Grand Canyon-sized discrepancy - why?

[bs]

any copyrighted mat'l following is reproduced consistent with the Fair Use Doctrine, which means it's excerpted for nonprofit educational use.

***quote from 20/20 Magazine, Sept. 2003:
____________________________________________________________ ____
MISCONCEPTION #4:
Glass super-high index is okay in the U.S. with a signed release from doctor and patient.
Super-high index glass is popular in other countries; however, it has not taken off at the same rate here in the U.S. The likely cause for this is our stringent impact resistant standards, as stated by the American National Standards Institute (ANSI). Such thin lenses will not pass the drop ball test (5/8 inch steel ball dropped 50 inches), which is required for all glass lenses dispensed in the ophthalmic market here. For a while, it was thought that, with a signed waiver from the doctor and patient, the dispenser and manufacturer would not be liable if an eye injury occurred. However, the FDA has stated that such waivers are not acceptable, and the dispenser and/or lens manufacturer would indeed be responsible and liable if such a tragedy were to occur. Given the trend for safety and "Duty to Warn," the trend to dispense more plastic-type lenses will probably continue.
____________________________________________________________ ____
***end quote

Is "waivers not acceptable" the truth?

I have seen a large poster on the wall of one of my optometrists for TLC refractive surgery superstores. The poster depicted an Olympic gold medalist and the large heading, "4 Gold Medals - 2 perfect eyes" and something about LASIK and getting the optometrist's referral. On the bottom, in small print, was the disclaimer, "Individual results may vary."

~~~~~How come no amount of warning is sufficient for dispensing glass spectacle lenses, while "individual results may vary" is sufficient for invasive surgery in which a wound is created INTENTIONALLY and then the wound's healing is "managed" in an attempt to reproduce the vision already being achieved with glasses?~~~~~

How come some optometrists or opticians are refusing to dispense glass while seeking and accepting finders' fees for invasive surgery? Somebody in opticianry is not using the same lawyers or the same insurance companies as the surgeons... Why the inconsistency of "no glass lenses because the risk is too great", sometimes in the actual shadows of 30-foot LASIK billboards? With glass lenses, there is an unquantified theoretical risk that you may get a cut in your eye. With heavily-promoted refractive surgery such as LASIK, there is an absolute certainty of cutting, deeply, into BOTH CORNEAS, intentionally, on purpose! How can optometrists take finders' fees or even do a free referral for elective incisional surgery and tell patients that their risk-benefit analysis does not permit them to dispense glass? I'm sorry, but that's insane. I'm sure that even some refractive surgeons themselves are giving this conflicting advice.

Because of photochromic lenses, I have worn glass photochromics since they were fairly new. My first pair was DRILLED, too, although I now enjoy semi-rimless monofilament frames. I read in an industry document that 64% of requests for glass are for photochromic lenses. Makes sense. While I have no connection whatsoever with Corning, I wanted to try updating with Thin&Dark gray and Photobrown Autumn Gold Thin & Dark. (I currently use an older Photgray formulation.) And with roughly -6.25D on both sides, even the dreaded semi-rimless should have the right thickness to groove the lenses. I'm getting tired of switching optometrists all the time and hunting for dispensers who will supply my consumer demand, especially in a climate where invasive surgery is pushed like bad drugs. It's quite ironic. Think about it.

I've spent significant time researching this odd commercial situation. Here are my findings, and if I could have found this info easily, I wouldn't have had to dig it up myself:

1. Suppliers have manipulated demand by actively discouraging glass lenses.
2. Glass lenses are always discouraged for reasons OTHER THAN optical excellence:
a) Plastic weighs less - but the weight of glass lenses doesn't bother everybody.
b) The fear of injury and lawsuits is exaggerated, and risk is much lower than other heavily advertised modes of vision "correction." Incidence of harm attributable to use of glass lenses is so rare that cases are difficult to discover, and glass lenses are subjected to the same shock tests as plastic.
c) Plastic lenses wear out faster because their scratch-resistance is so much lower than that of glass. However, from the perspective of the dispensing optician, this allows more product-replacement sales.
d) Patients are told that plastic photochromic lenses of today are no longer optically inferior to glass, which is false.
