Changing Rx's every year

[slate83]

I would like to know some of your professional opinions on spectacle prescription changes.

Do you feel that Rx's should change every year?

I have worked with Dr.'s who change people's Rx's every year and I have worked with Dr.'s who rarely change an Rx. Those Dr.'s who rarely change an Rx have told me that people from 40 - 60 yrs old should have a fairly stable Rx.

[Jeff Trail]

I don't think there is an "answer", depends on the OD or MD and how much they feel like making.
I know that refracting is not an exact science especially since we are dealing with a flexible thing like vision..where if you took the same person and went to 5 OD's over the length of one day you would have a variety of RX's. They maybe within a .25 or so and the axis can change from 0 to 7 or so degree's (or more depending on the amount of cylinder) ..how we see in the morning gets gradually worse over the day and the more we work the eye it will become worse..
All that said, I worked with an OD once who I thought really had some great idea's.. he actually explained (which we hardly see anymore) the RX to the patient and if it was only a .25 or so he made it clear it was really VERY optional to get the lens changed. If it really did not have to great of an effect on the acuity than he just told them so... the patients really appreciated and at times we replaced lens more because of the wear and tear than because of an RX change.. While I have worked with OD's who just filled out the RX slip and if it was only a .25 change or I even seen a couple of times a slight change in the axis (once a 3 degree change in a .25 cylinder!!) where he wanted them redone, which is amazing since phoropters have the axis in 5 degree increments..
A lot will depend on the greed of the OD or MD... Oh and the ones that said they settle in the age range was correct (40 to 60).. in fact myops tend to start to reverse as the crystalline lens begins to harden and than they become presbyops in that age range. BUT needless to say the eyes can be a "window" to other health problems so getting that annual check is still pretty important (at least in my opinion) Also the needs of the patient may change so another design or material may improve their quality of life (i.e., AR coats, Polarized, PAL's etc., etc.)
Like most things in our industry, other than the pathology side the refracting can be very fluctuating depending on the time of day and the person doing the refracting and the person being refracted.
Other words.. there is no one correct answer to your question, and you'll probably see as many differ opinions posted to this thread to help support that statement :-)

Jeff "optics..isn't it great" Trail

[optigoddess]

In my opinion, rx's should be "valid" for no more than 2 years. I think eye health exams should be every 2 years for those fortunate enough to have healthy eyes and bodies...every 1 year for students, diabetics, etc.

I have seen a "strange" range of "expiration dates" in my 13 years of dispensing...from 3 months (?) 6 months (?) and then NO expiration date .

I think that consumers appreciate when educated about WHY eye health needs to be checked...and maybe they will be fortunate and the rx will NOT change - but that it's SO important to keep on top of EYE HEALTH because so many disorders are "sneaky" and they can't be "felt" as they develop....

[NC-OD]

Jeff,

Your right on target when you talk about how important it is (and how unusual it is) to acutally explain to a person what is going on with their vision and their eye health.

Unfortunately, not all OD's and even fewer OMD's take the time to explain. Many eye doc's are too busy. I am fortunate to be in my own private practice where I can spend an hour or 10 minutes with a patient depending on the need. I have, however, filled in a numerous "chain" stores where the patients are schedueled every 10 minutes with a "walk-in" thrown in every once in a while. In these situation, it is IMPOSSIBLE to take the time and explain things.

And then there are patients that are just too plain stupid to understand ANYTHING except "You need more medicine in your glasses".

But the question is.....how often to change an rx?........Hmmmm.

My crazy philosophy is- whenever they need it!

I, personally, would not change an rx by +0.25 but I know some do. If their glasses are in good shape, I always tell the patient that there is very little change in your glasses and unless you just wanted to get a new pair or a new style, I would keep the ones you have.

This usually works but I have had someone go somewhere else and get glasses because "the guy down the street said I don't need any and I can't see". So you really have to use psychology and try to read the patients mind.

And if they are going to get glasses no matter what, you might as well make that 0.25 change.

Oh yea, the phoropter does have cylinder axis markings in 5 degree increments but the cylinder knob itself rotates a full 360 degrees. The markings are only guides (ie. halfway between the 0 and 5 mark would be 2.5 degrees).

