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Thread: BCVA written on the Spectacle Rx

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    OptiBoard Professional Excel-Lentes's Avatar
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    BCVA written on the Spectacle Rx

    Hi,

    I keep running into situations where a patient comes with an Rx for glasses, we make the glasses expecting an improvement on the visual acuities only to find the patient doesn't see that well. We call the prescribing doctor and are told that BCVA is 20/30, 20/50 and even 20/70. I have a hard time accepting this. Why doesn't the doctor, scribe, technician or whatever just right the BCVA on the prescription. Historically this was the way it was done.

    This would make everyone's job easier and certainly would be in the patient's best interest.

    Does anyone else agree???:bbg:

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    Doesn't BCVA mean "Best corrected vision accurity" ? If I saw this on a RX I would inform the patient that his or her new glasses may not give them 20/20. Their Dr. only could get
    a best corrected. If they have any more questions refer them back to their Dr. for the reading. 20/30, 20/40 or whatever they have. They must have been told by their Dr. what condition was keeping their vision from our perfect 20/20.

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    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Lots of us have been asking for the same thing from prescribing docs. You'd think they would want patients to know what to expect from new eyewear from the get-go rather than deal with annoying phone calls and visits after.

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    Quote Originally Posted by Excel-Lentes
    Hi,

    I keep running into situations where a patient comes with an Rx for glasses, we make the glasses expecting an improvement on the visual acuities only to find the patient doesn't see that well. We call the prescribing doctor and are told that BCVA is 20/30, 20/50 and even 20/70. I have a hard time accepting this. Why doesn't the doctor, scribe, technician or whatever just right the BCVA on the prescription. Historically this was the way it was done.

    This would make everyone's job easier and certainly would be in the patient's best interest.

    Does anyone else agree???:bbg:
    I've been around a long time and I can't remember VAs being a part of any Rx. While that might make your job easier, it would probably be a violation of HIPAA rules, as it would disclose info about a patient's medical condition. So just remember, not everyone "corrects up" to 20/20.

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    I agree, this would no doubt be a violation of the patients HIPPA privacy .

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    OptiBoard Professional Excel-Lentes's Avatar
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    Interesting point about HIPAA but I doubt that could be a violation because you are giving something to the patient that belongs to the patient. It is their choice to give it to the optician. I realize there are many causes of sub-par acuity but it isn't professional to only speculate what a certain Rx might do for a patient. I am mainly talking about when a patient brings in an outside Rx from another office.

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    Bad address email on file QDO1's Avatar
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    seems to make sense that the dispenser knows the VA's - there are circumstances that a professional dispenser would alter what he does with VA BCVA information

    The RX form, which is often what I get given:

    R -1.00
    L -5.00 -5.00 x 90
    Add + 3.00

    has a completly different feel if written like this:

    6/12 unaided R -1.00DS 6/5 corrected
    6/60 unaided L -5.00 -5.00 x 90 6/36 corrected
    Add + 3.00 R N5 L N36

    or another feel like this


    6/12 unaided R -1.00DS 6/5 corrected
    6/24 unaided L -5.00 -5.00 x 90 6/6- corrected
    Add + 3.00 R N6 L N5 N5 BE

    BVD = 12mm

    While I am at it it would be nice to know if any abnormal convergance issues etc. If the patient comes in wearing an individual lens then the data about the trial lenses needed to dispense the same lens again would be nice too

    I dont hold the "patient/doctor"" confidentiality issue as being applicable - it is the patient who gets poorer service if the right info isn't passed to the dispenser, nomater where he is - in your practice or anyone elses. if there is an issue, a patient would willingly sign a slip to allow the info to be passed on

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    Quote Originally Posted by QDO1
    seems to make sense that the dispenser knows the VA's - there are circumstances that a professional dispenser would alter what he does with VA BCVA information

    The RX form, which is often what I get given:

    R -1.00
    L -5.00 -5.00 x 90
    Add + 3.00

    has a completly different feel if written like this:

    6/12 unaided R -1.00DS 6/5 corrected
    6/60 unaided L -5.00 -5.00 x 90 6/36 corrected
    Add + 3.00 R N5 L N36

    or another feel like this


    6/12 unaided R -1.00DS 6/5 corrected
    6/24 unaided L -5.00 -5.00 x 90 6/6- corrected
    Add + 3.00 R N6 L N5 N5 BE

    BVD = 12mm

    While I am at it it would be nice to know if any abnormal convergance issues etc. If the patient comes in wearing an individual lens then the data about the trial lenses needed to dispense the same lens again would be nice too

    I dont hold the "patient/doctor"" confidentiality issue as being applicable - it is the patient who gets poorer service if the right info isn't passed to the dispenser, nomater where he is - in your practice or anyone elses. if there is an issue, a patient would willingly sign a slip to allow the info to be passed on
    You make perfect sense...optically speaking it would be very helpful to the dispenser, but, I think AARP and the ACLU would have a fit. Older Americans anyway are very sensitive about the possibility of losing a drivers license.

