For purposes of billing, yes; for purposes of prescribing, of course not.Originally Posted by Barry Santini
For purposes of billing, yes; for purposes of prescribing, of course not.
The blame is no more on us than it is on you for refusing to work for minimum wage.
And yes, you are bound by Texas law to honor the expiration date.
"Sec. 351.405. ALTERATION OF PRESCRIPTION.
A person may not alter the specifications of an ophthalmic lens prescription without the prescribing doctor's consent. "
And yes, this applies to PD if it's on the Rx.
Last edited by Tigerclaw; 10-23-2015 at 11:05 AM.
No, that's why they should be connected. One is not reliable without the other.
In an over arching way, I agree.
But "real-world" evidence suggests otherwise re: risk.
B
The question of frequency of visits, and what needs to be done on those visits is a complex mix of factors, and simpleminded formulas such as "annual exams" should never be used. For example, a glaucoma patient might need to be seen for a pressure check every 3 months, a visual field every year, and a fundus photo or OCT every 2 years. If he's a 25 year old myope, he might need a refraction every 6 months if his myopia is increasing, or every 2 years if stable.
I know that's an unusual case, but I actually have a patient like that and am changing my next visit calculations to include exactly what needs to be done and when.
Now for a 20 year old emmetrope who is ortho at distance and near and has no significant medical conditions, is asymtomatic visually and ocularly, I'm thinking he might need a "comprehensive eye exam" once every 4 or 5 years, or so, with a "healthy vision screening" with or without refraction every 2 years.
And of course their is a complete spectrum of possibilities between these extremes and beyond, so every patient should have a custom "recall" formulated at every visit that depends on their entire case history and a lot of professional thinking which has to consider insurance coverages and/or patient willingness to accept the plan.
That said, refraction must be done any time there is less than clear 20/20 vision at all working distances in each eye, and any significantly uncorrected hyperopia or astigmatism, binocular imbalance or "visual discomfort" (blur, diplopia, discomfort in eye, orbital area or headache, etc.).
On the far extreme case of a totally blind person with no chance of improvement (e.g., dead optic nerves or loss of both eyes), no refraction or eye exam is needed for the remainder of that person's lifetime unless some breakthrough allows a chance of improvement for the underlying diagnosis which must have been confirmed historically.
In all cases, a patient needs to be reminded to come in as soon as any signs or symptoms are noted, regardless of what their "recall" protocol is at the time.
Last edited by Dr. Bill Stacy; 10-24-2015 at 10:43 AM.
*Specifications* relates to sph, cyl, axis and add. Anything else put on the Rx (Varilux, Crizal, expiration) are considered suggestions. There is no legal wording/ precedence in the Tx. Optometric code to say otherwise.
Much too much a broad brush stroke here for me.
B
There are federal and state laws that enforce whatever we put on. To stray from our Rx without consent of the doctor is considered "practicing optometry", and since you aren't licensed, that is a crime. I double-checked with the board. They provided me with several references and said the FDA has parallel regulations. Not sure who gave you that idea, but it is wrong. Don't take my word for it, take it up with an attorney, a board member, a trusted adult friend, otherwise you could end up taking it up with a judge. Expiration dates are not "suggestions". They are LEGALLY BINDING PARAMETERS.
"(d) The prescribing optometrist or therapeutic optometrist has the authority to specify any and all parameters of an optical prescription for the therapeutic and visual health and welfare of a patient, but the prescription shall not contain restrictions limiting the parameters to private labels not available to the optical industry as a whole, unless the prescribing of a proprietary lens brand is medically indicated. The specifications of the prescription may not be altered without the consent of the prescribing doctor."
"The dispensing of medications, spectacles, contact lenses, or ophthalmic devices without a valid prescription constitutes the unlawful practice of optometry, subject to penalties under the Texas Optometry Act, §§351.251, 351.406, 351.602, 351.603, 351.606 and 351.607."
Notice "valid"? By definition, the prescription is not valid after the expiration date.
What will you do if "Coastal" ....................
What will you do if "Coastal" based in Vancouver, Rx made in Essilor labs sends consumer ordered glasses into Texas ? Opticians are deregulated as far as I understand.
