Breaking News in the Great Glasses Court Case [Archive]

Golfnorth

10-30-2006, 04:27 PM

Business owner lied under oath, court told

By Steve Buist
The Hamilton Spectator
(Oct 26, 2006)
The man behind southern Ontario's Great Glasses empire was repeatedly portrayed yesterday as a liar incapable of telling the truth during the opening day of a rare contempt case being heard in a Hamilton courtroom.
Bruce Bergez, of Dundas, is facing a possible fine of at least $4 million if he's found guilty in a civil contempt of court action that has been launched by the College of Optometrists of Ontario.
The College of Optometrists is alleging that Bergez and the Great Glasses stores have been violating an earlier court decision from 2003 that ordered the chain to comply with Ontario legislation that governs opticians, optometrists and physicians with respect to prescribing and dispensing eye glasses and contact lenses.
The college alleges that Great Glasses stores are preparing eye glasses and contacts without proper prescriptions from an optometrist or physician, and then dispensing them to customers without the proper supervision of an optician.
The Great Glasses chain, which has five stores in Hamilton and two in Burlington, is widely known for its "3 for 1" glasses promotion, as well as the offer of a free eye test for customers with no appointment necessary.
Roy Stephenson, the lawyer representing the College of Optometrists, spent the day attacking dozens of inconsistencies contained in three separate examinations under oath he conducted with Bergez earlier this year as he attempted to uncover how the Great Glasses empire operated.
The third examination had been ordered by the court with Bergez facing the threat of imprisonment if he didn't answer dozens of questions from the College of Optometrists.
"(Bergez) lies under oath, he lies in affidavits and I'm going to ask the court to find that he's fabricated documentation," Stephenson said.
"He's arrogant, he doesn't believe in authority and he's making millions of dollars doing it," Stephenson added.
Stephenson told Superior Court Justice David Crane that it took three examinations of Bergez and two court orders before he finally got some insight into how money flowed through the Great Glasses' franchises.
It wasn't until the third examination that Bergez revealed that the owner of Great Glasses' parent company was a "Buster Kafer."
Stephenson told the court that Buster Kafer didn't actually exist and that the name was simply an amalgamation of Bergez's dog's name, plus his mother's maiden name.
At one point, Stephenson pointed out that franchise agreements for the Great Glasses locations had all been signed "by Buster Kafer, which is astonishing because I didn't know that dogs could write.
"I guess this one can," Stephenson added wryly.
The case continues today.
sbuist@thespec.com (http://by114fd.bay114.hotmail.msn.com/cgi-bin/compose?mailto=1&msg=EA82AE90-8BCF-4377-9D20-88D2CCACD7CE&start=0&len=18683&src=&type=x&to=sbuist@thespec.com&cc=&bcc=&subject=&body=&curmbox=00000000-0000-0000-0000-000000000001&a=395c77133e719b5167f00fcdd1e7dfccbb0bc14ec10a03a8d340714782 aa46d8)
905-526-3226

mike.elmes

10-30-2006, 06:02 PM

Golfnorth

10-30-2006, 10:03 PM

http://www.hamiltonspectator.com/NASApp/cs/ContentServer?pagename=hamilton/Layout/Article_Type1&call_pageid=1014656316146&c=Article&cid=1161899444694

This is from the day after.....and NO decision has been made.
Thanks Mike......I am one of the many who are hoping to see justice done in this case.

Regards,
Golfnorth

Gary

10-30-2006, 11:03 PM

Thanks Mike......I am one of the many who are hoping to see justice done in this case.

Regards,
Golfnorth

I would like to suggest that those interested read the judges decision for a different viewpoint of some things:

http://www.canlii.org/on/cas/onsc/2003/2003onsc11255.html

http://www.canlii.org/on/cas/onsc/2003/2003onsc11137.html

I am not defending any of the various parties involved only suggesting that to fully understand what is happening may require more research and these are public documents that perhaps will increase each of our knowledges about the issues .

mike.elmes

11-01-2006, 12:08 PM

Check out the Oh Brother thread for more on the great glasses Debacle.

Golfnorth

11-07-2006, 08:53 PM

More Trouble for Great Glasses

10 Great Glasses sites facing WSIB charges

http://images.torstardigital.com/DART/ads/CMG/HamiltonSpectator/Spec_goathome300x250.jpg (http://ads.thestar.com/event.ng/Type=click&FlightID=9999&AdID=15996&TargetID=2529&Segments=2646,2664,2668,3649&Targets=3198,2529&Values=25,31,43,51,60,82,92,100,110,150,160,230,284,342,372, 374,375,428,440,448,577,579,6149,6177,6265,6278,6375,6396,63 98,6438,6442,6443,6444,6656,6667,6677,6679,6681,6841&RawValues=&Redirect=http://www.hamiltonspectator.com/NASApp/cs/ContentServer%3Fpagename%3Dhamilton/Render%26c%3DPage%26cid%3D1112188062650%23go_at_home) http://ads.thestar.com/image.ng/site=citymediagroup&VChannel=hamiltonspectator&SubChannel=news&position=bigbox&HChannel=news?GXHC_gx_session_id_=dc326ab4bfb411e0& (http://ads.thestar.com/click.ng/site=citymediagroup&VChannel=hamiltonspectator&SubChannel=news&position=bigbox&HChannel=news?GXHC_gx_session_id_=dc326ab4bfb411e0&)By Steve Buist
The Hamilton Spectator
(Nov 1, 2006) The operators of 10 Great Glasses locations throughout the Golden Horseshoe are facing a total of 38 charges laid under the province's Workplace Safety and Insurance Act.
The charges, laid against a variety of individuals and corporations, are related to either failing to register with the Workplace Safety and Insurance Board within 10 days of becoming an employer, or failing to file payroll statements with the WSIB.
The key issue revolves around the remittances employers have to make to WSIB for employees.
Great Glasses franchises have taken the position that they do not have employees but instead are staffed by independent contractors.
Eight of the WSIB charges were laid against operators of Great Glasses franchises in Hamilton, Burlington, St. Catharines, Cambridge, Brampton and Thornhill.
Fifteen of the charges were laid against three corporations that are associated with the three original Great Glasses locations in Hamilton and Burlington and another 15 were laid against Joanne Bergez, who is a director of the three corporations.
Joanne Bergez is the spouse of Bruce Bergez, the man who built the Great Glasses empire in southern Ontario.
The Bergezes and the three corporations are facing a possible fine of $5 million if they are found guilty in a separate contempt of court case that was brought by the College of Optometrists. A decision is pending in the contempt case.
The college is alleging that the Bergezes and the three corporations have been violating an earlier court decision from 2003 that ordered the chain to comply with Ontario legislation that governs opticians, optometrists and physicians.
The Great Glasses operators indicated through Bruce Bergez that they would not comment on the WSIB charges.
"They all request that we make no comment at this time, other than to state that each defendant awaits the full trial of the issues in order to utilize the courts to acquit themselves," said Bergez, who is acting as spokesman for the group.
If convicted under the Workplace Safety and Insurance Act, the maximum penalty against individuals is a $25,000 fine and up to six months in jail for each charge.
For corporations, the maximum penalty is a fine of $100,000 per charge.
sbuist@thespec.com (sbuist@thespec.com?GXHC_gx_session_id_=dc326ab4bfb411e0&)
905-526-3226

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Ory

11-19-2006, 10:41 PM

Interim Suspension

On November 16, 2006, the certificate of registration of Bruce Bergez R.O. C-1192 was suspended by order of the Executive Committee under section 37 of the Health Professions Procedural Code. The suspension is effective immediately and will remain in place until the matter of the allegations of professional misconduct against Mr. Bergez are disposed of by a panel of the Discipline Committee of the College.

From COO (http://www.coptont.org/current/current.html)

mike.elmes

11-20-2006, 12:05 AM

Ory

11-20-2006, 09:28 AM

Gary

11-20-2006, 09:23 PM

My understanding is that he is the only license. His mindset is that he can delegate his authority based on his instruction booklet given to each store. Any calls to the chain asking to speak with an optician are deflected.

I agree this will not affect their operation. His license was suspended last year sometime and I don't think it affected the stores.

If his is the only license , and that license is suspended then does it not follow that the delegation (asuming it was legal )for each store is also now suspended ? If that is the case then each and every store is now in violation . What am I missing here ? Why are the stores operating ? Are the stores still operating ?

mike.elmes

11-20-2006, 10:31 PM

If his is the only license , and that license is suspended then does it not follow that the delegation (asuming it was legal )for each store is also now suspended ? If that is the case then each and every store is now in violation . What am I missing here ? Why are the stores operating ? Are the stores still operating ?There is no trying to make sense of any of what has been allowed to go on with this company. I'm sure they are business as usual until a sherriff paddle locks the doors, which hasn't happened yet.

Dave Nelson

11-21-2006, 10:47 AM

it stands to reason that, with his license suspended, the delegation is suspended. Delegation is an extension of a license, therefore, no license, no delegation. I guess there are bigger fish to fry first.

muucow

11-30-2006, 12:54 PM

So yes a verdict was laid... but 1 mill? That is pocket change to this guy.
I was at the court case last month and it took a lot to just sit there.
I have strong passion for my profession and it really irritates me to see this guy abuse the system. Not to mention the stupid franchise owners who are operating their stores and listen to him. What is this some kind of cult???
I am trying not to get excited about this because I know he will appeal and when he does we are back to square one. The stores are operating as normal 3 days later - so what did it change??? nothing yet. Feel free to contact me if you would like me to add you to a list for information. I am in contact with the Hamilton Spectator and others for details.
I have also spoken to insurance companies who will now go after him for insurance fraud.
Rx's can only be done by an professional for it to qualify for insurance AND a licenced optician can only sign those forms. As of now Bruce Bergez is NOT as optician as his license was revoked.

Oedema

11-30-2006, 03:51 PM

I am trying not to get excited about this because I know he will appeal and when he does we are back to square one.

He may appeal, but I feel quite surely that the next court of appeal will simply review the transcripts and reject his petition. This is a pretty open and shut matter, in 2003 Burgez was ordered to comply with the RHPA, to my knowledge there has not been an apply to this decision, and now due to his beligerence Mr. Bergez has been found to be in contempt of the original 2003 decision. What is he going to do, try to prove that he has in fact been in compliance with the RHPA for the past three years, three years in which he openly violated the RHPA, claiming to serve the public interest with free eye exams? Even if he managed to single handedly change the scope of practice, as he seems to be telling reporters, he still has a one million dollar fine to pay.