[Traci]

Perhaps it would be easier if we could differeniate between glasses prescriptions and eye health exams. People more often than not KNOW when they need to change their glasses, however, it is not as easy to know when to have eye health checked.

People in general should have their eye health checked as they would a general physical. Eye health exams should be dictated by their OD or OMD based on their general health, age, risk factors, etc. . . NOT by how old their glasses are!

That is just my opinion.

[Jeff Trail]

Boy ole boy an OD agreeing with a lowly lab rat !! A banner day.. Just kidd'n ya. :-) Actually this is one of the reasons they should crack down on the requirements to get a lic. as an optician. If the OD's are strapped for time, and in the times of "third party" and cut rate chain battles I can see they are needing to double book more often. BUT I see this is a place where we should STRESS that opticians be degree'd and be able to fill in those blanks on pathology and the rest of the things. Oh if you are pumping out cookie cutter dispensing than a tech is OK, but when starting down the path of pathology and more complicated optical situations than it's time to up grade the staff. I know I do a lot of seminars with my accounts and am willing to help train the staff to take up the slack and free up the OD to do what they need to do to stay ahead of the game.
Shoot I even enlisted with the program at H. C. C. and am taking it to the next step and I am just a lab owner. I know I probably get 15 to 20 calls a day with questions about lens and optical problems that the STAFF should have to know.
I'm still amazed about how many of my accounts (the majority are private practices) where the staff have no idea about slabs, prism, oblique problems, magnification, vertex problems and things as simple as Prentice's law, Fresnel's equation and on and on ...
If you understand the "how and why" behind what you are doing it sure makes things a lot easier (in my opinion).. As for proof? I know that I got a few other people sign up for the program at H.C.C and have seen their average cost per job in an upward trend .. amazing how it seems easier to sell a polarized instead of that "tint" when you can explain how the polarizing filters work compared to what is happening to the eye when you just tint a lens Gr.3 .. or be able to explain how when you increase index you lose light transmission due to reflection and dispersion by understanding Fresnal's equation .. or even simple things like explaining how a transition lens works and what is the difference between a "glass" lens and a "plastic" lens that "changes".
I would think an OD would love to have a well educated and experienced staff taking up the slack and freeing their time for refraction, visual fields etc., etc.
All in all this is a changing industry (notice that word) where we used to be more of a profession .. chains and third parties have changed us, for better or worse, and we have to learn to adapt and thrive the best way we can.

Jeff "slightly off the thread theme BUT couldn't pass up the chance to pontificate from on high" Trail

[Traci]

I am slightly embarrased. I apologize if I have somehow misrepresented myself as an OD. I too am an optician (licensed) and an owner of an optical boutique.

I do STRONGLY encourage regular eye exams due to the many reasons of unnecessary vision loss, not to mention other diseases than can be detected by a good eye exam, but to expire the glasses? ? ? (I suppose it could be a liability issue).

Eye Health is the issue, not expiring the glasses Rx. I leave the pathology to the doctors, my job is to make the best glasses I can. If I think there may be another solution than what is presented to me, I'll ask, discreetly of course! No one likes remakes! The doctor, the optician, or the patient. Making glasses right the first time can go a long way with the wearer - expecially when they have had trouble before. Not any one person has ALL the answers. That is why we are here talking, Right?

Even if opticians could refract legally in the eyes of America, there still has to be communication between the optician and the doctor, after all, it is the patient who comes first.

Making new glasses for better visual acuity, to update fashion / style, or because the old glasses are falling apart makes a lot of sense - ANYTIME.

Traci

P.S. I am fortunate to have very good doctors to work with in this area. OD's and OMD's.


:cheers:

[Traci]

Now I really am embarrased. You were replying to NC-OD.

Sorry.

I am kind of new at this posting thing.

[ph]

I go with the often as needed principle. I show the patient the difference between the current and the new Rx and let them decide(assuming they are capable of making a decision). If there are problems then change. It is surprising how sensitive some people are to small changes and how others do not notice large changes.