An interesting query came up the other day, which certainly made me stop and think. Our member had a patient who sought advice for an elderly relative; the relative was not a patient of the practice, and indeed hadn’t had an eye examination for many years. He was house bound but in need of reading specs. The patient requested a pair of spectacles to be made for him: “Plus two would be fine”. What should our member do in such circumstances?
You can understand why I had to stop and think…the law states that a registered dispensing optician may dispense a pair of spectacles without a prescription by copying an existing pair. This is a subject I covered quite recently in a previous FAQ, but that wasn’t the case here. Who decided on a plus two?
You can well imagine the situation; faced with an infirm relative, keen to help but unable to comprehend how the problem could be tackled, the patient asked for +2.00D as a good compromise – well she could see with her +2s, couldn’t she? But that, I decided, is prescribing albeit twice removed. So, how best to help all concerned? A home visit would be the best answer. Apart from the possibility of a clinical problem, the best prescription would be found, even with poor acuity, and the best would be made of what little vision there was.
It is not unusual for such patients to decline a home visit, and “Can’t be bothered” is a frequent comment. Of course, such patients have every right to decline an eye examination but they should at least be asked and gently encouraged.
Without a prescription of any age, or at least an old pair of specs to copy, the DO can do very little to help. Suggesting a pair of ready readers or a magnifier may be a step towards a home visit, especially if they prove to be useless. The complexity of finding the correct power is hard for many people to understand; most think that stronger is always better.
Be wary though of suggesting a power for the ready readers to such a patient. Self-selection is within the law, but you saying a +3.00D would give higher magnification could also be viewed as prescribing. With an ageing population, such situations are likely to become more common, so it is a good idea to have some sort of procedure set up within the practice for these occasions.