His appeal is not going to get very far, and when it is rejected he has three choices; pay up, serve the time, or go into hidding.

Gary

11-30-2006, 04:33 PM

]]

muucow

11-30-2006, 10:40 PM

Well I took the time to actually call a Great Glasses location today. They are open but admitted to not performing eye exams anymore. I pretended to be a past client and asked if there are opticians in the store at this time. The little girl told me that no we have technitions I asked her again... She again repeated and said we are not doing eye exams and therefore only require technitions. Then I said that I had spoke with the College of Opticians and they said you need opticians. Then I asked if they would also be selling drugs soon as an add on sale because seeing as they are already illegal they may as well get commision for bonus items.
I have also contacted radio and newspapers asking to pull their ads and have sent the copy of the article in the paper to anyone I could think of.
Guess it is time to take matters into my own hands.
The college person involved is away until Monday.
And Gary.... It's always noon somewhere......

Caddy

11-30-2006, 10:47 PM

When people fall in love with money, they can fool themselves into believing they are fighting a just war. Bergez is a dangerous man.

Ory

12-03-2006, 11:00 PM

A fax from Bergez himself:

http://www.haltonsearch.com/hr/ob/story/3799615p-4394751c.html

Great Glasses founder says ruling gives monopoly to optometrists

Dec 2, 2006

The Oakville Beaver contacted the Great Glasses 220 North Service Rd. location for comment on the recent court decision. One of the store's managers faxed the newspaper the following statement prepared by Bruce Bergez, the founder of the Great Glasses chain.

* * *
Thank you for your interest in this exceptional story.
As a result of Justice Crane's order, Great Glasses has been restricted from using new technology in the form of the Eyelogic Sight Testing System to do an eyetest for the purposes of assisting people to buy glasses.
The ultimate result of this is that a monopoly has now been created by The College of Optometrists of Ontario as the virtual sole provider of eyetests for eyeglasses and contact lenses.
It is widely known that only a limited number of physicians provide eyetests for eyeglasses and contact lenses, as the College of Physicians and Surgeons directs their members to stay within their chosen scope of practice.
Hence, optometrists now have an exclusive monopoly on the scope of practice of eyetesting for eyeglasses.
The use of the courts to obtain this monopoly abrogates fully the intent of the Regulated Health Professions Act (RHPA). These comments have been stated about the RHPA;
The RHPA was widely regarded as ground-breaking legislation.
The RHPA replaces exclusive scopes of practice.
One of the central concepts of the RHPA is the replacement of monopolistic or exclusive scopes of practice.
People who use health services are the primary intended beneficiaries of the RHPA and thus it was intended that the RHPA, unlike the previous regulatory statute, would not unnecessarily limit consumer freedom of choice.
The dispensing function for eyeglasses should be regulated consistently and provide no advantage, however slight, to one profession over another.
There is no justification for establishing an uneven playing field whereby only one profession can be in the business of both prescribing and dispensing eyewear products.
That the right of individuals is to obtain services from the health professions of their choice.
We should encourage flexibility and encourage innovation in the provision of health services and allow professions to evolve as technology changes.
What the College of Optometrists have imposed on the citizenry of Ontario is a reversal of years of effort on behalf of the Ontario Government and effectively forced everyone to buy an eyetest from them, at a cost of $80 to $100, when there is a safe, reliable, computerized alternative available to the public. When OHIP was paying optometrists for eyetests, the Government valued this service at $40. For years it has been done for free. How do you explain the increase that the average optometrist now charges to the citizens of Ontario? What will your cost be now that a monopoly has re-emerged?
If I had the opportunity to properly elaborate on this subject, I could show you compelling evidence that the Ontario Government would have wanted the outcome to be different.
The Ontario Government wants the consumer to have a choice in health services, and the Ontario Government wants to reduce the cost of health care to its citizens, including making the purchase of eyeglasses more affordable. This is what the Ontario Government means when they mandate that the College work in the public interest.
From time to time, technologies do emerge that change industries. Would you, as a reporter, want to revert back to a day of the typewriter versus using your word processor?
Great Glasses has always acted in the interests of the public, providing free eye tests, doing so seven days a week for your convenience, not requiring you to wait for an appointment, and offering three pairs of glasses for the price your optometrist charges you for one pair.
Great Glasses still feels that an eyetest is a service you ought to have done for free, as an act of corporate benevolence. Great Glasses will be reimbursing everyone the cost of the future eyetest when you purchase eyeglasses from Great Glasses.
Great Glasses will also be appealing the decision. Great Glasses will conform to the order.
The appeal process must be respected.
Thank you for your interest.
Bruce Bergez

Oedema

12-04-2006, 09:22 AM

http://www.hamiltonspectator.com/NASApp/cs/ContentServer?pagename=hamilton/Layout/Article_Type1&c=Article&cid=1165187409483&call_pageid=1020420665036&col=1014656511815

Is Great Glasses obeying the law?Yes, says the boss. No, says College of Opticians of Ontario

By Steve Buist
The Hamilton Spectator
(Dec 4, 2006) The founder of the Great Glasses chain says his stores are complying with two court orders in the wake of a record $1 million fine imposed for civil contempt.
Bruce Bergez, a Dundas optician, said Great Glasses stores are no longer filling prescriptions for eyeglasses based on eye tests conducted on a computerized machine. Bergez also said stores have posted notices that customers must have a proper prescription from an optometrist or physician.
Bergez, his wife Joanne, and three related corporations were fined $1 million for blatantly violating a 2003 court order that required Bergez and the Great Glasses stores to comply with Ontario legislation that governs the prescribing and dispensing of eyeglasses and contact lenses.
Superior Court Justice David Crane also ruled that Bergez will be fined $50,000 for each day from now on that Great Glasses stores aren't in compliance with the judgment.
"We are abiding by the order," said Bergez.
But the College of Opticians of Ontario disagrees with Bergez's claim that he is complying with the order.
The college believes that Bergez and the chain are in violation of the order because there isn't an optician on duty at each Great Glasses store to dispense eye glasses and contacts.
Bergez has taken the position that opticians in Ontario are allowed to delegate their authority to dispense to anyone, even if the optician isn't on site.
"It is not acceptable for delegation to occur without an optician present on site and able to intervene," said Cathi Mietkiewicz, president of the College of Opticians.
"The delegation policies that we have in place are enforceable and they are expected to be followed by the profession, and it is professional misconduct not to follow those policies," she added.
"In my view, he is not in compliance with the order."
Mietkiewicz said the college is prepared to go back before the judge to enforce compliance.
Bergez said there's nothing in the legislation that prevents an optician from delegating the authority to dispense.
"There is absolutely no limitation whatsoever under the eyes of the law (on the right to delegate)," said Bergez. "There are no limitations within the law telling you that you need to be on site.
"What they're trying to do is rewrite the legislation using policy statements and then forcing it on their members," he added.
Bergez has been suspended from practising as an optician since Nov. 16, until the college's discipline committee deals with allegations he committed professional misconduct.
Bergez said the Great Glasses chain has hired "a few opticians" in the wake of his suspension, and they are also delegating their authority to dispense.

Oedema

12-04-2006, 09:27 AM

"It is not acceptable for delegation to occur without an optician present on site and able to intervene," said Cathi Mietkiewicz, president of the College of Opticians."

Interesting, the college does not allow opticians to delegate to off-site staff, but it is acceptable in their view for an optician to independently refract under the delegation of an off-site physician? Whats the rationale here?

muucow

12-04-2006, 11:43 AM

So has anyone besides me tried contacting the College? I have had no response so far and I have offered my services to volunteer as an inspector. Are we allowed to start protesting outside the malls that have a GGlasses store? Is anyone else as frustrated as I am about this.....
I AM WILLING TO HELP THE COLLEGE TO STOP THIS MADDNESS!!!!!
But I can't sit here while I still loose clients to an illegal operation?!?!?!

:drop: any thoughts people????

DrummerBoy

12-04-2006, 01:36 PM

I am in the same position that you are. In Ontario you are allowed to picket or protest wherever you want just as long as the signs are truthfull they can't do anything. There is a group of Opticians an Optometrists that are going to launch a lawsuit for loss of business. They are going to target the individual owners of a store in each town.

One of my employees hands out the article that Steve Buist wrote to the customers as they walk into the Great Glasses store in our town. She also puts it on the windshields of the cars in the parking lot.

Gary

12-04-2006, 02:31 PM

[]

Excalibur

12-05-2006, 12:12 PM

the judge's comments in his decision are far more damning. Take some quotes from the judge's decision and put it on a 1 page sheet that can be handed out. That would probably have a greater effect in getting across your message.

mike.elmes

12-05-2006, 01:03 PM

Interesting, the college does not allow opticians to delegate to off-site staff, but it is acceptable in their view for an optician to independently refract under the delegation of an off-site physician? Whats the rationale here?
It has more to do with the Physicians scope of practice guidelines within the health professions act. Ophthalmologists are not allowed to do remote refractions is my understanding of the situation in Ontario. Secondarily, Ontario's College of Opticians has not expanded its scope of practice to include refracting, as is the case in Alberta. I'm not sure what the status is in BC.

Oedema

12-05-2006, 02:54 PM

It has more to do with the Physicians scope of practice guidelines within the health professions act. Ophthalmologists are not allowed to do remote refractions is my understanding of the situation in Ontario. Secondarily, Ontario's College of Opticians has not expanded its scope of practice to include refracting, as is the case in Alberta. I'm not sure what the status is in BC.

Yes, I am aware that the authority to delegate the controlled act lies with the individual physician, however I'm wondering why the college of opticians takes no stance on members that are involved in the off-site delegation of "eye tests" but strongly objects to delegation of dispensing - even when an RO is on-site. Here's an honest question open for discussion; what carries with it a great potiential for harm, refraction and prescribing of eyewear in the absence of non-refractive data, or dispensing?

Do you know of any source outling ophthalmology's ban on remote refraction? I suppose it would be against the interests of most ophthalmologists to delegate refraction - many do own dispensaries.

