how can this be legal...

[fjpod]

just found out how it's legal

"Third, in a short "Terms and Conditions" paragraph, individuals are asked to check a box indicating that they understand that this is not a comprehensive eye exam, what a comprehensive eye exam means and how thats different from what Blink provides, and that a comprehensive exam with an optometrist is recommended every two years. This box must be clicked before vision testing may proceed."

http://www.goblink.co/for-optometrist/

That doesn't make it legal.

The matter is being studied. There is the issue of using unlicensed people, not directly under the supervision of a license. If you operated your store with unlicensed people, and you only stopped in every so often to check on things, you would be disciplined by your state board (assuming you are in a licensed state).

In addition, separating the refraction from an eye exam...while it is something many here would like to see, it is not specifically authorized in NYS.

The future is here...

[Paul Smith LDO]

What's next, a phone call to Dionne Warwick's; psychic refracting hot line.

[iD]

That doesn't make it legal.

The matter is being studied. There is the issue of using unlicensed people, not directly under the supervision of a license. If you operated your store with unlicensed people, and you only stopped in every so often to check on things, you would be disciplined by your state board (assuming you are in a licensed state).

In addition, separating the refraction from an eye exam...while it is something many here would like to see, it is not specifically authorized in NYS.

The future is here...

That paragraph and the patient acknowledging what they are receiving is a basic loop hole that lets blink off the hook. unless the court/government steps in and says that those terms and conditions doesn't relinquish blink of blame/fault. I know some states like California that don't need licenses for opticians if the doctor is licensed or something like that. I'm not too familiar with the language of that. I think this will quickly change once a few accidents happen (car crashes, falling down stairs, etc) because the blink member didn't do a thorough job.

[iD]

What's next, a phone call to Dionne Warwick's; psychic refracting hot line.

Miss Cleo has all your answers.

[Barry Santini]

What is the exact "blame/fault" that is being alluded to here?

B

[Barry Santini]

That doesn't make it legal.
In addition, separating the refraction from an eye exam...

The future is here...

Taking a look at the past, most doctor-opticals have separated the prescription from the eye exam for years. Although most will ask an 'ammetrope' when their last exam was before selling them Sunglasses, they never ask an emmetrope the same before fitting a new pair of Ray Bans.

Go figure.

B

[Tigerclaw]

Well said Barry. From a patient's perspective (seeking CL after expiration), the OD is extorting them for exorbitant exam fees, especially for those who have had the exact same Rx for the past 5 years, and who are seeing just fine. From the patient's view, the OD is using the force of law to keep them from taking care of themselves.

And we must admit that this is true. We charge our fees based on supply and demand. The requirement that only LDOs, MDs, and ODs can prescribe is a barrier to supply (thus increasing the cost). The requirement that patients possess a current Rx in order to take care of their eyes is an artificial boost to demand (thus increasing the cost). Patients pay more than what the service is worth because the law requires it. Anybody who seeks to get around the law can be fined or even jailed. This is coercion.

Now don't read me wrong. I am not saying that ODs are worthless. I am saying that the system artificially boosts their marketability through well-intentioned, but poorly reasoned, laws.

Ignorance in the truest sense of the word.

[drk]

Taking a look at the past, most doctor-opticals have separated the prescription from the eye exam for years. Although most will ask an 'ammetrope' when their last exam was before selling them Sunglasses, they never ask an emmetrope the same before fitting a new pair of Ray Bans.

Go figure.

B

This is going to be hard for you to understand, guys, but I'mma gonna take a crack at it. You'll learn something that even many ODs haven't thought through.

Statement: You can't "separate" a "refraction" from an "eye exam".

Explanation: An exam has three elements: history, exam, and medical decision making (which also involves patient education and answering questions, etc.)

Stipulation: Let's leave out the standard EXAM aspects of a comprehensive eye exam as defined by CPT: neurological evaluation (EOM, pupils, CVF), tonometry (only as needed, of course) and structure evaluation (usually via SLE and ophthalmoscopy). Let's leave off every per se "health test".

Contention: You still have an exam of some sort when you arrive at a spectacle prescription.

By way of illustration. Setting: The Old West.

History:
"Why ya here, Joe?"
"Need new double bar with double Ds for get-alooong-lil'-doggie duty."
"How you seein' with them old pups?"
"Fair-to-middlin', I reckon."
"Then, let's a-git 'er started."

Exam:
(BRAND SPANKING NEW I-PHONE AUTOREFRACTOR BABY! NOTHING BUT THE BEST FROM BEST BUY.)
"Now read the chart, Joe."
"I-W-E-A-R-C-H-A-P-S-W-I-T-H-O-U-T-T-R-O-U-S-E-R-S"
"Mighty fine."

