A QUESTION OF JUDGEMENT
This query is one that appears at ABDO very regularly but the advice might be helpful again. A member asked if she was allowed to change a prescription, specifically a reading addition, to change a working distance. To use my favourite expression, ‘It depends’.
The reading addition given in a prescription is to enable the patient to see at a particular focal distance, for example, reading at a third of a metre. It is enormously helpful if you know, either from being told or on reading the records, what that particular position actually is. If the spectacles you are dispensing are for a particular purpose other than reading at a third of a metre, making an alteration to the addition may be necessary to serve your patient’s requirements.
To go back to the answer, ‘it depends’, your records must show why you made such a change. It might say something like, ‘Px wishes for spectacles to use for singing in a choir, holding music at 50cm to be able to see over the music to view the conductor’. It would be ideal if a discussion could be had with the prescriber to consider the range obtained by the patient with the addition as given, a point which may well have been covered during the consultation.
To simply view a reading prescription and think, ‘That’s going to be too strong, I’ll just take it down half a dioptre’, would not be permitted.
There are, of course, other circumstances when the numbers in a prescription might be changed. Swapping from a plus to a minus cylinder would not be changing a prescription per se, but simply writing it in another form.
Another situation where a prescription might be altered is when making allowance for a change in vertex distance. The precise point on working distances is covered in ABDO’s Advice and Guidelines Section 2.7.2.