This is serious.

[Paul Smith LDO]

I see it as a simple black and white issue. Increasing the prescribing Dr's office workload Vs absolving the DIY business from doing their work. If you are in the business of selling eyewear and eyewear only, use your own methods for garnering required fitting measurements. Putting the prescribing office in the middle of a battle between, "adequately" vs "optimally" made eyewear, is a losing proposition. Exactly how does one go about explaining "adequate" vs "optimally" without insulting someone's sensibility, it's a precarious position many of us may be forced into.
The prospect of seeing more patients because we provided both the Rx and now the measurements used to fabricate another business's product is not a free market. Is a Mercedes dealership responsible for Jiffy Lube's "adequate" work. The Mercedes dealership is going to charge me a diagnostic and any other fees required to undo "adequate" work. How many office's are going to charge their patients for diagnostic tests on their Rx and measurements.

[Dr. Bill Stacy]

I've faced this issue many times over the years and never could bring myself to charge the patient for diagnosing a problem with their glasses purchased elsewhere. So I kind of treat it like I do if the patient used my CL Rx for lenses purchased elswhere and has a problem. I cover that under the original CL fit/refit fee, which basically covers them for a year. Similarly, I have a followup more or less built into my exam fee. Not specifically broken out like it is with CL fees, mostly because of the history of optometry and also inertia. Plus I'd get a lot of push back if I said something like: "That's $150 for the eye exam and another $50 for any followup visits. Too much like concierge medicine on another thread. One nice thing about health plans, some of them will pay for a visit that carries a complaint that can be justified as "visual discomfort". The patient usually has a copay with those, but hey, it works sometimes...

One other thing I do. If I'm not on their health plan and they have a copay, I'll accept the same amount as their copay and let the rest go into space. (no claims involved)

[Uilleann]

The cats are already out of the sack. No use trying to herd them up and stuff them back in again.

Look at this from an uneducated consumer's view (which is practically all of them of course):
Eyeglasses are nothing more in today's world (and in America in particular) than a cheap, disposable, fashion based commodity. They are not a medical device. They are used as often as they aren't to be seen in - as much as they are to see with. This trend was set in motion more than a century ago, but has constantly been moving in one direction - towards fashion, and away from "medical devices". It's what the public has always wanted, and now more than ever demands.

Right or wrong, that seems to be the free market at work. Internet sales of prescription eyeglasses (and contacts as well really - which are, lets face it, almost always worn for cosmetic reasons alone) have shown that there is a viable market for eyewear prostheses, without the need for a healthcare professional between the doctor and finished product. No argument that the bar has been lowered to such a laughable point it's hard to imagine it going any lower again - but stranger things have happened I suppose. Further, it is indicative of the continued erosion of the concept of eyewear as a medical device as opposed to a cheap fashion commodity. That seems to be what the public want, with greater emphasis every passing year away from medicine and health. After all, health is so passe anymore. It's all about image. The wild wild west had nothing on the current state of fashion eyewear (with prescription lenses...if I have to! *cue temper tantrum!)

[Dr. Bill Stacy]

Ok if I must, I'll place relative values on the health vs fashion idea. I think it varies with age, sex and use, but here's my 1st approximation:


Age 0-6............. 99% health....................1% fashion

Age 7-18........... 80% health....................20% fashion

Age 19-40 males......70& health......................30% fashion

Age 19-40 females...50% health ....................50% fashion

Age 41-70 males..... 50% health....................50% fashion

age 41-70 females....30% health...................70% fashion

above 70 ...............80% health....................20% fashion

Safety eyewear...... 90% health...................10% fashion

Low vision aids........100% health..................0% fashion

Mr Sulu, please activate shields...

