Backup glasses to contact lenses mandatory

[Aarlan]

For any ODs or fitting Opticians out there I have a question:
How adamant are you that a CTL patient has a wearable pair of eyeglasses (not necessarily a new pair, but 20/30 or so or better)?

If a patient has a -3 or higher and they have no backup glasses, doesn't that automatically mean they need to keep their contacts in to function, even in the event of redness, swelling, infection etc?

I was mentioning to an OD I am acquainted with that I wouldn't fit a patient with CTL unless they had a wearable pair of glasses, as it would lessen the likelihood of infection if they wear their glasses more often, or in the case of infection there would be less of a chance the infection would progress. The OD dismissed the comment but it got me to thinking...;

• if a practitioner can 'fire' a patient for noncompliance in regards to non complience due to the increased risk the patient puts both his/herself (health standpoint) and the doctor (liability), can you refuse to fit someone who doesn't have a pair of backup glasses?
• If a practitioner does fit someone who they know has no usable backup glasses, and is essentially helpless without vision correction, knowing that any CTL increases the risk for ocular infection, and that if the patient does get an infection they will assuredly be forced to keep the CTL in their eyes, then what kind of liability can the practitioner face
• Is simply recommending glasses sufficient? I have heard in some of my law classes in undergrad that waivers and warnings are often insufficient to prevent liability in many cases, so simply recommending glasses seems to be less than the fitter needs to do.

I have worked in practices where patients would come to see the OD regarding infections (often an emergency). When the doctor told them to wear their glasses, they replied that they didn't have any, and that's why they kept the lenses in.

Any Thoughts?

AA

[William Stacy O.D.]

For any ODs or fitting Opticians out there I have a question:
How adamant are you that a CTL patient has a wearable pair of eyeglasses (not necessarily a new pair, but 20/30 or so or better)?

AA

I'm pretty adamant about it, but not tyrannical. If they want to take the chance and risk having someone else have to drive them when their cls are out of commission, oh well...

[For-Life]

You are correct. We really should. It is an easy conclusion that if you are a -4.00 then you either have to wear glasses or contacts. So if they do not have glasses then they are wearing their contacts for about 16 hours a day.

[chip anderson]

My position is this. We should advise people on the wisest course to follow. As far as telling them they have to do someting (like have an eye exam) or back up glasses we are going further than we should be allowed to do. I have told patient's who went way too long between contact lens check-ups with me and eye exams with thier doctor that I would not see them or furnish lenses any more without compliance. But as far as glasses, if we did not have laws to the contrary, I would advise the patient, that it's been x number of years since your last eye exam, I think you would be most wise to get one before spending your money. If the patient refused or was in need of correction right now (you can't see an eye doctor for Rx in this town, right now) I would make him some glasses all the while advising him to get an eye exam as soon as possible..

If the patient was in contact lenses and too stupid or too cheap to get eyeglasses for back up, it's his problem, not mine.


Chip

[William Stacy O.D.]

If the patient was in contact lenses and too stupid or too cheap to get eyeglasses for back up, it's his problem, not mine.
Chip

But it could be your problem if you fit him with the CLS, knowing he had no SRx backup. He gets a corneal ulcer and sues because you helped him screw himself up. He probably wins. So the obvious answer is DO NOT fit contacts on someone who has no SRx backup; REQUIRE him to get glasses up front (either from you or require him to show a receipt that he has them on order). Maybe that would be a bit tyrannical, but I think that's what I'm gonna do...

[QDO1]

no glasses, no contacts. period

[rbaker]

I can understand your sentiments and your motivation but just remember this. You are going to have to live with stupidity all of your life. You can’t educate the stupid and you can’t legislate against them (although, God only knows, some try.) Don’t put conditions on your products or services and try not to get too paranoid. Your career is too short and unimportant to get all worked up about phantom lawyers and such. I eagerly await the citations of eyecare malfeasance that fuels your fear of practicing your profession.

[Happylady]

We see lots of contact overwear because people don't have glasses. I tell contact patients they need glasses also, but the doctors often don't say anything so the patients don't get any.

We sell glasses complete(lenses and frame)from $69.00 for cr 39 or $110.00 for poly single vision. Or they can take their rx to Costco if they want. They should have a pair.

I blame parents, too. When their kids get contacts they never bother to update the glasses. Then the parents say the kids never wear them so why get new ones. Maybe one reason they don't wear them is that they can't see out of them!

[William Walker]

I think it can be very possible to institute a 'no backup eyewear, no contact fitting, as long as the staff is fully aware of this, and makes an effort to let patients know this before coming in. I see nothing but an offie full of unhappy patients, (and therefore employees) for taking time out of their schedule to come see you, start the exam, only to get to the point where they find out you won't give them the contact lens fir they want, and will have to pay for your base exam, AND go see another doctor.