You mean it hasn't already happened? :smirk:
My dwarf tells me " happens all the time "
I don't see the issue with providing monocular PD's to a patient along with an Rx. I plan to ask my OD this time for my monocular PD's because I have had my PD mesaure for glasses 3 times at retail locations, and each time there has been a difference, last time it was huge (+4mm one eye, -3 mm the other eye). There is no way to know which is correct, so I am going to ask my OD to do it since I trust that he can do it correctly once and for all and I'll know what they're supposed to be. I would say, in my situation, its reasonable to ask for a monoocular PD so that way I can make sure my Rx's are filled correctly instead of with some PD number the optician seems to pull out of their butt.
Also, intentionally giving a bad PD is malpractice. Aren't you better than that? If not, quit practicing.
Do you want a cookie?
We don't measure PD and we don't want people to go online to buy junk that can harm them. Next time read the whole thread before replying, please. Everything has already been addressed.
first time I've seen an insult to opticianry and optometry in the same post.
Naive as well. I'm not proud of this, but I'd trust a random optician over a random OD to provide an accurate PD. We should be equally adept at this, but it's not something we traditionally do nor should it be.
I would say 3 bites at the apple is being more than fair. What would your suggestion be, try yet another location and hope they can get the PD right? I'm happy to listen to any suggestion at this point. I thought I'd ask my OD because I couldn't come up with any better idea.
First of all are you at a budget optical? How are they measuring and coming up with three different numbers? Ruler? Machine? Guessing? I know of a bad optician that was fired for stealing and naturally ended up being the highest paid "optician" at America's Worst, and she lists every PD as 30/30.
Machine, typical handheld pupillometer each time. I even asked if they were calibrated within recent memory and I was assured they were. I would say its a middle of the road chain, "RX Optical". Not sure if you have those in your neck of the woods. I got two different reading a year apart at the same location, and the really different reading was from a different location. That time they checked it with two different machines since it was so different from the record, came back the same in both.
I'm not going to read the whole thread, as it's getting pretty long, but your comment caught my attention. I take it you're an optometrist who doesn't do P.D.s. If you were neutralizing an unknown Rx and had no clue what the patient's p.d. was, , how would you know if there were any prism, wanted or not wanted, without measuring the P.D.? I assume you would be concerned if there were several prism diopters base in or out on a given Rx. Concerned if it were there when none was prescribed or concerned if it weren't there and it was supposed to be. And if you don't measure it, what, do you have a refractor that sets the p.d. by itself? If so, congrats. If not, do you really trust your "eyeball adjustment" to set the refractor p.d.? Even if it's a -9.00 o.u. and one eye is visibly displaced closer to the nose than the other? Seriously, P.D. measurement takes a few seconds and answers a lot of questions.
Or maybe you actually have staff that can reliably take P.D.s and actually does. If so, none of the above applies. Except I'd make sure that the staff reliably sets the p.d. on the refractor before you step into the room.
I don't measure it, I center the phoropter based on the patients's eyes. If I am checking the PD on a problematic pair of glasses, I measure the distance between the optical centers on the lensometer and ask the optician to check the PD. Or I measure it against an older, more comfortable pair of glasses if they brought them in. I do just fine in problem-directed resolutions, that doesn't mean I need to or want to measure PD on every patient just because the "superior" online model has gaps in their service. That's THEIR business model and its flaws. It shouldn't become my job to fix their gaps.
I center the phoropter based on the P.D. measurement, which is accurate to within a mm if you're any good with a mm rule, within .5 mm if you can use a pupillometer. Eyeballing the eyes behind a refractor is loaded with parallax and all kinds of possible errors due to head movement of the patient, of you, and who knows what else. Using the old spectacle "P.D" for anything but troubleshooting a problem is like the carpenter who uses the last board he cut to measure the next instead of the tape measure. Error multiplies on error.
Except my PD isn't measured on the phoropter, I simply center it for the purposes of facilitating that patient's looking through the center. The precision is irrelevant during monocular refractions and minimized during binocular refractions.
And my re-check rate is about 1-2 pairs per year, and then it's usually a hypersensitive patient. So I guess my method works.
what?????? What part of the field do you work in?
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