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Thread: Spherical Equivalent. .......Liability?

  1. #1
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    Spherical Equivalent. .......Liability?

    Rx -1.00 -1.25 × 090

    Most would select a toric lens I assume...

    But the patient doesn't want a toric and has always worn a sphere without achieving the best corrected VA of 20/20 but still better than 20/50.

    Please comment

    1. Would you fit a sphere?
    2. If you are an OD would you be OK with your rx being filled spherically?
    3. Any liability concerns that could arise from fitting a sphere?
    4. Spectacles have to be made within a tolerance of what was ordered with what was ordered being the prescribed rx. ....... contact lens powers can be whatever if they think they are happy?

    Thanks, looking forward to some interesting perspectives

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    Quote Originally Posted by LordElsinore View Post
    Rx -1.00 -1.25 × 090

    Most would select a toric lens I assume...

    But the patient doesn't want a toric and has always worn a sphere without achieving the best corrected VA of 20/20 but still better than 20/50.

    Please comment

    1. Would you fit a sphere?
    2. If you are an OD would you be OK with your rx being filled spherically?
    3. Any liability concerns that could arise from fitting a sphere?
    4. Spectacles have to be made within a tolerance of what was ordered with what was ordered being the prescribed rx. ....... contact lens powers can be whatever if they think they are happy?

    Thanks, looking forward to some interesting perspectives
    I'm not Canadian so if me posting here is against the rules I apologize.

    If the patient is unhappy with his prescription he should have that conversation with his doctor. I would fill the prescription as written unless it was amended by the doctor that wrote it. My understanding is that a spherical equivalent is a stop-gap, its not meant to be a permanent solution. Like if you were ordering eyewear for your patient and the lenses would take two weeks to arrive, but you had stock lenses in his spherical equivalent, so that he had something to get by while he was waiting.
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    Quote Originally Posted by LordElsinore View Post
    Rx -1.00 -1.25 × 090

    Most would select a toric lens I assume...

    But the patient doesn't want a toric and has always worn a sphere without achieving the best corrected VA of 20/20 but still better than 20/50.

    Please comment

    1. Would you fit a sphere?
    2. If you are an OD would you be OK with your rx being filled spherically?
    3. Any liability concerns that could arise from fitting a sphere?
    4. Spectacles have to be made within a tolerance of what was ordered with what was ordered being the prescribed rx. ....... contact lens powers can be whatever if they think they are happy?

    Thanks, looking forward to some interesting perspectives
    Assuming this patient is just too cheap to purchase the toric lens that would most likely provide 20/20 VA, IMHO fit them with a SE of -1.50, hope the tear layer fills in the rest, note it in the file the patient refused, collect your $$ and send them on their way.

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    Quote Originally Posted by Lab Insight View Post
    Assuming this patient is just too cheap to purchase the toric lens that would most likely provide 20/20 VA, IMHO fit them with a SE of -1.50, hope the tear layer fills in the rest, note it in the file the patient refused, collect your $$ and send them on their way.
    Your reply implies that by simply recording her refusal to wear a contact lens rx that closely represents the OD's refraction will free the dispenser from any liability. Is that all it takes?

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    What's up? drk's Avatar
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    Quote Originally Posted by LordElsinore View Post
    Rx -1.00 -1.25 × 090

    Most would select a toric lens I assume...

    But the patient doesn't want a toric and has always worn a sphere without achieving the best corrected VA of 20/20 but still better than 20/50.

    Please comment

    1. Would you fit a sphere?
    2. If you are an OD would you be OK with your rx being filled spherically?
    3. Any liability concerns that could arise from fitting a sphere?
    4. Spectacles have to be made within a tolerance of what was ordered with what was ordered being the prescribed rx. ....... contact lens powers can be whatever if they think they are happy?

    Thanks, looking forward to some interesting perspectives
    Here's the perspective from the U.S.
    1. You fill prescriptions, you do not fit contact lenses.
    2. If you do fit contact lenses, you have to have a license to do so, and you would know the answers to your questions.

    In Canada, it is a sad state of affairs. The mere fact that you have to go online to do your job is shocking. I certainly hope that in Ontario, that the government hasn't so deregulated contact lens wear and prescribing that essentially anyone can order contact lenses.

    But alas, no prescription is needed in British Columbia.

    You may as well be a consumer posting for professional advice.

    Here's my professional advice:
    1. Hire a professional
    2. Alternatively, become a real professional yourself.


    I am disgusted.

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    Quote Originally Posted by drk View Post
    Here's the perspective from the U.S.
    1. You fill prescriptions, you do not fit contact lenses.
    2. If you do fit contact lenses, you have to have a license to do so, and you would know the answers to your questions.

