This is serious.

[drk]

http://www.visionmonday.com/vmail-he....YXcJHquB.dpuf

Federal Trade Commission Seeks Comments About Eyeglass and Contact Lens Rule



By Staff
Friday, September 4, 2015 12:24 AM

WASHINGTON, D.C.—The Federal Trade Commission (FTC) is seeking comments on the efficiency, costs, benefits and impact of the Ophthalmic Practice Rule (Eyeglass Rule) and the Contact Lens Rule, both of which require prescribing eyecare professionals to provide prescriptions to patients. The request for comment is part of the FTC’s systematic review of all current FTC rules and regulations, according to the agency.

Originally issued in 1978, the Eyeglass Rule requires optometrists and ophthalmologists to provide an eyeglass prescription to patients, at no extra cost, immediately after an eye examination is completed.

In addition to general questions about whether the Eyeglass Rule should continue and if it should be modified, other more specific issues related to the Eyeglass Rule for which the FTC is requesting comment are: What modifications, if any, should be made to the rule to account for changes in relevant technology or economic conditions? Should the definition of “prescription” be modified to include pupillary distance? Should the rule be extended to require that prescribers provide a duplicate copy of a prescription to a patient who does not currently have access to the original? And should the rule be extended to require that a prescriber provide a copy to or verify a prescription with third parties authorized by the patient?

The Contact Lens Rule, effective since August 2004, requires eyecare prescribers to provide a copy of a consumer’s prescription to the consumer after a contact lens fitting is completed and verify with, or provide prescriptions to, authorized contact lens sellers. It also mandates that a contact lens seller may sell contact lenses only in accordance with a prescription the seller has received from the patient or prescriber, or has verified via direct communication with the prescriber.

The questions the FTC seeks to answer in regards to the Contact Lens Rule, in addition to whether it should continue and/or be modified, include: What modifications, if any, should be made to the rule to account for changes in relevant technology or economic conditions? And What significant costs, if any, including costs of compliance, has the rule imposed on businesses, including small businesses?

Comments must be received by Oct. 26, 2015, and instructions for filing comments appear in the Federal Register Notices linked to above. All comments received will be posted on the FTC’s Public Comments page.

[fjpod]

Serious, yes....
I can think of several changes, and about the fragmentation of care this has caused....of course, some will present the other side. It's hard for the professions to make recommendations without appearing to be self-serving.

[drk]

Hard, yes. Impossible, no. Historically, our record reeks.

I'm looking for "organized opticianry's" take on this, on this board.

From opticianry's standpoint, what Rx rules are in the public's best interests?

[optical24/7]

The biggest violation I see (consistently) is not handing a copy of the Rx to the patient after the exam. I will be writing the FTC to suggest an extremely costly fine for failure to do so. Also, Dr's offices need to stop hiding behind Hipaa on the release of said Rx's to 3rd party providers. ( Like making the patient physically come back to their office to sign a "release".)

I know some of you doc's here and out in the world feel fragmentation of care is not in the patients best interest. I will disagree to the extent that many Dr's offices have under qualified personnel they call "opticians" doing the fittings, lens recommendations, measurements and Rx verifications. ( not directed at doc's here, personally). That opticians work under their Dr's license is absurd. I know of no Dr that measures for lenses or verifies Rx's as they come in (unless there's a patient complaint, and even then, most doc's don't do the lens troubleshooting).

Many outside patients I see are coming to me because of the "optician" at their doctors office. (Even though we don't take their insurance, that shows you how desperate some of these people are for qualified, experienced help with their optical needs.)

Oh yes...I will be putting my 2 cents in....

[drk]

Fragmentation of care is a reality. Theoretically we'd be better without it, but sometimes there are special skill sets to take advantage of. Plus there is the issue of economic freedom.

I don't think patients have felt intimidated to ask for a copy of their prescription for glasses or contacts in my career (over the past 25 yrs). I think it is an unserious expectation to have Rxs given without request or a "large fine". That's just punitive. The FTC can let it go to the state boards instead.

[optical24/7]

Fragmentation of care is a reality. Theoretically we'd be better without it, but sometimes there are special skill sets to take advantage of. Plus there is the issue of economic freedom.

I don't think patients have felt intimidated to ask for a copy of their prescription for glasses or contacts in my career (over the past 25 yrs). I think it is an unserious expectation to have Rxs given without request or a "large fine".

^ This is the reason the law was written to say:

Originally issued in 1978, the Eyeglass Rule requires optometrists and ophthalmologists to provide an eyeglass prescription to patients, at no extra cost, immediately after an eye examination is completed.



That's just punitive.

Uh, yea, that's the point. Break the law, pay the price.


