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Thread: Backup glasses to contact lenses mandatory

  1. #26
    What's up? drk's Avatar
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    I like QDO1's concept that contact lenses are not a "stand alone" vision correcting device, and that they exist only in a system that includes a pair of glasses. (I'm going to use that one.)

    I also like Cassandra's 20/30 VA standard. (I'm going to use that one, as well.)

    I also know that the majority of the cases have SOME form of back up glasses, but that there are "odd ducks" out there that seem to want to break some rule, somewhere, and enjoy living dangerously. Those people should be sternly warned, given a copy of their SpRx, and be told that by next annual visit they need to have a pair of back up glasses to continue care with you, for their own best interest, period.

  2. #27
    Bad address email on file QDO1's Avatar
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    Quote Originally Posted by chip anderson
    Do your really think those with eyeglasses behave any better. Half the disposable lens wearers try to stretch them out and wear them til they hurt or can't see through them. Practically none of the rigid lens wearers clean them on removal as they should, if they clean them at all it's infrequently before insertion. The number of both that spit on their lenses before putting them in is astronomical. Even fitters now teach their patients insertion and removal (those that bother to teach them) under local anaesthesia (should never be used with contact lenses).

    All those cute little studies done with science students in college go out the window in the real world of 14-16+ year~olds. No relevance to the real world at all.

    I often compare patient use of lenses to a group of sorority sisters seeing who can "date" the most men before one of them gets pregnant.

    Don't bother to write how you obtain "patient compliance" it just doesn't exist.

    Chip:bbg:
    In my experience it all depends on the initial sessions. If you hammer the message home, use appropriate pictures of infected eyes, ensure they have spectacles, you end up with a compliant patient

    I use the phrase "please do not use other peoples contact lens soloutions, soloutions contain specific preservatives, and sometimes people become allergic to a particular preservative, just like that, over night - and if you have been chopping and changing, it makes it impossible to work out which one is the culprit. If you are going to change soloutions - have a consultation with me first"

    Get them back often in the early days - and continue to hammer the message home etc. Often practitioners do not explain what they are doing with a slit lamp. Why not say - the purpose of a contact lens check is partially to check for new blood vessel growth, corneal health. If you use Flouriscene in the test - the patient has to wait a while to put thier lenses in .... Tell the patient what you are doing in the check, as you go, and then they will be informed, and know the difference between a eye examination and a contact lens check

    Contact lens opticians have missed a trick here... by using digital slit lamps to monitor new blood vessel growth, they can ensure the patient is both compliant and loyal

  3. #28
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    Quote Originally Posted by QDO1
    In my experience it all depends on the initial sessions. If you hammer the message home, use appropriate pictures of infected eyes, ensure they have spectacles, you end up with a compliant patient

    I use the phrase "please do not use other peoples contact lens soloutions, soloutions contain specific preservatives, and sometimes people become allergic to a particular preservative, just like that, over night - and if you have been chopping and changing, it makes it impossible to work out which one is the culprit. If you are going to change soloutions - have a consultation with me first"

    Get them back often in the early days - and continue to hammer the message home etc. Often practitioners do not explain what they are doing with a slit lamp. Why not say - the purpose of a contact lens check is partially to check for new blood vessel growth, corneal health. If you use Flouriscene in the test - the patient has to wait a while to put thier lenses in .... Tell the patient what you are doing in the check, as you go, and then they will be informed, and know the difference between a eye examination and a contact lens check

    Contact lens opticians have missed a trick here... by using digital slit lamps to monitor new blood vessel growth, they can ensure the patient is both compliant and loyal
    King,
    I agree. I almost always show CL wearers a couple of pictures from journals of what could happen. You've got to drive it home at every visit. If you haven't, you've just not done your job. It's our responsibility to try.

  4. #29
    Optical Curmudgeon EyeManFla's Avatar
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    The OD here will NOT fit a patient with contacts UNLESS they have a backup pair of glasses.

    Of course, my feeling on that is its a conflict of interest since he owns the dispensory!
    "Coimhéad fearg fhear na foighde"

  5. #30
    Master OptiBoarder spartus's Avatar
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    Quote Originally Posted by EyeManFla
    Of course, my feeling on that is its a conflict of interest since he owns the dispensory!
    So send them to Target/Walmart/Sears/Costco/wherever. You don't need to insist that they have a pair of glasses that you sold, just that they're reasonably current.