From what I've seen in Ontario, opticals that offer "sight-tests" do so with the authorization of a variety of non-ophthal. MD's (ER Physician, Physcial Med &Rehab). The question that arises in my mind then is whether these physicans are adequately trained to prescibe for refractive error? Sure an ER doc sees plenty of eye trauma, and acute disorder, but do they really know what they are doing when they rubber stamp the Rx?:confused:

Also, I think there may be a question of whether the Ontario MD's that delegate refraction to independent RO's are actually authorized by their college to do so (yes I know the RHPA gives physicians access to 12 of the 13 controlled acts, but they must still abide by college regulations). For example, the terms & conditions (http://www.cpso.on.ca/Doctor_Search/terms.asp?Type=ADV&intCurrentPage=1&sNameRefNo=0023311&iCPSO=28102) of the MD supposedly (does anyone know if she consented to this?) used by Great Glasses says that Dr. Trotter (http://www.cpso.on.ca/Doctor_Search/summary.asp?Type=ADV&intCurrentPage=1&sNameRefNo=0023311) "may practise only in the areas of medicine in which DR. TROTTER is educated and experienced." As someone specializing in Physical Medicine and Rehabilitation I'm not sure she would be "educated and experienced" in ophthalmology, but maybe the college uses the phrase lightly. Any opinions?
CPSO: Delegation of Controlled Acts (http://www.cpso.on.ca/Policies/delegation.htm)
CPSO: Requirements When Changing Scope of Practice (http://www.cpso.on.ca/Policies/scope.htm)

Caddy

12-05-2006, 09:14 PM

Here's an honest question open for discussion; what carries with it a great potiential for harm, refraction and prescribing of eyewear in the absence of non-refractive data, or dispensing?Neither. Or both. It depends on what you consider harm. What's the worst that can happen? The wrong prescription in your glasses does not constitute direct harm, in my opinion. Furthermore, prescribing without dispensing is like thinking about swearing at an old lady, without actually saying it to her.

An optician who improperly refracts you for glasses does much less harm than an optometrist who improperly examines your retina.

Excalibur

12-05-2006, 09:34 PM

if you dispense an incorrect rx to a child you run the risk of inducing amblyopia.

Oedema

12-05-2006, 09:58 PM

But what harm, in your opinion, exists in dispensing eyewear? If there is little to no harm in prescribing an inappropriate spectacel Rx, why enforce the delegation of dispensing?

An optician who improperly refracts you for glasses does much less harm than an optometrist who improperly examines your retina.
How do you distinguish true refractive error from a drug toxicity or maybe NIDDM in the absence of physical examination of the eye?

Furthermore, prescribing without dispensing is like thinking about swearing at an old lady, without actually saying it to her.
What?:confused:

Dave Nelson

12-06-2006, 11:58 AM

We differentiate other possible causes of refractive error the same way you do.

DrummerBoy

12-06-2006, 01:07 PM

Well I wouldn't want to be driving on the road with the person that got the wrong prescription.

After all this publicity Great Glasses is getting we have had numerous people coming in saying that they recieved the wrong prescription from them. A lady came in with a pair of glasses from there that she thought were wrong. We tested her eyes and found that they were 1.50 diopters weaker then what they should have been. Not only that they had about 2.5 diopters of vertical imbalance. She was stuck with a bill of $700.00 for three pairs of single vision lenses in dollar store quality frames. Initially she asked for a refund but they wouldn't give her that. She then brought the new prescription to GG and they wouldn't even change it for her.
I have told her that if she wanted to take legal action she should do it not only with Great Glasses but with the College of Opticians for failing to keep the best interest of the public.

Dave Nelson

12-06-2006, 01:28 PM

And did you also tell her to sue the judge who issued a court order against Bergez which was ignored? Also, please omit any reference to wholesale prices, it is against posting guidlines.

Oedema

12-06-2006, 09:08 PM

We differentiate other possible causes of refractive error the same way you do.

Mr. Nelson,

What methods do you use to examine the fundus?

Dave Nelson

12-06-2006, 10:27 PM

sarcasm? Your previous questions have been rather thoughtful and with some insight into the issues raised in this thread. I suppose my previous answer was a bit curt, so maybe the sarcasm is deserved.
You know good and well opticians do not do retinal examinations. You mention possible drug interaction/ toxicity as a possible cause of refractive error, as well as non-insulin dependent diabetes. An eye examination must be about the poorest method in the world to detect diabetes, and a fundus exam to detect type 2 diabetes is a new concept to me. My somewhat limited knowledge of diabetes tells me that in the majority of cases, even incipient diabetic retinopathy is normally seen in those patients who are already aware they have diabetes, and are, or should be, on insulin. Refractive errors caused by pathology are often brought to light only after unusual or unstable refractive changes are noticed. I have seen many cases where an underlying cause of refractive change went unrecognized after a full eye examination, only to be diagnosed later after unusual changes were noted, some by opticians, some by optometrists. I noted, for example, some large hyperopic changes in a 14 year old boy, some time ago, who had just undergone a full eye exam by an optometrist. I referred him, on a priority basis, to his physician with a note of my concerns. That young lad was on insulin within days. I have seen keratoconus and other corneal dystrophies go undiagnosed until unusual refractive changes were noted, and I do not believe the prescribers in all of these cases were incompetent, yet each patient had had a mydriatic fundus examination recently. Clearly, a fundus examination does not detect all, or even most cases where refractive errors or changes have an underlying pathological or toxic causes, and your assertion that opticians are somehow missing a key step in determining an underlying cause for a refractive error is, in my opinion, misplaced.As you are aware, some ocular pathologies are accompanied by a reduction in corrected acuities, and some are not. Optometry has no monopoly on using those, and other tests, to determine the need for referal, often to an ophthalmologist or general pratitioner. In my humble experience, other signs, taken in a broader context,are key to determining underlying causes of refractive errors, such as familial history, best corrected acuities, meds, and other factors, which then may trigger a referal, and very possibly, another fundus examination, and possibly blood sugar testing, which, as you are aware, necessitates yet another referal. I need not make any sarcastic comments about asking how optometrists test blood sugar, any more than your inquiry about how I examine a fundus. I await your inevitable reply.
respectfully,
David Nelson

Oedema

12-07-2006, 01:46 AM

Mr. Nelson,

I’m sorry my reply came across as facetious, perhaps I need to explain where I’m coming from here: I am an optometry student (wasn’t an option when I signed up for this site) in the US, grew up in Canada, and just have a few genuine inquires. While I realize that the vast majority of RO’s do not do retinal exams, there is at least one in Ontario I am aware of, he has a practice with a family practitioner, that routinely picks up the direct o’scope to have a look inside. I guess I was just wonder if that’s what you meant when you stated that opticians make a differential diagnosis in the same way an optometrist does.

You correctly assert that a fundus exam is not the only component needed to determine a probable etiology for a refractive shift – it is but one of many procedures that allows the practitioner to rule out possible diagnoses before prescribing treatment. True, diabetic macular edema may not be very apparent upon inspection, but how will you know unless you look? What if you had a patient present with long standing stable blur, you refract, don’t examine the retina, or iris, dispense and miss neovascularization that proliferates and threatens your patients vision?

A fundus exam in isolation is by no means the sole basis of anyone’s diagnosis of DM, one cannot even make a certain diagnosis based on the results of a blood glucose test. However, a complete eye exam is a very powerful set of procedures, when used collectively will help the astute practitioner find the primary cause of the patients’ complaint. Is it foolproof? No, things do get missed by competent providers, but only by considering all possibilities and ruling them out can you be as sure as one can be that you’re not delaying necessary care. You really don’t know what you don’t know.

Speaking of blood glucose; I will admit I am not entirely aware of which provinces may or may not allow OD’s to use tests strips and a glucose meter (while technically I don’t think this is a controlled act in Ontario?) or order laboratories when indicated, but here in the US OD’s routinely test blood glucose in office and order full labs. Nonetheless, a single blood glucose test while often useful is not the basis of a DM diagnosis, multiple readings are necessary, as is a test of glycosylated hemoglobin (HbA1c) which gives an indication of the blood glucose levels over a period of a few months (not just what you ate for breakfast). The difference here is that OD’s DO want to know what a patients’ blood glucose state is while I’m concerned that opticians flirting with the idea of prescribing are indifferent to non-refractive data.

You are correct to note that many progressive anterior segment diseases will not be detected by a fundus exam, however I don’t accept this as an argument that a fundus exam need not be performed. An emerging keratoconic, unlike a diabetic, need not be detected at the absolute earliest moment – there is no preventative therapy that can be undertaken to help that patient avoid future complications. Sure it would be nice to counsel that patient before the correctable quality of vision is decreased, but RGP / penetrating keratoplasty is not necessary until that time.

You make mention of numerous other variables such as family hx and medications that you can investigate, and claim mitigate the need for physical examination of the eye. I know I may have chagrined you already with my questions, but just out of curiosity what aspects of family and personal health history do you and other RO’s investigate. Do you have a checklist? What are some of the conditions you’re looking out for? Do you screen medications?

I sincerely hope this does not come across as sarcasm, while I do not agree with the principle of sight testing, I am genuinely interested in learning about the position of opicianry in this regard. Sorry about the ridiculously long reply.

Ory

12-07-2006, 09:54 AM

While I'm sure Dave will go into this in more detail, the following is the form that the COBC requires patients to sign before undergoing a "sight test"

I've made my opinions on this clear in the past, I really doubt there's much reason to go into it again other than to say I disagree with the concept.

Client Notice - Automated Refraction (http://www.cobc.ca/pdf/Client%20Notice%20on%20Automated%20Refraction,%20Brochure%20 Format.pdf)

Dave Nelson

12-07-2006, 10:07 AM

I apologize for any misunderstanding about your intent. I take no exception to anyone who disagrees with any thing I have to say. One fundamental principle that keeps being overlooked by optometry in the whole refracting optician debate is this: It is not, was not, and will never will be intended to replace a full eye examination, and was, and is, always intended to be performed as a component of complete eye care, including eye exams. Here in B.C, those under 19 and over 65 are excluded from having an optician performed refractin unless they are directly refered by a prescriber. Your claim that I mitigate the need for an eye health examination is untrue: look at every post I haver ever made, and you will never see me suggesting eye exams are unnecessary. Opticians are eyecare professionals, and have always supported the promotion of ocular health. I know full well the need for periodic fundus and IOP checks, and have seen the effects of delayed diagnosis in glaucoma. We have consulted with ophthalmology every step of the way in this matter, have never excluded optometry from the process, and above all, have given every consideration to the one area of utmost importance: the safety and health of the people we serve. Perhaps the time has arrived for optometry to recognize opticians as health professionals who are capable of some clinical judgement, and stop trying to convince each other that optical store clerks are representitive of opticianry as a whole.
Where are you studying? when do you graduate?
All the best.

pauly47

12-07-2006, 10:56 AM

there is such a great divide in canada esp. in ontario between OD's and opticians...it just seems ridiculous that opticians can't work directly for an OD...is it because the "good 'ol boys" in the Cdn Optometric Assoc, in particular the Ontario assoc want to keep all glasses confined to OD's...why can't they all be friends..if only the assoc would realize that by letting the OD worry about the exam and eye and not so much about how to get the damn screw in the spring hinge, it would better serve the public..there would be no basis for this nutbar at GG to claim that there is a monopoly on eye exams...if OHIP would recognize the ability of OD's to detect, monitor and treat many pathologies there would not be a 1-2 year wait to see an OMD...rant over...go leafs go

Dave Nelson

12-07-2006, 11:09 AM

mapleleafs

12-07-2006, 12:06 PM

Dave,

Please follow this link to read about the numbers of diabetics and pre-diabetics (read as not diabetic by the current definitions of diabetes) that have diabetic retinopathy, either before or at diagnosis of type 2 diabetes. Perhaps a fundus examination may reveal more about diabetes in some cases than blood sugar testing or symptoms.