The FTC can let it go to the state boards instead.

To police themselves? Especially something they collectively don't like? Ummmm, no.

I never said that patients were intimidated to ask for their Rx. Many times they just don't think to ask for it (which once again, they shouldn't have to ask for it.) Or they assume the doc will simply provide it to another office with a simple phone request. That is exactly what is not happening way too often, at least in this corner of the world...

[Barry Santini]

Hard, yes. Impossible, no. Historically, our record reeks.

I'm looking for "organized opticianry's" take on this, on this board.

From opticianry's standpoint, what Rx rules are in the public's best interests?

1. Strict conformance with the Rx release rule
2. Creation of a more wholistic Rx paradigm, with less "treatment discretion" information hidden from outside fulfillment.
3. Include PD on present Rx to allow fulfillment of the spirit of the Rx release rule

Opticianry and optometry's skill sets are quite different, yet inherently complimentary. It's when one side decides the other has less value that all problems arise from, IMHO.

There's more. Enough for now. These are the main points.

Barry

[drk]

Which interpupillary distance?

[MikeAurelius]

Near and far, in right/left form.

[DanLiv]

Which optician here wants to accept a PD on a prescriber's Rx rather than take their own?

[Dr. Bill Stacy]

ditto for optometrists who sometimes fill outside Rxs. I often have to correct p.d.s, and of course sometimes the Rx itself is screwy. It's always awkward, but it does happen.

[Dustin.B]

Personally I'd like to see it made easier to get an Rx on behalf of a patient. I work at an optical center inside an army base and the often ridiculous hoops we get put through to get a patients outside Rx is staggering. The problem is often compounded even further when said Rx is a four hour time hop away.

[Barry Santini]

Which interpupillary distance?

binocular. The only really valid one.

B

[Dr. Bill Stacy]

Some might argue that monocular pds are the only really valid one.

[Barry Santini]

Monocular objective PDs are an elusive fantasy.

[Craig]

Monocular objective PDs are an elusive fantasy.

Explain please.

We just had a surgeon non-adapt to a progressive and his eyes did not agree with the monocular results.

[Barry Santini]

All objective PD measuring methodologies have a user/subject/basic assumption problem: it is thought that the corneal reflex represents the visual axis intersection with the corneal plane.

There are studies that have shown a portion of the population appreciably departs from this assumption.

Therefore, when true precision is necessary - and I am not saying it is - only a subjective measurement will do.

This is why surgical telescopes use empirically-derived pupillary/visual axis measurements.

PD matters. But what's interesting is that it matters both less than most think and more than most think.

B

[Craig]

All objective PD measuring methodologies have a user/subject/basic assumption problem: it is thought that the corneal reflex represents the visual axis intersection with the corneal plane.

There are studies that have shown a portion of the population appreciably departs from this assumption.

Therefore, when true precision is necessary - and I am not saying it is - only a subjective measurement will do.

This is why surgical telescopes use empirically-derived pupillary/visual axis measurements.

PD matters. But what's interesting is that it matters both less than most think and more than most think.

B

Do you have a solution to solve this issues and provide the best usable PD for the % that need it? We normally refer this type to our OD for a prism evaluation to see if that can help but the surgeon would not see our OD who went to a bifocal. He did have a axis shift that we felt caused the progressive issue but he saw well out of the trial lenses and was happy in a ft.

[Barry Santini]

Dr. Tom Clark has a patent pending on a modified CRP that allows the patient to take their own subjective PD. we're using one in the office to good results.

I think he is individually selling them now

B

[Dr. Bill Stacy]

This week I had a patient whose monoc p.d.s measured R 38 L 33.5. He ordered PALs. I'm trusting the pupillometer, although I had an assistant re-measure and I re-measured again just to be sure.

That said, I don't trust the pupillometer at all in cases of amblyopia, squint, inability to follow instructions, etc. and whenever in doubt I use the mm ruler, and sometimes even dot the lenses.

And I am interested in the "subjective" system if its not too expensive.

[Barry Santini]

What's most important is that Dr Clark has a companion verification device that quantifies that amount if progressive centration error, if any.

B

[rbaker]

Hey . . . what ever happened to the original theme of this post, the new FTC Comment Period. You pin heads can argue about PD's someplace else.

[Barry Santini]

Good point, Dick. Binocular PDs should be included on the Rx.

[drk]

Near and far, in right/left form.

Would you like fries to go with that?

[drk]

Dr. Tom Clark has a patent pending on a modified CRP that allows the patient to take their own subjective PD. we're using one in the office to good results.

I think he is individually selling them now

B

Barry, there's a fine line between being a wizard and a witch doctor. Be careful.