View Poll Results: Should Opticians Refract

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  • Yes (unequivocally, with no supervision or restrictions)- with formal training

    109 36.21%
  • Yes (with no supervision, but with restrictions as to whom can be seen)

    62 20.60%
  • Yes (with supervision)

    59 19.60%
  • No (because there is no need for Opticians to refract)

    58 19.27%
  • No (Opticians are not capable of refracting)

    13 4.32%
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Thread: Should Opticians Refract - The Poll

  1. #26
    Don't give up hope. Some opticians are already refracting under the direction of a doctor. I am lucky enough to work for an ophthalmologist who wanted me to refract. All three of our certified ophthalmic assistants also refract. He checks us all periodically, but as long as we were comfortable with the results and the patients responses, that is the refraction used. If a patient needs minor modifications to the glasses, I refract them, ask him if I can make the changes, he signs it and I save him time.

    I am also fitting, designing and evaluating contact lenses. This requires over refractions, changing power and perameters of lenses, and biomicroscopy. The only time my doc sees a contact lens patient is when I ask him to and that's the way he wants it. I wouldn't want to refract or fit contact without him there. Although I was very fortunate to receive a great formal education in opticianry, it is very reassuring to know that he's there for questions and reassurance.

    Assistant & techs refract in ophthalmology offices all day, everyday. I don't think that should be any different for opticians as long as they are trained properly.

    Education and organization are the key.

    Michele

  2. #27
    Bad address email on file kjw1231's Avatar
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    Thumbs up Refracting opticians? YES...

    A few thoughts...

    1. There must be a national unified borad to certify Opticians in all states.

    2. Then there should be courses that lead to a BS degree. Integrate a course that talks about detailed eye physiology, optics, refractions, medications.

    I am a licensed New York State Optician, JACHPO certified, and have refracted in an Ophthalmologists office. With proper training and certification an optician might be able to make a living!!!
    Last edited by kjw1231; 06-25-2001 at 06:45 AM.

  3. #28
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    AMEN Kevin!! I share your thoughts to a tee. The problem is, how do we lobby to get the unification? Who are we up against.
    I'm scared to say, I don't want to give the impression I'm bashing retail opticals and their rich corporate big wigs...oops.

  4. #29
    Bad address email on file Rick-Strong's Avatar
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    Question Refracting

    If Optician were allowed to refract, and Rick comes to my store and has it done. I charge Rick for this service and Rick decides to shop around, am I required to deliver a refund or write out the Rx?.

    :hammer:

  5. #30
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    Wave Backup for Maria!

    Yes John R, I can confirm that what Maria says is true. I too was taught refraction/retinoscopy at college for D.O Training in London.By the way are you the monoptica John R?

  6. #31
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    Hi Louise,

    Nice to see you here!

    I think Monoptica is a great site. I have already started to bookmark links from the lecture part of the site for our students.\
    And, I posted a question about virtual subjective refractions and got an immediate answer.

    We are just starting to mandate refraction in some of our dispensing optician programs around the country. We have had some debates on this board in regard to who should do what in our field...

    By looking at the discussions on your board, it appears that you are asking the same questions!

    How long is your DO program?

    Laurie

  7. #32
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    Thumbs up

    Hello Laurie,

    The UK course in Dispensing Optics is 2 years full time study or day release/ 3 years correspondence in full time employment in supervised practise with block release college dates. Following achievment of the diploma a further course of study to gain an (hons) can be undertaken in CL fitting, Low Visual Acuity or Spectacle lens design.

    Monoptica is great. There can be some meaty discussions!

    Louise

  8. #33
    Bad address email on file John R's Avatar
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    Re: Backup for Maria!

    Originally posted by louise
    By the way are you the monoptica John R?
    Yes tiss I :D

    Welcome to our little optical oassis in cyber space,
    Can i ask are you the Louise of Monoptica Fame.

  9. #34
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    no tis not I.:cheers:

  10. #35
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    Opticians in Europe....................................

    have been refracting forever, but with proper training.

    Here are the steps:

    1) become optician,

    2) become master optician..........can refract
    Chris Ryser
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    http://optochemicals.com............................. http://arcoatings.com

  11. #36
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    It seems to me that the only reason opticians would be interested in refracting is that it would allow them to prescribe and then dispense.