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3019

Stonegoat

12-07-2006, 03:30 PM

I have been following the discussions regarding sight testing, and find the platform of the opticians who advocate sight testing quite alarming.

As an optometrist I have seen many cases of serious ocular pathology in patients who were asymptomatic and correctable to 20/20. These include glaucoma (~20% of glaucoma patients never have an abnormally high IOP), active toxoplasmosis, melonoma, diabetic retinopathy (several patients were previously undiagnosed and their refraction was similar to the old glasses they brought to the exam), retinal detachments, retinitis pigmentosis, Coat's disease, etc, etc.

I have also seen patients with previously undiagnosed brain tumours.
I have seen a patient with Gardner's syndrome.
Of course many patients with diabetes and HTN.

In the vast majority of these cases, refraction alone would not have detected the condition.

The argument that many opticians make is that they DO think an eye exam is important, but only every 5 years...wow.

When is the last time someone gave you an accurate date of their last exam. Most people underestimate the time since their last exam, so 5 years may really be 7 or 10...who knows.

I have even seen patients who wear glasses from a sight test who have NEVER had an eye exam.

The sight testing issue in BC will be resolved politically. It is interesting to note that that Optometry and the College of Physicians and Surgeons in BC do not condone a refraction in the absence of a thourough eye exam. It is also interesting to note that these are the only groups medically educated.

So sight-testing opticians, go ahead and believe whatever it is you want to believe. I, however, cannot imagine doing a simple refraction and sending my patients out the door....I could not sleep at night.

Later,

JP

Dave Nelson

12-07-2006, 03:38 PM

Thanks for the link. Just this morning I read an article in the Vancouver Province newspaper about a breakthrough in identifying at-risk people for glaucoma coming out of Montreal. I lectured on low vision at the Canada West convention this year, and did a short discussion on the primary causes of visual impairment. I did express some surprise during the lecture about the stats on diabetes which I found on the Health Canada website. We can ill afford to ignore or minimize the threat to vision that diabetes and glaucoma present, and any effort to identify risk factors earlier will certainly have the support of all vision care professionals. Is mydriasis essential to an evaluation for diabetic retinopathy, or at least to detect minute changes in retinal vasculature? Can M.D.s be trained to recognize these changes? Thanks again for the link, mapleleafs.

Ory

12-07-2006, 05:38 PM

The form you show is not the form clients need to sign.

Thanks for the correction. I pulled it off the COBC website under the "sight testing" tab. Do you have a copy of the form patients actually do sign? One you could post or link to?

Gary

12-07-2006, 06:01 PM

[[

Dave Nelson

12-08-2006, 01:40 AM

We need another battle about refraction like we need a hole in the head. As Ory has indicated, everyone seems tired of yet another discussion about optician performed refraction, and starting another thread might be starting another war. The subject is like an alligator pit: put one toe in and suddenly you're dragged in for a bloody fight. Ory, there is a link on the college website for the consent form, but I couldn't get it to work. It may be down since the final document is still being developed. Oedema, good luck on your studies. I would be happy to answer any questions you have about the rather touchy subject of optician-performed refractions, on another thread.
Stonegoat, listing all the eye disease you have diagnosed is kind of redundant. Thats your job. Thats what eye exams are SUPPOSED to do. You SHOULD have trouble sleeping at night if all you did was a refraction. If I were a doctor and saw a patient for a physical examination and only did a blood pressure measurement, I'd have trouble sleeping at night as well. But if I were a pharmicist and helped an elderly person with a blood pressure measurement, and nothing else, I would sleep fine.
As far as seeing a person who had had a sight test and never an eye exam, I point to a B.C. optometrist convicted of bilking the medical services plan. Just because one guy does it, does'nt mean all optometrists do.
Finally, your assertion that the "medically trained" groups in B.C. oppose this initiative, I will leave you with this: the first group to ever suggest opticians seek changes in their scope of practice to include stand-alone refraction was BCEPs: the B.C. Eye Physicians and Surgeons. Yes, thats right. B.C. ophthalmologists put the idea on the table first, and its only fair for me to point out they are indeed "medically trained."

HarryChiling

12-08-2006, 11:29 AM

Thats your job. Thats what eye exams are SUPPOSED to do. You SHOULD have trouble sleeping at night if all you did was a refraction.

You are the man.

I have been following this thread and reading about the whole GG issue and am honestly ashamed of the guy. He sounds like the one bad apple in a bunch. I hope that he and his organization is crucified to the fullest extent of the law, to hopefully make an example. Good luck to those that want to picket and sue.

shawn b

12-08-2006, 04:34 PM

From what I see the issue is quite basic.
Optometrists do not want to loose their profits to opticians who are dispensing based on a computer generated script. :finger:

Opticians however would like to offer residents of Ontario an alternative to a complete eye examination. And as technology progresses these options will become readily accessible, and I think people will demand it. The reasons being:
1) Why pay for an eye examination, when all one really wants is a new pair of glasses or contact lenses? As an adult, in a democratic society, why should I be forced to pay to see clearly? If I choose to only get a new prescription, then why should anyone object? When did my prescription for sight, become part of an examination for my eye? They are two totally separate things.
2) Technology is progressing so quickly, the cost and accuracy of autorefractors is going to change everything. And one cannot logically dispute the consistent accuracy of computers. Machines are far more precise when it comes to measurements, and that is exactly what a prescription for vision is- a measurement.

A great case in point is, should you have to pay for a full physical every time you go to your physician's office? If MDs started lobbying the government for this action, wouldn't everyone stand up against such policy? I am sure even optometrists would complain and argue the validity in such a setup. And even though the doctor might give you medicine for a cold or a cough, they could easily argue that had they done a complete physical they could have attributed those symptoms more precisely to some other underlying physical complication/condition. :eek:

It is a shame that in today's time, we are forced to pay a fee to have crisp vision. Especially when one considers that there is an accurate and free alternative.

I am a firm believer, that when it comes to one's own body, what ever method they choose to correct their own condition is a freedom of choice every adult human has the right to. To force someone to do otherwise is unjust... doesn't matter what your intentions might be.

Great forum.... my regards to everyone who has participated.

mike.elmes

12-08-2006, 05:43 PM

The Ontario optical industry seems all turned around to me. Opticians should be legally allowed to work for Optometrists.....why is that??

Is this true?

Excalibur

12-08-2006, 05:59 PM

Optometrists should not be employed by dispensers for the same reasons physicians should not be located inside pharmacies and employed by pharmacists.

Excalibur

12-08-2006, 06:12 PM

Dave Nelson

12-08-2006, 06:16 PM

Optometrists should not be employed by dispensers for the same reasons physicians should not be located inside pharmacies and employed by pharmacists.
Bad comparison. Doctors are already prohibited from selling the meds they prescribe, but optometrists do make a profit from selling the same eyewear they prescribe.

Excalibur

12-08-2006, 06:18 PM

Indeed. And surgeons often recommend the surgery they may perform.

mike.elmes

12-08-2006, 06:35 PM

Why is it that a lisenced Optician can't work as a dispenser for an Optometrist in Ontario, is it against the Optometric regs or the Opticians regs??

Stonegoat

12-08-2006, 06:58 PM

I think the concern that optometrists have about a refraction performed without a full oculo-visual exam arises from the many patients that we see who have undiagnosed pathology, either ocular or systemic, who are asymptomatic, and are correctable to 20/20. Often these patients present for an exam simply because they want a new eyeglass Rx or CLs. If these patients have a sight test, they will go on their merry way with undiagnosed disease that could be sight threatening, or possibly even life threatening. Is this an acceptable situation?

JP

Gary

12-08-2006, 07:01 PM

]]

mike.elmes

12-08-2006, 07:05 PM

"1) Why pay for an eye examination, when all one really wants is a new pair of glasses or contact lenses? As an adult, in a democratic society, why should I be forced to pay to see clearly? If I choose to only get a new prescription, then why should anyone object? When did my prescription for sight, become part of an examination for my eye? They are two totally separate things."

---------------

The recent decision by Justice Crane in the Ontario Superior Court was able see through arguments that a refraction could or should be separated from a complete ocular assessment, a position that is wrongly echoed by some optical retailers.

Perhaps it's time the government permitted birth control pills to be obtained in vending machines too? Is it really necessary for sexually active women to have PAP smears? Of course not (and I say so sarcastically).... cervical cancer is rare. The problem is that in essence, a patient (or in the case of an optical dispenser... a 'client') "doesn't know what they don't know".

For a century, the optical professions have tried to move from the back of jewelery stores only to have some try to separate a refraction from a comprehensive assessment and push that 'procedure' to the back of an optical shop. How unfortunate. Many clients wish to have an Optician duplicate an older rx that they deem to be satisfactory to them for acuity. The CONSUMER HAS A CHOICE.....Just as the consumer should have a choice about an eye test or eye exam. It's available all over the world, and in Alberta and BC. The consumer shoulders the resposibility of their decisions. The government can't mandate something they don't pay for. At the current rate of inflation, how long will it be until the comprehensive eye exam will cost 125.00?? I am not saying that this level of care is not worth that , but the consumer is not looking to get a fully comprehensive eye health workup each time their eyes need a change of prescription.
In a dispensary in Edmonton, not far from here, a fellow Optician is sent patients from an nearby Ophthalmologist, to do retinal photography. The results are sent back to the doc for analysis. He also does corneal topography for his contact lens patients and has his own eyelogic system. This represents the future of Independent Opticianry for those who care to specialize and expand their scope of practice. Perhaps Optometry will have to separate the refraction to offer a less expensive service to the public if such a niche is to be created.