    In Canada, it is a sad state of affairs. The mere fact that you have to go online to do your job is shocking. I certainly hope that in Ontario, that the government hasn't so deregulated contact lens wear and prescribing that essentially anyone can order contact lenses.

    But alas, no prescription is needed in British Columbia.

    You may as well be a consumer posting for professional advice.

    Here's my professional advice:
    1. Hire a professional
    2. Alternatively, become a real professional yourself.


    I am disgusted.
    Thanks for the reply, being from Ontario i am not familiar with Ohio's standards of practice for OD's or Opticians. If Opticians do fit in your state perhaps you could elaborate. There are times I wished we had a system similar to the US when dispensing contacts

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    I would think if one is a licensed fitter, there will be no liability.

    Other than the licensure board overseeing your work.
    And your malpractice insurer covering your rear.

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    Here's how I would handle it:

    "Monty, today's torics are great. I want you to try it. If you don't like it, then we'll 'discuss alternatives'."

    Now, we don't know about the other eye. We also don't know what his objection is. We also don't know what his education level/experience with contacts is.

    But as a fitter, you do what YOU DO, and the patients have the privilege of your expertise. You are not a CL vending machine.

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    Quote Originally Posted by drk View Post
    Here's how I would handle it:

    "Monty, today's torics are great. I want you to try it. If you don't like it, then we'll 'discuss alternatives'."

    Now, we don't know about the other eye. We also don't know what his objection is. We also don't know what his education level/experience with contacts is.

    But as a fitter, you do what YOU DO, and the patients have the privilege of your expertise. You are not a CL vending machine.
    Agreed.....let me ask you if an associate of yours in the same office fit a sphere without hesitation when you have already discussed/determined that there is a need for a toric, this would not be a concern of yours because it's what "you do." I personally feel that I should respect the integrity of the OD's refraction and fit the cl's as close as possible. Unfortunately our standards do not address these concerns where as noted in another reply a simple notation in the file may be fine to free you of liability.

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    Quote Originally Posted by LordElsinore View Post
    Your reply implies that by simply recording her refusal to wear a contact lens rx that closely represents the OD's refraction will free the dispenser from any liability. Is that all it takes?
    Absolutely. Would you let your customer dictate the level of liability that should be imposed upon you in the event of their stupidity?

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    Quote Originally Posted by LordElsinore View Post
    Thanks for the reply, being from Ontario i am not familiar with Ohio's standards of practice for OD's or Opticians. If Opticians do fit in your state perhaps you could elaborate. There are times I wished we had a system similar to the US when dispensing contacts
    He's a harsh American OD. If you were a consumer you would already have your answer on to what to order. Consumers don't know the term 'spherical equivalent'.

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    So, wait, they let dispensers and "fitters" (???) choose materials, formularies, etc. etc. etc. in the Great North? I don't know what to do with that information, but drk's reply is pretty close to the mark.

    To give you an idea, in the US this is a non-issue. Doctor fits and sets the brand and formulary as part of the Rx and that's what the patient gets. Any spherical equivalents are handled by the OD, not by a dispenser. Once the ink's dry on the Rx, they don't get the option of coming to you and saying "WELL this is cheaper AND I don't know what I'm talking about but I should be able to skip wearing a -1.25 toric IF I WANT TO because I WOULD KNOW because they're MY EYES" ... Yeah, no, thanks.

    To me this is the same type of conversation an optician would have when discussing lens materials for specs. Sure, drk's not writing an Rx for poly (you horrible monster) but that conversation and this one sound more similar that I would be comfortable with as a US optician.

    Baffling stuff to say the least. Keep us posted.

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    Quote Originally Posted by Lab Insight View Post
    He's a harsh American OD. If you were a consumer you would already have your answer on to what to order. Consumers don't know the term 'spherical equivalent'.
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    Yeah, baby!

    I know it's not a consumer.

    We'd probably record the VA and advise accordingly.

    Hey, we fit monovision and multifocal CLs all the time, and the vision can be a little worse, even, than a diopter of uncorrected ATR!

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    Quote Originally Posted by Lab Insight View Post
    Absolutely. Would you let your customer dictate the level of liability that should be imposed upon you in the event of their stupidity?
    At what point do you become the stupid one for giving in to the patients demands?

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    Quote Originally Posted by LordElsinore View Post
    At what point do you become the stupid one for giving in to the patients demands?
    Who says it stupid? in fact, it's the opposite to know when to bail from a problem that will evolve and suck you in.

    I would say that's very smart and prudent.

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    We had a similar patient at my old practice, we fit him into two sets of trials one spherical one astig and showed him the difference in VA, Spherical did not make it illegal to drive and he liked it so he got it. 20/happy ... and lots of documentation :)
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