Dr.'s over-plusing adds on pals?
I had an old client come in with a new Rx for her regular glasses(Varilux's). Rx was +1.25-75x90 ou, with a 2.50 add; now this was a 1.25 increase in total reading rx, but alas, she then produced another Rx, written at the same time as a SV 'full reading' glasses, that a 0.50 'less' plus, called the dr's office, their nurse said that the dr. usually bumps up the add when he knows the pt wears pals. Do others have a similar priblem?
Hello Al,
The unfortunate part about that is that most might never know if the doc bumped the add or not if only one script is produced (which is usually the case) If doctors are doing that they need to stop. There is no necessity in bumping the add unless you know what type of frame the patient is going into. Even then it should be left to the opticians discretion since he/she will know how much of the bifocal gets cut off in the process of finishing. In a shallow B measurement frame it will be fine but in a deep B the patient is in for one wild rollercoaster ride.
I had a doctor that had handwritten "+2.50 if pt. goes into progressive." under the prescribed +2.25. I kept thinking to myself "Don't worry doc. I'll take care of the technical stuff." :) Actually I think some do it in order to make sure that everything is on the up-n-up in the event the bifocal needs to be bumped. That way you already have it in writing. I also think some do it because they are the doctor and what they say goes and some do it because they can't refract very well and are covering all of their bases.
Take care,
Darris C.
HI AL,
I CAN NOT EVEN BEGIN TO TELL YOU HOW MANY TIMES THIS
HAS BEEN A ISSUE FOR ME. I WORK AT AN INDEPENDENT BOUTIQUE AND DONT HAVE A DOCTOR ON THE PREMISES.
BECAUSE OF THIS ALL OF MY RX'S COME FROM OUTSIDE
DOCTORS. IT'S NOT A PROBLEM THAT ONLY APPLIES TO M.D.'S
ALOT OF O.D.'S IN THE AREA DO THE SAME. I HAVE CONTACTED
SEVERAL AND THE OVERWHELMING RESPONSE HAS BEEN THAT THEY SEE ALOT OF PATIENTS COME BACK WITH ADD SEGS TOO
LOW OR CUT OFF. I THEN EXPLAIN TO THEM THAT MY OBLIGATION
AS A LICENSED OPTICIAN IS TO FIND THE APPROPRIATE FRAME TO ACCOMADTE THE PATIENT AND THE RX!! THE DOCTORS JOB IS TO PROVIDE ALL OPTICIANS WITH THECORRECT RX TO FILL.
IF ALL MEASUREMENTS ARE ACCURATE AND THE PROPER FRAME IS SELECTED, THE "NON-BUMPED" RX SHOULD WORK JUST FINE :)
LVOPTICGAL
LAS VEGAS, NV
Darris, you're right, if the lady only showed me the pal rx, and then asked for readers, I'd have just computed the 'total' near rx and sh'd be reading with them at about 9", would'nt be too thrilled, and we'd be making them over at our expense, sort of like drs prescribing the 'trifocal' power, like we might have some control of that.
Some ODs over-plus or "bump" the add power with progressive lenses for one of two reasons:
1. Years ago, the old Varilux II lenses were introduced, which produced excess plus power because of the asphericity in the periphery of the lens. Consequently, some advocated increasing the add power in conjunction with extra minus in the distance power to compensate for this effect. Many "old-timers" might still take this approach. However, lenses are no longer designed like this, so it is not necessary today.
2. Many eyecare professionals also increased the add power with progressive lenses in an attempt to allow the patient to realize his/her full add power at a shorter distance from the fitting cross, particularly in small frames. In a situation where the minimum fitting height cannot be achieved, the patient may be better served by having the frame lowered slightly, selecting a slightly larger frame style, or of course by using a progressive lens style designed for smaller frames -- like AO Compact.
There are several good reasons not to bump the add power with progressive lenses:
1. At least one study has shown that more patients prefer the prescribed add power for progressive addition lenses to the over-plussed add power.
2. Increasing the add power effectively shifts the patient’s area of clear vision up from the near zone and into the progressive corridor, which is often the narrowest region of the lens.
3. Increasing the add power increases the level of unwanted blur in the periphery of the lenses and narrows the areas of clear vision through the lens.
4. Increasing the add power beyond what the patient requires needlessly restricts the patient’s depth of field -- the range of viewing distances through which the patient can clearly see his/her reading materials at near.
