I have a patient with two prescriptions. One from an OD and one from an MD :)
Rx from the OD is from March and is O.D pl -1.25 x100
O.S pl -1.25 x78
Rx from the MD is from September and is an easy spherical -1.00 OU!!
Generally, I'd prefer the OD's but here the MD's seems so much simpler....
Any ideas?
Why not make it even simpler and make em plano's
Originally Posted by jonah
Uhhhhhh Hurrr Durrrrrrrr use da minus onez!
Well the OS axis is what would concern me. In general I would trust who used the better tech to come to the final RX. If they were both done manually in a mesopic lighting then I guess the OD seems to have more fine tuning. There are too many variables to the question to know.
Trial frame the RX's and see what she prefers if both RX's are valid
You really have no way of knowing.... I would trial frame it as someone else said.
Maybe ask the patient which doctor THEY trusted more. Did one of them seem disinterested in the refraction or use a tech and just sign off on the Rx.
What does the NY state licensing board say on the matter? Surely THEY will have an opinion.
The MD is wrong! Funny Don................... The only way the MD rx could be right is if the patient had surgery on them eyes.
Complimentary axes (added together equaling about 180) are typical.
How can you miss a 1.25 DC? It was either purposeful (history of rejection) or incredibly lazy.In general I would trust who used the better tech to come to the final RX. If they were both done manually in a mesopic lighting then I guess the OD seems to have more fine tuning. There are too many variables to the question to know.
That, and look at the habitual Rx, if there is one.Trial frame the RX's and see what she prefers if both RX's are valid
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.
All + 1.
Yes, look at the current eyeglasses.
Opinion on what? Using techs to refract? NYS prohibits it, but will only investigate complaints made.
it is possible both are wrong.
slightly less likely, but not impossible, is that both are right.
Is the patient diabetic? Other health problems could also have an impact. Plus all of the above.
Diane
Anything worth doing is worth doing well.
Okay, called the patient. She said her current pair (which she barely wears) was prescribed by the OD. Asked how she saw in them......"not bad until this year when I started to squint". So why did you go to the Ophthalmologist? oh, because I wanted to get a really accurate prescription.
Have pt get a third opinion. From a DOCTOR. NOT a tech.
In most locations, OMDs suck at refractions, think about it... many OMD see 100_+ patients a day, the busiest OD I know sees about 15-35. You do the math, how much time is left for that refraction? I know OMDs who do more surgeries per day than an OD does in refractions, compacting their time further.
OMD's never consider the patients previous RX when finalizing, either, or what a slightly less power change has on VA.
Plus OMDs receive about 20 hours of refraction training in school, ODs receive about 9 months, and study different methods of obtaining a refined refractive state.
I would never trust an RX from OMD...
But your patient may have had a pathological condition that altered the correction. So trial frame is key.
Sharpstick 100%. Though there are exceptions - MD's are less concerned with refractions than pathologies. You don't go to a neurologist for a sliver. Trust an OD - it's their livelihood.
I have to agree with the OD comments here. I used to work for an OMD who did nothing but bleph surgeries all day. Refractions were an afterthought for all intents and purposes. ODs refract all day.
Coming Soon: Cellphone-based focus analysis. This will turn out, in cases like these, to be your friend!
B
Ophthalmologist's are medical doctors ..................................
Ophthalmologist's are medical doctors and surgeons specialized in their field who take a relatively short course to refract.
Optometrists take a 3 to 4 year course to learn to refract.
Now you decide who is going to determine a good correction for your glasses and who would be better to do your cataracts or blocked drainage canals and other types of eye surgery.
Right on . . . you can say that again, however, when the MD began selling glasses the line between ophthalmology and optometry began to blur. Funny how things change. Over the years, Optometry has progressed upward into the former realm of the MD while the MD descended into the realm of the OD and retail merchant. It won't be to far in the future when there will be no difference between the two and the poor old optician will still be sucking hind teat.
I dunno...is someone who makes people see by refracting and/or offering materials that make a difference, really descending,...and is someone who can't take the time to find a 1 diopter cylinder, really ascending?
Definition of Hippocratic Oath ......................................
Classic Version of the Hippocratic Oath
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
A Modern Version of the Hippocratic Oath
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
http://www.medicinenet.com/script/ma...ticlekey=20909
It's not the years of education - it does not take that long to learn how to "refract". Besides, most refractometers on the market are cheap enough that anyone can afford one and will find "the cylinder" in about 1 second. The PRESCRIBED prescription is another matter. Prescribing should be based on a patient's visual requirements- accounting for (among other things) health (is he/she diabetic, got cataracts etc...), binocular vision status and previous refractive correction - to assume one is necessarily wrong because it is from an OD or an MD, or one has cylinder when it "shouldn't" (or vice versa), is nonsense. There is no "trusting" an MD more or less than an "OD" - that is horse crap. Do your job and figure it out.
Maybe both are "wrong". Maybe both are "right". Deal with it. That's why you are a licensed professional, and why dispensing glasses, just like prescribing glasses, is a professional act (or should be) - you need to research (like ask questions!), analyze, think, counsel and make decisions with and for your client. Asking people on a forum which of the 2 to trust - maybe fun and provocative, but is professionally useless.
Last edited by optimensch; 01-25-2015 at 09:32 AM.
We have a sick definition of FUN.
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