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Thread: Has sight testing been harmful to optometrists in BC?

  1. #101
    What's up? drk's Avatar
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    Quote Originally Posted by throughalensdarkly View Post
    Doesn't a phoropter just "try on" different lenses?
    No
    Doesn't an OD's refraction rely on patient feedback?
    Yes
    Seems fairly similar to someone trying on readers until they find a pair that works.
    No
    Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works.
    That's practicing optometry.
    Not saying OD's can't do a better job of refracting or that there aren't other benefits to having a proper doctor such as yourself take a look at your eyes, just noting the broad similarities
    . So broad as to be meaningless
    A person isn't going to try (or at least wouldn't be successful at) suing the company that made the readers when they find out that they have glaucoma or something.
    Product liability doesn't equal professional liability.
    Why is it so different for glasses that aren't off the shelf ready readers?
    Do you work for Warby Parker or something? Is your argument to de-regulate spectacles?
    Try not to be so "glasses" focused. You, being an optician (I think) can only see a pair of specs. Look at this from the perspective of a patient with a health problem (yes, vision loss is a health problem): Don't people need trained, licensed professionals to fix their health problems? Or, just anyone?
    Again, people should get proper eye exams from proper medical professionals. But if they don't want to do that, why shouldn't they be able to buy a pair of glasses?
    They can buy a pair of glasses as it is, now, can't they? Can't people buy glasses? There's a whole lot of glasses buying going on, out there.

    You mean, why can't just anyone off the street measure refractive error and make glasses and sell people glasses. THAT'S THE ISSUE. It's not a "consumer's rights issue" (I WANT GLASSES AND I WANT THEM NOW!). It's a "consumer safety issue". (I WENT BLIND BECAUSE I WENT TO SOME IDIOT WHO DIDN"T KNOW WHAT THE HECK THEY WERE DOING!).

    It isn't providing substandard medical care to duplicate an old pair of glasses - it isn't providing medical care of any kind.
    Yeah, you're quite wrong on that one. I don't know your background or who trained you, but you're shockingly ignorant of your role.

  2. #102
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    Lol winding you up just became my new favourite hobby drk! I'm not attacking anybody, just thinking out loud and seeing what kind of feedback I get. Turns out that feedback is mostly defensive/combative! Look I'm not saying what I think is definitely right, and I certainly don't know everything. That would take an ego more like your own... Also, you say I'm shockingly ignorant of my role in the same breath as you say you don't know what I do (even though it says optical lab tech on each post I make... I hope your inattention to detail and massive ego serve your patients well:). No, I do not work for Warby Parker, and just to really hammer it home I think everybody should have a proper eye exam regularly. But people don't. We can't make them. They still deserve a pair of spectacles if they're willing to pay for them. They haven't received a medical examination so I'm not sure who you think is going to be liable for undiagnosed medical issues. If the patient can't see out of the resulting glasses they have recourse in the form of a warranty from the optical providing the sight test and the specs.

    I'll restate the basic premise in even less offensive terms than last time:
    1. People can buy Tylenol without a prescription. They assume some risks as Tylenol can do you harm if misused, and it only treats symptoms. If those symptoms are the result of some undiagnosed medical issue the person isn't curing the problem, just treating symptoms. They also won't find out about the problem until they see a doctor (even then it might be missed). This is 100% legal, and should be.
    2. Sight testing/autorefraction gives people the data they need to have a pair of glasses created to treat their visual symptoms. They aren't going to get any underlying problems diagnosed, like Tylenol. They DON'T assume any significant risk by wearing glasses, even with the wrong rx - unlike Tylenol. By comparison to Tylenol, so far it seems less risky to the patient.
    3. If the resulting pair of spectacles doesn't work, the optical will lose money doing a redo, providing some incentive for sight testing to be as accurate as possible. If the person isn't getting what they need through this method, they might think "hey I should see a doctor about this". If the glasses do the trick and the person does have a medical issue it will go undiagnosed. Just like with Tylenol.

    Once again I'd like to see every country provide a healthcare system that flat out pays for comprehensive eye exams. In the likely continuing absence of such systems, isn't sight testing and buying glasses a reasonable option for people so they can see well enough to live their lives? I'm allowed to let my brain tumour go undiagnosed and buy Tylenol, but I'm not allowed to let my glaucoma go undiagnosed and buy glasses? Seems strange is all I'm saying.

    EDIT: Oh yeah! Almost forgot, when you quote me and reply
    Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works.


    That's practicing optometry.

