Call for more transparency within the uk optical industry

[Seenow]

This article has been bugging me for years (sorry Daily Mail but the topic is important)

https://www.dailymail.co.uk/health/article-2100778/So-thats-new-specs-giving-headache.html

What do people think of sending a letter such as this to the GOC?

Dear Sir/Madam,

Re: Request for Transparency in Optical Prescriptions and the Inclusion of Visual Acuity Information

I am writing to raise an important concern regarding the transparency of optical prescriptions, specifically the inclusion of visual acuity achieved with the prescription provided to patients.

As you are aware, myopia is becoming an increasingly prevalent condition, particularly among children and young adults, and has significant long-term implications for eye health. With myopia rates on the rise, it is vital that optical prescriptions are accurate and that patients have a clear understanding of how well their lenses are correcting their vision. Recent concerns among patients and optical professionals about prescription discrepancies—including those involving a variance of up to 1.5 diopters—have prompted discussions about the need for greater transparency in the optical prescription process. These discrepancies can lead to symptoms such as headaches, eyestrain, and visual discomfort, and may even contribute to the worsening of myopia over time.
An important part of this issue is the lack of information on the visual acuity achieved with a given prescription. Currently, optical prescriptions do not routinely include this information, leaving patients unaware of how effectively their lenses are correcting their vision. I believe that including visual acuity on optical prescriptions would greatly benefit both patients and eye care professionals, particularly in light of concerns about myopia progression, pseudomyopia, and over-correction.

The Importance of Visual Acuity Information for Myopia, Pseudomyopia, and Over-Correction:

1. Myopia Progression:
2. As myopia progresses, it is critical that patients receive the appropriate level of correction. Under-correction or over-correction can lead to discomfort and potentially accelerate the worsening of myopia. If a prescription is not achieving the expected visual acuity, it may indicate that the patient is being under-corrected or over-corrected, both of which can contribute to increased strain on the eyes and may accelerate myopia progression.
3. Pseudomyopia:
4. Pseudomyopia refers to a temporary condition where the eye exhibits myopic symptoms, often due to accommodation stress or overuse of near-vision tasks. In these cases, an accurate prescription is crucial for differentiating between true myopia and pseudomyopia. Without knowing the exact visual acuity of a prescription, it is difficult to ensure that a patient’s lenses are not contributing to unnecessary accommodation strain, which could lead to worsening pseudomyopia.
5. Over-Correction:
6. Over-correction of myopia can occur when a prescription provides too much correction for the eyes. This can cause visual discomfort, including blurred near vision and eye strain, and may result in a phenomenon known as "lag of accommodation", where the eyes struggle to focus on close objects. By including the visual acuity achieved with a prescription, patients and professionals would have a clear indication of whether the prescription is appropriate, reducing the risk of over-correction and the associated negative effects.

Request for Action:
In light of the above, I respectfully request that the General Optical Council (GOC) consider advocating for the standard inclusion of visual acuity on optical prescriptions. By including this information, patients would have a clearer understanding of their visual correction, and optical professionals would be better equipped to identify potential discrepancies in prescriptions that could affect myopia management.

I also encourage the GOC to explore the development of best practice guidelines that ensure consistency and transparency in the prescription process, particularly for individuals with myopia or other refractive errors. These guidelines could help reduce the risk of inappropriate corrections that contribute to myopia progression or cause unnecessary strain on the eyes.
By adopting such measures, the GOC could greatly enhance patient outcomes and contribute to better long-term eye health, particularly in a time when myopia is becoming an increasingly widespread issue.
Thank you for your time and attention to this matter. I look forward to hearing your views on this issue and would welcome the opportunity to discuss it further.

Yours faithfully,

Your pen, your choice.
But I wouldn't be writing unless I had done far more research into the actual peer-reviewed research available, rather than a dm article.

Sorry, it’s early; what is your concern? What is the issue here?

@TheCountofMountingCrispBags, I have done a lot more research. So much (rabbit hole) it is difficult to know where to start. It is an a motive issue for me. But that aside, what do you think regarding the information I have included in the letter?

@HansHolbein, the issue is that the findings of the article showed a variation of 1.5 diopters from visiting different optical providers within the same month and the explanations are insufficient really considering how the prescription given can affect myopia progression.

I have severe myopia so this is an important concern.

Could it be differences in training? Equipment? Interpretation?

Not saying that’s ok…

Why has this article been bugging you so much?

When you have your eyes tested, an optometrist relies on patients to tell them what they are most comfortable with. However they then use a variety of other tests to make sure this is accurate- sometimes even putting drops in to knock out accommodation. This is all to give you the best vision possible.

I fail to understand how you think putting visual acuity on a prescription changes this. Do you only want to be tested to a certain standard or do you want the best vision?

I’m sure if you asked your optometrist would put this info on your prescription

They've probably all got customers like me who one minute I can see something with my glasses, the next minute I cant

Peri menopause, my eyesight is shocking in every day situations but when I have a test, the prescription is said to be fine and I can see what they are asking me to see.

Weird.

Also what is visual acuity and how come short sightedness is increasing, I wasnt aware of that?

@TimetoPour, putting visual acuity on a prescription would offer greater transparency in terms of whether the optometrist had taken a professional decision to either under prescribe or over prescribe without discussing this.

