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,

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.
@Seenow I haven’t had chance to read all the information but I have also done this. I got my eyes tested and just asked to stick with the older weaker script and have done for about 3 years now. I was obviously on a downward spiral with ever stronger lenses.

@Happyinarcon, yes, I think it can be an issue especially if someone suffers from eye strain and tense eye muscles. In these cases the eye muscles do not get enough chance to fully relax enough to see things properly at distance. This problem can be progressive as stronger prescriptions are issued as more that is in the near and mid distance visual field requires greater effort to accommodate and the muscles become over burdened/fatigued.

Who is collecting this data and analysing it?

Your visual acuity does not show how your myopia is progressing.

So where does it stop? Do you think pressures should be included on every prescription? That way patients can monitor this too. Perhaps a visual field map could be added or maybe a picture of their macular.

As eyes age there will always be a level of deterioration. Seeing this on paper for some patients causes a great deal of unnecessary anxiety as those changes are healthy and natural but still a deterioration non the less.

You can ask for information and it will be readily given. However, not everyone wants to be reminded they have age related changes.

I am not going to engage with you anymore because you are fighting for something that is already being given. If your optician was refusing, I would agree that you are entitled to that info but this isn’t the case. Having a VA on a prescription will not change how your myopia progresses and that is what your original post was about.

Please do keep these posts coming. As a professional and a practice owner, myself and my colleagues are highly entertained!

@Spamfrit, regulators, government bodies and researchers would be collecting and analysing data.

Your visual acuity does not show how your myopia is progressing.

Why do you say this? Several readings over the space of a few years I think would give some indication of myopia progression. Better indication than if all that were available were a prescription with no record of the corrected visual acuity achieved with it.

The OP is. You know, the one with years of education, a degree in optometry, ophthalmic dispensing and ophthalmology……

Seenow is the expert 😂

@JadeMember please can you explain the joke. As someone with severe myopia who is frustrated and disillusioned with the whole optical industry the fact that you and your colleagues find the whole thing apparently hilarious is not greatly reassuring.

@jademember really trying to stop ourselves commenting on all this at our practice too!

Seeing this on paper for some patients causes a great deal of unnecessary anxiety as those changes are healthy and natural but still a deterioration non the less.

@TimetoPour , do you not think a patient might find it equally the cause of great anxiety if their prescription appears to increase every year? Anxiety that might be avoided if the corrected VA was given and it turned out the optometrist had decided to corrected them them to an above normal standard because they had mentioned something like driving at night for a new job. The patient might have not wanted to ask and the optometrist not thought to explain. Professional standards avoid the ambiguity.

I didn’t say it was a joke. It’s just entertaining. And no, VA does not indicate myopia progression. People (esp children and teenagers) can have progressive myopia but with the correction their VA are still going to be 6/6. Their vision might be worse but when corrected with spectacles or contact lenses their VA will be 6/6. So, for example, we can see a child with progressive myopia for 10years. Their vision is worse, the prescription is higher, but the VA remains 6/6.

As someone else with "severe myopia" I recognise that 20/20 or 6/6 is a fairly arbitrary standard that has been decided at some point as "normal" vision, and I'm glad that my optometrists over the years haven't been happy to quietly settle for this standard for me, and will instead faff around for bloody ages refracting me, to get me the best corrected vision they possibly can without any overcorrection. That bit where they ask you if it's actually clearer, or just smaller? That's where they're checking for overcorrection. Getting you from 6/6 to 6/5 is not overcorrection, it's best corrected vision. If you want to be undercorrected because you think it will slow progression, then just say that.

@JadeMember but it’s very difficult for a patient to see the progression if they don’t know whether they’ve been corrected to the same corrected VA. If they’ve been corrected to differing standards of vision they cannot compare prescriptions.

So you’ve not heard of the data protection act? Your sensitive information cannot be shared with a third party without your permission. So no, there isn’t anyone out there collating and analysing your data, not from a high st opticians.
Again, your lack of understanding of what visual acuity is. It does not show how your myopia is progressing

I totally agree with @myopinionis

You’ve clearly got a massive bee in your bonnet about this, but you are misinformed.

