Eye doctor didn't ask to compare lenses (IE: which is clearer, #1 or #2?), is this normal?

[SCCpharm]

I took my 10 year old son to Lenscrafters today. The eye doctor didn't ask my son at all to compare lenses, like asking is #1 better than #2, #3 or #4?

She came in and asked a very brief history. Put lenses in front of him and asked him to read the letters on the board (They weren't the very fine print, maybe medium print). He read them perfectly. And then she was done. Gave him his prescription.

I asked "don't we need to do the lens comparison thing?" and she said "No, already done."

Is this normal? I'm hesitant to ask them to re-do my son's test. I just don't want him to be wearing glasses that are the incorrect prescription for the next year. He doesn't have any verbal communication issues, so I don't understand why we didn't do the lens comparisons.

I was trying to do my own research and it said he must have got an "Auto-refraction?" done versus a "subjective-refraction". Are these the correct terms?

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[generallyspeaking]

10 year old = 5th grade = reliable. no verbal communication issues. Did they use the phropter (mask of lenses) at all and show any comparisons without saying 1 or 2? "let me know when you can first read the letters" for example?

I dunno, but it sounds like you got gypped and that practice is unethical or not conforming to standards of care. My two cents.
subjective refraction is the most accurate method. autorefractors seldomly give accurate results, their usage is to get a starting point to refine through subjective manifest

 

[SCCpharm]

The tech came in and had him read the Snellen Chart and I think she wrote where he could read up to. Then the doctor came in and adjusted the lenses in the phropter and then had my son read the Snellen Chart. He didn't make any errors. And then she said we were done. She didn't ask him to compare any lenses on the phropter or make any other lenses changes on it.

 

[PBEA]

The tech came in and had him read the Snellen Chart and I think she wrote where he could read up to. Then the doctor came in and adjusted the lenses in the phropter and then had my son read the Snellen Chart. He didn't make any errors. And then she said we were done. She didn't ask him to compare any lenses on the phropter or make any other lenses changes on it.

that isn't unusual at all. In many cases asking "1 or 2" is totally unecessary

 

[generallyspeaking]

I disagree completely. Only if the patient is an unreliable reporter would I not do a subjective manifest.

 

[PBEA]

I disagree completely. Only if the patient is an unreliable reporter would I not do a subjective manifest.

you mean to tell me that as long as they are reliable you perform a subjective refraction on EVERY single person, regardless of their presentation?

not only is that totally unnecessary it is also misleading (enter the op), and a colossal waste of time.

 

[QueenieCSS]

The tech came in and had him read the Snellen Chart and I think she wrote where he could read up to. Then the doctor came in and adjusted the lenses in the phropter and then had my son read the Snellen Chart. He didn't make any errors. And then she said we were done. She didn't ask him to compare any lenses on the phropter or make any other lenses changes on it.

I work primarily with pediatric patients and I rarely ask them to pick one or two. Even if they understand the process it can occasionally be confusing and take a lot longer than necessary. I start out with retinoscopy (basically using the flashlight and optics to get my lens choice). As long as the child can see clearly with the lenses I choose, there isn't much need to refine them. Occasionally I change the lenses very slightly, but I would say over 90% of the time I don't need to make any alterations.

I dunno, but it sounds like you got gypped and that practice is unethical or not conforming to standards of care. My two cents.
subjective refraction is the most accurate method. autorefractors seldomly give accurate results, their usage is to get a starting point to refine through subjective manifest

I have to respectfully disagree with this statement. Not doing a subjective refraction is by no means unethical or not providing the standard of care. If you are good at retinoscopy you should be pretty close to the final prescription without needing a lot of (if any) refinement. You can also tell during retinoscopy if their accommodation fluctuates and if you need more of a subjective refraction, or even a cycloplegic refraction. We don't know for a fact if the practice did an autorefraction (or retinoscopy for that matter) so I don't think we should be assuming they didn't provide standard of care. Since we are not the doctor that provided the exam we can't say what was (or wasn't) done during the exam.

 

[KHE]

The OP didn't say why the child was examined. Was it a routine checkup or was the child having a complaint of some type?

 

[Optogal]

I've personally never heard of, was never taught, and have never conceived of NOT attempting a subjective refraction on an otherwise normal 10 year old boy for the purposes of prescribing glasses to him.

