" LDOs - Having Cursory Knowledge Of The Eye And Visual System Is Overly Complimentar

**EyeCon** · 08-21-2002, 04:09 PM

I just want to share with you all the narrowmindedness we all, at times, have to deal with, day-in and day-out...
Here is a thread I picked up on from one of the other vision forums. Never mind the authors' name for now...the subject is " Sight Testing "...and this is word-for-word...please, try to endure this!

" Hi folks, I don't know if you've heard about a new facet of the optical industry called sight testing. I believe it's only in Canada right now, probably due to liability issues. This is where a Licensed Optician does what is essentially an autorefraction on the customer. These " tests " are performed free of charge as long as the customer agrees to buy their specs there. Imagine a situation where people rarely get the health of their eyes examined; they simply ge these objective refractions done over and over again. To say that Licensed Opticians have a cursory knowledge of the eye and visual system would be overly complimentary, to say nothing of the pathology that will, and I stress the word WILL , be missed. Most people in Optometry know personally many folks who have experienced permanent vision loss due to non-examination of the eyes. Most of these folks experienced little or no symptoms until it was too late. What do you folks think of this practice? ".

Well, there you have it, verbatim. I suppose this individual, the author that is, is addressing this question to fellow Optometrists.

I've worked alongside Optometrists who prefer to do their own pre-testing...and also with those ODs preferring to entrust their opticianry staff to perform pre-testing routine...but always under close supervision...ALWAYS! The instrumentation being used is high-tech with a fairly high degree of accuracy...with experience, it becomes an everyday, routine task.
Now, I can understand a certain unwillingness on the part of an inexperienced optician to learn these seemingly complicated machines...but if these tasks are a part of a job description...then it becomes compulsory or out the door they go, the optician that is. At no time, have I seen these instruments used carelessly or hastily where a patient could be injured in some way. But to say or think, or even suggest that Licensed Opticians have an insignificant, or be shallow in their knowledge of optics is WRONG!
I can only say to the author of this thread, if he should lower himself to read these replys; Mr. Optometrist, OPEN YOUR OWN EYES!...WIDER...WIDER.

Best Regards,

John Stevenson
a.k.a. EyeCon

**chip anderson** · 08-21-2002, 10:05 PM

Don't know about your state but our optometrists have written themselves a law (which amoung other things includes a one year expiration of thier Rx's) that states they cannot designated any testing or fitting to anyone! Of course those with help in the office feel this applies to them, just to letting some judgment call being made outside their own office.

Don't know how this ALWAYS UNDER CLOSE SUPERVISION would apply in this case.

Chip

Same group once tried to pass a law that said: "Only an optometrist or physician can touch a contact lens." Don't know who writes thier stuff, but the office help would not have been able to "touch a contact lens." The patient would be in violation of the law if he "touched a contact lens." Of course this one was so stupid that even the legislature recognised the problems and didn't pass it.

**NC-OD** · 08-22-2002, 08:39 AM

For what its worth, I believe that post was written by a dispensing optician in Canada. It is on the Optometric.com website (Optometic Management mag.). If you look under the profile, it will tell about this guy.

**Texas Ranger** · 08-22-2002, 10:06 AM

Eyecon, I don't think this is nearly as bad as a doctor telling pts to just go down t and get "ready made" readers, "just try them on and get the ones that work best" once told that, folks tend to think the next time they seem to need a bit more time, it's OK to bypass the eye doctor, thereby avoiding an eye health exam, perhaps forever. I have seen many cases where the pt developed a serious eye disorder, who had skipped about 15-20 yrs of exams, because the dr. referrred them to K-mart! This is happening also as routine in post-lasik pts. pretty shameful! I think the eyecare field as a whole has done a less than mediocre job of promoting the need for eye health evaluations earlier than presbyopia! my wife is a school nurse, does vision screening, when kids fail the test, they inform the parents that they should get an eye exam, and often the eye doctor says the kid doesn't need glasses. they only do vision screening every other year. and then there's the famous doctor line; "there's not enough change to make a difference"; make s me a little nauseous every time I hear it. the pts question is, I'm having problems seeing, I want to see better, so why wouldn't a different rx make a difference? Sometimes even the "same rx" made up in a different lens design/material/size/frame, may make a lot of difference! So, why are such statements so common?

