May I, respectfully, ask all you Dr.s to

[Barry Santini]

...please add a word to the following statement I hear from my clients just about every day:

"My doctor said I have the *very* beginnnings of cataracts, but there's nothing to worry about.(insert word)."

Please add the following word: surgically!!!

Those pesky cataracts may not need surgical attention now, but they are definitely interfering with your expectations about *my* new progressive eyeglasses!

My two cents, what's yours?

Barry

[Dave Nelson]

I wasn't sure, until now if it was just us. We continually get the same thing here, the Drs tells the patient the cataracts are "nothing" but they do effect vision. We spend hours trying to convince people the Dr didn't mean it would have no effect on vision, and we didn't make the glasses wrong. While we're on the same topic, please, PLEASE, pretty please, put the corrected acuities on the rx. You cannot begin to imagine the time and trouble you could save us by supplying such basic info.

[HarryChiling]

I have said it in the past and I will say it again. If visual acuity were to be part of the prescription then at least we would know what the problems were and have a opportunity for our clients to know what to expect.

I can't tell you how many times a patient with cataracts has given us the "I can't read". If you don't know or don't ask about cataracts then you could potentially waste lots of time troubleshooting glasses.

[Barry Santini]

While we're on the same topic, please, PLEASE, pretty please, put the corrected acuities on the rx. You cannot begin to imagine the time and trouble you could save us by supplying such basic info.

Oh God!...yes...PLEASE put the acuities on the Rx...and take the time to explain them to your patients.

It really is NOT my job to do so!

Barry

[Audiyoda]

Agreed 150%. That has happened too many times to count. And the patient doesn't want to hear it from me - so I need to take time in the doctor's schedule to have a 're-refract' when I know good and well it's the cataract that's the visual issue.

[Audiyoda]

While we're on the same topic, please, PLEASE, pretty please, put the corrected acuities on the rx. You cannot begin to imagine the time and trouble you could save us by supplying such basic info.

That would be far too easy :shiner:

A few years ago I asked a OD why he didn't regularly put corrected VAs on the Rx...his response: "then the pateint would have certain expectations that may or may not be reasonable". :drop: :drop:

[Ladyoptician]

...please add a word to the following statement I hear from my clients just about every day:

"My doctor said I have the *very* beginnnings of cataracts, but there's nothing to worry about.(insert word)."

Please add the following word: surgically!!!

Those pesky cataracts may not need surgical attention now, but they are definitely interfering with your expectations about *my* new progressive eyeglasses!

My two cents, what's yours?

Barry

Just happened to me today, took 30 minutes to get her to understand!

[npdr]

Do you propose a standard acuity notation or use of optotypes?

1. ETDRS?
2. Snellen Projected?
3. Snellen Printed Chart
4. Lovie Bailey?
5. Sloan?
6. Pelli Robison?


How would acuity be helpful if the are all over the map? Just curious.

[dcdwn]

The doctors know that sometimes there patients best va's are 20/30 they will do a pin hole test and its still 20/30. how hard is it to write on the Rx best va's 20/30. PATIENT WOULD BE ALOT HAPPER NOT HAVING TO DRIVE BACK TO THE DOCTORS OFFICE. If my doctor wouldn't explain to me my eye problems the time and money I spent for an eye exam it is time to find another doctor. Like one time a doctor told me time is money,money is my time so don't waste my time or my money. And patient spend a lot of money for that eye exam. So opticians just tell those patient who are having problems to find an doctor who will write the VA'S ON THE Rx.

DON

[Joann Raytar]

I agree. VA's should be part of the Rx.

I understand that many patients want to see better and that they are often given a new Rx because it might make a little bit of a difference but Dr's need to explain the cataracts are going to impact vision in a number of ways.

[HarryChiling]

Do you propose a standard acuity notation or use of optotypes?

1. ETDRS?
2. Snellen Projected?
3. Snellen Printed Chart
4. Lovie Bailey?
5. Sloan?
6. Pelli Robison?


How would acuity be helpful if the are all over the map? Just curious.

Why do you mark visual acuitys in your charts if they are not usefull, by haveing the best corrected visual acuity we would be able to service the client better that helps both optician and optometrists. The alternative is optician wasteing a bunch of time to find out what the doctor already knew, the patient is not able to read small print no matter what lens is in front of them, sometimes that wasted time leads to loss of confidence in the optician so the optician needs to send the client back to the optometrists or ophthalmologist to tell them that they are not able to see the small print no matter what lens is in front of them.

[npdr]

Why do you mark visual acuitys in your charts if they are not usefull, by haveing the best corrected visual acuity we would be able to service the client better that helps both optician and optometrists. The alternative is optician wasteing a bunch of time to find out what the doctor already knew, the patient is not able to read small print no matter what lens is in front of them.

