Oh brother...

[Ory]

My personal opinion is there should be no refraction without an eye health examination. The average adult will not have significant refractive changes over the 1-2 year space between eye exams (with the exception of add powers.) Even over the 5 years on many waivers there should be little change. If the change is significant in this timeframe there is likely a reason for it that will not be picked up using the eyelogic system. Diabetic refractive change, macular edema, central serous chorioretinopathy, and nuclear sclerotic cataract are all possibilities here. All of these conditions can cause a refractive change but still allow the patient to see 20/20 with the right correction.

I have not heard of any cases where the public was harmed by the use of Eyelogic.

Sure. I've also never harmed anyone by using a retinoscope. It is a diagnostic test with zero risk of harm. It is the omission of subsequent testing that creates a risk of harm. An educated judge or an educated ophthalmic professional knows an optician will not be doing this testing, but the public doesn't. I've been called optician, optometrist, ophthalmologist, ofmalogost, oculist, ocularist, op-whatever. The average consumer doesn't understand the difference. They also don't get it when there is not even an optician on site, which is why this place has been around for so long and is making so much.

This is all my opinion but by allowing independent refractions we are taking a step backwards in our healthcare system. There is no lack of access to comprehensive eyecare in Canada, and hence no need for it. As I said before though, this has been dissected over and over in other threads.

[Dave Nelson]

Do you really think we have given no consideration to unusual refractive changes? We realize what constitutes an unusual refractive shift and make appropriate referrals. We are also aware of disorders which may present with no reduction in acuities, and with consultation with ophthalmology, set protocols to mitigate any risk. We also do indeed require any one sitting in for a sight test to have had an eye examination within a reasonable period, and advise eye examinations according to the American Academy of Ophthalmolgy, which are endorsed by the Canadian Ophthalmological society. Anyone sitting for a sight test is advised very clearly what the difference is.
"comparing an eye exam to a sight test is like comparing a thorough physical at the doctor's office with a blood pressure test at the local pharmacy." B.C. Association of Optometrists, public education brochure.

[Ory]

Who is not eligible for a sight test?
Under the existing COBC guidelines, those who are ineligible for sight testing by an optician, who instead will be referred for an eye health exam by an optometrist or ophthalmologist, are individuals who:
·Are over the age of 65, since the leading causes of visual impairment are age-related.
·Have specific illnesses and health condition such as diabetes, macular degeneration, cataracts and cardiovascular disease, unless already under a doctor’s supervision for their condition.
·Have high risk health conditions for retinal detachment such as hypertension, recent trauma to the head, recent pain in the eye, or people with lens prescriptions of greater than + 8.00 diopters or –10.00 diopters.
·Have specific visual symptoms such as recent onset of floaters, haloes, distortion, double vision, flashing lights etc.
·Have a history of any eye surgery.
In addition, individuals who meet the screening criteria will be referred to an ophthalmologist or optometrist for an eye health exam if after receiving a sight test they cannot achieve 20/30 or better vision or if their vision shows a change of more than plus or minus 1 dioptre in a six month period or total change of more than 2 dioptres from the original prescription.
These screening criteria, which are currently being followed by opticians, along with a focus on the effective training and communication of opticians, and the regulation by the College, will ensure that sight testing is conducted in B.C. in a safe and effective manner that benefits all B.C. residents.

All the conditions I listed above would pass these requirements and have a good chance of being asymptomatic otherwise.

I'm also worried to see no mention of children being unsuitable. Is this an oversight or a recent change?

[Ory]

Dave,

Getting back into the spirit of this original debate, could you please explain the following to me:

1. The COBC required opticians to undergo a course in automated refraction.

2. Eyelogic systems claims their product is independant of operator bias

Therefore, why is this education necessary? Why not just allow anybody to perform the refraction? My understanding is (and please correct me if I'm wrong) that most/all opticians are using the eyelogic system. None are manually refracting. What is being taught, when not to push the big red button? I'm not trying to belittle your courses but I really don't see what training is necessary if the machine is self contained and the patient has filled out the forms satisfactorily.