Under the age of 5 or 6, then yeah - it's ret and go. But for a 10 year old? I'll put in my 60-90 seconds on it.

 

[310]

There are two types of routine patients who often can't tell the difference between lenses: kids and old people.


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[SCCpharm]

Thanks for the responses.

The reason for the visit was my son was complaining about not seeing words that were far away. He previously wore glasses in 1st and 2nd grade. RX's were (OD +0.50, -0.50, 180; OS +0.50, -0.50, 165) and (OD +0.50, -0.25, 179; OS +0.75, -0.75, 170).

For third grade, we went to an independent doc who said my son doesn't need to wear glasses since he was borderline. (OD plano, -0.50, 170 OS plano, -0.50, 170).

This current RX is OD -1.50, -0.25, 150 and OS -1.25, -0.50, 010.

As far as machines used. First machine was the one where you look into it and he looked at a hot air balloon. Second machine was the one that blows air into the eye.

A retinoscope wasn't used.

We did the digital retinal imaging based on the doctor's recommendation.

 

[Optogal]

For those advocating no subjective.... your thoughts on this case?

I certainly have mine. I'll let you guys go first.

 

[QueenieCSS]

First - I just want to say I wasn't advocating that people don't do a subjective on a 10 year old. If that is your practice, and it works - then go for it. Just that there are other ways to get an accurate refraction.

That being said, this is why I do retinoscopy. I rarely use an auto-refractor, I find my ret to be more accurate and gives me more information, in less time. If the reflex fluctuates I can be more cautious about the minus. It gives me a lot more input into the patient's visual system and how they are handling things. Depending on what the entering VAs are, you can usually estimate about how nearsighted the patient is. And late elementary school is the time I find a lot of kids start to become more nearsighted.

I do believe auto-refractors can overminus but that isn't always the case. There are a lot of things that go through my mind when I am figure out a prescription, but all the parents see is me shining a light at their kid and then suddenly they could see the letters they couldn't before. I don't want to say what happened in this case, because I wasn't there. Just that it is possible to get a finalized (and accurate) prescription without asking someone: Which is better, one or two?

 

[Optogal]

The reason for the visit was my son was complaining about not seeing words that were far away.

There is absolutely not enough information here for any of us to know whether or not his final Rx is "correct/appropriate/reasonable" or not. One helpful piece of information would've been the value of his visual acuity (was it 20/30 or 20/80 or what?). Maybe the final prescription is OK - but without that as a baseline, it's hard to guess. The child's complaint of "not seeing words that were far away" unfortunately could mean he sees 20/200, or even 20/15+. We don't know.

Generallyspeaking said above, "autorefractors seldomly give accurate result". This definitely is not true. I'm not sure what autorefractos you're using, but some autorefractors that I've come across are remarkably accurate (in my experience, I've come across several - as you work with autorefractors, you start to know which ones are accurate, which ones aren't, but even those that aren't - if you know how/when inacccurate they are, they are still helpful - e.g. they are good with 40 year olds, but may overminus kids - so watch out when you have a kid). We probably have to assume the autorefractor used was believed to be accurate by the examining doctor.

I personally would've done attempted some type of subjective on that 10 year old. Barring that, I'd ret him/her just to double the AR result. Again - if his VA was like 20/60-20/80 range, then maybe some people will say it wasn't necessary. I personally would spend the time to do one of these 2 things, since glasses were going to be made and a normal 10 year old is more than capable of a reasonable level of subjective refraction.

I wonder if PBEA doubles as the President of the United States given that doing a quick 40 sec flip of lenses on a child, to him, is a "colossal waste of (his) time". I personally am willing to make an attempt at subjective when I get paid to do an eye exam, and don't consider it a colossal waste of anything.

Based on the context of what you wrote, you paid for digital retinal imaging as an optional service. That can be opined on as well.

 

[generallyspeaking]

Autorefractors have their place but cannot always be trusted for accuracy. subjective manifest is the most accurate way on a reliable patient - pure psychometrics. Any professional using solely their autorefractor values to prescribe are doing their patients a disservice.

 

[KHE]

Thanks for the responses.

The reason for the visit was my son was complaining about not seeing words that were far away. He previously wore glasses in 1st and 2nd grade. RX's were (OD +0.50, -0.50, 180; OS +0.50, -0.50, 165) and (OD +0.50, -0.25, 179; OS +0.75, -0.75, 170).

