Hey Optometrists!

[Fezz]

What is the bare minimum that you feel you *NEED* to practice?

I am talking equipment other than the standard lane.

If you were going to open a bare bones office...what would you *need*?

Thanks!

[drk]

Fezzster:
What do you mean "besides the standard lane"?

You must specify whether the OD will be practicing vision care or medical care or both?

[Fezz]

Fezzster:
What do you mean "besides the standard lane"?

You must specify whether the OD will be practicing vision care or medical care or both?

Hey drk-are you trying to be a smarty-pants?*

I was lead to believe, by all of the VERY vocal OD's on this forum lately, that ALL OD's practice both medical and vision care as standard of care? You are not suggesting something different are you?

;):cheers::D:cheers:;)

*No offense to any possible Smarty-Pants Optiboarders. This statement was meant as a term of LOVE and ADMIRATION of a fellow Optical Professional! No animals were harmed during the typing of this post.

[LandLord]

*trial lenses
*trial frame
*retinoscope
*pen
*paper

[Eyedoc71]

Agree with drk...what do you mean? I have a lot of stuff in my office that is necessary because of the level of pathology I manage, but isn't exactly necessary to do an bare bones "eye exam". I feel like I couldn't live without my stuff, but I have more than most ODs.

[IndianaOD]

It makes a difference if you want a refraction monkey or a real Doctor.

Don't need much to generate Rx's

[Eyedoc71]

*trial lenses
*trial frame
*retinoscope
*pen
*paper

And that's exactly the problem that ODs have with non-ODs giving what could be construed as an eye exam. You left out the most important stuff like a slit-lamp, tonometer and ophthalmoscopes. Wow, you got the patient to 20/20 but missed their tumor...I'm sure they'll thank you and you'll be very popular with everyone from their family to their attorney.

[drk]

Refraction monkey. Funny!

Oooh oooh oooh. Aaah aah aah. Eee Eee Eee.

[Johns]

Brother Fezz,

Pop your head into any WM (I can't for obvious reasons), or other chain store type OD offices. If your looking for bare bones, I'm guessing that would be them. Not that they won't have up to date equipment, but like the others said, it doesn't take a lot to generate an Rx plus a little more, and that seems to me the main function of the chain store ODs. (To be honest, I wish that was the main function of my ODs as well, but it doesn't always seem to be.:D)

[Oedema]

What is the bare minimum that you feel you *NEED* to practice?

I am talking equipment other than the standard lane.

If you were going to open a bare bones office...what would you *need*?

Thanks!

Slit lamp
Tonometer
Phoropter
Projector/LCD Chart
Keratometer
VF of some kind (FTD or Matrix at minimum)
Would probably also want a pachymeter

As for the rest of it... I already own it.

[Eyedoc71]

Brother Fezz,

Pop your head into any WM (I can't for obvious reasons), or other chain store type OD offices. If your looking for bare bones, I'm guessing that would be them. Not that they won't have up to date equipment, but like the others said, it doesn't take a lot to generate an Rx plus a little more, and that seems to me the main function of the chain store ODs. (To be honest, I wish that was the main function of my ODs as well, but it doesn't always seem to be.:D)

When was the last time you looked in one? If by bare bones you mean Optos, topographer, slit-lamp cameras, pach, VF and OCT (on the way), I guess you're right. If you look at a WM that doesn't have an OD yet, you will probably find close to bare bones, but most ODs beef up the office once they start seeing patients with their own stuff.

You wish that refractions were the main function of ODs? Wait, never mind you meant the OD that works with you. I hope it's never the main function of any OD. I would like to think that the main function is to make sure that the patients eyes are healthy.

[HarryChiling]

Hey Fezz I'm not a doctor but I can provide you with a list of the minimum for a doctors lane although I am sure you meant other than their lane what would they need.

§ 23.42. Equipment


An office maintained for the practice of optometry shall be fully equipped for the making of a basic optometrical examination including the following:
(1) Keratometer.
(2) Ophthalmoscope and retinoscope.
(3) Trial case and its accessories or a phoropter.
(4) Visual acuity charts.
(5) Ophthalmic chair.
(6) Field testing equipment.
(7) Slitlamp—Biomicroscope. (8) Tonometer.

Section 1320.95 Minimum Equipment List

Each office in which the practice of optometry is conducted shall contain, in good working condition, the following minimum equipment:

a) Ophthalmoscope − Direct and Indirect

b) Retinoscope or its equivalent

c) Tonometer

d) Automated Threshold Visual Field Testing Device

e) Color Vision Testing Device

f) Keratometer or its equivalent

g) Biomicroscope

h) Lenses for subjective testing

i) Blood Pressure Measuring Device

(a) The optometrist or therapeutic optometrist shall, in the initial examination of the patient for whom ophthalmic lenses are prescribed:

(1) Personally make and record, if possible, the following findings of the conditions of the patient as required by §351.353 of the Act:

(A) biomicroscopy examination (lids, cornea, sclera, etc.), using a binocular microscope;

(B) internal ophthalmoscopic examination (media, fundus, etc.), using an ophthalmoscope or biomicroscope with fundus condensing lenses; videos and photographs may be used only for documentation and consultation purposes but do not fulfill the internal ophthalmoscopic examination requirement; and

(C) subjective findings, far point and near point.

(2) Either personally make and record or authorize an assistant present in the same office with the optometrist or therapeutic optometrist to make and record the following findings required by §351.353 of the Act. The authorization for assistants to make and record the following findings does not relieve the optometrist or therapeutic optometrist of professional responsibility for the proper examination and recording of each finding required by §351.353 of the Act:

(A) case history (ocular, physical, occupational, and other pertinent information);

(B) visual acuity;

(C) static retinoscopy O.D., O.S., or autorefractor;

(D) assessment of binocular function;

(E) amplitude or range of accommodation;

(F) tonometry;

(G) angle of vision, to right and to left.

(3) Personally notate in the patient's record the reasons why it is not possible to make and record the findings required in this section.

(b) The willful or repeated failure or refusal of an optometrist or therapeutic optometrist to comply with any of the requirements in the Act, §351.353 and §351.359, shall be considered by the board to constitute prima facie evidence that the licensee is unfit or incompetent by reason of negligence within the meaning of the Act, §351.501(a)(2), and shall be sufficient ground for the filing of charges to cancel, revoke, or suspend the license. The charges shall state the specific instances in which it is alleged that the rule was not complied with. After the board has produced evidence of the omission of a finding required by §351.353, the burden shifts to the licensee to establish that the making and recording of the findings was not possible.

That's is the absolute must that you must have in PA, IL, TX (sorry if I left anyone out) to practice optometry, you'll find that other states have similar minimums in place by the boards, the additional equipment is just that additional.

And for the other equipment and needs:

Computer
Printer
EMR Software
Pens, Pencils, and Paper
Front Desk
Chairs at least 4

That's my idea of a non-dispensign OD's office, throw in a dispensary and you know the answer from the other thread in the professionlas forum and you know how to cut the fat from that one as well.

[Against the Rule]

And that's exactly the problem that ODs have with non-ODs giving what could be construed as an eye exam. You left out the most important stuff like a slit-lamp, tonometer and ophthalmoscopes. Wow, you got the patient to 20/20 but missed their tumor...I'm sure they'll thank you and you'll be very popular with everyone from their family to their attorney.

You're exactly right, which is why most opticians I know who either refract or want to don't claim they're performing an eye exam.
No sane optician wants to have the scope of practice that OD's do. If we go with "what could be construed as," does that mean I should sue my barber if he fails to spot the skin cancer on my scalp?

[IndianaOD]

You're exactly right, which is why most opticians I know who either refract or want to don't claim they're performing an eye exam.
No sane optician wants to have the scope of practice that OD's do. If we go with "what could be construed as," does that mean I should sue my barber if he fails to spot the skin cancer on my scalp?

Umm. Parents think reading an eye chart in the pediatrician's office or the 30 second school screening is an eye exam. I see it ALL THE TIME. "Oh why didn't the eye exam at the pediatrician's office find my child's amblyopia." As a pediatric OD its extremely common.

[Eyedoc71]

You're exactly right, which is why most opticians I know who either refract or want to don't claim they're performing an eye exam.
No sane optician wants to have the scope of practice that OD's do. If we go with "what could be construed as," does that mean I should sue my barber if he fails to spot the skin cancer on my scalp?

No, they don't. They want to eat their cake and have it also. You want to do the thing that brings people in for eye exams (more importantly, expand your financial portfolio), but don't want to do the legwork getting the education to do it properly and want to abdicate ALL of the responsibility for the hard part.

Does the general public equate a barber with a dermatological scalp examination? The general public thinks a refraction IS an eye exam. Hell, most patients think the DMV does an eye exam. Most patients don't know that there is any other part to an eye exam outside of the refraction. Even if you told them it wasn't a replacement, they really wouldn't appreciate the gravity of it. Again, you get them to 20/20 but they have a tumor that gets missed because they were seeing well so no harm no foul since you're not really calling it an eye exam. :hammer:

You also have to ask the question of whether those services are even needed. Does the public require more folks that refract? Is this a need that ODs can't meet? Both of those answers are a resounding no, so this is just about your profession and not the folks it's set up to serve.

[Johns]

You wish that refractions were the main function of ODs?

No...I said G-E-N-E-R-A-T-I-N-G Rx's. How they get there is their issue. Please don't try to tell me that the WM ODs main function isn't generating Rx's. (Maybe not in THEIR minds, but surely in WMs.) Since that's their main function, then I guess what they have is bare bones.

And no, I haven't been in a WM in over 10 years, nor do I have plans to go into one anytime soon.

[tmorse]

[quote=Eyedoc71;248457] Most patients don't know that there is any other part to an eye exam outside of the refraction. [quote]

This sounds like YOUR profession hasn't done their job of educating the public about what constitutes a full eye exam. Good thing that refracting opticians (at least in Western Canada) are providing this public education for y'all.;)

Y'all should be properly grateful!!

[Eyedoc71]

No...I said G-E-N-E-R-A-T-I-N-G Rx's. How they get there is their issue. Please don't try to tell me that the WM ODs main function isn't generating Rx's. (Maybe not in THEIR minds, but surely in WMs.) Since that's their main function, then I guess what they have is bare bones.