**icare** · 08-22-2002, 09:00 PM

Let me get this straight:

Guy walks in and says, 'I can't see so well. Do I need new glasses?' So the optician autorefracts and says 'a change in your spectacle prescription is in order.' And, let's tip the scale in the optician's favor. Let's say that the optician's knowledge of optics and the use of the autorefractor is superb.

The guy gets his new, acurately and expertly crafted eyeglasses and reports that, 'Things still just don't seem right.'

How does the optician know if the patient has a routine adaptive problem or a serious ocular pathology? Can someone please explain?

Well, he/she can't. Not without the education, equipment, and assumption of professional responsibility that is promoted through certification and licensure.

Something is wrong with this scenario. The free and easy fix for eye problems with glasses often does not exist. Glasses in the preponderance of cases will not correct ocular health problems. Isn't this why itinerant opticians were outlawed and licensure and accountability became the rule?

So, this guy goes headed out of the opticianry wondering if his glasses are right when really,...

...His blood sugar is through the roof, or
...His macula is hemmorhaging into the vitreous, or
...He just had a life-threatening stroke, or
...His cornea is at risk of rupture due to keratoconus, or,...

-should I go on?

**chip anderson** · 08-22-2002, 09:19 PM

Now tell me why a spectacle Rx should expire! The patient is no worse off with a new pair of spectacles (perhaps a little better) of the old Rx than he was wearing the old ones for years. Requireing a new Rx for glasses or contact lenses is just another way to "force" the patient to get a new eye exam, and you can bet if the doctor markets spectacles the Rx is gonna change. If the doctor doesn't market spectacles it may not change.

Yes I do think everyone should have and eye exam every year or two and when changes in vision are noted, but I know manditory expirations are just a legal method of forcing the patient to do same.

Chip:bbg:

**paw** · 08-22-2002, 09:48 PM

Chip,

I, respectfully, totally disagree. At least in our office, the Dr has the integrity to put the patient's welfare first. There are many, many times in our office where the patient simply did not need a change in Rx, and the Dr told the patient so. Why tell a patient he needs new glasses if he really doesn't? The patient will certainly figure it out when he picks up his new glasses and nothing has changed after spending $300. For a professional OD, that is no way to gain patient trust. A PROFESSIONAL OD's first priority is to provide health care. The glasses are secondary. A COMMERCIALIST provides eye exams in order to sell glasses. See the difference? And in the competitive environment we practice in, no professional OD is going to screw the patient because the patient can very easily go elsewhere.

**icare** · 08-23-2002, 04:22 PM

chip anderson said:
Now tell me why a spectacle Rx should expire! The patient is no worse off with a new pair of spectacles (perhaps a little better) of the old Rx than he was wearing the old ones for years. Requireing a new Rx for glasses or contact lenses is just another way to "force" the patient to get a new eye exam, and you can bet if the doctor markets spectacles the Rx is gonna change. If the doctor doesn't market spectacles it may not change.

Yes I do think everyone should have and eye exam every year or two and when changes in vision are noted, but I know manditory expirations are just a legal method of forcing the patient to do same.

Chip:bbg:

Chip, a mandatory expiration is what constitutes a prescription. It's part of the legal definition of a prescription. In the case of a spectacle prescription, the date that it expires is the longest amount of time that the doctor feels that the corrective therapy is going to be useful.

Prescribing glasses is an art and a science and a cultivated analysis of the patient's visual requirements and a judgement regarding how the patient's vision will change over time. All prescriptions change over time. No one holds constant forever. So, should a prescription be valid forever?

The process of requiring presciptions for spectacles would not have held up throughout the last 100 years of the convoluted and varied state legislatures if not for valid reasons. And, contrary to the thoughts of some, optometrists do not control the legislature - not by a long shot.

Look at how misuse of contact lens prescriptions has made a mess of patient compliance. And those prescriptions are actually required! Think, if they weren't required. If the required use of prescriptions was not mandated, patients would hurt themselves.

If patients choose to use to expiration to their advantage in order to avoid getting proper eye care, isn't that their decision? Perhaps some doctors know their patients well enough to realize that certain individuals are not responsible for themselves and need guidance (an expiration.)