    People like Chip, or is it Homer, keep saying that it is unethical for optometrists (how come they never mention ophthalmologists?) to dispense what they prescribe. By the same token, it would be unethical for opticians to dispense after they refract and prescribe. So all that opticians would ethically be allowed to do is refract.

    Is that really what you want?

    By the way, to say eye disease is rare is just ignorant, and opticians will get no respect by saying such a thing. I can't begin to count how many people we have seen who come in for a routine eye exam and the dr finds ocular hypertension, diabetic retinopathy, cataracts, blepharitis, dry eye conditions, macular degeneration, glaucoma, vitreous detachments, and other health concerns.
    Last edited by paw; 12-17-2002 at 08:48 PM.

  12. #37
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    Paw: Unless I am mistaken, on two points.

    1) I have always maintained that it is unethical for M.D.'s to have an economic associaton with the filling of thier own Rx's, especially optical goods. The AMA and The American College of Surgeons used to agree with me before opthalmology became so rich and powerful a force in medicines economics and politics.

    2) Opticians as far as I know don't refract and precribe in an independent setting. Only in an M.D. or O.D.'s office subject to his supervision (a very loose term I agree). But then non-opticians who are not O.D.'s or M.D.'s refract in many M.D. and O.D. offices. What is the problem if an M.D. or O.D. has to at least sign off on the Rx. Presumably the final check and eye exam is done by the M.D. or O.D. after the preliminary has been done by the office help (or a machine for that matter).

    Chip

    Now as an addenum I do know that some states forbid the above practices (with laws bought and paid for by O.D. lobbies in thier own behalf).

  13. #38
    Bad address email on file Tim Hunter's Avatar
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    Interesting debate, in the UK the only professionals allowed to sign a prescription for spectacles are suitably qualified doctors (medical) and optometrists (or ophthalmic opticians). I know that some Colleges/Universities have been providing courses in refraction and supplementary techniques to Dispensing opticians (the US optician), however I am unaware of any company or individual who has employed one of these DOs to refact for them and then the optometrist sign the prescription (which is the only way it would work with the law as it stands in the UK). I do know that orthoptists (who also are now trained in basic refraction at university) do occasionally refract and have their prescriptions signed by ophthalmologists in some hospital departments (where there are no optometrists), but they take legal responsibility for that prescription not the orthoptist.

    As an optometrist I would say that refraction is in itself relatively straightforward (machines can do it), the difficulty comes in deciding what to issue. Children's prescriptions are particularly difficult when linked with binocular vision problems and amblyopia, adults with anisometropic prescriptions, prism etc. etc.

    I would be careful about grouping refraction into a big comfortable pot, I've certainly seen patients whose prescriptions fluctuate because of diabetes (in fact it can be a diagnostic sign of undiagnosed diabetes). The statement that eye disease is rare should probably have read "I haven't seen much" but then if you don't look in the right places/ or know what you're looking for you wouldn't would you!

    DO (optician) refraction hasn't caught on over here in the UK and that's because there is no shortage of existing qualified refractionists available. I suspect unless there's a shortage in the US it won't take off over there and if you're trying to provide a cut price service unless you make it very clear to a "customer" that you haven't been able to carry out a satisfactory eye examination and they will have to go elsewhere for their ophthalmoscopic and anterior segment examination, look forward to litigation.

    Phew that was a long one.

  14. #39
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    I have a number of concerns over this issue:

    Firstly, refracting is only part of the job to providing comfortable specs. The actual science of refracting isn't particularly difficult, but then there's the artistic side of it, which is prescribing and modification of the subjective refraction. This takes a lot of experience to ensure a zero non-tol rate.

    As an optometrist who also dispenses, I occasionally find the transition between the two functions difficult and find the whole process more satisfying (for all parties) to have the two functions dealt with by two people. This avoids any perceived unprofessionalism and demarkates areas of responsibility. By blurring these areas, I think it can lead to customer confusion.

