Breaking News in the Great Glasses Court Case

[mike.elmes]

I would like to make a point about the state of eyecare in our region. Most Opthalmologists are so busy with cataract surgery,lasik, or their chosen specialty, that the days they spend in their practice are mayhem. If your appointment was 2oclock, maybe you see the doc at 3 maybe 3:30 or later. The tech's are doing the pre refracting, and other tests and the doc has a quick look at the end. The results are rarely as good, acuity wise, as people are happy with. Many people actually seek out Ophthalmology because health care pays for the exam, and also people feel they are going to see through walls, so to speak, with the new prescription. It is not my place at this point to question the Rx. After making,selling,dispensing thousands of these glasses I come to respect the differences in results of Optometrists, Ophthalmologists, and our Eyelogic results(which are signed by an Ophthalmologist) For many years before we got an Eyelogic, I would always reccomend to my repeat customers that they see an Optometrist for the most accurate refraction(their specialty) an Ophthalmologist if the Optometrist found eye health issues, and an Optician for the most accurate measurement of perameters pertaining to eyeglasses...The problem was to find a good Optometrist that is non eyeglass dispensing, that will send back my client with a script that will give optimal acuity, with a minimum of re-do's.
Every time I refer a client, I expect that client to reurn to me. Many Optometrists actually appreciate referals but many are so busy that their staff just send them into their dispensary to sell them the eyeglasses....the dispensary is expected to dispense as close to as many scrips as the doc's are generating....there is real pressure on the staff to maximize the proffits. Hey, I've worked for Optometry for more than a few years, and I learned volumes about that side of it.
We use the Eyelogic exactly how it was intended to be used. 100% within the guidlines of the Inventor, Dr Dyer. It is a means for Independent Opticianry to expand it's scope of practice, and to give the consumer, yet another choice in eyecare. We as Opticians are capable of more responsibility, with education and training, to provide more than we are....Each of the three O's are.

[shawn b]

Patients always have a choice in health care, they can choose the doctor of their liking, they can choose whether or not to follow recommendations, they can choose to be compliant (or not) with treatments, they have input into their preferred modality of treatment. However, autonomy (even in the name of patient choice) is not an acceptable justification for creating an lower standard of care (for certain health professions) that carries a significant risk of harm to the public.

If you say that it carries a significant risk or harm to the public, you might in fact want to take that up with the AmericanAcademy of Ophthalmology, who clearly state (and I quote):
"whether they wear glasses/contact lenses or not, adults between the ages of 20-29 need a comprehensive eye examination once throughout those years, while those between the ages of 30-39 should have two eye health examinations, and those between 40-64 need to be examined every two to four years."
What I ask you, is that if an entire association of highly specialized medical doctors (not optometrists- because they do not have a medical degree) has come to that conclusion- how significant is that risk of harm? Are the people getting the truth?
Also, the Canadian Ophthalmological Society, states that:
"A diagnostic eye examination involves the practice of medicine and requires the highly specialized training of a physician. A refractive examination involves taking measurements from the visual system, which is simply a data-gathering procedure".
You keep on referring back to a lower standard of care. Again, we have no desire to lower the standard. We would like optometrists to keep on doing what they are doing, however people should have a choice.
What I find amazing, is that you are fine with people having the choice to follow recommendations or not, meaning they can make that call on their own- however, you don't want to give them the right to make their own call on what type of treatment they desire. That doesn't make sense to me. On one hand you are forcing people to see the doctor- because you don't want to lower the standard of care. But then it's okay to say no to what that doctor recommends- after you forced me to see him/her? So I can decide for myself if a doctor is right or wrong in my diagnosis, essentially going over them, but I cannot decide if I want an eye examination, or my new refractive error measured? I just don't get it.

[fjpod]

Is there a difference between refracting, collecting data as you call it, and prescribing?

[Dave Nelson]

Oedema

I said people should seek an eye examination for EITHER preventative reasons OR symptomatic. You replied: "so you're suggesting that patients should seek an eye exam for specific symptoms of eye conditions?"
YES. Yes I am, oh my yes. Affirmative. Correct. On the money. Truly.
The alternatives are: people obtain an eye exam for every symptom, no matter how small, or, people do not get eye exams when they have symptoms. Now I know you do not mean either of these, so can you elaborate on why you think I am off base with my earlier statement?

