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GLASS PRESCRIPTION
AMONG YOUNGS AND
EDUCATE ELDERLY ABOUT
PROGRESSIVE LENSES
DR. AMARENDRA KUMAR
M.S
WHY WE PRESCRIBE GLASSES
 Majority of patients in our opd comes with complaints of
VISUAL SYMPTOMS
OCULAR SYMPTOMS
REFFER...
GLASS PRESCRIPTION
HYPEROPIA Age
Fogging
Refinement methods
1. Less than 3yrs ------- Full Correction
2. 3 to 8yrs -------...
GLASS PRESCRIPTION
 ASTIGMATISM
Normal Patients
: In child less than 3 yrs of age = 1.25DS regular
: Older than 3 yrs. = ...
RELATIONSHIP BETWEEN VISUAL
ACUITY AND REFRACTIVE ERROR
Snellens Visual Acuity Uncorrected Spherical
Errors(DS)
Uncorrecte...
SOME COMMON DIFFERENCES
BETWEEN ADULTS AND CHILDREN
CHILDREN < 5YRS ADULTS
* Give refraction on axis as refracted * Give c...
SOME COMMON DIFFERENCES
BETWEEN ADULTS AND CHILDREN
CHILDREN < 5YRS ADULTS
* Tolerate anisometropia; give full
regardless ...
SOME COMMON DIFFERENCES
BETWEEN ADULTS AND CHILDREN
CHILDREN < 5YRS ADULTS
* Tolerate aneisokonia better but also
consider...
SOME EXAMPLES
 We prescribe Spherical power on the basis of Wet AR
 Cylindrical power on the basis of dry AR
 For AR un...
CONTD.
 High refractive errors
12 Yrs old girl with dry AR
RE -5.25 DS -0.25 DC@37 v 3/60
LE -4.75DS -1.50 DC@157 v 3/60
...
CONTD.
 Small errors with eye strain
15 yrs boy with Dry AR
RE +1.0 DS +0.25 DC@88 v 6/6p
LE +1.25 DS +0.50 DC@104 v 6/6 ...
PROGRESSIVE ADDITION LENSES
 When the near point has receded beyond the distance at which the individual is accustomed to...
PROGRESSIVE LENS (NO-LINE BIFOCAL)
VS.
LINE BIFOCAL
 Advantages
 No sudden “image jump” from distance to near.
 An infi...
CONTD.
 Useful for long Computer user also protect from computer vision syndrome
 Can be prescribe comfortably to myopic...
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Glass prescription among youngs and educate elderly about

guide to prescribing glasses

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Glass prescription among youngs and educate elderly about

