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Thread: Expired Prescriptions

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    Expired Prescriptions

    Back when I was taking the optician course at NAIT, my instructor mentioned that if patients didn't have a current prescription but desperately needed glasses, he would just take a measurement off their current glasses and make lenses based on that. Is this something that we as opticians are allowed to do?

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    Quote Originally Posted by Trina View Post
    Back when I was taking the optician course at NAIT, my instructor mentioned that if patients didn't have a current prescription but desperately needed glasses, he would just take a measurement off their current glasses and make lenses based on that. Is this something that we as opticians are allowed to do?
    Yes. There is nothing wrong with neutralizing a pair of eyeglasses and making a new pair based off of that. Even if the patient says its older than 2 years, all you can do is recommend they are due. If they decline, go ahead and make a new pair up, because if you don't somebody else will.

    The days of playing by the rules and being squeaky clean are long gone. Do what you have to do to survive as a retailer.

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    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by Lab Insight View Post
    Yes. There is nothing wrong with neutralizing a pair of eyeglasses and making a new pair based off of that. Even if the patient says its older than 2 years, all you can do is recommend they are due. If they decline, go ahead and make a new pair up, because if you don't somebody else will.

    The days of playing by the rules and being squeaky clean are long gone. Do what you have to do to survive as a retailer.
    I can't say I agree that there's "nothing wrong" with doing this, but I agree that you should probably just do it. They absolutely will find someone who will, and they will do a much worse job at it than you will. You may want to have some boilerplate waiver of responsibility for them to sign if you plan on doing this regularly.
    I'm Andrew Hamm and I approve this message.

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    My office gets a lot of business from duplicating and filling expired RXs. I always tell the patient that is it important to get regular exams, for the health reasons, but that they are free to continue with an old Rx if they are happy with the script. I can't tell you how many times someone comes in with a very similar Rx to what they are wearing. They want to fill it because it is new, but often times, they end up switching back to the previous Rx.
    Have I told you today how much I hate poly?

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    Master OptiBoarder rbaker's Avatar
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    Quote Originally Posted by Quince View Post
    My office gets a lot of business from duplicating and filling expired RXs. I always tell the patient that is it important to get regular exams, for the health reasons, but that they are free to continue with an old Rx if they are happy with the script. I can't tell you how many times someone comes in with a very similar Rx to what they are wearing. They want to fill it because it is new, but often times, they end up switching back to the previous Rx.
    Must be a Maine thing. Back in the day we had the summer complaint to tend with as we were up to our eyeballs with tourists. The broke their glasses, lost their glasses, forgot their glasses and, as you know, the bottom of Lake Sebago and Lake Winnipesauke are covered with glasses. In as much as there aint no law that overrules common sense we were happy to neutralize their old scratched glasses and crank out a new pair for them. The same holds true with new Rx's that that the customer is unhappy with dispite numerous encounters with their eye care team. Remember, you are working for the customer not the refractionist.

    I think that the reluctance to duplicate lenses is the inability to accurately neutralize a pair of lenses. This factor generates "corporate" policy which prevents most opticians from practicing their craft.

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    Thanks, everyone! I appreciate the replies.

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    Quote Originally Posted by rbaker View Post
    Must be a Maine thing. Back in the day we had the summer complaint to tend with as we were up to our eyeballs with tourists. The broke their glasses, lost their glasses, forgot their glasses and, as you know, the bottom of Lake Sebago and Lake Winnipesauke are covered with glasses. In as much as there aint no law that overrules common sense we were happy to neutralize their old scratched glasses and crank out a new pair for them. The same holds true with new Rx's that that the customer is unhappy with dispite numerous encounters with their eye care team. Remember, you are working for the customer not the refractionist.

    I think that the reluctance to duplicate lenses is the inability to accurately neutralize a pair of lenses. This factor generates "corporate" policy which prevents most opticians from practicing their craft.

    Oh Sebago... I have some sunglasses down there that were my designated lake pair for a reason- I put very little money into them. Now I have a wooden pair to test the buoyancy of this year!

