The PD Battle Has Begun

[fjpod]

Think of it this way: Would your 5 yo grandson have been doing quite so well if he were a +9 that was 10mm off? (Assuming a typical 52 PD for a little guy...vs the "standard" 62 that online often uses.)

Not likely.

.

He is the cutest guy in a tux.

ehhhhhhh...but you're misreading the situation. I didn't say I didn't get him measured at all. I got him measured once, by a professional, or at least as professional as it gets in measuring a tux, and I asked for the measurements to go get another tuxedo at another shop. Neither party flinched at giving the data or accepting it.

[MikeAurelius]

(Assuming a typical 52 PD for a little guy...vs the "standard" 62 that online often uses.)

And where is your proof of this?

Massive FAIL.

[Uilleann]

And where is your proof of this?

Massive FAIL.

Mike good friend - look around at what the sites are actually doing. THAT is the fail sir. You might be amazed at exactly how flippant many are about the need for any PD at all, let alone a correct one.

[MikeAurelius]

Ok, stop with the bon homme, it doesn't work for you.

I've seen what many of the sites are doing. I've seen the step by step suggestions on how to measure a PD. I've seen examples given.

NO WHERE do I see a "default" or "standard" PD of 62 mm. Using 62 mm as an example is not the same as using it as a "default" or "standard".

Respectfully, I ask that unless you have factual evidence that "they" use a 'default' or 'standard' of 62 mm, that you use some other reason not to like what they do.

[Steve Machol]

Let's keep it civil guys!

[Barry Santini]

BTW, I believe that MIL-spec for a non-adjustable binocular device is 62-63mm.

B

[Darryl Meister]

the PD belongs to the patient because it is a physical measurement of the eye location with reference to the bridge of the nose, just like a prescription is the physical measurement of the powers needed to correct the vision. The places that refuse to give it out are just giving ammunition to the FTC to make a ruling requiring the PD be part of the prescription.

This is certainly the perspective of online retailers, but it ignores what I consider to be some fairly obvious facts:

1. In my opinion, an accurate PD measurement for spectacle lenses is generally not part of an eye exam. At least, I have never seen an optometrist or ophthalmologist bother to take his or her own accurate monocular PD measurements of a patient with a pupilometer. Instead, they generally have their staff optician or technician take this measurement at the time of an eyewear purchase. A rough estimate of the separation of the patient's eyes is needed to position the phoropter or trial lenses during the exam, which some techs may take during a pre-test, but that's about it. Of course, once the measurement has been taken for an eyewear purchase, it may be added to the patient's medical record for future reference.

2. The "PD" is not part of an eyeglass prescription unless the doctor actually specifies it on the Rx. Otherwise, opticians couldn't fill 99% of the Rx forms out there. And there really isn't any compelling reason for the doctor to specify a PD, unless he or she feels that it will not be measured correctly by the optician for some reason. Further, if a doctor does specify a PD, he or she immediately assumes responsibility for its accuracy. No one would argue, for instance, that a segment height measurement is part of an eyeglass prescription. In fact, the most accurate mono PD measurements, captured using video centration devices, are specific to the chosen frame (and how it fits on the wearer). I suspect that the misconception regarding PDs as part of the Rx has been inadvertently generated by a few well-meaning eye doctors who jot down on the Rx whatever they set their phoropter to, perhaps out of some misguided sense of professional courtesy.

3. While the PD may represent a physical parameter of the patient, someone must be paid to measure it, and it typically isn't the optometrist or ophthalmologist. (Of course, patients are certainly welcome to try to measure their own PDs.) I think this is where the biggest issue comes into play. A brick-and-mortar optical store or practice employs someone to take these measurements, which is factored into the mark-up price of the eyewear. Online optical companies save a great deal of money on overhead because they do not pay anyone to take these measurements. The same goes for adjusting the frames, which is obviously not possible with an iPhone app. So the online eyewear consumer gets a cheap pair of eyeglasses that lacks the accuracy and comfort of a properly fitted and dispensed pair from a local eyecare professional. Getting what you paid for is certainly not a new concept.

Best regards,
Darryl

[Barry Santini]

Even *if* a PD was a mandated part of te prescription, does it really matter?

Think of it this way: We all compete now based on someone else's prescription.

How is this any different from using someone else's PD?