    In the UK, dispensing opticians were de-regulated in the 1980s. If dispensing opticians also refract, I can see this leading to further de-regulation whereby eventually the likes of anyone can provide glasses, BECAUSE THE TRUTH IS, IN THE MAJORITY OF CASES, IT IS DEAD EASY TO REFRACT AND PROVIDE THE PUBLIC WITH SOME SPECS THAT WORK, but where do you draw the line?

    It's the same with contact lenses - the majority are simple and problem-free. It's the difficult ones where you earn your money and are pleased that you know what you're doing.

    And lastly, if optometrists were to lose their uniqueness to refract, we'd have to learn a lot more about eye diseases and become more doctor-like to survive. That sounds like far too much work to me!

  15. #40
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    Adam:

    You haven't been watching what's happening in the states. O.D.'s are making every effort to "become more doctor like," precribe medicine, try to perform non-invasive surgery, treat disease (including glaucoma, and other disease that is mostly treated by super-subspecialist [cornea or retina M.D.'s]. This from a group that just a few years ago was forbidden [on paper but not in practice] from calling themselves "doctor" or representing themselves as physicians.

    Don't know where things are going. I do know that several O.D.'s who are/were friends of mine who graduated from one of the South's largest schools of Optometry have told me that if they hadn't bootlegged a contact lens fitting on thier roomates they would never have seen a contact lens on an eye during thier education. Saw a lot slides, heard a lot of theory but never fitted anyone, never followed cases that had been wearing contacts for decades. These are the experts and we are the amateurs I guess.

    Chip

  16. #41
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    In my opinion a refracting optician is a wonderful idea.
    An Optometrist is basically an optician that can refract anyway. Anytime a major concern arises they send you off the the Opthalmologist anyway!

    How many times have you heard a patient say "Oh, I won't get my eyes examined here. I go to a real doctor"

  17. #42
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    HarryC,
    You've got to be kidding. Is that why, in addition to a full schedule today, we put in 2 "red eyes" and a foreign body removal today on an emergency basis? Is that why we received a call from the school nurse today wanting the dr's opinion about somthing relating to the boy he treated yesterday? Is that why people complement the dr on the thoroughness of his exams and refer people to him? Is that why the dr discovered what turned out to be a benign tumor? All this and more, because he's an optician who refracts and he's not a real dr? Wishful thinking on your part.

    A lot of the people on this board have an incredibly out-dated understanding of what optometrists do..

  18. #43
    Bad address email on file NC-OD's Avatar
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    PAW,

    I am with you. I just read through all of the post here and some of them are just plain rediculous comments from obviously uneducated, uninformed people. I have always been a supporter of refracting opticians if they are educated. There is no reason anyone with the proper training can't do it. But there is also a good reason OD's fought for the right to use diagnostics and therapeautic pharmaceuticals. We realized that there IS a great chance of missing pathology without dilating...and refracting alone was insufficient.

    I don't remember who it was that said something like "the OD or OMD can't always find glaucoma (low-tension) anyway". That's retarded thinking. We now have incredible instrumentation to detect and monitor treatment all kinds of glaucoma.

    Today I saw a patient referred from her PCP after he treated her with sulfacetamide for 1 week. Turned out she had uveitis secondary to trauma. Had a pt. with a traumatic corneal abrasion from a pencil lead. Had 3 patients with glaucoma in today that I am treating (I happen to be the only practice OD or OMD with an HRT in the area....thus I get alot of referrals from the MD community). Also had another referral from another MD who was treating a patient with a chemical injury with Ciloxan. Turned out he had a moderate corneal abrasion (with a very red eye).

    I have made a great living with an "ocular disease" practice. I have done this by being good and, more importantly, being friendly and compassionate to my referral sources.....not by trying to beat them up.

    To say that eye disease is "very rare" is just plain stupid. I have a private OD practice and have built a predominately "ocular disease" patient base over the past 3 years. Virtually nothing gets referred to an Ophthalomlogist unless surgery is needed. My training was so complete and through, that it is redundent.

    I have a tech that can refract. I would have an Optician if I could pry one away from one of our 5 Super-Walmarts. Evidently they would rather work 7 days per week with a 10% Walmart discount than be in professional practice with good pay and benefits ??

