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Thread: Breaking News in the Great Glasses Court Case

  1. #126
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    Quote Originally Posted by shawn b View Post
    Gary you are quite the comedian... LOL.
    I see this discussion going absolutely no where. I respect your point of view, and I hope that the next time your own health is in question that someone else makes your health decisions for you, because as long as they know more than you- it is acceptable for them to force their view on you.

    As far as you doubting me about educating patients before they make a decision- I cannot help you with that. If I say something and you think otherwise, that's between you and you- not you and me.

    And as far as you assuming that people who use Eyelogic are only doing so to drive up business, and not give patients a choice- that is absurd. I don't see the logic in your statement, only because automated sight tests are not their only option, which means people are free to make a decision for or against it. I cannot speak for everyone using the system, but I will say that people are free to make a decision between using the system and seeing an OD or MD- we can only answer their questions, we cannot make decisions for them.

    The most hilarious thing you said so far, "They are NOT using it to give the public a choice nor to give the public a free service. They are using it for their own market share reasons to sell more glasses." This is the best comment you made. Your speak with so much certainty, this argument can easily be re-worded to include ODs. And how can you logically say that providing an alternative option is not giving the public choice? And how can you logically say that by giving them this free option is not providing them with a free option. If the result of these options is increased market share and the selling of glasses- well then the public has spoken- who are you to decide over the majority?

    The fact, and I will say that again- the fact- is that you don't want people to have a choice, you want to make it for them. I don't see it like that, I think people who are trusted to drive on streets in moving vehicles, who vote for the people who run the country- should be entitled to make their own health decisions.

    And FYI Gary, I don't do any refractions or sight tests. Again, you can assume what you will. :bbg:
    Shawn,

    I think that its quite apparent that the notion of a "free" sight test is simply a loss leader to get more patients/customers into a practice - same as the "free eye exam" promotions common in Ontario where the optical will reimburese the cost of the exam with purchase. Having an eyelogics unit in your practice and offering a sight test still carries with it a cost to the practioner. There's the purchase/lease, operators time, marketing, real estate, insurance, and MD rubber-stamping fee. Where do you think the optician makes up the revenue to support this service?

    No competent self-employed person, doesn't matter what profession, would simply give away services that require such a heavy investment for free without an anticipated return in sales. That would be Absurd.

    What for the life of me I cannot understand is why a health care professional would ever concieve of creating or practicing under a lower standard of care when access to eye health in Canada is generally easily accessible and affordable.

  2. #127
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    Quote Originally Posted by Dave Nelson View Post
    Excaliber, you are most disapointing. This is a pressing issue, and the ramifications will change the face of vision care in North America for many years, impacting the scope of practice of opticians and optometrists, and the delivery of vision-care services to the public whom we serve. Having an optometrist resorting to name-calling in a forum read by many members of that same public is embarrasing and uncalled for. I recognize Harry certainly doesn't need me to "defend" him, but you are out of line.
    I am the first to admit I could certianly be wrong, but I would guess this will have little to no impact on future eye care in America. People may want cheap, but they don't want low class or lower standard of care, and believe me this stuff just draws that our of anyone who is medically trained. Where is the impetus for change going to come from? The complexity involved in invoking a change of this magnitude on the eye health public is just mind boggling. There aren't millions of people up in arms over the state of eye care. People expect the "test for glaucoma" and to bothered with dilation every now and again.

    This stuff in Canada that seems to be the hope and dreams of so many opticians (in Canada or wherever) just stinks to high heaven of poor care mixed with shoddy materials (or how else do you explain 3 for 1?), excuses of why liability won't be a concern (it would be), misinterpretation of patient expectations, misinterpretation of actual medical concerns (of which the vast majority on here were never trained to detect). etc.