Oedema

12-08-2006, 07:10 PM

Bad comparison. Doctors are already prohibited from selling the meds they prescribe, but optometrists do make a profit from selling the same eyewear they prescribe.

Dave,

The clarification offered by Exalicur in response was to clairfy the rationale that a prescriber, be it an MD or OD, should not be directly employed by those filling the prescriptions (RPh/pharmacy or RO/optical corp.) due to possible interference of the employer in clinical decision making.

The issue you raise is on the oppossite end of the issue. However, it is not uncommon for health providers to profit from the services and products they recommend. Do you not profit from the glasses and contacts you prescribe to clients based on a sight test?

In the past in Ontario, the college of optometrists prohibited OD's from having direct relationships with optician. However, there is a draft policy change that will allow OD's to employ opticians, but the ministry has decided to study all health conflicts of interests before approving any new changes by the colleges...

Ory

12-08-2006, 08:04 PM

A little more history on the situation in Ontario. Quite a number of years ago there was a gentleman in charge of the college of optometrists who got a little too excited about the idea of "protecting the public" and put into the regulation the above mentioned restriction of opticians not being allowed to work for optometrists. He is also the reason we sell on a dispensing fee model and cannot advertise.

As we all know, once something is on the books, it is tough to change. The college has been sending around the draft change to the conflict of interest regulation for months now....it's getting tiresome receiving a new copy every month or two with little changed. But that's beside the point.

The result of this is quite frustrating. I've worked in an office that hired an optician who let her license lapse in order to be employed. I've seen many offices that hire opticians on the sly....normally OK until you get a competing office ratting you out. Now people don't seem as concerned...there's an office in my town that has put the name of their optician on their letterhead, complete with R.O. after his name.

Believe me, no one will be happier to see some of these regulations changed than the optometrists in Ontario.

Excalibur

12-08-2006, 08:43 PM

I agree with Ory's comments about how many Ontario ODs would be very happy to hire a licensed optician if the regulations did not stand in the way.

I wonder, however, if an optometric practice may do better by hiring trainable (unlicensed) staff who could assist the optometrist in dispensing and do so at a much lower rate/hr than hiring an optician.

I am now putting on my flame-resistant suit!:angry:

Caddy

12-08-2006, 09:05 PM

There is nothing prohibiting an OD from hiring an RO. I know of a few practices that do so.

Excalibur

12-08-2006, 09:18 PM

My understanding is that in Ontario, an OD cannot hire a licensed optician. If someone can cite evidence to the contrary in legislation, please post to the list.

Having said that, what is the salary range for an optician in Ontario?

Dave Nelson

12-08-2006, 11:02 PM

I know of no law in Ontario that prohibits optometrists from employing opticians, but I can speak about B.C. B.C. optometrists are "allowed" to employ opticians, but are not permitted to be employed by opticians. I am unclear about the act which sought to prohibit optometrists from even working where an optician was employed, since it was challenged in court, and the optometric regulatory board lost. The judge ruled that although the optometrists did "yeoman's service" in trying to convince him of the conflict of interest that would result if the two groups were permitted freedom of association, he ruled that, since optometrists already sold the devices they precribed, the potential for conflict was just as great, and perhaps even greater.
Optometric efforts to save costs by paying less for "assistants" or other ancilliary personnel is a free market decision: go ahead, excaliber, you get what you pay for, and your patients will too . When you do get well qualified people who you trust who can do the more difficult work of a well qualified optician, consistantly sell good quality eyeglasses with few patients returning to complain or badmouth you and your office all over town, you can either pony up the bucks to pay a fair salary, or watch your best staff leave for greener pastures, while you hire the next trainee who edges 1.67 ellipse lenses upside down, chews gum, and thinks her pink thong looks hot crawling up her backside for all the world to see. Good luck with that. ;)

Ory

12-08-2006, 11:21 PM

There is nothing prohibiting an OD from hiring an RO. I know of a few practices that do so.

Correcting yours:

(4) It is a conflict of interest for a member to,
(e) engage in the practice of optometry in association, partnership or otherwise with or while employing or under the employment of a vendor of ophthalmic appliances or an ophthalmic dispenser registered under the Ophthalmic Dispensers Act or with any other person or corporation other than,
(i) with a member who is engaged in the practice of optometry,
(ii) with a legally qualified medical practitioner who is engaged in the practice of medicine provided that such practice is not inconsistent with Part V of the Act or regulations or by-laws,
(iii) as an employee or agent of a municipal or other government, agency of a municipal or other government, a university, hospital,
(iv) with a community health centre if the employment or any arrangement has been approved by Council, or
(v) with a corporation for the sole purpose of providing optometrical counsel and service to the employees of the corporation; or
(f) own or financially benefit from the operation of a company, firm or business that manufactures, fabricates, supplies or dispenses ophthalmic appliances. R.R.O. 1990, Reg. 550, s. 26 (4).

In other words, an optometrist may not work with or for an optician.

Dave Nelson

12-08-2006, 11:26 PM

Good heavens Gregory, it's 11:30 in Ontario. Shouldn't you be getting to bed?

Ory

12-08-2006, 11:35 PM

Worst part is I have a 1-day LASIK follow up tomorrow morning. Also my wife's due date. Will likely be a busy weekend!:cheers:

Dave Nelson

12-08-2006, 11:54 PM

Keep us posted on that big day. (I mean the baby, not the lasik check.):cheers:

HarryChiling

12-09-2006, 03:59 AM

I just erased the longest post I have ever written, the point is that optometry is a greddy profession. That was the gist of the whole post. In reality, in a medical office; allied health professionals are regularly hired to perform refraction for OMD's and a medical eye exam does not include a refraction as a routine part of the exam. The insurance companies don't consider refractions as medically necessary. The only people who think that refracting is the greatest thing since sliced bread is optometrists. In reality if opticians were allowed to refract their wouldn't be much of a place left for optometrists and I can live with that being the reason for optometry fighting so hard to keep refraction a skill that only they are allowed to perform, but to dress it up as for the good of the patient is nonsense. In that case you would say hey I don't understand as much about glasses as the guy down the road go visit him, or I don't understand as much about pathology as the OMD up the road go see him.

I think that all three O's have things that they are good at and specialize in, Opticians fabricate and dispense glasses this is our specialty, Optometrists refract and fit contact lenses that is their specialty, Opthalmologists diagnose and treat pathology that is their specialty. If it is OK for an optometrist to open up an optical dispensary in their office without really understanding fabrication and the intricaies of dispensing, I don't see why it is not OK for opticians to perform refractions.

The eyelogic systems are used in the US in OMD's offices as well and the OMD signs off on the exam. It is techs that perform these diagnostic tests and the OMD's that interpret the results and sign off on the scripts. These machines make refraction a science again as compared to magic as most optometrists try to make refraction out to be. Hey don't be upset I am sure a few opticians lost their jobs when automated lensmeters came out. They are making edgers now that a layman can figure out. Their is no magic in our field it is science and the offices that I have worked in that have embraced that are by far the busiest and best practices that I have worked for. I currently work for an OD, who is the best optometrists hands down. Everyone in our office has something they are good at and if I asked my doctor now how to refract (don't need to becasue I already know) she would not only show me how, but I am pretty confident she would show me how to do it correctly and show me some tips and pointers so that I would not only know how to refract, but could refract competantly, on the same note if anyone in my office wants to know how I do my job I don't pull out the smoke and mirrors I teach them and teach them to be the best or as good as I am. I have not found that to be the case with optometrists in the past most have tried to obfuscate refraction like it was this overly complicated procedure. The funny thing is that most opticians have been taught not only the science in our industry, but the art. I would have to say hands down I have learned the most rarest and most valuabe information in the short amount of years I have been doing this from opticians, if we can't share our knowledge and profession it's the other O's that will lose out.

Now you can crucify me.

Excalibur

12-09-2006, 06:20 AM

Thanks for the post. That clarifies the issue.

Correcting yours:

In other words, an optometrist may not work with or for an optician.

Excalibur

12-09-2006, 06:31 AM

Dave,

One of my best assistants is Rocco. He's been working in my office for 8 years, and I'm pretty certain he doesn't wear a pink thong. He's got a couple of blue tatoos. In fact, he'd probably give you a black eye because when he reads your comment he'll sure being seeing red.

If the law allowed me to hire an optician, I probably would. To date, I've done very well hiring trainable staff who work with me and the patient. We dispense over 80% of the patients who are in the office and require eyewear changes. No 'arm-twisting' tactics required-- just competent service, reasonable fees, great reputation in the community and a lot of referrals from satisfied patients. I don't think my patients have been harmed by having unlicensed staff. My staff and I rarely make lens rx/dispensing errors including 'upside down' PAL rxs.

We are also busy because our patients, family docs, several endocrinologists and OMDs send us new patients. They advertise our practice for us. Are we greedy? Sure! and... we take our jobs seriously but we don't take ourselves seriously.:bbg:

-----------
I know of no law in Ontario that prohibits optometrists from employing opticians, but I can speak about B.C. B.C. optometrists are "allowed" to employ opticians, but are not permitted to be employed by opticians. I am unclear about the act which sought to prohibit optometrists from even working where an optician was employed, since it was challenged in court, and the optometric regulatory board lost. The judge ruled that although the optometrists did "yeoman's service" in trying to convince him of the conflict of interest that would result if the two groups were permitted freedom of association, he ruled that, since optometrists already sold the devices they precribed, the potential for conflict was just as great, and perhaps even greater.
Optometric efforts to save costs by paying less for "assistants" or other ancilliary personnel is a free market decision: go ahead, excaliber, you get what you pay for, and your patients will too . When you do get well qualified people who you trust who can do the more difficult work of a well qualified optician, consistantly sell good quality eyeglasses with few patients returning to complain or badmouth you and your office all over town, you can either pony up the bucks to pay a fair salary, or watch your best staff leave for greener pastures, while you hire the next trainee who edges 1.67 ellipse lenses upside down, chews gum, and thinks her pink thong looks hot crawling up her backside for all the world to see. Good luck with that. ;)

Excalibur

12-09-2006, 06:42 AM

Most ODs don't disagree with trained technicians doing refractions within the confines of an ophthalmic practice where at least the refraction has been performed as part of an overall ocular assessment. I believe all ODs (and a lot of MDs.. and drum roll please... opticians too) do not agree with opticians stand-alone refractions.

