A never expiring rx....imagine that!

[Nettie]

There is a Dr. in my area that never writes expiration dates on his rx's....contacts and glasses. I called once and asked since the patient brought in an rx dated 3 years ago. The girl tells me "Oh they never expire. Dr. Whatshisbutt feels that his patients are capable of knowing when their vision needs a change and will come see him when they are ready". I gently reminded her to inform her patients that we will not honor an rx older than 2 years.

Another fine example of Dr. Whatshisbutt happened today. Mr. patient comes stomping in, slams his specs on the counter and says "Dr. Whatshisbutt said you made these wrong now I want them FIXED!!!!" Dr. Whatshisbutt had written an rx that said 'glasses made wrong... should be this rx...please remake. I then proceeded to pull out the first copy of the rx that the patient had brought us in January in Dr. Whatshisbutts handwriting and show him his bill of sale and informed him we DID NOT make the glasses wrong, that the rx was ordered exactly as written, but would gladly honor the Dr.'s request. I think Dr. Whatshisbutt is getting senile.

We get so many rx's from him because people have heard about his fantastic neverending prescriptions, and then we are the bad guys for not filling it after 2 years. Anyone ever had to deal with a similar situation? It's getting very frustrating.

[chip anderson]

Look Nettie: Rx's never used to expire, we just used to recommend a new eye exam every two years for the under 40 and yearly for the over forty. People are not really harmed (or at least very infrequently) by the wrong or not completely up to date specatacle Rx. The idea of expiration date is strictly a gimmic by prescribers who can influence the legislator in order get people in for new eye exams (cha-ching) and prevent sources outside the doctor's office from being able to re-fill the Rx without the doctor's office being able to get an examination fee an a chance to put the sales pitch on the patient for new spectacles before he can go out and shop with his new Rx.

Almost everything in this business comes down to money, patient's health is far secondary.

Chip

[Judy Canty]

Here in Virginia, spectacle rx's can not contain an expiration date unless it is deemed medically necessary. Contact lens rx's can and usually do expire after 1 year. We've been troubled in the past with rx's that expire within hours of the exam. These prescribing Dr.s find themselves called on the carpet by the appropriate regulatory body.

[Nettie]

I understand that Chip, and remember that as well. But in my fair state he is breaking the law.

And as far as it being a gimmick by the prescriber......a gentelman came in a few weeks ago after not having an eye exam for 5 years. Even he didn't think he needed a change but his glasses were old and funky so he knew he needed an exam to get new ones. My OD saw some things that worried him (nerve swelling, intraocular pressure, etc.)and sent the gentleman to the VA hspital for further tests where a large brain mass was discovered. Had he come in 3 years ago......who knows.

I think alot of it depends on the doctor. My OD is one who is VERY thorough and cares very much about his patients eye health. He never charges for followups within the 2 year timeframe if one of his patients is having problems. He even comes in on his days off if someone can't see him the other 5 days he is available. I know there are DR.'s out there who only care about $$$ but I have also worked with some amazingly caring OD's as well.

Oh I almost forgot....if a patient has had NO CHANGE he sends them out to us so we can give their existing glasses a free tune up and off they go. It's not always about $$$$.

My problem is with this one particular Dr. who makes it hard on the rest of us who do follow state laws.

[mhboptics]

No matter what an Rx say's, you could always neutralize a patients existing eyeglasses for them to purchase a new pair. On the other hand, my office will not fill any Rx older than 1 year( just our policy).

[C-10]

As a health care provider I feel it important to go over the importance of an eye exam. In the medical and in the interested of ones clients I hated when I have filled a prescription and a client comes back in a few months with a new Rx. Is it not our job to make sure that we fill every prescription in the interest of our patient and to duplicate a Rx with not informing my client about a eye exam in my opinion is malpractice? Yes I do duplicate Rxs but not after my little lecture on why an Eye Exam is so important. I do not get paid for the eye exam so financially I am no further a head. But with saying that we all have to eat and profit is not a four letter word if it was not for the money aspect of my job I would not be here As for your Dr. he is a Idiot. I am a fraid you will have to live with him.

[Johns]

We believe that customers DO know when it's time for an exam. I'm not the governing agency. If it doesn't have a date on it, we fill it. If it's not current and they want to fill it, we neut the glasses on go on.