Prescriptions often need to be tweaked - PDs often do too! (Ask me about a mis-calibrated pupilometer)

FWIW

B

[MikeAurelius]

This is certainly the perspective of online retailers, but it ignores what I consider to be some fairly obvious facts:

1. In my opinion, an accurate PD measurement for spectacle lenses is generally not part of an eye exam. At least, I have never seen an optometrist or ophthalmologist bother to take his or her own accurate monocular PD measurements of a patient with a pupilometer. Instead, they generally have their staff optician or technician take this measurement at the time of an eyewear purchase. A rough estimate of the separation of the patient's eyes is needed to position the phoropter or trial lenses during the exam, which some techs may take during a pre-test, but that's about it. Of course, once the measurement has been taken for an eyewear purchase, it may be added to the patient's medical record for future reference.

2. The "PD" is not part of an eyeglass prescription unless the doctor actually specifies it on the Rx. Otherwise, opticians couldn't fill 99% of the Rx forms out there. And there really isn't any compelling reason for the doctor to specify a PD, unless he or she feels that it will not be measured correctly by the optician for some reason. Further, if a doctor does specify a PD, he or she immediately assumes responsibility for its accuracy. No one would argue, for instance, that a segment height measurement is part of an eyeglass prescription. In fact, the most accurate mono PD measurements, captured using video centration devices, are specific to the chosen frame (and how it fits on the wearer). I suspect that the misconception regarding PDs as part of the Rx has been inadvertently generated by a few well-meaning eye doctors who jot down on the Rx whatever they set their phoropter to, perhaps out of some misguided sense of professional courtesy.

3. While the PD may represent a physical parameter of the patient, someone must be paid to measure it, and it typically isn't the optometrist or ophthalmologist. (Of course, patients are certainly welcome to try to measure their own PDs.) I think this is where the biggest issue comes into play. A brick-and-mortar optical store or practice employs someone to take these measurements, which is factored into the mark-up price of the eyewear. Online optical companies save a great deal of money on overhead because they do not pay anyone to take these measurements. The same goes for adjusting the frames, which is obviously not possible with an iPhone app. So the online eyewear consumer gets a cheap pair of eyeglasses that lacks the accuracy and comfort of a properly fitted and dispensed pair from a local eyecare professional. Getting what you paid for is certainly not a new concept.

Best regards,
Darryl

Actually, Darryl, I didn't "ignore" those facts, they were just not my part of the discussion.

What I was trying to get across in my post is that if/when the FTC makes a ruling forcing the recording of PD's on the patient's prescription, it will become an added procedure in the exam room. As you have pointed out, techs are already examining existing spectacles (for a starting point if the patient is new, or verification of an existing Rx). If they can go through the process of an initial phoropter exam, they can certainly measure a PD. And at that point, it becomes part of the prescription.

Now, as Barry and others have pointed out, yes, the PD DOES change, albeit slightly in a year (if at all), and if the PD is taken at the time of the change, then all is well. Does this mean the optician won't take it again? No, they SHOULD take it again. After all, with the number of incorrect exams being done every day, the PD could very well be off, but it then becomes incumbent on the optician to note the change on the patient's Rx for future reference, and again, this is part of the Rx, and belongs to the patient.

Y'all are looking for ways not to do it, ignoring the many ways it could/can be done. In my opinion, PD's WILL become a required part of the patient's Rx. Whether it is done in the exam room or in the original first dispensing office, they are still part of the Rx, and it belongs to the patient. Since EG1 forbids the practice of charging for an Rx, and since the PD is part of the Rx, then charging an additional fee for an existing patient is illegal. Now, I'm definitely NOT saying you cannot charge someone who is not your patient a fee for measurement, and have them sign a disclaimer, that's your business to do what you want. But if the PD is anywhere in the patient's records at either the doctor's office or the optician's office, EG1 requires you to release that information at no additional charge.

Since you cannot have an Rx without a PD, as you so rightly posted, Darryl, you prove my point. It *IS* part of the Rx. I agree with your point on seg heights, as those are centered on frame choice and bifocal type. We can argue back and forth all day on where seg heights should be located (and I think there are plenty of threads on that here on the board).

[optical24/7]

Mike, just to clarify, states optometry boards decide what constitutes an Rx. I'm very familiar with Texas Optometric laws (and many other states too). PD's are not considered part of an Rx here, some states do though.

[MikeAurelius]

Mike, just to clarify, states optometry boards decide what constitutes an Rx. I'm very familiar with Texas Optometric laws (and many other states too). PD's are not considered part of an Rx here, some states do though.

