Just out of curiosity I would like to know what most dispensing opticians think is the main or root causes of poor refractions. So we're talking redo's not attributed to a dispenser error, or restyle....
Just out of curiosity I would like to know what most dispensing opticians think is the main or root causes of poor refractions. So we're talking redo's not attributed to a dispenser error, or restyle....
90% of everything is crap...except for crap, because crap is 100% crap
Not taking enough time. That could be due to the changes in optometric training over the last four decades - The training is based more on the medical model, and less on the mechanics of refraction. The very word "optometrist" means "eye measurer." I've found that the practitioners I get the most re-dos from are either pressured to work faster by their employers, or they rely too much on the data they obtain from autorefractors without doing a careful subjective afterwards.Originally Posted by RIMLESS
Just out of curiosity I would like to know what most dispensing opticians think is the main or root causes of poor refractions. So we're talking redo's not attributed to a dispenser error, or restyle....
I agree with Sharon and I will add this: what we have run in to lately is just the subjective nature of the refraction. The last two remakes I did were first time glasses wearers who, it would seem, fudged on their responses to the doc. Then when they got their glasses they caused headaches, one from too much sphere, one from too much cyl. People seem to think more (stronger) is better until they get them on their face for the entire day.
The place we get the most scripts from has laid off or shortened hours for both techs and opticians. It's also the place we get the most bad scrips from. I used to think it was the shortstop dilemma- more action means more errors. But some of the patients say they feel cheated when the doc comes in for 2 minutes to sign something but the girl does all the work. Hmmm.
Here's the top three reasons for poor quality prescriptions in my shop-
1. The client was not refracted. VAs were checked, and if good, the old powers were Rx'd. Even if it was ten years old.
2. The client was told they didn't need new eyeglasses, although the Rx change was not, in the client's opinion, insignificant (lens surface, frame age and condition were also not accounted for).
3. All Add powers are for 40cm. If the CC was poor near, Rx Add is bumped, with no regard to cause, lens function, and work distance.
Last edited by Robert Martellaro; 02-29-2012 at 12:09 PM.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
Carelessness, and indifference, with a twist of "I don't give a .........." is the cocktail mix of the poor refraction kool-aid. IMO, and observations.
I find that a lot of our patients don't understand what they are doing when being refracted. We hear a lot of, "I wasn't sure what I was seeing. Nothing was really clear." Never mind that these are long term patients who have had a multitude of rx's. I think the refractionist must do a better job of communicating that this is a team effort, and if you (the patient) aren't sure if 1 or 2 is clearer, how am I (the refractionist) supposed to come to a good Rx?
Probably one thing that would help eye docs is the .25 change in rx. some don't feel comfortable prescribing new lenses for this "mild" change. If the patient calls for it in the chair, then give it to them. Why wouldn't you want them to see their very best!
For the same reason they send folks to the dollar store for OTC readers.
Science is a way of trying not to fool yourself. - Richard P. Feynman
Experience is the hardest teacher. She gives the test before the lesson.
Of course the best eye doc will be the one that takes the time to put a trial frame on the patient. Although that may not take care of all the problems, it does reduce errors/"bad" refractions to a manageable level.
how about the "doctor" that just takes the computer reading off the topographer
Cut the refractionist some slack. He is dealing with patients who when asked: "What's the lowest line you see." respond with: "Well I can't see line ..." Others that think memorizing the line will give them a better grade. I have even seen some that respond: "Do you mean on the eye chart?"
So many seem to think that this is some sort of test on which they must score a passing grade.
Chip
I am beginng to realize that opticians as a group are more concerned about what someone else is doing wrong and not concerned with thier own faults.
Chip
Thank you kindly Chip, you are obviously wise beyond your years !!!!!!!!!!!!!!!
I'll chime in more about the other answers in a little bit.
90% of everything is crap...except for crap, because crap is 100% crap
This being no different from 99% of the general population. Remember the OP stated re-dos not attributed to dispenser error or restyle.
=)
We have all sorts of variations not related to the refractionists skills. We saw one patient for an exam right after getting off work for the night shift, his RX way way off just because he was tired. You have hydration issues, too much coffee, medications, illness, high blood pressure, dry eye, and even mood.
How many patients only come in when their contacts are out and they have been wearing the same lenses for a month? Those red irritated and possibly swollen eyes are not going to refract perfectly.