    Doesn't that reduce your role to just refracting? Shouldn't you include all the medical knowledge/training/skills in your definition of optometry? If you don't, I suspect you may become obsolete in the near future. That's a pretty myopic view for an optometrist to take. Oh well, back to the grind!
    Last edited by throughalensdarkly; 02-22-2018 at 05:20 PM.

  3. #103
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    Quote Originally Posted by throughalensdarkly View Post
    Doesn't a phoropter just "try on" different lenses? Doesn't an OD's refraction rely on patient feedback? Seems fairly similar to someone trying on readers until they find a pair that works. Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works. Not saying OD's can't do a better job of refracting or that there aren't other benefits to having a proper doctor such as yourself take a look at your eyes, just noting the broad similarities. A person isn't going to try (or at least wouldn't be successful at) suing the company that made the readers when they find out that they have glaucoma or something. Why is it so different for glasses that aren't off the shelf ready readers? Again, people should get proper eye exams from proper medical professionals. But if they don't want to do that, why shouldn't they be able to buy a pair of glasses? It isn't providing substandard medical care to duplicate an old pair of glasses - it isn't providing medical care of any kind.
    Just had a patient today, his vision in the left eye had gone down about six months ago. His VA had dropped from 20/20 to 20/40- OS. He didn't rush right in because he figured his Rx had changed and he would come in next time he was eligible for new glasses under his plan. He comes in, we are able to improve the VA OS to ALMOST 20/20... Meanwhile, dilated exam showed vitreo-macular traction with an epi-retinal membrane. The cause of his refractive error shift was due to retinal traction and separation.

    Not all refractive error changes are harmless, even if the VA improves with simple refraction. When you change a patient's Rx (or confirm that it hasn't changed), and you improve the VA, you are giving the patient a false sense of security that "everything is alright".

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    Good point, not going to argue with you. That's why you guys are infinitely more valuable than an autorefractor. Again, I think we should all get eye exams regularly, just like we should have a regular checkups with a doctor for the rest of our bodies. But if someone doesn't want to have those checkups, what can we do? Do these people not deserve to be able to at least treat their symptoms?

    Something I should have added was that it's important sight testing isn't marketed/advertised/made to see like a real eye exam. Maybe it should be required that at every sight testing the patient is told "You should really see an optometrist for a proper exam, this procedure won't find any medical problems you might have. I can recommend Dr. so-and-so, here is their phone number"?

  5. #105
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    Quote Originally Posted by throughalensdarkly View Post
    Good point, not going to argue with you. That's why you guys are infinitely more valuable than an autorefractor. Again, I think we should all get eye exams regularly, just like we should have a regular checkups with a doctor for the rest of our bodies. But if someone doesn't want to have those checkups, what can we do? Do these people not deserve to be able to at least treat their symptoms?

    Something I should have added was that it's important sight testing isn't marketed/advertised/made to see like a real eye exam. Maybe it should be required that at every sight testing the patient is told "You should really see an optometrist for a proper exam, this procedure won't find any medical problems you might have. I can recommend Dr. so-and-so, here is their phone number"?
    People should be able to get copies of their old glasses at will. They should not, however, be given an incomplete "exam", or sight test and told, "well, it's alright to get a new Rx because you read the eye chart OK". Passing the test implies the eyes are "alright". (Actually, you don't have to tell them that. No matter what you tell them, they will assume that their eyes are alright if you fix them up with new a new glasses Rx.).

    That's my story, and I'm stickin' to it.

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    Fair enough fjpod, and thanks for your insight. I just wonder why it's ok to self diagnose and buy OTC medicine for non-ocular health, but for ocular health it's not ok to get "OTC" glasses to treat symptoms (except readers, which apparently are fine to buy OTC...)

  7. #107
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    It is required that the clients are told to seek a medical assessment of their eyes at least once every 5 years by an Optometrist or Ophthalmologist. They must sign a form as well. This is the requirement of our and all eyelogic system tests.

  8. #108
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    Quote Originally Posted by throughalensdarkly View Post
    Fair enough fjpod, and thanks for your insight. I just wonder why it's ok to self diagnose and buy OTC medicine for non-ocular health, but for ocular health it's not ok to get "OTC" glasses to treat symptoms (except readers, which apparently are fine to buy OTC...)
    It's not self diagnosis. It's a patient's own guestimate. But when a "professional" in an optical setting offers a solution to a patient's acuity problem, the perception becomes "that everything is alright because if it wasn't he/she wouldn't have given it to me". ...no matter what is signed up front.