By making patients aware, it doesn't have to sound negative...an office could ask at every time a pt makes an appointment if it will include contacts (instead of glasses OR contacts), and if they respond with contacts, tell them the doctor needs them to bring their glasses to best do the exam. If they reply that they don't have any, you can let them know that for the safety of the patient, we ask that all contact lens patients have a pair of glasses to fall back on, and could then give them your eyewear specials.

[William Stacy O.D.]

I think it can be very possible to institute a 'no backup eyewear, no contact fitting, as long as the staff is fully aware of this, and makes an effort to let patients know this before coming in. I see nothing but an offie full of unhappy patients, (and therefore employees) for taking time out of their schedule to come see you, start the exam, only to get to the point where they find out you won't give them the contact lens fir they want, and will have to pay for your base exam, AND go see another doctor.

By making patients aware, it doesn't have to sound negative...an office could ask at every time a pt makes an appointment if it will include contacts (instead of glasses OR contacts), and if they respond with contacts, tell them the doctor needs them to bring their glasses to best do the exam. If they reply that they don't have any, you can let them know that for the safety of the patient, we ask that all contact lens patients have a pair of glasses to fall back on, and could then give them your eyewear specials.

I like your approach. I was thinking of another alternative. I normally Rx CLs to expire in one year. I'm thinking that if they don't have a usable SRx then I might write for 3 mos or 6 mos only, and I'll extend it to a year when they provide proof. How does that sound? I know I might lose some patients over it, but probably not many. One other point, there are some for whom this whole idea is not workable: keratoconics and other irregular astigmatism patients.

[GOS_Queen]

I guess I wish that there was some kind of consistency within the optical industry.

The DR's I have worked with at LC have always included a spectacle exam with a contact lens exam. I can't begin to tell you how many times I have called for a glasses Rx from another DR's office (whether it is MD or OD seems to be no real difference) only to be told "we only did the contact exam not a glasses exam".

[Happylady]

I guess I wish that there was some kind of consistency within the optical industry.

The DR's I have worked with at LC have always included a spectacle exam with a contact lens exam. I can't begin to tell you how many times I have called for a glasses Rx from another DR's office (whether it is MD or OD seems to be no real difference) only to be told "we only did the contact exam not a glasses exam".

I have never heard of a eye exam not including a spectacle rx. How can it not?

[harry888]

When I was young and idealistic and thought human nature was basically good (maybe just some guidance needed), I would refuse a CL fit on anyone over a minus 4.00 who didn't have a back-up set of glasses to make 20/50.

Then while in the Navy, most eye clinics were next to psych, and I got to know the staff who burned out. "I'm tired of helping those that don't want to help themselves" they would often say. The social worker said he saw 40 people a day and probably only helped 2 or 3. Don't construe this as a mark against the military, it's exactly the same in the civilian world.

So, now I strongly counsel on getting glasses and document. If they weren't seeing us for an exam because we would insist on glasses, the CL Rx wouldn't be current, and things would be more dangerous not having eye health checked. And contacts are available on the internet anyway.

Five years ago, I did have someone come in with a 4 year old CL rx from cross town about a -9.00. He refused an exam or going back to original office, he was wearing one lens because this last pair was 3 months old. We didn't fill Rx. Two weeks later he died in a car wreck, don't know if he was still wearing just one nasty lens.

At least if the contacts are updated, even if they don't have specs, they are seeing well most of the time. If they are prone to infections and the pain doesn't make them get specs, refusing a CL fit isn't going to change their behavior. We do try like the social worker, maybe 3 out of 40 may listen.

Harry

[QDO1]

this is a simple question that has nothing to do with price nor what the patient wants

Contact lenses are an invasive form of correction, which are not (in general) designed to be a 24/7 - 365 DPY vision correction. on the basis that there are days the patient is not supposed to wear lenses (remember wearing sheduling?)

it is bloody obvious that spectacles are required. for the patient to be compliant he/she needs to be facilitated to be compliant. I.e. Spectacles are a definate pre-requisite for contact lens wearers. It is not "specs or contacts"... It is "specs or specs and contacts"

Without spectacles.. lenses WILL be worn inapporpiatally. Patients will risk infections and oxygen starvation etc...

No amount of wearing spectacles however will improve my spelling and grammar

[GOS_Queen]

I have never heard of a eye exam not including a spectacle rx. How can it not?

There have been a few times I have called to get the Rx for glasses and once the file is pulled, it is discovered that there is NO glasses Rx . I have had this from OD's and MD's (occasionally ~ most of the time, there IS a glasses Rx~ I think it's odd when there's NOT)

[chip anderson]

I have called "doctor's" offices and been told that a spectacle Rx was not included in exam. Later found out that patient had same given but it was not charged separately and therefore "not recorded in the chart." Have had other "doctors offices" tell the patient that since the didn't request it "at the time of exam" they would have to come by the office to pick same up and there would be a $25.00 addittional charge for same when picked up.

Seems the whole field is getting crazy or greedy or paranoid or something.

