On the official American Board of Opticianry website, Rx Interpretation is the second line item in the category of Opthalmic Optics that comprises 34% of NOCE questions. But what exactly does Rx interpretation mean?

Rx Interpretation Means Understanding the Patient’s Problem

Well, first of all, it means that when an eager, trusting patient walks through you door and hands you their script what’s on it makes sense to you. You can look at it and instantly know the patient’s refractive error and how the doctor wants YOU to correct it. There isn’t much on a prescription form. It’s a small, rectangular paper with some numbers and symbols on it, but those symbols contain a wealth of knowledge, knowledge YOU can read and decipher. Just think about it. Immediately, from that small printed paper:

• You know whether the patient is myopic (nearsighted) or Hyperopic (farsighted.) and…
• You know the magnitude of their problem.
  

From this you have a real good idea how the patient is going to be wearing his glasses. Myopes will tend to wear glasses more often. They know they need them… for the most part. But the average hyperope walking about on the street is probably not wearing his corrective lenses as he should. He can get by in the distance, and probably thinks glasses are mainly meant for reading. If the doctor doesn’t state NVO on the Rx, it might actually be for distance too! You can gently encourage the patient to change his way of thinking… possibly.

If the patient is a child, it really becomes important that you try to educate the parents concerning their child’s real need of the glasses. So many parents are in complete denial, and (worse!) they may have taken the doctor’s words out of context. “The doctor said they are only for the blackboard!” while you KNOW that it is a DISTANCE Rx. It is up to you to explain (again, gently) that if Johnny can’t see fine detail at the blackboard, he can’t see fine detail on anything else that is blackboard distance or beyond. Since our optical vocation is to provide our patients with a better life by having better vision, we definitely need to encourage our patients to accept that better vision as a Right and a Privilege (and to wear their glasses!)

• You also know if the patient has astigmatism, and how much.

Lots of people have the idea that astigmatism is some dread, diabolical condition. How many times have you come across some poor patient who comes to you saying “The doctor said I have a… STIGMATISM,” and they only have a -0.50D stig! They think that’s their problem when it’s really the -2.00 sphere that’s causing all the blurriness. You can explain to them that most people’s eyes are not completely spherical, and that what they have is very normal. It may make them a bit more comfortable with the idea of glasses and with you as their provider! Conversely, if they DO have significant stig, and it’s newly prescribed, you can warn the patient ahead of time that they might expect a time of adjustment to them.

• You know if the patient is likely wearing contacts.

A -10.00D script in the hand of a patient who isn’t wearing glasses is a real red herring! Yet I ask just about any myope who comes in bare-eyed if they are wearing contacts, and most of the hyperopes too! This opens up a dialogue with the patient concerning their contact lens script (which YOU could fill!) and may plant the idea of contact lenses in the minds of patients who haven’t worn them yet. Lots of people have been told long ago that they couldn’t wear contacts due to their prescription. Now, of course, there are very few patients that can’t be fit.

• You know the patient is presbyopic.

The ADD power gives that away. But even an NVO prescription implies that a multifocal might be an option. It’s never a wrong idea to call the doctor and ask for a full bifocal breakdown of the Rx for your records. The patient may just order readers from you, but if you know your onions (and hopefully you do) you will be informing your patient that if they someday want a pair of glasses they don’t have to take on and off all the time, you know JUST how to help them. They may take you up on it!

• You know if the patient is monocular.

The word “balance” in the indicator here. If you see that you know that the lens on the balance eye will simply be made to look like the lens on the good eye. You also know not to sell them glass, or even CR39 lenses. The one remaining eye needs to be protected. This is a poly or Trivex™ patient.

• You know if the patient has prism in their glasses.

You also know it will be a slightly more challenging job. Here, you know not to promise a quick turnaround time. Lots of lab opticians seem to quake at the very idea of prism. (And they fall down in a dead faint at the mention of slab off!) It’s best to pick your lab, if you have that option, with care.

• Similarly, you can tell if the patient may have difficulty with vertical imbalance at reading level.

You can clearly see from the numbers on the Rx that the poor patient has enough anisometropia to compromise their near vision when they progress to bifocals. It is up to YOU to decide whether or not the patient is a candidate for slab-off, and it is up to you to make the calculations and order the glasses. Now this is where we separate the optical “men” from the “boys!” Most opticians aren’t comfortable even discussing slab-off. If you can do it and provide your patients with the correction that they need, YOU are the master optician!