Medical decision making:
("Shoot. Ole Joe ain't a-gonna like that extra buck cyl x 45. Better cut it down, some, or he'll buck like a cayuse when he puts 'em on!")
"Joe, I'm not changin' yer perscription all that much."
"Why not, doc?"
"Causin' you might get all wobbly like after a Saturday night at the Silver Dollar Saloon. You said yer seein' pert good already."
"Right. How about them extry-wide bifocals that go all the way across? And Photograys. And a Durango collection frame."
"High-tail it over to Miss Sally to talk about all that stuff."


Ok. All the elements of an eye exam are there. So you can't just refract and go.

Now, you opticians have given away all services since the beginning of time; that's your business. But if a service is provided (history, exam, and MDM), there should be a fare.

So, Barry, please...

[Tigerclaw]

Yep, if I took his approach why should I hire a trained optician or other experienced stylist/dispenser when all I need is some high school kids to come in and give "good enough" service? Good enough is not good enough.

[Barry Santini]

Drk

you know I agree with your viewpoint. But...

Plano is just as valid an "Rx" as -0.25cyl. Yet, all the king horses, etc., will not get a doc to write a Plano Rx.

if they did, then every one of your points would become crystal clear for all.

B

[ml43]

Ml43, I simply disagree with your premise. True, the US is overpriced. But that is due to failed government regulation. Thus, healthcare tourism. As far as quality and advanced procedures, the US is top notch (if you can pay for it).

Dr. K, you are confusing status with progress. True, India is third world. But that is not the point. India is using new technology to make progress. The US has been top dog for a long time, but we should not rest in our status. We must continue to make progress. That means embracing new technologies without the stultification (love that word!) of overbearing government.

There is no current U.S. government regulation on the price of medical services, hence why things are the way they are in the U.S.

The U.S. also does not subsidize medical students. So in the U.S., graduate healthcare students incur huge amounts of debt.

The U.S. also makes it so the patient can sue anyone who touches them, should they think something went wrong.
The doctors and hospitals pay for this.


If your answer to progressing the medical field in the U.S. is to use technology and untrained/unskilled individuals to deliver this service,
then I'm afraid we highly disagree on your definition of progress, as that would be a huge regression, IMO.

It's the equivalent of corporations using out of state/country call centers to handle much of their day to day services.
Do more people get helped? Yes
Is the service better? No

[drk]

Drk

you know I agree with your viewpoint. But...

Plano is just as valid an "Rx" as -0.25cyl. Yet, all the king horses, etc., will not get a doc to write a Plano Rx.

if they did, then every one of your points would become crystal clear for all.

B

You're a sophist.

A plano lens has no therapeutic ability with regards to refractive error.

And light filters do not need an Rx, nor a license to write one.

Nor do you need a prescription to tell your patient "cut back on the ding dongs, get some exercise, and fer heaven's sake lay off the vodka."

Prescribing authority is for potentially harmful ergo controlled treatments.

[wmcdonald]

Yep, if I took his approach why should I hire a trained optician or other experienced stylist/dispenser when all I need is some high school kids to come in and give "good enough" service? Good enough is not good enough.

Most ODs do not hire anyone trained, and pay the lowest salaries in the industry......as reported by most salary surveys historically. Read the local want ads.......no experience necessary, will train. And even worse, they often leave the office and allow these "trained" folks to dispense eyewear to the public. It should be illegal. So do not sit on any high horse when it comes to ODs and their relationship with Opticians. You have done all you can do for as long as I have been involved in this industry to hold Opticians back. Now I understand your point quite well, but do not get on this board and talk about how ODs show benevolence to us poor Opticians.......it just isn't so!

[wmcdonald]

There is no current U.S. government regulation on the price of medical services, hence why things are the way they are in the U.S.

The U.S. also does not subsidize medical students. So in the U.S., graduate healthcare students incur huge amounts of debt.

The U.S. also makes it so the patient can sue anyone who touches them, should they think something went wrong.
The doctors and hospitals pay for this.


If your answer to progressing the medical field in the U.S. is to use technology and untrained/unskilled individuals to deliver this service,
then I'm afraid we highly disagree on your definition of progress, as that would be a huge regression, IMO.