[Barry Santini]

I see it as a simple black and white issue. Increasing the prescribing Dr's office workload Vs absolving the DIY business from doing their work. If you are in the business of selling eyewear and eyewear only, use your own methods for garnering required fitting measurements. Putting the prescribing office in the middle of a battle between, "adequately" vs "optimally" made eyewear, is a losing proposition. Exactly how does one go about explaining "adequate" vs "optimally" without insulting someone's sensibility, it's a precarious position many of us may be forced into.
The prospect of seeing more patients because we provided both the Rx and now the measurements used to fabricate another business's product is not a free market. Is a Mercedes dealership responsible for Jiffy Lube's "adequate" work. The Mercedes dealership is going to charge me a diagnostic and any other fees required to undo "adequate" work. How many office's are going to charge their patients for diagnostic tests on their Rx and measurements.

Some good points, Paul, as always. Especially the Mercedes analogy.

Despite the prospective hurdles and the protests to the contrary, I think the most persuasive thing to let your clients try what you trumpet to be inferior.

If it is, they'll know.

If it isn't, they'll go.

i've been doing business as an optician, without doctors or vision care plans, for decades. I think I know a little about what it's like to survive in the desert without water.

Alan Fortunoff, son of the founders of the same namesake store in LI, a fixture of service-oriented businesses for decades said, when asked to join a local merchant association trying to fight off a low-price flea market in an abandoned raceway lot nearby:

"If I can't survive facing this type of competition ー which is, literally, how my parents got started ー then I have no business being in business."

These are words we should all live by. The world is a changing. Don't get stuck in last century thinking.

B

[Paul Smith LDO]

Some good points, Paul, as always. Especially the Mercedes analogy.

Despite the prospective hurdles and the protests to the contrary, I think the most persuasive thing to let your clients try what you trumpet to be inferior.

If it is, they'll know.

If it isn't, they'll go.

i've been doing business as an optician, without doctors or vision care plans, for decades. I think I know a little about what it's like to survive in the desert without water.

Alan Fortunoff, son of the founders of the same namesake store in LI, a fixture of service-oriented businesses for decades said, when asked to join a local merchant association trying to fight off a low-price flea market in an abandoned raceway lot nearby:

"If I can't survive facing this type of competition ー which is, literally, how my parents got started ー then I have no business being in business."

These are words we should all live by. The world is a changing. Don't get stuck in last century thinking.

B

Survival in a desert, it's called an oasis, Barry. What you have is just that. You may be surrounded by sand but you have palm trees and fresh water at your disposal. You can politely smile and say, "no Sir or Mame I do not take insurance but I can provide you with unequaled service and an itemized statement" You are not required to produce four different Rx's along with four separate PD's with instructions for each one(if the FTC has it's way). Competition I can handle, just provide me with an even playing field and an objective officiating crew.

[Joe Zewe]

What says a lot to me about this is that it is being brought up by the Federal Trade Commission. Not the NIH or any medically related government agency.

To my eye (pardon the pun) the fix is in by heavyweights who outweigh anything the OD's lobbying arm can bring to the fight.

Interesting comment regarding the fact that it is the FTC looking at these regulations.

See the link regarding the function of the FTC: https://www.ftc.gov/about-ftc/what-we-do I would think many of the points against releasing PDs will fall on deaf ears. The FTC protects consumers and promotes competition. With the prevalence of online, I would assume the FTC will see online as competition that has brought costs down for consumers. Is anyone aware of evidence that shows widespread harm to consumers caused by the release of PD measurements or by consumers using PD measurements released by an ECP to buy glasses online? Does anyone really think the FTC will understand the issues raised with respect to issuing a PD? Will they care that it creates work for a doctors office? The FTC is on the side of the consumer. I doubt they will care about any burden this places on the ECP.

Maybe a more realistic approach would be to recommend accepting inclusion of a PD measurement on the Rx provided an appropriate disclaimer/warning is printed on the Rx emphasizing the relevant issues with dispensing eyewear. While many consumers will ignore, it could shed light on the issue and persuade some to purchase from an ECP.

In general, I believe too much effort is spent protecting the status quo and not enough energy spent embracing change by adopting strategies that align with the market.