Until the FDA/FTC redefine the rules, as they did with EG 1.

But, yes, I do know that information.

[Browman]

Oh, wow.

First off, I'm very sorry for any animosity or bad blood this thread may have created. It wasn't intended. I posted the story for a few reasons, which I'll elaborate upon below:

1) PD is becoming part of the public lexicon. What has been, until now, a term known only to those in the optical world and those attempting to order glasses online is slowly becoming a buzzword familiar to the eyeglass wearing world at large.

2) On the tail of #1: As PD becomes a more familiar term, individuals may become indignant at the idea of it being refused to them. Americans have a very "I want it because it's mine" attitude towards things, even if they don't necessarily need or want the thing(s) in question. The thought that a number which allows them to get glasses may be withheld from them may lead to individuals asking for it on nothing more than principal; especially in today's political climate, the thought of someone in a position of power restricting access to something someone views as inherently "theirs" could create a major backlash.

3) On the tail of #3: The likelihood of a lawsuit being generated over a PD issue becomes increasingly higher under these circumstances and in this climate.

4) The article represents why WP has succeeded thus far and why they'll become the real force to watch, as opposed to Coastal, EyeBuy, etc. WP knows that the online question is largely a matter of winning hearts and minds, as well as wallets. Anyone with the money can begin an online startup and offer a catalog of anonymous glasses and lens options. WP makes the consumer feel like they care, and has created a unique corporate culture and identity itself in order to give the customers something they feel like they can care about as well.

[Darryl Meister]

What I was trying to get across in my post is that if/when the FTC makes a ruling forcing the recording of PD's on the patient's prescription,

That would be analogous to forcing a tailor to measure every person who walked in his shop door for a suit, and to provide those measurements to the customer, regardless of whether the customer actually purchased a suit from the tailor. In any case, I'm not sure that the FTC would have much luck in forcing optometry and ophthalmology to add regulated services to what is already considered a medical examination, especially if it is in support of a consumer practice (the purchase of online eyewear) that is illegal in many states with licensed opticianry. But stranger things have happened.

Since you cannot have an Rx without a PD, as you so rightly posted, Darryl, you prove my point. It *IS* part of the Rx. I agree with your point on seg heights, as those are centered on frame choice and bifocal type

Actually, I said that the majority of Rx forms do not have a PD indicated on them (at least in Missouri, back when I was dispensing). So, how in the world could anyone argue that the PD be required part of a prescription? For that matter, the easiest solution here for eyecare proefessionals is to simply stop measuring and noting the PD of patients before they decide to purchase eyewear from you. However, once you have measured the PD, for whatever reason, you may eventually be legally compelled to provide it to the customer.

Best regards,
Darryl

[shanbaum]

I agree with Darryl; if a customer has purchased eyewear from you, the record of that purchase might (though wrongly, I think) be construed to be "a prescription." If he hasn't purchased from you, I can't foresee a regulation that would require you to provide a service for free.

I could argue that the PD is not simply the distance between the pupils (or optical axes), but a value derived from that, which includes other variables such as panoramic angle and vertex distance of the lenses in as-worn position, making the number that does attach to the spectacle order, specific to that order. Of course, that would require that you do that sort of thing...

[becc971]

Personal Policy: i will not take and give out a PD so someone can buy online. the first and last time i ever did it the lady's glasses ended up being mens, measured completely incorrectly, and just an overall bad fit, and guess who she blamed. this kid. As an optician, i retake PD's even if they ARE on the RX, because i don't trust anyone's measurements but my own.

i feel like if a doctor wants to take and give out the PD on their own, more power to them, but other than that this kid wipes her hands of the whole situation.

That being said, WP is doing it right, they've built a huge business, the frames really aren't garbage having seen some myself, now that they're starting in on having actual store fronts i'll be interested to see if the cost goes up with that. thats a whole bunch of extra and expensive stuff they haven't had to pay for before. BUT, they play on my generation VERY well. even i think they're cool :) I'll be interested to see how this all plays out.

Oh, wow.

First off, I'm very sorry for any animosity or bad blood this thread may have created. It wasn't intended. I posted the story for a few reasons, which I'll elaborate upon below:

1) PD is becoming part of the public lexicon. What has been, until now, a term known only to those in the optical world and those attempting to order glasses online is slowly becoming a buzzword familiar to the eyeglass wearing world at large.

