What are the causes of non‐tolerance to new spectacles and how can they be avoided?

Abstract

To investigate non-tolerance cases from several UK practices to determine their likely causes and how they might have been avoided. Methods:Patient complaint and refraction data were collected from nontolerance recheck examinations. For one practice, clinical data were also collected retrospectively to investigate the quality of the eye examinations.Results: Data for 279 rechecks were gathered from 10 practices and a recheck frequency of 2.3% was found. The mean patient age was 60 (SD 16) years, with cylinder changes responsible for 38% of prescription-related causes of rechecks, overplusing or underminusing 26%, and underplusing or overminusing just 11%.An assessment of 242 recheck corrections found that 40% were unsatisfactory (e.g., failed to address initial or recheck symptoms, N = 45) and retrospective analysis of 217 case records showed many limitations (e.g., 61% or 28% recorded no uncorrected or habitual visual acuity (VA) at either initial examination or recheck).Conclusions: Given that overplus-underminus was a much bigger proportion of prescription-related cases than overminus-underplus (26% vs. 11%), the refrac-

Changes in ocular astigmatism with age: A longitudinal study

“…It is likely that at least some clinicians follow this advice, particularly for small oblique cylinders and hence some patient refractive histories might have yielded more small oblique cylinders had a different clinician performed the refraction. However, in recent years with the increased use of autorefractors, it appears that many clinicians do appear happy to prescribe such cylinders 7 . This is further evidenced in the present study by the number of patients (44/51, 86% of those with variable prescriptions) who had an oblique cylinder prescribed in a variable cylinder history.…”

“…This is further evidenced in the present study by the number of patients (44/51, 86% of those with variable prescriptions) who had an oblique cylinder prescribed in a variable cylinder history. The prescription of oblique cylinders has been particularly implicated in patient complaints with new spectacles, with 23% of all complaints (rechecks) following the dispensing of new spectacles having an oblique cylinder noted as a contributory cause in our recent recheck study 7 …”

“…Small changes in oblique astigmatism have been shown to cause patient problems 7 and so in the short term, the temporary presence of oblique cylinders in many prescriptions could increase the likelihood of patient non‐tolerance compared with more stable oblique astigmatism that the patient has had time to adapt to. Additionally, out of 51 eyes which showed no clear trend and for whom their astigmatism appeared to vary markedly through their history, 44 (86%) had oblique astigmatism at some point, suggesting that clinicians who appeared happy to make big changes to a prescription, perhaps without reconciling their prescription with the patient's habitual prescription and presenting symptoms, were equally happy to prescribe oblique cylinders which might further increase the non‐acceptance rate.…”

“…The prescription of oblique cylinders has been particularly implicated in patient complaints with new spectacles, with 23% of all complaints (rechecks) following the dispensing of new spectacles having an oblique cylinder noted as a contributory cause in our recent recheck study. 7 Some patient histories started with spherical prescriptions for their first one or two recorded prescriptions (N = 25), and consequently it could be argued that these could have changed from WTR in earlier unrecorded prescriptions and so should be added to the 'through SPH' group. However, it is also likely these might have had an earlier OBL cylinder and hence it is impossible to state whether they should be added to the through SPH or OBL groups.…”

“…Where prescriptions pass through the oblique, how transient are these changes? Additionally, as an oblique change in cylinder of just −0.25 DC can potentially cause problems of non‐tolerance, 7 how likely are oblique cylinder changes to be prescribed and for which ages?…”