• You may be able to tell if their prescription has changed, and by how much.

When a former patient returns to you for their next pair of glasses, you have the luxury of checking their records of what they bought from you in the past. It is here where you can discern that the patient may have rapid myopic progression, have had recent cataract surgery, or might even have a typo on their Rx! Always take a look at these records. If their axis was 50º on their OD last year and it’s 140º this year (and the patient reports no problem with his last glasses) it’s a really good idea to call the prescribing doctor and double check the Rx! If you don’t, the patient will just return to you for a redo, and neither of you will be happy about it. Being pro-active is good for both of you.

Recommending Products Based upon Rx Interpretation

Once you know what the patient’s optical problem is, you know what product to recommend to him. I’ve always compared my position as an optician to that of a pharmacist. Patients ask a lot: “Are you the doctor?” They get optometrist, and optician mixed up! So I tell them that I’m like a pharmacist for glasses since I fill prescriptions.

Yet it really isn’t a true comparison. A pharmacist is told explicitly what to fill for each patient. Pharmacists have no true leeway. Despite the fact that they have to memorize the properties of thousands of drugs and their interactions, their job is actually simpler than ours. Doctors don’t actually tell us what product to sell the patient. They just give us the dioptric powers that will correct their refractive errors. WE have to know our products. And we have so many to choose from!

When I started as an apprentice back in 1983 there weren’t that many options for lenses, and some of the options available then are now antiques. We sold flat tops, executives, round segs, and the Ultex in either glass or plastic. Corrected curve lenses were high tech. Progressive lenses were so new I think there were only three brands!

Now there are hundreds of progressive brands, and free-form technology is changing the industry. We have multiple options for lens materials. There are even new and better ways of taking measurements. All of these options should be things you are familiar with, and it’s up to you to present the right ones to the patient. It’s all in the Rx! When you see it you know what the lenses are going to look like and how they will perform.

As an optician, you know not to fit a -4.00 patient with one of those large wrap sunglass frames. The tag may say it goes from +4.00 to -4.00 but YOU know what the flat bases of those -4.00 lenses are going to do to that lovely parabolic frame curve! YOU also know that a +8.00 base really isn’t a viable option.

You know to check for minimum blank size with a +4.00 Rx and to help the patient choose a frame for which you can order a “knife edge”. You also know to present the aspheric option for better optics and appearance.

When a patient wants a “no-line bifocal” you don’t just sell him any one (or the most expensive one!) You sell him the one best suited to his needs within the price he wants to afford. You look at his old lenses too. If Mrs Smith is wearing a “high end” brand you make sure that your recommendations will match its performance, and you will explain to her why.

Rx Interpretation on your ABO exam

Most apprentice/trainees obsess over mathematics. I never met one that didn’t. And there will be plenty of questions involving both math AND Rx interpretation on your exam (which we will explore in my Part 2 article.) Yet computational questions are actually rather easy and straightforward. Either the answer is right or it isn’t, and there is only ONE right answer. Memorize your formulas and their application, plug in your data, and, providing you don’t make a careless error, you should ace every one!

It is the non-mathematical questions that may actually challenge you more… These are questions which will require you to make a value judgement based upon your understanding of optics and your knowledge of optical products. Some of these will not seem so straight forward, which is actually more realistic since very little in real life is either absolute or straight forward! In real life few solutions are perfect. You do your best with each unique patient problem, and then go on to the next.

These questions may give you an Rx and then a selection of possible product options. In some instances, most of the answers are viable and you have to select the best one. In others, the optimal answer will not be given and you will have to select the best out of a string of not so good answers. Sometimes you will be given some extra patient information such as age, profession, or hobbies that will impact the answer. Some questions, however, will contain patient information that is superfluous. It is up to YOU to figure it out, and there will be some questions that you simply will have to make a guess!

The best way to prepare for questions like this is to do everything you can to KNOW YOUR PRODUCTS and to learn their benefits and limitations. Ask questions on the job. If you are already making sales, analyze each sale and envision a question based upon the patient information and the available products you had to work with.

And take practice tests! There are hundreds of questions in the passyouropticalboards database that will challenge you. You can even read our answer explanations which will explain WHY one choice was the better answer instead of another.

Happy studying, and Pass Your Optical Boards!