Either have this screen available or print off these case studies to use in your discussion. Please take notes on completion of your discussion of the main points you decided with your colleague.

Remember, your interaction should last for at least 10 minutes (and completion of the submission will be taken as your statement that this is true) and you will be required to submit the outcome of your discussion along with the name and GOC number of the person with whom you have interacted.