For third grade, we went to an independent doc who said my son doesn't need to wear glasses since he was borderline. (OD plano, -0.50, 170 OS plano, -0.50, 170).

This current RX is OD -1.50, -0.25, 150 and OS -1.25, -0.50, 010.

As far as machines used. First machine was the one where you look into it and he looked at a hot air balloon. Second machine was the one that blows air into the eye.

A retinoscope wasn't used.

We did the digital retinal imaging based on the doctor's recommendation.

In that case, it would be highly unusual for someone to not attempt a subjective refraction on a 10 year old.

 

[310]

I'd get a recheck and bring in the old rx. That kind of change can happen in a ten year old, but I'd be skeptical if no retinoscope was used.


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[Optogal]

For those who think subjective isn't necessary, I'd say the OP proves they are wrong. Otherwise their patients are at risk of coming onto forums like this and starting threads questioning the competence of their doctor. Point set match.

I'll do a quick subjective, even on some 20/20, ret near plano, just to move the dials around and let the parent's see I'm doing "something". An eye exam without a subjective refraction goes by really fast - probably too fast. Sometimes you just have to act the part a bit. (the refraction can be just adding +050 to each eye, confirming things got worse, then just using the JCC to see if he 0.25 that you retted is there or not. Something simple like that.) I mean, I think a show of some kind that you're doing some type of "eye exam" however minimal it may be. You may be sure the child is fine, but you have to show the parent why you believe that through your actions.

 

[VA Hopeful Dr]

For those who think subjective isn't necessary, I'd say the OP proves they are wrong. Otherwise their patients are at risk of coming onto forums like this and starting threads questioning the competence of their doctor. Point set match.

I'll do a quick subjective, even on some 20/20, ret near plano, just to move the dials around and let the parent's see I'm doing "something". An eye exam without a subjective refraction goes by really fast - probably too fast. Sometimes you just have to act the part a bit. (the refraction can be just adding +050 to each eye, confirming things got worse, then just using the JCC to see if he 0.25 that you retted is there or not. Something simple like that.) I mean, I think a show of some kind that you're doing some type of "eye exam" however minimal it may be. You may be sure the child is fine, but you have to show the parent why you believe that through your actions.

This post gets it.

As a family doctor, I do lots of exam components that I know will not change anything. I do them because patients expect it and will get mad or feel short-changed if I don't.

For example, if a kid has no fever, no ear pain, and just a runny nose then they don't have an ear infection; but, God help me if I don't look in their ears.

 

[PBEA]

if we review the op it sounds like lenses were held in front of the rx, which in many cases may be all that is required. I have no idea whether it was valid to limit the refraction to this, but to say that it is "unethical" or "absurd" based on so little information, is irresponsible. Having said that, if it was recommended to get "retinal imaging" (at an additional charge), for no other reason then to document a normal retina, that alone would make me suspicious of the practice.

As for putting on a show to make pts feel better then I can understand that, I don't subscribe to that, or act in that fashion, but I can understand why some doctors do it. In my office refraction costs an additional $40 on top of the office visit so I try and limit it to those cases where I feel it is necessary, or the pt specifically requests it.

 

[Optogal]

Eye exams in my jurisdiction can't be ordered "a la carte". Everything is included, so a refraction is a "necessary" part of the exam.

 

[PBEA]

Eye exams in my jurisdiction can't be ordered "a la carte". Everything is included, so a refraction is a "necessary" part of the exam.

You must be in some country outside of the US then. In the US we use CPT codes to define each and every procedure (refraction, office visits, etc) and to these codes is an assigned fee. Although I wouldn't describe it as "a la carte", services are generally chosen by the doctor based on presentation, and this then determines the fee.

"everything is included"? seems an odd statement to me. For example, if a pt requires gonioscopy because you note narrow angles, is that included? or lets say you suspect glaucoma and order OCT, is that also included?

Also, "a refraction is a necessary part of the exam" doesn't make much sense either. Lets say a pt with moderate AMD is back for 6 months f/u, they have reduced vision but its stable, and even though you refracted 6 mo ago you are saying that your jurisdiction requires you to perform ANOTHER refraction?

 

[Optogal]

OK - so yeah I'm in Canada. Speaking of CPT codes, I was doing CEwire yesterday and listening to Craig Steinberg's lecture and was reminded again that you guys do things differently. (for the record, I find the billing lectures fascinating if irrelevant, but I have to really pay attention because it's all new to me - can't sleep through those ones!)

I wasn't clear in my reply. Where I'm at, there is something called a "Major Eye Examination" as opposed to a "Minor Eye Examination". Basically, a Major EE is generally any first encounter, and requires history, a BV assessment, a refractive assesssment, and a health assessment. Other than medical or emergency cases (infectious presentation, FB, trauma, chemical splash etc.), a refraction is basically expected on first-patient encounters. So I guess that's where my thinking comes from. In the case of the OP, this seems to me to clearly be a "Major EE".

In a follow-up "minor" exam, the implication is that the patient has been seen before, and the testing done can be problem specific.

 

[KHE]

Based on the initial presentation reported by the Op, I think it's safe to say that virtually all optometrists would have attempted a subjective refraction on that patient because it would have been warranted.

 

[eye love lamp]

For those who think subjective isn't necessary, I'd say the OP proves they are wrong. Otherwise their patients are at risk of coming onto forums like this and starting threads questioning the competence of their doctor. Point set match.

I'll do a quick subjective, even on some 20/20, ret near plano, just to move the dials around and let the parent's see I'm doing "something". An eye exam without a subjective refraction goes by really fast - probably too fast. Sometimes you just have to act the part a bit. (the refraction can be just adding +050 to each eye, confirming things got worse, then just using the JCC to see if he 0.25 that you retted is there or not. Something simple like that.) I mean, I think a show of some kind that you're doing some type of "eye exam" however minimal it may be. You may be sure the child is fine, but you have to show the parent why you believe that through your actions.

Or, you know, instead of doing a smoke and mirrors physical exam, you could just spend that time communicating to the patient and answering their questions that would prevent them from coming online.

*gasp*

 

[Optogal]

Or, you know, instead of doing a smoke and mirrors physical exam, you could just spend that time communicating to the patient and answering their questions that would prevent them from coming online.

*gasp*

I don't see how doing a subjective is a "smoke and mirrors" exam. Besides, doing a subjective might actually be more time efficient than "spend(ing) that time communicating" to the patient why you aren't doing a subjective or skipping tests. Why are you advocating doing fewer baseline procedures in exchange for explaining why they shouldn't be done? It's not as though we're talking about von Graefe phorias, we're talking about subjective.

 

[eye love lamp]

I don't see how doing a subjective is a "smoke and mirrors" exam. Besides, doing a subjective might actually be more time efficient than "spend(ing) that time communicating" to the patient why you aren't doing a subjective or skipping tests. Why are you advocating doing fewer baseline procedures in exchange for explaining why they shouldn't be done? It's not as though we're talking about von Graefe phorias, we're talking about subjective.

If your patient is 20/20 +1 without correction, are you really going to bother doing a subjective refraction? Now they're 20/15 -1 with a -0.25 + 0.25 x 180, great! But are you going to prescribe that? Are you going to charge the $35 - $50 refraction fee? Maybe if you're trying to increase revenue or boost your optical's sales; but your patient will never bother wearing it.

You need to have a good reason to do every "procedure" in the office. A patient without complaints and with good visual acuity does not require a subjective refraction.

 

[Optogal]

If your patient is 20/20 +1 without correction, are you really going to bother doing a subjective refraction? Now they're 20/15 -1 with a -0.25 + 0.25 x 180, great! But are you going to prescribe that? Are you going to charge the $35 - $50 refraction fee? Maybe if you're trying to increase revenue or boost your optical's sales; but your patient will never bother wearing it.

I posted above that I don't live in the U.S. and a subjective comes with the full examination. I don't get paid extra and do not charge an extra $35-50 for doing a refraction. If you had bothered to read the thread, you would discover your post is out of context with my situation, which I clarified above.

Furthermore, your "solution" wouldn't have changed the fact that the OP didn't feel satisfied with the examination she was given. And who knows. Maybe she was charged a "refraction" fee for the autorefraction she received.

You need to have a good reason to do every "procedure" in the office. A patient without complaints and with good visual acuity does not require a subjective refraction.

Did you even read the opening post? The patient complained of blur at distance, and was given a pair of glasses. What situation are you talking about? You are saying this person actually had good visual acuity and we are all mistaken?

 

[eye love lamp]

I posted above that I don't live in the U.S. and a subjective comes with the full examination. I don't get paid extra and do not charge an extra $35-50 for doing a refraction. If you had bothered to read the thread, you would discover your post is out of context with my situation, which I clarified above.

Furthermore, your "solution" wouldn't have changed the fact that the OP didn't feel satisfied with the examination she was given. And who knows. Maybe she was charged a "refraction" fee for the autorefraction she received.



Did you even read the opening post? The patient complained of blur at distance, and was given a pair of glasses. What situation are you talking about? You are saying this person actually had good visual acuity and we are all mistaken?

This is your post, no? This was the post that I replied to and the quote is contained in my prior reply; did you even read the context in which I replied?

For those who think subjective isn't necessary, I'd say the OP proves they are wrong. Otherwise their patients are at risk of coming onto forums like this and starting threads questioning the competence of their doctor. Point set match.

I'll do a quick subjective, even on some 20/20, ret near plano, just to move the dials around and let the parent's see I'm doing "something". An eye exam without a subjective refraction goes by really fast - probably too fast. Sometimes you just have to act the part a bit. (the refraction can be just adding +050 to each eye, confirming things got worse, then just using the JCC to see if he 0.25 that you retted is there or not. Something simple like that.) I mean, I think a show of some kind that you're doing some type of "eye exam" however minimal it may be.

My point that an extra five minutes spent sitting down and answering questions (instead of flipping between +0.25 sphere and plano on a refraction which you'll never give to kill time) is more worthwhile to the patient. And that extra time to answer questions may prevent them from coming online and asking questions in a forum.

Your "rule" that all patients need to be subjectively refracted is wrong.

 

[Optogal]

This is your post, no? This was the post that I replied to and the quote is contained in my prior reply; did you even read the context in which I replied?

You're the one who replied out of context. I don't get paid extra for doing subjective, so you telling me that I gain $50 for doing it unnecessarily is you spewing hate.

My point that an extra five minutes spent sitting down and answering questions (instead of flipping between +0.25 sphere and plano on a refraction which you'll never give to kill time) is more worthwhile to the patient. And that extra time to answer questions may prevent them from coming online and asking questions in a forum.

You're an ophthalmologist right? The last oph I worked with saw 110 patients a day. I see about 15% of that total. You're telling me to spend more time with my patients? What you seem to be conveniently ignoring is that an optometrist can do BOTH. We can do a 40 sec subjective on a 10 year old AND spend 5 minutes answering their questions! To use your vocabulary, GASP! Hard for your intellect (narcissism?) to understand eh?

BTW - VA Hopeful Dr, MD, above, stated that he does unnecessary ear checks on patients. Can you please take the time to tell him that he's wrong to do this and should instead, spend 5 minutes explaining why he isn't?

Your "rule" that all patients need to be subjectively refracted is wrong.

First. I never said that. Don't take me out of context. I wrote this above:

Under the age of 5 or 6, then yeah - it's ret and go. But for a 10 year old? I'll put in my 60-90 seconds on it.

Second. It's not my rule. It's the rule established by the governing body where I reside. You may think everyone practices with the same rules where you reside, but sorry the world doesn't revolve around you.

 

[Optogal]

Eye love lump.

Please opine on the OP. You still haven't done that yet. Was anything done wrong?

 

[Optogal]

Eye love lump. Reply to this man!! Do the world a favor and save his patients from all those unnecessary tests!!!!

This post gets it.

As a family doctor, I do lots of exam components that I know will not change anything. I do them because patients expect it and will get mad or feel short-changed if I don't.

For example, if a kid has no fever, no ear pain, and just a runny nose then they don't have an ear infection; but, God help me if I don't look in their ears.

 

[eye love lamp]

You're the one who replied out of context. I don't get paid extra for doing subjective, so you telling me that I gain $50 for doing it unnecessarily is you spewing hate.



You're an ophthalmologist right? The last oph I worked with saw 110 patients a day. I see about 15% of that total. You're telling me to spend more time with my patients? What you seem to be conveniently ignoring is that an optometrist can do BOTH. We can do a 40 sec subjective on a 10 year old AND spend 5 minutes answering their questions! To use your vocabulary, GASP! Hard for your intellect (narcissism?) to understand eh?

BTW - VA Hopeful Dr, MD, above, stated that he does unnecessary ear checks on patients. Can you please take the time to tell him that he's wrong to do this and should instead, spend 5 minutes explaining why he isn't?



First. I never said that. Don't take me out of context. I wrote this above:



Second. It's not my rule. It's the rule established by the governing body where I reside. You may think everyone practices with the same rules where you reside, but sorry the world doesn't revolve around you.

Eye love lump.

Please opine on the OP. You still haven't done that yet. Was anything done wrong?

Eye love lump. Reply to this man!! Do the world a favor and save his patients from all those unnecessary tests!!!!

Damn, the crazy seems to come out of you quite easily.

I thought people from Canada were more chill??

 

[Optogal]

When you lose an argument, resort to ad hominems.

 

[eye love lamp]

When you lose an argument, resort to ad hominems.

Is that you in the avatar pic??

The hot ones are always crazy

 

[Optogal]

What does my avatar have to do with subjective refraction?

You need to have a good reason to do every "procedure" in the office.

Keep in mind you're an ophth and your exams are problem based. Further, people who see "specialists" usually don't visit routinely (unlike annual visits to the GP, dentist, optometrist, etc.). Non-routine visits may only occur once or twice in a lifetime, so there is no "expectation" of what needs to be done in that exam, as they have no precedent. Optometry visits are not like that. Parents have their own lifetime of visits to compare their child's visit to. Sometimes you do things because an auto-refraction and VA, just wouldn't be enough for a parent watching the exam occur. Lastly, some people do refraction because their regulatory body demands they do, not because of some cynical ploy to collect $50 from an unwitting patient. Hope this makes sense to you. An eye exam without a subjective goes by really really fast, on an otherwise normal/healthy 10 year old boy (especially if they are booked for 20 minutes - those 20 mins have to be passed somehow. 45 sec doing subjective isn't going to kill anyone and, I don't see why you're making a big fuss. It seems you believe anyone who chooses to do subjective is wrong and should be told to stop). I'd say someone who chooses to talk through their exam (as you suggest) as opposed to doing baseline measurements is the one who's doing the smoke and mirrors exam.

 

[stoikiometry]

I thought people from Canada were more chill??

I am chill, but I also could be a robot.

 

[eye love lamp]

What does my avatar have to do with subjective refraction?



Keep in mind you're an ophth and your exams are problem based. Further, people who see "specialists" usually don't visit routinely (unlike annual visits to the GP, dentist, optometrist, etc.). Non-routine visits may only occur once or twice in a lifetime, so there is no "expectation" of what needs to be done in that exam, as they have no precedent. Optometry visits are not like that. Parents have their own lifetime of visits to compare their child's visit to. Sometimes you do things because an auto-refraction and VA, just wouldn't be enough for a parent watching the exam occur. Lastly, some people do refraction because their regulatory body demands they do, not because of some cynical ploy to collect $50 from an unwitting patient. Hope this makes sense to you. An eye exam without a subjective goes by really really fast, on an otherwise normal/healthy 10 year old boy (especially if they are booked for 20 minutes - those 20 mins have to be passed somehow. 45 sec doing subjective isn't going to kill anyone and, I don't see why you're making a big fuss. It seems you believe anyone who chooses to do subjective is wrong and should be told to stop). I'd say someone who chooses to talk through their exam (as you suggest) as opposed to doing baseline measurements is the one who's doing the smoke and mirrors exam.

lol are you still going at this

I don't see 110 patients per day, and I do plenty of well visits and annual exams on both adults and peds. The peds visits are not short - they wait 40-60 minutes for full cycloplegia. How do you get them in and out in <20 minutes?

I've skipped out on subjective refraction plenty of times: if the kid doesn't need it, is too young, too uncooperative. Ditto for adults.

I always chat with the patient/parents at the end. Never once has someone even questioned it.

 

[PikminOC]

I took my 10 year old son to Lenscrafters today. The eye doctor didn't ask my son at all to compare lenses, like asking is #1 better than #2, #3 or #4?

She came in and asked a very brief history. Put lenses in front of him and asked him to read the letters on the board (They weren't the very fine print, maybe medium print). He read them perfectly. And then she was done. Gave him his prescription.

I asked "don't we need to do the lens comparison thing?" and she said "No, already done."

Is this normal? I'm hesitant to ask them to re-do my son's test. I just don't want him to be wearing glasses that are the incorrect prescription for the next year. He doesn't have any verbal communication issues, so I don't understand why we didn't do the lens comparisons.

I was trying to do my own research and it said he must have got an "Auto-refraction?" done versus a "subjective-refraction". Are these the correct terms?

My 16yo patient said the same thing. His prescription is not very good for distance with the exam his optometrist did.

 

[Optogal]

delete

 

[VA Hopeful Dr]

So this seems pertinent... http://www.llr.state.sc.us/POL/Optometry/PDF/minieyexam.pdf

Turns out in SC you're required to do a refraction for routine exams.

 

[Optogal]

I'm going to declare I was mistaken. I love lump is an ophthalmologist and I therefore assumed that what she posted would be intelligent. I gave her the benefit of the doubt. I was wrong.

She can't stay on topic, everything she writes is basically a cheap insult, and the only arguments she "wins" are false hyperbolic claims (e.g. I never said anywhere that I subjective refracted everyone - I in fact said the opposite. Further, if someone truly held that foolish position, she should be smart enough to know she shouldn't waste her time arguing with that person).

In short, she's a narcissist and a troll.

 

[PikminOC]

I'm going to declare I was mistaken. I love lump is an ophthalmologist and I therefore assumed that what she posted would be intelligent. I gave her the benefit of the doubt. I was wrong.

She can't stay on topic, everything she writes is basically a cheap insult, and the only arguments she "wins" are false hyperbolic claims (e.g. I never said anywhere that I subjective refracted everyone - I in fact said the opposite. Further, if someone truly held that foolish position, she should be smart enough to know she shouldn't waste her time arguing with that person).

In short, she's a narcissist and a troll.

There's nothing to say she is verified. Do they verify if you are a resident? I know they verify attendings. I am verified. Anyone can say they are anything else I think.

 

[eye love lamp]

I'm going to declare I was mistaken. I love lump is an ophthalmologist and I therefore assumed that what she posted would be intelligent. I gave her the benefit of the doubt. I was wrong.

She can't stay on topic, everything she writes is basically a cheap insult, and the only arguments she "wins" are false hyperbolic claims (e.g. I never said anywhere that I subjective refracted everyone - I in fact said the opposite. Further, if someone truly held that foolish position, she should be smart enough to know she shouldn't waste her time arguing with that person).

In short, she's a narcissist and a troll.

I dont know how youd think that "all hot chicks are crazy" would equate me being female

If you're subjectively refracting 20/20 sc patients I dont know who you wouldnt refract?

 

[310]

So this seems pertinent... http://www.llr.state.sc.us/POL/Optometry/PDF/minieyexam.pdf

Turns out in SC you're required to do a refraction for routine exams.

A refraction is required as part of a routine (S code) exam. It is not required as part of a comprehensive (92) exam, which is why there's a separate code for refraction when included with a comprehensive, but not with a routine s code.


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[VA Hopeful Dr]

A refraction is required as part of a routine (S code) exam. It is not required as part of a comprehensive (92) exam, which is why there's a separate code for refraction when included with a comprehensive, but not with a routine s code.


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Yes which is why I said "routine exams" in my post.

 

[310]

Yes which is why I said "routine exams" in my post.

Well, there's only one insurance where I use S codes instead of 92004. 92004 is basically the same except you aren't required to refract and have the option of medical tests if the plan covers it.


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[VA Hopeful Dr]

Well, there's only one insurance where I use S codes instead of 92004. 92004 is basically the same except you aren't required to refract and have the option of medical tests if the plan covers it.


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You must be in a good area. When I used to do billing for my dad's office, at least half of his yearly exam patients had some form of vision insurance that required refraction.

 

[PBEA]

My 16yo patient said the same thing. His prescription is not very good for distance with the exam his optometrist did.

why do you say the "prescription is not very good"? How did you arrive at that conclusion?

 

[PBEA]

So this seems pertinent... http://www.llr.state.sc.us/POL/Optometry/PDF/minieyexam.pdf

Turns out in SC you're required to do a refraction for routine exams.

there are a few states that spell out testing for "routine exams", but the majority do not. From what I can tell, those regs are throwbacks from a time when optometry was trying to prevent the kind of "quickie" evals that so often took place in corporate offices, the mall, etc. Now we just pretend it doesn't happen. I doubt the regs help anyway. What Eye love lamp is alluding to is correct, for a large segment of the population frequent refractions are unnecessary. IMO, "blurred vision" is often due to some other problem anyway. However as you point out often the pt expectation is there, and if there is a concern it makes sense to address it.