  1. 1. GLASS PRESCRIPTION AMONG YOUNGS AND EDUCATE ELDERLY ABOUT PROGRESSIVE LENSES DR. AMARENDRA KUMAR M.S
  2. 2. WHY WE PRESCRIBE GLASSES  Majority of patients in our opd comes with complaints of VISUAL SYMPTOMS OCULAR SYMPTOMS REFFERED SYMPTOMS • BLURRED VISSION • DIPLOPIA • CONFUSION • HEADACHE • ASTHENOPIA • EYE STRAIN • OCULAR IRRITATION • PAIN • In child intractable blepharitis and conjunctivitis
  3. 3. GLASS PRESCRIPTION HYPEROPIA Age Fogging Refinement methods 1. Less than 3yrs ------- Full Correction 2. 3 to 8yrs -------------- depends on tropia or phoria 3. Adults to follow rule of strongest+  MYOPIA 1. Thumb rules Full Gross Value subjective to AC/A Full net--- optimal, undercorrecti on Normal Patients • -1to -6 full correction • >-6 undercorrect Esotropia • -6 DS or Above under correct to optimal Exotropia • Over correct in intmittent Exotropia
  4. 4. GLASS PRESCRIPTION  ASTIGMATISM Normal Patients : In child less than 3 yrs of age = 1.25DS regular : Older than 3 yrs. = all astigmatism should be corrected  Child and young : followed up 6 monthly  Adults : 6 month to yearly  Frequent changes : over correct (0.25D)  Every patients suspected of refractive error should be checkeked Dry and Wet AR  For >5yrs Tropicacyl Plus every 10 min upto 30 min AR rechecked after 40 to 60 min  For 3-5 yrs Atropine sulphate ointment tds for 3days AR rechecked after 3days  Cyclopentolate may be other option in little childs
  5. 5. RELATIONSHIP BETWEEN VISUAL ACUITY AND REFRACTIVE ERROR Snellens Visual Acuity Uncorrected Spherical Errors(DS) Uncorrected Cylindrical Error(DC) 6/6 <=0.25 <=0.25 6/9 0.50 1.0 6/12 0.75 1.5 6/18 1.0 2.0 6/24 1.5 3.0 6/36 2.0 4.0 6/60 2.0-3.0 >=5.0
  6. 6. SOME COMMON DIFFERENCES BETWEEN ADULTS AND CHILDREN CHILDREN < 5YRS ADULTS * Give refraction on axis as refracted * Give cyl close to 90 or 180 degree * Full hyperopic cycloplegic refraction tolerated well if less than age 5yrs * Maximum tolerated plus even in refractive accommodative esotropia * Subjective manifest refraction less important * Subjective manifest refraction important
  7. 7. SOME COMMON DIFFERENCES BETWEEN ADULTS AND CHILDREN CHILDREN < 5YRS ADULTS * Tolerate anisometropia; give full regardless of age, strabismus, amblyopia * Tolerate anisometropia poorly * < 12yrs non wearing or wearing wrong prescription will affect eye health * Non wearing or wearing wrong prescription have only minor temporary consequences # amblyopia, deviation, loss binocularity # asthenopia, red eye, dry eye
  8. 8. SOME COMMON DIFFERENCES BETWEEN ADULTS AND CHILDREN CHILDREN < 5YRS ADULTS * Tolerate aneisokonia better but also considered an implement to fusion and has amblyopia potential * Tolerate aneisokonia poorly * Anisometric Rx, Aneisokonic spectacle Rx has a role especially in patients requiring occlusion * Will not wear Rx that has a large difference in refraction between the 2 eyes(threshold ? Different from patient to patient)
  9. 9. SOME EXAMPLES  We prescribe Spherical power on the basis of Wet AR  Cylindrical power on the basis of dry AR  For AR under TP we reduce 0.75 3yrs old boy with dry AR RE +5.0 DS +1.0 DC@142 LE +6.0 DS+ 0.75 DC@71 wet AR RE +4.75 DS + 0.75 DC@152 LE +6.25 DS + 0.50 DC@69 Patient with phoria Prescribed glass RE +4.0 DS +0.5 DC@140 LE +5.0DS +0.25DC @ 70 5Yrs Boy with Amblyopia Dry AR RE +0.25 DS + 0.50DC @137 v 6/6 LE +5.25DS + 0.75DC @54 v 6/36 Prescribed Glass RE Plane v 6/6 LE +3.50DS v 6/18 with proper occlusion and followup
  10. 10. CONTD.  High refractive errors 12 Yrs old girl with dry AR RE -5.25 DS -0.25 DC@37 v 3/60 LE -4.75DS -1.50 DC@157 v 3/60 Wet AR RE -5.0DS -0.50DC@38 LE -4.25DS -1.50DC@151 Prescribed glass RE -4.75 DS v 6/6 LE -4.50DS -0.50DC @160 v 6/9 18yrs old boy with dry AR RE -0.25DS -4.75 DC@6 v 3/60 LE -0.50DS -4.0DC@177 v3/60 Wet AR RE +0.25DS -4.75DC@4 LE +0.25DS-4.0DC@177 Prescribed glass RE -3.75 DC@5 v 6/9 LE -3.25DC@180v 6/9
  11. 11. CONTD.  Small errors with eye strain 15 yrs boy with Dry AR RE +1.0 DS +0.25 DC@88 v 6/6p LE +1.25 DS +0.50 DC@104 v 6/6 p Wet AR RE +3.5DS +0.75DC@70 LE +3.25DS +0.50DC@100 Prescribed glass RE +2.0DS V 6/6 +1.75DS v 6/6p (Full +latent Hyper ) 19yrs girl with Dry AR RE -0.75 DC@87 v 6/6 p LE -0.75DC@92 v 6/6p Wet AR RE +0.75 DC@177 LE +0.75 DC@184 Prescribed glass RE -0.50DC@90 v 6/6 LE -0.50 DC@90 v 6/6 (transposition) 20 yrs boy with Dry AR RE +0.50DS +0.50DC@93 v 6/9 LE +0.5 DS+0.75DC@95 v6/9p Wet AR RE +1.5DS +0.50 DC@88 LE +1.50DS +0.75DC@93 Prescribed glass RE +0.75DS +0.50DC@90 v 6/6 LE +0.75 DS +0.75DC@90 v 6/6
  12. 12. PROGRESSIVE ADDITION LENSES  When the near point has receded beyond the distance at which the individual is accustomed to read or to work is known as presbyopia in Latin old man’s eyes.  Decrease in amplitude of accommodation with age  Increase in near point of accommodation with age  Progressive spectacle lenses, also called progressive addition lenses (PAL),progressive power lenses, graduated prescription lenses, and varifocal or multifocal lenses, are corrective lenses used in eyeglasses to correct presbyopia and other disorders of accommodation.  Progressive lenses more closely mimic the natural vision that you enjoyed before the onset of presbyopia. Instead of providing just two lens powers like bifocals (or three, like trifocals), progressive lenses are true "multifocal" lenses that provide a smooth, seamless progression of many lens powers for clear vision across the room, up close and at all distances in between. Age in yrs Distance in cm Amplitude of accommodation(D) 10 7 14 20 10 10 30 14 7 40 20 3 50 40 2
  13. 13. PROGRESSIVE LENS (NO-LINE BIFOCAL) VS. LINE BIFOCAL  Advantages  No sudden “image jump” from distance to near.  An infinite number of focal points to view objects at different distances.  No visible line where the bifocal power begins.  More natural vision for near viewing.  A variety of lens designs to fit virtually any application.  Disadvantages  Requires a short period of adaptation to progressive lens for first-time wearers.  Peripheral Distortion: Progressive lenses suffer the disadvantage of the power progression creating regions of astigmatic aberration away from the optic axis, yielding poor visual resolution.  Costs more than a regular bifocal.
  14. 14. CONTD.  Useful for long Computer user also protect from computer vision syndrome  Can be prescribe comfortably to myopic with presbiopia  Better lens materials. Today's progressive lenses are available in all the latest lens materials, making them thinner, lighter and more comfortable than ever before. Progressives made of high-index plastic lens materials can be up to 50 percent thinner than standard plastic bifocals.  Today, many progressive lenses have compact designs specially made for smaller eyeglass frames. With these new designs, wearers with small faces or anyone who wants a smaller, fashionable frame can enjoy all the benefits of progressive lenses.

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