[Dave Nelson]

First concern, children under 19 are excluded from the sight test. Second, yes you are correct, there are conditions not detected by a sight test: thats why it is not an eye examination! Those conditions are often, but not always, detected by an eye examination, not by a refraction. In the same manner, the previously mentioned blood pressure test is considered an essential part of a routine physical examination, but can also be conducted in isolation. It is not intended to replace a physical examination, and there are any number of ailments that same physical exam could disclose, that the blood pressure measurement will not. I could list a number of diseases that will go undetected by the blood pressure measurement, but it would be an exercise in futility: the machine is only intended to measure blood pressure. At the same time, a physician conducting a blood pressure measuement during a routine physical examination also has a duty to perform other tests which may disclose the presence of disease: that duty does not extend to the blood pressure machine or the pharmacist who may assist a client in obtaining the reading. Optometrists are bound by a duty of care to provide a refraction and eye examination, and, unless clinically justified, cannot seperate the two. Opticians can, providing that they advise the client of the limitations, in the same manner the pharmacist can assist in the blood pressure measurement. In the manner of the course in automated sight-testing, even the Eyelogic people have a course they have always given to opticians who use the system. It is geared towards people who have an understanding of the principles involved, and relies on a refracting physician to interpret the data and confidence limits the eyelogic system prints after a subjective refraction. As you may be aware, the proposed regulation in B.C. allows the optician to perform the test independantly, and thus we felt more training would be appropriate. We also responded to ophthalmology in expanding the training in referral criteria, and the course emphasizes this. We continue to work with ophthalmology to insure any concerns are met, and have several times, approached optometry to seek input: the result has always been the same: input could be miscontrued as consent so optometric input has been limited to an all out effort to stop opticians from sight testing in any manner. Some optometrists have approached "under the table" but fear universal condemnation from their colleagues. Sales reps quiver with fear, lest they be seen, even slightly, favouring one group over the other.

[Ory]

Thanks for that reply Dave. I still don't have answers to a couple of questions:

1. What is being taught in these refracting courses? NAIT is the only western college I could find that lists the refracting course online, and they give a minimal description of what it entails. (Also: Is this course a distance ed course?)

2. Why is this training necessary if the system is self contained? I've read your college's bylaw amendment that has the new forms. They seem pretty thorough for ruling out most people who shouldn't have this test done. What value-added service is there in having a trained optician running a self-contained machine? Going back to your example, why have a pharmacist help with the BP measurement instead of the cashier?

Regarding the eyelogic system:
http://www.eyelogic.com/software.htm
Look at point number 2 - the machine is designed for untrained personnel who can learn to use it in a few hours.

I will admit I've never used an eyelogic system, but does it not give you a refraction and a confidence level? Would an optician or ophthalmic technician not already be able to look at this, know what it means, and make glasses from it? I'm still trying to figure out what the additional training is for.

Again, the next step I forsee in this process is non-licensed individuals "refracting" and dispensing. I know you may argue they are not allowed, but here's a scenario:

Customer sits in front of eyelogic system and results are generated. Results faxed overseas. Customer picks out glasses. Frame info faxed overseas. 2 weeks later customer gets new specs in the mail. Technically no laws have been broken - no diagnosis was given and the glasses were made in a different jurisdiction.

This would be the first step. As the opticians who are sight testing have shown there is no risk of harm so eventually someone (likely with money) gets the ear of a politician. Eyeglass dispensing becomes deregulated.

Sure, maybe its a little far fetched but then so is this situation in Hamilton...and it is for real.

Edit: After further looking on the COBC website I eventually found reference to the under 19 group not being eligible. You may want to fix the info that is most easily accessible to the public.
http://www.cobc.ca/sighttesting.htm#5

[mike.elmes]

Ory, you can not debate the eyelogic system's ability to provide the consumer with an alternative means to provide an accurate refraction....we're not talking medical exam here. Just as they can have the glasses duplicated for ten years in a row if they decide.We guarantee satisfaction, whether the prescription is written by you or any other doc, right or wrong. It is my company the bears the cost of the redo....and a chance to fix the problem if they can't see with a new RX.

I bought an eyelogic system to expand my scope of practice. I intend on using it to provide a service to my customers at no cost to them. I invested the money in part because a doctor or two in our city refract very poorly and my redo's were getting out of hand.The consumer will ultimately decide...all I can say is the results are enthusiastically happy customers. We do screen everyone and refer many to the optometrist down the hall....

[Ory]

Actually Mike I was not questioning the accuracy of the eyelogic system. What got this post spinning out of control was my assertion that it will be non-opticians running the eyelogic system soon.

I don't get how opticians can start refracting when the laws are questionable, and then not expect the same thing to happen with untrained staff. What possible benefit is there to having an optician run the automated machine? It will still give the same result. (Yes, I know there is a benefit in having an optician make/dispense the glasses, but that's not my point.)

