Distance visual acuity was not found to be a useful predictor of participant preference to a new prescription and is likely over-relied upon in practice. The results of a recent retrospective study support the adjustment of the subjective prescription where appropriate to aid patient adaptation and comfort, according to the researchers.
Although clinicians usually prescribe for best visual acuity, for some patients, a partial change is prescribed to ease adaptation, despite providing suboptimal visual acuity. This study was designed to determine which factors predict patient preference between spectacle prescriptions by using a retrospective analysis to compare ease of adaptation, subjective quality of distance vision and optimal distance visual acuity. The factors predicting patient acceptance of a new spectacle prescription must be determined to make optimal prescribing decisions, the researchers explained.
The study used a 196-patient data set in which participants wore 2 prescriptions, 1 based on the subjective refraction of an optometrist modified by judgement and 1 on autorefractor results modified for ease of adaptation by an algorithm. Spectacles were worn for 3 weeks each, and participants responded to questions about which prescription they preferred and their quality of distance vision and ease of adaptation (on a 0-10 scale) with each prescription. A logistic regression analyzed which variables predicted whether participants responded yes or no to the question, “If you had purchased these spectacles for $100 (US$200 adjusted to 2023 value), would you be happy with them?”
The results demonstrated a significant difference between the preferred and non-preferred prescriptions for the subjective quality of distance vision rating (medians 9 vs 8; Z = -7.80, P < 0.0001) and ease of adaptation rating (medians 8 vs 5; Z = -8.32, P < 0.0001) but the distance binocular visual acuity was not significantly different (both means = -0.09 logMAR; Z = -0.60, P = 0.55). Overall, 94% preferred the prescription that was easier to adapt to, but only 59% preferred the prescription with better subjective quality of distance vision and best visual acuity.
Reference
Hughes AR, Bullimore M, Elliott D. “Ease of adaptation” predicts preferred spectacle prescriptions better than visual acuity: a retrospective analysis. Clin Exp Optom. 2024 Jan 18:1-8. doi:10.1080/08164622.2024.2304060
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