Welcome to question of the day #209

Eyetool question of the day #209

My manager at work who is also an eye specialist asked me why I didn’t make a note of the patient’s current spectacle prescription and visual acuities with the current glasses in the clinical records. I know I was taught that at university but it slows me down and I don’t see the point of it. My manager told me I had to include this information but didn’t elaborate on why. What should I do?

I’m with your manager on this.

A record of the current spectacle prescription forms part of each patient’s ocular history. It is important to have information on the current prescription.

If the patient is new to the practice and they have their current glasses with them, then focimeter the current glasses and enter the prescription into the clinical records you are completing for that patient for your examination. This might mean focimetering a distance pair, or a distance and near pair of bifocals or varifocals. Whatever the person has brought with them take a focimetry reading or get a trusted member of staff to do it for you. Note the measurements and type of lens in the clinical records. If the patient has not brought any glasses with them then note this in the clinical records. If they have been examined in the practice before and have had glasses note the previous prescription in the new clinical record. If you use a computer system bring the previous prescription forward to your clinical record.

When the refraction element of your eye examination is complete the practitioner can compare the new prescription to the current prescription to see if the prescription has changed and if so by how much. The nature of the change is used by the practitioner (along with the condition of the current lenses and frames and the patient’s wishes) to determine whether or not to recommend new spectacles.

Where I work many patients receive a contribution from the State towards the cost of their glasses. For some patients, the State will pay the total cost. The State audits these prescriptions and will query whether there is any visual benefit from small prescription changes. Practitioners who regularly prescribe small prescription changes that are unlikely to provide any visual benefit risk losing their license to practice.

Knowing the previous prescription and prescribing only when there is a visual benefit will help prevent any audit problems. Without a record of the current spectacle prescription, it is not possible to compare the new prescription to the current prescription. Without this comparison, a patient may be prescribed and supplied with unnecessary new spectacles. When practitioners prescribe clinically unnecessary spectacles negative word of mouth will spread between patients and prospective patients. Negative word of mouth can kill a practice.

The comparison between the new and current prescription is used in conjunction with a comparison of the visual acuities with the current spectacles and the visual acuities with the new prescription.

A record of the visual acuity with the current spectacles also forms part of each patient’s ocular history.

It is important to have visual acuity values for each eye with the current prescription. These values can assist in the corroboration of any symptoms the patient may have and can help in the management of those symptoms. An improvement in visual acuity in one or both eyes with the new prescription can guide the practitioner as to whether there would be any visual benefit in prescribing and supplying new spectacles. Without knowing the visual acuity of each eye with the current spectacles, it is impossible to determine if the patient sees any better with the new prescription compared to the old.

You may be saving a little time at each examination by not noting the current prescription and visual acuities in the clinical records but you are not conducting the examination the patient deserves and you are risking the success of the business.