On a slightly different topic: Mike, you said you use the system free of charge. I know AB is different but the proposed BC regulations will require opticians to give out a written prescription after performing a sight test. I wonder how long it will take the online shoppers in BC to figure out they can avoid the "costly" eye exam too! As discussed in other threads, perhaps you should start charging for all your services, including the sight test.

[890890]

Safilo's also after them because they're selling Safilo brands but don't have an accout with them nor do they have any records as to where these Armani frames came from....

Those brands or Salfilo's whatsoever are easy to obtain on internet in low price nowadays. How come they need an account to sell it? does internet brand seller have account?

[Ory]

Those brands or Salfilo's whatsoever are easy to obtain on internet in low price nowadays. How come they need an account to sell it? does internet brand seller have account?

1. They are using safilo brands in their advertising. These brands and their logos are copyrighted and they do not have permission

2. They are selling frames that can only be purchased from Safilo. They did not purchase them from Safilo. Safilo wants to know where they came from and are suspicious these are counterfeit.

And yes, I would assume any online retailer selling brand name frames acquired them legally or the company licensed to produce those frames will bring legal action against them.

[mike.elmes]

Can anyone find a follow up to this?? Surely this fiasco isn't still happening.

[Ory]

Nothing has been updated. The college of opticians has it listed on their site as all set to go sometime in August (link)

I've sent an email to the ontario association of optometrists so I will let you know when/if I hear anything.

[LKahn]

If frames or anything else for that matter is counterfeit, contact the US Customs Department. You can find them on the web. They will pay a reward. They also destroy the goods.

[Ory]

The College was informed yesterday that the matter against Great Glasses is being heard today and tomorrow in Hamilton at the John Sopinka Courthouse. The address and telephone number of the Courthouse is:

45 Main Street East
Hamilton, ON.
905-645-5252
Please ask for the Ontario Superior Court

We'll see what happens....

[samuelson]

thanks for the site.

[mike.elmes]

A couple more updates from the Hamilton Spectator.

http://www.hamiltonspectator.com/NAS...=1161814214431

and...

http://www.hamiltonspectator.com/NAS...=1161899444694


Still no conclusion though...

[mike.elmes]

http://www.hamiltonspectator.com/NAS...=1014656511815

His empire is in big trouble, and may crumble.

[Ory]

I wonder if Steve Buist (the author) was burned by them, is related to an optical professional, or just loves the "My dog signs the cheques" defence.:hammer:

[Bill West]

Looks to me like MIke is being used as a test for this system. I think MD's and OD's will be using something like this in the near future. People trust computers and they will even more one day. Don't fight it just learn to survive.:cheers:

[Oedema]

Wow, this guy really is out to lunch... So now we can all just make ourselves and our licenses into machines...:hammer:

From another article:

The Eyelogic machine was invented by Alberta ophthalmologist Dr. Alan Dyer.
Bergez said that because the machine was invented by a doctor, the printouts it generates can be
considered proper prescriptions from a physician.
By extension, Bergez argued, Dyer has delegated his authority to prescribe to the people at Great
Glasses who use the Eyelogic machines.
"He is allowed to reproduce himself in the form of a computer program," Bergez told Ontario Superior
Court Justice David Crane.

[Dave Nelson]

Since we are so short of ophthalmologists here in B.C. ant technology that allows them to reproduce themselves would be welcome. We have the eyelogic here, but I can't find the damn button that would make a replical of Dr Dyer appear.
Wow. Dogs that can sign cheques, ophthalmologists that can reproduce themselves... you guys in Ontario are way ahead of us technologically.
At the very least, your'e giving B.C. a run for the money as the wack-job capital of Canada.;)

[Oedema]

Since we are so short of ophthalmologists here in B.C. ant technology that allows them to reproduce themselves would be welcome. We have the eyelogic here, but I can't find the damn button that would make a replical of Dr Dyer appear.
Wow. Dogs that can sign cheques, ophthalmologists that can reproduce themselves... you guys in Ontario are way ahead of us technologically.
At the very least, your'e giving B.C. a run for the money as the wack-job capital of Canada.;)

I can't wait to buy myself one of those instruments that some cataract surgeon make himself into! :bbg: Imagine how fast that surgical waitlist would disappear!

[Leslie]

Does anyone know any of the companies that are supplying Great Glasses?

[Refractingoptician.com]

..

[Refractingoptician.com]

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