[orangezero]

Wow, not sure where to start on this one. That doc sucks.

I do think its seriously mistaken for a contact lens prescription to not have an expiration date. Or a spectacle prescription really. I feel bad for those in the industry that can't see a value in a regular eye exam, whether it be every 1, 2 or 4 years.

Everyone thats worked in this industry long enough has had an example of a person coming in simply for glasses and finding a brain tumor of some sort, or diabetic edema, or a cranial nerve malfunction caused from a lung tumor, or giant cell arteritis, or a end stage glaucoma, or keratoconus, or whatever. Its a good thing that those who don't know what those things mean do not make the recommendations on how often a person should get an exam. Sure they don't happen everyday, but they do happen. I don't think its just some big conspiracy to make eye doctors more money.

Plus, as an eye doctor (and i dont' make a dime off of glasses) in a given day I would say most people come to me because of a broken frame or whatever, and I end up making them see much better than their old glasses. There are so many reasons for this, and not all of them are because of their lenses are scratched up. Its amazing what people will put up with. If anything, I'd say most patients I see have no idea how often they are supposed to see an eye doctor, even the ones who have contacts that expire every year.

Perhaps instead of charging $70 for a contact exam, we should just give out free contacts to everyone and charge $500 or $1000 when patients have a central corneal ulcer. That would be where the money is, if thats all we care about.

Sorry, its a friday and I'm tired.

Plus, the same money frenzy argument could be made about the opticians on here that will make a pair of glasses from any piece of paper that is shown to them with a few numbers on it, despite the laws.

I dont' want to start an argument on here, but I think to equate standard of care and recommendations of the leaders in the field with only financial gain is to have a skewed outlook on things.

[Ory]

Well said, orangezero!

[Chris Ryser]

Look Nettie: Rx's never used to expire, we just used to recommend a new eye exam every two years for the under 40 and yearly for the over forty.

Chip is right..........................an Rx for glasses will only expire because the patioent needs another addition or an increase for distance.............the other reasons might be a medical factor.

Therefore when patients arms become too short to read its time for another exam.

[Ory]

A prescription for glasses will expire when the prescribing doctor says so. End of story.

I don't tend to write an expiry date on my prescriptions but I will in a few cases. The majority of these are the kids who need to be reassessed often due to concerns such as amblyopia. When there is a risk of harm from them continuing to use the same Rx then I will use my judgement. That being said I will always recommend a new exam to anyone who wants new glasses if the Rx is around 2 years or older. Most people understand that it may be a waste of money to buy new glasses and then find there is a change.

To say people will know when their prescription is no good is like saying they will know when they have a heart condition. Of course they'll figure it out when the have that heart attack......but we can't force them to see a cardiologist.

[rbaker]

Chip and Chris bring up the pertinent point. Medical need is (or should be) based upon tangible physiological changes and not the calendar. For years it was suggested that an the patient had an eye exam every five years unless they were having a problem. The only exception to this rule was an existing pathology.

To require an eye exam on an annual or biennial basis is not warranted for the asymptomatic patient with no pathology and to refuse to make eyewear unless the Rx is less than a year old is a disservice to the patient.

Have we become so pressured to increase chair time and eyewear sales that we have to resort to these “company policies” to provide us with our bread and butter. Do we have to resort to efforts to pass legislation and influence insurance providers to aid us in lining our pockets.

You can shuck and jive all you want – it’s still greed!

[Jubilee]

so by that assumption should we let cl patients keep renewing there scripts via online places, since they will let us know if there is an issue?

I had a lady lose sight in her right eye this week because she noticed some change in vision, but didn't get around to seeing us till she didn't pass the screening and the BMV.

Previously undiagnosed diabetic retinopathy can do that, and this was a lady who's mother had lost vision due to retinopathy as well.

Maybe if she came in for her biannual exam that was due at the beginning of the year, we could have saved her vision.

But you are all right, it is a matter of greed on our part, and has nothing to do with a genuine concern over patient health or vision.

Cassandra

[Johns]

Dentists have suceeded in their marketing to convince people to get a cleaning every 6 months. Optometry has taken a page out of their book and gone to one year. I benefit from their position (we all do), but let's not call it anything more than it is.

Yes, I said that people know when they need an exam. And of course, that's not the case. But they do know when they can't walk, and they know when they can't see.

