Rx: Prescription or Formula

[Homer]

Related, in my opinion, Judy's thread on MD's ..........

Recently Dr. James E. Sheedy brought up a very interesting subject in Optical Dispensing News, an e-mail news letter.



Concept: While a prescription for drugs has, by and large the anticipated effect and expected results if taken in the correct dosage, the eyeglass "prescription" can very often have different effects since it depends on the dispenser to decide on the brand, placement, material and the type of lens used to "fill" the Rx. In other words, a dispenser could use everything ranging from SV Glass to super high index ocular-surface progressives with AR.



The prescription may have widely ranging effects and therefore must be considered a formula for vision unless all of the other variables are included.



Making the formula into a true prescription would make the prescriber (particularly those who own their private "eyewear pharmacy") very happy, while making the dispenser a mokey on a string.



Thoughts??

[Joann Raytar]

It's funny you brought this up Homer. Judy's thread bugged me as well. The funny thing is, the thing that bugged me the most was that the Doctor in question was wearing his glasses on his head. It bugged me even more because that's not the first time I've heard that.

If an eyecare provider, no matter which of the O's, is wearing their glasses on their head then something is wrong. There is no reason for that, other than someone has either incorrectly filled an Rx or the wearer is too stubborn to realize that one set of eyewear will not do everything in certain situations. There is something that practice is missing in either case since the wearer is an eyecare professional and should be more savy about their own needs. That lack of knowledge or lack of flexibility has obviously been transfered to a patient.

Then you have to go and post this topic. I think Dr. Sheedy may be correct but that scenario may go beyond presriber/dispensers. Being from a licensed state, I don't understand why dispensers can work under MD's and OD's without having to meet the same criteria as those working in Optical Dispensaries which are not doctor owned. Licensure doesn't guarantee skill but at least folks realize that there are standards out there and maybe some of them will try to meet them. I'm not saying that doctors shouldn't own dispensaries but they should staff them with qualified people.

The same goes for Optical Shops, there should be a way to standardize what we do. The public deserves to have better chance at being fit by someone who is well trained in fitting eyewear.

(PS - I know there are knowledgable professionals in all the O-practices; however, I am willing to bet that the percentage of unskilled dispensers may just weigh in a little higher. Remember, I am talking about all providers here both corporate and private, doctor owned and optician owned. That's a number of people.)

[chip anderson]

This is one of my pet peves on contact lens fitting. When the doctor specifies, Rx, base curve, power and even brand. This ties my hands. The doctor is too busy or too lazy or too busy to do follow-ups or trial fittings. I often feel he just consults a chart provided by the little girl in a mini-skirt from the manufacturer. So if what the precribed doesn't fit, falls off , hurts, or the patient can't see or whatever. What is one to do, ignore the Rx and fix the problem? Wait weeks or sometimes months for the important doctor to have time to re-examine the problem? Just hand the lenses to the patient and say: "That's what your doctor precribed, take it up with him. Call the doctor? The women in the doctor's offices now think the doctor is so important that he cannot speak with any life form lower than other doctors, what good is a message relayed through six women in the office?

I won't tell you what I do as no matter what it is that I would do, because I would no doubt get a handfull of responses about why that would be wrong no matter what I did.

Chip

[LENNY]

So what do you do if the Rx states Varilux high index?
Which one do you use ?
Can you use poly?
May we use transitions?
What if Dr pescribes a Super no line? :D

[Homer]

So what do you do if the Rx states Varilux high index?
Which one do you use ?
Can you use poly?
May we use transitions?
What if Dr pescribes a Super no line? :D

It's just a formula, someone must take the formula a interface (so to speak) it with the patient and their life style. That's us ....... or ..... we are just monkey's on the string of the prescribers.


BTW - look at the independent study - Shamir has ha copy - of how Super-no-line comares to others. My experience is that it is a valuable lens not to put aside lightly by all of "new technology" hype. New technology = bigger bucks ... not necessarily patient comfort, adaptability or useful vision.

[Homer]

..... I'm not saying that doctors shouldn't own dispensaries but they should staff them with qualified people.

The same goes for Optical Shops, there should be a way to standardize what we do. The public deserves to have better chance at being fit by someone who is well trained in fitting eyewear. ......

Having worked directly for doctor owned dispensaries, I fully, 2000%, agree that "they should staff them with qualified people". To their own discredit, as well as decreased "bottom line", they often do not. That is because, often, they do not mentally "own" their dispensaries and/or labs as a legitimate part of their practice but only as a step-child "profit center".

On the other hand, being from a non-licensed state, it seems stupid to think that the customer has a "better chance of being fit by someone who is well trained in fitting eyewear" when the doctor owned dispensaries are not required to employ "licensed professionals".

Don't get me wrong. I would love to see nation, standardized licensing of eyewear dispensing professionals as long as it is standard and required in Docor owned dispensaries as well. Otherwise it is a sham. There are no "dead bodies" in unlicensed states. If we found a way to determine ill-fit eyewear, the Doctor owned dispensaries woud likely be more guilty than independent optical dispensaries ( I am not counting corp chains).

The real question, however, is should the knowledgable eyewear dispenser, licensed or not, sick to the "prescription" or the suggested formula?

[Homer]

Yep!

[LENNY]

Hommer

I have seen that study also!
I was amazed by the same thing!
My partner only dispense SNL and has no problems as long as it fitted correctly. He bought that practice from an OD who only dispense Varilux and swithched EVERYBODY who had clear lenses to SNL.

SNL rulessssssssssssssss!

Especialy for $XX!

[Blake]

I read an article in Lenses and Technology by Palmer Cook, OD, in which he used the term formula to refer to the Rx. I found that interesting coming from an optometrist, but to me it does make more sense.

A spectacle "prescription" is nothing more than the desired refractive effect of the lenses. That would be like a physician prescribing "clear sinuses" instead of Claritin (I know that's now available OTC, but I can't think of any better examples that don't involve Viagra).

[Chris Ryser]

A spectacle "prescription" is nothing more than the desired refractive effect of the lenses. That would be like a physician prescribing "clear sinuses" instead of Claritin (I know that's now available OTC, but I can't think of any better examples that don't involve Viagra).

Claritin ................other brands..............generic will all have the same effect. But some people will get adverse reaction to some of them.

It is right to say a spectacle "prescription" is to correct a refractive error, but the results can be very frustrating for some people doing a job where a certain type of lens is not the right one. Sometimes a single vision will provide more comfort to somebody tha a progressive. We can not judge people by looking at their glasses as we do at people who drive Rolls Royce's or wear a $15,000 Rolex.

It is the dispensers job to learn to sell the right lens in the right frame for the purpose of maximum vision and comfort.

Being a steady watcher of the Optibard I am convinced that a large part of ttoday's dispensers take a lot of their education from manufacturers information and advertising instead from independent textbooks and then decide to let the patient use the best way to see for the purpose intended. A lot of satisfied customers send their friends to the professional who gave them the best for their comfort. And it might not have been the most expensive.

[Spexvet]

How often do you have a patient where the Rx is the same, but you change PAL brand and material, for example. It's an entirely new visual experience for some people. Also, I've switched patients from a Sola XL to a Panamic, and had to switch them back because they hated the Panamic so much. Everybody is unique, and every combination of options unique. A new Rx is often the variable with the least amount of impact on a patient's satisfaction.

We truly are spectacle designers!:)

[Homer]

Being a steady watcher of the Optibard I am convinced that a large part of ttoday's dispensers take a lot of their education from manufacturers information and advertising instead from independent textbooks ...

Chris, I agree

Also, I've switched patients from a Sola XL to a Panamic, and had to switch them back because they hated the Panamic so much. Everybody is unique, and every combination of options unique.

Yes, that's why the "lens of choice" should be patient related and not lab, spiff, or brand loyalty related. I'll put my "adaption rate" up against any of the exclusive C******, P******, or E****** fitters. I have even been successful in putting an "off brand" (sic), lens across from one of the above in a one-lens-only replacement.

Forget the blow, get in the know.

[LENNY]

Spexvet!

You probably got a few of my patients.
As i mentioned before Adaptor and XL are my two favorite lenses.
Unless they will lower the price on others !

[JennyP]

I think the previous posters have made some very good points, but something about this thread worries me. I did not read the article by Dr. Sheedy, mentioned at the top of the thread, so please forgive me if he addressed the following concern:

I already have trouble with people wanting to use an old (over 2 years....sometimes as much as six years old) rx to get new lenses! If anyone starts calling it a "formula" I will have those same (often loud) customers insisting on writing their own formulas for lenses! Or saying they want a refill of the last set of glasses (and you better have another of those six year old frames that they got last time!)

Picture this: two people standing over a chart for windshield wipers: recommended brands and sizes for different model cars. If the recommended size is not on the shelf, they pick another...or more likely, they look at the price and decide that they can make the cheaper one fit their car. Then the same two people mosey over to the lens/frame catalog department. They choose frame, then lens features, and estimate the strength. Maybe there is even a few pair of ready-mades to self-diagnose. What do they know about why one will work better or how it will suit their needs?? And why do I care, because now I am just a catalog order clerk?

Anyone not see my point??

I agree that as trained/certified/licensed professionals, we should be able to make educated recommendations for styles and brands of lenses, just as we make our own measurements for seg height, etc. In that respect, we are handed a "formula" that originated from the doctor. We interpret that formula to meet the needs of the patient/customer. But please do not call it a formula!!!! Formulas don't have expiration dates, and don't need regulated professionals to interpret them. Might as well call it a recipe and allow everyone to create their own versions.

Added note: Expiration dates have often been debated, but they are a means to encourage more frequent exams. And while we opticians are in the business to sell glasses and contacts, we are also trying to help people see better and maintain their eye health. Check yearly!!!

[Joann Raytar]

Don't folks who wear ready readers already come up with their own formulas?

[Homer]

Jo is correct, ready made, off-the-shelf readers is a box-cake recipe.

Now what if a knowledgable auto parts person (not a walmart stock clerk) walks up to the people deciding on wiper blades and says "did you know that this blade with triple action, shaves your windshield much closer than the standard 'original equipment' imitation? You should also know that they are 1.25 inches longer and cover 10% more of your winshield for clearer vision during night driving in the rain." The WallyWorld person would go to the plastic index prescription hanging by a chain in the isle and say this is what the doctor says you should have; it is factory recommended original equipment.

The good doctor did not write an article on this. It was a paragraph statement in a newsletter, bringing up the matter. In other words: A prescription equals a pre-designed set of parameters from which one can not diviate because of the expected effect - like a drug. Usually one Rx = one pair of eyewear.
This only requires a clerk to fill out the order form.

A formula is a general statement of what is needed for best visual accuity at infinity and some near distance around 14 inches. The professional optician then takes this information and designs several solutions which will fulfill the lifestyle needs of the patient, making changes for working distance, vertex distance and wrap as well as occupations.
This requires an understanding of optics, refraction, depth of focus, material effects, and other sopthisticated information.

So bring me a recipe and I make you a cake from scratch!!

[Stopper]

Why not call it a prescription formula? This will allow the flexibility of the optician to use the best judgement in providing the most functional eyewear for the patient and still maintain the inegrity of the dr patient relationship.

[drk]

Just my take, but I think the distinction here should be:

Spectacle prescription (optometrist)
Lens design parameters (optician)

[Chris Ryser]

So bring me a recipe and I make you a cake from scratch!!

What's all the big fuss about nothing.......................................?

In German speaking countries the ophthalmologist, the optometrist, the master optician all are doing refractions and all issue a

recipe

(A recipe is a set of instructions that show how to prepare a culinary dish. It normally consists of four or five components: the name of the dish, the ingredients, preparation techniques and the number of servings. Recipe writers sometimes also list variations of the traditional dish.)

So they have been wrong forever. However you not make an Rx or prescription for a fish dish or a cake from scratch. Therefore I think that any optical professional can read a piece of paper that says OD or OS a few sign like - or + and can make some sense of it.

Just try to be pharmacist who probably studies half the time it takes him to learn the profession to learn everything about hand writings and how to decipher them.

I would not care how you want to call it as long as the numbers are right and the patient/customer can see properly through the end product and is happy how good he or she looks.

[Spexvet]

In German speaking countries the ophthalmologist, the optometrist, the master optician all are doing refractions and all issue a

recipe

I can't imagine American MDs learning the characteristics of lens design, materials, etc. that are needed to "design" the right eyewear for a patient. Can You?

[Homer]

This is not about the name we give the piece of paper that someone has issued. This is about the effect that the writer of the paper had in mind.

As Chris stated, there are many who do not have the understanding to prescribe effects which would include lense design, material and fitting relationship. They simply write down their findings and hand it of to the next professional to design eyewear that works. A case in point would be conpensation that we used to do when the paper writer noted the refraction vertex and we had to calculate the power change when the post-cataract lenses were fitted a different vertex distance.

Or .... we take the numbers and fit them with a Zeiss RD or Shamir Office which do not have the distance powers noted on the paper.

The point, again is, If the paper writing community insists that this is a prescription like drug prescription it will define everything for the optician and nothing, including the brand name, PD or fitting hight could be changed.

