Skip to main content
Low Vision Tools and Resources
Low Vision Exam Videos
Manufacturers and Suppliers
Prescribing Pearls Checklist from Dr. Greene
Make friends with your patient.
Talk to the patient, the family will be listening.
Control the interview- get to the important facts fast—what do they want to accomplish?
They’ll talk about reading—you should ask about seeing faces and making eye contact- do they feel isolated?
Have them do their homework- make a list of the activities that they would like to improve- this speeds up the history.
Review their present glasses and magnifiers- find out what they use and find most helpful now.
Do a quick refraction- if you can’t improve acuity by at least two lines, and can’t improve their ability to see a face from across the room- don’t prescribe!
If VA is 20/70 or better spend a bit more time doing a refraction- I always use a trial frame- If VA is 20/100 or less, and retinoscopy is close to neutral I don’t spend much (if any) time on refraction.
If retinoscopy is dull, find out why- this will reduce acuity and contrast- is there a medical/surgical option to clear up the media?
Check fixation in each eye individually- have them touch your finger- if they can’t do it, you won’t be able to help them much.
Check their gross depth perception- can they touch your finger held sideways? If not, is lack of stereopsis affecting their function?
Have them look through a 4x12 handheld telescope (pre-focus it first)- see which eye they take it to- that’s the dominant eye- you want to prescribe to the dominant eye if at all possible.
I hope the patient can read fluently 4x better with the telescope, but I also want them to see a face from across the room well- if they can that’s promising, if they can’t than telescopes may not be indicated.
If there is a dominancy conflict- meaning the better seeing eye is the non-dominant eye- try to prescribe binocularly if at all possible
Acuity goals for fluent reading with magnifiers are at least 20/40. If you want your patient to read 20/40 fluently you need to give them enough magnification to read two lines smaller (though not necessarily as fluently).
When prescribing reading aids, consider breaking up the magnification between a prism half eye and a 2x condenser magnifier- this works very well for acuities better than 20/100 as is maintains a more normal working distance.
When writing checks to pay bills- you need less magnification to write the check than you do to see the bill- use the prism half eye to write the check and combine it with the magnifier to read the bill.
Don’t forget about ergonomics- use an inclined reading stand to bring the material closer
Don’t forget about lighting- bright lights are probably half the solution- the broad-spectrum OTT lights are usually not bright enough for AMD patients.
Always show CCTVs if for informational purposes only. Patients who get them love them- don’t think about the money- that’s the patient’s decision not ours.
Find out the furthest distance the patient can see your face well- that’s the distance they should watch TV. If all they want to do is watch TV, a larger TV is often a better solution than any telescope we can offer.
If they want to see better at a distance, once the refraction is the best you can give them, they either have to walk up closer, or use a telescope. That’s all the options there are. Telescopes and bioptics work great. I have many seniors who use them regularly. Demonstrate them- let them see their family from across the room- they will sell themselves.
Promise less than you expect to deliver.
Offer them a prognosis of how likely they will achieve their goals.
Offer to help them learn how to use the devices- they are not on their own.
Tell them what your refund policy is- don’t short change yourself.
Make recommendations- don’t decide for them.
Don’t let the family decide for the patient what they will get.
Tell them they don’t have to decide right away (unless they can)- they can always call back to order something- take measurements first if it’s a custom order- this lowers the pressure they feel.
Enjoy yourself- low vision is fun!