Dr RX

[AdmiralKnight]

I think we are obligated to give them what they are used to if it works...WHy fix something that is not broken (besides the RX) If one is satisfied I will match PD, seg ht, material, lens style etc..
It's only changed if specified.

I think we are obligated to give them what's best for them. If that means keeping them in a lens that's 20 years old, so be it. But you can't just automatically give them the same thing over and over again. Lens technology is contantly improving, and to limit somone to an older lens 'because it's not broken' is a disservice in my opinion. I will only copy PD's etc if and only when I know for sure I trust the person who took them. If not, it's my reputation, and my butt if it's wrong.

[drk]

How pertinent is this?

I just had two longstanding patients drop in this morning for (additional) copies of their SpRx's. I overheard them saying they wanted them to take out for "cheap computer glasses".

My receptionist asked if they would like to see what we could do for them, and they said "Well, Eyeglass World has a $50 special". Obviously, we choose not to provide materials and services at that level.

We released the distance Rx with add.


Later on, he called me back. Eyeglass World wants me to provide the "computer Rx". I explained to the patient that lens design services are part of the eyewear purchase. I design my own lenses for my optical, but since they've sought optical care elsewhere, I'd let the next professional handle their own lens design.

I immediatly got a call back from a youngster at Eyeglass World who again asked me for "the computer Rx". After explaining to him his responsibilities, he appealed to his lab manager, who he said was "making him get this information".

I offered to talk with the lab manager, but he was unavailable, and will call me back when he's not busy.


You see, this lens design issue can be very easily solved.

[Barry Santini]

Excellent!, drk!

Barry

[HarryChiling]

How pertinent is this?

I just had two longstanding patients drop in this morning for (additional) copies of their SpRx's. I overheard them saying they wanted them to take out for "cheap computer glasses".

My receptionist asked if they would like to see what we could do for them, and they said "Well, Eyeglass World has a $50 special". Obviously, we choose not to provide materials and services at that level.

We released the distance Rx with add.


Later on, he called me back. Eyeglass World wants me to provide the "computer Rx". I explained to the patient that lens design services are part of the eyewear purchase. I design my own lenses for my optical, but since they've sought optical care elsewhere, I'd let the next professional handle their own lens design.

I immediatly got a call back from a youngster at Eyeglass World who again, asked me for "the computer Rx". After explaining what his responsibilities were to him, he appealed to his lab manager, who was "making him get this information".

I offered to talk with the lab manager, but he was unavailable, and will call me back when he's not busy.


You see, this lens design issue can be very easily solved.

Bravo, you provided the necessary tools for a competent optician to fill your Rx to whatever the patients needs were, you owe them nothing more. I am glad to see you stood your ground and didn't provide a cheap par of glasses at your level of service, and I am also glad you didn't give your service away to the cheap eyewear retailer.

Now the patient has no choice but to trust this eyeglass shack (which we can infer will obviously make you look better) and they will value your service in the future if they chose to use it.

[drk]

Well I appreciate the support of two leading opticians on this one. The patients and the "optician guy" seemed perplexed at the concept. I'm probably going to look like "the bad guy that won't release the prescription" but what the hey.

If the Rx were BF, MF, SVNO or SVDO, then all the information is there. If they have "game" and can design occupational lenses, they have what they need.

What they really want is for me to design the lenses. That's not part of the eye exam, as we have noted here.

Apparently (sarcasm font), you can't hire professionals that understand optics in a $50 eyeglass joint.

That lab manager never did call me back...:D

[steff]

Look. I'm not infallable (I can't even spell it, so I definitely can't be it):D Yes.. occasionally I"ll come out with an rx that is 5 degrees off axis... I'm definitely not perfect. That being said, it is pretty rare, I also don't think anyone in their right mind would deliberately write out an incorrect script just to cost a dispenser money... holey moley!