    You brought up a really good point that I almost went back to touch on, so I will do it now. I have a hesitance with duping, not because of incompetence, but because I don't know who made it and how much they follow tolerances (especially with tourists). I will always tell people, if they have a written version- even if it is expired- I would rather work off of that then dupe.
    Have I told you today how much I hate poly?

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    Quote Originally Posted by Quince View Post
    Oh Sebago... I have some sunglasses down there that were my designated lake pair for a reason- I put very little money into them. Now I have a wooden pair to test the buoyancy of this year!

    You brought up a really good point that I almost went back to touch on, so I will do it now. I have a hesitance with duping, not because of incompetence, but because I don't know who made it and how much they follow tolerances (especially with tourists). I will always tell people, if they have a written version- even if it is expired- I would rather work off of that then dupe.
    Just as an aside - have you tried the new Dragon Float sunglasses? As long as you put trivex in them, they float! Perfect for lake season. :)

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    Interesting I come across this today. Me being from Florida ( a licensed state) where a eyeglass Rx is good for 5 years unless it has a expiration date on it, here in Maine (a unlicensed state) I just got a spanking this morning from the office manager for filling a Rx that was a few months past 2 years old. I honestly didn't know where to look in their EMR to find dates. I was taken aback, TWO YEARS! I had to look it up in and sure enough it is a state statue.
    None the less each state will have its own expiration date for contacts and eyeglasses but when you look up those rules make sure you are looking at a Optometry board RULE or a Opticianry board RULE or a STATE STATUE. And then each practice will have its own little guide lines.

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    Quote Originally Posted by CCGREEN View Post
    Interesting I come across this today. Me being from Florida ( a licensed state) where a eyeglass Rx is good for 5 years unless it has a expiration date on it, here in Maine (a unlicensed state) I just got a spanking this morning from the office manager for filling a Rx that was a few months past 2 years old. I honestly didn't know where to look in their EMR to find dates. I was taken aback, TWO YEARS! I had to look it up in and sure enough it is a state statue.
    None the less each state will have its own expiration date for contacts and eyeglasses but when you look up those rules make sure you are looking at a Optometry board RULE or a Opticianry board RULE or a STATE STATUE. And then each practice will have its own little guide lines.
    I called my association to clarify for this very reason! Thanks!

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    Quote Originally Posted by Trina View Post
    Just as an aside - have you tried the new Dragon Float sunglasses? As long as you put trivex in them, they float! Perfect for lake season. :)
    Just looked these up- very cool! Thanks for the recommendation. The wood ones we have tried are fun but tend to be problematic when switching out lenses. I've been contemplating different replacement lines and this is at the top of the list.
    Have I told you today how much I hate poly?

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    Quote Originally Posted by Trina View Post
    Back when I was taking the optician course at NAIT, my instructor mentioned that if patients didn't have a current prescription but desperately needed glasses, he would just take a measurement off their current glasses and make lenses based on that. Is this something that we as opticians are allowed to do?
    Trina,

    Wisconsin makes no mention of expirations, but addresses duplicates, and to some degree neutralization, although we need to give some thought to the statement "not requiring optometric service", and our professional responsibility to the patient.

    (2)Dispensing opticians. A dispensing optician is one who practices optical dispensing. The practice of optical dispensing comprises the taking of necessary facial measurements and the processing, fitting and adjusting of mountings, frames, lenses and kindred products in the filling of prescriptions of duly licensed physicians or optometrists for ophthalmic lenses. Duplications, replacements or reproductions not requiring optometric service may be done without prescription. Nothing herein contained shall change the responsibility of physician to patient, or optometrist to patient.
    https://docs.legis.wisconsin.gov/sta...es/449/_1?up=1

    However, best practice says to call the prescriber for the Rx. This eliminates errors from neutralization, and errors in the existing eyewear. We should strongly encourage our clients to travel with a spare pair of eyeglasses, and easy have access to their Rx (the cloud might work for most folks). That said, I'll neutralize for a nursing home resident when the prescriber is unknown and the need is high, but I'll strongly recommend that they see an eye doctor ASAP.