If however we are dealing with a suggested norm, we then enter into the design mode and make Distance Only, Near Only, Distance and Intermediate, Intermediate and near, lower ads for outdoor lenses, higher ads for specialized work and so on and so on............

It is not about the name of the paper but what can be done with it after it is received by the eyewear designers.

God, it is hard to communicate ! :hammer:

[drk]

It's my opinion that this very issue is why opticians must be a licensed profession! It's the lens design that makes your profession uniquely important. As an OD, I will tell you that most ODs don't care much for this, and that means that your profession has to do the heavy lifting here.

An OD, most of the time these days, is going to provide the "prescription": refraction findings modified as needed. Most ODs should be happy to depend upon an in-house or outside optician to do the actual lens design, be it for special occupational or avocational uses, progressive design determination, sunglass lens design, etc.

The problem is that the necessary relationships have not been nurtured, where trust and communication allows the seamless delivery of excellent patient care. If I were an "indy" optician, I'd be busting my butt to take the prescibing MD (whomever) to lunch regularly to foster that relationship, and I'd take any other team members with me.

Most of the time, though, if an Rx "walks" out of the prescribing Dr.'s office, the patient will self-refer to whomever, and disallow a referral-type process.

While the prescribing doc is probably just miffed that he's losing a opportunity to provide a service, he should be cognizant as to why the patient prefers to seek optical services elsewhere, and either make his optical services more attractive, or encourage referrals to colleagues for optical services he's disinclined or unable to provide (luxury opticals, high-fashion botiques, or low-cost opticals come to mind, or even for third-party plans not participated in).

It's really all about relationships.

[Homer]

as an optician, I say THANK YOU Dr. K. for your kind words and understanding. You have stated the situation well!

Having been part of movements in two states to obtain licensure for opticians, the experience has shown that you are among a minority of OD's since we found that it was mostly OD's who were against the Idea. I hope that is a position whic is changing, just as optometry has been changing nation wide of the past few years.

If we were to be licensed, I would only want to see it on a nationally uniform basis. Perhaps similar to many state optometric licensing boards accepting the national board examination as the major criteria with perhaps the states testing only on individual state laws. ( why could this not be done even at the same setting by declaring the states for which one wished to qualify?)

Anyway, I have strayed, as usual.

Thanks again for the very positive response!

[Spexvet]

as an optician, I say THANK YOU Dr. K. for your kind words and understanding. You have stated the situation well!

Having been part of movements in two states to obtain licensure for opticians, the experience has shown that you are among a minority of OD's since we found that it was mostly OD's who were against the Idea. I hope that is a position whic is changing, just as optometry has been changing nation wide of the past few years.

If we were to be licensed, I would only want to see it on a nationally uniform basis. Perhaps similar to many state optometric licensing boards accepting the national board examination as the major criteria with perhaps the states testing only on individual state laws. ( why could this not be done even at the same setting by declaring the states for which one wished to qualify?)

Anyway, I have strayed, as usual.

Thanks again for the very positive response!

I live in an unlicensed state (Pa) and I have been licensed in New Jersey since 1984. The average salary difference between the two states for a full time optician is about $15,000 a year. Licensing tests will always reduce the qualified labor pool. The reduction in the supply of opticians, even when demand remains constant, will inflate the "cost" of the optician. This, in turn, reduces the profit of the owner/corporation. So those with money (owner/corporation) lobby the legislature (campaign contributions) to keep licensing from being implemented. I'm sure they argue that the cost of eyewear would increase. We all know that the quality of service would increase at least proportionally to the increase in cost.
:cheers:

[drk]

I live in an unlicensed state (Pa) and I have been licensed in New Jersey since 1984. The average salary difference between the two states for a full time optician is about $15,000 a year. Licensing tests will always reduce the qualified labor pool. The reduction in the supply of opticians, even when demand remains constant, will inflate the "cost" of the optician. This, in turn, reduces the profit of the owner/corporation. So those with money (owner/corporation) lobby the legislature (campaign contributions) to keep licensing from being implemented. I'm sure they argue that the cost of eyewear would increase. We all know that the quality of service would increase at least proportionally to the increase in cost.
:cheers:

Private OD's are under no obligation to have a licensed optician in-office, so they shouldn't oppose such legislation. In fact, they should support it, for, at least, the self-serving motive of stifling chains in the state. Those are the entities that are against optician licensure, for obvious reasons.