I know some opticians refract under the authority of an O.D. or M.D. but this is concerning opticians being able to refract completely independently. If the appropriate licensure/formal training were set up in every state, do you think it would benefit the consumer to be able to see an optician for an update on their spectacle Rx? The average person who wants an updated Rx has to currently go through an eye exam whether they want to or not. What are your thoughts on this? I am a current 3rd year optometry student and my school has assigned me a debate topic on refracting opticians. Just want to hear opinions and different viewpoints.
Opticians Refracting Indepently
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The situation you describe is why optometry evolved in the first place. The need for an eye exam even for patients who JUST want a refraction is imperative. Patients do not realize that there are a million and one things that can cause shifts in refractive error. Most of these things aren't life threatening. But some are. Just because a patient wants a refraction only doesn't mean he/she should get it. When I go to the dentist I don't say just clean the front teeth because that's the only place I see that there's gunk in them.
Now if it was an access to care issue then I'd say there's a difference. But there isn't. There's already more than enough optometrists to fill the said gaps.
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If you want an honest answer to a poll like this, you shouldn't post it here. You're obviously going to get very biased results. It's no different than the pool on the ophthalmology forum asking "should optometrists be allowed to do surgery?"
What sort of response are you expecting?
What sort of response are you expecting?
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Knowing what I now know about eye care, I don't think there is any problem with opticians having independent refracting rights, at least on an empirical level. The reason most ODs would oppose it is not because it's inherently wrong, it's because it could put many of us out of business. The requirement of an Rx for a pair of glasses is something we pushed for, not something that should be an obvious requirement for most spectacle Rx's (Ok, people, we're not talking about amblyopes here so simmer down).
Do we require a "foot exam" from a podiatrist, in order to be sized to buy a pair of shoes?
I'm not arguing that it's not beneficial, overall, for patients to be required to be seen for an eye exam before being Rx'd glasses - that's a given. The health assessment that goes along with an SRx is an obvious benefit to the general public, but there really is a disconnect between someone who just wants a pair of glasses, and someone who has a medical eye problem, or wants an eye exam. In my view, people shouldn't be forced into an eye exam if they just want glasses - it's their decision.
If and when opticians get independent refracting rights, every doc-in-a-box OD will be in a state of total panic. That day will come, and it will be sooner than later. It's inevitable.
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for the patient who just happens to have no ocular or systemic health conditions, and just happens to be easy going about the range of how clear his/her vision will be with glasses, and just happens to not desire refractive surgery, and just happens to not have much astigmatism, and just happens to not have any binocular eye teaming issues, and just happens to have fully functional visual capability and distance and near with no asthenopia, headaches, or focusing issues, and just happens to trust someone to fit him/her with contact lenses who has not been trained in a university setting to do so, then for this patient an optician would truly be great for ordering the glasses or contacts.
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That's still a lot of particular stipulations. Not worth it.
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Refracting a normal, healthy patient is very easy - sorry to burst your bubble. You certainly don't need a doctorate to do it. There are refracting opticians out there who could refract your pants off. I've worked with some who could pass for an OD easily, even with routine anterior seg pathology.
About 95% of the population could be easily refracted by an optician and be very happy with the results. So, basically, for refractive purposes, ODs are necessary for about 5% of the nation.
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Any fair assessment of refraction would agree with this. Keep in mind, probably >95% of the world's population do not have access to doctors of optometry. These folks are refracted by techs, refracting opticians, or autorefractors.
I may have been a little exaggerating when I said "who does not have much astigmatism," but for the most part I stand by my statement, because functional vision issue correction is an art that takes some practice to understand. If we consider vergences as part of refraction, there are times when its indicated to interpret the data differently, to use an alternative technique, etc. There are times a duochrome may help with refraction, there are times not. Choosing the final Rx is something which must be taken into account from trial framing the patient, lensometry findings, etc, and this all is without even considering contact lenses. This all takes time, and I feel as if an optician who is working independently without an OD's advice has not had the background for these subjective considerations. An optician refracting under an OD's "watch," or if in the same building, etc: this is fine for refraction's sake most of the time. There are indications for retinoscopy on high powers though. The list goes on.
If it is a 3rd world country setting and quantity is what is most relevant, then I'd be fine with Rxs which are pretty good, but these are exceptions. Just because there are some refracting opticians qualified for any kind of refraction does not mean that it should be a rule allowing for opticians to refract independently. Of course there are opticians who have been around the field for a while and are really good at the art of a perfect refraction.
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As a certified ophthalmic assistant, I'd refract 25 or more people a day. The only complaints came when people ordered their glasses from sketchy places or online (and that was due to the glasses themselves.) I must say I did experience some troubles with patients having severe keratoconus or other conditions from time to time. But for the most part, I felt comfortable and confident performing refractions without having a doctorate degree.
By the way, not saying it is a positive or a negative--just saying it the way it is.
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Like I said.....95% don't require a doctor's level of understanding. The other 5% (actually, it's probably a smaller number), do require that kind of training.
Look, I'm not going to tear you apart, because you're a student and you'd have absolutely no way to understand how much you don't know. When I was a student, I thought "the art of refraction," was some sort of elite skill that only a doctor could master. What you'll realize, shortly after you graduate, is that there are thousands of refracting techs out there, many of whom are better than you are now. I've worked with new grads who spend 6 minutes on a routine refraction, and they think they're rock stars. You guys don't have any idea how much you don't know until you get out into the real world.
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Maybe you're some BV star at your school, but giving a pair of glasses to someone (which includes the vast majority of the population) so that they can see isn't that hard, no matter how you try to spin it. You won't be diagnosing all the stuff you brought up nearly as much as you think you will, unless you want to see one patient every 2 hours like you do in student clinic. Otherwise, you'll be doing a whole lot of work to prescribe -2.00 sph OU to someone, an effort that doesn't do much other than allowing you to convince yourself you're the best optometrist on earth and the patient's entire visual existence has been saved because he was in your hands, and that he would've basically undergone years and years of oculo-visual pain and suffering had he seen anyone else (for that same -2.00 OU Rx).
You'll realize that this isn't the reality once you start seeing folks who were seen by someone else who are wearing the same pair of glasses for years that have them over-minused by 1 to 2 diopters, sitting in your chair and whose only complaint is, "yeah my glasses didn't feel that right, but I never went back to get it fixed". You'll get these ones right, and good for you, but the human visual system is more robust (and less problematic) than you give it credit for. The fact that the refractioinist across your street spends 3 mins on an eye exam whereas you spend 30 mins on one, might make a difference in 1/1000 patients, But since that guy is seeing 10 times more patients than you, he has the time to miss a few.
BTW. We're not talking 3rd world mumbo jumbo. We're talking Japan, France, Germany, Italy, South Korea and other first world countries.
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I train all my techs to refract. Takes about 6 months for them to perfect it. Refracting is about as boring as watching paint dry. It's about as complicated as setting up a smart phone.
Patients do not need or want to spend 2 hours getting a bunch of random test that were developed 80 years ago by optometrists to make themselves seem important since they could do nothing medical at the time.
VT is mostly voo-doo. Even the one is 1,000 patient that you find with a problem will not want to do anything about it. You might be able to convince a mom that little Johnny is going to fail out of school and become a career criminal if she doesn't bring him back for your Brock String therapy
. But 99% of the time, you will be wasting your time and energy. And little Johnny will be fine.
Please don't think you will do anything different. It's ALL been tried before by hundreds of thousands of ODs before you.
The vast majority of your time will be spent flipping dials up and down while thinking about what you could have become.
Patients do not need or want to spend 2 hours getting a bunch of random test that were developed 80 years ago by optometrists to make themselves seem important since they could do nothing medical at the time.
VT is mostly voo-doo. Even the one is 1,000 patient that you find with a problem will not want to do anything about it. You might be able to convince a mom that little Johnny is going to fail out of school and become a career criminal if she doesn't bring him back for your Brock String therapy
. But 99% of the time, you will be wasting your time and energy. And little Johnny will be fine.Please don't think you will do anything different. It's ALL been tried before by hundreds of thousands of ODs before you.
The vast majority of your time will be spent flipping dials up and down while thinking about what you could have become.
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As a tech, I agree. That's why I am happy it is in the dark and they are behind the phoropter...then I can yawn as much as I need to and they have no idea.
This for sure how you feel as a tech! I guess that is one of the reasons I want to be an O.D. I enjoy working in eye care, but I want to do more than just the pre-tests and refract. I understand it is not a glorious job and lots of repetition. I have a pretty solid understanding of the field, and I still want to pursue an O.D. So, please don't bash me because I want to go to optometry school. In my opinion, it beats being a tech for the rest of my life.
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No one is going to bash you for deciding to go to optometry school, we'll just feel sorry for you. You're committing to 4 years of lost income, 150-200K in educational expenses, and entering a workforce in which your services are less valued than when you started. (The saturation problem is far worse for ODs than for opticians, especially refracting opticians.) You're basically going to give up income, and pay a huge sum of money in order to call yourself "doctor." When you end up in Walmart, Cohen's, VisionMart, or one of the infinate equivalent practice locations, you're basically going to be doing a lot of what you're doing now; refracting - that's about it.
Sit down with a pen and paper and write out what you hope to gain both profesionally and financially, by getting an OD. Compare your current income, account for 4 lost years of income, and add in the total sum you think you'll spend on your degree. Then take your expected income as an OD (I wouldn't go any higher than 80K, because that's really going to be about the ceiling by the time you get out, probably lower for new grads) and subtract your student loan obligations. I can almost guarantee you that your "adjusted" OD income will not be much higher than your current one.
You can say that "Money doesn't matter, it's all about what I'm doing," but that's really where you get caught. You see, the new ODs of the future, most of them anyway, will be doing exactly what you're doing now - refracting. The numbers just don't allow for anything else.
Nonsense Jason! He will be refracting AND handing out dry eye samples. See there is variety.
But I won't give him grief. He's familiar enough with the field, I suppose. But I can say that I've never meet an optician or tech that didn't think, "oh man, if I was just the doctor, I could clean up and make a mint". They see all the money patients are paying and think every bit of it, except the piddly among paid to them, goes into the docs pocket. In reality, a very small % does.
The grass certainly isn't always greener. And if an OD degree was $20,000 I'd say absolutely-- it beats being a tech. At $200,000 ($300,000+ with interest), I just can't recommend it with a straight face. Maybe he has a way to keep the tuition down.
But I won't give him grief. He's familiar enough with the field, I suppose. But I can say that I've never meet an optician or tech that didn't think, "oh man, if I was just the doctor, I could clean up and make a mint". They see all the money patients are paying and think every bit of it, except the piddly among paid to them, goes into the docs pocket. In reality, a very small % does.
The grass certainly isn't always greener. And if an OD degree was $20,000 I'd say absolutely-- it beats being a tech. At $200,000 ($300,000+ with interest), I just can't recommend it with a straight face. Maybe he has a way to keep the tuition down.
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Here's the thing with refraction.....
With a good autorefractor on most people, it should take about 30-45 seconds to refract one eye well for distance.
With a good autorefractor on most people, it should take about 45-60 seconds to refract one eye REALLY well for distance.
I think where most people run into trouble, whether they be techs, opticians or optometrists is that extra 15 seconds.
With a good autorefractor on most people, it should take about 30-45 seconds to refract one eye well for distance.
With a good autorefractor on most people, it should take about 45-60 seconds to refract one eye REALLY well for distance.
I think where most people run into trouble, whether they be techs, opticians or optometrists is that extra 15 seconds.
the real question is "should a refraction be allowed as a stand alone test?". And if so why limit it to opticians? Its not like they can run an autorefractor better then anyone else. There are self refracting kiosks available that anyone can operate so why bother with an optician? Just let the kid down the street do it for you, because its not like you need any "training" for that.
I don't think stand alone refraction should be allowed at all. One only has to look at glaucoma (which is fairly common) and has no symptoms in early, moderate and even some advanced stages, to see the folly of "stand alone refraction".
I don't think stand alone refraction should be allowed at all. One only has to look at glaucoma (which is fairly common) and has no symptoms in early, moderate and even some advanced stages, to see the folly of "stand alone refraction".
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I don't think any OD or student would attempt to mount an argument that the public would be better served by having stand-alone refractions, but what about personal freedom? I posed a question before, that I think is pretty analogous. If we don't require a foot exam from a podiatrist to be measured for shoes, why do we require a full eye exam for glasses? Could it possibly be for the benefit of the ODs/MDs more than the patients? Is the reason we require an exam for glasses really a public health concern? I don't think so. We can't use public health as the reason, since a decent portion of the population wears no correction at all. Are they to be ignored? If public safety were the justification, then we should see the government forcing us to see a primary care physician or NP for a routine physical once every year or two, to pick up systemic conditions like diabetes or hypertension. The public health justification doesn't cut it.
If you remove the children from the equation, and say that everyone under 18 needs an exam to get a prescription, what right do we have to force an adult into an eye exam, that he or she may or may not want, just to create work for ourselves under the guise of public health? I'm aware that the net effect of doing so is positive, but personally, I think if someone is stupid enough to want to get glasses without an eye exam, he should be allowed to do it, from a legal standpoint.
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What right then do have to force any adult to get a prescription for any medication?
I agree with that, but as our country is heading towards becoming more and more socialist, what right does any person have to decide anything for themselves? We aren't allowed to think for ourselves or practice accountability. We must do what "they" say is best for us...for our own good...
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We actually don't require prescriptions for most of the medications that people buy; they're available over the counter. We are allowed to by decongestants, sleep aids, cold remedies, topical steroids, NSAIDS, and many others....all without an Rx. So, as far as topical and systemic meds are concerned, we are allowed to buy our routine medications without a prescription, but when it comes to more significant problems, we need to see a doctor, NP, or PA. Why is that not the case with refractive error? We require an Rx for even the 19 year-old kid with now health issues, a current physical, and a -1.00 DS manifest refraction.
Medicine doesn't say, "Well, we can't allow you to buy Tylenol or Aspirin at Walmart because there's a possibility that you might have diabetes or cancer." That's what we're doing. We're saying "You need to get a full eye exam because you might have glaucoma or diabetes, and we have to be able to see it."
It makes no sense from an objective standpoint, even if it would be bad for public health to change the rule. That's all I'm saying.
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The reason we allow those OTC medications has more to do with the relative undersupply of MDs than the requirement of spectacle Rxs has to do with the relative oversupply of ODs.
You can't have every person needing some tylenol to get them through a day or two of fever or a person needing some minor allergy relief clogging up the doctors office. It's more of a public health problem that other more sick people will get delayed treatment than it is that the person with the minor allergy will overdose themselves.
I think the case with OTC medications too is that they are for temporary relief of problems whereas refractive error in most cases is something that needs to be corrected on an ongoing basis.
some conflicting comments in your post
first you want more personal freedom for the public to allow themself to go blind and then you say how stupid that is. So is it a good idea or is it not a good idea?
second you say it isn't about public health but then you want "remove children from the equation". Why is that?, oh right...public health
. And seriously what about grandma or your other family members? Get a grip man.I understand you are a disenfranchised OD, but I'm amazed you dont see the OBVIOUS benefit to physical exam beyond refraction. Speaks volumes as to why you have an increasingly low opinion of optometry/ophthalmology.
I think in cases like this the public just doesnt have enough understanding to make a sound decision. As learned professionals we of course know better. As such ODs have an ethical responsibility to perform proper evaluation, and dont really have any other choice. As you said yourself "its stupid" to do otherwise, and has nothing to do with any economic incentive. Regarding that it seems rather predatory to have people line up for refractions at the mall kiosk, pumping out glasses as fast as the "optician" can push them. Now that's economic incentive.........
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some conflicting comments in your post
first you want more personal freedom for the public to allow themself to go blind and then you say how stupid that is. So is it a good idea or is it not a good idea?
second you say it isn't about public health but then you want "remove children from the equation". Why is that?, oh right...public health
I understand you are a disenfranchised OD, but I'm amazed you dont see the OBVIOUS benefit to physical exam beyond refraction. Speaks volumes as to why you have an increasingly low opinion of optometry/ophthalmology.
I think in cases like this the public just doesnt have enough understanding to make a sound decision. As learned professionals we of course know better. As such ODs have an ethical responsibility to perform proper evaluation, and dont really have any other choice. As you said yourself "its stupid" to do otherwise, and has nothing to do with any economic incentive. Regarding that it seems rather predatory to have people line up for refractions at the mall kiosk, pumping out glasses as fast as the "optician" can push them. Now that's economic incentive.........
You need to read my post before responding. I stated, several times, that there is an obvious, inarguable benefit to mandatory spectacle Rx's so I'm not sure where you got the idea that I was saying otherwise. Judicious, specific use of the quote feature is always helpful to avoid confusion on this site. Please don't skim my posts, get all excited, and start typing. Below is the very first statement from the post you are referring to.
Jason K said:
As far as the children exclusion, I mentioned that because every student would be on here in 5 seconds, screaming about the 4 year-old anisometropic hyperope or strab. I also mentioned it because there are states that require a mandatory eye exam before starting school.....for public health reasons. And thirdly, I mentioned it because it makes sense. If an adult wants to disregard his or her health, that's fine in my book, whether it's my grandmother or my 300 lb neighbor, but kids are a different story. We live in a free society, which comes with risks and benefits. So, perhaps that clarifies some confusion.
By your line of thought, the US government should require an annual physical for every American over 50, but we don't do that, do we? We should require prostate exams for all adult men over 50, but we don't do that either. By your line of thinking, physicians "know better," so we should just require every citizen to have a physical with the thumb plug, right? What's the difference? Why don't we do that? I'm sure the MDs would love it.
Just because something has a societal benefit, doesn't make it right.
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No part of me feels that the mandate is due to an oversupply of ODs. I agree that the MD undersupply contributes to the prevalence of OTC meds, but the point is, if public health were such an issue, we'd require it, undersupply or not. If you could drop dead from a slightly excessive dose of Tylenol, we'd see it regulated. Likewise, if we had a very high risk factor for normal, young, healthy patients getting glasses from an optician or auto-refraction, then we'd be justified in the requirement. But the fact is, there is no such risk factor. The risk is extremely low, but it's there, just like it is for getting OTC meds without a phyiscal exam. Why do we allow one, and not the other? I believe that prevailing societal forces would allow for glasses to be purchased without a doctor's Rx, but it's our profession(s) that have stepped in to require it. It benefits us, and it benefits the patient overall, but that doesn't mean it makes sense from a legal standpoint.
If you say so but it still sounds conflicted. Also for every analogy in medicine you give that doesnt exist to impinge on this "personal freedom", I'm sure there are 10x as many analogies that do exist that impinge on "personal freedom". Just the way it is. As well, with medicine I think "popular culture" knows that skipping out on physicals with their MD is taking some risk, whereas "popular culture" sees little or no risk in not getting their eyes checked. The public just doesnt realize that serious eye disease is often absent significant symptoms. That being true (and it is) the so called "refraction" is basically the ONLY opportunity to catch something that can prevent serious problems. If you want to call it a "nanny state" go ahead, but I'd rather we collectively spend a few bucks on the front end preventing serious burden which as you should be well aware, can and does translate to spending many, many dollars on the back end, when that pt ends up disabled and basically a ward of the state. Can't drive, cant work, cant see shiit.
It's called prevention, and its relatively cheap and easy to deliver.
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If you think that a significant quantity of the normal, healthy, adult US population will end up as wards of the state because they got a pair of glasses without an Rx, I think you might be overestimating our impact. If that were the case, we'd see refractive error as a protective trait among adults, since they should have an increased capture rate for pathology at eye exams. No such protective trend has ever been found. There are plenty of adults who wear no correction, never get eye exams, and they're not wards of the state. If they develop a problem, it will eventually get picked up, albeit much later in the process.
My only point with all of this is to illustrate the fact that we, as eye care professionals, have pushed for Rx mandates, not the public, and not the government. We did it. If you think that was not largely self-serving in its true core origin, I think you're missing something.
No matter. Now that Comrade Obama is back in office, an eye exam paid for by the gov't (from money that 50% of the population believes Obama picks from a money tree on the White House lawn) will likely be mandatory for every person as will a physical and every thing else......until you get to the expensive stuff.
I expect a limit on personal income, a limit on the size of car you can drive and a limit on how big your house can be.
I expect a limit on personal income, a limit on the size of car you can drive and a limit on how big your house can be.
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I'd just like to say that in the vast majority of the world, getting new glasses is a matter of going to the optical store and having the store owner perform the refraction on you using autorefractor then a quick trial lens frame double-check. You get glasses updated because you don't see well in the way you would go get your hair cut because your hair's too long. There's no expectation or belief by the consumer that the store owner knows anything "medical" about the eyes. That's how it is, don't blame the messenger.
If someone in these places has an "eye problem", they check themselves into the ophthalmologists, who by and large run primary-care practices. They get called back by these places every 1-2 years for an eye "wellness" check.
If someone in these places has an "eye problem", they check themselves into the ophthalmologists, who by and large run primary-care practices. They get called back by these places every 1-2 years for an eye "wellness" check.
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I would like PBEA to clarify his position....
He is advocating against stand alone refraction because there are many asymptomatic eye diseases that can be sight threatening and to do stand alone refraction is a public health problem yet on this and other forums he also advocates for dilated exams only every 5 years on patients absent risk factors and also defers refraction on patients who have good vision.
That to me seems just as conflicted.
What eye diseases is he on a crusade against? Dry eye syndrome? Blepharitis? (???)
He is advocating against stand alone refraction because there are many asymptomatic eye diseases that can be sight threatening and to do stand alone refraction is a public health problem yet on this and other forums he also advocates for dilated exams only every 5 years on patients absent risk factors and also defers refraction on patients who have good vision.
That to me seems just as conflicted.
What eye diseases is he on a crusade against? Dry eye syndrome? Blepharitis? (???)
I think you are to narrowly focused on "refraction" as the point. Another way of saying "stand alone refraction" is saying "dont check for anything else". So my beef isn't necessarily with others performing a "refraction" but instead that they arent checking for anything else, and thats the problem. As for "many other diseases" I never said that. IMHO all I have to do is look at glaucoma and see a really obvious and pretty common example.
Now I know this may be difficult for you to comprehend, as in CT there is perhaps no such thing as asymptomatic glaucoma, diabetic retinopathy, occult cnvm, retinal holes/tears, tumour, etc but outside of the land of milk and honey those things actually do occur (gasp!) and they do cause problems. Perhaps its all that high socioeconomic status stuff that has sheltered you from such things. Clearly from your past comments you have seen less then 5 cases of such things over the last 13 years so OBVIOUSLY you are sheltered (a statement which I find unbelievable btw). Whereas I probably have at least that many in the last year, and I know my office is not as busy as yours soooo..........Just 2 days ago some guy comes in thinking something is wrong with his lid, but sees fine and has "no problem with his eyes", which of course turns into 50% RD superior hanging just above the macula. Think he should go get his refraction done? what on earth would be the point of that?
Surely you are baiting me.
