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Thread: "Do eyewear standards still matter...."

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    "Do eyewear standards still matter...."

    Who has read this article in 20/20 magazine? I may be guilty of misinterpreting "close enough" and "getting a smart balance of vision and value".

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    Blue Jumper Who has read this article in 20/20 magazine?..............................

    Quote Originally Posted by finefocus View Post

    Who has read this article in 20/20 magazine? I may be guilty of misinterpreting "close enough" and "getting a smart balance of vision and value".
    By Barry Santini,

    I just glanced through it, it is very elaborate and down to nitty gritty.


    Check it out at:

    https://www.2020mag.com/article/do-e...the-online-age

  3. #3
    sub specie aeternitatis Pete Hanlin's Avatar
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    I always enjoy Barry's articles- and this one is no exception. That said, I believe there is no question ANSI standards are necessary, and I also believe their purpose is grossly misunderstood.

    ANSI standards are more about capability than they are about efficacy. The standards are there to establish expectations between the laboratory and the practitioner regarding what level of accuracy is reasonable/feasible. A couple examples, the tolerance for prism accuracy is 0.33D not because unintended prism beyond this amount will be noticeable/intolerable to the wearer. The standard is 0.33D because the equipment used to block the lens in the average lab should routinely be able to produce less than 0.33D deviance from the prism ordered (and therefore, if the deviance is >0.33D it is reasonable to assume the laboratory did not follow best practices or made an error while processing the lens). Likewise, the 0.12D power tolerance is somewhat tied to the combination of the rounding error common to traditional surfacing on the back surface and the normal variation encountered from the manufacturer on the front surface of the lens (the front surface usually varies by 0.03D from lens to lens in a SF lens- although ISO actually allows for a significantly wider range).

    So yes, standards are still necessary- because there needs to be a ruler against which a laboratory can be measured (and from the laboratory's perspective, there needs to be a definition of what a reasonable expectation should be for the practitioner). In this age of growing "direct to consumer" sales (which is somewhat new to our industry), it is still important to know what is reasonable to expect from a quality perspective (if for no other reason than to establish a ruler to be used during litigation).
    Pete Hanlin, ABOM
    Vice President Professional Services
    Essilor of America

    http://linkedin.com/in/pete-hanlin-72a3a74

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Hi -
    Someone pointed me to this new thread.
    Ask away!

    Barry

  5. #5
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    The easiest way to understand why 'close enough' may be OK is to always first ask yourself "close enough to what?"

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    What's up? drk's Avatar
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    I boo this. Lustily.

    Barry, you are a sympathizer with cutting professionals out of the equation. You are aiding and abetting deregulation.

    You are sowing seeds of "fuzzy logic".

    You are dumbing down standards.

    It's a shame you can't stand for better, what with your increasing platform in the trade rags.

    You could have used it for better, sir.

  7. #7
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    drk
    Not trying to dumb down. Rather, trying to enlarge optician's perspectives on what really matters: Wearer satisfaction, which has to integrate a personal value quotient and therefore degree.
    B
    Last edited by Barry Santini; 04-28-2017 at 03:45 PM.

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    What's up? drk's Avatar
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    No. You said "in this age of online eyewear".

    That's what you're really talking about.

    Not "opticians' professional judgement", but "Hey, relax. Standards/schmandards."

    I dare you to come out with an article that JUST ONCE criticizes some dude from opening an online website that hooks up a wholesale lab with a consumer.

    You're discussing angels-dancing-on-the-head-of-a-pin-type sophistry when my six year old +4.00 amblyope's mom is purchasing glasses online.

  9. #9
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    People's satisfaction was just given a wider berth in an online age. Get used to it. Slavish devotion to standards that in no way tell the whole story behind total quality eyewear is tilting at windmills, IMHO.

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    Lustily tilting!

    (Sorry, couldn't resist.)

    I enjoyed the article, Barry. The ISO story made me chuckle.

    With regard to kicking back a 1.00 cyl for being 5 degrees off...sure I've worked places where that was given a pass.

    My problem with that isn't believing that the doc nailed the axis precisely. It's knowing s/he maybe didn't. It's my job to give the Doc the margin of error...not add my own to it. The doc sure isn't thinking about me fudging ANSI when they apply their techniques and strategies. I don't think they should have to. It's simply not my job to try and outsmart them.

    By being an ANSI stickler, I'm being a precision instrument of the prescriber. When there's a problem coming back to them, I'm darn sure not going to give them a more complicated mystery to wonder if the loosy-goosy pass was at fault and invite the finger-pointing to begin. (To be perfectly honest, I try to have that potential dispute strategically won with the doc of every patient who walks in the door. If their patient comes back to them, the specs they bring to the recheck are a bullseye of what they asked for and they're forced to think...instead of reflexively wave their hand and say 'base curve, they made it wrong.' 5 degrees on a 1.00 cyl---I just won't give them that kind of ammunition.)