You also quote that optometry is a 'greedy' profession. Where I practice (Ontario), many retailers charge $600 for something I can't charge more than $400 because of dispensing fee regulations. That's greed? Really.
Your comment that optometry is a greedy is not only nonsense, but just plain asinine.

------------

I just erased the longest post I have ever written, the point is that optometry is a greddy profession. That was the gist of the whole post. In reality, in a medical office; allied health professionals are regularly hired to perform refraction for OMD's and a medical eye exam does not include a refraction as a routine part of the exam. The insurance companies don't consider refractions as medically necessary. The only people who think that refracting is the greatest thing since sliced bread is optometrists. In reality if opticians were allowed to refract their wouldn't be much of a place left for optometrists and I can live with that being the reason for optometry fighting so hard to keep refraction a skill that only they are allowed to perform, but to dress it up as for the good of the patient is nonsense. In that case you would say hey I don't understand as much about glasses as the guy down the road go visit him, or I don't understand as much about pathology as the OMD up the road go see him.

I think that all three O's have things that they are good at and specialize in, Opticians fabricate and dispense glasses this is our specialty, Optometrists refract and fit contact lenses that is their specialty, Opthalmologists diagnose and treat pathology that is their specialty. If it is OK for an optometrist to open up an optical dispensary in their office without really understanding fabrication and the intricaies of dispensing, I don't see why it is not OK for opticians to perform refractions.

The eyelogic systems are used in the US in OMD's offices as well and the OMD signs off on the exam. It is techs that perform these diagnostic tests and the OMD's that interpret the results and sign off on the scripts. These machines make refraction a science again as compared to magic as most optometrists try to make refraction out to be. Hey don't be upset I am sure a few opticians lost their jobs when automated lensmeters came out. They are making edgers now that a layman can figure out. Their is no magic in our field it is science and the offices that I have worked in that have embraced that are by far the busiest and best practices that I have worked for. I currently work for an OD, who is the best optometrists hands down. Everyone in our office has something they are good at and if I asked my doctor now how to refract (don't need to becasue I already know) she would not only show me how, but I am pretty confident she would show me how to do it correctly and show me some tips and pointers so that I would not only know how to refract, but could refract competantly, on the same note if anyone in my office wants to know how I do my job I don't pull out the smoke and mirrors I teach them and teach them to be the best or as good as I am. I have not found that to be the case with optometrists in the past most have tried to obfuscate refraction like it was this overly complicated procedure. The funny thing is that most opticians have been taught not only the science in our industry, but the art. I would have to say hands down I have learned the most rarest and most valuabe information in the short amount of years I have been doing this from opticians, if we can't share our knowledge and profession it's the other O's that will lose out.

Now you can crucify me.

Jubilee

12-09-2006, 07:51 AM

Optometrists should not be employed by dispensers for the same reasons physicians should not be located inside pharmacies and employed by pharmacists.

So you don't have the whole "minute clinic" deal springing up all over Canada?

Here in the US many pharmacies have nurse practicioners (who can prescribe meds) located within their businesses to offer routine low level care... such as treating respiratory infections, sore throats, flu, infections..etc..

So much for that separation....

Ory

12-09-2006, 10:20 AM

Now you can crucify me.

Harry,

I have a lot of respect for your knowledge. You consistently post reasonable, well thought out comments.

In this case, I take exception to 2 items. The first is labelling all optometrists as greedy. I think most people who know more than one or two of us will find that to be the exception rather than the rule. I could easily say opticians are all lazy and uneducated based on one or two I have met, but I''m well aware that isn't the case. So please stop with these insulting blanket statements.

The second issue I have with your post is stating that without refraction there would be no need for optometrists. You are of course entitled to your opinion, and I'm sure I won't be able to change it. In the area I work in we have a shortage of ophthalmologists. Optometrists refract, assess binocular vision (something no one else does), perform minor procedures (punctal plugs, foreign body & rust ring removal, etc). Once the Ontario government gets its act together we will have the best pharmaceutical privileges in the country. Currently I just request the appropriate meds from the patient's GP, most of whom understand that I know what I'm talking about. So basically, I provide primary care. There is no need to see an ophthalmologist for much short of surgery, of which there is enough demand that everyone is happy.

I know that when opticians get the right to refract I will be OK. And yes, I used the term "when" because I have no doubt it will happen. I'm not happy about it, I strongly disagree with it, but it is the most likely end result.

shawn b

12-09-2006, 01:53 PM

Excalibur... I can understand your position, but I find your arguments quite weak. You are correct to say that comprehensive eye examinations should be available, but only as an option... not as a requisite.

My comment was that as adults living in a democratic society, should we not have the right to choose what type of treatment we want? Your rebuttle, brings forward the idea of obtaining prescription medication from a vending machine, and the necessity of PAP smears. I cannot make the connection, but what I dislike is the arrogrant attitude brought forward in your comment that the "patient" "doesn't know what they don't know". What does that mean? That you get to decide for everyone else? That your knowledge is so vast and deep that you know the correct thing for me and my health? No thank you Excalibur. I don't need anyone making decisions for me or my health. People should be educated and information should be available for them to make their own decisions.

HarryChiling

12-09-2006, 01:58 PM

You consistently post reasonable, well thought out comments.

I really try to stay out of these discussions, but what happens is everytime their is a discussion about the subject it seems that all the optometrists that post have the same canned response. This usually gets me froathing around the lips and all of a sudden I have said some stuff, I probably should not have said. I know that optometrists do have a place in the whole system and will probably always be the bioggest role, but the whole belitlle another profession to make ones own profession just gets old.

You also quote that optometry is a 'greedy' profession. Where I practice (Ontario), many retailers charge $600 for something I can't charge more than $400 because of dispensing fee regulations.

This quote of yours reminds me of an old expression "look at the pot calling the kettle black". You must be upset that you can't charge more. $$$, it's not fair.

I know that when opticians get the right to refract I will be OK. And yes, I used the term "when" because I have no doubt it will happen. I'm not happy about it, I strongly disagree with it, but it is the most likely end result.

Absolutely you will be OK, if you embrace the change what will happen is these opticians will be refering their patients to you for various reasons, opticians can be your greatest ambassadors. I think that the change creates fear and this is what leads to the unrational thoughts, both on my part and on some of the optometrists that post whenever this subject comes up. I always make it a point to make my opinion be know on this subject, because it will only make my position stronger the more I debate on it. I have consistently seen optometrists argue their point about this subject untill they are blue in the face and their position only gets stronger, if I can empassion one optician to try and make change the tides will turn. No offense meant to anyone, but if you lay in front of a tank you get run over. ;)

Excalibur

12-09-2006, 02:14 PM

Of the 3 "O's", optometry has had the greatest success from a legislative perspective across North America. Optometry is a 'centrist' profession, meaning it provides the widest breadth of diagnostics and treatment modalities for the vast array of ocular anomalies. This has created some marginalization of opticianry and ophthalmology. It is, however, important to recognize that each of the professions does have it's strengths.

If adults believe that the best interests lie in providing free-standing 'refractionaries', then perhaps this should be made a part of the federal government's election platform. And yes, "patients don't know what they don't know" ... I see this all the time in my practice when I (and my colleagues) diagnose asymptomatic eye disease. As you know, the eye does not have a sophisticated 'early warning system'.... and regular ophthalmic consults/assessments help in reducing the risk of eye disease despite what a refractionist might say.

---------

Excalibur... I can understand your position, but I find your arguments quite weak. You are correct to say that comprehensive eye examinations should be available, but only as an option... not as a requisite.

My comment was that as adults living in a democratic society, should we not have the right to choose what type of treatment we want? Your rebuttle, brings forward the idea of obtaining prescription medication from a vending machine, and the necessity of PAP smears. I cannot make the connection, but what I dislike is the arrogrant attitude brought forward in your comment that the "patient" "doesn't know what they don't know". What does that mean? That you get to decide for everyone else? That your knowledge is so vast and deep that you know the correct thing for me and my health? No thank you Excalibur. I don't need anyone making decisions for me or my health. People should be educated and information should be available for them to make their own decisions.

HarryChiling

12-09-2006, 02:44 PM

Of the 3 "O's", optometry has had the greatest success from a legislative perspective across North America. Optometry is a 'centrist' profession, meaning it provides the widest breadth of diagnostics and treatment modalities for the vast array of ocular anomalies.

You are absolutely correct, and they have gained this wide scope of practice by chipping away at both ends of the profession. Optometry has not only used their legislative powers to grow their scope of practice, but they are always using those same legislative powers to oppose the other O's professions, which they have no business doing. For that reason I will always speak my mind and keep trying to spark a fire to push opticianry forward.

.... and regular ophthalmic consults/assessments help in reducing the risk of eye disease despite what a refractionist might say.

Again right on the money, however pairing refraction with an ophthalmic consult/assesment is not only unnecessary, but archaic. That is an old model that no longer applys, their is a need for refraction seperate from assesments. And refractionists don't to my knowledge doubt that. Try to look at it from the other side of the fence your patients, for whatever reason, your fees are too high, they hate to wait in your office and go through all the rigamarole, they just had their eyes checked a short while ago and just feel they need a slight tweek. I am only touching on the various reasoning behind it.

shawn b

12-09-2006, 02:48 PM

Your arguments, reasoning and logic are flawed Shawn .

The reason to do a full exam is prevention of disease and it is in the best interests of the patient .

Unbundling the refraction from the eye health check up is purely profit motivated and not in the best interests of the patient.

Putting untrained people in charge of equipment that they have no understanding of is ridiculous. Put these people through a real refraction and training course and maybe I will think differently . If you want to be an optometrist then it's simple ... take the same training they did . And if you want to be an optician then take that training and learn what the job is all about . If you want to run a chain of optical stores then run them properly and do FREE EYE EXAMS though an optometrist or ophthalmologist .

Cutting every corner possible is not for humanitarian reasons but purely for profit in my opinion !

The optometrists I know do a great job and they are decent people . Don't slam them based on profits . They work hard and they are diligent.

If you have any doubts about this compare it to safety inspections required for cars and emissions testing . The public has proven over and over again that they would continue to drive unsafe vehicles and would continue polluting the environment , except that now these things are mandatory. And it is for everyone's good , including their own.

It must be past noon somewhere :cheers:
Hey Gary, again I can totally see your point. And I do agree with you that as an option, a complete eye examination should be availble- to those who chose to get one.

