Keratoconus and Presbyopia

[Lia Williams]

I've reached the age where I have to admit that I need a proper pair of reading glasses, rather than a cheap pair of ready readers, to wear over my contact lenses.

I've been undergoing a refit of the contact lens for my right eye for over two years. I've kept promising myself that I'll treat myself to a designer pair of reading glasses when I have a stable contact lens prescription. Last week I went for my annual eye test at a high street optician (the hospital doesn't do a full eye test) and asked for a prescription for reading glasses to wear on top of my lenses but I was told that although they can prescribe me back-up glasses it is the responsibility of the person prescribing the contact lenses to provide the prescription of any glasses to be worn over the lenses. They did however add the if the hospital agrees they will provide a prescription.

So my question is what do others do? Use ready readers or get an additional prescription from the hospital they attend?

Lia

[Andrew MacLean]

I've never heard such nonsense. My high street optometrist prescribes and dispenses reading glasses to wear over my contact lenses; there has never been any question of turf war over this with any of the high street opticians whom I have consulted in my decades of contact lens wear, before or after my grafts.

Andrew

[Lia Williams]

I wouldn't exactly call it a turf war but I was surprised by his reluctance to prescribe reading glasses; especially as I had mentioned this to the receptionist when I booked the appointment.

I really can't see the hospital being upset about it either - the hospital optometrist at my last appointment did suggest that I would be better off with a proper pair of reading glasses, so naturally I assumed the High Street was the place to go.

Lia

[Andrew MacLean]

Lia

In your place I'd go to another optometrist on the high street. Stuff and nonsense (I almost want to add "Bah humbug!")

[Lynn White]

Hi Lia and Andrew,

Lia has stumbled across an interesting legal issue.

You see, to prescribe a pair of readers over the top of contact lenses has the implication that you have done a check up of said contact lenses and are satisfied that they are suitable etc. However, the contact lenses have been prescribed elsewhere and the optometrist cannot decide whether they are "OK" without doing a proper check, which would require and additional examination, probably incurring a fee. I presume they did a non contact lens related eye examination.

So, if Lia was to have a serious issue with her lenses, causing damage, say, and this was ongoing when the reading glasses were prescribed,then it could be possible to show that the optometrist was being negligent by not noticing the issue when prescribing the reading glasses over the top of the lenses.

However, if they prescribed spectacles that relate to non contact lens wear, they have performed a proper examination under the terms of the NHS Act and can quite properly issue a prescription relating to that examination.

Furthermore, they are quite correct in saying that they can make up a prescription that the hospital has provided (as the hospital did the contact lens related examination and can take responsibility for it) OR they can do a prescription fro reading glasses over the top if the hospital says so, as the hospital is taking responsibility for the contact lens fitting.

OK, so you may say why can't the optometrist simply do a quick contact lens check? Well, apart from anything else, this then is interfering with the professional relationship between the hospital and the patient. This is complicated by the fact that it is hard to do a check up on a KC patient without previous notes, as you have no idea what the lenses are that they are wearing. If you wear disposables, for instance, you can most likely produce the boxes they come in or the blister packs.

So it is a bit of a minefield and although "bah Humbug" is an understandable lay response, its not much comfort to an Otpometrist being sued. You may think this is unlikely but it does happen and many practices simply do not want to take the chance.

Lia may be able to find a practice that is happy to just prescribe readers, she may not. If not, then the best advice is to get the hospital to either issue a prescription itself or a letter to say they are happy for an optom to prescribe readers.

Lynn

[Andrew MacLean]

there you are; England is a foreign country and they do things differently there.

[Lia Williams]

Hi Lynn,

I really didn't think getting a pair of readers was going to be so complicated!

The eye test I had last week was a standard eye test which I didn't pay for as my glasses prescription is for complex lenses. ( sph + cyl -11.25 plus the ADDs for close vision). I commented that I probably didn't fit into a standard appointment slot and he said they did allow extra time for someone like me! I will probably remain with the same optometrist because the glasses prescription I have gives me reasonable back-up vision (Left 6/12, Right 6/24) - something no one else has managed to do.

Meanwhile with my lenses in I'm switching between +1.00 for the computer screen and +2.00 for reading but this is only really working with the left eye, the right eye (depending on which lens I'm wearing) needs stronger ADD). What the High Street optometrist did suggest (when I get a stable contact lens prescription (!)) was a special type of varifocal for the screen and reading. So when I get 'permission' from the hospital this is probably what I'll be looking for.

Lia

[Lynn White]

HI Andrew,

Its Europe, my friend, not England! Sometimes life is how complicated we make it....

Lia, its a really good idea to stick with the optom you have as they do know your eyes!

Lynn

[GrandPaClanger]

Interesting. I was looking around yesterday for a pair of reading sunglasses for my hols in September . I was going to go to my "old" optician i.e the one that referred me back to the hospital. I want a decent pair and ones where the lenses could be changed as the right grafted eye will change a lot over the next 18 months with adjustment to stitches and a lens being fitted. I assumed that it would be a case of asking for +1.5 left and right please (right is beyond glasses correction at the mo so it makes no odds). In the end I decided not to bother, shame as I may have been able to add more info to the debate. I did however find that there are masses of designer framed prescription glasses available on the web although the range of sun readers is more limited. I am back at the hospital in a couple of weeks I'll ask the question.

Ian

[Anne Klepacz]

Some hospital eye clinics (eg Moorfields) also do glasses. So another option would be to get the readers that way. Presumably that would get round the issues you describe, Lynn. After I'd had grafts in both eyes and couldn't yet wear contacts (and when the vision was fluctuating quite a bit as the months went by) I got all my glasses from Moorfields. Of course, that was stand alone glasses rather than readers on top of lenses, but it should be possible for readers as well?
Anne