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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    Master OptiBoarder rbaker's Avatar
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    Quote Originally Posted by Quince View Post
    Oh Sebago... I have some sunglasses down there that were my designated lake pair for a reason- I put very little money into them. Now I have a wooden pair to test the buoyancy of this year!

    You brought up a really good point that I almost went back to touch on, so I will do it now. I have a hesitance with duping, not because of incompetence, but because I don't know who made it and how much they follow tolerances (especially with tourists). I will always tell people, if they have a written version- even if it is expired- I would rather work off of that then dupe.
    When you neutralize a pair of glasses you are not concerned with errors or tolerances. You are duplicating a pair of lenses not diagnosing the refractive error second guessing whoever made the lenses in question.

    You are responsible to insure that the new lenses are within tolerance with your neutralized findings.

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    I would add that state laws govern this and you should check what they are. But in a pinch you should do what's best for the patient...i.e. what's better? They have a pair of glasses that off by 3% or no glasses at all?

    In NY, there is no limitation on duplicating eyeglasses and no expiration dates on the prescription.

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    Quote Originally Posted by Trina View Post
    Back when I was taking the optician course at NAIT, my instructor mentioned that if patients didn't have a current prescription but desperately needed glasses, he would just take a measurement off their current glasses and make lenses based on that. Is this something that we as opticians are allowed to do?
    Can't believe this question is from an actual NAIT graduate. Of course this procedure is within our Optician scope of practice... it is called lens 'duplication' and if someone presents with even a scratch on a lens, we duplicate that lens power using lensometry.

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    Quote Originally Posted by rbaker View Post
    Remember, you are working for the customer not the refractionist.
    I would have rathered that you conceptualize this as "I want the patient to get the best vision care possible, and I need to collaborate with the patient's doctor's office." Otherwise you are a merchant. Are you? Or a professional?

    I think that the reluctance to duplicate lenses is the inability to accurately neutralize a pair of lenses. This factor generates "corporate" policy which prevents most opticians from practicing their craft.
    1. "Corporate policy" is (unfortunately) opticianry's boss, these days.
    2. "Opticians practicing their craft" kind of goes out the door when you're working for Costco.

    Can't have it both ways: independent and employed.

    I wish it weren't like this, but don't blame everyone else ("refractionists"--whomever that refers to--and "corporate"). It's unseemly.

    Be a professional and do professional things, or be a merchant and do merchant things.
    Last edited by drk; 05-23-2018 at 12:05 PM.

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    I never duplicate. Ever. Never ever.

    How are you going to get the PAL right? You can't.

    How are you going to know whether they're in an individualized SV lens? You can't.

    How are you going to match the index? You aren't.

    You're not "duplicating" at all. That went out in about 1980.

    Let's get real.

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    What you're doing is taking a short cut that very possibly compounds error.

    Refraction: -1.00 (+/- 0.25D)
    Original lens fabrication error: -1.25 (+/- 0.25D)
    "Duplication" lensometry error: -1.50 (+/- 0.25D)
    "Duplicated" lens fabrication error: -1.75 (+/- 0.25D)

    You are crappy, now.

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    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by drk View Post
    What you're doing is taking a short cut that very possibly compounds error.

    Refraction: -1.00 (+/- 0.25D)
    Original lens fabrication error: -1.25 (+/- 0.25D)
    "Duplication" lensometry error: -1.50 (+/- 0.25D)
    "Duplicated" lens fabrication error: -1.75 (+/- 0.25D)

    You are crappy, now.
    With all due respect, I don't think you understand how good some of us are at this.
    I'm Andrew Hamm and I approve this message.

  20. #20
    What's up? drk's Avatar
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    The point stands.

    Whether you're good at it or not.

    Think I'm not good at it?

    If you were really "good at it", you'd simply call the doctor's office, and get the Rx, if it wasn't expired.

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    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by drk View Post
    The point stands.

    Whether you're good at it or not.

    Think I'm not good at it?