[Johns]

so by that assumption should we let cl patients keep renewing there scripts via online places, since they will let us know if there is an issue?

I had a lady lose sight in her right eye this week because she noticed some change in vision, but didn't get around to seeing us till she didn't pass the screening and the BMV.

Previously undiagnosed diabetic retinopathy can do that, and this was a lady who's mother had lost vision due to retinopathy as well.

This is a great case:

Family history, non-compliant to recalls (assuming she was recalled), didn't come in even after she noticed loss of vision, and you could have saved her vision? Do you incarcerate them to make sure they follow up ?

[Jubilee]

She was "between" practicioners. For insurance reasons she had switched providers a couple of years back. It changed again, and we had just seen her son, and she decided to go back to us as well.


The point is, that people don't always KNOW when they are having a change or at least a significant one.

How many of your patients have NO CHANGE whatsoever in 2 years? How many come in thinking there is no change, when there is? Ever had patients get an updated rx when they didn't think there was a need, then put on the glasses and were "amazed" at the difference?

Do you want to be on the road with people who don't get check ups every few years?

[chip anderson]

This woman knew she had a problem she was just too lazy or too cheap to schedule an appointment. This was not the fault of the law, the eye doctor, the insurance company or anyone else other than the patient. Not anything short of God himself can save one from stupidty. And the idea that she couldn't renew her eyeglasses without a new Rx or eye exam would have helped is ludicrous. She still would have procrastinated, anyone who notices a loss in visio and won't get it seen about is beyond help and you can see the results in her case.

Chip

[orangezero]

Out of all the exams I've done, I've only had one patient think it was a "conspiracy of eye doctors" to make them come in for an eye exam.

consider this, one estimate puts the number in the US alone with "pre-diabetes" at almost 41million. This is in addition to the 8 to 10 million people with diabetes that don't even know it. Just one example, one disease.

Why don't you guys wake up and realize people aren't just going to eye doctors for Rx's for so you can sell glasses, or the OD can sell glasses. They go because they see a value in regular health checks, either because they were educated by an eye care professional or because of their own intuition. Its crazy there are people in the industry willing to persuade them to do otherwise.

It seems silly there is such a discussion about this. I feel bad for the three O's if many opticians really feel this way. Makes me want to self educate my staff in my new practice and avoid an "educated" optician altogether if this is the norm.

I can only hope you all have reached this conclusion because of some poor excuse for a doctor that does shoddy exams and/or has poor business practices. The vast majority of eye doctors do realize there is a fine line between financial gains and professional advice. Usually we are happy because both go hand in hand. I don't think we should be punished for trying to make a living helping people to have better lives.:hammer:

OH, and it just occured to me. Perhaps the reason some on this forum have no problem telling people not to get regular exams is because of their almost complete lack of malpractice liability in regards to the subject. Its great if you feel you are part of the health care team, but if you don't take any of the legal responsibility, you are just a liabilty to the real health providers and will be avoided. Don't you see how these opinions are dangerous to YOUR profession?? Sure, I agree, its the women's own fault for not returning to care, but when she's monocular, crying on the stand, I'll be the one the jury looks to to pay up. Not the optician who's telling her an exam wasn't necessary. Please don't make me pull out silly (from a common sense standpoint) examples that would illustrate my point.

[Johns]

Not the optician who's telling her an exam wasn't necessary. Please don't make me pull out silly (from a common sense standpoint) examples that would illustrate my point.

I haven't heard any opticians here say that exams are not necessary. I won't cite silly examples either, but when OD's write 3 month expirations, write an Rx in cross cyl, and other techniques trying to thwart a pt/customer from shopping around, it puts the issue of expiration dates in a whole new light. Yes, we do want what's best for the patient, but you can't mandate eye exams.

[For-Life]

So when do you guys think is a suitable time period in between exams? We have heard a few different views already, but just want to see peoples opinions and justifications.

[rbaker]

Orangezero,

The optometrist is in no way considered to be a primary care practitioner in our medical delivery system. Cripes, you can’t even draw blood for lab work. Lets leave the diagnosis of medical condition to the physician.

This is not to say that you are not trained to look for certain gross signs that may indicate a pathology and refer in an appropriate manner. Lets encourage patients to see their primary care physician at appropriate times and stick to our knitting. I sure hope that you are not leading your patients to believe that you are capable of giving them a clean bill of health in any area other than rudimentary visual analysis.