    If anything, the long term trend is going to be for more personal responsibility in a patient's health care needs. No more big corporation to cover everything including co-pays. If it comes out of their pocket they will expect and demand quality and value that is sorely lacking here.. I think people may be surprised what the local OD and OMD will do to survive and prosper in this type of environment. ODs aren't all bumbling idiots and money grubbing fools so many on here are quick to bring up every chance they get.

    Did I get through this without disparaging opticians?? Not the time to go back and check, none intended. But honestly, its a pipe dream to think this type of stuff will spark some type of optical revolution and emancipation from the demon ODs...

    Its really disappointing to see name calling at all on boards such as these, and it is at least good that we can have poor banter in one topic and a civil conversation about something actually useful in another.

    [warning: this post not checked for grammar or spelling]

  3. #128
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    Quote Originally Posted by Oedema View Post
    Shawn,

    I think that its quite apparent that the notion of a "free" sight test is simply a loss leader to get more patients/customers into a practice - same as the "free eye exam" promotions common in Ontario where the optical will reimburese the cost of the exam with purchase. Having an eyelogics unit in your practice and offering a sight test still carries with it a cost to the practioner. There's the purchase/lease, operators time, marketing, real estate, insurance, and MD rubber-stamping fee. Where do you think the optician makes up the revenue to support this service?

    No competent self-employed person, doesn't matter what profession, would simply give away services that require such a heavy investment for free without an anticipated return in sales. That would be Absurd.

    What for the life of me I cannot understand is why a health care professional would ever concieve of creating or practicing under a lower standard of care when access to eye health in Canada is generally easily accessible and affordable.
    Hey Odema,

    You make some valid points- however, we do not share the same opinion.
    Your question about where the optician makes up the revenue to support the service is easily answered- with customers who support the service and are willing to purchase based upon it.
    Your comment that "No competent self-employed person, doesn't matter what profession, would simply give away services that require such a heavy investment for free without an anticipated return in sales. That would be Absurd." Is valid, however, you are talking about something you are unclear about. If you actually read the posting I made in response to Gary, he was stating that the only reason was to drive up business. My response was it was not soley about increasing revenue, but also to give people choice... and if you did read the post it says "And as far as you assuming that people who use Eyelogic are only doing so to drive up business, and not give patients a choice- that is absurd". Again, to assume that everyone is doing it soley for revenue is to miss a large part of the picture.

    I can understand your question regarding practicing under a lower standard. But I honestly do not see that as the issue. What I think the true issue is about, is adults being able to make decisions about their own health. It's about adults choosing which method or treatment suits their needs and values.
    Again, if an adult chooses to have a complete eye examination- that option should be available to him/her.
    And, if an adult chooses just to have their current refractive error measured- that option should be available to him/her.
    As someone living in America, I am sure you cannot dispute one's freedom to make their own health decisions. :bbg:

  4. #129
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    Quote Originally Posted by orangezero
    [warning: this post not checked for grammar or spelling]
    I like that I need to add that to my signautre line. I personaly don't get offended by the name calling, it doesn't reflect on me or my profession. And I certainly don't think that one bad apple represents all OD's or their opinions. Keep in mind this guy is new and may not be ready for the level of discussion that happens here. I also think that GG in no way represents opticianry in canada. It is the poster boy optometry wants it to be for opticianry, but I could point out too many bad apples on both sides.

    I disagree with a few of your points:

    I disagree that this wil not spark change in the states, I think it is only a change of this magnitude because optometry will oppose it tooth and nail.

    I don't see how this system:

    Quote Originally Posted by orangezero
    just stinks to high heaven of poor care mixed with shoddy materials
    especially when in the states we offer the same level of care in the majority of the states, an exam from an OD or OMD and glasses dispensed by Jethro the town idiot (no offesne to any Jethro's on this board or to any members that may have family named Jethro). The end result is that a poor refraction mixed with a great pair of glasses = shoody vision, the same holds true the other way around. A great exam with poor glasses = shoody vision. The advantages to having opticians refarct is one stop shopping. That one may sting a little because it is something I have actually lifted from OD's posts in previous threads here on optiboard, but whats good for the goose .... I don' think that refraction really needs to be discussed opticians in canada have proved to their government that they are both professional enough and responsible enough to perform refarction. They are checked by medical professionals so their are safe guards built into their systems. I think that every optician in the states is asking themselves how do we emulate their system and bring this type of forward thinking to the US.

