How do you (or your people) handle this phone call?

[drk]

I look at it this way: We are about relationships, not transactions.

When people schedule with our office and walk in the door for the first time, they establish a doctor-patient relationship. We immediately become responsible for their eye care. Not just some of it--all of it. Glaucoma to vision correction.

When someone calls with the intention of fragmenting their care from the outset, that's a big strike for us. If they need to fragment their care because we can't provide a certain type, say, surgery, then we work in a formal shared-care relationship with the third party. We are still responsible for how things go; we'll get sued just as readily if shoddy cataract surgery occurs.

Same with optical care. We hesitate to fragment and let, say, Vision Shack do part of the vision care on our patients. We want to do it ourselves; we want to provide the treatment we prescribe. But if we have to get into a relationship with the Shack due to patient demand, they are informed of their decisions and ramifications and we reluctantly go along with it.

We do not endorse sharing patient care with online entities for contact lenses or glasses. We frown upon it because of lack of regulation and expertise. We decline to participate with patients who want to get glasses online, period. The answer to the original question would be "No, we do not release p.d.'s" and let it go at that.

We are likewise not in the business of wasting our time trying to counter the misinformation and foolishness that exists out there. On our established patients, yes. On prospective patients, no.

[AngeHamm]

I look at it this way: We are about relationships, not transactions.

Approaching our work with this attitude has the happy side-effect of also increasing transactions long-term.

[Uilleann]

I look at it this way: ...We do not endorse sharing patient care with online entities for contact lenses or glasses. We frown upon it because of lack of regulation and expertise. We decline to participate with patients who want to get glasses online, period. The answer to the original question would be "No, we do not release p.d.'s" and let it go at that.

We are likewise not in the business of wasting our time trying to counter the misinformation and foolishness that exists out there. On our established patients, yes. On prospective patients, no.

Doc, I'm coming to work with YOU! :)

[Rockstargazer]

Greetings to all- Here's my approach and underlying philosophy: If they want to buy glasses online they're going to buy glasses online, period.

My office is in the heart of Silicon Valley and many of my patients are on the leading edge of internet technology, both as end users and as creators. I have to be perceived as a willing participant to the world around me otherwise I risk being reviewed on yelp as old fashioned, low tech, etc. When asked either in person or on the phone about PD's I respond very politely with, "Absolutely we can measure your PD. We charge $25 for this service, which gives you an accurate PD measurement, and we ask that you return to our office after you have received your online glasses so that we can verify that they were made correctly and perform any adjustments needed." At least if they opt out of paying the $25 we don't come across as snarly opticians that resent the online glasses world............. Now, here's the caveat: Experience has shown me over and over our "children" will stray from time to time but they most always come back home because they've had a bad or even horrible experience. Frankly I embrace the fact they are purchasing glasses elsewhere because invariably they return saying I'll never do that again! If we do our job accurately, professionally
and treat patients fairly THEY WILL COME BACK PEOPLE!! It's that VALUE thing.

[Happylady]

Do people really get calls like that? I never have and I rarely have anyone ask for a PD, it happens maybe once every few months. If they ask I take it and give it to them, I just do a binocular PD, not mono.

When I started where I work now I was told to take the PD and write it on the rx. I did for a while since I was told to but it never made sense to me. I stopped after a while and no one has said anything about it.

[Browman]

So you lost an eye exam over a PD? Wow!

+1

I really can't wait for someone to sue over a PD charge, inevitably win the case, and set a precedent, so we can move beyond this petty issue.

[optical24/7]

Experience has shown me over and over our "children" will stray from time to time but they most always come back home because they've had a bad or even horrible experience. Frankly I embrace the fact they are purchasing glasses elsewhere because invariably they return saying I'll never do that again! If we do our job accurately, professionally
and treat patients fairly THEY WILL COME BACK PEOPLE!! It's that VALUE thing.

^ This is what I've experienced also.

+1

I really can't wait for someone to sue over a PD charge, inevitably win the case, and set a precedent, so we can move beyond this petty issue.

Only way they would win is if you have it down on one of their records. Example, My MD does not record one anywhere on the chart. They would have had to have glasses made by us to have a record of PD.

[Stan Tabor]

Do you really get calls asking to schedule an exam and if you also get a PD? I think there are bigger fish to fry relative to threats to independent ECPs than worrying about giving out a PD. We are talking about a PD here. This isn't brain surgery. Get the guy in your exam room and show him why he should be buying through an ECP versus online.

According to the Vision Council, online is 3% of eyewear sales. And of those 3%, a significant amount are second or third pairs just for fashion because they are cheap. Stuff has been selling online for 15 years. If this has only reached 3% in this time, this tells you something.

It is easy to be drawn into the emotion around PDs and online eyewear. Keep your eye on the ball and take care of the business that really matters.