[Chris Ryser]

Put me in the camp that says:
1. spectacle and contact lens dispensing is vision care
2. vision care is health care
3. health care needs regulation.

Put Barry in the camp that says:
1. spectacle dispensing is retail
2. retail needs significantly less regulation.

He's right, from his (wrong) perspective.

Have you ever seen any pictures of on-line opticals lab. I have seen a few and they look like most super modern installed places with the latest in equipment helping them do some decent work or better.

The more you argue about PD's, the more the persons developing automatic PD measurement devices are working double time, as the one automatica on the street corner or the shopping center that will measure the PD and print it out for a buck in the slot and maybe even takes credit cards.

Your biggest on-line competitors these days are the 2 largest optical manufacturers and suppliers in frames and lenses that operate also the largest on-line opticals world wide.

How do we think that the optical retail world in N.America can come to an agreement on PD hand outs if they all are of the same opinions as the OptiBoard poster community.

.

[ml43]

Maybe a more realistic approach would be to recommend accepting inclusion of a PD measurement on the Rx provided an appropriate disclaimer/warning is printed on the Rx emphasizing the relevant issues with dispensing eyewear. While many consumers will ignore, it could shed light on the issue and persuade some to purchase from an ECP.

In general, I believe too much effort is spent protecting the status quo and not enough energy spent embracing change by adopting strategies that align with the market.

When you make something federal policy, there is no grey area.

disclaimers of any kind on an rx, releasing liability is not allowed by the FTC, nor is it allowed by state boards.

The issue of required release and implementation of such is what's being debated.


To make an inexact analogy, would you give a consumer access to your drill point software after the purchase of one set of clips, so they can come to me and have it made next year for 1/4 the price?

[Barry Santini]

Q: If an otherwise well-corrected emmetrope dons a stylish frame with acrylic demo lenses, or with Blu blocking lenses, should this be done only under the auspices of a licensed vision care professional?

B

[MikeAurelius]

Interesting comment regarding the fact that it is the FTC looking at these regulations.

See the link regarding the function of the FTC: https://www.ftc.gov/about-ftc/what-we-do I would think many of the points against releasing PDs will fall on deaf ears. The FTC protects consumers and promotes competition. With the prevalence of online, I would assume the FTC will see online as competition that has brought costs down for consumers. Is anyone aware of evidence that shows widespread harm to consumers caused by the release of PD measurements or by consumers using PD measurements released by an ECP to buy glasses online? Does anyone really think the FTC will understand the issues raised with respect to issuing a PD? Will they care that it creates work for a doctors office? The FTC is on the side of the consumer. I doubt they will care about any burden this places on the ECP.

Maybe a more realistic approach would be to recommend accepting inclusion of a PD measurement on the Rx provided an appropriate disclaimer/warning is printed on the Rx emphasizing the relevant issues with dispensing eyewear. While many consumers will ignore, it could shed light on the issue and persuade some to purchase from an ECP.

In general, I believe too much effort is spent protecting the status quo and not enough energy spent embracing change by adopting strategies that align with the market.

+1

The FTC is responding to an increasing number of complaints from consumers about the 'refusal' to measure of give P.D.'s. This is EXACTLY the same scenario that played out when Eyeglasses I came into being forcing the OD/MD to hand over the written Rx to the patient once the visit was concluded and fees paid.

The FTC is going to look at the issue like this:

1. The correction needed is a physical measurement of the optics of the eye(s) that the doctor measures in order to make correct optical lenses.
2. The PD is the physical measurement of the distance between the eyes, that is required in order to make the correct optical lenses.
3. Since both are physical measurements of the eye and related structures, the PD is part of the prescription and therefore must be measured and released to the patient.

The FTC will *always* take the side of the consumer. I expect within the next year that the FTC will release a rule indicating that the PD is part of the prescription and must be measured and given to the patient.

