Another question....is this ethical?

**Nettie** · 04-14-2006, 01:54 PM

A patient walks into your optical shop. He hands you an RX for Acuvue2 8.3. He says he doesn't want those anymore...he would much rather wear the O2optix because his friend thinks they are more comfy. You tell him you have to dispense the RX as it is written. He tells you to call his Dr. where he was examined and ask if he can wear the O2optix. Do you make that call? Why or why not? I definetly have an opinion on this but I would like to find out what others think first. And to the OD's here....how do you feel when you get a call from another optical shop where your patient is asking for these changes over the phone?

**For-Life** · 04-14-2006, 01:56 PM

Originally Posted by Nettie

A patient walks into your optical shop. He hands you an RX for Acuvue2 8.3. He says he doesn't want those anymore...he would much rather wear the O2optix because his friend thinks they are more comfy. You tell him you have to dispense the RX as it is written. He tells you to call his Dr. where he was examined and ask if he can wear the O2optix. Do you make that call? Why or why not? I definetly have an opinion on this but I would like to find out what others think first. And to the OD's here....how do you feel when you get a call from another optical shop where your patient is asking for these changes over the phone?

No, you go to the back and do the necessary measurements for the contacts

**karen** · 04-14-2006, 02:49 PM

Is the Doc local? I wonder why the patient doesn't get his contacts there? If it were me I would say I would fill it as written and if he wants his Doc to change it, he can go there and get that accomplished. I would explain it like at the pharmacy they can't just change his meds because the orange pill is easier to swallow than the big pink one....although that may make him say the pharmacy would call the Doc, why won't you....

**Framebender** · 04-14-2006, 03:09 PM

I want a written Rx for the contacts we dispense from outside offices.

**Dave Nelson** · 04-14-2006, 03:51 PM

The ethics depend on the jurisdiction. Here in Canada optometrists do not prescribe contact lenses, they are fitted and dipensed by either the optometrist or a registered contact lens optician using a spectacle rx only. If someone wants to try another lens I am free to refit them, even if they obtained their contacts from the optometrist. There is no ethics problem, and I assume the responsibility for the fit and follow up.There seems to be a real hodge-podge of regs and scope of practice issues in the states from one jurisdiction to the other, so the ethics depend on the regs. IMHO, In jurisdictions where the optom is responsible for the contacts, you would be unlikely to convince one to ok a lens change without a return to the prescriber.

**For-Life** · 04-14-2006, 03:57 PM

I think it is a lot more ethical fitting someone with the BEST lens, than the lens that the doctor is trying to sell.

**chip anderson** · 04-14-2006, 05:01 PM

I'm with For-Life. Too many contacts are fitted with by whichever mfg's. rep gave the most samples and had the best legs in a mini-skirt.

**Dave Nelson** · 04-14-2006, 05:19 PM

I'm insulted by the implication that my clinical expertise and judgement could be compromised by a pair of well formed legs...it was the plunging neckline and cleavage that did it.

Originally Posted by chip anderson

I'm with For-Life. Too many contacts are fitted with by whichever mfg's. rep gave the most samples and had the best legs in a mini-skirt.

**karen** · 04-14-2006, 07:26 PM

Originally Posted by For-Life

I think it is a lot more ethical fitting someone with the BEST lens, than the lens that the doctor is trying to sell.

But perhaps the Doc thinks that is the best lens and that is why they prescibed it. My dad's CL rep for his favorite lens was a guy so that kind of blows Chip's theory in at least that case....

**For-Life** · 04-14-2006, 07:35 PM

Originally Posted by karen

But perhaps the Doc thinks that is the best lens and that is why they prescibed it. My dad's CL rep for his favorite lens was a guy so that kind of blows Chip's theory in at least that case....

maybe, maybe not

The doctors in my area do almost nothing with contact lens patients. They just hand them a pair after the exam and tell them to phone them if they want to order some.

It is up to you to make the decision for your patients. Would you trust someone elses PD measurement, or seg height? I wouldn't.

**fjpod** · 04-14-2006, 07:38 PM

Originally Posted by For-Life

I think it is a lot more ethical fitting someone with the BEST lens, than the lens that the doctor is trying to sell.

...and opticians only sell the best lenses while doctors sell junk? Oh puhleeze!

BTW, don't assume a silicone acrylate is always the best lens.