  6. #31
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    Quote Originally Posted by EyeManFla
    The OD here will NOT fit a patient with contacts UNLESS they have a backup pair of glasses.

    Of course, my feeling on that is its a conflict of interest since he owns the dispensory!
    Eyeman,
    Is it a conflict of interest for an OMD to perform the surgery he recommends?

  7. #32
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    It is a conflict for any MD to force any treatment or surgery on a patient.

  8. #33
    Bad address email on file QDO1's Avatar
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    Quote Originally Posted by chip anderson
    It is a conflict for any MD to force any treatment or surgery on a patient.
    there isnt an element of forcing anything. if the patient doesnt like it, they can go elsewhere.

    The doctor says to the patient having a hip operation "you must loose weight" - why - because it is in the patients best interest. Thats my starting point too... whats in the patients best interest. I have no want to play corneal roulette, and I feel it is my job to ensure my patients are safe

    bottom line.. the long term ocular health of a patient far outweighs the possible short term profits, or the short term narrow aspirations of of an un-educated patient

  9. #34
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    second try

    Chip and Eyeman,

    Let me rephrase my question...Assuming the dr. is honest and is working in the best interest of the patient, is it a confilict of interest for an OMD to provide the surgery he recommends? Yes or No?

  10. #35
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    Wave

    Yes, but not on condition that the patient buys some product in addittion to what is required or desired from the doctor.


    Chip

  11. #36
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    Quote Originally Posted by chip anderson
    Yes, but not on condition that the patient buys some product in addittion to what is required or desired from the doctor.


    Chip
    Chip, I'm not quite sure what you are saying here. On the one hand you said it is a conflict of interest, but on the other hand you say it's alright as long as the surgeon doesn't try to sell the patient something else.

    Does this mean it is unethical for the surgeon to provide, say cataract surgery, if he finds that what the patient needs, and that it is more unethical to try to sell the patient an accomodating IOL that is not covered by medicare?

    I'm not clear on what you are saying.

    The surgery IS the product in this context. Just like the dentist says you need fillings and he drills and fills them...

    The States, apparently seeing some usefulness in this arrangement of allowing healthcare providers to provide goods and services directly to consumers, has established laws defining and enabling such practices. To protect the public, they have created various state boards governing credentialing and professional discipline. From time to time, they update the laws in concert with educational and technological changes. It may not be a perfect system, but it establishes the rules of engagement.

    So again, Chip or anyone else who would like to address the issue, I ask the question: Is it inherently a conflict of interest for a surgeon to provide the surgery he recommends? Yes or no?

  12. #37
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    I don't know if this has changed or not but I thought IOL's were furnished (bought and sold) by the hospital, not the physician. The hospital would be presumably an "innocent party" as the physician would be ordering whatever was to be used without financial interest. Of course even these standards probably have changed since a great deal of such surgeries are no longer done in hospital settings.


    Chip

  13. #38
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    Quote Originally Posted by chip anderson
    I don't know if this has changed or not but I thought IOL's were furnished (bought and sold) by the hospital, not the physician. The hospital would be presumably an "innocent party" as the physician would be ordering whatever was to be used without financial interest. Of course even these standards probably have changed since a great deal of such surgeries are no longer done in hospital settings.


    Chip
    The surgeon buys and supplies the IOL. He makes the professional judgement as to size, brand, material, cost,and now, whether it "accomodates" or not. Just like the optometrist or uptician does when fitting CLs.

    But, alas, the question is still not answered...

