The College of Optometrists

Does anyone know whether you are supposed to do binocular addition on everyone or just after binocular balancing? I realise that you are doing it to find the maximum plus to relax accommodation, so would it not make sense to just do it on those that still have some accommodation?

yes. 'pushing plus' is okay on those with accom and larger but for elderly with no accom and small pupils you will be adding plus into a large depth of focus only (this can cause distortions and other problems).

If you are doing a good job - then when you do monoc accom range - it should be the same for both eyes (as will hte add needed).

I am not mad on pushing plus - I can't see what is wrong with being a bit minusy myself. Try experimenting.

Also you can ask college library for a suitable book of ideas.

I would agree. I did not give do binocular plus in routine exam on pre-presbyope, as there was no indication to do so, and this was not mentioned by examiners. I would generally only try to give binoc. plus if I felt Pt had not accepted full correction during refraction, eg. if more plus had been found on ret than subjective.

Lisa

a couple of months ago I wrote on pqetalk an answer to this giving my routine and people found this interesting. It maybe worth a read.