[optical24/7]

Imho, this talk about PD release or not is small potatoes compared to what's down the road ( and soon...) Apps are already out there, and surely to be refined for self refraction. Will the FTC side with ECP'S in maintaining that only a licensed Dr can produce one? Will they mandate "professional" care, or side with consumers since they already allow "self refraction" via OTC readers and Plano sun wear?

On liners already aren't required to obtain a copy of consumer's Rx's. You just enter the info yourself...Any old Rx you want. Think your glasses are too weak? Jack your Rx yourself.

Yes, times are a changin'. And the changes may very well be something much bigger than imagined today...(And you're worried about PD's...)

[Barry Santini]

Will they mandate "professional" care, or side with consumers since they already allow "self refraction" via OTC readers and Plano sun wear? (and tilting their head back when wearing progressives!)

On liners already aren't required to obtain a copy of consumer's Rx's. You just enter the info yourself...Any old Rx you want. Think your glasses are too weak? Jack your Rx yourself.

Yes, times are a changin'. And the changes may very well be something much bigger than imagined today...(And you're worried about PD's...)

Outstanding!!! Yes....when consumer "say" they don't*"need* a prescription, and they buy PLANO suns, they are, in fact, self refracting!!!!

Unless, of course, only a licensed doc or refracting tech can determine this.

Luv it!

B

[drk]

Have you ever seen any pictures of on-line opticals lab. I have seen a few and they look like most super modern installed places with the latest in equipment helping them do some decent work or better.

The more you argue about PD's, the more the persons developing automatic PD measurement devices are working double time, as the one automatica on the street corner or the shopping center that will measure the PD and print it out for a buck in the slot and maybe even takes credit cards.

Your biggest on-line competitors these days are the 2 largest optical manufacturers and suppliers in frames and lenses that operate also the largest on-line opticals world wide.

How do we think that the optical retail world in N.America can come to an agreement on PD hand outs if they all are of the same opinions as the OptiBoard poster community.

.

But I already said I don't care about P.D.s. I welcome new DIY PD technology. More power to the DIYers.

Keep me out of it, then.

What's more...please decide, society, if vision care is regulated or not. We want to know.

[drk]

Q: If an otherwise well-corrected emmetrope dons a stylish frame with acrylic demo lenses, or with Blu blocking lenses, should this be done only under the auspices of a licensed vision care professional?

B

What's a "well-corrected emmetrope"?

[drk]

+1

The FTC is responding to an increasing number of complaints from consumers about the 'refusal' to measure of give P.D.'s. This is EXACTLY the same scenario that played out when Eyeglasses I came into being forcing the OD/MD to hand over the written Rx to the patient once the visit was concluded and fees paid.

The FTC is going to look at the issue like this:

1. The correction needed is a physical measurement of the optics of the eye(s) that the doctor measures in order to make correct optical lenses.
2. The PD is the physical measurement of the distance between the eyes, that is required in order to make the correct optical lenses.
3. Since both are physical measurements of the eye and related structures, the PD is part of the prescription and therefore must be measured and released to the patient.

The FTC will *always* take the side of the consumer. I expect within the next year that the FTC will release a rule indicating that the PD is part of the prescription and must be measured and given to the patient.

-1.

Where's "the evidence" that the FTC is getting pd release complaints? I'm sure people complain, but really?

Also, don't be a dork, Mike. A p.d. is dependent upon the lens application. Releasing distance p.d.s for readers is pointless. It is application-dependent. Maybe we should be forced to take p.d.s for distance, intermediate, and near.

[drk]

Imho, this talk about PD release or not is small potatoes compared to what's down the road ( and soon...) Apps are already out there, and surely to be refined for self refraction. Will the FTC side with ECP'S in maintaining that only a licensed Dr can produce one? Will they mandate "professional" care, or side with consumers since they already allow "self refraction" via OTC readers and Plano sun wear?

On liners already aren't required to obtain a copy of consumer's Rx's. You just enter the info yourself...Any old Rx you want. Think your glasses are too weak? Jack your Rx yourself.

Yes, times are a changin'. And the changes may very well be something much bigger than imagined today...(And you're worried about PD's...)

