Dr RX

[LandLord]

To help in getting back on topic,

The only thing I consider to be a prescription is a measurement of the refractive state of the eye. Or, said another way, the effective power of a lens to correct lower order aberrations. ANYTHING ELSE on an rx is extra information which may or may not be helpful.

I will routinely agree or disagree with extra notes on an rx, however, I will never (99.99%) attempt to change effective powers. Mind you, I may certainly change actual powers of a lens to achieve the result desired by the refractionist -- readers, computer glasses, etc.

Example:
New Rx:
R -2.00 -0.75 090
L -1.75 -1.00 080
ADD +2.50
Rx states "Nikon i"

Old Rx:
R -3.00 DS
L -3.00 DS
ADD +2.00
Patient is wearing Ess. Natural.

Patient wants lowest possible price.
Patient states no problem with current lens design.
I will put him in Natural.

In the above example, the patient will always complain. And I guarantee it's because of reduced minus at distance and increased plus at near. Not because of the progressive design.

After I fill this disasterous rx, I will send him back to the prescriber.

[Johns]

After I fill this disasterous rx, I will send him back to the prescriber.

...who will then proceed to blame you!;)

[LandLord]

...who will then proceed to blame you!;)

Naturally.

[npdr]

An area Optometrist once wrote an Rx with the OD in -cyl and the OS in +cyl form. Before I would spend MY money on a re-do, I called him , just in case a transcribing error had occured. He answered with the same arrogant attitude..."Just transpose it!!".

I was furious. I had to waste my time with a phone call because of his lack of refractive discipline. OD phoropters are designed to be read in -cyl, and I reasonably expected all OD Rx's to be written in -cyl form only.

So, perhaps you can enlighten me. Exactly why would you choose to alternate your Rx form, -cyl to +cyl, one day to the next?

tmorse,
Before you get hot and bothered, OD's sometimes don't get to choose their phoropters and although most like minus cylinder phoropters, I write on the Rx what the phoropter says and don't waste time transposing it. So I would respectfully check whether you're prescriber has the same issue as I have.

In other words, I would have told my nurse to say to you "transcribe it". I would, though, respect a call to verify the Rx. I just hate smart aleck opticians.

[AdmiralKnight]

But does your phoropter measure one in + cyl and one in -? I've had this happen more than once, from different ODs. most of the time it was a mistake, but twice (I think) It was supposed to be like that, and for the life of me, I still can't understand why.

npdr, you didn't answer the question. I'm curious too as to why you would write in plus cyl one day and minus another. Is it because of different offices, with different equiment?

[npdr]

Yes. I even have different phoropters in different rooms. 2 of 3 are plus cylinder.

[tmorse]

tmorse,
Before you get hot and bothered, OD's sometimes don't get to choose their phoropters and although most like minus cylinder phoropters, I write on the Rx what the phoropter says and don't waste time transposing it. So I would respectfully check whether you're prescriber has the same issue as I have.

In other words, I would have told my nurse to say to you "transcribe it". I would, though, respect a call to verify the Rx. I just hate smart aleck opticians.

As you appear to be an OD working for OMD's, you can still show basic OD professional courtesy and 'waste some time' transposing to -cyl if your RX's are under your own name. Don't you take pride in your OD designation. Is it really that much trouble, or are your transposing skills suspect?

By the way... tell your nurse to get you a dictionary for Xmas

Webster's Dictionary: Transcribe, v.y., to make a written or typed copy

Not to be confused with "transpose".;)

[Dannyboy]

Funny
Dannyboy

[npdr]

As you appear to be an OD working for OMD's, you can still show basic OD professional courtesy and 'waste some time' transposing to -cyl if your RX's are under your own name. Don't you take pride in your OD designation. Is it really that much trouble, or are your transposing skills suspect?

By the way... tell your nurse to get you a dictionary for Xmas

Webster's Dictionary: Transcribe, v.y., to make a written or typed copy

Not to be confused with "transpose".;)

Correct tmorse. Since I dictate all of my notes, I usually ask the nurse to find the transcription on the computer (EMR). If you do suspect someone's skill, then don't fill it. Just tell the patient to go to another optician. In the meantime, I'll know and never refer to you again.

I find it difficult to fathom why you question skill or knowledge, it would be best that you keep that to yourself. Such a position will not be received by any prescriber.

It is not about pride that plus or minus cylinder are written. I write them down, and I really don't care where it gets filled. I just tell the patients if the optician that they went to didn't want to fill it, then they should go find someone who will. If the optician doesn't want my business or is hassling me too much, I jus give out the two cards of two other opticians. Simple.

