Dr RX

[HarryChiling]

I know that someone on this list confused esophoria and esotropia. There would be very few ODs that would confuse the effect of a subjective and objective angles of deviation in configuring glasses.

I know it is a stretch, maybe, but how can you say you understand low vision?

That was me that mixed the terms up, but not the condition. Don't get it twisted I have sat through the same training that OCT get on low vision and can confidently say we both don't have a clue as to what we are doing, to an extent. I at least have knowledge in the optics. I am amazed that you would find an OCT more qualified than an optician for LV. Not to say that all opticians are qualified, but I have not meet any OCT that are qualified, it's just another area to bill for them. By the way the training I attended was more focused on billing than on provideing the correct optical aids and when questions came up from OCT their lack of knowledge in the field was disgusting.

Their was recently an OD on this board in another thread that said some pretty dumb things concerning prism and you think they would know better, right. I brought up more than a few instances in this thread where the patient could be better served by the doctor provideing more information to the optician who provides a very valuable and necessary service based on the information gathered by the OD, but rather than discuss the merits of those issues they were picked apart for semantics or lack of the proper term. In reality, the information does not belong to you, it belongs to the patient. If you really believe that by holding information hostage for the patient you are doing them a favor or provideing better patient care then this thread has really outlived it's use and I am disgusted. Lately the more I talk to OD's the more arrogant and self serving the attitudes seem to be getting.

Last time I get smacked in the face with an olive branch I try to extend.

[npdr]

HarryChilling,

Back to the thread. If you were doing low vision, what kind of information would you want on the script?

[HarryChiling]

HarryChilling,

Back to the thread. If you were doing low vision, what kind of information would you want on the script?

I explained to you before I am not qualified to do low vision, but I am qualified by experience to say without VA, VD, and ceratin conditions I can't perform my role in the process adequately. That is why i have commonly taken a stance that OD's are greedy. I have heard your professions battle cry all my years, "That's not good for the patient". Yet with holding relevent patient information while beign told that this information can and will provide your patients with better care seems to fall on deaf ears. It is not for you to decide what iformation I need to perform the best for the patient, it is your job to provide the patient with the relevent information to get good care so do it and shut up already, or don't and stop with the holier than thou crap.

[Stonegoat]

NDPR...you do come across as pompous. The problem with low vision care, at least in my region, is inadequate personell to deliver services. I would be more than happy if a qualified LDO was interested in providing those services in my area...I simply don't have the time.

Harry...why do you always bash ODs as a group rather than take issue with those individuals that you have a problem with. The majority of ODs that I know are good and honest people, who try to do what's best for their patients. Sure there are a few that are only interested in $$, and maybe those individuals have been problematic for you. However, I can name more than one LDO who offers horrible service with inferior products and shady sales tactics...should I paint you with the same brush as those distasteful individuals??

[obxeyeguy]

5. The optician is important, though, as a purveyor of the goods.

You assume you know our educational backround, and continually talk down to us. Do you really believe that all we have is a 20 minute correspondence course from the university of phoenix? Just do as I the doctor says, no questions.

Personally, I don't, and have never done low vision, so I can't debate that equally with you. But your condescending attitude towards opticians is becoming more transparent. Now we are purveyors, kind of like the kid that served your happy meal, right? Move on doc.

[npdr]

Only when talking about low vision, that's all. I said the LDO's do a great job on the other stuff.

[HarryChiling]

NDPR...you do come across as pompous. The problem with low vision care, at least in my region, is inadequate personell to deliver services. I would be more than happy if a qualified LDO was interested in providing those services in my area...I simply don't have the time.

Harry...why do you always bash ODs as a group rather than take issue with those individuals that you have a problem with. The majority of ODs that I know are good and honest people, who try to do what's best for their patients. Sure there are a few that are only interested in $$, and maybe those individuals have been problematic for you. However, I can name more than one LDO who offers horrible service with inferior products and shady sales tactics...should I paint you with the same brush as those distasteful individuals??