**For-Life** · 04-14-2006, 08:02 PM

Originally Posted by fjpod

...and opticians only sell the best lenses while doctors sell junk? Oh puhleeze!

BTW, don't assume a silicone acrylate is always the best lens.

you did not read my last post :finger:

It is nothing to do with OD, RO, MD, PHD or even OB

It has to do with not knowing if the the person the other patient saw is making a fair choice or not, and that we should only trust our opinions.

Sounds like people are looking to pick a fight ;) Remember, I said some, not all.

**fjpod** · 04-14-2006, 08:20 PM

Originally Posted by For-Life

you did not read my last post :finger:

It is nothing to do with OD, RO, MD, PHD or even OB

It has to do with not knowing if the the person the other patient saw is making a fair choice or not, and that we should only trust our opinions.

Sounds like people are looking to pick a fight ;) Remember, I said some, not all.

I wasn't talking about your last post. Many opticians in my area sell contacts simply by looking at the patients lens boxes and making a sale...no exam, nothing. What's the point of making a statement like that? :hammer: This thread was Is It Ethical...I daresay, your statement wasn't. Not picking a fight, just trying to keep the thread honest.

**For-Life** · 04-14-2006, 08:27 PM

Originally Posted by fjpod

I wasn't talking about your last post. Many opticians in my area sell contacts simply by looking at the patients lens boxes and making a sale...no exam, nothing. What's the point of making a statement like that? :hammer: This thread was Is It Ethical...I daresay, your statement wasn't. Not picking a fight, just trying to keep the thread honest.

the point of the statement is that because some people prescribe things based on factors other than that thing being the best for the patient it is up to us to use our knowledge when needed. Thus satisfying the original question.

**Lynne** · 04-14-2006, 09:46 PM

Originally Posted by Nettie

A patient walks into your optical shop. He hands you an RX for Acuvue2 8.3. He says he doesn't want those anymore...he would much rather wear the O2optix because his friend thinks they are more comfy. You tell him you have to dispense the RX as it is written. He tells you to call his Dr. where he was examined and ask if he can wear the O2optix. Do you make that call? Why or why not? I definetly have an opinion on this but I would like to find out what others think first. And to the OD's here....how do you feel when you get a call from another optical shop where your patient is asking for these changes over the phone?

Nope, the doctor has to see the lens ON the eye before he can Rx it, so he would need to return for a refit in this state. I would maybe offer to call and make the appointment for them, depending on whether they got stroppy or not!

Happy Easter, everyone!:)

**fjpod** · 04-15-2006, 03:42 AM

Originally Posted by For-Life

the point of the statement is that because some people prescribe things based on factors other than that thing being the best for the patient it is up to us to use our knowledge when needed. Thus satisfying the original question.

This statement is correct. The other one was an unfair generalization.

**fjpod** · 04-15-2006, 04:33 AM

Originally Posted by Nettie

A patient walks into your optical shop. He hands you an RX for Acuvue2 8.3. He says he doesn't want those anymore...he would much rather wear the O2optix because his friend thinks they are more comfy. You tell him you have to dispense the RX as it is written. He tells you to call his Dr. where he was examined and ask if he can wear the O2optix. Do you make that call? Why or why not? I definetly have an opinion on this but I would like to find out what others think first. And to the OD's here....how do you feel when you get a call from another optical shop where your patient is asking for these changes over the phone?

An ODs opinion...as you asked...
Here in New York, a CL licensed optician can fit/refit CLs from a spectacle Rx, so your scenario rarely happens. At least, It's never happened to me and I've been in practice 28 years. I don't have any objection to another appropriately licensed professional taking on a case, but I hope it's for the right reasons...not just to sell a more expensive product, or because that's what's in stock, or just to make an optometrist look bad. But I think if a patient is asking to buy different lenses from YOU, YOU should take the responsibility for the refit...and get paid for it. I personally would do a retrial, followed by biomicroscopy, over-refraction, history, etc.

You know, I myself have opted many times to suggest a newer contact lens to a patient. Things tend to follow the rule of "thirds". If you try to refit "all" HEMA wearers into Silicone Acrylates, one third of them will be happier, one third will feel no change, and one third will be less happy (SiAs bite:bbg: ). So, I don't try to refit ALL. I focus in on the ones with problems or those with increased risk of corneal problems.