[tmorse]

I find it difficult to fathom why you question skill or knowledge, it would be best that you keep that to yourself. Such a position will not be received by any prescriber.

Displays of Optometry arrogance disturb me. You obviously have no regard for the third 'O' in eyecare, the Optician. Start paying for you own OD re-do's and maybe Optometry will be better received.- Smart Aleck

It is not about pride that plus or minus cylinder are written.

Of course professional pride is involved. Ophthalmologist pride... as a group they refuse to adopt the OD -cyl phoropter, even though I am sure phoropter manufacturers would love it stock only one (1) cyl type for inventory purposes.
Most stock lenses are bagged in -cyl and lab price sheets are in -cyl, so I too prefer -cyl Rx's. All it would require is that manufacturers all agree to discontinue all production of +cyl phoropters... the old guard OMD's would gradually die off, their +cyl phoropters would become boat anchors, and the need for transposition would eventually cease.:D

[npdr]

Displays of Optometry arrogance disturb me. You obviously have no regard for the third 'O' in eyecare, the Optician. Start paying for you own OD re-do's and maybe Optometry will be better received.- Smart Aleck...'

I believe that the third "O" just have to do their job that is all. It's not arrogance.

[Ory]

Start paying for you own OD re-do's and maybe Optometry will be better received

That is a weak argument. We all know most redos are due to patient error, not doctor error. If you started charging us For redos, the cost of an exam goes up. The patient pays for it regardless.

[Dannyboy]

Writting one in plus and one in minus I call that ODiotic. I like it better when they write Rx in .12 or better yet when their penmanship is bad. Or when they leave the signs out or when its the third remake an they call you in private an tell you the patient is "inconsistent", but at least they called! I Find it funny that we (the public) had to have a law written so that the "prescribers" write legible. Just as in grammar school!

Despite all this ODs are good people...they can write what they want in suggestion box and I think it should be followed as long as it logical.

I personally like them better if they did not dispense...but that is another story.

My favorite error is when progressives are upside down or in the wrong eye...wonder if that was from an Optometrists store or an Opticians store? Getting old so i forgot...

Dannyboy

[tmorse]

That is a weak argument. We all know most redos are due to patient error, not doctor error. If you started charging us For redos, the cost of an exam goes up. The patient pays for it regardless.

Humbug!!;)

[HarryChiling]

That is a weak argument. We all know most redos are due to patient error, not doctor error. If you started charging us For redos, the cost of an exam goes up. The patient pays for it regardless.

That's true Ory, but the patient see's where the charges actually come from in certain cases. The better docs won't have to worry about it affecting business too much the ones that pump out scripts will have to raise their costs to adjust for the number of those scripts that come back.

I don't think it's fair that the optician, or lab pay for it. It has been traditionally done that way because doctors didn't dispense and it was the opticians way of keeping refferals, but the model has changed so this is an area that should be chaneged as well.

[Jubilee]

Its not exactly fair to the optician to burden the costs for errors that are not their own either.

While a good portion are patient inconsistancies, there are times where I have found other doctors or their offices rude.

Patient comes in with new rx, wants to fill it with me. Patients current glasses look nothing like new rx. Verify old powers and patient has over 7 diopters of horizontal and 1.5 vertical in old pair. No prism in new rx. Called prescribing doctor's office for rx check. Not in on Wednesday. Wait till Thursday call again. Finally someone answers around 1pm Thursday and I explain what the problem is. After 5 mins, the tech gets on the phone and tells me to order and dispense as written.

Patient has had no indication from the doctor that there was a major change in rx. I explain to the lady that I "had" to order as written. The glasses come back from insurance (Davis) 3 weeks later and patient instantly complains of double vision. I ask her to try them and gave the referring doctor a call to give them a heads up.

Patient calls back and says she can't use them. Tried for 2 weeks. Over 3 MONTHS the patient kept being told that she needed to get used to them till her regular doctor gets back from leave and sees her. He told her that "I can not believe they didn't call when there was no prism in these. That should have been a dead give away." Lady at least responded that she was present when I did call...

Of course, now it is past time for insurance to cover remakes. After writing on behalf of patient, and several calls, finally get them to "refund" her and then reissue her pre-purchase benefit so she can get her glasses, 4 1/2 months after she initally came in....

This is why phone calls, and "communication" outside of the rx itself doesn't always work. If you can't get through the beauracracy and stuff to get the actual problem resolved.. it won't satisfy anyone..including the patient.

[chip anderson]

I have had doctor's offices (thier optical expert) tell me: "You neutralize the old ones and put the prism in. We can't do that with the prism and all." This from an M.D.'s office that is supposed to be retinal specialist as well as general ophthalmologist.