    Quote Originally Posted by orangezero
    If anything, the long term trend is going to be for more personal responsibility in a patient's health care needs.
    I actually hope so, but don't see that trend in my neck of the woods. Everyday more and more people walk through the door with little or no information as to what their insurance covers. Some are even under the impression that since we are a provider we should have all their information and get upset when we ask them to fill out forms. How many times have you had to call and make sure that your refferal reached it's destination, or schedule an appointment for someone to see an ophthalmologist when necessary, becasue you know the patient won't do it. I think the need for opticians refracting is a direct result of patients not wanting to be inconvienienced. People would like glasses more often than they need health exams. What difference does it make if a patient sees you every 2 years to get a new Rx and check their health -or- sees you every 2 years and sees an optician one year between to update their lenses or get a new pair of glasses, this is better for the clients in the long run. It is not like they can walk into a opticians office with 10 years of avoiding health checks and get a refraction, their are measures in place to prevent that.
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  5. #130
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    Yawn!

    This post was not intended to offend, alienate, disparage, or criticize anyone...but if it did, toughen up you babies.

  6. #131
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    Sight testing a loss leader? During a newspaper interview, I once told the reporter that, yes, opticians did hope to sell more eyeglasses by offering free testing, and no, it wasn't being offered as a humanitarian gesture for the betterment of all mankind.
    Next day, "sight testing a "money-making gimmick," claims optician."
    Man did I hear about that one.
    Now, as to the importance of eye exams. Canada has socialized medicine. Federal law dictates that all Canadians are entitled to free health care, and that the standard of health care be second to none in the world. It is a requirement that all the Provinces provide health care, although there is some leeway as to what may be covered, although ALL essential healthcare must be provided free, while some coverage, such as chiropractic services may or may not be a covered service. All jurisdictions have a board that makes these determinations, as well as setting the fee structure for various procedures, and all of these boards use physicians, including ophthalmologists.
    ALL 10 PROVINCES has de-insured eye examinations as an insured benefit for adults between 19 and 65. Independantly.
    All 10 jurisdictions, with extensive medical consutation, have de-insured routine eye examinations in a country where the law says you MUST provide all essential health services. When cutting back, its usually the FIRST thing to go. Now that doesn't mean I agree, but for heavens sake, lets try to keep some perspective here.

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    Quote Originally Posted by Dave Nelson View Post
    Sight testing a loss leader? During a newspaper interview, I once told the reporter that, yes, opticians did hope to sell more eyeglasses by offering free testing, and no, it wasn't being offered as a humanitarian gesture for the betterment of all mankind.
    Next day, "sight testing a "money-making gimmick," claims optician."
    Man did I hear about that one.
    Now, as to the importance of eye exams. Canada has socialized medicine. Federal law dictates that all Canadians are entitled to free health care, and that the standard of health care be second to none in the world. It is a requirement that all the Provinces provide health care, although there is some leeway as to what may be covered, although ALL essential healthcare must be provided free, while some coverage, such as chiropractic services may or may not be a covered service. All jurisdictions have a board that makes these determinations, as well as setting the fee structure for various procedures, and all of these boards use physicians, including ophthalmologists.
    ALL 10 PROVINCES has de-insured eye examinations as an insured benefit for adults between 19 and 65. Independantly.
    All 10 jurisdictions, with extensive medical consutation, have de-insured routine eye examinations in a country where the law says you MUST provide all essential health services. When cutting back, its usually the FIRST thing to go. Now that doesn't mean I agree, but for heavens sake, lets try to keep some perspective here.

