Analysis of readymade readers and near–inter-pupillary distance for presbyopic patients in optometric practice in Cape Town, South Africa

Abstract

Purpose and background: This study has particular significance in ophthalmic dispensing as well as for optometry when considering the use of readymade readers (RMRs) both in private practice and in the public health sector. This study investigated firstly whether the optical centre (OC) distance for a sample of RMRs correlates with the near–inter-pupillary distance (near-IPD) for presbyopic patients, whether induced prism occurs with convergence when reading and whether RMR lenses are free of optical strain. Methods: Near-IPDs (measured by a single individual) were obtained from record cards of 1080 patients (540 male patients and 540 female patients). The OC distances were determined for 60 RMRs using a Nikon PL-2 screen vertometer, and induced prismatic effects were calculated for vertical and horizontal meridians. The presence of optical strain was analysed and graded using crossed polarised filters (within a polariscope). Results: The measured average near-IPD was 59.04 mm (s.d. ±2.87) for the 540 female patients and 61.59 mm (s.d. ±3.08) for the 540 male patients. The measured average RMR OC distance was 64.49 mm (s.d. ±3.74) for female patients and 62.77 mm (s.d. ±1.57) for male patients. Based on the mean near-IPD and the corresponding RMR OC distance, the average horizontal prismatic effect found in RMRs designed for female patients with induced prism was 0.11 pd base-out (5.06 mm outwards) and 0.04 pd base-in (1.26 mm inwards). For male RMRs, this was 0.03 pd base-out (1.32 mm outwards) and 0.02 pd base-in (1.28 mm inwards). When comparing RMR distances with near-IPDs, t = -7.87, p < 0.001 for female patients and t = -3.69, p < 0.001 for male patients. The average vertical differential prismatic effect for female patients was 0.67 pd and it was 0.68 pd for male patients. Optical strain was observed in 66.67% and 56.67% of RMR lenses for female and male patients, respectively. The strain pattern was found to be most severe in the inferior temporal periphery for 34 RMRs for female patients and for 20 RMRs for male patients, followed by the inferior nasal periphery for 27 and 18 lenses (RMRs) for male and female patients, respectively. Conclusion: Most RMRs were found to be within international standard tolerances for horizontally induced prismatic effects, but 10% of female and 36.67% of male RMRs had vertical prismatic effects, which exceeded international standards. Significant optical strain was found in the inferior nasal reading portion of the RMRs. Keywords: Readymade readers (RMR’s); prismatic effect; strain; interpupillary distance; presbyopia; reading