What I have trouble understanding, is the totalitarian attitude that
"The reason to do a full exam is prevention of disease and it is in the best interests of the patient. Unbundling the refraction from the eye health check up is purely profit motivated and not in the best interests of the patient." Best interest of the public? Who decided that? And what I am saying is that if I choose not to pay to get what is for my "best interests", who are you to decide that I am wrong? If I can see clearly, and I am content... who is anyone else to decide about my health and wether it is correct or incorrect? Why do I need to pay to see? You mention profit driven, but as a whole people would be spending less on eyeglasses and contact lenses if they didn't have to pay for an eye examination... isn't that true? So how can we be profit driven if we are reducing the total amount of money spent?

Your need to bring up profit factor to an optician with my view is silly. Only because my view is that we want to provide a measurement free of charge... that is for no money. So really Gary, how would someone with that view be profit driven?
You might say that more people would come because they wouldn't have to pay for an eye examination. And that is my point exactly, adults would choose not to pay for a new prescription. What is wrong with that? :D

shawn b

12-09-2006, 03:12 PM

Of the 3 "O's", optometry has had the greatest success from a legislative perspective across North America. Optometry is a 'centrist' profession, meaning it provides the widest breadth of diagnostics and treatment modalities for the vast array of ocular anomalies. This has created some marginalization of opticianry and ophthalmology. It is, however, important to recognize that each of the professions does have it's strengths.

If adults believe that the best interests lie in providing free-standing 'refractionaries', then perhaps this should be made a part of the federal government's election platform. And yes, "patients don't know what they don't know" ... I see this all the time in my practice when I (and my colleagues) diagnose asymptomatic eye disease. As you know, the eye does not have a sophisticated 'early warning system'.... and regular ophthalmic consults/assessments help in reducing the risk of eye disease despite what a refractionist might say.

---------

Again, Excalibur I respect your opinion, but you are not addressing the case at point.
I have never questioned the notion that "ophthalmic consults/assessments help in reducing the risk of eye disease despite what a refractionist might say". So I don't understand where the part "despite what a refractionist might say" came from, because clearly that was never stated by me.
What I did say, and what you continually choose not to address is the fact that as an adult, if I choose not to have this complete eye examination, why does that mean I don't get a new prescription for my eyes? Please answer this question, and please don't try to make a point by brining up comments I do not support and did not make.

Gary

12-09-2006, 05:38 PM

mike.elmes

12-09-2006, 06:44 PM

Gary, we use the Eyelogic System, as do MANY others in Alberta., and we do not cut corners....and we DO know what we're doing.I hope I don't have to type in CAPITOLS to make you understand!! The public can read and write....we very simply explain our proceedures and limitations and they either fall into the criterea set out to govern sight testing or they don't. No one is being deceived, ITS THAT SIMPLE!!

shawn b

12-09-2006, 07:02 PM

What is wrong Shawn is very simple . The people doing it presently DO NOT KNOW WHAT THEY ARE DOING !

THEY ARE CUTTING CORNERS !

THE PUBLIC DOES NOT KNOW WHAT THEY ARE NOT GETTING AND THEY ARE BEING DECEIVED and preyed upon .

IT IS THAT SIMPLE !

Shawn , if OHIP paid for your eye exam at an ohthalmologist or optometrist would you go there and have it done if it was free and cost you nothing ?

Gary to run an Eyelogic machine you really don't need to know much about anything. As long as you know how to use a keyboard and a mouse, you're set! If someone is using a manual phoropter and trial lenses, then yes some in depth training would be beneficial.

You are correct the public isn't clear on what is happening- and again I wish people were getting more information to make an intelligent decision for themselves. I feel that educating the public is essential. With regards to your comments on the public is being prayed upon and deceived- you are open to your view. I disagree, only because I don't feel it is coming from a place of malice.

To answer your question Gary- Yes I would go to have an eye exam if it was paid for by the government or even if it was not. I went when OHIP covered eye exams, and I go now and pay out of my pocket. Nothing has changed for me. What I hate is having to have my entire eye checked just to get my new refractive error measured. :bbg:

And again Gary, you manage to avoid the main question- why don't adults have a choice? Do you disagree with adults having the choice between a complete eye exam they pay for, or a measure of their refractive error for free?

And try to ease up on the caps. This isn't an agrument or a fight. It's simply an open forum for people to bring forward their views and have discourse. I appreciate an opposing view. :)

Caddy

12-09-2006, 10:59 PM

Personally, I think the Eyelogic system could actually improve eye care safety.

The reason is, during an Eyelogic test, people are clearly told that their eye health is not being checked.

In contrast, when getting an ocular health exam + refraction from an optometrist, the patient is never told that some eye diseases will only be detected by an ophthalmologist. Therefore, a false sense of security is applied.

Excalibur

12-09-2006, 11:07 PM

"In contrast, when getting an ocular health exam + refraction from an optometrist, the patient is never told that some eye diseases will only be detected by an ophthalmologist. Therefore, a false sense of security is applied."

Your statement is nonsense.

Optometrists are held to the SAME medico-legal standard as ophthalmologists when managing patients.

Excalibur

12-09-2006, 11:16 PM

"why don't adults have a choice? Do you disagree with adults having the choice between a complete eye exam they pay for, or a measure of their refractive error for free?"

-----------

Again, I say "patients don't know what they don't know".

Perhaps we should start letting dental hygienists start opening stand alone teeth-cleaning clinics too? After all, who really needs to see a dentist if all they need to do is get their tartar removed? Or why see a family doctor for birth control pills -- they are relatively safe, so let's make them available in high-school vending machines. Performing a refraction in tandem with an ocular health assessment guarantees that the patient will have their eye health checked. How many of you also feel that over-the-counter reader availability is a good thing for patients? Frankly, I tell patients with simple reading rxs that OTC readers aren't necessarily bad as long as they see me regularly so I can check their fundi.

Dave Nelson

12-10-2006, 12:26 AM

but thats where you lose me...OTC readers aren't so bad if you do ophthalmoscopy at periodic intervals? So how is optician-performed refraction different? How is it bad if you tell people to get the same checks done for eye disease? Your argument that people will forego eye exams for simple refraction holds true in both cases...some people will heed your advice about eye exams when purchasing drugstore readers and some will not. Some people will heed your advice and get regular eye exams if opticians perform refractions, and some will not. You can't have it both ways. You cannot say OTC readers are "not so bad if you get eye exams too" and not say the same thing about optician-performed refraction. And in niether case do you have a means of insuring your advice is met. At least with OPR, there is advice given, in writing, and verbally of the importance of eye health examinations, and people at risk for age-related complications are screened out. But they can (and do) purchase OTC readers by the bushel. BTW, dental hygienists in B.C. do stand alone, and the state of our oral health in B.C. is fine.

Excalibur

12-10-2006, 07:48 AM

Dave,

Read Justice Crane's decision of Nov 2006, and read the Ontario HPRAC regulations from May 2006. Their findings boil down to refractions not being in the public interest if there is no concurrent eye health assessment. And yes, OTC readers are not so bad if they are clinically appropriate. The problem is that by doing a refraction only how can you guarantee that a patient will be assessed for an other ocular anomaly? You can't. You are providing libertarian 'care'. You state that the patient should be allowed 'free will' and freedom to lose their optic nerve if they have early glaucoma, or a have an early retinal break ignored because it's not bothering them. Such callous disregard, veiled in 'freedom of choice' does no patient any good. You do a refraction in an optical shop, give the 'client' a form and then tell them that 'this is not a full eye check up so you better go get a real one in the future because there may be something else going on anyway' flies in the face of reality. Once they get your 'rx', it's highly unlikely they will do anything else other than get their specs. I suspect that many refractionists are performing this act only to sell a pair of specs and could care less if one of their clients have something else going on. A refraction should only be performed at the same time as a health assessment. Period. Your way is the way it was done 100 years ago in the back of jewelery shops, and I must humbly inform you that clinical care has progressed significantly since that time.

but thats where you lose me...OTC readers aren't so bad if you do ophthalmoscopy at periodic intervals? So how is optician-performed refraction different? How is it bad if you tell people to get the same checks done for eye disease? Your argument that people will forego eye exams for simple refraction holds true in both cases...some people will heed your advice about eye exams when purchasing drugstore readers and some will not. Some people will heed your advice and get regular eye exams if opticians perform refractions, and some will not. You can't have it both ways. You cannot say OTC readers are "not so bad if you get eye exams too" and not say the same thing about optician-performed refraction. And in niether case do you have a means of insuring your advice is met. At least with OPR, there is advice given, in writing, and verbally of the importance of eye health examinations, and people at risk for age-related complications are screened out. But they can (and do) purchase OTC readers by the bushel. BTW, dental hygienists in B.C. do stand alone, and the state of our oral health in B.C. is fine.

Ory

12-10-2006, 08:51 AM

In contrast, when getting an ocular health exam + refraction from an optometrist, the patient is never told that some eye diseases will only be detected by an ophthalmologist. Therefore, a false sense of security is applied.

Please name one.

fjpod

12-10-2006, 09:08 AM

From what I see the issue is quite basic.
Optometrists do not want to loose their profits to opticians who are dispensing based on a computer generated script. :finger:

Opticians however would like to offer residents of Ontario an alternative to a complete eye examination...
I almost hate to add to this discussion, as the two sides will probably never agree, BUT, there are two sides.

Shawnb (and others) you say, "it's quite basic. Optometrists do not want to lose their profits..", but the other side says, "opticians only want the right to refract so they can sell more glasses, make more profits and not for the good and welfare of the public."

Both sides can make "good and welfare" claims and both sides can make "greed and profit" claims.

Opticians want the right to offer refractions, they say, "for free", but why should this be so? They will say it's for the good of the public, but could it be so as to make a quick eyeglass sale and turn a profit? "Free" won't last very long, and it shouldn't. Refraction and prescribing are learned skills that require many hours of learning in a classroom, AND the examination of hundreds of patients in a supervised clinical setting. Computers or no computers. The public should pay for this, just as they might pay for a tune-up on their car. If you hide the cost of a refraction in the cost of a pair of glasses, and then tell the public they got a refraction for free, you are being disingenuous. And please, before I get lectured about this, I realize that some optometrists and commercial optical operations have been doing this for a century already.

I've often heard statements by opticians on this forum that prescribing and selling glasses under the same roof is a conflict of interest. I agree this can be a problem for the public if they place their trust in someone who is dishonest. But this world is full of examples similar to ours. Dentists diagnose your cavities?, then they charge you to fill them. OMDs diagnose your cataracts?, and then charge you to take them out, and some of them will even sell you the glasses. And I hear ad nauseum on this forum that the examination/dispensing model of physicians and pharmacists should be our model in eyecare, but there have been tons of cases where pharmacists and physicians were in collusion to prescribe/dispense/refer simply for profits. So, no model will guarantee the protection of the public.