I get painted with that brush every day. In the previous posts I was painted with that brush, the term optician when refered to in this thread is not the same optician I refer to, npdr seems to want to refer to the mctician who barely knows his a$$ from a hole in the ground. I am refering to the many opticians I have meet and look up to that are so far engrossed in optics they make me feel retarded.

I hav not meet very many good OD's, mainly becuase of the competitive nature of our work. Low vision is tied hands down to the optical devices their are no if ands or buts, the opticiasn that provide this service are not just handing people different magnifying glasses and hoping for the best as npdr would like to make it out to be. I have however meet OCT that do this, they have no clue how the optics work or how to provide the right device for the right situation. I have seen patients come into our office with large heavy magnifiers that they were given when their need was reading a book. How do we know that this was the need when they saw an OCT, we sent them there. In the previous example of prescribing a 2x lens how does that help int he slightest? The problem is more compicated than that. The rehabilitation comes in the fact that the person provideing the service needs to show the patient the correct use and the correct illumination, the correct scenario where the particular device is to be usefull and also the areas in which the device would be contraindicative, and yes if the patient is reading a book with a heavy a$$ magnifier then they are going to quit.

But rehabilitation is different. You cannot separate the rehabilitation from the low vision. Of course you will get results but you want to do rehabilitaiton without doing the sweat to get certified (as OTR). You also don't want to go to OD school so you can better understand low vision diagnosis and etiology.

It is somehow assumed OK for the OCT to dabble in optics without the certification (ABO) or whatever, but the other way around isn't OK. That's ridiculous.

OD School, that is insulting again I don't want to be an OD. I can't understand how any OD can have spectacles in their offic an accuse me of trying to be them when they are trying to be me. Opticians provide eyewear and optical devices, we are the best suited to perform these services. As for the diagnosis, I don't want to diagnose it I want you to provide the patient with the diagnosis so that I can help with the proper devices. npdr has a problem writing down the proper information, heck why not just leave the add, and minus or plus signs off of all the scripts so we can't find out any of the refractive conditions as well.

Harry...why do you always bash ODs as a group rather than take issue with those individuals that you have a problem with.

Lately the more I talk to OD's the more arrogant and self serving the attitudes seem to be getting.

That was the only thing directed at OD's and it has been true from my recent experiences.

[HarryChiling]

Only when talking about low vision, that's all. I said the LDO's do a great job on the other stuff.

The threads not about LV, it was only steered that way to stroke your ego and give you examples from you verylimited area of practice and now your so arrogant we can't talk about that because you are the LV god right.

[npdr]

The threads not about LV, it was only steered that way to stroke your ego and give you examples from you verylimited area of practice and now your so arrogant we can't talk about that because you are the LV god right.

You're correct about the direction of the thread going this direction. But it was about prescribing information. Even if we added it, there wouldn't be enough room.

Ok Well said.

[steff]

. Lately the more I talk to OD's the more arrogant and self serving the attitudes seem to be getting.

Harry,

I find this quote insulting. I believe there are good opticians, and bad opticians. Just like I believe that there are good ODs and bad ODs. I think it is unfair that you have just decided that ODs are arrogant, greedy and self serving... ?

I have found a lot of your posts insightful, and thoughtful, and have certainly learnt lots from them, however the last few posts about a profession in general, I have found a little spiteful.

Have a great day.

steff

[steff]

NPDR,

I'm with Stonegoat on this one. You are coming across as arrogant, and pompous...

purveyor of goods??? That makes them sound like a haberdasherer!!!


Come on everyone... let's go with MUTUAL respect and recognition. I know for a fact, that if I had to make a Franklin bifocal, I'd be up the creek without a paddle.

If Harry mixes up a trope and a phoria, give him a break!

