Tips on Reducing Re-Makes

[drbizzaro]

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To all the doctors out there who are owners/partners/etc, where re-makes can reduce profit, what are some tips that you have figured out over the years?

Some dr's insist on matching b.c., lens material, and PD. Others do not.

One of my colleages also reduces the cyl down to a comfortable level to ensure that the patient does not return their glasses (even if they cannot see as clearly) (ie. 20/20 with -1.25 cyl, vs 20/30 with -0.50 cyl but higher comfort level)

 

[qwopty99]

You might want to look this up in the literature.

 

[qwopty99]

duplicate post.

 

[qwopty99]

anyone wanna share any rules-of-thumb?

 

[qwopty99]

One of my colleages also reduces the cyl down to a comfortable level to ensure that the patient does not return their glasses (even if they cannot see as clearly) (ie. 20/20 with -1.25 cyl, vs 20/30 with -0.50 cyl but higher comfort level)

I do the same, but I would not cut it down so much. If the patient was wearing -0.50 in his last pair of glasses, and refracted to -1.25, I'd give him -1.00.

If he wore spherical lenses before, but I was sure he had -1.25 DC, I'd give him -0.75, and tell him that he might find his glasses a bit strong the first few days (first time needing to adapt to cyl).

If he had either -0.75, -1.00 or -1.25 in his old specs, I'd give him the full -1.25, with the counseling (for the -0.75) that he might find his new Rx a bit strong the first few days.

 

[KHE]

To all the doctors out there who are owners/partners/etc, where re-makes can reduce profit, what are some tips that you have figured out over the years?

Some dr's insist on matching b.c., lens material, and PD. Others do not.

One of my colleages also reduces the cyl down to a comfortable level to ensure that the patient does not return their glasses (even if they cannot see as clearly) (ie. 20/20 with -1.25 cyl, vs 20/30 with -0.50 cyl but higher comfort level)

"Cutting cyl" is, at least in my experience a dangerous practice in most cases. The age of the patient needs to be considered carefully as well as what the person is going to be using the glasses for but you are much more likely to have someone return complaining that one eye sees better than the other than you are to have someone come and complain about "leaf room effect." The first thing that any person who gets new glasses does is immediate looks accross the room. The second thing they do is start covering one eye and going back and forth. This is why I rarely cut cyl. Education that the glasses might "seem weird" for a few days has always gotten me further than trying to explain why I have to make one eye see worse than the other for the next 1 to 2 years.

I also disagree with the other poster who suggested avoiding oblique cylinders. I have not had problems with that AS LONG AS both eyes have the same level of obliqueness. Axis 100 and axis 80 is fine. Axis 100 and Axis 45 is usually not.

Overprescribing add is a common problem, especially in this day and age of heavy computer use. When it doubt, shoot low.

 

[362.04]

I think there are many more remakes associated with multifocals than with single vision.

 

[eyestrain]

One thing I've had a problem with is seg heights. I've had a couple patients lately who I've put into PALs with the fitting cross set perfectly who've come back complaining that they have to tilt their head down to see. Then I mark up their old specs and find out the fitting cross is 5mm below their pupils. So I'm going to start checking it on everyone and trying not to change it too much (I probably should have done it long ago, but it wasn't much of a problem until the last month).

I haven't had a problem with people doing the one eye at a time thing. What I've found is that 99% don't have a clue which eye sees clearer even when there's a two or three line difference. So if there's a good size cyl change in one eye, but not the other, I'll often cut it back even though it means that eye might not be quite as clear. Especially if that patient didn't notice one eye was blurrier than the other, which like i said, almost always seems to be the case.

 

[drbizzaro]

Do any of you have a solution to the super-picky patients? You trial frame them and they see 20/20 with excellent comfort, but when they pick up their glasses, they say everything is blurry. You check the new pair and find it is within tolerance of your lab standards but is off by 2 degrees (+/- 2 degrees is fine for the cyl value).

Now, do you remake this and tell the lab person to be more accurate? I find that some lab guys just don't have the skills to be exactly on the actual degree.

 

[eyestrain]

Do any of you have a solution to the super-picky patients? You trial frame them and they see 20/20 with excellent comfort, but when they pick up their glasses, they say everything is blurry. You check the new pair and find it is within tolerance of your lab standards but is off by 2 degrees (+/- 2 degrees is fine for the cyl value).

Now, do you remake this and tell the lab person to be more accurate? I find that some lab guys just don't have the skills to be exactly on the actual degree.

I'd say there's something else wrong than the cyl. 2 degrees shouldn't affect much unless they've got a ton of cyl. Maybe start comparing PDs, base curves, materials, etc between the old and new specs.

 

[drbizzaro]

You might want to look this up. A broad-based survey of re-dos.

Prescribing spectacles: reasons for failure of spectacle lens acceptance.

Ophthalmic Physiol Opt. 2006 Jan;26(1):111-5.
Hrynchak P.
.

Thanks for finding those two articles. They were both pretty good reads.

 

[qwopty99]

Thanks for finding those two articles. They were both pretty good reads.

👍

 

[drbizzaro]

What about the patients who are now 60 years old, but have never worn glasses.

They have been struggling with reading up close for years, and decide on getting an rx finally.
They are also hyperopes.

I have had experiences where giving a small hyperopic rx with people who have never had an rx results in remakes as well. (even with pt education, they still feel more comfortable with the plano rx for distance).

So as an example:

VAsc: 20/30 OU
VAcc: 20/20 OU (+1.25-0.50x180 OU)

What's everyone's opinion on this?

 

[eyestrain]

So as an example:

VAsc: 20/30 OU
VAcc: 20/20 OU (+1.25-0.50x180 OU)

What's everyone's opinion on this?

I know what you mean, but this person is usually 45-50, not 60, in my experience. Either way, the most I'd put in the distance rx is half that. In this case, probably +0.50-0.50x180. Spherical equivalent there is only +.25 so it should bother too much. You'll most likely have to ease them into that Rx over a period of several years.