Ontario Opticians refracting?

[tmorse]

I have seen many patients post "sight-test" who have had problems. I'm sure I'm not the only OD who has.

By the way, what is a "canard"??? Is that a term for a well-endowed, highly sophisticated, incredibly handsome man?? If so, when did we meet??

I am sure the same can be said by many OMD's that have seen OD patients post "eyehealth assessments" who have had problems. You're also forgetting the role of the patient's primary health care provider, his/her family physician. Patient with all these listed medical ailments have no doubt already visited their own GP.

You're also forgetting recent advances in refraction technology, producing equipment that make for very accurate and consistent refractions. Just think...many years ago it was routine for a MD it taste a person's urine for sweetness in order to detect diabetes. Bloodwork and strips can do it now.

As for the word 'canard', obviously you are not overly 'erudite'. Perhaps you might request a dictionary for Xmas.:D

[Excalibur]

Let me take the liberty of providing some clarification. I think Stonegoat means retinoscopy, ophthalmoscopy/binocular and monocular, tonometry, pupillary tests, pachymetry, etc etc. This would cover most primary methods of acquiring objective data. There would of course, be other important clinical testing, such as binocular testing, visual field analysis, and other forms of imaging. Perhaps Stonegoat could expand on this if I missed anything.

[Stonegoat]

Tmorse,

If an individual, say 43 years old presents for a sight-test complaining of blurred vision, and you correct them to 20/20 with an increase in hyperopia of +0.50 D OD and +1.00 D OS, you will think that the person simply requires the hyperopic correction to alleviate symptoms. I doubt you would refer this patient out, especially if their old Rx is several years old.

An OD would refer this patient out because during the course of the examination, while obtaining all of the objective data to formulate an appropriate assessment/plan, an amelanotic choroidal melanoma would have been detected in the left eye, the elevation of which was resulting in a hyperopic shift.

This is not a hypothetical patient, but one I saw last year.

I know that primary melanomas and secondary cancers are very rare in the eye, but they do happen.

Also, on numerous occasions I have sent patients to their GP for testing who had serious undiagnosed systemic disease.

Anyway, I could give example after example of why eye care should not be fragemented, and I would not change any sight-testers mind.

[Barry Santini]

For me, however, I think that:

1. If you believe that opticians who refract (and/or the refraction itself) SHOULD NOT be separated from eye health assessments, then you MUST legislate out the "self-refraction" by the public for selecting their own OTC readers and (now) bifocals. This, of course, protects the welfare of the public's vision (and Dr.s practices?)

2. Or...As long as the lay public can "prescribe/refract" for themselves...well then so should I (with, of course, the proper accreditation).

My two cents

Barry

[HarryChiling]

Stonegoat,

I am glad you mentioned some of these issues as it seems the opticias are one step ahead of you.
http://www.cobc.ca/my_folders/Forms/Form%203%20Brochure%20Client%20Notice%20on%20Automated%20Ref raction.pdf

An automated refraction/sight test is not a regular eye health examination.

Because eye health conditions or other illnesses will not be found through an autmoated refraction/sight test, it is important that you have regular eye health examinations.

That is the first few lines from the client notice brochure. So the opticiasn like you have mentioned do see the need for the eye health assesment. The brochure also exaplains in more than one area in BOLD UNDERLINED CAPS, that a automated refraction/sight test is not and eye health examination. This brochure must be signed by the opticians that it was discussed with the p[atient and a copy must be provided to the client.

I don't agree that refractions being done seperately by an optician is fragmented eye care, I fell it is the opposite. More people will likely go to see their opticians for regular sight testing if they didn't have to go through all the other procedures which gives the opticians more of an opportunity to recommend an examination. It creates an enviornment where the opticians doesn't have to compete with the optometrist allowing them to work together more closely on making sure the cleint recieves the proper care.

[HarryChiling]

Just think...many years ago it was routine for a MD it taste a person's urine for sweetness in order to detect diabetes. Bloodwork and strips can do it now.

mmmmmmmmmmmmm.............sweet urine, the perks of the job.:D I had a buddy back in middle school who used to eat or drink anything for $1.00, maybe he's the guy they send urine to when they call for lab work. He would be the designated tester.