Personally I suspect I have been routinely over prescribed as I have corrected to the 20/10 line on a Snellen. This is worrying since I experience the symptoms of pseudomyopia and my prescriptions have progressed systematically by about one diopter each visit until I decided (off my own back) to wear older weaker prescriptions for near work. It was only after doing this my myopia progression settled down.

Been corrected

Oh and also wore weaker prescriptions for mid distance (in the house) as part of my experiment.

I think what I would like to see is corrected visual acuity.

Please don't apologise for quoting the Daily Mail. Its a national newspaper, people can read what they like.

@Freysimo, thank you. It’s just I know it puts some people off.

Visual acuity is a measure of clarity of vision at a distance. Often expressed as 6/6 (or 20/20 in the US). So, if you have perfect vision, you can see at 6m what most people can see at 6m. If you are short sighted and you can only see at 6m what most can see at 36m, you have 6/36 vision.

Myopia is thought to be increasing because we all spend too much time looking at things in our hands or on our laps.

Ohhhh! This is so helpful to read - I’ve been finding my vision blurry for the last month and went to the optician yesterday and they said my vision is fine! No significant change since last year! But I am early 40s so…

@SpanThatWorld

Myopia is thought to be increasing because we all spend too much time looking at things in our hands or on our laps.

Made worse by an over correction of minus, I would have thought. (Look at the stuff regarding using PALs to control myopia progression)

pmc.ncbi.nlm.nih.gov/articles/PMC9213207/

Putting VA on a prescription wouldn’t change this. The article is correct in saying that everyday is different. If you had multiple eye tests over a month, at different times of day, tested to the same VA- the prescriptions would be different. If you hold a book at 30cm v 35cm that will be different prescription for reading. If you are tired, it will be different. At certain ages, prescriptions change quicker than others.

I absolutely agree that opticians need to be open with their patients. Patients need choice and to be able to voice concerns. They need to discuss adaptions and lifestyle choices. Whether you are happy with your current prescription or not. Are you legal to drive a etc? If you don’t trust your optician, vote with your feet and go elsewhere. This goes for all patients not just high myopia.

@JackShephard, don’t underestimate the effects of eye strain.

I just liked the pun in the thread title

@TimetoPour, that level of variance is actually deemed unusual across the industry and if was experienced with the same optometrist would warrant investigation. Corrected visual acuity would tell the patient if the optometrist had over (corrected to better than 20/20 vision) or under prescribed (worse than 20/20 vision)

I am fully aware. I have worked in the industry. In the UK we usually work in 6s (ie metres rather than feet) 6/6 is standard vision. 6/5 is better than standard etc and it is normal across the industry to test to this level. Even hospital optometrists (that don’t sell specs) test to this level. I don’t know any optician that only tests to 6/6 or 20/20. Most people that don’t require glasses can easily read beyond this level.

The VA tells us what level of vision a patient is able to attain and what is their “normal”. If last time you could see 6/5 and this time you can only see 6/6 no matter what prescription, it means that something else could be a miss. You may still have “normal” vision but it isn’t normal for you and warrants further investigation.

Optometrists are all aware of increasing myopia and yes, it is likely down to the fact people now spend more time looking at phones and screens etc. There are lenses out there designed for these purposes. Prescriptions are prescribed based on what patients want from their glasses. If a patient tells you one day they want best vision for driving that is what you will give them. If they want a pair of glasses the next day that are for wearing in an office, you may prescribe a slightly lesser minus prescription because they want them for a different purpose. It is not the same as taking the same amount of medication each day.

Optometrists need to talk to their patients and prescribe what works best for their lifestyle not just what makes them see the lowest line on the chart. If your optician is doing this then you need to go elsewhere. It is not the standard in the industry though.

As someone who has a prescription of -17 in one eye and - 14 one other and knows many people with similar prescriptions I'm not sure why the concern about increasing myopia. It is an easily corrected condition.

I agree research into why different prescriptions would be useful but so much depends on what the patient tells the optician it's going to be hard. I've spoken to friends who will say they can't read a line if they can't see all the letters whereas I'll pick out the ones I can and if I'm not sure about some will say that I'm not sure but it might be whatever.

@TimetoPour so wouldn’t it be useful to note down the corrected visual acuity achieved on the prescription? I honestly don’t understand why you think this information would not be useful to the patients. (It could be noted in metres - I really don’t mind, I just used feet because that is what I am most familiar with, anyone easily can convert.😉)

@helpfulperson where do I start? The expense the inequality between people who can afford myopia progression interventions and those who can’t. The links between increasing myopia and macular degeneration, cataracts and glaucoma.

I’m saying you are arguing over something that is irrelevant. Putting VAs on a prescription will not change whether people are prescribed a certain prescription or not.

Each of my patients were always encouraged to put on their own glasses and then compare to the prescription found that day. If the difference was noticeably beneficial they were encouraged to change their glasses. If they were happy as they were then they could leave it two years until their next routine exam (or return earlier if they changed their mind). Putting a VA on their copy would not change this. It is not about numbers on a piece of paper. It is what is beneficial to each different patient.

If you feel your optician is prescribing lenses that you are too strong or encouraging you to purchase lenses that are stronger but don’t make a difference then change providers.