    Mr. Nelson,

    the language of the Canada Health Act requires provincial programs to provide for all "medically necessary" care. Failure to do so allows the feds to cut off vital funding to an offending province. The definition of medical necessity is essentially any procedure/service vital to preserve life and remedy illness and disease. As you have alluded, preventative/routine/rehabilative care, for better or worse, is not an absolute requrement under the act. Under certain circumstances provinces have however elected to provide for services that were deemed potentialy cost saving (flu-shot anyone?).

    Long story short, I really don't you can infer much of a value statement vis-a-vis insured services. Just because the government is unwilling to pay doesn't mean it is of low importance, there are plenty of available services not covered but are still held to the same professional standards and diligence as those that are.

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    I'm not minimizing the importance of eye examinations, nor the diligence and skill one must apply to undertake to provide them. On the contrary, I can state with some conviction, that Canadians enjoy a very high level of optometric care, and access to it. Many far-flung communities enjoy the services of an optometrist, and usually one who could double his/her income by working in larger urban centers. Education and practice standards are high, as well they should be: the responsibility to insure ocular health and safety is a serious one, and you will probably find no disagreement on this board. But you yourself agree that socialized medicine decrees that essential services are provided, and that eye examinations are, at least by those who make the decisions, not essential. I stress that eye exams are covered for a variety of reasons, such as age or diabetes, but the routine eye exam in the healthy adult is not considered essential. I don't make the decision, I do not even necessarily agree with it, but there you have it. Optometrists who try to convince legislators that the sky will fall in if opticians refract, are talking to people who do not consider eye exams particularly important in the first place. Optometrists have to wake up to the reality that they must educate the public about the importance of preventative care in eye health, and the dangers of eye disease like glaucoma, and realize many, if not most, people who arrive for an eye exam are there for a refraction. The motivation to seek an eye exam should be the other way around: people should seek an eye exam either for a specific symptom or for preventative reasons. Such an eye exam may, or may not include a refraction, depending on the clinical judgement of the practitioner. (before anyone screams, most ophthalmologists now do NOT routinly do refractions during eye examinations, at least here in B.C.) Optometrists want to prescribe meds, and expand their clinical scope into the domain of ophthalmology, yet many ophthalmologists do not do refraction. Opticians want to do refraction, but get accused of shoddy practice, and third world care by optometrists. There is something really, really wrong with this whole picture.

  9. #134
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    Quote Originally Posted by Dave Nelson View Post
    I'm not minimizing the importance of eye examinations, nor the diligence and skill one must apply to undertake to provide them. On the contrary, I can state with some conviction, that Canadians enjoy a very high level of optometric care, and access to it. Many far-flung communities enjoy the services of an optometrist, and usually one who could double his/her income by working in larger urban centers. Education and practice standards are high, as well they should be: the responsibility to insure ocular health and safety is a serious one, and you will probably find no disagreement on this board. But you yourself agree that socialized medicine decrees that essential services are provided, and that eye examinations are, at least by those who make the decisions, not essential. I stress that eye exams are covered for a variety of reasons, such as age or diabetes, but the routine eye exam in the healthy adult is not considered essential. I don't make the decision, I do not even necessarily agree with it, but there you have it. Optometrists who try to convince legislators that the sky will fall in if opticians refract, are talking to people who do not consider eye exams particularly important in the first place.
    Mr. Nelson,

    The opperative words in the Canada Health Act is "medically necessary," not simply "necessary." Periodic eye exams are a necessity, but they do not meet the medical necessity test in the absence of pre-diagnosed confounding conditions. Why? Unless the patient has a condition that must be monitored/treated to prevent death or progession of a disease state then the province is not obligated to cover the service under the act. However, the government is benevolent and kindly covers lots of additional services for us.:bbg:

    Please explain how the abscence of medically necessity for a service reduces the risk of harm in the provision of that service.

