Announcement

**William Stacy O.D.** · 01-28-2006, 08:19 PM

you're both right

It's obvious he's fudging a bit on the left lens Rx, but the right one is correct in that if you went to a 15 mm vertex from a 13.5, there is approximately a quarter diopter correction that must be applied due to the difference in effective powers.

**QDO1** · 01-29-2006, 01:40 AM

If he didnt specify a vertex distance in the first place, then he ought to have. On the other hand, I wouldnt have ordered this job without a BVD in the first place. in terms of the numbers - William is right
This is a classic - what came first? type of question

Just make sure the patient does, because thats the last place a patient wants to be - between two arguing practitioners

From a practacle point of view, the Dr ought to specify the BVD for the test, by actually measuring it in the test, in real time, at the time - and write it on the order - this DR has demomstrated the importance of doing so

BTW - was the original script the one that was specified without a BVD last time? or the one that was "adjusted for vertex last time", and "measured on a focimiter this time"

My last point highlghts another problem to do with record keeping, and competency in the person measuring the spectacles (before the sight test). The person measuring the spectacles for the DR ought to also be measuring the BVD too, and the Dr ought to be taking that into account in the test

**GOS_Queen** · 01-29-2006, 12:00 PM

Originally posted by hip chic

Per the customers conversation with the Dr. and her retelling of it to me, it's obvious that the blame was placed with the glasses I provided her. This is so irritating to me.

I agree ... :finger:

**drk** · 01-29-2006, 03:41 PM

I'd remake them and smile. Keep the patient.

Also keep the referral source: call the prescriber and apologize "for the confusion". Ask how "you" can avoid the problem next time. Thank him/her for "recommending the patient to your optical" because you, like him, are interested in the best, for your "mutual patients".

Make some delicious lemonade!

**Framebender** · 01-29-2006, 04:16 PM

Can you say. . .

why yes Doctor I'm happy to redo that for you?? Of course Doctor, you're perfectly right?? Don't forget the right amount of groveling inflection.

Then the next time the sales rep come through. . .you know the one that's a walking rumour mill. Tell him very confidentially something really juicy about the Doc and laugh all the way to the bar.

Seriously though there's not much you can do. Very few Doctors are ever going to look at the patient and say, "You know, she made your glasses right, I screwed up." Its good to be at the bottom of the heap sometimes because there's no where to go but up!!

I hope you're having fun and making money!!

**hip chic** · 01-29-2006, 05:56 PM

QDO1
Both the prescription the patient presented me with two years ago and the prescription she gave me 2 months ago, had no indication of vertex distance. Only after she had problems with her new prescription and returned to the Dr. did he write something about the vertex distance (i.e. "please remake to accomodate new vertex distance").

When the patient came in with her new (remake) prescription, I accepted it with a smile and told her I would gladly remake her new lenses. I, agree, that the worst thing a practiioner can do is put the patient in the middle.

On the other hand, I think the Dr's comments were dishonest (as the changes he made were not only due to the vertex distance) and unprofessional. It irritates me (in this business and in life in general) when people feel they have to blame someone or something for everything that goes wrong. Quite honestly, in this case, I don't even blame the Dr. for the prescription change. Perhaps the patient had a cold, was tired, stressed out. Or maybe the Dr. heard 1 instead of 2 somewhere along the way..who knows...and who cares...the most important thing is that the customer get her correct prescription and I think this can happen without laying blame. Rant over. And back to my comment/question of how would you handle this with the Dr (whom I actually have a LOT of respect for).

Thanks
hip chic

**QDO1** · 01-29-2006, 06:38 PM

Originally posted by hip chic

QDO1
Both the prescription the patient presented me with two years ago and the prescription she gave me 2 months ago, had no indication of vertex distance. Only after she had problems with her new prescription and returned to the Dr. did he write something about the vertex distance (i.e. "please remake to accomodate new vertex distance").

When the patient came in with her new (remake) prescription, I accepted it with a smile and told her I would gladly remake her new lenses. I, agree, that the worst thing a practiioner can do is put the patient in the middle.

On the other hand, I think the Dr's comments were dishonest (as the changes he made were not only due to the vertex distance) and unprofessional. It irritates me (in this business and in life in general) when people feel they have to blame someone or something for everything that goes wrong. Quite honestly, in this case, I don't even blame the Dr. for the prescription change. Perhaps the patient had a cold, was tired, stressed out. Or maybe the Dr. heard 1 instead of 2 somewhere along the way..who knows...and who cares...the most important thing is that the customer get her correct prescription and I think this can happen without laying blame. Rant over. And back to my comment/question of how would you handle this with the Dr (whom I actually have a LOT of respect for).

Thanks
hip chic

im with you on this one. I would do something that works for me... in the first instance deal with the patient and pour a decent glass of wine for yourself

secondly, in a few weeks instigate regular professional meetings, with you, your profesional staff and the Drs.. in that way - they can keep you abreast with whats on thier mind, and the latest things happening, and you can do likewise.. often these things "just iron them selves out" in this non-confrontational environment. Just distance this discussion from that specific patient.

**hip chic** · 01-30-2006, 06:33 AM

QDO1

Thanks again for your suggestions.

F.Y.I. I am an independent optician. I do not have a Dr. in my shop. The Dr. I have written about is not affiliated with me or my shop. No Dr. is. I do not depend on Dr. referrals for business.

hip chic

**drk** · 01-30-2006, 11:46 AM

Hip;

While you do not depend on Dr. referrals, I know you appreciate them! The more that think you are the best thing going (which it sounds like you are) the better!

Why don't you keep a list of all referring docs and tick off a little line each Rx you see? When you get up to three lines, maybe you should send over a little something nice, or at least a thank you card.

**chip anderson** · 01-30-2006, 01:31 PM

Me, I'd call the good doctor and say: "Dr. I will be happy to re-make the lenses as requested if you would only be so kind as to let me know what distance you refracted the patient at."

Chip

**Robert Martellaro** · 01-30-2006, 03:30 PM

Originally posted by hip chic

After two weeks of wearing her new specs, she was having headaches because of the strain she felt when looking at things in the distance (though her intermediate and near corrections were perfect).

That's not a typical response from someone who's overplused +.25DS, (maybe a different story if overminused) with road signs appearing less distinct being more typical, so there might be something else causing the headaches. I would look for waves at or near the OC and fitting cross.

Here's some numbers for comparisons sake. Keep in mind that the Ansi standards allow +/- 2% at these powers.

Old Rx
OD -11.00 -1.75 x 66 sph equivalent -11.87
OS -12.75 -0.50 x 68 sph equivalent -13.00

New Rx
OD -10.50 -1.75 x 67 sph equivalent -11.37
OS -12.25 -0.75 x 71 sph equivalent -12.62
The doc seems to be saying that both of these Rx's were done at 13.5mm.

If the new glasses rest at 15mm, the compensated lens power is
OD -10.67 -1.81 x 67 sph equivalent -11.58
OS -12.48 -0.77 x 71 sph equivalent -12.87

Nearly identical to the sphere equivalent of the latest Rx
OD -11.62
OS -13.00

Regards,

Announcement

Vertex Distance and what would you do question.

Vertex Distance and what would you do question.

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