So, my friends, I fear nothing will be resolved. There is no "higher ground" here. There is no right side and wrong side. Battles like this usually wind up in the legislature and some arbitrary set of rules will be set up, and most of us will follow them honestly...until the next challenge evolves.

In the spirit of staying with the thread, I don't think Great Glasses and it's owner(s), and pets, are the model that ANYONE would use to advance a cause such as optician refracting.

Excalibur

12-10-2006, 09:31 AM

FJPOD,

Thank you for the post. I think you summarized this controversial issue very well.

---------------------
I almost hate to add to this discussion, as the two sides will probably never agree, BUT, there are two sides.

Shawnb (and others) you say, "it's quite basic. Optometrists do not want to lose their profits..", but the other side says, "opticians only want the right to refract so they can sell more glasses, make more profits and not for the good and welfare of the public."

Both sides can make "good and welfare" claims and both sides can make "greed and profit" claims.

Opticians want the right to offer refractions, they say, "for free", but why should this be so? They will say it's for the good of the public, but could it be so as to make a quick eyeglass sale and turn a profit? "Free" won't last very long, and it shouldn't. Refraction and prescribing are learned skills that require many hours of learning in a classroom, AND the examination of hundreds of patients in a supervised clinical setting. Computers or no computers. The public should pay for this, just as they might pay for a tune-up on their car. If you hide the cost of a refraction in the cost of a pair of glasses, and then tell the public they got a refraction for free, you are being disingenuous. And please, before I get lectured about this, I realize that some optometrists and commercial optical operations have been doing this for a century already.

I've often heard statements by opticians on this forum that prescribing and selling glasses under the same roof is a conflict of interest. I agree this can be a problem for the public if they place their trust in someone who is dishonest. But this world is full of examples similar to ours. Dentists diagnose your cavities?, then they charge you to fill them. OMDs diagnose your cataracts?, and then charge you to take them out, and some of them will even sell you the glasses. And I hear ad nauseum on this forum that the examination/dispensing model of physicians and pharmacists should be our model in eyecare, but there have been tons of cases where pharmacists and physicians were in collusion to prescribe/dispense/refer simply for profits. So, no model will guarantee the protection of the public.

So, my friends, I fear nothing will be resolved. There is no "higher ground" here. There is no right side and wrong side. Battles like this usually wind up in the legislature and some arbitrary set of rules will be set up, and most of us will follow them honestly...until the next challenge evolves.

In the spirit of staying with the thread, I don't think Great Glasses and it's owner(s), and pets, are the model that ANYONE would use to advance a cause such as optician refracting.

HarryChiling

12-10-2006, 01:47 PM

Fjpod,

It's good to hear your point of view, I agree that GG is no model for anything and that is agreed upon by all I believe. I do want to add that your comment about

Shawnb (and others) you say, "it's quite basic. Optometrists do not want to lose their profits..", but the other side says, "opticians only want the right to refract so they can sell more glasses, make more profits and not for the good and welfare of the public."

Both sides can make "good and welfare" claims and both sides can make "greed and profit" claims.

Do not apply to opticians here in the states, I hate to say this because it is not what I believe, but something that has been forced on my profession. I as an optician do not have to take the patients welfare into account when I make decisions. In our state opticians have tryed to be part of the health care system and it has been optometry and retail chains that have insured that opticians remain sales oriented staff, apparetly their is no harm that can be done by anybody making and selling glasses. So in a sense yes it does make great business sense to have opticians refract, after all no harm can come of improper lenses placed in front of someones eyes (refraction). Optometrists as doctors on the other hand do have to take into consideration the good and welfare of the public they serve and for that you have my respect, however your profession has on numerous occasions, legislatively been devious and have colluded with public servants of the state to squash bills that were meant for the good of the public (licensed opticians). I hold myself to higher standards than optometry holds me too.

Your way is the way it was done 100 years ago in the back of jewelery shops, and I must humbly inform you that clinical care has progressed significantly since that time.

It wasn't clinical care back then and the arguement is that refraction is not clinical care now. Back then you would have been called an optician and you should have been proud to call yourself that. It was this past prestige that optometry built its foundations on so for you to bellitle it is to shake the very foundations of your own house. Back then opticians had to have skills in metalurgy, optics, chemistry, art, science and various other skills to perform the jobs that they did. It was optometry that split off and created a profession that focused on the science of refraction, at first you did not have the right to call yourselves doctors because you refracted. That did not mean that the science in opticianry was lost. To this day a majority of optometrists don't have a clue how to fabricate a pair of eyeglasses with the very same equipment in their offices, while many opticians are trying to learn refraction and various other diagnostic skills. If we are not allowed to use them for the good of the public on our own then why are we trusted to use them in the offices of optometrists. The AOA has even created a paraoptometric field where they have their techs learning all these skills, why would they do that if opticianry already has these skills.

I think optometry needs to step back and take a look at the whole picture objectively. The precious scripts you write and hold so highly are allowed to be fabricated by dimwits in your very same office, and the motivation is to save a few bucks. If this isn't greed I don't know what is. As an optician, I value my art and skills, but every optometrist in town hires an idiot and starts making eyeglasses based on cost instead of value therefore devalueing my products and skills to the point where in my state the public just doesn't respect what I do. If opticians were to offer refractions for free, guess whos services would be devalued? Any takers, how long before your level of respect is nill? Realisticaly the arguement over refraction is over "dollars and sense" (absolutely not misspelled). As an optician in a state that does not recognize me in the health care system it's OK for me to argue the monetary advatages and I peform refractions everyday when I take a old pair of glasses off a client and place the new ones on and they say their old one is better, I take the old pair back and neutralize (which should have been done by the doctor who prescribed the Rx) and find many cases where the pd was wrong in the old pair. (not the doctors fault right, it should be; are you neutralizing for prism?), or I find that the base curves are wrong (not the doctors fault right, does magnification factor into your prescribing at all?), the point is that many times these patients have to go back to a doctor who is p*ss*ed about wasteing precious chair time on this patient again, or the patient has to schedule more time off of work to get to see the doctor, when I have already diagnosed the problem, is this the model that works. It only works because I get all the blame and headaches from the transaction. Maybe this seems like a good arguement for OD's to have despensaries in their offices, but you only exagerate the situation. Refraction should be closer to the supply side of the chain to better serve the public, it makes business sense and it does no harm.

If the arguement is that refractions are a way of getting the public in to see the OD so that they can check the health than why are so many OD's allowing their patients to opt out of a dilation, isn't this where most cases of disease are caught. And if it's not about the money why are OD's working for chains that have quotas on visual field exams?

I truly do appreciate these discussions, becasue it helps to strengthen both sides, I see it in the posts and arguements of the ones who are always ready and willing to discuss it.

Excalibur

12-10-2006, 02:05 PM

Harry,

You stated that "it does make great business sense to have opticians refract, after all no harm can come of improper lenses placed in front of someones eyes (refraction)"

I disagree. If a child is prescribed or dispensed an incorrect rx, you can induce amblyopia. By the same token, you can miss amblyopia by not thoroughly assessing a child ocular status either -- in many cases, a simple dry refraction can miss latent hyperopia.

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HarryChiling

12-10-2006, 03:00 PM

Do not apply to opticians here in the states, I hate to say this because it is not what I believe, but something that has been forced on my profession. I as an optician do not have to take the patients welfare into account when I make decisions. In our state opticians have tryed to be part of the health care system and it has been optometry and retail chains that have insured that opticians remain sales oriented staff, apparetly their is no harm that can be done by anybody making and selling glasses. So in a sense yes it does make great business sense to have opticians refract, after all no harm can come of improper lenses placed in front of someones eyes (refraction).

Excalibur,

It is nice to see you using all that education of yours to quote me out of context. If you are going to quote me to say I am wrong please read what you quote, otherwise you risk making a donkey out of yourself. I actually agree that harm can and does come of idiots being allowed to sell glasses, but your counterparts here in the states would have to pay educated opticians more and that cuts into their bottom lines so their stance is that opticians don't need to be educated or licensed. I have worked in a pediatric practice for a year and our office specialized in starbismus and amblyopia, and I saw the number of PD's that were off in children with these conditions and the galsses that were made by complete idiots that called themselves opticians only made the situation worst and may have even lead to further damage. I take monocular PD's for all children that come to my office and I occlude when I take my measure, and measure the pupil reflex, or in children that will not sit still sometimes I go from inner to outer canthus.

Now would I be wrong in questioning your education when your retention of the information your read shows that you can not complete a paragraph without losing focus. I do not have to be a doctor to diagnose this as tunnel vision, just as I believe you are not a doctor because you refract. You earned the right to call yourselves a doctor when you went beyond refracting. It is the same history that opticians look to when furthering our scope of practice. Our foundations are the same, you cannot say we have bad genes when we come from the same family.

Excalibur

12-10-2006, 03:34 PM

Looks like you are quite conscientious -- no sarcasm intended or implied. I highly doubt most of your colleagues are as diligent. Sounds like we are two concerned practitioners who care about the welfare of humankind and do not believe that stand-alone refractionists do the public any good.

PS. your posts are good but your spelling needs a little work. :finger:

Excalibur,

It is nice to see you using all that education of yours to quote me out of context. If you are going to quote me to say I am wrong please read what you quote, otherwise you risk making a donkey out of yourself. I actually agree that harm can and does come of idiots being allowed to sell glasses, but your counterparts here in the states would have to pay educated opticians more and that cuts into their bottom lines so their stance is that opticians don't need to be educated or licensed. I have worked in a pediatric practice for a year and our office specialized in starbismus and amblyopia, and I saw the number of PD's that were off in children with these conditions and the galsses that were made by complete idiots that called themselves opticians only made the situation worst and may have even lead to further damage. I take monocular PD's for all children that come to my office and I occlude when I take my measure, and measure the pupil reflex, or in children that will not sit still sometimes I go from inner to outer canthus.

Now would I be wrong in questioning your education when your retention of the information your read shows that you can not complete a paragraph without losing focus. I do not have to be a doctor to diagnose this as tunnel vision, just as I believe you are not a doctor because you refract. You earned the right to call yourselves a doctor when you went beyond refracting. It is the same history that opticians look to when furthering our scope of practice. Our foundations are the same, you cannot say we have bad genes when we come from the same family.