    Quote Originally Posted by Dave Nelson View Post
    The motivation to seek an eye exam should be the other way around: people should seek an eye exam either for a specific symptom or for preventative reasons. Such an eye exam may, or may not include a refraction, depending on the clinical judgement of the practitioner. (before anyone screams, most ophthalmologists now do NOT routinly do refractions during eye examinations, at least here in B.C.)
    So your're suggesting that patients should seek an eye exam for specific symptoms of eye conditions? That supposes people can differentiate the symptoms of uncorrected primary refractive error and refractive error / diminished vison secondary to something more insidious. How do they do that when so many people are under the impression that glasses are fix-all?

    Under the BC Health Schedule of Benefits, an Ophthal. consult(02010), which must include an "eye examination," and basic eye exams (02015) require a measurement of refractive error. When a patient presents you your practice you obtain their UCVA and CVA with habitual SRx, if the patients acuity is diminished a refraction must be performed to determine BVA which helps the practioner ascertain the etiology of any reduced acuity. If an ophthalmologist is billing these codes and not completing a refraction there may be some concern of fraud. whether or not the practioner is using this refraction to develop a SRx or not is another matter.

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    Quote Originally Posted by shawn b View Post
    What I think the true issue is about, is adults being able to make decisions about their own health. It's about adults choosing which method or treatment suits their needs and values.... As someone living in America, I am sure you cannot dispute one's freedom to make their own health decisions. :bbg:
    Patients always have a choice in health care, they can choose the doctor of their liking, they can choose whether or not to follow recommendations, they can choose to be compliant (or not) with treatments, they have input into their preferred modality of treatment. However, autonomy (even in the name of patient choice) is not an acceptable justification for creating an lower standard of care (for certain health professions) that carries a significant risk of harm to the public.

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    I would like to make a point about the state of eyecare in our region. Most Opthalmologists are so busy with cataract surgery,lasik, or their chosen specialty, that the days they spend in their practice are mayhem. If your appointment was 2oclock, maybe you see the doc at 3 maybe 3:30 or later. The tech's are doing the pre refracting, and other tests and the doc has a quick look at the end. The results are rarely as good, acuity wise, as people are happy with. Many people actually seek out Ophthalmology because health care pays for the exam, and also people feel they are going to see through walls, so to speak, with the new prescription. It is not my place at this point to question the Rx. After making,selling,dispensing thousands of these glasses I come to respect the differences in results of Optometrists, Ophthalmologists, and our Eyelogic results(which are signed by an Ophthalmologist) For many years before we got an Eyelogic, I would always reccomend to my repeat customers that they see an Optometrist for the most accurate refraction(their specialty) an Ophthalmologist if the Optometrist found eye health issues, and an Optician for the most accurate measurement of perameters pertaining to eyeglasses...The problem was to find a good Optometrist that is non eyeglass dispensing, that will send back my client with a script that will give optimal acuity, with a minimum of re-do's.
    Every time I refer a client, I expect that client to reurn to me. Many Optometrists actually appreciate referals but many are so busy that their staff just send them into their dispensary to sell them the eyeglasses....the dispensary is expected to dispense as close to as many scrips as the doc's are generating....there is real pressure on the staff to maximize the proffits. Hey, I've worked for Optometry for more than a few years, and I learned volumes about that side of it.
    We use the Eyelogic exactly how it was intended to be used. 100% within the guidlines of the Inventor, Dr Dyer. It is a means for Independent Opticianry to expand it's scope of practice, and to give the consumer, yet another choice in eyecare. We as Opticians are capable of more responsibility, with education and training, to provide more than we are....Each of the three O's are.