Photochromic action reduces over time in plastic, while this reduction of function is insignificant in glass. Plastic also produces more lens-induced peripheral distortion. Even Corning's plastics aren't as good optically as their glass. Also, Corning Thin & Dark (glass) is the only photochromic that has some function behind windows.
e) Suppliers have created a self-fulfilling prophesy in saying nobody uses glass any more; they are the ones in a position to advise patients.
f) The result of the above is a shortage of equipment and skilled professionals who can produce glass lenses.
g) Competition for fast turnaround time works against glass. Plastic lenses are the only ones that can be produced in an hour at a shopping mall by lower-skilled, lower-paid technicians.
3. Glass rimless that's drilled was outlawed by the FDA or the FTC sometime in the 1970s - the government must have been too busy approving RK scalpels and laser surgery machines. [I actually had a drilled glass rimless, one of the first Photograys, that SAVED my eye in a car crash many years ago.]
4. Grooved-edge semi-rimless glasses (using monofilament "fishline") with glass lenses are completely legal in the USA, if you can still find somebody who knows how to do it.


Please correct me if I'm wrong about any of this. In my search for information, I have also learned that:
nobody in photography wants plastic camera lenses, unless they can't afford glass,
nobody in optometry wants plastic lenses in the exam chair kit.

Although I am a mere consumer researcher, I can assemble a semi-rimless pair of GLASSes as well as the best of you. Just groove 'em for me, will ya? People who like glass semi-rimless lenses are not terrible persons. I used to get service with a smile as I purchased these premium-cost products. Now, too many vendors treat me like I just robbed a bank! There's a matter of professional tact here, too. If vendors can't do it, or won't do it, they should be happy to send you to a competitor -or foreign country- who will. ...as opposed to the old switcheroo. And as for Corning, they could use a better PR department. How about using a LASIK consent form, that says at the bottom, "either party may instead opt for glass eyeglass lenses, as long as we're talking risk."?

Gary Vatter
Massachusetts, USA

[chip anderson]

Does this supprise you, haven't you noticed the tylenol and advil adds always compare pain relief to each other. They never claim to be better for pain or headache than asprin. There are no rules in the world of advertizing. Even when one uses the law for excuses.



Chip

Here we fear the lawyers and worship money. The customer desires are far out weighed by the above.

[hcjilson]

Please correct me if I'm wrong about any of this. In my search for information, I have also learned that:
nobody in photography wants plastic camera lenses, unless they can't afford glass,
nobody in optometry wants plastic lenses in the exam chair kit.

You are quite right about the above. Camera lenses do not sit in front of the human eye. Trial sets of lenses get used back and forth, many times daily but are only in front of the eye briefly and under very controlled conditions.Glass lenses are suitable for this purpose.

Gary, I've been in this industry for a while, including a stint in industrial eye safety work. No one has ever given me a good reason to place a piece of glass (regardless of the degree of impact resistance) in front of a human eye.

Welcome to Optiboard and congratulations on your first post. You raise some valid points, although, as an optician, I've not ever been offered a finders fee for a LASIC referral.

[Chris Ryser]

Please correct me if I'm wrong about any of this. In my search for information, I have also learned that:
nobody in photography wants plastic camera lenses, unless they can't afford glass,
nobody in optometry wants plastic lenses in the exam chair kit.

You said it the right way, but you might get some reaction by manufacturers whose gold mine of high markups would be seriously reduced if glass would ever become popular again. In the far east countries were glass is still number one the optical companies are buying up used machinery in Europe to branch out into plastic materials.

Glass is a lot more labour intensive. Just think about the work of making bifocals, grind the surface and fuse the buttons into the front surface. Or make a glass progressive lens as they did in the 50s.

Today you a mold and can make hundreds with the same mold in materials like CR39. If you take polycarbonate, the mold produces six or 8 lenses on a rack in a few seconds and sell them at even higher prices.

All the plastic craze has evolved into a manufacturers gold mine as they can produce lenses easier at markups that are manifold the one of glass lens production. They also take advantage to promote it to the public which was never done in the old days.

Opticians in Europe have always been laughing at the Americans with their rule about making thick and hardened safety lenses for every job sold. Statistics in Europe have shown that actual injuries by broken lenses are minimal and the mentality of knowing that glass can break is still alive.

AR coatings on glass are also better and easier to make.

The ANSI safety standard should be revised so that the use of glass lenses to an adult could be a matter of choice and not law.

[eromitlab]

Here we fear the lawyers and worship money. The customer desires are far out weighed by the above.

this about sums it all up as to why we don't see a lot of glass. b/c you know there will be some idiot that will get a pair of Hi Index glass lenses and then try to play with his kids with 'em on and they break into his eyes... the next day your company is being sued by said dumb@ss with the help of one of those ambulance-chaser lawyers and you're in for a nasty court battle.

As long as there are people that don't listen to opticians' warnings' and slimeball shiester lawyers, there will be fear of thin glass lenses on our part (no matter how much better they may be for sight).

The lawyers are the reason healthcare is in decline right now, since Doctors can't afford rising insurance costs b/c of all the frivolous lawsuits... and the money will always be the golden calf of the people.

[Shutterbug]

We're all suckers for advertising, and eventually the $$ put into "educating" the public will make the glass lens a dinosaur. When the money is gone, so will be the material. Case in point - have you tried recently to get a good lens for a person who had cataract surgery before the days of implants? Since there is no money in it any more, the manufacturers are dropping it like the proverbial hot potatoe.

Such is life in America:)

shutterbug

[Joann Raytar]

Gary, I've been in this industry for a while, including a stint in industrial eye safety work. No one has ever given me a good reason to place a piece of glass (regardless of the degree of impact resistance) in front of a human eye.

Harry, I know there are cons but I had a pair of glass polarized and plastic and poly couldn't compare in terms of how crisp things looked through the glass.

[drk]

Gary,
Good post. I would say this:
1.) The photchromic properties achievable in glass makes glass superior for your photochromic needs. You are right about plastic photochromics.

2.) I think the optics issue is overblown. Standard CR-39 for optical qualities is close enough for a human.

3.) We live in a disposable age. If you scratch lenses so heavily that you can't make them last 2-3 years, the lifetime of a good frame, then you are too rough on your glasses, and it's your fault. The manufacturers will remake your lenses within 12 months, anyway. Everything is disposable, these days, and it's not a bad thing. Sunglasses and readers may be the exception.

4.) Accepting kickbacks from surgeons is illegal. Opticians do not refer for refractive surgery, anyway. Your comparison, trying to highlight opticianry's hypocricy, is invalid. If you want to indict the industry of eyecare, as a whole, maybe you have a point.

5.) Surgery is not considered the same as a product. Product liability laws are totally different, and precedent has been set, as well as federal guidelines. There yet may be a similar malpractice precedent in refractive surgery, someday, (if there isn't already) but let's hope not.

6.) Optical professionals are scared of losing their businesses by being sued by a person who purchased an odd-duck Rx. Who can blame them? Don't blame the optical field, blame the greedy public and product liability lawyers and judges that allow this stuff. You are a victim of the "product liability lottery", but so are we. You can sense the general approval of glass lenses on this board. Why do you think waivers were used in the first place? To HELP people get a product they wanted, while trying to minimize our liability! You see how far that got us.

[bs]

While ODs often are vendors, too, I shouldn't use optometrist and optician interchangeably by any means. I am sorry if I left an impression that I think opticians refer patients for refractive surgery.

I stand by my assertion that optometrists have done so many times. The practice is called "co-management", and when I asked the optometrist with the TLC surgery ad on the wall, I was told yes, the surgical clinic pays a certain percentage for the referral and the rest after the patient goes through with the operation. Also, I have talked to RK and LASIK patients who personally were referred for surgery by their personal ODs. There is no doubt that these referrals happen, and they happen for money.

But maybe it has been stopped. My discussion about the poster was in 2000. If co-management, ethically dubious but not illegal then, has become illegal recently, I'd like to know when. If you know TLC, the clinic chain, you might ask them. While disturbing, co-management with fees is one of the least of the problems in the refractive surgery industry.

"JO", you said it! What I'm saying is, refractive surgery sells convenience at the expense of quality, so why not make available the option of quality at the expense of hammer resistance? Quality is a good thing. When I do physical activity, I can use contact lenses part-time. Just as a consumer, I think glass gets a bad rap. Naturally, I'm hard to convince that I've been doing something wrong for decades, when it's worked so right.

Among the skilled professionals out there, who'll groove some glass lenses for me? I've already used them for a third of a century I'll sign whatever you want me to. Like I say, just get a LASIK lawyer to help the product liability lawyer write up the papers, if necessary.
Cheers.
Gary Vatter

[Ryan]

I am surprised that you are using a computer writing this. The typewriter does just as good job a computer. Just type it, and drop it in the mail.

[For-Life]

3. Glass rimless that's drilled was outlawed by the FDA or the FTC sometime in the 1970s - the government must have been too busy approving RK scalpels and laser surgery machines. [I actually had a drilled glass rimless, one of the first Photograys, that SAVED my eye in a car crash many years ago.]
4. Grooved-edge semi-rimless glasses (using monofilament "fishline") with glass lenses are completely legal in the USA, if you can still find somebody who knows how to do it.

This one is always my favourite. My fathers boss used to say that glass drill mounts kept the doors open. That was when a pair of glasses used to be $20 and the lens would always snap.

[Rebecca Petris]

I stand by my assertion that optometrists have done so many times. The practice is called "co-management", and when I asked the optometrist with the TLC surgery ad on the wall, I was told yes, the surgical clinic pays a certain percentage for the referral and the rest after the patient goes through with the operation. Also, I have talked to RK and LASIK patients who personally were referred for surgery by their personal ODs. There is no doubt that these referrals happen, and they happen for money.

Yes

But maybe it has been stopped. My discussion about the poster was in 2000. If co-management, ethically dubious but not illegal then, has become illegal recently, I'd like to know when.

No, it hasn't. If it ever did, the business model for much of the RSI would have to go through some major gyrations to deal with it. Co-management is the standard and many ophthalmologists do little to none of their own preop and postop work (other than say day 1 postop).

While disturbing, co-management with fees is one of the least of the problems in the refractive surgery industry.

I couldn't have said it better myself.

Rebecca
www.lasermyeye.org

[drk]

Gary and Rebecca, you're both nuts. Sorry.

I'm an optometrist and I know what I'm talking about. There is no such thing as a kickback for a referral. Period. I'm not saying it hasn't happened somewhere, but not often.

Comangagement is not even remotely related to a kickback. I'm a little put out at having to explain such simplistic things, but here's how it works:

You need a doctor to longitudinally assess your candidacy: health, vision stability, expectations, etc., etc. That would be your family eye Dr.

Then, you need someone who has a working knowledge of which surgeons are the best, which are average, etc. Who better than your family eye Dr.? I guess trusting-the-old-family-Dr.-to-care-for-his-patients-best-interest-concept must be a thing of the past?

Then, you need post-operative followup care, do you not? Does not that person deserve a fee commensurate with the service? Who better than your family eye Dr.? He/she is ususally more geographically convenient, well-trained, and preferred to the surgeon's staff EVEN BY THE SURGEON. Do you think they want to have many optometrists on staff to do followup care? Some do, some don't. You choose to have pre/post care with the surgeon, if you want. Some surgeons around here charge more than I do for followup care!

Some people like you, Gary and Rebecca, want to see the ugly side of things in this world. Sure, it's there, but there's probably more good than bad, if you could crawl out of the negative hole you seem to live in and open your eyes.

How many on Optiboard want to take risk and groove some glass for Mr. Sunshine, now?

[Rebecca Petris]

Gary and Rebecca, you're both nuts. Sorry.

I'm an optometrist and I know what I'm talking about. There is no such thing as a kickback for a referral. Period. I'm not saying it hasn't happened somewhere, but not often.

Comangagement is not even remotely related to a kickback. I'm a little put out at having to explain such simplistic things, but here's how it works:

DRK: Get a grip.

Re-read my post, please, and tell me exactly how many times I used the "kickback" or in any way suggested that co-management is synonymous with the concept of a "kickback".

I am perfectly acquainted with the co-management practice, thank you, among other reasons because i was (by choice) co-managed by my longtime optometrist. I am not an enemy of the co-management process. When it is good, it can work quite well, because the patient may have the benefit of someone who really knows their eyes well - for example, is familiar with their history of contact lens intolerance. When it is bad, well, that's why websites like mine are born. I have seen the process break down many times. That is not because co-management itself is inherently bad. The problem is much more complex than that.

[bs]

Who said "kickback"? Read my posts. Not me. I politely call the arrangement finders' fees.

*Rebecca is an outstanding humanitarian.

For a professional, you sure like name-calling. How are going to get customers by berating and attacking them?

I won't have time to revisit here after today. I would encourage you to contact the major laser eye surgery chains and ask if paid referrals are OK with them, yes or no. Report on your findings. Your level of defensiveness is greater than appropriate. Methinks thou dost protest too much.

My past remarks regard the fact that some individuals caution against the risks of glass spectacles without providing statistics and sometimes the same individuals refer patients to have incisions placed in their eyes intentionally. An objective person can see the irony in this.
Best wishes. Over & out.

[CB]

Gary and Rebecca, you're both nuts. Sorry.

<edit>
Some people like you, Gary and Rebecca, want to see the ugly side of things in this world. Sure, it's there, but there's probably more good than bad, if you could crawl out of the negative hole you seem to live in and open your eyes.

How many on Optiboard want to take risk and groove some glass for Mr. Sunshine, now?

Hoo baby. The 'ugly side of things' is being called NUTS. I know Rebecca, she is not 'nuts'. Nor negative. And she doesn't live in a hole. I do not know Gary but I find his questions and comments regarding the current marketing and advertising for eyecare, eyewear and eye surgery during his quest for quality vision anything but 'nuts'. I hope the glass lenses he is looking for are still available.

Cindy
www.lasermyeye.org

[chip anderson]

Unless the practice has stopped. Those dear highly respected lecturing refractive surgeons at LSU pay(ed) Eye Masters for lasik referrals, quite hansomely, I might add.

Chip

[drk]

How come some optometrists or opticians are refusing to dispense glass while seeking and accepting finders' fees for invasive surgery?

Why the inconsistency of "no glass lenses because the risk is too great", sometimes in the actual shadows of 30-foot LASIK billboards?

How can optometrists take finders' fees or even do a free referral for elective incisional surgery and tell patients that their risk-benefit analysis does not permit them to dispense glass? I'm sorry, but that's insane. I'm sure that even some refractive surgeons themselves are giving this conflicting advice.

climate where invasive surgery is pushed like bad drugs

Suppliers have manipulated demand

Glass lenses are always discouraged for reasons OTHER THAN optical excellence:

from the perspective of the dispensing optician, this allows more product-replacement sales.

Patients are told that plastic photochromic lenses of today are no longer optically inferior to glass, which is false.

Photochromic action reduces over time in plastic, while this reduction of function is insignificant in glass.

Plastic lenses are the only ones that can be produced in an hour at a shopping mall by lower-skilled, lower-paid technicians.

the government must have been too busy approving RK scalpels and laser surgery machines.

Grooved-edge semi-rimless glasses (using monofilament "fishline") with glass lenses are completely legal in the USA, if you can still find somebody who knows how to do it.


Please correct me if I'm wrong about any of this.
I can assemble a semi-rimless pair of GLASSes as well as the best of you.

