Welcome to question of the day #397

Eyetool question of the day #397

I work in a community eye care practice and see a lot of older people with cataracts and age-related macular degeneration. One of my patients has right eye 6/12 and left 6/18 from cataracts. When I was conducting subjective refraction I asked: ‘Are the letters just as good with this lens’ as I added an extra +0.25 DS. The patient said to me ‘Why are you asking me if the lens makes them just as good? The letters aren’t good with any lens. I have cataracts.’ Do you have any tips on how to ask about letter appearance with different lenses?

I think that 90% of being an eye care practitioner involves communication and 10% is testing and treatment. Good communication will usually lead to a good eye examination. Poor communication nearly always leads to a poor (in some way) eye examination.

I think a lot about what I say to patients and how I say it. I don’t want any misunderstandings and I don’t want an anxious/upset patient.

Using good words during subjective refraction will help you get the optimum prescription for each patient.

I suggest when you are asking about letter appearance during subjective refraction consider the following phrases.

When refining the prescription with a +0.25 DS lens: ‘Do the letters look just the same with this extra lens?’

 In my experience if the letters are the same people will say they look the same with the lens. If it is a plus lens you probably want to add it to the prescription and repeat the step. If it is a minus lens you might not want to add it to the prescription.

If the lens makes the letter look worse people will notice this and tell you they look worse. You can then not add the lens to the prescription.

If the lens makes the letters look better then you can add the +0.25 DS to the prescription. Same if you are refining using a -0.25 DS lens. Then repeat the step.

Using a phrase like “Do the letters look just the same…?’ is neutral and probably won’t upset anyone.

Another phrase to avoid is when a patient is leaving with their newly purchased glasses:

‘Don’t hesitate to come back if you have any problems.’

The patient leaves your practice on a negative note and may be thinking “What problems might I have with these glasses? Are they expecting me to have problems? Why would I have problems? Is there something wrong with these glasses? Is there something wrong with my eyes?’

The patient may then actively search for a problem and return when they think they have found one.

It’s much better to say:

Thanks very much. See you when it’s time for your next eye test. All the best. Bye-bye.’

Good communication is the foundation for all successful practices.