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    Quote Originally Posted by Oedema View Post
    Patients always have a choice in health care, they can choose the doctor of their liking, they can choose whether or not to follow recommendations, they can choose to be compliant (or not) with treatments, they have input into their preferred modality of treatment. However, autonomy (even in the name of patient choice) is not an acceptable justification for creating an lower standard of care (for certain health professions) that carries a significant risk of harm to the public.
    If you say that it carries a significant risk or harm to the public, you might in fact want to take that up with the AmericanAcademy of Ophthalmology, who clearly state (and I quote):
    "whether they wear glasses/contact lenses or not, adults between the ages of 20-29 need a comprehensive eye examination once throughout those years, while those between the ages of 30-39 should have two eye health examinations, and those between 40-64 need to be examined every two to four years."
    What I ask you, is that if an entire association of highly specialized medical doctors (not optometrists- because they do not have a medical degree) has come to that conclusion- how significant is that risk of harm? Are the people getting the truth?
    Also, the Canadian Ophthalmological Society, states that:
    "A diagnostic eye examination involves the practice of medicine and requires the highly specialized training of a physician. A refractive examination involves taking measurements from the visual system, which is simply a data-gathering procedure".

    You keep on referring back to a lower standard of care. Again, we have no desire to lower the standard. We would like optometrists to keep on doing what they are doing, however people should have a choice.
    What I find amazing, is that you are fine with people having the choice to follow recommendations or not, meaning they can make that call on their own- however, you don't want to give them the right to make their own call on what type of treatment they desire. That doesn't make sense to me. On one hand you are forcing people to see the doctor- because you don't want to lower the standard of care. But then it's okay to say no to what that doctor recommends- after you forced me to see him/her? So I can decide for myself if a doctor is right or wrong in my diagnosis, essentially going over them, but I cannot decide if I want an eye examination, or my new refractive error measured? I just don't get it.

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    Is there a difference between refracting, collecting data as you call it, and prescribing?

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    Oedema

    I said people should seek an eye examination for EITHER preventative reasons OR symptomatic. You replied: "so you're suggesting that patients should seek an eye exam for specific symptoms of eye conditions?"
    YES. Yes I am, oh my yes. Affirmative. Correct. On the money. Truly.
    The alternatives are: people obtain an eye exam for every symptom, no matter how small, or, people do not get eye exams when they have symptoms. Now I know you do not mean either of these, so can you elaborate on why you think I am off base with my earlier statement?

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    Important background

    Eyelogic is a system that allows refractions to be done by anyone (a monkey if you ask Dr. Dyer). It does so in isolation from binocular vision considerations and any eye health assessment. It has only been tested for its precision (not accuracy) and the results published in a journal which demonstrated that there was little operator influence (A fully automated remote refraction system. J Telemed Telecare. 2000;6 Suppl 2:S16-8 Dyer AM, Kirk AH) but never tested against the results of a experienced refractionist (optom, ophtho) or for the number of things missed by not performing the sight test in the context of a complete eye exam.

    The most important assumption made before you can believe that eyelogic should be operated outside of a complete eye exam is that all of the patients presenting for the sight test have no problems besides a refractive error, and that if there was something wrong, the patient or the operator would know before the end of the test so that the appropriate referral could be made.

    The following study (Blurred vision. N Engl J Med. 2000 Aug 24;343(8):556-62. Shingleton BJ, O'Donoghue MW.) speaks to the importance of a complete overview of the eye when differentially diagnosing blurred vision and was published in the New England Journal of Medicine.
    "BLURRED vision is the most common symptom
    related to the eye. It is manifested in many
    ways and has a wide variety of causes. Here we
    review for nonophthalmologists the examination techniques
    and diagnostic algorithms that are useful in the
    evaluation of blurred vision. We also describe how
    to determine when patients need urgent ophthalmologic
    consultation and treatment.
    The eye examination, as performed by a practitioner
    who is not an ophthalmologist, is divided into
    six parts: visual acuity, visual field, pupils, movement
    of extraocular muscle, anterior segment, and posterior
    segment. Because some serious eye conditions are

    not readily apparent, systematic progression through
    all six parts of the eye examination is essential for every
    patient with blurred vision." (bolding mine)

    The patient and eyelogic operator who "knows" all that is needed is a refraction may have overlooked the other five parts of the exam in an effort to fix the problem with "stronger" glasses.
    The epidemiology of eye disease is well known and documented and there are too many people (how many is too many when vision loss is almost always entirely or even partially irreversible?) losing vision to a sight test when access to optoms and ophthos is pretty quick. The reason these people have not been heard from -they are reluctant to take legal action (good Canadians) or the problems have been "fixed" by busy doctors with no time to get involved in litigation. Just like the patients who are being treated by their family docs with polysporin for an iritis, we look the other way, people make mistakes.