[Chris Ryser]

There are only 15 million pairs sold by the largest 4 online opticals on this continent a year that ECPs do not sell and the figure will get bigger this year.

Glasses made by online opticals are like the glasses you get back all finished by a lab you work with. You have to check them and they need an adjustment on the buyer. In my opinion at that stage they are not a finished product.

By refusing to touch them you alienate the consumer instaed of helping them against a professional charge.
If the appliance service people can charge $ 87.00 to come and look at my upper tray in the diswasher which has fallen out of its track, I could see an optician charging to finish a pair of glasses that came straight from the lab at the online optical a thousand miles away.

You are making these charges when selling you own frames and lenses to the consumer without asking. The difference is now that an online lab sells now at prices without your services included.

There will be more and more people buying their glasses through the internet so why not charge them $ 50.00 to take a proper PD and give them a certificat covering full checking and adjusting the glasses properly when they get them.

[Browman]

Only way they would win is if you have it down on one of their records. Example, My MD does not record one anywhere on the chart. They would have had to have glasses made by us to have a record of PD.

My SIL is a malpractice attorney. Some points that have been brought up:

1) Many, if not all, autorefractors include a PD printout. A could successfully argue that, regardless of the accuracy, because it's included along with the prescription, it counts as a component of the RX and not a separate measurement.

2) A bigger blow: Eyeglass I was meant to ease the accessibility of affordable eyewear for patients, the intent behind necessitating the release of the RX to patients. A patient could argue that, because the PD is required in order to fabricate a pair of glasses, it necessarily becomes a part of the RX, and that by witholding the PD or adding an additional charge to the exam, the entity in question is preventing/making the acquisition of eyewear more difficult, in violation of the intent behind Eyeglass I.

[standarduck]

Many, if not all, autorefractors include a PD printout. A could successfully argue that, regardless of the accuracy, because it's included along with the prescription, it counts as a component of the RX and not a separate measurement.

Because a specific machine takes a certain measurement, that could become required by law? Is that true?

[Browman]

Because a specific machine takes a certain measurement, that could become required by law? Is that true?

The reasoning:

The autorefractor's purpose is to give the OD/refracting optician a ballpark on an RX with which to work in order to narrow it down to the specific, correct RX. Therefore, each measurement generated by the machine represents a necessary number which will then be modified in order to determine the proper RX. Ergo, since the PD is generated as one of these numbers, it represents a necessary component of the RX.

It's the same reasoning behind SIL argument regarding Eyeglass I: If an RX cannot be fabricated without the PD, then the PD is a part of the RX, and a court would rule that it belongs to the patient. Note that we are referring to a static number here-- a PD would be the same in glasses X as it would be in glasses Y. Not withstanding injury, growth, or other external factors, the distance between the patient's pupils remains the same regardless of what frames he/she wears. She does not believe that a court would ever rule in favor of seg heights belonging to the patient because they are dynamic and dependent upon a factor independent to the patient's body-- namely, the position of the eye in a specific pair of frames.

[optical24/7]

Once again, there is NO record of PD in my MD's charts. (Not even an auto refractor generated one. The starting point of the refraction is many times the pt's habitual pair.) PD positioning can vary from frame to frame and it can also be argued that vertical position of the pupil should be accounted for in even SV lenses. But the biggest argument a practitioner can fall on is the provider of the eyewear has ALWAYS (historically) been the party responsible for the PD measurement.

Until they re-write Eyeglass Two, I don't think a plaintiff would win such a case. Flat out, if it's not recorded there is nothing to release.

[kcox]

What about offering to give them their PD measurements, (unless it really isn't something your office does) but making it clear that it isn't part of an exam, and that they need to sit and have a conversation with you first. That way you can give them their measurements, share a little knowledge and then they will make their decision on where they get their glasses. If you have the opportunity to do that, maybe if they go somewhere else and end up unhappy with their glasses, they will remember how helpful you were and decide to come back.

We have a form in our office that patients can sign that basically says if we give them their PD measurements that we aren't liable if they get glasses made elsewhere that end up incorrect.

[drk]

What if you just tell them "no"? What's the problem with that?

Feel "too mean"?

Feel "too wimpy"?

Think there's really nothing wrong with non-prescription glasses?

[optical24/7]

The mis-guided aren't lost forever doc. Do you think the average person would go back to a place that (in their mind) wasn't helpful at all? Let's me and you have a fly catching contest. You use vinegar and I'll use honey....

[Caroline]

PD positioning can vary from frame to frame

Please explain. I certainly get the vertical placement, but how does the PD itself vary?

[standarduck]

Please explain. I certainly get the vertical placement, but how does the PD itself vary?

I thought PD was a facial measurement. I too would like clarification.

[m0002a]

Please explain. I certainly get the vertical placement, but how does the PD itself vary?

It doesn't. Only the fitting height varies with the frame. Maybe that's why some people buy glasses online.