When I do an exam and the patient's Rx hasn't changed appreciably, I tell them flat out that a change is not indicated. I do it almost every day at least once. We often remark how stable the Rx is that I gave them previously and the fact that it is still performing well years later. I still confirm again what new prescription will be a satisfactory therapy and put an expiration on it.

Most optometrists I know care very deeply for the welfare of their patients and will not compromise care issues for commercial gain. Most optometrists I know are living a very humble lifestyle because of their unwillingness to allow greed to interfere with their mode of practice. If your experience working with optometrists is currently otherwise, I'd suggest you keep looking for the right professional to represent.

No offense intended.
:)

**Texas Ranger** · 08-23-2002, 04:55 PM

paw, do you see that you are saying that if there is only a small rx change, that it's not in the pt's welfare to prescribe them; when the prescription release laws require that the pt be given an rx, even if there is no change. is it OK for the eye doctor to just say that there is very little change and they shouldn't expect much improvement, instead of saying "it's not worth it to get new glasses", that's an economic value issue, isn't it? will the pt see as well with new glasses? some pts just want new glasses, their old frames are trash, their lenses are scratched, they've gained 30 lbs and their older frames are running ridges in their wider skulls. maybe, they've changed jobs, now need a trifocal or pal, or computer lenses, maybe they now do a lot more driving and might like polarized sun lenses? if it's bee sveral years since their last glasses, all of theses things are reasons to get new glasses. but many folks will just wear the same old beat up glasses until their doc tells them that they can have new ones. so, look around your world, see how most folks look in need of new eyewear, and become part of their solution, not their problem. think of it this way, most folks don't like wearing glasses, but they always like it when they get new ones that look and see better, and they do really want to look their best and see their best, or don't you believe that? if you feel guilty taking money for providing such a service, stick to refracting and contacts, put a good optician next door and share the guilt...there are folks who like shoes, clothing, purses, etc, see eyewear as apparel, and enjoy having a wardrobe of glasses; my aunt had 47 pair, kept them in a plastic shoe rack; even when folks tell you how glasses are too expensive, understand that they would think nothing of buying a 40" tv, when they already own two 27" ones. as a matter of fact, there's a new store around the corner called "ultimate Electronics" that sell tv's as expensive a $14,995. now the buyer of one of those will come in here and gripe and moan about the high cost of a $250 pair of glasses, then they'll drag out their visa and pay for it; they just want to whine!

**paw** · 08-23-2002, 05:29 PM

Perhaps I was too brief in my post, I should have more fully explained myself.

The Dr will tell the patient that the patient does not have to get new glasses based on his new prescription. If the patient wants to get new glasses because his frame is shot, because he's tired of his frame, because he wants a new "second" pair, because he has insurance that will pay for it and he doesn't want to "waste" his insurance, etc, whatever the PATIENT'S reason, well, we certainly don't stand in his way. For heaven's sake, we are more than willing to sell the patient new glasses. (We never say "it's not worth it" to get new glasses. Those are your words, not mine.)

However, in the case of it not being necessary due to Rx, we make it crystal clear that the patient is getting the new glasses because THE PATIENT wants to, not because the Dr wants him to.

As I said in my last post, the Dr tells the patient, specifically, that he doesn't need A CHANGE IN RX, not that he doesn't need a change in FRAMES. I think it's extremely important that the patient understand that difference.

Tex, we really are on the same side!

**Joann Raytar** · 08-23-2002, 06:41 PM

I agree with Texas Ranger. Nothing makes me cringe more than hearing "it is such a small change that you do not need new glasses." A +0.25D this time, +0.25D next time = +0.50 and time for new glasses. You would be surprised how much +0.50D will knock a patient for a loop.

Is that the goal? Hold off until the patient feels a noticable difference so that the value of the exam and new glasses is reinforced and the patient realizes why they spent their money?

**chip anderson** · 08-23-2002, 07:14 PM

Should I tell you about the ophthalmologist who says: "The ideal contact lens patient is one who comes in with an old pair of glasses and sees 20/50, then I can sell him some soft lenses, if he sees 20/30 he's happy. If he comes in seeing 20/20 he won't be happy unless he sees as well."