    All of the suggested exam freqencies often cited by eyelogic supporters are those from OMD organizations, who specifically refer to medical eye exams, when interpreted, reads "with an MD". The optometry organizations publish more frequent exam recommendations because they mean with an optometrist and those recommendations haven't changed because eyelogic came on the seen. If you would ask the optom orgs their recommended frequency for exams with an MD they would say at time of surgery, so once or twice a lifetime.

    Remember, eyelogic sells to anyone with money, and there is no requirement for an optician to operate them, refraction after all is in the public domain. Ontario, in their 2006 HPRAC report, came close to deregulating opticians and return the harmless act of dispensing eyeglasses to the public domain, as it is in the majority of the U.S. If sight testing were to be legalized in Ontario (with remote supervision and signing by a reviewing MD) it could create a scenario where the opticians are not involved in the refracting, prescribing or dispensing of eyeglasses. A win-win for the public who now have lay people earning less money doing these services for them at reduced costs, for all you consumer choice advocates. If dispensing were to be deregulated anywhere that allowed sight testing, there would be a serious crisis in the opticians camp. By the way, the same MD that is signing your eyelogic Rxs could also remotely supervise your dispensing, and by "your" it now means any business man or woman,, no credentials necessary, only dollars.:idea:

    Be careful what you wish for, you just might get it.


  16. #141
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    MD says OD's not doctors

    I have a close friend who went to 2 seperate OD's because of a "shadowy darkness in one eye." He was told his retina's were fine. 2 weeks later, he went to an ophthalmologist and was told his "retina has been detached now for a couple of weeks, and vision is 85% lost." The MD said, "don't blame the OD, blame the government. Optometrists are not doctors."

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    Quote Originally Posted by Dave Nelson View Post
    I said people should seek an eye examination for EITHER preventative reasons OR symptomatic. You replied: "so you're suggesting that patients should seek an eye exam for specific symptoms of eye conditions?"
    YES. Yes I am, oh my yes. Affirmative. Correct. On the money. Truly.
    The alternatives are: people obtain an eye exam for every symptom, no matter how small, or, people do not get eye exams when they have symptoms. Now I know you do not mean either of these, so can you elaborate on why you think I am off base with my earlier statement?
    Mr. Nelson,

    I think we have some confusion to clear here. My intentions are not to ignore your endorsement of preventative optometric care, in fact since prevention is somthing we seem to agree on I thought I'd leave it at that.

    What I do have an issue with is the inference (real or percieved) in your statement that patients should seek an eye exam not for refraction but either "for a specific symptom or for preventative reasons." My question, hopefully is clearer language is this: If the symptoms of of an eye disorder/disease are often the same as, or are confused with with refractive error, how do you suppose people differentiate and decide on either a complete oculo-visual assement or a sight-test?

    Just as a refraction with prescription should not be unbundled from the eye exam, an eye exam should not be unbundled from refraction - how else is an optometrist or ophthalmologist suppossed to determine best corrected VA when acuity is decreased?

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    Quote Originally Posted by shawn b View Post
    If you say that it carries a significant risk or harm to the public, you might in fact want to take that up with the AmericanAcademy of Ophthalmology.... how significant is that risk of harm? Are the people getting the truth?

    Shawn,
    The quotes you bring up are in regards to the recomended frequency of eye exams do not in any way diminshes the risk of harm involved in examining a patient, counselling, and prescribing.

