1. The way it should be with expiration dates: If the patient is progressive in their refractive error, there should be an appropriate expiration date, and it should be followed. If it's stable refractive error, there should be a longer expiration date. Expiration dates are for the benefit of the patient. Who's expiring a stable 30 yo's expiration date in one year? There should be a reason if so.
Though I mainly work with OMD's, 1/4th of our volume comes from walk-ins with OD Rx's. Not one of the 20+ OD's in my area vary expiration's. Every single one has a 1 year expiry, no matter what. One wouldn't perform a new exam on a pregnant patient of his OR release the latest Rx, even after being told she had busted her only pair. ( I duplicated her busted ones... Call me Gypsy Glasses Peddler..)
2. If a patient wants a "refraction", I ask, "why"? If their vision's changed,
they need to know why. That's what a doctor's for. A loss of vision shouldn't be ignored.
Why do they need to know why? If you get a headache, do you need to know why? Should everyone with headaches go see a neurosurgeon? ( I could say yes to that question, I've know 3 people in my life with brain tumors. One, a 34 yr old OD I worked for that died in the early 80's.) The point is, there are no laws mandating doctoral care. Folks can go buy meds that have the potential to kill them, yet, they can't buy a device, with absolutely no history of nor likelihood of causing harm.
1. People don't "self refract". They try on readers. No refracting involved. No prescribing involved.
Call it what you want, prescribing? No. Determining which refractive error lenses seem to work best for them, yes. (which is better, pair one or two?)
2. Nobody presumably gets amblyopia or crashes a motor vehicle when sitting down with a book and their OTC readers.
3.There should be a law against wearing OTC readers for drivers licenses. But they don't know how to do it. There used to be minus readers available but they took them off the market.
4. I think OTC readers are grandfathered in. I don't love them, to be honest, but it is what it is.
OTC readers haven't been outlawed because there is no proof of harm.
I think that's bad policy. Good opticians don't like to duplicate. I don't duplicate. You know it's just working around the better method of calling the practitioner for the prescription.
I agree! IF the previous practitioner will release it! ( see my note on that subject above).
For that matter, online contacts are a public health hazard, as well, but we see that a lot of money goes a long way in Washington. So "legal" is not evidence of "good".
I wholeheartedly agree! CL's are a medical device that certainly can cause permanent harm. Glasses can't, that's the subject I think we're talking about here.
1. You can't get a "simple refraction". There are no "simple refractions". Do I have to do a bunch of scenarios?
Give me a plausible, common scenario on why a healthy 30 year old that's had a complete medical exam of his eyes within the last couple of years couldn't get a simple refraction to replace/purchase new eye wear.
2. A refraction is not a prescription. There has to be a practitioner making a treatment plan for a vision problem.
Again, wholeheartedly agree! A skilled practitioner should be involved in a medical treatment plan. Yes, refraction is not a prescription, it's also not a medical procedure, ( So says Mr Prentice! )
it's the bending of light that is practiced daily by non-certified personnel in OMD offices.
3. You can only imagine the number of people with loss of vision that think "magic glasses" will solve their problem.
Deal with it daily...AMD, cataracts, diplopia's, retina issues, ect. Those folks need a skilled practitioner! But once again, does every single person need a complete eye workup every year? How many of the folks in the age bracket they allow in Canada to get simple refractions will fall through the cracks? Yep, there will be some. But even here in the US we use risk assessments to determine level of care and what we allow the public to buy to "self medicate" ( People die taking Tylenol, yet it doesn't require an Rx because of the low risk assessment for the vast majority of the public.)
4. Even so, in America you have a right to be stupid and self-treat. If one want's to grind one's own lenses, somehow, more power to them. But in presumably an advanced society, there are protections against OTHER PEOPLE hanging out a shingle and taking money for providing cures that they don't know anything about. It's called "quackery".
See, I agree a lot with you! Training, credentialing, certifications and C.E's should definitely be required for anyone to recommend a treatment. My understanding of Canada is that they do require training a certification to perform refractions.
If someone comes to my office with reduced vision, and I diagnose macular degeneration, and I put them on a high-carb diet and recommend yoga, I'm a quack. My license to practice optometry on people will be yanked.
If someone comes to your office with reduced vision, and you "diagnose" refractive error, and you put them in glasses but they really have a branch retinal vein occlusion, you're a quack. You need a license to be yanked. If you don't have a license, then the person doesn't have protection other than "buyer beware", like they have to do with a flea market.
Once again, risk assessment. Branch retinal vein occlusions, along with quite a few other ailments are not common.
I suppose somewhere along the line society decided that on matters of health care, "buyer beware" isn't good enough. Check out the credentialing that ODs have to go through to be providers for VCPs and health insurances and to maintain licenses and board certifications and maintenance of said certifications (C.E.).
It's not my problem if you undervalue your role in health care and see yourself as a glasses peddler.
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