What full‑time spectacle prescription should be given for a patient with a refraction of +2.25 – 1.75 × 135 in the right eye (OD) and +2.50 – 1.25 × 125 in the left eye (OS), with no near addition (ADD 0.00 D)?

Spectacle Prescription for Hyperopic Astigmatism Without Presbyopia

The full spectacle prescription should be OD: +2.25 – 1.75 × 135 and OS: +2.50 – 1.25 × 125, with no near addition (ADD 0.00 D), prescribing the full measured refraction for this hyperopic astigmatic patient. 1

Rationale for Full Correction

For adult patients with hyperopia and astigmatism who are not presbyopic, full correction of the measured refraction is the standard approach to optimize distance vision and minimize accommodative demand. 1

• The American Academy of Ophthalmology's 2023 Refractive Errors Preferred Practice Pattern states that full correction may not always be necessary for hyperopia in younger patients due to physiologic accommodative tone, but as patients age, full correction becomes necessary to provide optimal distance vision and minimize difficulties with near vision 1
• For astigmatism, full cylindrical correction should be prescribed, though adults may not accept full correction if this is their first pair of eyeglasses or if their astigmatism has been only partially corrected previously 1
• In this case, with moderate hyperopia (+2.25 D and +2.50 D) and moderate astigmatism (1.75 D and 1.25 D), full correction is warranted to prevent asthenopic symptoms and optimize visual function 1

Key Considerations for This Prescription

Anisometropia Assessment

• The spherical equivalent difference between the two eyes is minimal (OD: +1.375 D vs OS: +1.875 D = 0.50 D difference), well within the tolerable range 1
• The majority of adults can tolerate up to 3.00 D of difference in eyeglass refractive correction between the two eyes, so this patient should have no difficulty with aniseikonia or induced vertical prism 1

Astigmatic Axis Considerations

• The cylinder axes differ by only 10 degrees (135° vs 125°), which is clinically insignificant and should not cause adaptation issues 1
• Substantial changes in axis or power are not well tolerated, but this represents the baseline prescription, so no adaptation concerns exist 1

No Near Addition Required

• With ADD 0.00 D specified, this patient is not presbyopic and requires only distance correction 1
• Individuals with hyperopia must exert more accommodative effort when using eyeglasses than contact lenses, but full distance correction actually reduces total accommodative demand for near tasks 1

Critical Pitfalls to Avoid

• Do not undercorrect the hyperopia in an attempt to reduce accommodative demand; this strategy is counterproductive and will lead to asthenopic symptoms and blurred distance vision 1
• Do not reduce the cylinder power without clinical justification; while partial cylindrical correction is sometimes used for first-time wearers, there is no indication in this case to deviate from full correction 1
• Ensure proper vertex distance and centration during dispensing, as these factors are especially important in patients with moderate refractive errors to avoid induced prism effects and optical aberrations 1
• Verify that refraction was performed with accommodation relaxed using fogging techniques or cycloplegia if needed, to avoid over-minusing 1, 2

Prescription Format

The final spectacle prescription should be written as:

OD: +2.25 – 1.75 × 135
OS: +2.50 – 1.25 × 125
ADD: 0.00 D (or no ADD specified)

This represents the full measured refraction and provides optimal distance visual acuity while minimizing accommodative strain for this non-presbyopic hyperopic astigmatic patient. 1