    You guys got to get out of your 1965 thinking of OD's. Your getting left in the dust and making fools of yourself in the process.
    Last edited by NC-OD; 12-20-2002 at 07:56 AM.

  19. #44
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    Optometry

    Today's OD is a long way from the OD of the past. As NC-OD has said, the OD's today are well trained and well educated. I, of all people, are for Opticians providing refractions. I taught the first course in refraction developed for Opticians in an academic institution in NYC, where we trained approximately 200 students. But we never intended them to be "junior eye docs". Their training was dedicated to the optics involved in refraction and the clinical application of the process. Many of those practice today in hospitals aand clinics as well as private practices in conjunction with the MDs and ODs, and are profecient refractionists. They received a thorough education in the subject matter before applying it. But Opticians sometimes are limited in any educaction and or training. Many do not even understand the optics of dispensing, and it is not prudent for us to cast any disparaging remarks towards other professions who have made a top rate education a part and parcel of their professional training.
    To the ODs....the primary reason many Opticians feel the way they do towards Optometry is simple; ODs have been somewhat hypocritical. They learned medicine and what did they hear from MDs? If you want to be a real doctor go to medical school. In a similar vein, we are hearing that if we want to refract, go to Optometry school. Neither are correct or realistic. Opticians can and should refract, but only after adequate education and training. I was trained by a wonderful OD in a private program. It was an excellent investment and I was pleased to have completed it. I encourage all Opticians to learn refraction, even if they don't want to refract. It will make them better Opticians. I am appreciative of NC-OD for his comments and support. We need to wake up and smell the coffee Opticians. No one will give this to us. We must first educate ourselves if we are ever to climb back up the mountain of success again. Until them we will flounder in the mediocrity of today.

  20. #45
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    Angry

    I vote for refract.

    Dave

  21. #46
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    Exclamation Re: Optometry

    wmcdonald said:
    Today's OD is a long way from the OD of the past. As NC-OD has said, the OD's today are well trained and well educated. I, of all people, are for Opticians providing refractions. I taught the first course in refraction developed for Opticians in an academic institution in NYC, where we trained approximately 200 students. But we never intended them to be "junior eye docs"....................................................... ..



    Congratulations. an excellent argument everybody should take at hart.
    Chris Ryser
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    DLO. NA.IC.I.T.PO

    http://optochemicals.com............................. http://arcoatings.com

  22. #47
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    If I offended anyone with my post I apologise, it wasn't meant to be derrogative. My opinion was asked, and I gave you my opinion.
    There are many qualified Optometrists that can treat mild occular disease and do a fine job of it. However through personal experience I tend to trust the expertise of an Opthalmologist more. I'm not saying that every Opthalmologist is qualified, personally I would trust the refraction of an Optometrist over an MD. I feel though that better care is given within the confines of private practices including OD's private practices. I wouldn't take my retinal detachment to Wal-mart and expect good treatment.
    Likewise, I wouldn't buy my glasses in a big chain and expect to get the same quality of a local small shop.
    My father always said "Don't get your eyes examined between the tunafish and the tires.

  23. #48
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    Harry C said, "My father always said "Don't get your eyes examined between the tunafish and the tires."

    I like that! Maybe we should put that on our business card -- ha, ha.

  24. #49
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    Intention

    Chris,
    Don't misinterpret my comments as not for refraction....I am THE proponent for Opticianry and refraction in many parts of the country. But education must come prior to any expansion of scope of practice. It is important for me to clarify my position here. You took only a small part of my post to make a point, and I am certain you had good intentions, but I want all Opticians to understand that our weakness is in a lack of education and training and it needs to be corrected....I am not trying to offend anyone, only to point out that we need to do something.

    Warren

  25. #50
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    I'm curious does the training US "opticians" receive for refracting include binocular vison assessment?

    I accept that what most of you are talking about is refraction without any attempt to assess the internal ocular health of the eye but you can't divorce prescribing of a spectacle correction from an understanding of the way it can affect binocular function. Would you propose an age limitation on who you could refract to avoid having to deal with amblyopic children, what would you do about young adults with convergence problems.

    I have some concerns (albeit relatively theoretical ones as US practice is unlikely to impact on my patients in the UK)that some of you have a very simplistic view of what a refraction is.

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