#2. If the patient complains of blurred vision or decreased vision, you should ask is the blurred vision for near or distance? If the blurred vision is for reading / sewing then the patient may need reading glasses rather than an operation. A good light for reading / sewing often is useful / helpful.
Recently several patients were referred for cataract surgery that actually needed a refraction and not surgery. PLEASE try not to refer patients for cataract sx. that only need a refraction / glasses. Most patients do well with cataract surgery but it is an operation. There can be complications.
If the cataract isn’t dense ( white / mature ) then a Pin Hole should be done. Many patients do not understand how the Pin Hole works and will simply say “ I don’t see anything.” If the V.A. doesn’t improve with a P.H. test and you are considering cataract referral, then please also do a refraction. It doesn’t take long to show the patient a -0.75 sph, a -1.25 sph., a +0.75 sph., and a + 1.25 sph. That will usually determine if patient can be improved with glasses.
A refraction is a subjective test and you need the patient’s help. With a refraction you really need to talk to the patient. You need to get patient interested in helping you get to the best possible glasses. You need to explain to the patient that each time you are giving them two choices, “which is better” ? “Even if it is not perfect, which is better” ? “Blink a few times” “Keep your head up to the machine but don’t press against the opening”. ”Two choices in the machine, which is better” ”What you tell me is what you get”
You need to carefully evaluate any pt who is being considered for sx. Check IOP’s. Get a hx --- did pt use to see well in that eye? Dilate pupil --- look at disc and macula.
If pt is scheduled for cataract surgery, then need to have a serious discussion with patient and family about what to expect.