I would be annoyed if a dispenser just randomly decided to take 0.75 off the script in order to make computer specs. I would expect to see the patient again, in order to determine the power of the appropriate intermediate add. If the patient tells me that Intermediate specs is what they want, then they will get an intermediate add on their script as well as a near and distance.

I will not write health information on the prescription. I think that that is between the optometrist and patient - I think that is confidential information. If they have ARM, and complain about their script to a dispenser, then I expect to see the patient again, as it means that they do not fully understand their condition.

I will also write stuff like 'warned about adaptation probs' etc, as I think it helps the dispenser to provide good information eg 'Yep Mr Jones, remember how your optometrist said that these glasses would make you feel a bit funny at first, instead of... have you had a large change in prescription?'

Look, as I see it, I only write other stuff down when I think it's important. I don't do it willy nilly, so I guess I expect that dispensers will do me the courtesy of realising that I've done it for a reason.

Last thing though, we don't have refracting opticians like you guys do... my opinions be different if we had them... (but then I think we'd have a lot more animosity between professions) :-)

steff

[Fezz]

I applaud you DRK!!!!


Way to go.

Now send them a bill for the phone consultation! :idea:


:D:cheers::D:cheers::D

[AdmiralKnight]

Awesome, awesome post drk! It scares me to think not one single person in that whole place could make a pair of computer specs from the script you gave them. Basic math for gosh sakes. I can somewhat understand it if this was just a young person, just starting in the field, but not a single person in the entire shop? Wow.

As for steff, I'm gonna step out on a limb here and say you'd probably be annoyed by a lot of people on this board. It's not rocket science once you have a full distance and add script to figure out how to make a set of computer lenses. With that info it's all down to the equations. If you know how far away they want to focus, there's definitely no reason for them to make another trip back in to see you. What happens if they don't tell you they want computer specs? If it comes up while they're in my dispensary that they also want computer lenses, I'm not going to call their OD up and ask for a refraction specifically for that, or else I'll get people like drk coming online and posting about how dumb I was :D

[odosou]

If they are getting a $50 special, my guess it would be single vision. If single vision, then can the optician "legally" adjust the Rx for the computer distance? If they are making an "Office" progessive near only lens then they have what they need. For single vision the add would need changed for the computer distance and would the optician be allowed to change that? Anyone know what the law would allow for this?

[steff]

As for steff, I'm gonna step out on a limb here and say you'd probably be annoyed by a lot of people on this board. It's not rocket science once you have a full distance and add script to figure out how to make a set of computer lenses. With that info it's all down to the equations. If you know how far away they want to focus, there's definitely no reason for them to make another trip back in to see you. What happens if they don't tell you they want computer specs? If it comes up while they're in my dispensary that they also want computer lenses, I'm not going to call their OD up and ask for a refraction specifically for that, or else I'll get people like drk coming online and posting about how dumb I was :D

I guess if we had well trained opticians, like you guys have/are, I'd be much more open to someone adapting my prescription. I completely agree with you... it's not rocket science... however, I think what would happen here, is people would just whack off 0.75 and call them computer glasses. Without a regulated dispensing course here, I really don't like 'any old Joe' playing with my rxes.

steff

[AdmiralKnight]

If they are getting a $50 special, my guess it would be single vision. If single vision, then can the optician "legally" adjust the Rx for the computer distance? If they are making an "Office" progessive near only lens then they have what they need. For single vision the add would need changed for the computer distance and would the optician be allowed to change that? Anyone know what the law would allow for this?

I guess it depends on what you would call adjusting. By making up a single vision computer spec, we're not changing the RX. In effect, it's the same as making a set of readers. All the info is there, it's just a matter of putting it together properly to make the lenses focus at a specified distance.

I guess if we had well trained opticians, like you guys have/are, I'd be much more open to someone adapting my prescription. I completely agree with you... it's not rocket science... however, I think what would happen here, is people would just whack off 0.75 and call them computer glasses. Without a regulated dispensing course here, I really don't like 'any old Joe' playing with my rxes.

steff

I can definably see where you're coming from. It's a total different ball game when you're dealing with Joe Blow who doesn't know the difference between a diopter and a dipstick.