Some patients kick cyl, some don't. Variations in pupil size are another factor, it's a dark room after all.
Mothers with screaming or antsy children? Patients discracted with stress?
I am actually surprised that so few refractions are wrong.
Can you translate this please?
Opticians face the same thing with contacts wearers. They show up wearing their contacts with no case to put them in, then get pzzed at us because they have to wait 30 mins for equilibration and (hopefully) clear vision. They always want to just pick up their glasses and run off with them. You can't see me but I'm rolling my eyes right now.
Nice post.
I have found that refractionist more interested in success will not put all adds at 40 cm. Some concideration should be given to where the patient likes to read, how long his arms are and where does he view his work.
While some of the latter may be concidered more on pairs just designed for work, many perhaps most patients have only one pair of glasses and some compromises must be addressed.
A patient reading blue prints on a dest (and this is a patient who will not like progressives as well as other lens forms) may need an add at 60 or more cm. Some folks just like to read 12" from thier face. It never hurts to find out and Rx for what the patient does and some of his overall physiology.
Chip
+1000
It is so frustrating when every refraction I get is for a 14" add. The only people who read that close are myopes who take their glasses off! I have to back off adds often for folks who have to, like Chip said, compromise with their one pair of glasses, so that they can see their desks. And forget about the doctor's who put everyone over 55 in a +300 add. Thankfully I have been given the go ahead to adjust add powers as needed for our patients. It certainly saves a lot of remakes.
Of course, there is always the 20% or so of patients who you can tell until you are blue in the face that their new rx will be for 14", you show them 14", they nod their heads, and then come pick them up and scream at you because they don't hold anything that close. Le sigh....
One of my articles from a few years ago I think should be revisited:
http://www.2020mag.com/lt/9070/
B
This!! I wish refractionists would question presbyopes about their expectations as far as computer/reading distances. The work-at-a-desk world is not the same visual situation as it was ten years ago! A 30 second Q&A in the chair would save so much frustration on everyone's part.
I think the biggest cause of errors in refraction is time. The dwindling reimbursements leads to jamming more patients on a schedule.
I have seen MD's do a quick streak retinoscopy, and never touch the JCC. One MD locally doesn't even have a phoropter. I think he lens racks patients. Had a patient overminused by 2.75 D. I reduced her minus, and she decided to go back to the MD...and he stated I was completely wrong. I was tempted to send copies of the autorefraction tape to show him otherwise...
The other error I see, is OD's not taking the time to further evaluate possible latent hyperopes. I worked in an office where the autorefractor had a patient at +3.50 OU. The OD actually crossed out the autorefractor results, wrote "error", and prescribed +1.75. A year later I see her, do a wet refraction, and she is more like a +7.50.
The other problem I see, and didn't realize until I dealt with the public on such a level, is that there are many out there who aren't the brightest. Even trial framing, and asking the patient to hold the reading card at about the distance they "would like to have something when doing up close work or reading" often leads to working distances all over the place. Then I spend another few minutes telling the patient to stop trying to make the works clear by tromboning the card in and out. Then another few minutes of telling patients to repeatedly drop there head, so that their line of sight is through the center of the trial lens, and not to try to use the lenses like a progressive lens. Then the patient states that, they are not really sure where they hold things distance wise...
Too bad we can't figure out a way for people to actually know what they want. It's all frustrating, isn't it? (Not being sarcastic.)
Very hard to explain. I've had patients that are much more visually comfortable with a spherical Rx then s/c Rx. One that will not take any portion of a -3.00 cyl and is content to see 20/30- without the cyl. Spherocylinder lenses induce various lens aberrations that some people just cannot comfortably tolerate. Kinda defies logic a bit that's why it's called an art
90% of everything is crap...except for crap, because crap is 100% crap
"Kicking cyl" is when a patient shows they need cyl but for any reason can't tolerate it in the final RX. Its common with low cyl contact wearers, but it can happen any time. Cyls send some people for a loop.
In my case if you auto refracted me I would show -1.00 D cyl, but my final RX will only have -.50. The exta cyl only gains me a DVA improvement of 20/15 -3 to a DVA of 20/15 -2. Its a tiny improvement for a lot of cyl. So I do kick cyl myself a bit.
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