Although experiential prescribing maxims are quoted in some optometric textbooks their content varies significantly and no direct research evidence was available to support their use. Accordingly in chapters 2 and 3, the uses of several potential prescribing rules were investigated in the UK optometric profession. Our results indicated that the subjective refraction result exerted a strong hold on the prescribing outcome with 40-85% of optometrists prescribing the subjective result in a variety of scenarios. The finding that after 40 years qualified, experienced optometrists were three times more likely to suggest a partial prescription was an important discovery that provides significant support for the prescribing rules suggested by various authors. It would also appear from the results of the retrospective evaluation of the 'if it ain't broke, don't fix it' clinical maxim in Chapter 4 that spectacle dissatisfaction rates could be reduced by between 22 to 42% depending on how strictly the maxim is interpreted by the practitioner. Certainly an 'if it ain't broke, don't fix it much' maxim was suggested as being particularly appropriate. Chapter 5 included a reanalysis of previously published data that found no change in falls rate after cataract surgery to investigate any influence of refractive correction change and /or visual acuity change on falls rate. Unfortunately these data were not sufficiently powered to provide significant results. In chapter 6, a spectacle adaptation questionnaire (SAQ) was developed and validated using Rasch analysis. Initial studies found no differences in SAQ with gender or age.

Although experiential prescribing maxims are quoted in some optometric textbooks their content varies significantly and no direct research evidence was available to support their use. Accordingly in chapters 2 and 3, the uses of several potential prescribing rules were investigated in the UK optometric profession. Our results indicated that the subjective refraction result exerted a strong hold on the prescribing outcome with 40-85% of optometrists prescribing the subjective result in a variety of scenarios. The finding that after 40 years qualified, experienced optometrists were three times more likely to suggest a partial prescription was an important discovery that provides significant support for the prescribing rules suggested by various authors. It would also appear from the results of the retrospective evaluation of the ¿if it ain¿t broke, don¿t fix it¿ clinical maxim in Chapter 4 that spectacle dissatisfaction rates could be reduced by between 22 to 42% depending on how strictly the maxim is interpreted by the practitioner. Certainly an ¿if it ain¿t broke, don¿t fix it much¿ maxim was suggested as being particularly appropriate. Chapter 5 included a reanalysis of previously published data that found no change in falls rate after cataract surgery to investigate any influence of refractive correction change and /or visual acuity change on falls rate. Unfortunately these data were not sufficiently powered to provide significant results. In chapter 6, a spectacle adaptation questionnaire (SAQ) was developed and validated using Rasch analysis. Initial studies found no differences in SAQ with gender or age. / College of Optometrists

No / Purpose:¿ A follow up study to investigate whether UK optometrists partially prescribe significant changes in refractive correction to assist patient adaption and whether various aspects of practitioner profiles are linked to the nature of these prescribing decisions. Method:¿ A case scenario type questionnaire was distributed by post and via the internet to UK optometrists. Five case scenarios were described that included information on patient age, symptoms, habitual refractive correction (if any), subjective refraction and any other relevant clinical information. In each case respondents were asked to indicate and justify what refractive correction they would prescribe. Results:¿ A total of 592 questionnaires were completed. Between 41% and 84% prescribed the subjective refraction result depending on the scenario. The likelihood of partial prescribing increased by 34% for every 10 years following qualification and thus after a typical 40 year career, respondents were now over three times more likely to partially prescribe. There were no other links with the propensity to partially prescribe. Conclusion:¿ The subjective refraction result exerted a strong hold on the reported prescribing outcome, particularly for newly qualified optometrists. Partial prescribing was increasingly proposed the greater the number of years the respondent had been qualified. This suggests that with increasing exposure to patients who return dissatisfied with their spectacles, a greater appreciation of partial prescribing is gained. This link seems to be an important finding that provides significant support for the prescribing rules suggested by textbooks, which are not yet supported by research evidence.