    So am I my lab's favorite client? Probably not. But again, I try to do precision measurements when the baton is in my hands so I can afford to give them the full breadth of ANSI wiggle room, too. Labs need ANSI. Docs need the rest. IMO, we dispensers should be trying to be the Spartans who need the least.

  11. #11
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Agreed. And THIS is why opticians Must Be able to refract.

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    What's up? drk's Avatar
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    You're 1000 degrees off-axis, Barry.

    Opticians refracting is just as bad as autorefractors.

    There is no such thing as "refracting". I'll say it till I'm blue in the face. It's not about "refracting". I have an autorefractor. You can purchase an autorefractor.

    It's about vision care, and vision care is the same as eye care, so you have to do the whole thing or it's a step backwards into crap.

    How's that for progress?
    Last edited by drk; 04-29-2017 at 09:15 AM.

  13. #13
    What's up? drk's Avatar
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    And whether people are tolerant of their self-serve junk or not has nothing to do with the subject. The notion that somehow the public now doesn't need to see correctly is bogus and only in your head.

  14. #14
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    In my humble experience, there is just about nothing sacrosanct about the current Rx format. So I'll asked to be excused if I'm on the hook for both the money and the client satisfaction and want a degree of control that I'm currently being restricted from enjoying

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    Quote Originally Posted by Barry Santini View Post
    Agreed. And THIS is why opticians Must Be able to refract.
    And if we were Refracting Opticians, wouldn't we get the same resulting Rx, and wouldn't we still have the same question when we inspect the finished product? Can I accept 5 or 10 degrees off axis, is 1 prism diopter of vertical OK? I won't know the answer just because I know what PAL design they wore last time. Did I note during the exam that this patient is insensitive to changes beyond ANSI? Do you doctors out there note that kind of thing? Do you not bother to refine the Rx inside a half-diopter? I agree that a sixteenth of a diopter is an unrealistic standard for power, but allowing a half because a bunch of GI's didn't notice is also unrealistic. If I'm going to allow low standards, or kinda-like no standards, why would I continue to inspect every job? The doctor was probably wrong about the Rx, and anyway the patient won't notice, so why not save the time to concoct better ways to make a cheap suit cheap? And for the occasional eye-for-eye, or ninety-off, or plus-for-minus, well we'll remake them and anyway we're still ninety nine percent accurate, so let's not slow down the production line by paying attention to every job like it matters. My personal feeling is that the slide from Healthcare Professional-to-Savvy Businessman-to-Opportunistic Huckster-to-Prostitute might happen without the individual steps registering as they occur.

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    Before the rabbit hole gets too deep, I get what Barry is trying to say. Now, I'm just a simpleton that runs a lab, so I may not understand all of the nuances. But yes, I do have the cost vs service ratio to consider so that I can keep growing the business.

    Barry is correct in saying that the lab has a work ticket. Numbers, just numbers, that we have to make sense from, and then fabricate the product accordingly. We have to put our trust in the optician that ordered the product. Trust me when I say this, we see a lot of questionable SH, Pds, etc. too many notes, not enough notes, contradicting notes. Yet, we divine the information and translate it into the final product. Then the product is returned because either we did not translate the gibberish properly, the optician has higher personal standards, or worse yet, the optician isn't worth their 'salt'.

    There are some great opticians that we serve, and we trust them implicitly. There are others that we serve and we shake our heads. We still make the eyewear, but we also know that it will come back as a redo. Worth their salt.

    Standards are there to be followed and used as a benchmark. It is a go-no go for us. If something is questionable, we utilize multiple eyes and multiple vertometers to make a final determination on quality. Is it a go-no go? Without standards, where is the benchmark?

    We all know that discount chains and internet shops will put cost over quality first. Many of you know who they are. BOGOs, free exams, 2 for $59, etc. Reputable labs will put quality over cost first. There should be no grey area, and this is where I will disagree with Barry. If a job is off axis, and outside of standards, it needs to be redone. Go-no go. End of discussion. As long as the lab maintains their vertometers for accuracy, there should be no grey area. I can't say that dispensaries maintain their vertometers regularly. I can't say that all opticians can zero the eyepiece every time. I can't say that they even know if the power drum, or even the axis drum is aligned properly. This is where the grey area starts to seep in. Again, I believe Barry was pointing to this when he says "any optician worth their salt".

    We lab peeps are just simpletons that grind lenses to fit into frames with a given RX and specs. We inspect said items to insure that they are within standards, thus the need for standards. Outside of that, what can we do, other than trust that the RX is correctly refracted and that the optician was skilled in fitting the frame?