If we denote acuities are noted, how would you convert them between the systems of charts? There is a variation between all of the above mentioned systems.

[HarryChiling]

It is not really important for us to have the actual acuities, the important thing is to know wheather the clients expectations of what they are going to be able to see are in line with the reality of what they are going to see.

[Fezz]

If we denote acuities are noted, how would you convert them between the systems of charts? There is a variation between all of the above mentioned systems.

Is there a "standard"? I see plenty of driving forms, medical forms, ins. forms, etc. They all ask for acuities, but oddly, I never see it broken down as to which on of the 6 forms of acuities that you mention. When you fill out an ins. form, or a state driving, or medical form how to you notate your found acuities? Do you specify that it is based on the Lovie Bailey, Sloan, or Snellen projected?

[akeroptical]

npdr,

What system do you use when noting VA in your records? I have worked many different places and have always encountered Snellen charts and VAs marked in 20/20 ect. In school we also learned of the various methods of recording VA, but are there really many different methods being used in the USA.?

I agree with the thread that VA should be marked on the Rx. As Opticians we spend a good deal of time trouble shooting glasses to find out that the Pt's VA will never reach that of 20/20. I'm sure you can understand that it is helpful to have knowledge ahead of time, especially in the case of cataract patients.

[Dave Nelson]

Acuities using a snellen chart have been the universal standard for decades. Every MDs office I have ever seen uses the snellen, and every vision care professional and medical doctor on the planet knows what 20/40 means. It isn't necessary to specify the exact illumination in the refraction room on the stupid rx, or the means you use to obtain them, just the acuities.
Its also really helpful to make a referral when one finds best corrected acuity of 20/80 on a patient whose previously recorded acuity in that eye was recorded as 20/30 the month before.

[sailorman126]

npdr
no offense but i think you are just being stubborn looking for a reason not to do your job.
how much varince is there between all your chats?
will one say 20/30 and another says 20/300 or is it more like one says 20/30 and the other says 20/25.
so why not tell the pt you have cataracts forming they are not ready for surgery, this new rx will let you see the best you can until the surgery is needed? just doing that can save me hours a week of week of wasted time.

[lvmopt]

You are right on! I try to write the VA's on all Rx's that have poor VA. I would only guess that some OD's just don't think of what you go through. These newer OD's don't know or think of the other side since they don't want the Optical side. They want to do the Doc thing only. Since I edge and dispense my own lenses since 1985 I have had the same problems you have. I actually don't want to take some Dr's outside Rx's since they bounce more than others. As the Big Box Opticals take over, the OD's are forgetting skills they ought to use. Like ophthalmic optics and the Patient.


Those pesky cataracts may not need surgical attention now, but they are definitely interfering with your expectations about *my* new progressive eyeglasses!

My two cents, what's yours?

Barry[/QUOTE]

[MarcE]

Cataract surgery is so very low risk now, why not do it when VA is diminished? I know that many patients aren't ready mentally, but they need to be preped by the Dr for this.
And as a side note, why not recommend a "lensectomy" and IOL for a patient w/ a -13.00 Rx? Patients w/ these Rx's spend so much $ on specs; I think it would be an easier sale than Lasik. Isn't it safer?

When accomadating IOLs are perfected, that is the future. When you turn 18 and your vision is stable; go get your lensectomy and IOL. It will be as common as a breast implants, and much safer.

[orangezero]

Cataract surgery is so very low risk now, why not do it when VA is diminished? I know that many patients aren't ready mentally, but they need to be preped by the Dr for this.
And as a side note, why not recommend a "lensectomy" and IOL for a patient w/ a -13.00 Rx? Patients w/ these Rx's spend so much $ on specs; I think it would be an easier sale than Lasik. Isn't it safer?

When accomadating IOLs are perfected, that is the future. When you turn 18 and your vision is stable; go get your lensectomy and IOL. It will be as common as a breast implants, and much safer.

There are still serious risks associated with cataract surgery, and in my area a non-insurance patient would pay about $3700 per eye. It comes down to costs, and even if the patient had insurance it won't be covered unless its "necessary" according to their rules, not the patients.

Optically, there can be benefits for high myopes to undergo cataract surgery. However, I wouldn't trade an extra 25-30 years of pseudophakia for slightly cheaper glasses. I'm sure it has happened.

Back on topic, I don't think I've ever seen a VA listed on an Rx in my life. I guess it would have to start at the schools and eventually take years to develop any meaningful change. Honestly, I think there are already enough changes going on in eye care for doctors to seriously want to change this.

No offense meant, but probably much lower down on the scale of importance. I think the last person the doctor is hoping to help out is the optical competition, at least subliminally.