And, yes, occasional anecdotes do exist about some OD referring a patient to an MD and saving his sight, but the same holds true for other ancillary medical personnel and occasionally even a bus driver.

[fjpod]

Orangezero,

The optometrist is in no way considered to be a primary care practitioner in our medical delivery system. Cripes, you can’t even draw blood for lab work. Lets leave the diagnosis of medical condition to the physician.

This is not to say that you are not trained to look for certain gross signs that may indicate a pathology and refer in an appropriate manner. Lets encourage patients to see their primary care physician at appropriate times and stick to our knitting. I sure hope that you are not leading your patients to believe that you are capable of giving them a clean bill of health in any area other than rudimentary visual analysis.

And, yes, occasional anecdotes do exist about some OD referring a patient to an MD and saving his sight, but the same holds true for other ancillary medical personnel and occasionally even a bus driver.

rbaker,
your monicker, old geezer, serves you well. Thankyou for your opinion on what ODs are qualified to do or not do.

[Ory]

Orangezero,

The optometrist is in no way considered to be a primary care practitioner in our medical delivery system. Cripes, you can’t even draw blood for lab work. Lets leave the diagnosis of medical condition to the physician.

This is not to say that you are not trained to look for certain gross signs that may indicate a pathology and refer in an appropriate manner. Lets encourage patients to see their primary care physician at appropriate times and stick to our knitting. I sure hope that you are not leading your patients to believe that you are capable of giving them a clean bill of health in any area other than rudimentary visual analysis.

And, yes, occasional anecdotes do exist about some OD referring a patient to an MD and saving his sight, but the same holds true for other ancillary medical personnel and occasionally even a bus driver.

If this holds true then I guess opticians are only qualified to fill the exact prescription given them. Hence they should not even have opinions about expiry on prescriptions as they know nothing about it. :angry:

[orangezero]

I haven't heard any opticians here say that exams are not necessary. I won't cite silly examples either, but when OD's write 3 month expirations, write an Rx in cross cyl, and other techniques trying to thwart a pt/customer from shopping around, it puts the issue of expiration dates in a whole new light. Yes, we do want what's best for the patient, but you can't mandate eye exams.

Um, excuse me, I think thats the point. We CAN (as ODs) mandate prescriptions. Sorry if you can't understand that. That being said, I'm not sure ever write too man Rx's that have less than 2yr experiations other than contacts.


Rbaker, ODs ARE primary care physicians. Get with the times. Perhaps the old OD in your city doesn't consider himself one, but the new grads do, and it is a fact. Sure, it does depend on what state they practice in, but I'm about to start a job in a medical arts building and have full hospital priveledges. I'll pretty much only refer to specialists, neurology, retinal, whatever.

rudimentary visual analysis, give me a break man. learn what an OD is trained to do. I'm sorry if that sounds mean.

I agree, asking an optician about standard of care is just silly.

[Johns]

Um, excuse me, I think thats the point. We CAN (as ODs) mandate prescriptions. Sorry if you can't understand that.

man·datePRONUNCIATION: mndtNOUN:1. An authoritative command or instruction. 2. A command or an authorization given by a political electorate to its representative. 3a. A commission from the League of Nations authorizing a member nation to administer a territory. b. A region under such administration. 4. Law a. An order issued by a superior court or an official to a lower court. b. A contract by which one party agrees to perform services for another without payment. TRANSITIVE VERB:Inflected forms: man·dat·ed, man·dat·ing, man·dates
1. To assign (a colony or territory) to a specified nation under a mandate. 2. To make mandatory, as by law; decree or require: mandated desegregation of public schools.


Oops! Sorry about that! I forgot that this is a worldwide forum. I'm not sure if your location ( Ill.) is a province in some communist country, or possibly a dictatorship where it is written in the law that everyone must have an eye exam, but here in most of the US, it is up to the discretion of the patient as to when (or if) an eye exam is performed. Of course, in some states, the government has decided that parents do not have the sensibilities to know when to have their childrens' eyes examined, and has made it a condtion of entering school. Conveniently, the governments of these states now pay (great news for ODs!) for these exams.

Um, excuse me, I think thats the point. We CAN (as ODs) mandate prescriptions. Sorry if you can't understand that.

You really can mandate prescriptions ? You're right...I can't understand that.:hammer: