The following was printed on an Rx presented to me. Kinda gives a new meaning to Doctors change you know, with all that confidence the Doc is showing in that Rx.:hammer: For me, it was after the 90 days, so it was not an issue. What would you do?
Remarks: Filling this prescription constitutes an agreement to make spectacle lenses at the doctor's discretion for a period of ninety days without further charge to the doctor or the patient.
Originally Posted by obxeyeguy
Hand them a printed card from you that states:
Doctor's Error remakes done one time only at No Charge, further changes made at 50% charge. Buying glasses from me supercedes any other contract.
Seriously, though does that Doc have that many remakes? IF so, you might want to refuse their Rxs. And tell the customer why.
DragonlensmanWV N.A.O.L.
"There is nothing patriotic about hating your government or pretending you can hate your government but love your country."
Remind that examiner that the FTC prohibits that.There is a $10,000 fine for putting a disclaimer like that on an rx.
It came from your neck of the woods ( Ca ).
put terms like "Doctor's remake" or redo in the trash along with:
1."1/12th diopter"
2. "Match Base curves"
3. "there's only a small change, so you don't need new glasses"
Barry
If you are fortunate enough to have a doctor referring you work that does not dispense himself. Eat it and smile. If he's a compeditor tell him what the Russian said.
Chip
Barry,
I love the "1/12th" diopter (ex. -2.37) , which is not really a twelfth of a diopter, it's an "EIGHTH" of a diopter people!! I've heard this all over the optical industry from Opticians to Ophthalmologists. Second, the average lab isn't going to send you a lens with that Rx anyway, they'll round up or down and sent it out. When Dr's write Rx's in eighths, it drives me nuts, like they're being more precise or something. The only way to ensure you get an eighth is to use a digitally surfaced lens, right??
Ahem, there's no way you'd find me refracting in 1/8 steps...
Had a patient in today with a three year old pair of progressive lenses on that I made. Here was his complaint.
"I can't read anything small, I can't see my computer unless I look through the bottom and I can't see the car in front of me unless I look through the middle".
When was your last eye exam?
"Oh just a month ago, he said not much of a change so something must be wrong with my glasses".
Sigh, you need another exam. No really.....you do.
He finally realized the situation and promised to see his doc next week. But seriously, what does that mean "Not much of a change?" What would warrant a change in lens I wonder?
When you are making wrap eyewear, or other "POW" compensated eyewear, you *must* prescribe and order in 1/8th diopter precision.
Ex: If most 20 foot test distances yield Rxs that are 0.16D underfocussed for full infinity vision (read: DRIVING!), then, at a minimum, a wrap Rx would routinely require an additional 0.12D more minus on the RX BEFORE you begin the wrap/POW compensation calculations.
Yes?
Barry
If you order from my lab you WILL get a -2.37
When I was an ophthalmic tech, I was taught to refract everyone to 0.12
We do it regularly on a 108 and 506 cylinder machines. :D
And another thing, some Drs are starting to read in 0.10 steps. Have seen several Rxs that way.
Pity, some of your patients would love you more if you did.
Really people we can't call it Dr. Error, we need to say a re-evaluation of patient requirements.
Chip
:cheers:
Barry
NO!
Barry, for the millionth time: if you refract at ANY DISTANCE...20 feet...50 feet...40 centimeters...there is a margin of error that is statistically going to be undercorrected 50% of the time and overcorrected 50% of the time!
Let me illustrate, again:
1. Let's say the patient's refractive error is -2.11 D. Let's say the patient to screen distance is 40 feet (no error). The patient is forced to choose between -2.00 and -2.25. Sometimes they'll choose one, sometimes the other.
DRK
I thought that by fogging a patient, you'd ensure they'd be prevented from over minus. Therefore, I'm not sure the 50-50 choice applies.
Dialogue
Barry
Which is blurrier: +0.12 or -0.12? That's the question you are asking.
Non-presbyopes are going to take the extra 1/8 D. Presbyopes, who knows?
As to "fogging", here's what is happening:It's at step #2 that a tweener patient is going to have to choose...over or undercorrection.
- Overplus to relax any accommodation...that's the "fog". This eliminates gross overminusing.
- Add -1/4 D steps until additional lenses don't improve/worsen subjective acuity.
Bottom line: Yes, test distance is a variable to be controlled, but so are so many other variables! Don't go monkeying with a single variable in isolation. You are just as likely to hurt as help.
Plus, quite frankly, it's not your job, Barry, to compensate for what you consider incorrect refraction technique. That's outside your job description.
You are OK to position-of-wear compensate, which includes face-form, panto, vertex. You are OK to design near glasses. But, as I've said before, the distance Rx is considered sacrosanct and must not be adjusted to deliver anything other that what's on that piece of paper.
You write for 20/20 magazine and have increasing influence on opticians, so I think you have an obligation to get this right.
Thanks form your continued help drk. I can see where I may be oversimplifying the test distance factor.
However, as I am charged with making eyewear that will perform "as the doctor (refraction?) intended", I think that suggesting that I *never* mess with a correction in the manner described may also tend toward oversimplification.
I do however appreciate your opinion and contribution toward "keeping me in line".
I'll be the first to admit I have alot to learn about these subtleties of refraction. I'm glad you and others continue to contribute here, as I learn from all your posts.
Barry
Last edited by Barry Santini; 06-23-2009 at 12:27 PM.
Barry, you're so polite that I never know what I'm getting with you! :o
Let's have it out, man!
Do you, or do you not, regard the job of an optician to deliver the Rx as intended?
OR
Do you feel an optician's job is to "improve" an Rx?
P.S. I have no right or responsibility to "keep you in line". I'm nobody. But I have a keyboard and caffeine, so that makes me dangerous.
Bad idea to add 0.12 to the Rx for distance as long as the metric is 5 minutes of arc measured at 20ft on a chart.
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drk,
I think my job is to "deliver the Rx as intended".
However I'm "blessed"(?) to recieve Rxs from several Dr's offices that, by their own admission, are not always up to snuff. And the make no bones about allowing me to improve the correction, as I see fit, since experience has shown they see their clients back in the chair less when I fulfill their Rxs.
Think of it as me living near the LOVE canal, and having to deal with clearing polluted waters on a daily basis.
Barry
Last edited by Barry Santini; 06-23-2009 at 01:39 PM.
OK, Barry, I totally agree that if you have express (and probably should be written) consent to modify prescriptions with certain Drs., then you are doing a service.
Routine modification of prescriptions is not at all the same, and I'm afraid some uninitiated optician will misconstrue your posts and a disservice will be done.
You da man!:cheers:
Point taken, drk!
Barry
Not to be a prick (since you're supporting my point), but 5' of arc is 5' of arc anywhere.
Plus, the acuity chart is irrelevant to the refraction process. You could ask them if a doorknob looked clearer with #1 or #2.
OK, I'm a prick.
Actually Harry I don't do that. What I do *do* is take the client outside with their present or new Rx (trial frame) and have them look down the street at an expressway sign 200 or more yards away.
If plus *or* minus 0.25D make a *demonstrable* difference in sharpness, I hold that figure aside, compensate the RX and use those findings to *round* off the 0.01D ordered power in the "right" direction.
verstehen?
Barry
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