I know I do write "balance" on there occasionally when its needed and I assume that lets the dispensor know the patient doesn't see well in that eye. Could save a bit of time, and its at least one time I purposely do something to help the optician.

I think this is one example of how getting your Rx filled at the prescribing doctor's optical can be "better" IMHO. If there is a problem on pickup, the staff can look in the chart, or even ask the doctor, and have the answer right in front of them. Notes can be made, etc. I'm sure I'll get ripped for this :)

[HarryChiling]

I think this is one example of how getting your Rx filled at the prescribing doctor's optical can be "better" IMHO. If there is a problem on pickup, the staff can look in the chart, or even ask the doctor, and have the answer right in front of them. Notes can be made, etc. I'm sure I'll get ripped for this :)

RIP :D

No offense meant, but probably much lower down on the scale of importance. I think the last person the doctor is hoping to help out is the optical competition, at least subliminally.

I think you are right about this, I have had problems calling doctors offices to get refracted vertex distances. This little piece of information is not for the opticians benefit, but for the clients benefit. When I have a client that has a problem I always double and triple check everything and then sit down with my client and explain that maybe there is something I am missing. The first step (after everything checks out) is to call the doctors office and get the exam (patiet is there to sign HIPPA so it's never an issue) now we have the chart to read and we offer the client a discount on their next exam with us to help avoid any further confusion. Our doctor also does not mind doing a quick recheck , when she's not busy; if it saves the client from wasteing a trip to another doctors office. (this one service aloe has gained our practice so many patients it is ridiculous)

Our practice is growing, now in it's second year and well on it's way to becomeing a million dollar store. Keep messing around with your patients and watch us razzle dazzle them with service. ;)

[fjpod]

Cataract surgery is so very low risk now, why not do it when VA is diminished? .

Cataract surgery and implantation of a lens is not low risk surgery. It is invasive. And if a patient has commensurate retinal degeneration or nerve fiber layer loss, or Fuch's dystrophy, due to age, their post-op VA may be no better. So if you think that patients get ****** when their eyeglasses don't meet their expectations, you should hear them when their surgery doesn't.

Accomodating IOLs...? I wouldn't hold my breath...unless 20/40 VA and haloes and starbursts at night are an acceptable standard...but then again the patient could have had that without cataract surgery

[Barry Santini]

And as a side note, why not recommend a "lensectomy" and IOL for a patient w/ a -13.00 Rx? Patients w/ these Rx's spend so much $ on specs; I think it would be an easier sale than Lasik. Isn't it safer?

When accomadating IOLs are perfected, that is the future. When you turn 18 and your vision is stable; go get your lensectomy and IOL. It will be as common as a breast implants, and much safer.

No, it isn't safer, at least for high myopes. Anytime you poke or prod an axially-large eyeball, with concurrent retina stress and/or tension, you risk retinal detachment.

Glasses aren't bad...they're just chosen, fitted, manufactured and dispensed so poorly (especially in the USA, and across the world):

That its no wonder that public doesn't like eyeglasses!

For goodness sake, why can't any of the 4-5 manufacturers of spring hinges either make a better one, or the frame vendors *choose* a hig her-quality design. This one aspect of eyewear design/manufacture is the achilles heel of eyewear ownership, and a travesty foisted upon the unsuspecting public!

I know this is diverting the thread, but surgical correction of ammetropia is ALWAYS goin' to be more risky and invasive than dispensing quality eyewear (if you can find it!)

My two cents, what's yours?

Barry

[Barry Santini]

I think this is one example of how getting your Rx filled at the prescribing doctor's optical can be "better" IMHO. If there is a problem on pickup, the staff can look in the chart, or even ask the doctor, and have the answer right in front of them. Notes can be made, etc.:)

You know, given the obstacles I've encountered, there's quite a bit of truth to your statement!

Barry

[drk]

Great discussion.

I oftentimes go through the same issues with outside Rx's. I also go through the same issues when a patient is seeing me for refractive care, and the patient also sees a retina specialist, etc.

The bigger abstraction here is not necessarily OD's putting VA's on Rx's (which is technically incorrect to do so, and possibly a privacy violation), but an issue of coordination of care.

I can't tell you how much help it would be for me to have a report from the ophthalmologist, or even the previous OD.

What are the solutions?
1.) No hesitation to communicate interprofessionally.
2.) Handy medical records release forms
3.) Some day, electronic records that can be easily e-mailed or faxed on the spot.

If I were in your position (and I am, oftentimes), if the patient has a disconnect between reality and expectations, I acknowledge the issue, put on the dog-and-pony show to make sure I've made no errors, and simply offer to call the prescribing Dr. for information.

I would think most good Dr.s wouldn't mind the communication and may, in fact, enjoy meeting and working with a concerned fellow professional. It would be good business as well as good patient care.