2) On the tail of #1: As PD becomes a more familiar term, individuals may become indignant at the idea of it being refused to them. Americans have a very "I want it because it's mine" attitude towards things, even if they don't necessarily need or want the thing(s) in question. The thought that a number which allows them to get glasses may be withheld from them may lead to individuals asking for it on nothing more than principal; especially in today's political climate, the thought of someone in a position of power restricting access to something someone views as inherently "theirs" could create a major backlash. (i feel like this is one of the major problems with society in general today? the whole "give it its mine" attitude, without wanting to learn why professionals would withhold it in the first place. or the ever indignant "i spent $XXX on these glasses 5 years ago they shouldn't scratch!" when really their INSURANCE spent most if not all of that money on the glasses and the patient paid about $50 in copays, and then tells me they've only been cleaning them with alcohol the entire time *sigh*. it seems as though they only think the PD is "theirs" because the internet told them so, and we know the internet is always right ;)

3) On the tail of #3: The likelihood of a lawsuit being generated over a PD issue becomes increasingly higher under these circumstances and in this climate.

4) The article represents why WP has succeeded thus far and why they'll become the real force to watch, as opposed to Coastal, EyeBuy, etc. WP knows that the online question is largely a matter of winning hearts and minds, as well as wallets. Anyone with the money can begin an online startup and offer a catalog of anonymous glasses and lens options. WP makes the consumer feel like they care, and has created a unique corporate culture and identity itself in order to give the customers something they feel like they can care about as well.

[Steve Machol]

Personal Policy: i will not take and give out a PD so someone can buy online. the first and last time i ever did it the lady's glasses ended up being mens, measured completely incorrectly, and just an overall bad fit, and guess who she blamed. this kid.

Exactly the point I tried to make earlier. Once you have contributed something to this prescription you become liable for the results, at least in the customer's eyes if not the law.

[Barry Santini]

Mike's right: If you can't supply a binocular PD that is within 3mm of whomever decides what the "real" PD value is....

Then....FAIL!

B

[jakef]

I'm with Becc971. Warby Parker has a trendy feel and a positive market presence in my generation. I've even ordered a pair to see what the quality was. They are not poorly made, and I didn't feel like I was getting the cheapest thing out there. That being said, my WP glasses would have been miserable to wear had I not properly adjusted them, and I've helped other patients trouble shoot issues with WP glasses. I think the concept of holding out or charging for a PD is an overly defensive attitude. The opticians at our optical are currently coming up with a complete online service package that we can sell, so if people want to buy online that's OK, we'll even help! A PD is really one of the least expensive services our opticians give in terms of time invested and difficulty. Our intention is to shift our goods in a direction that more clearly reflect the services we offer, and what they are worth.

[Darryl Meister]

I could argue that the PD is not simply the distance between the pupils (or optical axes), but a value derived from that

Yes, this is the point that I alluded to earlier when discussing video centration devices. Unfortunately, the industry has dumbed down important concepts like this to the point that a layperson no longer perceives any real knowledge or skill in the fitting and fabrication of eyeglasses. This is what has allowed online optical to secure a foothold in this industry. The art and science that was opticianry has been reduced to something that John Q Public thinks he can do just as well by printing something off from a cheap website or with an iPhone app.

Best regards,
Darryl

[Barry Santini]

I think it's important again to move away from discussing/classing eyewear into pass/fail categories, and move to using more fuzzy terms, like adequate, more adequate, tec.

The public will find, I predict, that SV eyewear made and delivered over the internet, is adequate for the price paid.

Let it simmer for a while, and, if you've been doing the right thing all along, I also predict they will be back.

B

[Robert Martellaro]

Until the FDA/FTC redefine the rules, as they did with EG 1.

That would require an EG 3. The FTC is not going to be able to preempt and rewrite state statutes, no way no how.

I could argue that the PD is not simply the distance between the pupils (or optical axes), but a value derived from that, which includes other variables such as panoramic angle and vertex distance of the lenses in as-worn position, making the number that does attach to the spectacle order, specific to that order. Of course, that would require that you do that sort of thing...

Monocular PDs are of no use without reference to the frame. - Mo Jalie

[drk]

NYS law says you can only charge a patient up to 75 cents per page for records. Anybody who charges a patient/customer 75 cents for a copy of the record which contains the PD is nuts.