[Stonegoat]

I really do agree Harry, that there are ways that ODs and opticians could work together. I am all for that. However, in BC it has been my experience that patients always underestimate the time since their last eye health exam. In addition, some opticians disregard their own guidelines. I have even seen patients who have received glasses from a sight test who have never had an eye exam.

I had a monocular patient (had a prosthesis) who had glaucoma in the other eye who came to me for a second opinion on the glasses he received from a sight test. He had not seen an eye Dr. in 3 years.

How do we solve this?? I'm not trying to stir-up sh!t, but this is the reality.

[Stonegoat]

By the way Harry, I have a licensed optician on staff, and pay her well for her expertise. She and I work far more like partners than employee-employer. My hunting partner is also an optician, and he owns his own lab, which, we as well as many others utilize. I do respect opticians, but before they can perform stand-alone refractions, more effective checks and balances must be in place to ensure patients don't slip through the cracks.

A waiver just doesn't cut it, because patients might not have any idea of why an eye exam is important.

[HarryChiling]

By the way Harry, I have a licensed optician on staff, and pay her well for her expertise. She and I work far more like partners than employee-employer. My hunting partner is also an optician, and he owns his own lab, which, we as well as many others utilize. I do respect opticians, but before they can perform stand-alone refractions, more effective checks and balances must be in place to ensure patients don't slip through the cracks.

A waiver just doesn't cut it, because patients might not have any idea of why an eye exam is important.

I am under the impression that sight testing is still a new thing in BC as well, their will be bugs to work out and unfortunately growing pains. It's not perfect yet, but they are working on it and doing a good job. I don't know if it would be realistic to catch every case coming through the door, I am sure none of the O's has a 100% batting average. I would personally put more responsibility on the patient in the case you gave above, a patient with one eye and glaucoma in the other eye should know better. The arguement could be made that the doctor didn't impress upon the patient the importance of routine health examinations, but that would be speculation. The patient made a bad choice in that case and their shoudl be checks in place to prevent that, the form does ask if they have glaucoma, I guess the patient ignored that or the optician failed to go over the form properly.

I do like a checks and balance in place, but what suggestions could be made to improve the system?

[Stonegoat]

Harry,

As you well know, many patients are not particularily sophisticated when it comes to their eye health, or health in general. Stating that a patient should know better, and seek the appropriate professional to address their issues is very much a "buyer beware" mentality. It should not be the patients responsibility to ensure that they are receiving care from a qualified professional....thats what the various colleges and boards are for.

As for recommended checks and balances, I think that opticians must align with non-dispensing ODs or OMDs and arrange for patients to have an ocular health assessment within a short time of the refraction. The ODs would be happy for the business, and their would be no competition, and the patient would be served well with no fragmentation of the eye care.

[HarryChiling]

Harry,

As you well know, many patients are not particularily sophisticated when it comes to their eye health, or health in general. Stating that a patient should know better, and seek the appropriate professional to address their issues is very much a "buyer beware" mentality. It should not be the patients responsibility to ensure that they are receiving care from a qualified professional....thats what the various colleges and boards are for.

As for recommended checks and balances, I think that opticians must align with non-dispensing ODs or OMDs and arrange for patients to have an ocular health assessment within a short time of the refraction. The ODs would be happy for the business, and their would be no competition, and the patient would be served well with no fragmentation of the eye care.

Sounds good in theory but hasn't worked in the states, it's not buyer beware. The alternative is the patient doesn't go most of the time. I can't tell you how many times we have had patients avoid the examination because they hate the drops or applanation, or neumatic (even worst). So they avaoid their OD's or OMD's like the plague. If they were to see their optician for a refraction the arguement could be made that at least if they were not able to get them to 20/20 or they saw something on the form that didn't jive they would recommend they see a qualified professional for a full health evaluation.

Both sides have a valid point, but you have to understand that both me and you are one sided as we both want whats good for our profession and often times we use the terms best for the patient, or better care as guise for best for our profession. I am not saying that this is your intention, but it sure does tickle a funny bone in my arm.

Who are we to say it's good for the patient, you see them as avoiding you because they have me. I see them as having another opportunity to see a you because they have me.

