That's a sad, short list...Originally Posted by Kujiradesu
That's a sad, short list...
Have I told you today how much I hate poly?
If by lowest common denominator you're referring to the generation that is now coming into their own who are well educated, internet savvy and heavily in debt, then we're in trouble. Just last evening, i was at a restaurant when I overheard a customer ask their server where she purchased her glasses. You guessed it, on-line.
This generation is so accustomed to purchasing everything on-line. if they can purchase it on-line without driving to the store, they will. Their mentality revolves around the internet, if they believe they are receiving an "eye exam" by using an app, they will use the app.
This generation is so accustomed to purchasing everything on-line....................
Perfectly said.......................
Why is the largest optical corporation on the globe investing big time on online opticals, because their little finger said so.
Hey, Hi Dr. K and all. I haven't been too active here lately.
These apps, Warby Parker, Opternative, Blink.co/Eyenetra....they are not really telemedicine.
At least in New York (and I am not at all claiming that we have this under control), telemedicine requires a doctor patient relationship....face-to-face, mano-a-mano, if you will. Even if it is by facetime, or video-phoning, a doctor must interact live with a patient. This is the definition....again, at least in NY.
Telemedicine can also include perhaps a registered nurse talking to a patient, then relaying to the physician, but in all cases, licensed professionals have to be in contact with the patient in real-time.
These companies are all going to try and get away with what they can. Everybody should complain, or better yet, have your patients complain to the appropriate state boards.
Autorefraction has been the way large ophthalmic clinics have been run for many years and will be the way the online opticals are headed in the very near future.
It is already open territory in British Columbia.
Quick correction here. EyeNetra stopped doing Blink two years ago. Today we run something we call OnSight, where we take ODs to companies to provide comprehensive examinations using our tech.
Today any OD can do the exact same service. Revenues are usually double what you see in a regular practice and you see 4x as many patients. It's not for everybody though.
Vitor Pamplona
CEO, EyeNetra Inc
Last edited by vfpamp; 05-31-2017 at 04:47 PM. Reason: Missing My name
The idea that refraction is a part of a routine medical eye exam has become part of our social psyche. It is an idea that has become so powerful that many actually have begun to believe that they are in fact inseparable or mutually inclusive. They are not and they do not have to be.
Will the implementation of refractive technology mean that some individuals (who just happen to wear glasses) will go with undiagnosed eye health issues? Yes, yes it will, with 100% certainty. Just as all those individuals that don’t currently wear glasses do. But arguing that means that refraction must include a medical eye exam is like saying – “Every visit to an audiologist will now require that you also have a CT brain scan.” If you dig deep, you will find that every argument made that refraction and medical eye exams must remain together, is an empty one.
Every optician should be fighting for access to refractive technology. Fight bully legislation that is used solely to protect business practices. Fight for our right to make eyeglass lenses from the data produced by refractive technology. Fight for our right to regain control of our own destiny. Fight for what is right.
Let's be clear: I and other opticians are Not asking for access to gatekeeping nor would we want to. Opticians need to refract in order to provide the type of wholistic eyewear experience the public is already paying a premium for.
B
You're right they're not inseparable. However, the analogy of a CT brain scan by the audiologist is a false one. The current OD service path isn't a product of Rube Goldberg profiteering. It was, and remains, a synergy localizing competency and efficiency. Refractions are Controlled tests. They require supervision of the patient. Inconvenience of the patient...who is forced to comply with testing parameters even when they don't understand them and would prefer to think of it as a 'suggestion.' Supervised control of the light level. How many fields let patients test themselves with widgets? We don't even trust patients to take their own pregnancy tests...they have to take a whole new blood test at the doc's. How well do cell phones and web cams control the variables of distance and perspective? The answer is easy--how easy is it to screw up a picture you take with them? If refractions are still Health Care, then the difference between that kid in scrubs administering the pretests and his/her absence becomes pretty significant pretty quickly.
If we think cleaving refractions from routine exams is some kind of 'expansion' of health care access, we have to dumb down the definition of health care to label it a success. And it doesn't do health care costs any favors if we do. If ODs lose refractions, we lose ODs. Access supply goes down, exam cost goes up. MDs probably wipe out the OD profession entirely, and we all know how excited people are with the idea of a career in medicine these days....
I'm not a doomsayer, I think Uilleann is correct. There's enough sane people in the world to keep land under our feet even if a flood of insanity rises high for a while. Opticians with refractors isn't the worst imaginable outcome of all this ridiculousness---but it'd be a pretty sad step backwards. We would miss ODs when they're gone....
Ah, here is the thing - I don't believe that opticianry is a part of healthcare and I don't believe that refraction technology applications are either.
Refractive technology is refractive technology and a medical eye exam is a medical eye exam.
I'm not going down the rabbit hole yet again...
I should know better.
Funny how close these refraction discussions are to religion and politics.
Just because we believe something doesn't mean it is true.
Heck I could be wrong but --- the science, technology and the steady growth of actual, real world, applications of refractive technology certainly supports my position.
"A lens is not a pill"
A lens can certainly foul up your vision affecting several dimensions of your balance and safety. Doing our job wrong can cause literal and ongoing pain. I've had patient files dropped on my desk by clinic administrators asking me to figure out what going on because neither a refracting tech or the original optical (not mine) could diagnose a vertical imbalance when a fluke router bypasses an OD safety net and an excellent surgeon (but not an OD) signed off on rebound Rx's instead. So let me assure you, I'm in health care.
Semantic spirals aside, I think we have to cop to eye care (and therefore opticianry's role in it) being politics since it is Economics. Applied health care unavoidably affects both. Maybe that's why its policies are important.