Should I tell you about all the doctors offices that call and want contact lens specifications (they usually ask for the contact lens precription, which is not the same). Do they ask for the pre-fit K's, a history or anything about the lenses or the patient except the specifications (so they can sell him some more without any effort on thier part? Should I tell you about the number of offices that call for specifications and the dumb broad they designate this to doesn't know what the numbers mean? The ones that want to know the "Brand" because specifications don't mean anything to them?

Should I tell you about the doctors who will Rx a .12 cylinder no sphere) in a pair of Rx welding goggles? Should I mention those that will Rx a pair of glasses for distance over contacts instead of changing the contact because it cost them money to change the contact and they make money putting the 1/2 or 3/4 in the glasses?

Lets not talk about integrity in this business.

**paw** · 08-23-2002, 08:13 PM

My, my, you people are touchy. I thought this was a board for eye professionals of any kind. I didn't know this was an anti-optometry optician's board. What is the value of this forum if you all preach to the choir? I think a forum should be a respectful exchange of ideas, not sh--ting all over those whose views differ from yours.

This will be my last post, and in signing off, I will remind you not to lump all eye doctors, MD or OD, into the same barrel of bad apples, and I will not do so with opticians (not that I have been).

**icare** · 08-23-2002, 08:48 PM

Your opinion and experience matters.

(And sometimes the choir does sing for its own enjoyment.)

There's no need to ditch the forum altogether. We all can learn from eachother.

**chip anderson** · 08-23-2002, 10:20 PM

Paw: MD's and O.D.'s wrote the Rx's Opticians filled them, we all need to clean up our act or admit what we are.

I didn't even share the tales from my friends and patients who investigate Medicare/Medicaid fraud in the state. Then you would really know about us.

**Joann Raytar** · 08-23-2002, 10:37 PM

paw said:
I didn't know this was an anti-optometry optician's board. What is the value of this forum if you all preach to the choir?

It's not. I manage an OD's office. That doesn't mean I have to like the phrase "the change is so little..."

Just like Chip said, "MD's and O.D.'s wrote the Rx's Opticians filled them we all need to clean up our act or admit what we are."

**John R** · 08-24-2002, 10:00 AM

paw said:
. I thought this was a board for eye professionals of any kind.

It is, we come from all parts of the optical world, in every way...

From a simple point of view i think its right to be told that your perscription has not changed enough to warrent a new pair of glasses, but everybody has the common sense to make their own mind as to wether or not to replace the ones they have. Many people have more than one pair. I have more than 4 so to replace just because of a 0.25 change in RX is going to cost me a bomb even with what i can scam via work....
There is a lot of odd things that happen in optics like its o.12 off power or the best i have ever had is a +25.00 +3.00 lens which was going to cost a lot to be made (outside standard range) so the guy dropped the sph to +22.00 and lost the cyl altogether just so it was a standard range job ????? Now i wonder what the optician made of that......

Paw dont leave just because of a few who have their own views, live and let live....

**paw** · 08-24-2002, 02:14 PM

OK, one more reply.

I am amazed at how many of you think that when the Dr says that the Rx doesn't have to be changed, that the patient thinks he's not allowed to get new glasses. No way! As John R put it, the patient has the common sense to make up his own mind as to whether or not replace the ones they have.

Anyway, I think we are at the point where we are beating a dead horse. Let's start a different interesting thread. Contact lens horror stories, anyone? :D

**John R** · 08-24-2002, 03:34 PM

paw said:
Anyway, I think we are at the point where we are beating a dead horse. Let's start a different interesting thread. Contact lens horror stories, anyone? :D

Here Here....Contacts Na lets go for the lazer razor instead....

**Joann Raytar** · 08-24-2002, 09:56 PM

paw said:

As John R put it, the patient has the common sense to make up his own mind as to whether or not replace the ones they have.

:cheers:

I agree! It is good to see that you stuck in there for one more reply.

**Texas Ranger** · 08-26-2002, 10:19 AM

paw...whew, missed a couple days, pleeeze don't go away. you've contributed greatly to this board; I didn't mean to imply that YOU told folks it wasn't worth it to get new glasses;and I'm decidedly not anti optomertry. As an independent optician, I have a high regard for the education, skills and knowledge of all eye care professionals, and especially optometry. theses problems are far more likely to be dealt with in dispensing MD practices. But each and every day, I hear a pt state that their eye doctor told them it "wasn't worth it" to get new glasses, then they show me an rx with a -.25 dist, change, 5 ' axis change on a 2.00 cyl. and a +.50 add change,(net +.25). I believe most of our clients could tell an improvement in their glasses with such "small" changes. A lot of the time, the pt has carried thge rx around with them for a few months, and are amazed at how much better their glasses are when they get them "for a new look". we are on the same side < PAW>, you're likely one of the ones that does it right!