[mapleleafs]

Important background

Eyelogic is a system that allows refractions to be done by anyone (a monkey if you ask Dr. Dyer). It does so in isolation from binocular vision considerations and any eye health assessment. It has only been tested for its precision (not accuracy) and the results published in a journal which demonstrated that there was little operator influence (A fully automated remote refraction system. J Telemed Telecare. 2000;6 Suppl 2:S16-8 Dyer AM, Kirk AH) but never tested against the results of a experienced refractionist (optom, ophtho) or for the number of things missed by not performing the sight test in the context of a complete eye exam.

The most important assumption made before you can believe that eyelogic should be operated outside of a complete eye exam is that all of the patients presenting for the sight test have no problems besides a refractive error, and that if there was something wrong, the patient or the operator would know before the end of the test so that the appropriate referral could be made.

The following study (Blurred vision. N Engl J Med. 2000 Aug 24;343(8):556-62. Shingleton BJ, O'Donoghue MW.) speaks to the importance of a complete overview of the eye when differentially diagnosing blurred vision and was published in the New England Journal of Medicine.

"BLURRED vision is the most common symptom
related to the eye. It is manifested in many
ways and has a wide variety of causes. Here we
review for nonophthalmologists the examination techniques
and diagnostic algorithms that are useful in the
evaluation of blurred vision. We also describe how
to determine when patients need urgent ophthalmologic
consultation and treatment.
The eye examination, as performed by a practitioner
who is not an ophthalmologist, is divided into
six parts: visual acuity, visual field, pupils, movement
of extraocular muscle, anterior segment, and posterior
segment. Because some serious eye conditions are

not readily apparent, systematic progression through
all six parts of the eye examination is essential for every
patient with blurred vision." (bolding mine)

The patient and eyelogic operator who "knows" all that is needed is a refraction may have overlooked the other five parts of the exam in an effort to fix the problem with "stronger" glasses.
The epidemiology of eye disease is well known and documented and there are too many people (how many is too many when vision loss is almost always entirely or even partially irreversible?) losing vision to a sight test when access to optoms and ophthos is pretty quick. The reason these people have not been heard from -they are reluctant to take legal action (good Canadians) or the problems have been "fixed" by busy doctors with no time to get involved in litigation. Just like the patients who are being treated by their family docs with polysporin for an iritis, we look the other way, people make mistakes.

All of the suggested exam freqencies often cited by eyelogic supporters are those from OMD organizations, who specifically refer to medical eye exams, when interpreted, reads "with an MD". The optometry organizations publish more frequent exam recommendations because they mean with an optometrist and those recommendations haven't changed because eyelogic came on the seen. If you would ask the optom orgs their recommended frequency for exams with an MD they would say at time of surgery, so once or twice a lifetime.

Remember, eyelogic sells to anyone with money, and there is no requirement for an optician to operate them, refraction after all is in the public domain. Ontario, in their 2006 HPRAC report, came close to deregulating opticians and return the harmless act of dispensing eyeglasses to the public domain, as it is in the majority of the U.S. If sight testing were to be legalized in Ontario (with remote supervision and signing by a reviewing MD) it could create a scenario where the opticians are not involved in the refracting, prescribing or dispensing of eyeglasses. A win-win for the public who now have lay people earning less money doing these services for them at reduced costs, for all you consumer choice advocates. If dispensing were to be deregulated anywhere that allowed sight testing, there would be a serious crisis in the opticians camp. By the way, the same MD that is signing your eyelogic Rxs could also remotely supervise your dispensing, and by "your" it now means any business man or woman,, no credentials necessary, only dollars.:idea:

Be careful what you wish for, you just might get it.

[Caddy]

MD says OD's not doctors

I have a close friend who went to 2 seperate OD's because of a "shadowy darkness in one eye." He was told his retina's were fine. 2 weeks later, he went to an ophthalmologist and was told his "retina has been detached now for a couple of weeks, and vision is 85% lost." The MD said, "don't blame the OD, blame the government. Optometrists are not doctors."

[Oedema]

I said people should seek an eye examination for EITHER preventative reasons OR symptomatic. You replied: "so you're suggesting that patients should seek an eye exam for specific symptoms of eye conditions?"
YES. Yes I am, oh my yes. Affirmative. Correct. On the money. Truly.
The alternatives are: people obtain an eye exam for every symptom, no matter how small, or, people do not get eye exams when they have symptoms. Now I know you do not mean either of these, so can you elaborate on why you think I am off base with my earlier statement?

Mr. Nelson,

I think we have some confusion to clear here. My intentions are not to ignore your endorsement of preventative optometric care, in fact since prevention is somthing we seem to agree on I thought I'd leave it at that.