A little off the subject, but I find it sad that so many "fitters", (and the public) perceive contact lenses to be like a new pair of socks. While they have to fit, there is a wide latitude in what the feet will tolerate. Contacts are so often treated as an item to "sell" and not an item to be "fit". We, the fitters/sellers are responsible for the publics perception of CLs as a commodity. So many places use CLs as a loss leader item... of course nobody wants to "fit" them. There is no built in fitting fee like there is with glasses. They just want to give them away so as to move on to the eyeglass sale.

Also off the subject...almost every optometrist I know takes an active role in fitting contacts in his or her practice, whether it be a private office,, storefront, corporate setting, HMO, employed, franchised, does therapeutics, whatever. I mean ACTIVE role. If you follow most of the threads on this forum related to CL fitting, you would think ALL optometrists gave up CL fitting decades ago. It just isn't so. I'm sure there are great opticians out there fitting CLs very well, but optometry has not just rolled over.

FWIW

**Jubilee** · 04-15-2006, 08:46 AM

Recently we had a patient who was fit with an AV 8.3 on her last exam. When the doctor talked to her about the contacts, how they were doing, etc.. no complaints, eyes looked healthy, decided to keep her in same.

Went to process the order and she asked "can I get the advance instead? When I had my last script filled at Sam's Club, that is what they gave me. They're a lot more comfortable."

One, we never released her contact lens script. So did they just go by box tops? Two, wouldn't you have mentioned this when in the exam room talking about your cls? Three, When I asked if they ever checked them on her eye, they had said "their just an improved version, and not it wasn't necessary for a refit."

Cassandra

**chip anderson** · 04-15-2006, 08:55 AM

The scary part of this thread: "Ethical depends on where you are."

Do we fit contact lenses? Or do we fill precriptions (sell) for contact lenses?
We know what happens at Sam's Club and 1-800 whatever and a lot of places. Contact lens fitting entails follow-up, observation of the lens on the eye by slit-lamp and other means. Evaluation (not refraction) of visual acuity (at least as compared to spectacles) and observation of what happens to the eye over long (weeks, months, decades) periods of time. If you don't do this (whether you are an O.D., M.D., or Optician) you ain't fitting contact lenses. If you have other people in or out of your office that do this and you do not, you ain't fittin contact lenses. If you don't personally instruct and observe the patient (at least the new ones) on insertion, removal, re-location, and care/hygiene of contact lenses, you ain't fittin' contact lenses.

Any fool (or nowdays his machine), can take K readings and read a silly chart, this is not contact lens fitting.

Chip

**Jubilee** · 04-15-2006, 09:04 AM

Originally Posted by fjpod

A little off the subject, but I find it sad that so many "fitters", (and the public) perceive contact lenses to be like a new pair of socks. While they have to fit, there is a wide latitude in what the feet will tolerate. Contacts are so often treated as an item to "sell" and not an item to be "fit". We, the fitters/sellers are responsible for the publics perception of CLs as a commodity. So many places use CLs as a loss leader item... of course nobody wants to "fit" them. There is no built in fitting fee like there is with glasses. They just want to give them away so as to move on to the eyeglass sale.

Also off the subject...almost every optometrist I know takes an active role in fitting contacts in his or her practice, whether it be a private office,, storefront, corporate setting, HMO, employed, franchised, does therapeutics, whatever. I mean ACTIVE role. If you follow most of the threads on this forum related to CL fitting, you would think ALL optometrists gave up CL fitting decades ago. It just isn't so. I'm sure there are great opticians out there fitting CLs very well, but optometry has not just rolled over.

FWIW

We are currently are working with a patient that just doesn't get this. She is new to our office, and wants colored, disposable contacts. She has a minimal refraction of +0.25-0.50 and pl-0.25. It took us a couple of tries to get something available in a non tinted to check rx etc. So it has been a week since her intial visit, and she calls up and asks if we got the trials in. I tell her yes, and we will dispense those to her on Monday afternoon at her follow up appt. "why can't you release them to me now? I have worn contacts before!" So I try to explain to her that this doctor has never seen any contact lens on her, let alone this particular brand, so he has to dispense them and check them before she can leave with them.

So she calls her insurance company to have them gripe me out. She told them she was having migraines, and thought it was eye related. I explained to the insurance person that the patient has a minimal rx requirement, and it was unlikely. If indeed she is that sensitive, then she would be better served by glasses. The rep asked why it took a while to get trials. So I explained to her that most cls trials for brands that are also tinted aren't available in +0.25. The person asked "is that a high rx?" I then explained to her that it was a very low power that most patients wouldn't seek correction for, let alone a contact lens for.