This is the best post.

We just have to see the bigger picture.

DIY optometry to go with DIY opticianry.

I'm here to tell you, I don't care.

DIY medicine, too. It's a free country.

JUST...KEEP...ME...OUT OF IT.

[optical24/7]

I would like to add a little history lesson on refraction;

Charles Prentice’s pioneering studies in optics earned himthe praise of prominent ophthalmologists at home and abroad. But his status asa leading refracting optician also inspired contempt among medical doctors *****garded Mr. Prentice’s trade as a threat to medicine.

Trained as a mechanical engineer in Germany, Mr.Prentice applied his knowledge of math and physics to the field of optics. In1890, his papers on the “Law of Declaration” and “A Metric System of Numberingand Measuring Prisms” won him a worldwide reputation as a brilliant innovator.

Mr. Prentice and a handful of others formed the OpticalSociety of the State of New York in 1895, in part to counter M.D.s who accusedrefracting opticians of violating medical practice laws. In 1896, Mr. Prenticesuccessfully argued that fitting glasses constituted the treatment of light,not disease, and so did not infringe upon medicine’s purview.

So, it was argued (successfully) 120 years ago that refraction was NOT medicine. The same could be argued today. Health ins. does not consider it medicine, they don't pay for refractions. Consumers already self refract. Eye glasses are extremely low on the totem pole of creating a health issue, even extremely poorly made ones. It's reflected in how low the cost of malpractice ins. charges for our coverage.

The example of BC Canada de-regulating refraction can be held up too. There are no dead bodies in the streets there due to poor/self refractions.

You can talk till you're blue in the face of how it's used to diagnose medical conditions, yet, mandated exams do not exist. If they did, we'd all be required to get colonoscopies to cut down on deaths from colon cancer, of which 10's of thousands die. Someday, consumer's right to refuse a medical exam to obtain a visual aid will be obsolete.......


Oh yea...it already is, with regards to OTC's and Plano eye wear.

[drk]

Outstanding!!! Yes....when consumer "say" they don't*"need* a prescription, and they buy PLANO suns, they are, in fact, self refracting!!!!

Unless, of course, only a licensed doc or refracting tech can determine this.

Luv it!

B

When buying sunglasses at Macy's is called "self-refracting" you have entered...The Santini Zone.

[drk]

I would like to add a little history lesson on refraction;

Charles Prentice’s pioneering studies in optics earned himthe praise of prominent ophthalmologists at home and abroad. But his status asa leading refracting optician also inspired contempt among medical doctors *****garded Mr. Prentice’s trade as a threat to medicine.

Trained as a mechanical engineer in Germany, Mr.Prentice applied his knowledge of math and physics to the field of optics. In1890, his papers on the “Law of Declaration” and “A Metric System of Numberingand Measuring Prisms” won him a worldwide reputation as a brilliant innovator.

Mr. Prentice and a handful of others formed the OpticalSociety of the State of New York in 1895, in part to counter M.D.s who accusedrefracting opticians of violating medical practice laws. In 1896, Mr. Prenticesuccessfully argued that fitting glasses constituted the treatment of light,not disease, and so did not infringe upon medicine’s purview.

So, it was argued (successfully) 120 years ago that refraction was NOT medicine. The same could be argued today. Health ins. does not consider it medicine, they don't pay for refractions. Consumers already self refract. Eye glasses are extremely low on the totem pole of creating a health issue, even extremely poorly made ones. It's reflected in how low the cost of malpractice ins. charges for our coverage.

The example of BC Canada de-regulating refraction can be held up too. There are no dead bodies in the streets there due to poor/self refractions.

You can talk till you're blue in the face of how it's used to diagnose medical conditions, yet, mandated exams do not exist. If they did, we'd all be required to get colonoscopies to cut down on deaths from colon cancer, of which 10's of thousands die. Someday, consumer's right to refuse a medical exam to obtain a visual aid will be obsolete.......


