A new study from the United Kingdom found that 83% of the time, intolerance to new spectacles was due to poor quality refractions.
The study details.
Data for 279 rechecks were gathered from 10 optometry practices in the United Kingdom, with the mean patient age being 60 years. Patient dissatisfaction was found in 2.3% of eye examinations conducted, which corresponds to more than 0.5 million rechecks per year.
What were the main refracting issues?
"Don't reduce a happy myope."
Overplusing or underminusing accounted for 26% of causes, while underplusing and overminusing accounted for only 11% of causes. Thus, the teaching mantra in subjective refraction of “maximum plus for maximum VA” needs to be more balanced with other prescribing maxims such as “cut the plus,” “don't reduce a happy myope,” and “if it ain't broke don't fix it (much).”
"If it ain't broke, don't fix it."
Patients who reported no problems at the initial examination accounted for more than one third of all rechecks.
Where the recheck prescription was either returned to the habitual finding, or within half the difference of test-habitual prescription, just one patient (4%) subsequently reported being unhappy.
If either maxim, “if it ain't broke, don't fix it,” or “if it ain't broke, don't fix it (much)” had been applied to such patients, one third of all rechecks could have been avoided.
Oblique cylinder.
Changes in either cylinder power or axis accounted for 38% of all prescription-related causes of rechecks, and patients with changes in oblique astigmatism were approximately twice as likely to report problems than those who have with- or against-the-rule astigmatism.