[optical24/7]

It's how each frame fits on the patient. If you've noticed, most monocular PD's are not identical. Nasal symmetry is not always identical either. How a patient habitually wears their glasses also needs to be taken into account. As example if a patients nose slopes toward the left and they habitually wear their glasses down the nose slightly it can affect pupillary placement.

A binocular, non-POW pupillary measurement may be a constant, but can/will vary by frame, adjustment and wear position.

[uncut]

It doesn't. Only the fitting height varies with the frame. Maybe that's why some people buy glasses online.

I disagree with this statement. The interpupilary measurement should be the average of up to 5(five) attempts when you are producing a accurate optical wearable device. In it's accurate interpretation for fitting, it is monocular, device use driven(infinity, intermediate, neartask, occupational, or even hobby related).............it is only a guesstimate when it is "selfied".

[m0002a]

I disagree with this statement. The interpupilary measurement should be the average of up to 5(five) attempts when you are producing a accurate optical wearable device. In it's accurate interpretation for fitting, it is monocular, device use driven(infinity, intermediate, neartask, occupational, or even hobby related).............it is only a guesstimate when it is "selfied".

I would agree that the PD "could" vary a bit depending on the lens design and/or task (especially near vs far), but it "should" not vary by frame unless the frame was non-symmetrical in the frame shape or non-symmetrical nose-pad adjustment. Many people in this thread have reported that a PD is part of an exam (before a frame is selected), and that is my experience also. But as you said, I agree that small adjustments in PD could be made depending on the lens design and eyewear task.

[Chris Ryser]

I'm getting a little sick of these...


"Hi, if I schedule an eye exam, will you give me my PD on my prescription."

If you get sick of these calls you must get them often and there is nothing you can do about it but have to understand that there is now an irreversible trend to make purchases on the web.
Most probably you do so yourself, and we might just all do.

Here is a possible answer you might give, adapted it to your business without offending a possible customer:

"The PD has nothing to do with the Rx examination. It is a measurement to properly place the optical centers horizontally when cutting the lenses for insertion into the frame.

The PD alone is not really the only measurement needed for that purpose, also vertical placement can play a big role for that purpose. This measurement can only be taken by measuring when the new frame is placed on the face.

Wrong PD in the horizontal, and vertical placement measurements can result in discomfort when wearing the glasses, from the light to the severe variety.


If you decide to purchase your frames online, we can offer you the following:
For charge of $ 50.00 (or whatever you decide) we will provide you:

1) The requested measurements PD and vertical. (he/she does not have the frame yet)

2) We will check that the Rx and the measurements are correct or not. So you can return them to the supplier for correction.

3) In the case of multifocal lenses we will also check the positioning of the reading area.

4) We will adjust the frames to fit on your face as perfect as possible.

All newly manufacturerd eyeglass frames of any type have been made to standard settings, while individual faces and heads vary from one to the next.

Buying a fridge, cell phone, TV or an airconditioner on line is not the same as purchasing a pair of glasses which have to be fitted to a face and sit right on the head. Poeple have crooked noses, one eye higher than the other, and the same with ears. The real nitty gritty adjusting has to be done by an expirienced optician."


The person that calls you does not know all of these above items and only see's of what they think, is a wholesale pricing for a usable item. This item might just not be usable and comfortable, but you give them an insurance that will protect them.

By beeing positive you will not alienate a maybe future customer. But for an additional charge to the cost of online RX glasses they have an insurance that these glasses will at least work.

There will be over 20 million pairs sold this year by the online opticals and they will have to be serviced at some point. The consumer will still need an optician at some point along the way.

[m0002a]

My guess is that there are OD's who are willing to do an exam and include a mono PD. A consumer may have to shop around, but they probably can find one. In states where a PD is not required on the Rx, then an OD would obviously be within their rights to charge extra for that. OD's should price their exams so that they can survive without having to dispense to make a reasonable profit.

There are certain types of lenses, such as Zeiss ID 2, Hoya MyStyle, etc that require special measurements and/or software that not every OD with optical shop has available to them. If a patient wants one of those lenses that an OD is not prepared to dispense, I would think that the OD would still welcome the exam business without an expectation of dispensing, but maybe I am wrong about that.

[m0002a]

Here is an interesting question:

Would a consumer who is shopping for a moderate to high power progressive lens be better off getting an Rx with mono PD at a local OD, and then:

1. Going to the average Optical Shop (optical shop at the OD office where exam was given, local independent optical, or Big Box optical, etc).
2. Dealing online or by phone with Robert Martellaro of Roberts Optical Ltd. in Wauwatosa WI. Please note that I don't believe Robert does this, nor does he have anything to do with this post, and I only know him from optical forums.

Even though Robert probably would not do this, I am pretty sure he could dispense remotely better than 99% of other opticals could do locally with patient in their shop, and if the right video technology were employed, that he could achieve the same results as he does with a patient in his shop.