What I do have an issue with is the inference (real or percieved) in your statement that patients should seek an eye exam not for refraction but either "for a specific symptom or for preventative reasons." My question, hopefully is clearer language is this: If the symptoms of of an eye disorder/disease are often the same as, or are confused with with refractive error, how do you suppose people differentiate and decide on either a complete oculo-visual assement or a sight-test?

Just as a refraction with prescription should not be unbundled from the eye exam, an eye exam should not be unbundled from refraction - how else is an optometrist or ophthalmologist suppossed to determine best corrected VA when acuity is decreased?

[Oedema]

If you say that it carries a significant risk or harm to the public, you might in fact want to take that up with the AmericanAcademy of Ophthalmology.... how significant is that risk of harm? Are the people getting the truth?

Shawn,
The quotes you bring up are in regards to the recomended frequency of eye exams do not in any way diminshes the risk of harm involved in examining a patient, counselling, and prescribing.

What you have brought up here is an example of how ophthalmologists and optometrists (as two solitudes) have failed to come up with uniform recommendations, not only regarding exam frequency, but also treatment of amblyopia, hyperopia, etc. Why do we have disagreement on these things? For one, the studies probing the most efficatious approaches are not complete, and in many instances the two professions have different definitions of what would constitute a good outcome.

You keep on referring back to a lower standard of care. Again, we have no desire to lower the standard. We would like optometrists to keep on doing what they are doing, however people should have a choice.
What I find amazing, is that you are fine with people having the choice to follow recommendations or not, meaning they can make that call on their own- however, you don't want to give them the right to make their own call on what type of treatment they desire. That doesn't make sense to me. On one hand you are forcing people to see the doctor- because you don't want to lower the standard of care. But then it's okay to say no to what that doctor recommends- after you forced me to see him/her? So I can decide for myself if a doctor is right or wrong in my diagnosis, essentially going over them, but I cannot decide if I want an eye examination, or my new refractive error measured? I just don't get it.

Shawn, it is not the optometric standard of care I'm concerned about lowering here. If a patient seeks out an opinion from a health practitioner for any reason, that person should be afforded confidence that their provider is providing the best care possible, and not ommitting vital considerations before initiating treatment.

[Dave Nelson]

You make well thought out arguments, now if we could just get you to listen to some simple reason.:D We could discuss this in circles till the end of time, but Im getting a little weary of the whole issue. I'm sure someone will make some comment that will get my back up, and I'll jump back in,but right now, I have to try and get Harry Chilling to take up hang-gliding. One of the optometrists on this thread called him a swine, so if I can get a picture of Harry hang-gliding, I can send it to the B.C. Association of Optometrists, who told me they would allow opticians to refract when pigs fly.
Later

[Oedema]

Thanks Dave, I too tire of this back and forth. I am open to simple reasoning, but I also think it should be backed up with accurate and reasonable justifications. Either way, this thread is out clearly out of control, no thanks in part to myself.:hammer:

Anyone know whats happening with Burgez? I suppose he has appealed and doesn't have to place the advertisments and signs in his locations until there is a decision from the next court?

[HarryChiling]

I have to try and get Harry Chilling to take up hang-gliding. One of the optometrists on this thread called him a swine, so if I can get a picture of Harry hang-gliding, I can send it to the B.C. Association of Optometrists, who told me they would allow opticians to refract when pigs fly.

I fly to florida in january, how about a picture on the plane. :D

[rikriz]

I was just at the local mall yesterday and the Great Glasses store there STILL has a giant sign in the window advertising "Free Eye Exams". I'm beginning to think that nothing short of going to prison will get Bergez to comply with the court order. Are ANY of the stores complying with the order?

[Oedema]

I was just at the local mall yesterday and the Great Glasses store there STILL has a giant sign in the window advertising "Free Eye Exams". I'm beginning to think that nothing short of going to prison will get Bergez to comply with the court order. Are ANY of the stores complying with the order?

Following the court ruling, Bergez stated that Great Glasses would stop sight-testing and rather reimburse patients for their eye exams. I suspect thats what the sign is all about? Although, given the track record here, he and his associates might just be bold enough to continue business as usual.

[HarryChiling]

I was just at the local mall yesterday and the Great Glasses store there STILL has a giant sign in the window advertising "Free Eye Exams". I'm beginning to think that nothing short of going to prison will get Bergez to comply with the court order. Are ANY of the stores complying with the order?

This guy is a real scum bag.

[Excalibur]

This guy is a real scum bag.

Harry,

Although we have disagreed on many points in this thread, I definitely agree that this guy is a real scum bag. :angry: