Howell-Duffy Chris, Hrynchak Patricia K, Irving Elizabeth L, Mouat Graham S V, Elliott David B
School of Optometry and Vision Science, University of Bradford, Bradford, West Yorkshire, United Kingdom.
Optom Vis Sci. 2012 Jan;89(1):105-11. doi: 10.1097/OPX.0b013e31823b0073.
A significant number of patients return to optometric practice dissatisfied with their spectacles. An important question is whether any of these cases are preventable. There are several different clinical maxims that are used to modify the subjective refraction when determining the refractive prescription. These maxims aim to improve patient comfort and adaptation and thereby reduce patient dissatisfaction with new spectacles. They are not based on research evidence, but rather on expert opinion gained from clinical experience. The aim of this study was to retrospectively analyze a large number of case records of dissatisfied patients to assess the possible usefulness of the prescribing maxim "if it ain't broke, don't fix it."
Three hundred eighteen non-tolerance cases from a university-based Canadian optometric clinic were categorized by a focus group of optometrists. Three prescribing categories were defined and comprised cases in which application of the proposed maxim may have prevented the recheck eye examination; a more limited application of the maxim for one working distance may have been appropriate; and finally scenarios in which the maxim did not work in that the practitioner was judged to have initially followed the maxim, yet patient dissatisfaction was still reported. The remaining unallocated records comprised prescribing situations outside the scope of this study.
Approximately 32% of non-tolerance cases were judged to have been preventable by use of the proposed maxim. Furthermore, an additional 10% reduction in recheck cases may have been possible by a more liberal interpretation of the maxim. Conversely, 4% of cases were deemed to comprise scenarios in which the maxim was followed yet the patient returned later to report problems with their spectacles.
The prescribing maxim "if it ain't broke, don't fix it" appears to have a role in reducing recheck eye examinations and improving patient satisfaction with new spectacles.
相当一部分患者对验光配镜后所配眼镜不满意而重返验光诊所。一个重要的问题是这些情况是否都可以预防。在确定屈光处方时，有几种不同的临床准则用于调整主观验光结果。这些准则旨在提高患者的舒适度和适应性，从而减少患者对新眼镜的不满。它们并非基于研究证据，而是基于临床经验所得的专家意见。本研究的目的是回顾性分析大量不满意患者的病例记录，以评估“没坏就别修”这一配镜准则的潜在效用。
加拿大一家大学验光诊所的318例不耐受病例由一组验光师进行分类。定义了三种配镜类别，包括应用该准则可能避免复查验光的病例；该准则在一个工作距离上更有限的应用可能是合适的病例；以及最后一种情况，即从业者最初被判定遵循了该准则，但患者仍报告不满意，表明该准则不起作用的病例。其余未分配的记录包括本研究范围之外的配镜情况。
约32%的不耐受病例被判定可通过应用该准则预防。此外，对该准则更宽松的解释可能使复查病例再减少10%。相反，4%的病例被认为属于遵循了该准则但患者后来仍回来报告眼镜问题的情况。
“没坏就别修”这一配镜准则似乎在减少复查验光和提高患者对新眼镜的满意度方面发挥作用。