    Anyway....

  9. #109
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    Quote Originally Posted by mike.elmes View Post
    It is required that the clients are told to seek a medical assessment of their eyes at least once every 5 years by an Optometrist or Ophthalmologist. They must sign a form as well. This is the requirement of our and all eyelogic system tests.
    The signed papers may lessen your "guilt" legally in the event something happens, but the patient will still walk away with the perception that everything is OK.

  10. #110
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    Quote Originally Posted by throughalensdarkly View Post
    Do these people not deserve to be able to at least treat their symptoms?
    Uh, yes they do. Go to the doctor.

    Something I should have added was that it's important sight testing isn't marketed/advertised/made to see like a real eye exam. Maybe it should be required that at every sight testing the patient is told "You should really see an optometrist for a proper exam, this procedure won't find any medical problems you might have. I can recommend Dr. so-and-so, here is their phone number"?
    There are one hundred and forty seven unenforceable requirements to make these stupid "sight tests" safe. What's the point? Just...go...to...the...doctor already.

    Geez, I thought we were moving forward in the 21st century, not backwards to third-world health care. Anything for a buck. Sell out your fellow countryperson's (that word's for Justin) health so you can steer people away from doctors and into your glasses shack.


    Since you are analogy woman, think of this: "I have chest pain. I should have the right to have my symptom treated. But not by a doctor. I want the right to get it treated by a chiropractor." Woman goes to chiropractor who diagnoses "thoracic vertebral misalignment" and adjusts her spine and she drops dead the next day because of an aortic aneurysm. She exercised her right, and the chiropractor was grossly negligent. Aren't "rights" great?
    Last edited by drk; 02-22-2018 at 10:52 PM.

  11. #111
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    Quote Originally Posted by mike.elmes View Post
    It is required that the clients are told to seek a medical assessment of their eyes at least once every 5 years by an Optometrist or Ophthalmologist. They must sign a form as well. This is the requirement of our and all eyelogic system tests.
    Oh boy, I bet they're really going to do that.

    Enabler.

  12. #112
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    Quote Originally Posted by fjpod View Post
    It's not self diagnosis. It's a patient's own guestimate. But when a "professional" in an optical setting offers a solution to a patient's acuity problem, the perception becomes "that everything is alright because if it wasn't he/she wouldn't have given it to me". ...no matter what is signed up front.

    Anyway....
    Exactly.

    "Hey, here's your new glasses. Remember, I'm not a doctor or anything. Don't hold me liable for anything. See a real doctor if you have any real problems. We're just here to sell you a pair. Aren't we the nice guys?"

  13. #113
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    Quote Originally Posted by drk View Post
    Exactly.

    "Hey, here's your new glasses. Remember, I'm not a doctor or anything. Don't hold me liable for anything. See a real doctor if you have any real problems. We're just here to sell you a pair. Aren't we the nice guys?"
    And a 'real' doctor is an MD.

  14. #114
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    Maybe in Canada.

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    Well DrK you are in the Canadian forum... also I'd take Canada's healthcare system over the USA's any day of the week, even though my eye exams are no longer covered. By the way, this is the second time I've seen you assume a gender for someone you're talking to on the board, and the second time I've seen you guess wrong. I'm a gent, and I don't understand your problem with analogies. Maybe because you don't seem to understand them? You talk about referring someone to a chiropractor. As far as I remember subluxation theory has been discredited and chiropractors pose as real medical professionals - any good they do can probably be chalked up to placebo effect. You're comparing that to a sight test that is clearly labelled as a non-medical exam, the recipient has to sign a paper saying they understand this, and using theory that hasn't been discredited (I think guys like Mike.Elmes stand a pretty good chance of producing a working pair of glasses using these sight tests because THEY WORK). Most importantly, the Chiro might cause harm or let something go undiagnosed while posing as a medical professional. The glasses aren't gonna hurt anyone, and the client understands that they aren't receiving medical care. Apples and oranges, your analogy doesn't work/is misleading/etc. I guess you don't have to understand logic or be able to read critically to become an OD in Ohio.