The rep then asked, if she wore them before, why can't you let her have them? So again, I explained that this doctor has never seen her with a contact lens of any brand in. When I had her records forwarded from her last office, the only thing they could tell me was she wore a Ciba brand lens. She hadn't had any cls for over 3 years, and we were going to be held liable for someone elses outdated information! If they were improperly fitted, then it can harm her eye, and we would rather take her eye health seriously, than being a vending machine. IF they rx is that important to her, then she should have a back up pair of glasses period! The only reason why the doctor hadn't required it, is because he was under the impression she was wanting them for the tint, not the power.

The insurance rep then had the light bulb go off, and I told her the doctor was unavailable today (Good Friday) and the only reason why I was in the office was to take care of some projects. So we would be happy to assist her on Monday!

Sorry, just had to vent about that one... seems we have more people get upset that we do take cls seriously, rather than hand them out like candy.

Cassandra

**chip anderson** · 04-15-2006, 09:40 AM

Cassandra: There is very little point in having the doctor look at the contact lenses on the eye until she has worn them at least a week, and then this should be done after the lenses have been worn for some time (morning insertion, afternoon observation). All he can tell is: "Can she see, does it center, does it move" which you should be able to tell as well as he.

Chip

**fjpod** · 04-15-2006, 03:48 PM

Cassandra, that's exactly the kind of situation I was referring to.
I feel WE, the ophthalmic professionals, are to blame for not taking CL fitting seriously enough. For rushing through it because we're too busy making money doing something else, or because it takes too much time and patients aren't willing to pay for time, or because corporate wants us to move so many boxes of product per month.

If you don't do it right, it's gonna catch up to you sooner or later.

Name one other product, which is sold at such a low a profit margin as CLs. Do restaurants give away bottles of wine at $1.00 above cost? Do dentists give away braces at cost? Can you get a hearing aid at cost? You bet your Bippy you can't.

**For-Life** · 04-15-2006, 04:28 PM

Originally Posted by fjpod

Cassandra, that's exactly the kind of situation I was referring to.
I feel WE, the ophthalmic professionals, are to blame for not taking CL fitting seriously enough. For rushing through it because we're too busy making money doing something else, or because it takes too much time and patients aren't willing to pay for time, or because corporate wants us to move so many boxes of product per month.

If you don't do it right, it's gonna catch up to you sooner or later.

Name one other product, which is sold at such a low a profit margin as CLs. Do restaurants give away bottles of wine at $1.00 above cost? Do dentists give away braces at cost? Can you get a hearing aid at cost? You bet your Bippy you can't.

well that is the thing. Contacts are being turned into low involvement purchases, where they really should be a high involvement purchase.

**Jubilee** · 04-15-2006, 11:16 PM

Originally Posted by chip anderson

Cassandra: There is very little point in having the doctor look at the contact lenses on the eye until she has worn them at least a week, and then this should be done after the lenses have been worn for some time (morning insertion, afternoon observation). All he can tell is: "Can she see, does it center, does it move" which you should be able to tell as well as he.

Chip

We do see them at one week post dispense as well. The point is we won't let any cls go out of the office till the doctor has had a chance to see them on. IF all is well, and they demonstrate proper insertion, removal, and care.. they can take wear them home, and come back in a week for a check for how they wear, fuction, etc.

Cassandra

**Nettie** · 04-16-2006, 12:26 AM

I love learning new words like Stroppy and Bippy.:D

This is my opinion.....here goes.
I do not think it is professional on my part to call an outside Dr. and ask them to write an RX for a patient over the phone. I think it makes me look unethical and ignorant. It would be like a pharmacist calling someones Dr. and saying "hey doc....you wrote this rx for loritab but they want prozac instead...whaddya say?"

Do I want to sell contacts to every patient....yes indeedy.
Do I want to sell only what they are prescribed and not go making a fool out of myself by calling their Dr. and asking them to change the rx? Yes indeedy.

Would YOU call a Dr. on your patients/customers behalf and ask them to change what has been prescribed just because the patient wants something new because it is on sale or they heard it was better?
Would a better response be to hand the patient the phone and let them make the request themselves and ask to have it faxed over?

How would you respond to that request?