Oh yea...it already is, with regards to OTC's and Plano eye wear.

Wrong. Nobody refracts themselves. People try on glasses. That's not refracting. Don't get goofy.

Wrong. Insurers don't cover a lot of things, and it has nothing to do with some definitive classification system.

Wrong. We aren't looking for literal dead bodies, are we? We are looking for functionality issues.

I'm sure you all agree on licensure for tattoo artists and cosmetologists and hair stylists and fast food restaurants. I guess optometry and opticianry don't rank as high as that. http://www.businessnewsdaily.com/249...-licenses.html

[optical24/7]

Technology has displaced/replaced professions throughout history. Ask any blacksmith.

[optical24/7]

Wrong. Nobody refracts themselves. People try on glasses. That's not refracting. Don't get goofy.

Which is better doc, one or two? Call it what you want, I'll call it refraction.

Wrong. Insurers don't cover a lot of things, and it has nothing to do with some definitive classification system.

Ask your insurance co. why they don't pay for it. "Because it is not a medical procedure".

Wrong. We aren't looking for literal dead bodies, are we? We are looking for functionality issues.

Functionality is in the *eye* of the beholder. How many CL wearers do you have as patients that are happy with 20/30 acuity..As long as they get to keep wearing their CL's.

I'm sure you all agree on licensure for tattoo artists and cosmetologists and hair stylists and fast food restaurants. I guess optometry and opticianry don't rank as high as that. http://www.businessnewsdaily.com/249...-licenses.html

You and I can agree on what needs licensure. But, does the public? Why are most states un-regulated as far as Opticianry? Why have we been seeing an assault on licensure in states with it, including yours?

[ak47]

age 7-8....65% health 35% fashion
age 9-18 40% health 60% fashion
age 61-74 males 70% health 30% fashion
age 75+ males 95% seeing the television and finding their pills

Ok if I must, I'll place relative values on the health vs fashion idea. I think it varies with age, sex and use, but here's my 1st approximation:


Age 0-6............. 99% health....................1% fashion

Age 7-18........... 80% health....................20% fashion

Age 19-40 males......70& health......................30% fashion

Age 19-40 females...50% health ....................50% fashion

Age 41-70 males..... 50% health....................50% fashion

age 41-70 females....30% health...................70% fashion

above 70 ...............80% health....................20% fashion

Safety eyewear...... 90% health...................10% fashion

Low vision aids........100% health..................0% fashion

Mr Sulu, please activate shields...

[drk]

You and I can agree on what needs licensure. But, does the public? Why are most states un-regulated as far as Opticianry? Why have we been seeing an assault on licensure in states with it, including yours?

Refraction IS covered as a special diagnostic procedure under certain circumstances. Look it up.

Subjective feedback during a refractive procedure is certainly helpful, but that's a far cry from someone "refracting themselves". I was pretty sure you were talking about choosing OTC readers as "self-refracting" anyway.

The public is whom we serve, but they don't make the rules. They vote for leaders who appoint supposed experts to serve the public by regulating various private industries, including health care. This is not a democracy, and we don't have a "giant tally" of whether something is policy or not. It's in the hands of experts. But politicians are for sale, and they tell their experts what to do.

Why certain states aren't licensed is beyond me. Why certain states face de-licensure we can all agree has less to do with public safety and more to do with special interest lobbies wanting regulation removed so they can make more money.

[drk]

I'm a little ****** off at some of the comments, and I'll say why.

What we're seeing at the big-picture level is deregulation of our segment of health care.

Some here seem to think that good ol' progress has obsoleted the need for professionals, therefore regulation is passe.

What I'm seeing is flouting of existing regulation and a well-funded attempt to remove what regulation barriers still exist.

Opticianry: yes or no? In your professional opinion, should we do away with 1. state dispensing regulations/standards, 2. state licensure of opticianry, 3. state optometry practice regulation, 4. spectacle correction as prescription only, 5. contact lens wear as prescription only?

I can point to examples of pressure on all five of these aspects.