Appearently this doctor's office didn't even know how to neutrallize, prescribe, or use prism. Incidentally this was not a PAL.

Chip

[HarryChiling]

I have had doctor's offices (thier optical expert) tell me: "You neutralize the old ones and put the prism in. We can't do that with the prism and all." This from an M.D.'s office that is supposed to be retinal specialist as well as general ophthalmologist.

Appearently this doctor's office didn't even know how to neutrallize, prescribe, or use prism. Incidentally this was not a PAL.

Chip

More common than you think. I have had offices tell the patient the PD's were off instead of neutralizing the prism, then the patient comes in ticked off that we made the last pair with the PD's off and then they see double out of the new pair and think we are the boobs.

[Barry Santini]

This is why phone calls, and "communication" outside of the rx itself doesn't always work. If you can't get through the beauracracy and stuff to get the actual problem resolved.. it won't satisfy anyone..including the patient.

Yes, Jubilee (sorry), but this is also a clear reason that the vision industry is being held "hostage" by insurance.

What utter nonsense!

Barry

[HarryChiling]

this is only a suggestion,receit

Great now we got the last "O" on the food chain the Orangutang who just wants to advertise his company by posting garbage.

[Fezz]

Great now we got the last "O" on the food chain the Orangutang who just wants to advertise his company by posting garbage.

Harry,
Your being much to nice! You can only imagine some of the names I've been calling IT !!!!!

[chip anderson]

How can a re-do be due to patient error. It's not like they can overdose, or underdose or take the medication at the wrong time. The doctor is in charge of writting the Rx, total control, if he's any good he has a damn good idea of the Rx after dilated retinascopy. Patient response to his his questions should have little if any effect on the final result. Not to mention if he uses a reliable (if there is such a thing) automated machine before he starts, what has the patient got to do with poor Rx?
Is he telling the doctor I want to see distance at only 10 feet, or read at 10 inches?
Chip

[HarryChiling]

How can a re-do be due to patient error. It's not like they can overdose, or underdose or take the medication at the wrong time. The doctor is in charge of writting the Rx, total control, if he's any good he has a damn good idea of the Rx after dilated retinascopy. Patient response to his his questions should have little if any effect on the final result. Not to mention if he uses a reliable (if there is such a thing) automated machine before he starts, what has the patient got to do with poor Rx?
Is he telling the doctor I want to see distance at only 10 feet, or read at 10 inches?
Chip

Chip,

I agree and don't agree with some of that. Let's start with don't agree, I am one of those patients that doesn't like my full Rx so I understand that the Rx is fluid as Barry likes to call it and one day I may like to have more minus than I would the very next day. So there is a comfort thing involved with the Rx, but I also know that the doctor I see knows that and if I needed to see him again some other day he would more than likely say that instead of jump to write me an Rx. I have even heard of some doctors that play relaxing music in their waiting rooms and try to tone down any unnecessary stimulation in the transition from outside to exam room to get the patient ina comfortable place for making the best decisions when behind the phoropter. Now where I agree with you, the Rx is never due to a patient error. Either the doctor rushed through the exam, the timeing for the exam wasn't right, or the glasses were fabricated outside of tolerance. That is what I see a majority of the time in our office, I only have control over the fabrication which if I goof I pay for. The exam is all doctor, if the patient is giving eradict responses to the choices, trial frame them and have them walk around for a while to see if that was really the choice they wanted. If the patient is rushed or stressed deal with that issue before refracting for more accuracy. Those are just my opinions, but if I had a dollar for every patient that felt they were too rushed during the exam or were stressed out during the exam I wouldn't be here typing.

[Stonegoat]

Chip,

I think the largest cause of redos in my office is the inability of patients to adapt to some change in their Rx. For example, I may have a patient who has a habitual Rx of -2.00-175X167 (20/25-) from 10 years ago. The patient's chief complaint is poor distance VA. I may find the patients new refractive error to be -2.00-175 x 002 (20/15). I realize that to Rx the new findings will likely not be tolerated well, so I may split the difference to something like -2.00-175 x 175. Most patient will adapt to the change after a week or so, and appreciate the improved VA, however some just can't adapt, so I may have to redo something closer to the habitual. Refraction is as much art as science, and there will always be a few patents who cannot adapt to changes in their Rx. If you are an optician, you need to accept this before filling the Rx, or send the patient to someone else who is willing to take the risk (albeit small) of a redo.

[chip anderson]

Stonegoat:

Seems to me I remember when changes (or even the origional Rx for) in cylinder were large, the prescriber would only prescribe part of that found and slowly increase this over the next few years. Is this no longer standard proceedure?

Chip