Chip

[Aarlan]

You are going to have to live with stupidity all of your life. You can’t educate the stupid and you can’t legislate against them (although, God only knows, some try.)

But if you're the boss at your particular office, you DO NOT have to live with stupidity that may harm your patients. If they're too cheap to make a $99 purchase every 3-6 years or so to protect the only set of eyes God gave them, I'd prefer they go somewhere else to screw themselves up.

Your career is too short and unimportant to get all worked up about phantom lawyers and such.

I'm less worried about lawyers (though I still feel it is a valid concern) than I am having a patient willfully and deliberately harming themselves. They can do it, just not as a patient of mine. And please don't respond by saying that I will lose tons of money on this because although a few lost fits every year may be a fair amount of money, I feel that the profit should always take a back seat to ensuring the health and safety of our patients.

AA

[William Stacy O.D.]

I have called "doctor's" offices and been told that a spectacle Rx was not included in exam. Later found out that patient had same given but it was not charged separately and therefore "not recorded in the chart." Have had other "doctors offices" tell the patient that since the didn't request it "at the time of exam" they would have to come by the office to pick same up and there would be a $25.00 addittional charge for same when picked up.

Seems the whole field is getting crazy or greedy or paranoid or something.

Chip

It depends on what was done. If the person just came in for a CL eval/refit, and was not refracted without CLs on the visit, then having them come back and doing the refraction without CLs would deserve a separate fee for that refraction. If it had already been done on the first visit, it would be an illegal (per FTC) charge.

[chip anderson]

Aarlan: Always captalize GOD.

[Golden Dragon]

this is a simple question that has nothing to do with price nor what the patient wants

Contact lenses are an invasive form of correction, which are not (in general) designed to be a 24/7 - 365 DPY vision correction. on the basis that there are days the patient is not supposed to wear lenses (remember wearing sheduling?)

it is bloody obvious that spectacles are required. for the patient to be compliant he/she needs to be facilitated to be compliant. I.e. Spectacles are a definate pre-requisite for contact lens wearers. It is not "specs or contacts"... It is "specs or specs and contacts"

Without spectacles.. lenses WILL be worn inapporpiatally. Patients will risk infections and oxygen starvation etc...

No amount of wearing spectacles however will improve my spelling and grammar

I think it's too strong to say CLs WILL be worn inappropraitely with no glasses. Everyone is different..I have a friend with a high rx who until recently ONLY had RGP contacts. He was ultra careful cleaning etc and never had any infection or overwear problems over 15 years. He said he'd have never have put the lenses in if he had had infection, he'd have either got by with one lens if only one eye was infected or seen an optician to get some glasses made (He doesn't drive so that's not an issue). But it never happened. He only got some glasses eventually as he wanted a different look - not because his optician made him - and he never wears them anymore because he doesn't think the vision compares to contacts. I know lots more people that wear contacts and own glasses but never wear them and haven't had problems.

Personally now I finally have contacts I MUCH prefer them to glasses and wear them most of the time. I have a very high rx (-16) though and have to have some correction to do pretty much anything.

My non-professional feeling is that being tyrannical on this issue will be counter productive. Why not advise the use CLs that are oxygen transmissable enough for all day wear (with the CL materials available now I wouldn't have thought over wear should be issue for most people??), get them to come for regular check ups, give strong advice on hygience and just buy a cheap pair of glasses every 2-4 years for emergencies?

[QDO1]

I think it's too strong to say CLs WILL be worn inappropraitely with no glasses. Everyone is different..I have a friend with a high rx who until recently ONLY had RGP contacts

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

[fjpod]

CLs will definately be worn inappropriately, causing ocular injury, without ownership and part-time wear of spectacles. I've seen it a bazillion times.

[Ed_Optician]

Unfortunately we are dealing with patients who may be ignorant of the factors of CL wear. I always offer glasses to CL patients just to make sure they have a pair of socially acceptable current Rx glasses... at a reduced price. If a patient refuses I make a note in their record back up glasses offered patient refused similar to issues regarding glass/plastic/Poly a part of Duty to Warn. If someone has a CL problem and has no BU glasses I charge full price. I also suggest 2 days per week of NO CLS at all give your eyes a break

Ed

[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:

[Jubilee]

Our policy is that you must have glasses that you can achieve 20/30 with. The doctor I work for is very rigid in this regard. He has no problem telling a patient that you will get new lenses or glasses, or there will be no fit. He also notates any sign or incidence of overwear, and will use that insist on a 6 month minimum supply to get started. Since we maintain all cl purchase information with the chart, it is easy for him to go through and see if the patient has been compliant in the manner of purchasing. Since all release information is also recorded on the same area, and the amount for approval.


I think it does help. You would not believe how many patients I have that make their appts early for annual, and actually thank us for the "education" when they realize how much better their eyes feel and see. We also participate in a host of rebate deals for CLs, so we try to show our patients how economical it can be.

Cassandra