ANSI Standards and digital lenses

[ml43]

How about no duplication without a prescription? I like that better.

indeed, 2nd derivatives are useless, unless you know the original function.

[Barry Santini]

And, I will add (cautiously, because I don't have all the solid facts) that lensometry is index-dependent.

So chill out, Edwin Hubbles.

Here's some weaksauce that may be interesting: a decente refractionista will tilt their phoroptorista about 5-10 degrees for some panto.

Actually drk, it is not index dependent. It is abbé dependent, but only in the higher powers.

B

[Barry Santini]

The problem is the prescriber never knows if there is going to be compensation of not, or even simple OC measurement or compensation at all. Are they going to Haute-Couture-Optik for a $1000 pair, or getting 8 pair for $9.95 with free shipping? In cases when we do compensate we are assuming a base zero panto, zero wrap, vertex 12.0 (refracted vertex is of course just guesswork) refraction, because we have no information otherwise. If the prescriber is already compensating, then obviously final compensation will off.

I think it would be cool if a doc did issue scripts with *actual* phoropter panto, wrap, and vertex values on the Rx. Those values would usually be closer to final frame fit than 0,0,12 so even if patients went with simple conventional lenses they should get a better final result, and then if we did compensate from there we need only measure and calculate deviation from the phoropter values.

Correctly, the term "OC" measurement should be renamed pupil height. When you adjust this for pano, it is to be sure your optical axis in a CC lense intersects the eye CR. it is not about abbé. This may be a serendipitous benefit, depending on the gaze angle at the time.

B

[MakeOptics]

How about no duplication without a prescription? I like that better.

That makes sense, but sucks.

[optical24/7]

How about no duplication without a prescription? I like that better.

How about the vacationer that broke their glasses and needs a duplication right away but out of town doc won't release the Rx? How about the pregnant lady who trashed her lenses accidently on the pavement and who's Dr won't refract her or release her 18 month old Rx? How about the 35 yr old out of a job, no ins. who also broke his glasses but who's doc wouldn't release his 1 yr and 1 week old Rx? All these scenario's have happened with me.

I'll give you no duplication if you give me refraction under emergency conditions. I like that better.

[Barry Santini]

I think our field would benefit from not linking eye health gatekeeping the refractive event.

B

[drk]

How about the vacationer that broke their glasses and needs a duplication right away but out of town doc won't release the Rx? How about the pregnant lady who trashed her lenses accidently on the pavement and who's Dr won't refract her or release her 18 month old Rx? How about the 35 yr old out of a job, no ins. who also broke his glasses but who's doc wouldn't release his 1 yr and 1 week old Rx? All these scenario's have happened with me.

I'll give you no duplication if you give me refraction under emergency conditions. I like that better.

Don't get all practical and patient-centered on me.

That's not a failure in the system, just individual break downs.

You could just as easily solve it with little wallet-sized laminated SpRx cards (l love those).

[drk]

I think our field would benefit from not linking eye health gatekeeping the refractive event.

B

You say you want a revolution.
Well, you know
we all want to change the world.
But if you want refractions by people with minds that (don't know nuthin' about eye health)
All I have to say brother you have to wait.

[Robert Wagner]

You know it's going to be alright, alright

Thanks drk I'm going to be brain singing this all day long!!!!!!!!!!!!!!!

[optical24/7]

Don't get all practical and patient-centered on me.

That's not a failure in the system, just individual break downs.

You could just as easily solve it with little wallet-sized laminated SpRx cards (l love those).

If you noticed, there was also a theme to my post. They all involved Dr offices that refused to release relatively recent Rx's. I'm sure you don't do this, but it's epidemic around here for OD offices to;

A. Not give a written copy of the Rx to the patient upon completion and payment for the exam.
B. Hold the Rx as *hostage* to force the patients return, yearly, regardless of eye health.

I can also assure you, every patient encounter I have where offices refuse emergency info to be provided or make patients jump through hoops and hide behind HIPAA to obtain even a current Rx are convinced by me that they should seek another provider. (And they usually do.)

[Robert Martellaro]

Actually drk, it is not index dependent. It is abbé dependent, but only in the higher powers.

B

Wavelength dependent also, for those interested in these things.