Have a great day everyone!!

steff

[npdr]

Steff,

Point taken

[Dannyboy]

NPDR you'll be amazed what an optician can accomplish in low vision.
As for "measuring the field of vision" you'll be surprised what a patient can describe. If your talking about using field expanders such as prisms for those with limited VF or using excentric fixation or trying some how relocate the image to areas of the macula that are healthy you are not the only one that has tried that, in fact there was an outfit in Tampa that did that an they were not even opticians. I guess if it was for you even a pair of readers would need to be "prescribed". In Florida and in many other states Opticians are helping people see with low vision aids. I do not understand why you are so against opticians helping people. Low Vision does not provide good income as eyeglasses. Maybe you are complaining because the CCTVs mark up is no longer that great. I dont know what is your problem but there are not to many ODs trained in low vision and if anyone can help the better. Better a trained Optician than a mere receptionist working for you. People with low vision need help and your arrogancy toward opticians that do help seems unexplainable.

Dannyboy:(

[steff]

Thanks NPDR...

Have a fantastic day!

steff

[HarryChiling]

Harry,

I find this quote insulting. I believe there are good opticians, and bad opticians. Just like I believe that there are good ODs and bad ODs. I think it is unfair that you have just decided that ODs are arrogant, greedy and self serving... ?

I have found a lot of your posts insightful, and thoughtful, and have certainly learnt lots from them, however the last few posts about a profession in general, I have found a little spiteful.

Have a great day.

steff

Sorry, I find myself more and more offended from patients and then I come onto a board that is supposed to be professionals and I see where my clients get their disrespect from. I didn't mean to offend you, I have always found you open minded.

[npdr]

'.... People with low vision need help and your arrogancy toward opticians that do help seems unexplainable.

Dannyboy:(

I'm waiting for them to show up. I'm waiting for the LDO who can talk more about an aid. I'm talking about the rehab portion. That is all. If the LDO can talk rehab, I'm with t hem. Any LDO want to talk about testing and rehab? If not then accept the fact that LDOs do 1/3 of the low vision pie and if they do that well. Great. And if they are the only ones doing it, great. More power. But please don't try to tell me that you know what low vision is in its entirety. Please don't try to tell me why you don't know why OTR' s make more money on low vision than either you or I. Yes, they can bill up to 2500 /year where I can only bill maybe 500/year.

[HarryChiling]

I'm waiting for them to show up. I'm waiting for the LDO who can talk more about an aid. I'm talking about the rehab portion. That is all. If the LDO can talk rehab, I'm with t hem. Any LDO want to talk about testing and rehab? If not then accept the fact that LDOs do 1/3 of the low vision pie and if they do that well. Great. And if they are the only ones doing it, great. More power. But please don't try to tell me that you know what low vision is in its entirety. Please don't try to tell me why you don't know why OTR' s make more money on low vision than either you or I. Yes, they can bill up to 2500 /year where I can only bill maybe 500/year.

Wow, we're not even 1 full day into 2008 and Mr. Donkey of the year emerges, take a bow and accept this award.

[npdr]

Thanks. Gladly taken. last message on this thread.

[Teamwork Marketing]

The debate here exemplifies the difficulties faced by our partially sighted senior citizens. The fact is that ECPs have a responsibility to apply their training and a caring approach toward diagnosing, treating, and rehabilitating these patients. Those who bemoan the compensation and/or continually fail to meet patient expectations should consider another profession or team with multiple ECPs who are trained to provide the specialized services these patients need to acquire independent living tools and skills.

A multidisciplinary patient-centered approach involving the appropriate combination of specialists: Ophthalmologists, Retina Specialists, Optometrists, Opticians, CLVTs, and/or low vision trained Occupational Therapists, is best. It greatly helps to properly identify specific patient needs and puts them in the hands of those best skilled in each step of the process.

[HarryChiling]

A multidisciplinary patient-centered approach involving the appropriate combination of specialists: Ophthalmologists, Retina Specialists, Optometrists, Opticians, CLVTs, and/or low vision trained Occupational Therapists, is best. It greatly helps to properly identify specific patient needs and puts them in the hands of those best skilled in each step of the process.