    The rest is up to the skill of the opticians, and the ODs. If ever there is a grey area and the optician has a great relationship with the ECP, then shouldn't the optician reach out to the ECP and say "hey, I have this 1 cyl that came back 5º off. What does your chart say? You ok with this? I hate to make the patient wait another 3 days." If the answer is yes, then go for it, it's on the doc at this point. If the answer is no, send it back. The lab does not have that luxury, so they should stick to the standards. I say should, instead of need to, only because of my experience on both sides of the glass.

    In perfect ophthalmic world, all parties would be aligned, understanding the business goals, customer service goals, and eyecare goals, so that conversations and articles like this need never arise. Question is, how do we get there?

  17. #17
    What's up? drk's Avatar
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    Quote Originally Posted by Barry Santini View Post
    In my humble experience, there is just about nothing sacrosanct about the current Rx format. So I'll asked to be excused if I'm on the hook for both the money and the client satisfaction and want a degree of control that I'm currently being restricted from enjoying
    Welcome to the real world.

    Who has the "control"? If I write a drug Rx, I have to deal with the price fluctuations of the med or sometimes obtain a prior authorization.

    If I want to order a certain lens for a patient, but they have a certain VCP, their lab may not be able to do it in a decent timeframe. Or anything like that.

    Or the patient may want to involve, say, Costco in my treatment plan.

    That's life, Barry.



    Plus, I don't know who provides care in NY, but I fail to see how you're going to take everything into account and provide a better visual experience than the current optometric community.

    For crying out loud, Barry, the only thing you DON'T get to fudge is distance Rx, and I know that you fudge that all the time, anyway.

  18. #18
    What's up? drk's Avatar
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    I'll say this again. You should see how little ODs know about ophthalmic optics. I guarantee that 9/10 couldn't explain the basics of POW or individualized progressives or asphericity or lens materials, and I'm talking some otherwise smart *****es. They just don't care. They're certainly not being taught it anymore, because that knowledge is lost.

    SOMEBODY has to retain and nurture that knowledge base.

    Now I get it that it doesn't pay like it should. But it's REAL. Online is dog crap. Every Tom, Dick, and Smartphone refracting is dog crap. If I were you, I'd stick with what the world truly needs.

  19. #19
    What's up? drk's Avatar
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    Quote Originally Posted by lensmanmd View Post

    In perfect ophthalmic world, all parties would be aligned, understanding the business goals, customer service goals, and eyecare goals, so that conversations and articles like this need never arise. Question is, how do we get there?
    I think we already know. Professionalism.

    Over the years I've worked with highly professional frame reps, highly professional and knowledgeable independent labs, amazing CL reps, and the list goes on. They work hard to know their stuff, do the right thing, and advance their field in order to serve humanity.

    It's the MF-ers that work for big box retailers or online pirates or greedy, out-of-control manufacturers, or power-hungry-insane VCP Frankensteins that are the problem. What's the common denominator? They only care about money. Never, ever about people. Never, ever, about standards of care and doing it right. Never, ever, never, ever, ever about professionalism. All they want to do is strip-mine the industry and get out.

  20. #20
    What's up? drk's Avatar
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    But today, 700 years later, the arrival of online prescription eyewear direct to the consumer has produced a fault line dividing eyecare professionals into two opposing camps: Those who maintain that precise standards compliance represents the highest calling of the spectacle making artisan facing off against a more pragmatic group who sees eyewear made close enough to spec as, well... close enough. The fundamental divide between these two camps centers on the question of whether traditional pass-fail metrics—the tolerances used in adjudicating eyewear to a standard—are ensuring that consumers receive high quality eyewear well matched to their needs. With the traditional gatekeeping role of ECPs greatly diminished or even absent in direct-to-consumer prescription eyewear, the debate begins to center around whether any eyewear standards are still relevant in an online age.
    So here's your thesis:

    Two camps within opticianry (? optometry?) exist in regards to a patient designing their own glasses (including measuring themselves if they even bother and entering all parameters as they see fit), avoiding whatever state laws designed to protect them, and wearing around a set of lenses that are in no way guaranteed to be in correct alignment:
    1. "Picky, out-of-date augenoptikers"
    2. A "pragmatic group".

    Now, firstly, what OPTICIAN has any interaction with people that go online? If a person goes online, an optician doesn't retain care of that patient. They simply went somewhere else for optician services. Namely, the patient did-it-themselves. How would an optician have an approving "well, it's close enough" viewpoint, in that case? The optician has nothing to do with it. Their opinion on the matter matters NOT. It's none of their damned business. They've been replaced.

