Welcome to question of the day #377

Eyetools question of the day #377

I work in community eye care practice. I’ve noticed that some of my older patients with eye diseases such as cataract and/or age-related macular degeneration don’t believe me when I tell them that it is their eye condition has reduced their vision and I can’t help them see any better with stronger glasses. Some of them even go to another eye practitioner for a second opinion. Do you have any tips on how to deal with this type of patient?

Many older patients have been attending for an eye examination for many years. They have become used to their vision problems being solved with a new pair of glasses. It is not surprising that some of them find it difficult to believe that new glasses will no longer solve their vision problems.

I was working with a patient who complained of blurred and misty vision. Her quality of life was only slightly impacted in that she could look after herself but TV text and reading was ‘a bit more difficult’ than in the past. There was no change in her glasses prescription and her visual acuity was 6/10 in each eye. She had bilateral cataracts which caused her visual symptoms. Her glasses were in good condition.

When I advised her that her lens power hadn’t changed, that she had the best possible glasses and that it was the cataracts that were causing her vision problems, I could tell that she was surprised.

I’ve had similar experiences with patients who have dry age-related macular degeneration.

I explained to the patient with cataracts that the cataracts blocked some light from going into her eyes, that this was causing her vision problems with TV viewing and reading and that making her glasses stronger would not help her see any better. If she had new glasses she wouldn’t see any better.

When there is no visual improvement and current glasses are in good condition, we shouldn’t be pressurised into prescribing new glasses even if that pressure is coming from the patient themselves when they have an expectation that new glasses will help them see better.

If, under these circumstances, new glasses are recommended what is likely to happen is that when the patient receives them they will not be able to see any better than with the previous glasses and be disappointed. A refund may be necessary and your reputation may be damaged.

If the patient goes to another practice for a second opinion and new glasses are provided it will up to that practitioner to deal with any problems.

As eye care practitioners we want to do the very best for our patients and sometimes this means not recommending new glasses but giving an explanation instead.