Correctly, the term "OC" measurement should be renamed pupil height. When you adjust this for pano, it is to be sure your optical axis in a CC lense intersects the eye CR. it is not about abbé. This may be a serendipitous benefit, depending on the gaze angle at the time.

B

I think one of the problems is that the pupil position is ambiguous for the fabricators. For example, a segmented multifocal might need the vertical OC 5mm above the seg, or 2mm above the seg. I don't see how that can translate to pupil height. Maybe we should separate the two, using both a pupil height and an OC height, making it easier for another optician to easily determine the fitter's intentions. What does the VCA recommend?

Whenever possible, I do use the term pupil height, due to your gentle, yet relentless prodding.

How about the vacationer that broke their glasses and needs a duplication right away but out of town doc won't release the Rx?

I tell my clients to travel with their spare pair, and if possible, take a picture of their Rx, to be stored on their mobile device and/or in the cloud.

[MakeOptics]

If you noticed, there was also a theme to my post. They all involved Dr offices that refused to release relatively recent Rx's. I'm sure you don't do this, but it's epidemic around here for OD offices to;

A. Not give a written copy of the Rx to the patient upon completion and payment for the exam.
B. Hold the Rx as *hostage* to force the patients return, yearly, regardless of eye health.

I can also assure you, every patient encounter I have where offices refuse emergency info to be provided or make patients jump through hoops and hide behind HIPAA to obtain even a current Rx are convinced by me that they should seek another provider. (And they usually do.)

Most practices have a 50% capture rate or better. Most practices that are billing medically currently have a clinical revenue to dispensary revenue that is a 1:1 ratio, knowing this why would anyone withhold an Rx and risk the other half of their revenue stream. This scenario is literally "a bird in the hand is worth two in the bush". Given the fact that it is much more difficult to obtain new patients than it is to keep existing patients every patient lost due to gate keeping negatively impacts the practice long term, where as the gains of gate keeping are short lived and may not be evident immediately but do effect overall growth throughout the years.

I no longer worry about the doctors that hold Rx's they are shooting themselves in the foot, and as the paradigm continually changes towards patients having more access to their health records it becomes even more polarizing that the office holding are not offices that patients should stay with.

AGAIN I REITERATE, IT SUCKS BUT IT MAKES SENSE. I will also add don't blame the doctors for something so evident years ago, opticians never stepped into a role that was practically served on a platter. At this point I am more confident that techs and medical assistants will be allowed standalone refraction then an optician.

[Barry Santini]

Wavelength dependent also, for those interested in these things.

I think one of the problems is that the pupil position is ambiguous for the fabricators. For example, a segmented multifocal might need the vertical OC 5mm above the seg, or 2mm above the seg. I don't see how that can translate to pupil height. Maybe we should separate the two, using both a pupil height and an OC height, making it easier for another optician to easily determine the fitter's intentions. What does the VCA recommend?

Whenever possible, I do use the term pupil height, due to your gentle, yet relentless prodding.

I tell my clients to travel with their spare pair, and if possible, take a picture of their Rx, to be stored on their mobile device and/or in the cloud.

Nope. I'm sticking by pupil height. It can be the basis for computing seg height, or seg below.

I really dont give a rat's *** what will confuse the lab. They oughta learn the correct way of thinking. Anyone who can't follow...UNDER THE BUS THEY GO!

B

[Robert Martellaro]

Nope. I'm sticking by pupil height. It can be the basis for computing seg height, or seg below.

I really dont give a rat's *** what will confuse the lab. They oughta learn the correct way of thinking. Anyone who can't follow...UNDER THE BUS THEY GO!

B

I don't want to take this thread too far off topic, so I'll just agree to agree, and leave the details for another thread.

Cheers,

Robert M.

[drk]

If you noticed, there was also a theme to my post. They all involved Dr offices that refused to release relatively recent Rx's. I'm sure you don't do this, but it's epidemic around here for OD offices to;

A. Not give a written copy of the Rx to the patient upon completion and payment for the exam.
B. Hold the Rx as *hostage* to force the patients return, yearly, regardless of eye health.

I can also assure you, every patient encounter I have where offices refuse emergency info to be provided or make patients jump through hoops and hide behind HIPAA to obtain even a current Rx are convinced by me that they should seek another provider. (And they usually do.)

My theme was cooler. :)

I don't endorse those law-breaking meanies.

