The College of Optometrists

For case records, is it necessary to include binocular balancing and binocular add for everyone even if this didnt change??!!!

Yes reccord that you did it and that there was no change

YES

If pt returns for a recheck how will you know you did it? More importantly if pt returns to someone else for a recheck, how will they know that you did it?

Having worked as a locum I have variously come accross people who record their refraction, then alter after balancing, people who only record the final Rx after balancing, but may not write how much was accepted by either eye,people who seem not to have balanced at all, and various other combinations.

If you found no change simply record that fact on the record card, and there is then no doubt.

i would stop balancing at 65yrs old since lack of acc, does that sound reasonable?!

from davis elliots book, "clinical procedures in primary eye care" he has suggested performing balancing up to the age of 55. However, does anyone know for what age they would stop performing binocular add?

I only do binocular add in patients where i suspect they have not relaxed accommodation sufficiently, usually because they accept less plus subjectively than on ret. This usually happens in kids, but occasionally in older uncorrected hypermetropes. I have never come accross it in a patient over 45, and very rarely in those over 35.

Lisa

in my view, your record card should show an auditable trail of what you did and what happened. So everything must be written down, including nil results. You can do this most easily by writnig small and neat, scrawl tends to run out of room and is slower. Assume the reader is a raw beginer and lead him/her through what you did and you can't go wrong. Ditto for the advice, include in your advice health and saftey warnings and also a fallback plan incase needed. eg - varifoc's, but if intol try 2 pairs.

Bino ballancing is a worthwhile technique at any age as most times all you are doing is balancing blur circles and depths of focus - and nothing to do with accom. If both eyes have the same depth of focus and depth of field - then the reading focus will also match - this is important for vari's. Just a thought: palfi :-)