Since I’m sick of reading about all off the “massive” prescription changes patients post on here only to find out they’re 0.25D different, docs, what’s the biggest rx change you’ve seen?

I saw a 50M PL OU go to +6.00 OU from uncontrolled diabetes. I just gave him some +6.00 reading glasses until he got it controlled and went back to PL.

More recently saw a 30M with a +2.00 hyperopic shift in one eye while still 20/20, so I checked his retina and sure enough, big ol' CSR (thankfully not a tumor). Again, I told the patient we're waiting on new glasses to see if it resolves, either without or maybe eventually with treatment.

Oh, and not really a change, but had a kid who was -1.00 OU on A/R but 20/20 sc. So I'm thinking maybe some over-accommodated latent hyperopia. Drop tropicamide, wait 30 minutes, kid is at -0.50 on A/R but still giving weird subjective refractive results, so drop cyclo, wait 30 minutes, and the kid is a +5.00 OU.

Had some other rather large changes with cataracts, maybe +/-5.00 D, but once the cataract is bad enough to do that, I think they've all been sent out for surgery rather than getting new glasses.

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