    I know good OD's, I don't question the value of the role. But if it's just refracting then OD's days are numbered. Evolve or die! Technology is going to get better, not worse, and people DO NOT NEED A COMPREHENSIVE EYE EXAM TO GET GLASSES (they need it for other reasons). I've seen bad OD's refuse to give PD's for fear of onliners and prescribe 1.67 for patients with less than -3 myopia OU. You think the fact that they sell those pricey lenses to the patient didn't influence the decision to "prescribe" them? Don't you think the fact that it comes from a doctor makes the patient think they "need" 1.67 when they definitely do not? A system where a medical doctor also sells what they prescribe is open to abuse, and I've seen it abused. The exam costs $100+ in most offices I've seen, and I've seen sight testing offered free. If the recipient of a sight test has to sign a paper saying they understand this isn't a medical exam, due diligence has been done. They know they aren't seeing a doctor, and they know that they aren't adding hundreds of dollars to the cost of getting their family the glasses they need (they don't need an eye exam every single year, and can't afford it!). I don't think you have legitimate medical concerns about this, I think your concerns are financial. In which case welcome to the world of business (a place where doctors shouldn't be in the first place, not your fault just a stupid system). If over the counter readers are OK, even though they are mostly for people in an age range where it's even more important to get an eye exam, then other spectacles should be too. Get over it - it's happening.

  16. #116
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    There must be a bumper crop of straw in BC this year...so many straw man arguments...

    Hey, it's free, right? What's the harm, right?

    You don't need a doctor to diagnose and manage your eye and vision disorder...because...because...OTC GLASSES THAT'S WHY!!!!

    Don't worry, maam, this "exam" is a "non-medical exam". You know, it's that "other kind" of exam...

    ...the kind that's free, that's not done under the supervision of any licensed doctor or anything, and the kind that doesn't really solve your eye issues, so you have to get a "real one" if you want that, but it sure is the kind that will let me sell you a pair of nifty glasses!

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    Yeah don't need a doc for OTC tylenol and tylenol can do more harm to you than glasses. Doesn't find disease just treats the symptoms. It's ok for non-ocular health but somehow this field is special for literally no reason. A curved piece of plastic requires more regulation than actual drugs you put in your system, sure doc, whatever you say. Look drK it's been fun but this is getting circular, we're producing more heat than light with diminishing returns. Get a grip and have a nice day:)

  18. #118
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    I'm glad you've logically deregulated the vision care industry.

    You're amazing, you know?

    Sheer logic!

    You are tons smarter than everyone else who ever thought this out.

    I cannot begin to thank you enough.

    We've witnessed greatness, here.

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    Straw man argument? Lol in the words of Inigo Montoya, I don't think that word means what you think it means. Pretty sure I've been using analogies and comparisons to other fields, not constructing a straw man argument, claiming you said it, and then responding. My responses have been based off of what you actually said, unlike yours which have nothing to do with what I've written. I didn't say I was amazing, I specifically said I'm not saying I definitely know what's best. Your last post is a great example of a straw man argument drK. Once again, get a grip:)

  20. #120
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    Quote Originally Posted by drk View Post
    There must be a bumper crop of straw in BC this year...so many straw man arguments...

    Hey, it's free, right? What's the harm, right?

    You don't need a doctor to diagnose and manage your eye and vision disorder...because...because...OTC GLASSES THAT'S WHY!!!!

    Don't worry, maam, this "exam" is a "non-medical exam". You know, it's that "other kind" of exam...

    ...the kind that's free, that's not done under the supervision of any licensed doctor or anything, and the kind that doesn't really solve your eye issues, so you have to get a "real one" if you want that, but it sure is the kind that will let me sell you a pair of nifty glasses!

    Logic and truth evades the Pacific Palisades, doc.
    Eyes wide open

  21. #121
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    Quote Originally Posted by drk View Post
    Maybe in Canada.
    Sorry, but even in the states, optometry school upon graduation does not designate an MD Doc.

  22. #122
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    Didn't say that Mr. Straw Man.

    Said ODs were "real docs".

    And we are.

    You should try to be a "real optician".

    Maybe darkly can post more than 13 times and learn something, too. That is, if Coastal Contacts is allowing that kind of time on the internet at work.

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    Lol you can't even remember what names you called who... I shudder to think what you're like in person. Don't work for Coastal either, keep guessing bunny rabbit

  24. #124
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    Quote Originally Posted by drk View Post
    Didn't say that Mr. Straw Man.

    Said ODs were "real docs".

    And we are.

    You should try to be a "real optician".

    Maybe darkly can post more than 13 times and learn something, too. That is, if Coastal Contacts is allowing that kind of time on the internet at work.
    You wind up so easily its actually entertaining.

  25. #125
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    I just hope you guys are as good of opticians as you are as trolls.

    But I sure doubt it.

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