And remember Eyeglasses 1??? Among other things it said you couldn't charge a patient extra for releasing a prescription... If we keep denying release of PDs, or overcharging for it when it is already in the record, regardless of state law, some Senators spouse is going to get pi$$ed, and get her husband to call the FTC...as has been done in the past with the Fairness to Contact Lens Consumers Act.

Yeah, but where do YOU draw the line? The p.d., that's it. No, verification, that's it. No, seg heights, that's it. No, free troubleshooting if they can't see, that's it. What's the limit to how much you can get pushed around? How scared are you?

[drk]

if/when the FTC makes a ruling forcing the recording of PD's on the patient's prescription, it will become an added procedure in the exam room. As you have pointed out, techs are already examining existing spectacles (for a starting point if the patient is new, or verification of an existing Rx). If they can go through the process of an initial phoropter exam, they can certainly measure a PD. And at that point, it becomes part of the prescription.

After all, with the number of incorrect exams being done every day, the PD could very well be off, but it then becomes incumbent on the optician to note the change on the patient's Rx for future reference, and again, this is part of the Rx, and belongs to the patient.

In my opinion, PD's WILL become a required part of the patient's Rx. Whether it is done in the exam room or in the original first dispensing office, they are still part of the Rx, and it belongs to the patient. Since EG1 forbids the practice of charging for an Rx, and since the PD is part of the Rx, then charging an additional fee for an existing patient is illegal.

But if the PD is anywhere in the patient's records at either the doctor's office or the optician's office, EG1 requires you to release that information at no additional charge.

Since you cannot have an Rx without a PD, as you so rightly posted, Darryl, you prove my point. It *IS* part of the Rx.

On what planet is anything you wrote more that just your opinion?

[drk]

Another thing driving this online eyewear stuff is this geek chic push. When that wears off, the whole Warby Parker Nerdo vibe goes out the door.

Not saying it will put an end to people doing it themselves, but it is driven (I'd suppose) by 20-somethings upgrading to zyl.

What may propel it, however, is the demise of the vision care plan. When people find out what a rip off it is to purchase themselves, they'll be looking for alternatives.

[Robert_S]

Actually, Darryl, I didn't "ignore" those facts, they were just not my part of the discussion.

What I was trying to get across in my post is that if/when the FTC makes a ruling forcing the recording of PD's on the patient's prescription, it will become an added procedure in the exam room. As you have pointed out, techs are already examining existing spectacles (for a starting point if the patient is new, or verification of an existing Rx). If they can go through the process of an initial phoropter exam, they can certainly measure a PD. And at that point, it becomes part of the prescription.

Now, as Barry and others have pointed out, yes, the PD DOES change, albeit slightly in a year (if at all), and if the PD is taken at the time of the change, then all is well. Does this mean the optician won't take it again? No, they SHOULD take it again. After all, with the number of incorrect exams being done every day, the PD could very well be off, but it then becomes incumbent on the optician to note the change on the patient's Rx for future reference, and again, this is part of the Rx, and belongs to the patient.

Y'all are looking for ways not to do it, ignoring the many ways it could/can be done. In my opinion, PD's WILL become a required part of the patient's Rx. Whether it is done in the exam room or in the original first dispensing office, they are still part of the Rx, and it belongs to the patient. Since EG1 forbids the practice of charging for an Rx, and since the PD is part of the Rx, then charging an additional fee for an existing patient is illegal. Now, I'm definitely NOT saying you cannot charge someone who is not your patient a fee for measurement, and have them sign a disclaimer, that's your business to do what you want. But if the PD is anywhere in the patient's records at either the doctor's office or the optician's office, EG1 requires you to release that information at no additional charge.

Since you cannot have an Rx without a PD, as you so rightly posted, Darryl, you prove my point. It *IS* part of the Rx. I agree with your point on seg heights, as those are centered on frame choice and bifocal type. We can argue back and forth all day on where seg heights should be located (and I think there are plenty of threads on that here on the board).

Mike, I like reading your posts for the most part but I totally disagree with you on this subject. The online supply of eyewear isn't good for anyone but those selling it. They assume the provision of services which they don't have to pay for, like an eye exam, troubleshooting issues, fitting the frames, and of course this topic, centration measurements. Please tell me how it is fair for one company to profit at the expense of an infrastructure that is essential to the public? The worst thing is that, on top of this parasitism, most online retailers spread and perpetuate the myth that they are saving the public from our greed. Our greed!