    What you have brought up here is an example of how ophthalmologists and optometrists (as two solitudes) have failed to come up with uniform recommendations, not only regarding exam frequency, but also treatment of amblyopia, hyperopia, etc. Why do we have disagreement on these things? For one, the studies probing the most efficatious approaches are not complete, and in many instances the two professions have different definitions of what would constitute a good outcome.

    Quote Originally Posted by shawn b View Post
    You keep on referring back to a lower standard of care. Again, we have no desire to lower the standard. We would like optometrists to keep on doing what they are doing, however people should have a choice.
    What I find amazing, is that you are fine with people having the choice to follow recommendations or not, meaning they can make that call on their own- however, you don't want to give them the right to make their own call on what type of treatment they desire. That doesn't make sense to me. On one hand you are forcing people to see the doctor- because you don't want to lower the standard of care. But then it's okay to say no to what that doctor recommends- after you forced me to see him/her? So I can decide for myself if a doctor is right or wrong in my diagnosis, essentially going over them, but I cannot decide if I want an eye examination, or my new refractive error measured? I just don't get it.
    Shawn, it is not the optometric standard of care I'm concerned about lowering here. If a patient seeks out an opinion from a health practitioner for any reason, that person should be afforded confidence that their provider is providing the best care possible, and not ommitting vital considerations before initiating treatment.
    Last edited by Oedema; 12-14-2006 at 12:21 AM.

  19. #144
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    You make well thought out arguments, now if we could just get you to listen to some simple reason.:D We could discuss this in circles till the end of time, but Im getting a little weary of the whole issue. I'm sure someone will make some comment that will get my back up, and I'll jump back in,but right now, I have to try and get Harry Chilling to take up hang-gliding. One of the optometrists on this thread called him a swine, so if I can get a picture of Harry hang-gliding, I can send it to the B.C. Association of Optometrists, who told me they would allow opticians to refract when pigs fly.
    Later

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    Thanks Dave, I too tire of this back and forth. I am open to simple reasoning, but I also think it should be backed up with accurate and reasonable justifications. Either way, this thread is out clearly out of control, no thanks in part to myself.:hammer:

    Anyone know whats happening with Burgez? I suppose he has appealed and doesn't have to place the advertisments and signs in his locations until there is a decision from the next court?

  21. #146
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    I have to try and get Harry Chilling to take up hang-gliding. One of the optometrists on this thread called him a swine, so if I can get a picture of Harry hang-gliding, I can send it to the B.C. Association of Optometrists, who told me they would allow opticians to refract when pigs fly.
    I fly to florida in january, how about a picture on the plane. :D
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  22. #147
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    I was just at the local mall yesterday and the Great Glasses store there STILL has a giant sign in the window advertising "Free Eye Exams". I'm beginning to think that nothing short of going to prison will get Bergez to comply with the court order. Are ANY of the stores complying with the order?

  23. #148
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    Quote Originally Posted by rikriz View Post
    I was just at the local mall yesterday and the Great Glasses store there STILL has a giant sign in the window advertising "Free Eye Exams". I'm beginning to think that nothing short of going to prison will get Bergez to comply with the court order. Are ANY of the stores complying with the order?
    Following the court ruling, Bergez stated that Great Glasses would stop sight-testing and rather reimburse patients for their eye exams. I suspect thats what the sign is all about? Although, given the track record here, he and his associates might just be bold enough to continue business as usual.

  24. #149
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    Quote Originally Posted by rikriz
    I was just at the local mall yesterday and the Great Glasses store there STILL has a giant sign in the window advertising "Free Eye Exams". I'm beginning to think that nothing short of going to prison will get Bergez to comply with the court order. Are ANY of the stores complying with the order?
    This guy is a real scum bag.
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  25. #150
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    Quote Originally Posted by HarryChiling View Post
    This guy is a real scum bag.
    Harry,

    Although we have disagreed on many points in this thread, I definitely agree that this guy is a real scum bag. :angry:

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