Mean Dr. Mustard
works in the dark
Makes opticians bark
Won't release their papers...

[drk]

I tell my clients to travel with their spare pair, and if possible, take a picture of their Rx, to be stored on their mobile device and/or in the cloud.

I am the eggman
I am the eggman
I am the Robert!

Good, good,
Good, good
Good, good, good, good, good (idea)

[MikeAurelius]

Just wait until those idjits get a letter from the FTC with a summons to court to 'show cause' as to why they are violating Federal Law. I'd like to be the little spider on the wall...

My doc prints it out right in the exam room and hands it to me, usually with a comment about being sure to talk to the dispenser to tell him that I do glass. I like my doc ;-)

[optical24/7]

My theme was cooler. :)

...

I'd like to tell you thank you on behalf of the group and ourselves, and I hope you pass the audition.

[drk]

Let It Be album, right?

[optical24/7]

Let It Be album, right?

Yup. At the end of "Get Back". Recording the song, Paul glared at Yoko every time he sang " Get back to where you once belonged. " (According to Lennon.)

[optical24/7]

I don't want to take this thread too far off topic, so I'll just agree to agree, and leave the details for another thread.

Cheers,

Robert M.

This thread is already way off topic, we might as well kill it with more!

Nope. I'm sticking by pupil height. It can be the basis for computing seg height, or seg below.

I really dont give a rat's *** what will confuse the lab. They oughta learn the correct way of thinking. Anyone who can't follow...UNDER THE BUS THEY GO!

B

I hope the bus I go under is one of those jacked up jobs like at a Monster Truck rally....

WRT *OC* or *pupil height* ; 1st off OC height is independent of pupil height. Let's refer to SV for now. The pupil height may be 25, where's the OC to go? Depends, depends on tilt. Let's say you have a lab do your Rx work. Even if you give them POW measurement, they do not adjust the OC height for panto if you give them a pupil height.

Ordering uncuts, if you give a pupillary height, they will not adjust OC placement comped for tilt. They comp the power with atroicity/asphericity, for wrap, tilt and vertex ( some for CR). They don't comp the OC for tilt. These lenses usually come so cribbed down that they won't cut out if you had to adjust the OC compared to pupil height. (They crib them down so much you pray the feelers on your edger dosn't fall off the edge, preventing edging.) you HAVE to give an OC height. The industry is set up to put an OC anywhere (within reason) you want it. I like I can specify where I want it.

A quick reference to using OC instead of pupil height is a patient with imbalance vertically. I can juggle OC 's to reduce VI in a FT by moving the OC down enough to eliminate the need for slab off on certain Rx's. ( I had a doc when I worked wholesale labs that would adjust PD's (OC) to keep from paying a prism charge! Funny seeing a PD of 87).

OC's are the standard, understood placement of optics in our industry. There's no reason to fix what's not broken. I'll stay in the OC club.

[MakeOptics]

I've always considered part of a professionals duties as being able to explain complex processes that encompass the things I do in a straight forward and understandable way to my intended audience.

I would rather explain to my lab how I want my job made in the manner that they can most efficiently work on it, then to insist they use my particular vernacular. This opti-talk lead to the creation of a standard:

https://www.thevisioncouncil.org/sit...l%20June16.pdf

I like to use the standard, but often times need to go outside of accepted terms to avoid confusion.

[RT]

In 2014 The Vision Council published a voluntary standard regarding lens marking that included a new section on compensated lenses. Refer to http://www.thevisioncouncil.org/site...inal_12-14.pdf section 4.3. This is voluntary standard, and not all manufacturers may follow it. However, it does define a mark that going forward can identify compensated lenses.

This revision of the lens marking standard defined mark of a caret ("^") that when engraved on a lens indicates that the lens has been compensated. The soon-to-be-released 2015 revision of ANSI Z80.1 will reference this mark as optional. The proper way to interpret this mark would be "do not replicate". Now, there may be some ECP's capable of reverse calculating the original Rx from the compensated Rx, but even that is suspect because different manufacturers may use different compensation formulae. Proceed with caution.

[MIOPE]

This caret ("^") mark is very usefull.
What about freeform progressive that adjust the progressive length to the pupil high? Also called dynamic designs. Has been considered a way to mark on the lens the progressive length used on each job?