It's the equivalent of corporations using out of state/country call centers to handle much of their day to day services.
Do more people get helped? Yes
Is the service better? No

Sorry, but the US spends billions annually subsidizing medical and allied health professionals. If one were to serve in underserved areas, this costly education can be completely free! If you really want to know the truth about liability issues, do some research on the number of people who ever gain from suing a medical professional. You will be surprised,, and the number of people who sue ODs is miniscule compared to the number of patients seen. All this malarkey is about dollars and cents. Who has control. It is not about who gives the best "service"......whatever that means. Can this kind of technology be employed and used effectively, and at a much lower cost? We do not know, because there has been no study on its efficacy. I suspect the OD political machine will do all it can to see that there is none, as they did with Opticians. The constant barrage of articles and comments regarding all of the dangers of allowing the lesser-trained Optician to refract was very effective, and remains so in this thread. No study on how it could be accomplished, just all of the negative comments on why it should not. But now we have major corporate heads with astronomical funding Opticians do not have wanting to provide a similar service via technology. Lets see what happens. If it works well, why not.

[drk]

Most ODs do not hire anyone trained, and pay the lowest salaries in the industry......as reported by most salary surveys historically. Read the local want ads.......no experience necessary, will train. And even worse, they often leave the office and allow these "trained" folks to dispense eyewear to the public. It should be illegal. So do not sit on any high horse when it comes to ODs and their relationship with Opticians. You have done all you can do for as long as I have been involved in this industry to hold Opticians back. Now I understand your point quite well, but do not get on this board and talk about how ODs show benevolence to us poor Opticians.......it just isn't so!

1. Most ODs don't hire anyone trained? You'd better back that up, buddy.
2. If they do hire someone untrained, they train them. How is it bad to receive an "apprenticeship" for pay? You want schools but there aren't any/many for us to choose from.
3. We may pay less than chains, but they have to pay higher wages because it devours your soul. What other "industry" positions are paying "higher than ODs"?
4. "Often leave their offices and leave untrained staff dispensing". You'd better back up that libel, too, Mr. I-Hate-Optometry-So-I'm-Going-On-A-Public-Forum-And-Throw-Bombs-Not-Caring-One-Whit-About-What-Damage-I-Do-To-Patients-Who-May-Read-This-And-Question-The-Care-They-Get. So professional. So professional.
5. I've only been doing this 25 years, and maybe you've been doing this 50, but you're fighting a 1960-70's battle against optometry. We used to have old Chip Anderson on this board, and he was a great guy but he was a dinosaur like you who had nothing but an axe to grind against optometry.

Look, as I see it, commercialism leveled opticianry, not professionalism. Optometry isn't "the massa that kept you on the plantation" for a heck of a looonng time. The modern era started when you got your lunch money stolen by Lenscrafters and other superopticals in the '80s and it continues today with vision care plans and monsters like Essilor. That's sad for all of us.

[drk]

I suspect the OD political machine will do all it can to see that there is none, as they did with Opticians. The constant barrage of articles and comments regarding all of the dangers of allowing the lesser-trained Optician to refract was very effective, and remains so in this thread. No study on how it could be accomplished, just all of the negative comments on why it should not. But now we have major corporate heads with astronomical funding Opticians do not have wanting to provide a similar service via technology. Lets see what happens. If it works well, why not.

I sincerely hope that our "political machine" gets it's head out of it's @$$ and does lobby to protect quality eye health care in America. No need to personalize it.

I get it with some of you: you think this autorefracting phone crap or autorefracting computer crap will allow patients to self-refract and you'll make a bundle. But you won't.

We've had autorefractors for, like, thirty years. They're tools in the hand of a professional AND NO PROFESSIONALS PRESCRIBE OFF OF THEM! WHAT DOES THAT TELL YOU? Just because there is some cheap and available autorefraction technology coming, that doesn't mean:
1. That it's going to be good.
2. That it's going to release the floodgates of pent up refraction demand, held back by that pesky, evil optometry/government complex.
3. That you're going to be able to prescribe and be this super-new independent profession.
4. That you're going to make all this new money selling all these glasses.

Get real. It just means that there's more crap to wade through. Crap online glasses. Crap online refractions to go with them.

[Tigerclaw]

I sincerely hope that our "political machine" gets it's head out of it's @$$ and does lobby to protect quality eye health care in America. No need to personalize it.

I get it with some of you: you think this autorefracting phone crap or autorefracting computer crap will allow patients to self-refract and you'll make a bundle. But you won't.

We've had autorefractors for, like, thirty years. They're tools in the hand of a professional AND NO PROFESSIONALS PRESCRIBE OFF OF THEM! WHAT DOES THAT TELL YOU? Just because there is some cheap and available autorefraction technology coming, that doesn't mean:
1. That it's going to be good.
2. That it's going to release the floodgates of pent up refraction demand, held back by that pesky, evil optometry/government complex.
3. That you're going to be able to prescribe and be this super-new independent profession.
4. That you're going to make all this new money selling all these glasses.