Best regards,
Darryl
Might there still be lenses out there for which a 0.25 bump makes sense? I know an opthamologist who routinely includes a 0.25 bump (+0.25 a bottom, -0.25 at top) when patients want to order progs from Zenni.
Wrong site if you want advice for on line gas station prescription glasses and cannot spell the MD's professional title correctly.Originally Posted by jasg
Never a good idea to over plus a progressive lens. Please reread what Darryl said and keep in mind he wrote this 22 years ago. Adding a "bump" on the bottom of a progressive lens has been known to be wrong for a long time now. And I have never seen an "opthamologist" write their own Rx, it's always techs that do it.
Even zenni progressives are more advanced now and don't need a bump IF they are fitted correctly. That's a big IF LOL. Good effin luck with that
Darryl nailed it:
Never a good idea to over plus a progressive lens. Please reread what Darryl said and keep in mind he wrote this 22 years ago. Adding a "bump" on the bottom of a progressive lens has been known to be wrong for a long time now. And I have never seen an "opthamologist" write their own Rx, it's always techs that do it.
Even zenni progressives are more advanced now and don't need a bump IF they are fitted correctly. That's a big IF LOL. Good effin luck with that
Darryl nailed it:
This particular opthaLLLLLLmologist does in fact do refractions. She has an equally dim view of online specs dealers, as do I. However, because online sales are a thing that's not going to go away, and because these places do nothing to fit lenses properly, she feels that adding a bump is the best she can do to help patients who insist on buying online. Not knowing whether she's out of date (she's in her 70's) or knows something the person I was replying to didn't, I think my question was reasonable.
Sorry if my typo insulted any opthaLmologists out there, or overstimulated the salivary glands of the amateur sleuths amongst y'all.
Just because she has a MD does not mean she understands how lenses work, not all opinions are equal. When it comes to how to deal with a retinal detachment I will talk to your Doc, but when it comes down to the best way to make progressive lenses... Go with the master optician. Darryl knew more about optics than most of us can ever hope to know.
Fes coming in strong lol, I like it.
I used to work with an MD in his mid to late 70's that would put an extra +0.25 in the add for progressives, which I would promptly ignore when filling the RX.
I've never worked with a MD that did their own refractions either, and I worked with over a dozen. Personal opinion only: I wouldn't see an MD for a refraction. OD>>>>>>MD.
...and you still haven't spelled Ophthalmologist right. Haha
1000%
I knew 3 OMD’s that did their own refractions..and nailed them. I had one of those 3 send me patients for many years. At first, I wanted to add 50% to fill his Rx’s. He was terrible! After years of dr remakes, he listened to suggestions, and continued improving. I ended up running multi opticals locations for him. He got extremely good at refracting. I asked him why he didn’t let a tech do it for him. He said they came to him for their vision, and he felt responsible to provide it personally. He was special…
But I had 2 referring OMD’s long term that didn’t have an optical (yea, rare now a days). They did their own refractions and they were always solid So there are good refracting MD’s. But I will give a shout out to some techs that refract, and do it well. Refraction isn’t a medical procedure on its own. Experience is really the largest factor in refracting well.
Oh, and to keep with the theme of this thread. I know an OD working in an OMD practice that still to this day puts “ add +.25 if PAL”. And he’s relatively young, in his 40’s. I asked him once why he did that….It was to give them more life out of their Rx…They wouldn’t need new glasses as soon! ( no, he got no profit from the optical).
You have passed the first test...You may enter...This particular opthaLLLLLLmologist does in fact do refractions. She has an equally dim view of online specs dealers, as do I. However, because online sales are a thing that's not going to go away, and because these places do nothing to fit lenses properly, she feels that adding a bump is the best she can do to help patients who insist on buying online. Not knowing whether she's out of date (she's in her 70's) or knows something the person I was replying to didn't, I think my question was reasonable.
Welcome to Optiboard.
What is your title?
NOW GET BACK TO WORK!!!
*This was a later episode now that I think about it while Penny was getting a pedicure from Leonard.
Last edited by Uncle Fester; 11-15-2023 at 11:06 AM. Reason: not season one....
Scroll down a little to see a link to OB:
https://www.google.com/search?client...i+optical#ip=1
The only professional site fwiw.
After thinking about it would this be because we do not endorse on-line anything prescription eye wear?
Last edited by Uncle Fester; 11-15-2023 at 12:27 PM. Reason: tweak...