And no, I haven't been in a WM in over 10 years, nor do I have plans to go into one anytime soon.

Well, I guess you're an expert then. You haven't been in one in 10 years and you won't go in one, yet you're expousing how the offices practice and their purpose?

No, the main function isn't generating rxs for WM ODs. There has been a big shift in the management philosophy of the professional affairs dept. There was a time when it was all about rxs, but that time is past. The majority of correspondence between WM and the ODs is about medical billing and expanding the scope of our care. They've realized that the best way to build revenue is by building patient loyalty through exemplery care. Times change.

[Eyedoc71]

This sounds like YOUR profession hasn't done their job of educating the public about what constitutes a full eye exam. Good thing that refracting opticians (at least in Western Canada) are providing this public education for y'all.;)

Y'all should be properly grateful!!

My profession has 100% dropped the ball in this aspect.:( That having been said, flooding the market with even MORE people that aren't needed for that particular service isn't going to help anyone. Like I've said many times, 99% of the blinding ocular disease found by ODs was brought in by people who thought they only needed a refraction (and were correctable to 20/20).

I'll give an example. You go into the minor med with a cold. They treat your cold, but don't test you for anything else. They tell you that you should be checked, but their tx worked for the cold. How many of those people are going to schedule a physical w/blood work? Zero. Do you need a physical w/blood work for a cold? Nope, but that doesn't mean that you shouldn't get a physical and it's BECAUSE there's no requirement that our health is what it is in the US. People die unnecessarily (and cost millions of tax payer dollars) for stuff all the time that could have been treated if found during a routine check.

We HAVE that system in the US and so far it works really well because we DO find those blinding diseases. You'll forgive me if I pass on Canadian healthcare.

[npdr]

What is the bare minimum that you feel you *NEED* to practice?

I am talking equipment other than the standard lane.

If you were going to open a bare bones office...what would you *need*?

Thanks!

I practice bed side and in senior centers about once a week and the minimum for this:
1. Hand held slit lamp
2. BIO
3. tonometer
4. Phoropter with protable stand
5. Lensometer

That is what I think the absolute mimimum is for first encounter examination. In no way, though should this minimum be considered for more elaborate or secondary care of patients suspected of pathology.

[Fezz]

I appreciate all of the input so far!

Thanks to all!

:cheers::cheers::cheers:

[scograd]

[quote=IndianaOD;248224]It makes a difference if you want a refraction monkey or a real Doctor.

I externed with a retinal surgeon who had this little panorama of a little monkey doctor refracting a little monkey patient. It was the funniest thing I have ever seen!!!

[ziggy]

It makes a difference if you want a refraction monkey or a real Doctor.

Thats funny! so how much longer do you Doctors think that it will be before you are not doing refractions any more? What I'm talking about is as your scope of practice expands, do you think you will have time for such mundane tasks as refracting?
ps: sorry for hi-jacking your thread Fezz!

[renee1111]

It makes a difference if you want a refraction monkey or a real Doctor.

If I wanted to get a refraction from a real doctor....I wouldn't have anywhere to go, since OD's aren't "real doctors" and MD's aren't allowed to refract. This statement seems a bit misleading and since this OD's believe that Opticians are tricking the public into thinking that we are perfroming eye exams, maybe y'all should take a look in the mirror.

(Eyedoc71) You also have to ask the question of whether those services are even needed. Does the public require more folks that refract? Is this a need that ODs can't meet? Both of those answers are a resounding no, so this is just about your profession and not the folks it's set up to serve.

I must disagree here, only because, there are 11 OD's practicing in my town. Every office, other than WM, has a three month waiting list and they charge from $90-130 per eye exam. Opticians can fill this void and offer a more competitive price.

[Eyedoc71]

If I wanted to get a refraction from a real doctor....I wouldn't have anywhere to go, since OD's aren't "real doctors" and MD's aren't allowed to refract. This statement seems a bit misleading and since this OD's believe that Opticians are tricking the public into thinking that we are perfroming eye exams, maybe y'all should take a look in the mirror.


I must disagree here, only because, there are 11 OD's practicing in my town. Every office, other than WM, has a three month waiting list and they charge from $90-130 per eye exam. Opticians can fill this void and offer a more competitive price.

Technically, we are doctors in every sense of the word. We both independently diagnose and treat conditions of the body and have a doctorate level degree. In what sense do we not fit the bill? Medical school? I'll be sure to let my friends that are DOs, DPMs and DDS that they're not doctors either...the DOs are really going to be surprised.

If you're performing refractions, you ARE tricking the public into thinking you're doing eye exams. Not being adversarial here, just stating a fact. You imply that we're "tricking" the public. I'm curious in what way. Are you aware that there are laws as to what has to be performed in order to call it an eye exam? Do you somehow think the laws are lacking?

As far as more competitive price? Give me a break. Offering 10% of the service for 50% of the fee isn't being competitive, it's being misleading. I'm fairly sure my Lexus would have considerably less expensive without seats, engine or tires...that doesn't make it the same thing, though.