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    Bad address email on file QDO1's Avatar
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    Quote Originally Posted by fjpod
    You make perfect sense...optically speaking it would be very helpful to the dispenser, but, I think AARP and the ACLU would have a fit. Older Americans anyway are very sensitive about the possibility of losing a drivers license.
    im in the UK. if the patient isnt fit to drive they are not fit to drive, thats a fact, which shouldnt be open to interpretation. You are not doing the patient a favour by turning a blind eye to the data infornt of you. if they are unfit - you should positivley discourage them from driving - it could be thier own grandchild they run over - or yours!

    I just want to make the patients vision as good as possible, its bloody hard to do that with a lack of basic data

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    Quote Originally Posted by QDO1
    im in the UK. if the patient isnt fit to drive they are not fit to drive, thats a fact, which shouldnt be open to interpretation. You are not doing the patient a favour by turning a blind eye to the data infornt of you. if they are unfit - you should positivley discourage them from driving - it could be thier own grandchild they run over - or yours!

    I just want to make the patients vision as good as possible, its bloody hard to do that with a lack of basic data
    Agreed.

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    Quote Originally Posted by QDO1
    im in the UK. if the patient isnt fit to drive they are not fit to drive, thats a fact, which shouldnt be open to interpretation. You are not doing the patient a favour by turning a blind eye to the data infornt of you. if they are unfit - you should positivley discourage them from driving - it could be thier own grandchild they run over - or yours!

    I just want to make the patients vision as good as possible, its bloody hard to do that with a lack of basic data
    OK I'm going to retract my objection based on HIPAA, at least regarding the written Rx. Phoned in and faxed might be an issue, but I can see where it would be helpful to a dispenser. I'll think about adding it to my Rxs. Re your comments on driving, unfortunately it IS open to interpretation, and many people are on that uncomfortable edge between adequate and inadequate. I HATE making that decision, but often have to, since in CALIF. they rely pretty heavily on our recommendations. I wish there were black and white guidelines. There aren't, at least not here...:(

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    BCVA is assuredly NOT a part of a spectacle Rx, but it is sure helpful to know what you're filling.

    Ideally, there would be some sort of communication between the two entities, but I do believe there would be HIPPA ramifications if there were no records release signatures.

    That leaves you with telling the patient "go back to the Dr., if you don't like the glasses" or at least trying to communicate with the Dr. regarding their problem at dispensing or followup (after needed paperwork is filled out). Bad system, but that's what we've got.

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    Back when I used to teach.

    In the past (from the '60's on) I have fit a lot of contact lense on aphakes, a lot of cones and a lot of patients with amblyopia and other retinal problems. When the doctor doesn't give bcva I foolishly assume it's 20/20. While I always continue to try to get the best possible va and it is often better than the doctor could get with spectacles, it would be nice to know the patient's capabilities before wasting a lot of time, thought and effort on both my and the patient's time.
    I must admit that I finally gave up, I can't even get experienced doctors to get smart enough to refract over a ridgid contact lens. Many just have them take them out in the office and refract. Of course they have a useless batch of momentary figures for an Rx, but they persist.

    Chip
    Last edited by chip anderson; 12-27-2005 at 08:18 PM. Reason: Need same.

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    Quote Originally Posted by chip anderson
    In the past (from the '60's on) I have fit a lot of contact lense on aphakes, a lot of cones and a lot of patients with amblyopia and other retinal problems. When the doctor doesn't give bcva I foolishly assume it's 20/20. While I always continue to try to get the best possible va and it is often better than the doctor could get with spectacles, it would be nice to know the patient's capabilities before wasting a lot of time, thought and effort on both my and the patient's time.
    I must admit that I finally gave up, I can't even get experienced doctors to get smart enough to refract over a ridgid contact lens. Many just have them take them out in the office and refract. Of course they have a useless batch of momentary figures for an Rx, but they persist.

    Chip
    BVAs should definately be included in specialty cases like this...where the fitter and the doctor are not the same person. It shouldn't be too much trouble to get the information released by the dr. I can't imagine fitting a keratocone without knowing the BVA with spectacles. It also would make good sense on "regular" Rxs as well. We should all probably check with our state associations legal counsel before starting to include BVAs though.

    I have a feeling that in NY it would be OK for a dr. and CL fitter to exchange BVAs, since our optician/CL fitter legislation requires the dr. and fitter to be in direct contact with each other. But, this only addresses cases involving contact lenses fit by a duly licensed CL fitting optician...not spectacles... I think our optometry and opticianry laws are silent on this. If I'm not mistaken our laws say "an Rx MUST include whatever information is necessary to fabricate the eyewear" . I think it would be a leap to say that this means you MUST include BVAs on spectacle Rxs.

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    Should be no problem with hipaa, any information exchanged in the treatment of a patient is allowed unless explicitly forbidden by the patient. No release needed. this is no different than sending a referral letter to a retinal specialist for an RD referral. I'm no lawyer but that is my understanding of the rule.
    :cheers: Life is too short to drink cheap beer.

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    Over the years I am stunned at what customers think that little Rx form provides in the way of information to the optician; visual accuity, difference of old and new Rx, health of their eye, etc.

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    This could be a topic for another thread, but we still have pateints that bring in an outside RX and ask for contacts. They think their RX is for both. Let's all try to educate our population. Thanks

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