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Thread: Free Spec checks- time limit - fees

  1. #26
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    Quote Originally Posted by Barry Santini View Post
    Hmm. Not sure if this is completely fair, Craig.

    I'll tell use this: If you prescribed me to full infinity, i.e., 20/20 or 20/15, I'd be one unhappy person.

    B
    I am not sure what you mean? I just fill-em as written but if we do have an issue with an RX it is usually a tiny tweak that is a comfort issue but does not usually mean they can tell the difference on a regular chart. That we find is a personal preference in the room with the doctor and a trial frame along with a few minutes usually solves the issue for the change and they are happy to have it solved.

  2. #27
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    Barry is confusing visual acuity with far point of focus.

    I often Rx far point at optical infinity, usually for young folks with normal accommodation, convergence and orthophorias at distance and near. Sometimes this focus gives them 20/20 or 20/15, sometimes it doesn't depending on other factors, but it always gives them the sharpest acuity possible when driving at night.

    Just as often I cut the "full infinity" power in myopia, or slightly over correct in hyperopia, especially in pre-presbyopia, presbyopia, and in situations where the patient is stuck in an office environment. Sometimes .25 or .50 D. will still give them 20/15 or 20/20 in the exam lane, but even if it is not a perectly clear 20/20 or 20/15, it's still what it is.

    Unfortunately, there are many people who cannot get 20/20 or 20/15 no matter what we do. Like people conned into getting multifocal IOLs. Like people with early cataracts, macular degeneration, amblyopia, etc. The list is almost endless.

    Remember, 20/20 is just the ability to read a certain letter size at 20 feet. By itself, it says very little about refractive state. A good example of this is the 10 year old +3 O.U. hyperope who can get 20/20 unaided, but desperately needs the +3.00 for comfort and/or to eliminate diplopia.

  3. #28
    Master OptiBoarder rbaker's Avatar
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    And, lets not forget the diabetic. How about the alcoholic or druggie. These folks will never provide a stable refractive state for you to work from.

  4. #29
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    Quote Originally Posted by rbaker View Post
    And, lets not forget the diabetic. How about the alcoholic or druggie. These folks will never provide a stable refractive state for you to work from.
    Yes, let's not. But let's differentiate those whose conditions are out of control vs those that are under control, or well controlled.. The former are as you say, the latter of each category can be remarkably stable, refractively speaking.

  5. #30
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    Quote Originally Posted by Barry Santini View Post
    Hmm. Not sure if this is completely fair, Craig.

    I'll tell use this: If you prescribed me to full infinity, i.e., 20/20 or 20/15, I'd be one unhappy person.

    B
    I agree. There is a big difference between "20/20" and "20/20 happy"

    There is a reason they call subjective refractions subjective.

  6. #31
    What's up? drk's Avatar
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    The real reason they call "subjective refractions" subjective is because we take into account their subjective response. But the endpoint is always the lens that gives maximal distance vision acuity.

    Now as to prescribing, we can take into account their particular needs. Rarely do I undercorrect distance vision.

    The concept of "refracting to <an acuity>" is alien.

  7. #32
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    Barry,

    I'm "just" the lab manager and try to stay out of the other department's business, that is the OD office policy.
    Clinton Tower

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  8. #33
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    Quote Originally Posted by scriptfiller View Post
    Barry,

    I'm "just" the lab manager and try to stay out of the other department's business, that is the OD office policy.
    In defense of Script's office manager, I think it's important to note there are legitimate business, and yes health care, dynamics at work in a policy like this. Patients who decide to go several months without addressing a problem are in fact compounding the complexity of diagnosing it. If there is an issue of quality control of the original refraction, it becomes that much more difficult to diagnose because of the span of time that elapses before it can be investigated.

    I would be very interested to see some research numbers that could answer Barry's question. (Vision Council, go for it if you haven't already!) But I think every doctor would agree the odds of significant Rx delta between <30 days and >90 days encompasses a much wider array of possible explanations unrelated to "refraction error" (however one chooses to define it.)