Get real. It just means that there's more crap to wade through. Crap online glasses. Crap online refractions to go with them.

Exactly. Anyone who uses that poor quality refraction for glasses is going to get their glasses online, probably from China.

[Tigerclaw]

Most ODs do not hire anyone trained, and pay the lowest salaries in the industry......as reported by most salary surveys historically. Read the local want ads.......no experience necessary, will train. And even worse, they often leave the office and allow these "trained" folks to dispense eyewear to the public. It should be illegal. So do not sit on any high horse when it comes to ODs and their relationship with Opticians. You have done all you can do for as long as I have been involved in this industry to hold Opticians back. Now I understand your point quite well, but do not get on this board and talk about how ODs show benevolence to us poor Opticians.......it just isn't so!

Somebody hired you, right? Are you as cheap as a fresh-off-the-street employee? My point was you get what you pay for, not that all OD's understand this concept when it comes to hiring staff. There is always someone willing to work more cheaply than you are as an optician, and the same applies to me. Cheap refractions are worse than a cheap measurement in the vast majority of cases, which means the OD's job is more crucial than the optician's (no offense, that's just the facts). If the OD's importance can be minimized then you can be darn sure yours will be, and in case you haven't noticed, it already has been. This does NOBODY any good except the few lucky idiots who get their glasses online that actually DO fit correctly and the corporate hacks who profit from it - you know, the same guys you seem to be cheering on. You will cut off your nose to spite your face.

[wmcdonald]

1. Most ODs don't hire anyone trained? You'd better back that up, buddy.
2. If they do hire someone untrained, they train them. How is it bad to receive an "apprenticeship" for pay? You want schools but there aren't any/many for us to choose from.
3. We may pay less than chains, but they have to pay higher wages because it devours your soul. What other "industry" positions are paying "higher than ODs"?
4. "Often leave their offices and leave untrained staff dispensing". You'd better back up that libel, too, Mr. I-Hate-Optometry-So-I'm-Going-On-A-Public-Forum-And-Throw-Bombs-Not-Caring-One-Whit-About-What-Damage-I-Do-To-Patients-Who-May-Read-This-And-Question-The-Care-They-Get. So professional. So professional.
5. I've only been doing this 25 years, and maybe you've been doing this 50, but you're fighting a 1960-70's battle against optometry. We used to have old Chip Anderson on this board, and he was a great guy but he was a dinosaur like you who had nothing but an axe to grind against optometry.

Look, as I see it, commercialism leveled opticianry, not professionalism. Optometry isn't "the massa that kept you on the plantation" for a heck of a looonng time. The modern era started when you got your lunch money stolen by Lenscrafters and other superopticals in the '80s and it continues today with vision care plans and monsters like Essilor. That's sad for all of us.

I think you read me wrong. I certainly do not hate ODs, and in fact many of my best friends are ODs, but it is common practice in most states for ODs to leave their offices with no licensed person on duty. It is called delegation. Read the NAO and other salary studies, and it is clear who pays less and it is private OD offices. The same is true for OD associates......they pay less than other places. Nothing wrong at all with apprenticeships, but they are not "trained" people. They are people in training and the very nature of apprenticeship is direct supervision.

Now to your tone......it does not have any affect on me to be called a dinosaur! I am harder on Opticians than and our purported "leadership" than anyone, and I do not see ODs as the enemy. But as one who has sat in legislative hearing after hearing and heard ODs limit our ability to advance, which is common knowledge, I do not see a need to argue the point. It is inter-professional turf, and I understand it completely. They are not the only ones......Opticians have been their own worse enemies, and I am well known for saying so here and in lectures across the nation and publications......so if you wish to discuss fine but do not think you will find I am an enemy to Optometry at all. When I was still lecturing I spoke at many OD and MD meetings, and addresses similar issues.

Now relax......I am not your enemy. I responded to Tigerclaw who asked a specific question related to the hiring of trained people. Do some research, and you will find I am correct in my assertion. Commercialism has been a real issue, and one we agree on, but it affected ODs differently. You all had the foresight to develop a solid education and licensure process back in the 40s, while we continue to wonder what happened.

[wmcdonald]

I sincerely hope that our "political machine" gets it's head out of it's @$$ and does lobby to protect quality eye health care in America. No need to personalize it.