A myope having better than 6/6 (20/20) acuity does not mean they are over-corrected at all. I would expect most people to correct to 6/5 for a start. You only even think this is some magic standard because of the phrase “20/20”. It’s just a measurement - it’s not the “gold standard.”

If a myope has better vision when an extra minus lens is put in front of their eye, then they are currently under-corrected. If an extra lens improves VA it is not over-correcting myopia.

You’ve written a massively long letter in a way that you think makes you sound very well-informed, but it doesn’t. If this letter is to the GOC, why do you feel the need to explain what myopia, pseudomyopia, accommodative lag and even “the GOC” means? Funnily enough, they know all that already.

It actually is helpful for prescriptions to contain visual acuities, but it’s helpful really for other optometrists - not for members of the public with no knowledge or training to make up their own prescriptions and decide for themselves what lenses they need, as you are suggesting.

You’ve apparently been thinking about this for 13 years and gone into loads of research, but you don’t even understand how visual acuity and a myopic prescription are correlated, so it doesn’t suggest that leaving that decision to members of the public would be a good idea.

Myopia management is probably the biggest current topic in optometry at the moment, optometrists are talking to children and parents about it more than ever and there are more appropriate ways of trying to minimise future myopia than varifocals.

Optometrists don’t “decide to correct to an above normal standard” 6/6 isn’t “normal.” In fact, as you seem to be obsessed that you’re being overcorrected, it’s now recognised undercorrection is more likely to cause myopia progression.

You keep arguing the same things, but you literally do not understand how it works. What you’re saying is nonsense.

Where I work, we do include VAs on prescriptions anyway, so job done…

It reminds my of someone from long time ago. Coming in with the spreadsheet of prescriptions over the last 20 years and fixated on the axis ‘fluctuating’ between 175-178 ( with -0.25cyl)!

What data would this be? The visual acuity data is recorded, even if it's not printed on the bit of paper given to the customer. Printing it on a bit of paper that is then stuffed in a bag or drawer off the premises does nothing to aid in data collection.

I've recently been referred for a procedure and, even though visual acuity isn't recorded on my prescription card, it was there on the referral letter (6/7.5 and 6/60 in this case. I get the joy of aftercataract and I'm not even slightly myopic)

And so often when I'm in the optician's, I overhear one of the optical assistants having to explain to someone rather confused what their prescription means, in very simple terms. Many people do not need even more numbers on their prescription card.

Thank you! I just couldn’t go into all of that because I feel it will fall on deaf ears!

I know! I typed it out an hour ago and thought “why bother” but then I pressed send anyway!!

I've never had an optometrist get me to an arbitrary predefined level and go "yeah that'll do". They always try to tailor the refractive correction to give my eyes the tools they need to perform at their best. My eyes are capable of seeing a fair bit better than 6/6 (as are most people's, I believe), if they're given the opportunity by means of corrective lenses. Giving me lenses too weak for me to make use of that acuity would be a deliberate choice. It's a choice you might want to make, if you believe that weaker lenses will slow progression, but it's still a choice.

Acuity isn't something you can push further and further by use of stronger and stronger lenses. Going stronger than you need won't push you into better acuity.

So did you ask your Optometrist for your VA?

(Not that this is anything other than academic to me right now — I'm wearing entirely the wrong prescription but can't afford new glasses anyway. Bloody fifteen quid for a complex lens voucher… it's an order of magnitude out, IMO. I'd like to see whoever decided that £15 was a reasonable supplement for high prescriptions try to go about their daily life in some -12 CR-39s.)

My vision varies - sometimes I can use a screen without glasses, mostly use VDU prescription, occasionally if I'm feeling a bit headachey my reading glasses will be better.

Depends on
Time of day
Lighting
tiredness
screen contrasr
Sugar levels...

Not to mention those massive changes where it goes from 5 all the way up to 180 just in 2 years!!

To be fair it would be nice if all the eye people could pick a notation type and stick to it 😅