Gary Vatter
Massachusetts, USA

Yeah. Nothing in that post to take offense to.

[drk]

Yes

What were you saying "yes" to, then?

[mlm]

But perhaps things are different in the US...

None of the ODs I've ever worked with are/were paid "finders' fees" for Lasik or PRK referrals. Patients pay the ophthalmologist the surgery fee and pay the optometrist the co-management fee for pre- and post-op exams. No money is exchanged between the ophthalmologist and the optometrist. A few laser centres in Vancouver do their own co-management; in that case, the co-management fee goes to the ophthalmologist (and we aren't involved at all until the next routine eye exam).

Until I read this thread, I thought that this was the way it worked everywhere.

(Sorry, I know the original topic is glass lenses, but this whole laser surgery comparison had me confused.)

[Rebecca Petris]

What were you saying "yes" to, then?

To the statement which I quoted immediately above where I typed the word "yes". I don't see the word "kickbacks" there either.

I am re-reading that statement and realise that it certainly is not a complete definition of all types of co-management or fee-sharing arrangements that exist. But it certainly represents at least one of the arrangements.

Co-management is a topic on which I am conflicted. On the one hand, if someone's going to get laser surgery, in a purely theoretical sense I think that there is a great deal to be said for one's regular optometrist to at least be an integral part of the screening process. Who knows your eyes better? But three years + of patient advocacy have brought me face to face with a rather different reality. For some, of course not all. But for those some it's a stark enough reality. There is a depth of bitterness in co-managed patients with poor outcomes - in particular, those attributable to easily identifiable risk factors or relative contraindications - that is like nothing I've ever come across. It's terribly sad. I think that these patients are sometimes more emotionally damaged by the sense of betrayal if the co-managing optometrist was their longtime regular primary care eye doctor than by any other part of the experience. In a great many cases it permanently alters how they relate to the entire medical profession.

[Dragonlensman]

Among the skilled professionals out there, who'll groove some glass lenses for me? I've already used them for a third of a century I'll sign whatever you want me to. Like I say, just get a LASIK lawyer to help the product liability lawyer write up the papers, if necessary.
Cheers.
Gary Vatter[/QUOTE]

My lab will groove glass lenses,only if the frame has an upper nylon cushion, but we do require a waiver. After all, anyone remember how this Duty To Warn came about?

[hcjilson]

Unless I am mistaken, its the same way radial keretometry came about! :)....yes folks....a broken glass lens.

[Bev Heishman]

To much liability...!!!! You should have to repair the lids and orbits of patients that thought nothing can ever happen to me.

We had one that I recall that fell against their counter top at home and caught the edge. 8 hours of repair to try to save the lid. Unfortuneately, the levator muscle was injured and that eye does not close right since. The last several years it has been tears and patching and a bandage contact lens to retain moisture on the cornea. The dryness impacted the cornea, the largest refractive media of the eye, and has produced scarring. Was glass worth it? I think not.

They won't touch it with a ten foot pole. They now enjoy a pair polycarboante lenses.

As a manufacturer...even if you are finishing the lens only, CYA at minimum 1-3M to survive product liability. Keep your records too. Medicare says 6 years; it is best though to keep for seven. It happens. Why do you think polycarbonate or Trivex is recommended for kids. Loss of vision is the major one that I am familiar with.

My understanding with an discussion I had with an attorney is that although you may have signed a waiver..as a professional I know better and would be held liable even though you signed off. Sorry, I could be liable personally as well as the practice and I am not going to risk my assets to provide something some one is advocating for.

On the same venue, in our state motorcyclist are allowed to ride without helmets but drivers & front seat passengers must wear a seat belt or be fined. If I was in charge those whom decided to ride without helmet or seatbelts are responsible for their own medical problems that occur in accidents and should bear the costs associated and not insurance and other drivers. The same with malpractice...police your own.

[Jason Carruthers]

I am surprised that you are using a computer writing this. The typewriter does just as good job a computer. Just type it, and drop it in the mail.

This gets my vote for the most concise and entertaining post in this thread.