I could agree with that, but when the when a link in the chain believes he/she is the bees/knees and belittles every other profession that could possibly offer assiatance you end up with qualified and competent people that may be turned off from even ventureing into this area of opticianry. What if the arrogance of this guy here causes someone to think they would never be qualified to provide these services? This is not patient care. Our office does not provide LV, however we have available many resources and can point patients in many directions and provide assistance along the way even thoguh I can't bil for it. In many cases their are "LV Specialists" OCT that refer to them selves as specialists that are just in it to bill for it. Opticians can and do provide this service very well to many people in this country and it's a shame that someone who deems himself a specialist is so arrogant.

[Teamwork Marketing]

WOW!
I had no idea that my suggestion for a multidiciplinary approach for the benefit of the patient would be viewed as arrogant. I think I'll stick with my consulting business and let you guys go at it. Clearly, with over 3,500 OptiBoard posts (compared to my 2), this Harry Chilling is preoccupied.

The fact that he directs patients as he does is positive. However, his view of low vision trained Occupational Therapists is bias and unfair. They are highly trained medical professionals who see patients that must be referred by an Ophthalmologist or Optometrist. OTs provide and routinely bill for prescribed Medicare services: 97003 OT Evaluation, 97530 Therapeutic Activities (eccentric viewing), 97532 Development of cognitive skills, 97533 Sensory integrastive techniques (use of low vision aids), 97535 ADLs (Activities of daily living), 97537 Community/Work integration, and more.... all proven as beneficial Medicare services for seniors. Call me arrogant.

[HarryChiling]

WOW!
I had no idea that my suggestion for a multidiciplinary approach for the benefit of the patient would be viewed as arrogant. I think I'll stick with my consulting business and let you guys go at it. Clearly, with over 3,500 OptiBoard posts (compared to my 2), this Harry Chilling is preoccupied.

The fact that he directs patients as he does is positive. However, his view of low vision trained Occupational Therapists is bias and unfair. They are highly trained medical professionals who see patients that must be referred by an Ophthalmologist or Optometrist. OTs provide and routinely bill for prescribed Medicare services: 97003 OT Evaluation, 97530 Therapeutic Activities (eccentric viewing), 97532 Development of cognitive skills, 97533 Sensory integrastive techniques (use of low vision aids), 97535 ADLs (Activities of daily living), 97537 Community/Work integration, and more.... all proven as beneficial Medicare services for seniors. Call me arrogant.

Sorry if that came off as directed at you it was not, the previous posts would give you a bit of explanation, I do like a multidiciplinary approach like you mentioned. I pretty much iked the entire idea, my previous post was just pointing out that sme in the profession believe that only their particular part of the patients care is important. Ophthalmologist, Ocupational Therapists, Optometrists, Opticians, and even Ophthalmic Medical Professionals all cn and do provide care in LV. Again if I came off as directing my statement towards you I apoligize.

I understand that Ocupational Therapists are professionals, however when it comes to devices an optician that provides low vision services is just as capable if not more capable in this area, IMO.

3,500 posts, just goes to show you my addication for this board nothing more.

[Teamwork Marketing]

Harry,
Your generalization of OT capabilities is wrong. A Certified Low Vision OT has a degree in Occupational Therapy and has been trained and tested in a full array of rehabilitation services that go far beyond that of an Optician (see Medicare Codes in my earlier post). They are trained to identify activities of daily living (ADL) goals, detect and teach eccentric viewing skills needed to use devices, and only then help patients select and use the best devices for achievement of their goals.... often in the patient's home. Don't be too quick to compare their skills to yours.

[Oedema]

I think the problem we're seeing in this discussion is that there are possibly three different, yet somewhat overlapping and contiguous aspects of providing low vision care. I haven't by any means put much though into this...but I'm thinking there is the;

1. LV evaluation
2. Provison of LV aids + adaptation
3. Rehabilitation


Some of the posters here are speaking mainly about #1,2 or 3 and not realizing the importance of the other steps along the way. I think that this is were much of the conflict is coming from.

It might be helpful to step back and think about all of the services needed by patients that are on the continuum between partially sighted and totally blind - not all of these people will be helped by an optical aid, but there certainly are things we can do for them or services we can refer them to for improved activities of daily living.