Science, technology, applications are great. So are clinical studies validating their efficacy. If I'm being 'religious,' why not provide some of your citations to the discussion to expose my lack of logical and scientific stringency?
Are the eyes part of the human body?
Can a bad refraction/glass harm the patient in some way/s? Yes. If too strong of an add is prescribed, you can diminish certain patients accommodative ability. I consider removing someone's accommodative ability *harm*. A newly anisometrope from say recent cataract Sx. With enough imbalance, and no use of bi-centric grinding in a multifocal can create a permanent monocular style near task use of their glasses. Harm? Yes/no?
These are just two examples of how bad refraction/glasses can do harm. I call it "healthcare" If you are treating/recommending treatment for any body part.
I've been the 1st one here many times citing that it was Charles Prentice, the father of optometry that successfully argued over one hundred years ago to state lawmakers that "refraction is not medicine, but the bending of light". This is true..But medicine, medical care, and standards of care have changed a lot since then. Sure, it doesn't take a medical degree to perform a refraction, it's done daily by basic tech staff in MD offices. Heck I re-refract two referring MD's Rx re-checks.
But I don't think it wise to turn refraction loose on the public via Opticians (let alone laypersons with an app) without rigorous training and lots of practical practice under their belt. Won't happen, at least in the 29 states that don't even license Opticianry.
Some people don't get the picture.
You are dealing with people and their problems.
There are lots of problems.
If you, for some reason, wish to measure the refractive state of their eyes, have at it.
Yes, there are some people whose only reason they present for care is that they think they want you to measure the refractive status of their eyes.
But, if you ask them why, they'll either:
a. disclose that they're having a problem, or
b. "just want to get new glasses", and want to be sure they're seeing their best with the new pair.
In the case of "a", they need a diagnostic process. That's currently too complex for automation.
In the case of "b", they're really asking you to screen them for undetectable/asymptomatic vision loss. Again, that requires a little more than a machine. It's really followup care on their refractive error condition.
Are you saying the cost of a refraction is included in the cost of the high quality service and materials you provide?
edit: (that's a slippery slope)
Last edited by fjpod; 06-03-2017 at 11:32 AM.
I can't even begin to tell you the number of people that come in to see me "Just for new glasses", but then turn out to have a partial thickness macular hole, cataracts, DME, or whatever. Human nature being what it is, when they can't see right, the first thing they think of is their glasses.
Not to cast aspersions on Third World Countries, but that's the way they do it there. "...Ehhhhh give them new glasses. Come back if you still can't see. Then we'll have a real doctor look at you." Is this what we want? Somehow, I think we are going to get it, but the refractionist is going to be a computer.
To refract is the last step of a dispensing opticians education .....................
John is absolutely right .................................
In a worldwide view and in an actual situation of North America, as the USA and Canada, where individual states are not unified and only 50% are regulated to sell the end result, a pair of glasses, and in Canada the trend is now to deregulate the whole country, while most countries worldwide are fully regulated.
To refract is the last step of a dispensing opticians education, in most parts of the world, and each one has the choice to achieve this level of professionalism, by simply learning it the legal way.
This is also why the online opticals have chosen North America as their testing ground and it has become a full fledged selling tool on the way like an avalanche.
Chris;
Are you saying that it was unions that killed Imperial Optical and National Optical?
Regards,
Golfnorth
No it was more than that, but the unions helped bringing them down.
No it was more than that, but the unions helped bringing them down.
My lab was the only independent lab that got unionized.
In my own case the same union infiltrated my own lab, and we had just started to get into plastic lenses as the second lab in Quebec.
We got to be extremely busy and the unionized employees refused to do overtime to clear constant backups.
Chris;
It was real estate that brought Imperial Optical down. The boys bought waterfront property thinking that Toronto would get the 88 Olympics.
The property was purchased at the height of the boom and Imperial had to sell off assets to make the payments on the properties (ie. Safety Supply, Standard Optical etc). I heard that they even sold the building at 21 Dundas Square but the deal didn't close. Then when they could not keep up with the payments they were petitioned into bankruptcy. The night before the court date, Sydney Hermant passed away.....many believe by his own hand.
A very sad ending indeed but not because of unionization.
Thank you for the news I did not even know about. Nice piece of history.
Opticians rountinely refract in Europe. Im not hearing/seeing about add'l undiagnosed eye disease. Are you?
I am sure you find some physiological issues on examination, but the data indicates the incidence is actually low. It happens most in children and older adults, correct? So why not limit the use of these technologies, and as I have taught for years, Optician refraction to 18-55 or thereabouts?
[Original link and comment redacted--was arguing from two mutually exclusive positions and that's not fair to Barry.]
WHO indicates "avoidable blindness" in Europe vs. US even at 9.6%, this still ignores the big semantic issue: "Opticians" in Europe and elsewhere have educational overlap with US OD's by adding on post-grad Therapeutics to their refraction training.
Last edited by Hayde; 06-08-2017 at 02:41 PM. Reason: aborting an unwinnable statistics discussion before it starts.
Now that is not a partner Union. My lab is also a Union shop, however, I do not have issues like this at all. When we get in the weeds due to equipment issues or unusually high volume spike, my staff requests OT, and as long as my director approves it, the Union is happy. The Union will come to me and ask why we don't open overtime when a rep tells them that I won't consider it. As long as my reasoning is adequate, they leave me alone. That said, not all unions are evil, as long as you have a good relationship with them. I believe that this is due to the fact that I respect my staff's opinions on workflows, production enhancements and feedback. I do not micro-manage them and only intervene when things start to go sideways.
your slippery slope .....................
your slippery slope .....................
...............is actually practised all over the world. In European countries any optician that advances to a master optician refracts, and in most countries there is no charge if you purchase the glasses from them, or is included in the glasses price.
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