    Now an optometrist, however, has to retain this patient. If the dumass can't see with the glasses they made for themselves, who has to deal with it? Who's going to show up a year later for another eye exam for whatever reason. Do you really think optometrists are a "pragmatic group" that you refer to? No. No way.

    So in reality, Barry, there are no such two groups, a "picky, unreasonable, unforgiving, Fundamentalist, Brooks and Borish-thumping" artisan and a "evolved, up-to-date, practical, aligned-with-the-times" practical group.

    You made that stupid stuff up out of whole cloth.

    You said that in a way to influence people to NOT be one way, and BE another.

    You said that in order to get opticians to soften their professionalism.

    You. The guy who wants to write for 20/20.

    You. The guy who came to Optiboard about ten years ago and now uses all this razzle-dazzle in order to push your agenda in a non-peer-reviewed trade rag.

    You, who wants to represent your profession.

    This will serve as your peer review.









    Perhaps the best way for ECPs and labs to ensure the consumer receives the best quality eyewear begins by stepping back from the lensometer long enough to refocus your perspective. It is, after all, your perspective that really matters most. Today, success in optical requires a bit less myopia about standards compliance and a lot more farsightedness about seeing the big picture of what really matters to consumers: Getting a smart balance of vision and value for every dollar spent on eyewear. That is arguably the most desirable standard of all.
    And this is your grand conclusion. "Low price is what matters to consumers"? "A smart balance of vision and price"? Is this some kind of news flash?

    The point stands: If you like your society to elect officials to regulate practitioners of health care, you will appreciate professional oversight (board regulations).

    If you like your society to produce experts in a field, you will appreciate education and continuing education and credentialing.

    If you want quality and consistency, you need standards.

    If you just want to have all the goodies for free, then you're an idiot.


    Conclusion: This is a big,stinking, political opinion-piece in the "Lenses and Technology" section of a national trade magazine that apparently is hurting for contributors. You couldn't just talk about lenses and technology; you had to use your platform to soften our stance on the complete antithesis of professional opticianry. Great job, Barry. Great job.

    I hope the next person that tries to defend against this onslaught of deregulated health care doesn't have to sit across from some legislator waving your opinion-piece dressed up like a scientific paper in an optician's publication. What a credit to opticianry you have become.

    Last edited by drk; 04-29-2017 at 11:55 PM.

  21. #21
    What's up? drk's Avatar
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    A final thought:

    Instead of being the chew toy for the outsiders and insiders that are destroying opticianry, and having some DonQuixotian refracting-rights escape pod fantasy, how about fighting for opticianry next time you get the chance to address the industry?

  22. #22
    What's up? drk's Avatar
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    To the rest of Optiboard:

    Next time you read someone who throws out a bunch of statistics or numbers or mumbo-jumbo in order to dazzle you and make you feel stupid and make you "bow down to the scientists", please know what's going on.

    This is ALL OVER our world, right now, not just in the optical world. I could give you several prominent examples.

    Just do what you believe is right.

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    3D HEAD SCANNING AND THE FUTURE OF FRAME STANDARDS...

    I've been waiting for the '3D printing' shoe to drop for close to 6 years now...In fact, as I'm currently working the front desk of a technical college, there's a brand-spanking new 3D printer that's been screaming for attention for around 18 months. No interest...no use. I also understand there to be another (much,much, more expensive) unit upstairs...still, no use. Everywhere, anywhere, actively searching for practical applications, noticing only the occasional theoretical science fiction articles of the 'coming soon to a home near you!!' variety.

    But then, here's me...Custom printed Eyewear? It might seem like magic to the frustrated patients with loose screws and the crooked, slippery frames---but, it ain't. Go ahead, train your legions in CAD, use as much capital as possible for the latest 3D tech, and at the end of the day revel in all the pennys you've collected. On the other hand, learn how to bend stuff good...Problem solved.

  24. #24
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by drk View Post
    A final thought:

    Instead of being the chew toy for the outsiders and insiders that are destroying opticianry, and having some DonQuixotian refracting-rights escape pod fantasy, how about fighting for opticianry next time you get the chance to address the industry?
    I am fighting for opticianry...but for a different kind of optician.

    An Optician who is well versed, prepared and skilled for the realities of optical in the early 21st century, not the last millennium.

    B

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    Blue Jumper The realities have started to change in the early parts of this 21st century.........

    Quote Originally Posted by Barry Santini View Post

    I am fighting for opticianry...but for a different kind of optician.

    An Optician who is well versed, prepared and skilled for the realities of optical in the early 21st century, not the last millennium.
    B
    The realities have started to change in the early parts of this 21st century and have reached near top speed by the end of last year.

    Just the thought that just about 50% of optical suppliers websites have disappeared from the internet, since 2009, should be one indication of a new trend.

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