**Traci** · 08-26-2002, 12:06 PM

This discussion/debate seems to be refractive error vs. ocular health. Should everyone who has an exam and requires glasses be allowed to expire. Sure. But when? What are the factors for deciding expiration dates. Is it based on ocular health issues? Or growth factors for children? Presbyopic changes for the 40's, they'll be at your door when they can't see at near.

We all know that glasses that are 0.25 or even 0.75 off are not going to cause any ocular damage. If someone has more change than that in their glasses, they will be knocking on your door. Diabetics for instance!

The majority of Rx's I see exp. 1 year, yet I have seen doctors say "you are young and healthy, low risk for eye disease and neg. family history. You don't need glasses, come back in about two to four years, unless you notice any problems before then." What is up with that? If you need glasses come back in one year, if you don't come back in four!

I suppose it all comes down to liability issues! We have to have these laws in place for our own protection against our own ignorance! If that is the case, shouln't it be mandatory to get eye, dental, ear, heart, blood and every other body part exams once a year for our own protection? Maybe on our birthday or we can't have a birthday! :bbg:

Note: I cannot believe that glasses will be useless after one year or self destruct when the expiration date comes.

P.S. I am all for maintenance exams for overall good health for all! And I completely respect the professions of Optometry, Opticianry, and Ophthalmology, as well as Dental, Heart, etc. :cheers:

**John R** · 08-26-2002, 01:29 PM

Traci said:
I cannot believe that glasses will be useless after one year or self destruct when the expiration date comes.

Well lets put it like this...A guy 30 ish has problems seeing so he see's his eye doc pays the test $150, gets a pair of glasses and can see fine. Now doc says come back in 2 years to get your eyes tested. The guys a bit tight so he thinks why waste $150 getting his eyes tested as he can still see fine... Soon this guy is 40 ish but he's still wearing the same script can still see OK but he could see a lot better if he'd gone to have his eyes checked every 2 years.....

Its not the glasses or contacts its to make sure you keep having your eyes tested..... Thats why we here a lot Your RX ain't changed that much As i said before the customer will know when they want to pay for a new pair, the eye doc just advises.....Lets face it even if the doc says new glasses needed, they dont always get them do they.....

**Traci** · 08-26-2002, 04:24 PM

If this 30ish guy misses his appointment in 2 years, he is risking his eye health. Who is to say if he does the $150.00 test (ocular health), he would have to buy new glasses at that time. After all, exams and glasses can be purchased separately.

Isn't ocular health the basis for an eye exam? There is a misconception that one has to go to the doctor for a glasses Rx and the eye is "checked" at that time. It should be to get your eyes checked and get glasses Rx as a VERY important part of the exam.

One can always go to the doctor before any appointed time if needed since some cases of vision loss is not due to refractive error and therefore should ALWAYS be evaluated by an eye doctor, not just anyone who can auto-refract, or refract. Too many things could be missed.

I just don't see all the fuss about the glasses Rx expiration date when it is the health of the eye that should be at the heart of the exam. Motivation to go to the doctor? What happened to the recall and reminder system that dentist and other doctors use? It has been my experience that people will go get an exam before spending money on new glasses anyway. ;) It is too much of a control issue.

Missing an eye appointment is much like missing a dental or physical exam for one's overall good health. Tsk. Tsk. Missing an appointment is risky business.

**chip anderson** · 08-26-2002, 07:06 PM

Strangely enough, I do agree that everyone should have an eye exam every year or two. But I still believe that having an expiration on a spectacle or contact lens Rx is strictlly ecconomic. No damage will result from wearing an old spectacle Rx as long as it bears some resemblence to what is needed (if it doesn't the patient won't see and he will get an exam.). It's not like a medication for diabetes or cardiac where the current situation needs evaluation or death or deterioration will result.

You also need a physical every year or two. But there are different reasons for Rx's for medications to have expirations or no refill restrictions.

Chip

And Yes I hope PAW will stay with us.