[chip anderson]

First remember I am an independent optician/contact lens tech. I fit, adapt and modify or whatever is needed to achieve the best contact lens fit possible (at least to my own satisfaction). I get Rx's that have spectacle Rx and the words "O.K. for contacts" on them. I don't want Rx's that are more specific.
Now when a patient comes buy and asks for his prescription, do I really need to give him any more of an Rx than the one I recieved. To I need to supply the "girl" from Wally-Mart or the doctor's office with more? They usually only ask for the Rx, being too dumb to ask for contact lens specs (and no one really ever asks for history, origional K's or other important things). Of course they usually call back later and ask for Contact lens Rx (still haven't wised up enough to ask for CL spec's.) Often these people only ask for "the brand". Having no clue that each brand may have many fits.
If you don't calulate the "computer Rx" why should I have to do thier contact lens fitting for them. Especially knowing that half the time they will come back with contacts from thier doctor's office or dispensary wanting me to find out what's wrong with them (or worse yet wanting me to look and tell the doctor what's wrong). Of course I don't do either.

Chip:bbg:

[AdmiralKnight]

It's a little different here in Canada (or atleast NS) when it comes to contact lens fittings. If I have someone come in who's bought contacts from you down the street, I can't just call you up and get the specifics and give them a set of contacts. We have to do a full fitting before they can get any lenses. We have lots of people come in "I wear -5 accuvues, can I buy a box?" Nope. Not unless you've had a fitting here before. I dunno if it's law (I'm not a contact lens fitter myself) or just everyone's pretty much on the same page, but that's the way it's done here.

[odosou]

I understand what you are saying about contact lenses, it is completely different how they perform on the eye, so you often have to adjust the Rx to get the best vision. But would you do that with a pair of single vision distance glasses.... If you change the Rx that I wrote for single vision distance then you have become the prescriber not me. So with that argument how could you change the add to get the computer Rx without prescribing and at least in Ohio would that be prescribing without a license?

[AdmiralKnight]

The thing is though, that add is for a specific distance. Knowing that, you can extrapolate what your refracted power would be at a different focal length. It's using your refraction, just set to a different length to that which you wrote on the actual piece of paper. Saying that it's changing the Rx is like saying making up a pair of readers is changing the Rx. It just isn't. It's using the rx you prescribed, just not exactly the same way as it's written.

[gemstone]

Consult your local board. Mine says if there is no medical reason, make note on the back and fit as you please.

[obxeyeguy]

Later on, he called me back. Eyeglass World wants me to provide the "computer Rx". I explained to the patient that lens design services are part of the eyewear purchase. I design my own lenses for my optical, but since they've sought optical care elsewhere, I'd let the next professional handle their own lens design.

Thank you DRK. All I want is to be able to do what I am good (trained) at, no more, no less.

[OHPNTZ]

I don't look down on opticians, and I am fortunate to work along side a very talented one in my office...but...

My concern is that in your mind, you are computing focal lengths, diopters, base curves, etc...when in my own mind when determining refractions / contact lens fits I'm assessing ocular health/physiology, visual function as a "system", previous and current ocular history.

Even with my optician (who also fits CLs), I have seen a few times where he would fit without regard to health or physiology... Also, I am concerned with the optician fitters who may overlook ocular health signs while in the process of the fits...that's my only concern.

With specs, I don't suggest types of lenses (I don't even know what all is out there...that's where I rely on the Optician) for fitting. I do have a problem with those who will do over-refractions over the specs. I don't have a problem with those who would change an add...however, I would caution that when I determine an add, it's not always based on a standard 40 cm working distance. IF you assume that it is for and add adjustment, or computer use lens, you may be making an error...