Let's just agree to disagree on this one as our professions haev always done in the past. I am lookign forward to the day when the US adopts some of these Canadian standards in our country, because in the states our biggest opposition (our beign opticians) has been optometry and it has not lead to better patient care, but the opposite.

By the way Harry, I have a licensed optician on staff, and pay her well for her expertise. She and I work far more like partners than employee-employer. My hunting partner is also an optician, and he owns his own lab, which, we as well as many others utilize. I do respect opticians, but before they can perform stand-alone refractions, more effective checks and balances must be in place to ensure patients don't slip through the cracks.

It wasn't that long ago that opticians in the states had that same respect from OD's and OMD's, but the business changed. For one an optician relies on scripts to maintain a business.

Here are some things that don't benefit the patient that are law in many of our states:

1. Opticians cannot hire doctors.
2. Doctors don't have to hire licensed opticians.
3. Their are still loop holes in our Eyeglass Rx release rule that a few take advantage of. (similar arguement to the guy Burgez being an optician we don't like him, but he is one of us and he hurts us)
4. Doctors in some states can prescribe lens options and it is considered part of the script. (this is often used as an advantage to keep scripts in house or avaoid the patient price shopping)

I don't know of one advantage an optician in the states has over and OD or OMD and the advantages that the OD's and OMD's have over the opticians in the states is more centered around economicla advantages and often does nothing for the patient as far as care is concerned.

[Stonegoat]

Harry,

ok..lets agree to disagree.

Please do not assume that I am against opticians doing stand-alone refractions for economic reasons, although I am sure that many ODs are concerned about that.

There is a sight-tester in the town where I practice, but he has little or no impact on me. I am almost always fully booked or over-booked, and do almost $1.5 million/year. My biggest competition for dispensing, by a wide margin is an independent non-sight-testing optician who works down the street. She sends patients to me who require a prescription and I NEVER offer to sell glasses to patients she sends to me. I would say she makes about $20,000/month from my prescriptions.

The sight-tester isn't as busy as either of us.

[HarryChiling]

Harry,

ok..lets agree to disagree.

Please do not assume that I am against opticians doing stand-alone refractions for economic reasons, although I am sure that many ODs are concerned about that.

There is a sight-tester in the town where I practice, but he has little or no impact on me. I am almost always fully booked or over-booked, and do almost $1.5 million/year. My biggest competition for dispensing, by a wide margin is an independent non-sight-testing optician who works down the street. She sends patients to me who require a prescription and I NEVER offer to sell glasses to patients she sends to me. I would say she makes about $20,000/month from my prescriptions.

The sight-tester isn't as busy as either of us.

It sounds like you are a very honorable guy/gal, I wish we had more like you. I have worked in a practice where the doctor would say to us in front of the patient that we are sending them back to the doctor, but would scould us behind closed doors if we didn't try to sell them.

[tmorse]

... I know that primary melanomas and secondary cancers are very rare in the eye, but they do happen. Also, on numerous occasions I have sent patients to their GP for testing who had serious undiagnosed systemic disease... Anyway, I could give example after example of why eye care should not be fragemented, and I would not change any sight-testers mind.

Point taken... but as to serious undiagnosed systemic diseases missed by the GP, who knows all the facts...what symptoms were presented to the Dr. that were supposedly missed? My 86-year old neighbour would boast that he has never visited any doctor in his life. So the patient does need to accept some responsibility for his health.

IMHO your insistence on a comprehensive eye health exam every time a person is tested for a change in Rx is similar to a GP insisting on a complete physical medical exam every time the patient presents at his office with the sniffles.

Sight-testing protocols and procedures may need some tweaking from time to time, and I am sure our regulatory College of Opticians of BC will be up to the task. It's probably the same with your relatively new use of Therapeutic Pharmaceutical Agents (TPA's), that OD's were granted the right to use not so long ago.

And you are probably correct when you suggest that nothing you say will change sight-tester minds, just as nothing they can say will change your
own mind.:cheers:

[mike.elmes]

Screening clients is key, and a part of the regiment used in either BC or Alberta. Part of the form we get the client to read and sign clearly states that:

A SIGHT TEST IS A TEST TO DETERMINE WHETHER GLASSES ARE NEEDED.
IF GLASSES ARE NEEDED A SIGHT TEST WILL DETERMINE THE NECESSARY PRESCRIPTION.