    If you were really "good at it", you'd simply call the doctor's office, and get the Rx, if it wasn't expired.
    My first course of action is obviously to call the doctor's office. My point is that some of your margins of error are exaggerated.

    Thanks for being unnecessarily insulting, though! Have a great day!
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    What's up? drk's Avatar
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    Of course they're exaggerated. But not outside the realm of possibility.

    That, plus all the other slop makes it better to obtain the prescription, like you usually do.

    But more important than accuracy is the professional behavior that keeps patients from end-running their doctors' care.

    I had a nice patient two days ago. A return annual visit, contact lens patient. New patient to me, last year. Just shows up. No records, nothing. She's -8.00 or so, and ultimately I successfully refit her into MF SCLs.

    Turned out she's post-surgical bilateral retinal detachments, being managed by her retina doctor. I had to obtain records last year after taking her case, and work out some kind of a shared-care agreement, as we usually do in those circumstances, in order to define what roles we all have (and the patient's responsibility).

    So the first thing I have to do on the return visit is see where she stands with her retina appointments (we should have gotten a report, but we didn't). She can't remember. We call...she's complying with care, and not due, yet, so...green light.

    In taking the history and formalizing the reason for visit, she states she wants to take her CLRx because her partner sources them on the internet. Major red flag: even further care fragmentation in a high-risk case. Kudos for honesty (really naivete), though.

    I explain that we supply contact lenses competitively and I'm not releasing any CLRx in her case and she knee jerks. Won't hear a word I'm trying to tell her about what I think is best for her, and what I'm willing to do for her and what I'm not, as she's under my care. (She sure liked me last year when I fit her so well in the CLs, of course.)

    So, we parted ways, not amicably. Got the perfunctory nasty phone call later on.

    Why recount this saga? Because that's the perspective from my side. All I'm trying to do is give good care to people. With cataracts. With diabetes. With amblyopia. With you name it. And all the "alternative treatment providers" (online CL suppliers, online optical suppliers, unscrupulous or unskilled brick-and-mortar McTicians) make it just more difficult.

    I expect that REAL opticians behave responsibly and take the big picture into account. That's all.
    Last edited by drk; 05-23-2018 at 03:12 PM.

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    Quote Originally Posted by drk View Post
    I never duplicate. Ever. Never ever.

    How are you going to get the PAL right? You can't.

    How are you going to know whether they're in an individualized SV lens? You can't.

    How are you going to match the index? You aren't.

    You're not "duplicating" at all. That went out in about 1980.

    Let's get real.
    Actually, all of the above is pretty easy to figure out. But in all honesty, lens duplication is almost always an emergency *bandaid*, not an attempt to run an end around proper optometric care. ( At least in my experiences). Of course, a good Optician will attempt to get a current Rx from the prescriber, that's not always possible though.

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    Quote Originally Posted by optical24/7 View Post
    Of course, a good Optician will attempt to get a current Rx from the prescriber, that's not always possible though.
    And I'm certainly not going to A) lose business to the guy down the street who's willing to do it, and B) send a patient down the street to a guys whose competence at doing it I am unsure of.
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    One eye sees, the other feels. OptiBoard Gold Supporter
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    Client was wearing their spare pair one Rx cycle back. They didn't have a clue. Not from a nursing home.

    Client wearing eyeglasses with the lenses reversed (not from me). Returned to optician but was told they were fine. Wore them that way for years.

    Age 75 client wants new eyeglasses. Says their present eyeglasses/Rx are a year or maybe two years old. I call the prescriber and the last visit was six years ago.

    Eyeglasses measure 2∆ VI. Mild Rx (+2.00 add 2.50). Pupil height and datum line level. Is the prism prescribed? Maybe one lens was prism thinned, and the other wasn't. I saw that one last week. It was a fabrication error- not my client (but is now).

    I could write a page or two of different scenarios, and 50+ more pages if I document every occurrence I've seen in the over 40 years of my dispensing ophthalmic lenses experience.

    Things will go wrong in any given situation, if you give them a chance. -Murphy

    Best regards,

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    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

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