    A remake/redo policy is for the benefit of the patient. Good practices will make allowances for the possibility of an occasional 'error' (for lack of a better word) for the patient's benefit both financially and visually. There is nothing wrong with engineering a remake policy making the determination of such an error efficient for the practice to isolate and confirm--specifically in the time frame that suggests a problem is more likely to be due to refraction error.

    Incentivizing a patient to resolve a vision problem quickly is also their best interest medically. If as a patient I delay addressing a problem until it's convenient for me despite making the process more difficult for my care provider to diagnose and fix, then I should expect to be charged more for blowing my reasonable 'free' window. Even if not all of those potential problems are strictly medical, that doesn't mean they're not relevant and costly.

  9. #34
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Since DMV standards allow 20/30-20/40 acuity, I see no reason that a general use pair for a 55+ YO cannot be tailored for optimal indoor use, which is the bulk of their day.

    I have many clients that respond: "Why didn't any doctor advise me about how my glasses could be tailored this way?"

    Further, I see many people with new implants testing to -0.50 DV, and say they don't require Glasses for much of the day. So, using this 20/20 uber allies logic, should these people feel they've been given less than they bargained for?

    B

  10. #35
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    How are your rechecks handled with the doctor? We had a patient who got his glasses and was having problems seeing with them. (Rx written by MD but tech did the refration) After I, the optician, checked the glasses and was sure that they were made correctly, I sent him to have the rx checked with the OD. (This is a patient who has had vitrectomies and other health problems with his eyes) He went to see the OD, the tech does the work up and has the chart for the OD to see. He refuses to see the patient and makes the tech do everything. She could not solve the problem and the patient leaves angry because he never saw a doctor. This is a patient the OD never saw before. The reason for the refusal to see the patient was because it wasn't billable. The OD didn't want to waste his time seeing the patient because there was no money to be made on the visit and that is why in his mind the patient should just see a tech. I have NEVER seen this before and am livid with the service that the patient has received. What is your recheck policy with your doctors? Thoughts?

  11. #36
    OptiBoard Moron newguyaroundhere's Avatar
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    Quote Originally Posted by mervinek View Post
    How are your rechecks handled with the doctor? We had a patient who got his glasses and was having problems seeing with them. (Rx written by MD but tech did the refration) After I, the optician, checked the glasses and was sure that they were made correctly, I sent him to have the rx checked with the OD. (This is a patient who has had vitrectomies and other health problems with his eyes) He went to see the OD, the tech does the work up and has the chart for the OD to see. He refuses to see the patient and makes the tech do everything. She could not solve the problem and the patient leaves angry because he never saw a doctor. This is a patient the OD never saw before. The reason for the refusal to see the patient was because it wasn't billable. The OD didn't want to waste his time seeing the patient because there was no money to be made on the visit and that is why in his mind the patient should just see a tech. I have NEVER seen this before and am livid with the service that the patient has received. What is your recheck policy with your doctors? Thoughts?

    Usually we will do rechecks within 90 days
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  12. #37
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    Ever have a doctor refuse to see the patient just because the visit was for a rx recheck? That's where I'm stumped.

  13. #38
    OptiBoard Moron newguyaroundhere's Avatar
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    Quote Originally Posted by mervinek View Post
    Ever have a doctor refuse to see the patient just because the visit was for a rx recheck? That's where I'm stumped.
    Never with a doctor I actually worked with or for.
    Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity

  14. #39
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    Right. Just crazy.

  15. #40
    Ghost in the OptiMachine Quince's Avatar
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    We are flexible. 30 days satisfaction guarantee for style changes, frame changes, and RX changes. If the patient came in knowing there would be possible RX change coming up, we will plan accordingly (make something in house or go with a lenient lab) and extend to 60 or 90 days.

    I've heard of a doctor who would deny a recheck because they can't make money off of it. That's a good example of why I don't refer patients to him... too bad we share a wall.
    Have I told you today how much I hate poly?

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