Some of the shall we say "seasoned" among us, to include me especially (old as dirt!) should remember that Varilux early on needed extra plus, because of its soft design. That remains in the minds of some remaining docs to this day, although designs are improved, and it is not suggested. But folks, ignorance is often bliss. The acceptance rate for people entering med school, depending on the school, can be as low as 1.5%. Ophthalmology residencies are typically small! Top people in their med school classes get in. In 10 years, the AMA data suggests we will be in need of 124,000 MDs in America! Most of that need is in primary care, so Ophthalmology will remain small. To say 1000%, I'd never go to an MD for a refraction is fine, but to suggest that a board-certified Ophthalmologist can't refract is just ridiculous. George said above it isa all about experience. Suggesting that also, one of these highly trained individuals should leave lenses to someone with no education, many who think Prentice's Rule is a ruler to take PDs is again ludicrous. They can refract when they want to, and that is easy. MDs want to do more complicated, complex things than spinning dials, and asking which is better! There are some crazy folks here, me included, that suggested that Opticians could move into refraction, and that was supported by the American Academy of Ophthalmology. Not to make junior eye doctors, but to work in clinical settings to be more valuable. We fought it, like we do education, and so here we remain. Refractions can be done, and quite accurately with technology today. If we had any level of consistent training and education, versus cheap labor, we could be fare more. Optometry evolved from us, and showed us the way, but we were blissful! They have excelled, while we languish in mediocrity. Change is hard. We could have been, and still can be so much more than eyeglass salespeople! Even the corporate entities are realizing the need for better people. Years ago, a friend who was an OD had a practice here in SC. He went back to be an RD (his words- stood for Real Doctor), and he completed that and Ophthalmology residency. He passed a few months back at 84. Today, that RD thing is long forgotten. ODs have done miraculous things, and made themselves better, while we still have "professionals" who think they are the finest with their PD rulers! The great state of Florida had a bill in this session to remove the title Doctor from the OD and others, and I am proud to have sent one of the many letters against it. Some here will be surprised, but you shouldn't be, it was discussed widely. ODs work hard, and that is earned degree that comes with the title!
Someone above complained about "mail order" glasses and fitting. Before you throw rocks at others, in this case MD specialists that spent many years in school, internship and residency, remember the old adage, people that live in glass houses. shouldn't throw rocks! I did my best to try to improve this crowd. You can lead a horse to water, but you can't make him drink. But pay attention! After Leadership in January of this year I saw new people, excited and eager to learn, grow and develop into more. You'll see things coming shortly. I hope to continue to do something more.
Nice strawman, no one is saying MD's cannot refract, it's just they typically don't. If you have a MD that does refract let me ask you this question: If you had to blindly (pun intended) choose between two people to do your refraction would you want someone who typically sees and refracts 15 patients a day or someone who sees and refracts 5? Customers may put more stock into a MD's rx because of the title but the proof is in the pudding.
"One of these highly trained individuals" what are they trained in? How much time did they spend in medical school discussing progressive lens design? And heck she went to medical school 50 years ago, I'm sure nothing has changed in progressive lens technology since... But I'm sure instead of doing continuing education on medical advancements for surgery she spent the majority of her time better understanding progressive lenses. It's her title versus Darryl's expertise in lenses, he explained it perfectly. This MD is stuck in an old mindset that's been wrong for a long time.
WHAT ARE WE YELLING ABOUT!
They are supposed to depend on us for the lens design, but we have little real knowledge as a whole. We are judged by our lowest common denominator, and as long as the individual who sells the most at some big box store is doing the "training" we won't improve. I'm more concerned, and always have been, about Opticianry. But march on, you have it any way you want it.
I'm not disagreeing with you on education is the way forward. I don't look fondly back on my time working at box big stores for the evil empire.
This is my experience, too.
I'm sure there are a few OMDs that are out in the boonies that have to do it all but the extreme majority of OMDs are sub-specialists and literally took maybe one course on refracting and promptly forgot it. Maybe the peds OMDs are good at it, but in a town big enough for a peds OMD they have a coterie of ODs working as well.
Goofing around with PALs is stupid. They're well-designed. Don't presume, because you make a PRES of U and ME. (Did I get that right?)
Nothing like reading the beginning of a post, and realizing it was made when I was in diapers still. The optical world must be so different than it was 20 years ago.
I feel you on that. It's interesting how things change and how they stay the same. I was just shy of five when this thread started lol.
Love that you still spelt it incorrectly
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