I get it with some of you: you think this autorefracting phone crap or autorefracting computer crap will allow patients to self-refract and you'll make a bundle. But you won't.

We've had autorefractors for, like, thirty years. They're tools in the hand of a professional AND NO PROFESSIONALS PRESCRIBE OFF OF THEM! WHAT DOES THAT TELL YOU? Just because there is some cheap and available autorefraction technology coming, that doesn't mean:
1. That it's going to be good.
2. That it's going to release the floodgates of pent up refraction demand, held back by that pesky, evil optometry/government complex.
3. That you're going to be able to prescribe and be this super-new independent profession.
4. That you're going to make all this new money selling all these glasses.

Get real. It just means that there's more crap to wade through. Crap online glasses. Crap online refractions to go with them.

Lets see what the research says once it is around for a while. MDs used to say (and some still do) that you folks should not be doing "medicine." Time will tell what uses we can find for such technology.

[wmcdonald]

Somebody hired you, right? Are you as cheap as a fresh-off-the-street employee? My point was you get what you pay for, not that all OD's understand this concept when it comes to hiring staff. There is always someone willing to work more cheaply than you are as an optician, and the same applies to me. Cheap refractions are worse than a cheap measurement in the vast majority of cases, which means the OD's job is more crucial than the optician's (no offense, that's just the facts). If the OD's importance can be minimized then you can be darn sure yours will be, and in case you haven't noticed, it already has been. This does NOBODY any good except the few lucky idiots who get their glasses online that actually DO fit correctly and the corporate hacks who profit from it - you know, the same guys you seem to be cheering on. You will cut off your nose to spite your face.

Fine, but your initial comment, which started this ongoing conversation from my perspective, asked about why you should hire trained people. Typically ODs do not, and salary survey after salary survey support my assertion. I am not against you here, but you also need to know ODs are historically lower paying than every other area, and the same is true for new OD associates.

[Barry Santini]

You're a sophist.

A plano lens has no therapeutic ability with regards to refractive error.

And light filters do not need an Rx, nor a license to write one.

Nor do you need a prescription to tell your patient "cut back on the ding dongs, get some exercise, and fer heaven's sake lay off the vodka."

Prescribing authority is for potentially harmful ergo controlled treatments.

Not at all. Do NOT tell me that mild ametropia...say up to 0.50D SPH and/or Cyl, is NOT routinely "prescribed", i.e., "your eyes are fine...healthy."

Yet I chase my tale with suns that "impact their vision."

BULL****!

You are refracting them...And collecting a co-pay for such. Everyone deserves their findings.

If we did the optical thing in general medicine, then when someone's "numbers" were normal, we simply wouldn't tell them.

B

[Tigerclaw]

If we did the same thing in general medicine we would hand them a blank prescription sheet. Besides, there's lots of normal findings we don't explicitly mention. If the issue is whether or not vision plans will cover plano sunglasses, take it up with the vision insurance or even medical (since they'd be footing the bill for surgeries or chronic disease treatment).

[Robert Martellaro]

Do NOT tell me that mild ametropia...say up to 0.50D SPH and/or Cyl, is NOT routinely "prescribed", i.e., "your eyes are fine...healthy."

The surgeons in my area routinely send their patients to the local pharmacy to obtain OTC readers, declaring that their cataract surgery was so successful that they'll never need eyeglasses for distance again, and that OTCs are all that they'll ever need. It's not uncommon to see ± .50 to .75 sphere equivalents, and/or cyls over .75. I don't know what their thinking, probably a combination of a God complex and ignorance.

[drk]

Fine, but your initial comment, which started this ongoing conversation from my perspective, asked about why you should hire trained people. Typically ODs do not, and salary survey after salary survey support my assertion. I am not against you here, but you also need to know ODs are historically lower paying than every other area, and the same is true for new OD associates.

If you look up what an average OD makes via the BLS instead of the "B.S" that the AOA puts out, you'll see very few ODs are getting rich. What you'll see is, perhaps, inefficient staff-heavy practices that may slice the pie too thinly, but there just ain't that much to go around, Dr. Mac.

I literally get $40-$60 per exam with VCPs. I won't have to discuss margins on optical goods and services or contact lenses.

Who's driving these prices low? You know it: VCPs. (Don't let someone like Racethe1320 blow sunshine up your backside.) Next it will be online DIY.

Now, how much can anyone afford to pay an optician with dispensing fees through the floor? Look up the BLS data on opticianry, again. It ain't pretty.

The only way to make money in opticianry is to own an optical or three or to move up the corporate ladder at Luxottica. It is what it is.