A SIGHT TEST IS NOT A MEDICAL EYE EXAMINATION AND WILL NOT DETERMINE THE PRESENCE OF EYE DISEASES.

IF YOU SUFFER FROM DIABETES OR HAVE ANY EYE DISEASE, A MEDICAL EYE EXAMINATION BY AN OPTOMETRIST AND OR AN OPHTHALMOLOGIST IS RECOMMENDED.

IF YOU ARE UNAWARE OF ANY MEDICAL CONDITION AFFECTING YOUR EYES, A MEDICAL EYE EXAMINATION FOR ADULTS IS RECOMMENDED BY THE AMERICAN ACADEMY OF OPHTHALMOLOGY AS FOLLOWS:

Once or twice before the age of 40
Every two to four years from age 40 to 60
Every one to two years after the age of sixty
All criteria above applies to adults over the age of 18

We screen thoroughly and follow these exact guidelines.
We do not test children or seniors or anyone not previously tested in the past 4-5 years by an Optometrist or Ophthalmologist.
We do not test Diabetics or people with prismatic prescriptions.
It has worked with incredible success for us.

[AdmiralKnight]

You know, after reading this thread, I've realized it's been my ignorance on the subject more than anything giving me the opinion stated earlier... those guidelines sound great. I especially like the part about not testing anyone who hasn't had an exam from an OD for 4 years.

[tmorse]

mmmmmmmmmmmmm.............sweet urine, the perks of the job.:D

LOL:D Harry... you are one sick puppy at times.

[HarryChiling]

LOL:D Harry... you are one sick puppy at times.

So next time an optician tells you he used to have to grind lenses down by hand you can tell them it's a heck of a lot better than his doctor having to taste urine all day.:D

tmorse I can't help it that was just funny and a great example of why we don't do things the way we used to.

[Barry Santini]

I would say she makes about $20,000/month from my prescriptions

Correction, I would say that she makes about $20K/mo from her own sweat fulfilling those corrections.

Barry

[Golfnorth]

It sounds like you are a very honorable guy/gal, I wish we had more like you. I have worked in a practice where the doctor would say to us in front of the patient that we are sending them back to the doctor, but would scould us behind closed doors if we didn't try to sell them.

OK Stonegoat very honorable to send the patient back to the optical store down the street that referred the patient to you. My question is what happens in two years when the patient books an eye exam with you after your recall? Do you still send them back down the street or is it anything goes and you try to sell them glasses? If the latter is the case then you could be making the $20,000 per month back.

Regards,
Golfnorth

[AdmiralKnight]

I think that's an unfair question. For the first visit, the optical did the work to get those patients the exam. For the recall, the office did. Yes, the origional referral was from that optical, but if the optical was doing a proper job with THEIR recalls, then it wouldn't be an issue, and the patient should tell the office such.

[Stonegoat]

If the optician has created the kind of relationship with the patient that she should when she initially fills his Rx, then the patient will return to her without being prompted by myself.

[tmorse]

If the optician has created the kind of relationship with the patient that she should when she initially fills his Rx, then the patient will return to her without being prompted by myself.

I agree with Stonegoat. The Optician had the opportunity to build the initial rapport. But if it becomes an issue, the Optician can always take the necessary training to offer in-house 'sight-testing.;)

[HarryChiling]

I agree with Stonegoat. The Optician had the opportunity to build the initial rapport. But if it becomes an issue, the Optician can always take the necessary training to offer in-house 'sight-testing.;)

Ditto that, again it's hard to differentiate the business from what's good for the patient. Choice is a good thing, if they went to the OD and liked their office better than maybe you need to update your office, if their staff was nicer then maybe you need to hire nicer staff. I think stand alone refractions helps level the playing field a bit as the client no longer has to choose between the better refraction or the better glasses.

[LandLord]

The best way to solve the competitive advantage problem is for all opticians to go back to school to become OD's. Then the only problem will be too many OD's. Wait a second, we already have that problem so it's okay.