Day 4: 1 - Male, 57. 2 - Female, 40 (PC)

Things I learned today:

First px was relatively normal, nothing too unusual. Another hyperopic presbyope. Never filled in his previous script.

Things I learned:

1. With a solid record of healthy history, you can simply ask them if there was any change in medications or medical problems.

2. Think about the reason behind doing a test.

3. With a px's first pair of glasses, and with a heavy script, it may be prudent to drop off a quarter dioptor to make it easier for the px to adjust to wearing glasses.

====

Second px was a 40 year old female with no past record at the school. What could possibly go wrong?
"I see double sometimes and I have prisms in my glasses". Oh crap. I forgot how to determine base directions in lensometry, but other tests I've done suggests that the prisms were BO and BD

She was a poor and slow responder, her tear film made subjective very difficult. NFV at 6m: x/3/-2, Maddox rod of 2BD OD, Von Grafe 10 esophoria. Accommodation was starting to decrease. She also had psoriasis, but thankfully no uveitis. In the end we prescribed 6BO and 2BD OD according to Sheard criterion on top of her refraction. I didn't think a +1.00 add would negatively affect her esophoria so I just gave it to her.

Things I learned today:

1. Don't pinhole until after subjective

2. Do broad H closer so you don't have to move your arms as far

3. THINK ABOUT PROBLEM SPECIFIC TESTING

For someone with double vision, we should have been checking

• Von Grafe phorias
  
• PFV/NFV @ 6m, 0.4m
• +/- VVs
  
• W4D
• Comitancy

but we ran out of time.

4. Having 3 people in the room with the patient can be very stressing for the patient. I can feel that she was on the verge of breaking down after I was doing FFC fields.

5. Don't show the 6/4.5 line until they can read the 6/6 line. Otherwise they'll begin to feel discouraged.

6. Get a multiple pinhole - its been needed more than once now. Pxs have a difficult time finding that 1 small hole.

7. Change up the choices, use more than just 1 or 2, add 3 or 4, 5 or 6, 7 or 8. Some people may preferentially pick '2'.

8. You CAN have prisms in PALs, but its not done by decentering.