[npdr]

First remember I am an independent optician/contact lens tech. I fit, adapt and modify or whatever is needed to achieve the best contact lens fit possible (at least to my own...

I have no arguement about fitting contact lenses, but because you are so adamant about your privilege to do so...

1. Would you think it is acceptable to fit contact lenses, and change its prescription to allow for monovision when it was not originally intended?
2. Would you purposely change a spectacle prescription by adding any kind of lens power to get a certain level of acuity when you weren't sure why the prescriber wrote the rx that way?
3. Would you change a OU Plano +6.00 ADD written in bifocal form but stated in SV near only form and make it as a bifocal?

[chip anderson]

NP:
1: I try never to fit monovision (only lazy physicians think this is acceptable) I fit bifocals and trifocals. Only if the patient is already in monovison and happy with it or if I have exhausted all possible binocular options would I fit monovision.
2) Are you talking about a contact lens with Plano and a +6.00 add? Can't say I would mess with this.
3) Whenever I fit contact lenses as I mentioned, I have an Rx with "O.K. for contact lenses" on it. This used to mean (before O.M.D.'s got in the optical merchandising field) that the doctor was saying: "The eye is healthy enough for contact lens fitting and accepting legal responsibility for what was done."
4) Whenever I cannot determine what is wrong (I usually can spot any corneal disturbance) or if I can and it is beyond a ("linear punctate stain from dust.) I send the patient back to the doctor, if I can actually get the doctors people to see the patient promptly enough to be of some use.
5) I also do as much as I can to promote the patient returning to the prescribing doctor for annual (or as advised by the doctor) exam..

What problem do you have with this?

[HarryChiling]

Would you change a OU Plano +6.00 ADD written in bifocal form but stated in SV near only form and make it as a bifocal?

Yes, before you go into explanation if you wanted SV Near Only you should write it as SV Near Only, by writing it in bifocal form you are suggesting that the patient has the option of getting it this way.

Would you purposely change a spectacle prescription by adding any kind of lens power to get a certain level of acuity when you weren't sure why the prescriber wrote the rx that way?

I would only change the Rx to compensate for any change in the spectacle plane. (tilt, vertex, NVEE, focal changes, etc.) By just saying I compensated I could just about put any prescription in the eyewear between . So changing the power is unnecesary. (and before any naysayers attack this post, it is the same as putting more faceform or panto tilt to glasses)

Would you think it is acceptable to fit contact lenses, and change its prescription to allow for monovision when it was not originally intended?

Yes, but not chaneg the prescription just use the one provided.

[AdmiralKnight]

Would you change a OU Plano +6.00 ADD written in bifocal form but stated in SV near only form and make it as a bifocal?

If you write it as a bifocal rx, you're stating it can be used as a bifocal as well... now, wether or not I'll be able to make a plano, +6.00 add is a better question. I don't think I can get a +6.00 add :hammer:

[chip anderson]

SeaFarer:
Bout time you learned about Franklin Bifocals. You can make 9's, 10's or whatever.
Course you can't do this in a contact lens.

Chip

[npdr]

I disagree that writing a prescription in bifocal form and saying SV only means that it could be dispensed as bifocal. It just means that you get the notion that the distance rx is nil and maybe that is for convenience. I believe that a prescription with an add can be dispensed as bifocal. Never the prior though. I would hope the dispenser would just fill it as written and nothing else.

I do a fair amount of low vision and I sometimes get these calls for +6.00 adds. I say, fill as SV only! What, you cannot read? Trying to make a bifocal sale? Geez!

[chip anderson]

I have subnormal vision patients who either wear contacts or need nothing helps at distance so if they desire to walk around in the shopping center or see across the room without taking thier glasses off, I make a Franklin bifocal. I have one patient who amoung other things needs a very high add to see the cards but wants to see the other players so we made him high add bifocals for this use.
While many subnormal patients get "written off" as not being intelligent enough to look at anything but picture books, some are quite smart and we try to enable them of do as many things as they want if we can.

Chip