  14. #39
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    Quote Originally Posted by QDO1
    And when your friend gets a corneal abrasion, or conjunctivitis.. what is he/she going to do... imagine they were a 4 hour drive from home.... You and I know full well that the person is going to put contact lenses back in to see, because they cant see without them. The reasonning behind my philosophy is not to be tyranical, but logical

    Here is some food for thought...You can get conjunctivitis, even if you dont wear contact lenses. Conjunctivitis is a contra-indication for wearing lenses (and bloody unfomfortable too), Wearing lenses increases the risk of these sorts of problems. Your friend may well be the most compliant patient ever in terms of lens hygine, but your friend can not take into account all of the potential problems and pitfalls if they are adamant they only will have contact lenses. It is only with backup spectacles can we know (as pratitioners) that the patient HAS A CHANCE of doing the right thing, when things get sticky

    You say that the patient has a high prescription - well statistically the higher the prescription, the lower the chance of it being a stock spectacle lens. so when your friend does come swanning in wanting an "emergency" pair of glasses, the answer might be "that will take 3-4 days"

    The problem with some contact lens wearers, is that despite being told, they have the impression that they are invincible, and nothing will ever go wrong. As a practitioner who has been in this profession for nearly 20 years, I am telling you that invariably this attitude ends up with a very upset patient, demanding everything yesterday, throwing mud all over the place... why - because suddenly they realised that they infact ought to have listenend, and they thus vent their frustration they have with themselves, onto us useless opticians who "never said they needed specs" and at the slowness of sorting out the new specs, and the slowness of the recovery of thier eyes, and the inconvinience of all of the subsequent check ups

    I am not over dramatizing this scenario - this is exactly how it unfolds time and time again in practice
    I wasn't suggesting this person was being sensible - just pointing out his case. Playing Devil's advocate a bit but what if this same friend wore glasses, broke them and didn't have spare pair? If all contact wearers should have some back up glasses shouldn't glasses wearers with a high rx have an reasonably up to date spare pair as mandatory? They are not going to going to be able to function without any glasses so they are in a similar situation (but without infection risks etc). And as you say if the rx is high it might not be a quick job to get a new pair?

  15. #40
    Bad address email on file QDO1's Avatar
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    Quote Originally Posted by Golden Dragon
    If all contact wearers should have some back up glasses shouldn't glasses wearers with a high rx have an reasonably up to date spare pair as mandatory? They are not going to going to be able to function without any glasses so they are in a similar situation (but without infection risks etc). And as you say if the rx is high it might not be a quick job to get a new pair?
    absoloutley correct. that is why it is legislated in certain countries that anyone with a correction needs a backup, available in the car, when driving. Germany is a good example of a country for these sorts of laws. Germany also requires the spectacles to be of a certain standard - so photochromic lenses in some instances need to be AR coated to improve transmision for night time driving (and yes the traffic police have a device to measure the transmission of the lenses)

  16. #41
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    We prefer to tell patients that contacts are the backup to glasses, despite those cl wearers who wear their cls 16 hours a day. For all the obvious reasons everyone has articulated that a backup pair of glasses are necessary. We must get out of the mindset that glasses are the backup to contacts. I suggest it is the other way around. This way it ends the debate of the need for glasses. In the case of someone with a high rx as spoken about somewhere in this string, they most certainly should have 2 pair of glasses. Like a major league clean up hitter with extra bats in the dugout if one gets cracked. If you can not function without your glasses, you can not do your job or most anything else. Price is no longer the issue, survival is. Give up the Starbucks, or whatever you are allocating your money on and buy a couple pair of glasses, whether it be at a big box, discounter or whoever, you dont have to spend the kings ransom, but you need the glasses. I but your dentist has a backup drill and so on... We can all talk about why someone needs them and what can happen, we need to talk about why arent you doing it.

  17. #42
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    Informed Consent is a great model for this issue. Rather than:

    - gatekeeping appointments (you will get hung up on if you get into an argument about not buying backups on the phone, period)
    - running aground of the various laws that prohibit basically this
    - letting Px roam the wilderness with no/inadequate education

    ... instead we can rework how we educate CL patients. Informing them and giving a waiver option is the most pragmatic way to go, informing Px in the doctor's chair what risks and concerns come with improper CL use (which we should be doing anyway,) but with Px having agency over those decisions by signing a release to that effect. If they don't want to buy specs, that's fine, but when they come back in six months and cry foul that you never warned them about conjuctivitis... well, did you?

    Give your patient what they need to make the best decisions for themselves and you're 90% of the way done with most of the issues we run into in this field. Gatekeeping will result in them walking, and they'll go find someone that'll dispense whatever they want because they just want to keep the lights on. If we aren't educating and are instead just diagnosing and dispensing, we're just Warby with a nicer office.

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