Now I know this may be difficult for you to comprehend, as in CT there is perhaps no such thing as asymptomatic glaucoma, diabetic retinopathy, occult cnvm, retinal holes/tears, tumour, etc but outside of the land of milk and honey those things actually do occur (gasp!) and they do cause problems. Perhaps its all that high socioeconomic status stuff that has sheltered you from such things
. Clearly from your past comments you have seen less then 5 cases of such things over the last 13 years so OBVIOUSLY you are sheltered (a statement which I find unbelievable btw). Whereas I probably have at least that many in the last year, and I know my office is not as busy as yours soooo..........Just 2 days ago some guy comes in thinking something is wrong with his lid, but sees fine and has "no problem with his eyes", which of course turns into 50% RD superior hanging just above the macula. Think he should go get his refraction done? what on earth would be the point of that?Surely you are baiting me.
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I think you are to narrowly focused on "refraction" as the point. Another way of saying "stand alone refraction" is saying "dont check for anything else". So my beef isn't necessarily with others performing a "refraction" but instead that they arent checking for anything else, and thats the problem. As for "many other diseases" I never said that. IMHO all I have to do is look at glaucoma and see a really obvious and pretty common example.
Now I know this may be difficult for you to comprehend, as in CT there is perhaps no such thing as asymptomatic glaucoma, diabetic retinopathy, occult cnvm, retinal holes/tears, tumour, etc but outside of the land of milk and honey those things actually do occur (gasp!) and they do cause problems. Perhaps its all that high socioeconomic status stuff that has sheltered you from such things
Surely you are baiting me.
What I have said is that in 13 years of practice, I can count on one hand the number of patients that I have dilated on a routine basis who were ABSENT RISK FACTORS OR SYMPTOMS who had actionable retinal pathology.
I'm not talking about the 1/2 disk diameter choroidal nevus or the one pinpoint drusen way out by the vortex vein.
You claim all these cases of asymptomatic occult CNV, retinal holes etc. etc. but you advocate against stand alone refraction but for dilation every 5 years on many patients.
If you're dilating asymptomatic patients every 5 years, where are you finding all these retinal holes and occult CNVs and diabetic retinopathy cases?
if when you practiced as an OD, did you offer to perform stand alone refraction? why or why not?
Great! but how does that translate to "stand alone refraction"? Example pt presents c/o blurred vision and goes to get a stand alone refraction. One eye refracts at half a diopter difference from their old glasses and suddenly the pt "sees better" and is happy. All done?
Or do you think that only the people "ABSENT RISK FACTORS OR SYMPTOMS who had actionable retinal pathology" will be the ones going to get stand alone refractions. Seriously?
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On the one hand you are advocating against stand alone refractions due to serious potential ocular health problems.
On the other hand, you advocate for very sporadic dilations in many cases which seems to go against the apparent concern of serious potential ocular health concerns.
That seems somewhat incongruous. How do you decide who you are going to dilate and who you are not?
In the case of the patient presenting with blurry vision and they are found to have a half diopter difference from current glasses and are happy, how do you know that they don't have occult CNV or peripheral detachments if you're not dilating?
Are you saying you dilate every patient with a complaint of blurred vision?
O cmon already, you've read how I make that determination several times already. Healthy, young, established pts (whom I have dilated previously), no new symptoms, no relevant history, no past pertinent physical finding, etc, etc. That ends up being a relative minority of cases but they do occur often enough. That as opposed to the stand alone refractionist which never dilates any pts....ever.
diabetic pt? nope
glaucoma pt? nope
hypertensive pt? nope
taking plaquenil? nope
unexplained vision loss? nope
pappilledema? nope
c/o headache? nope
blurred vision? nope
got a tumour? nope
any pt? nope
in your typical obtuse fashion you appear to want to equate my not dilating established healthy normals (whom I have dilated previously) with the stand alone refractor never dilating anyone, regardless of presentation. Sorry to dissappoint, but its not even close. I dilate (or perform other diagnostic testing) pts all day long, and I do it when I feel it is indicated, which in my office is the overwhelming majority of the time.
Give it a rest KE, I'm sure one day your dream of training refractionists and making a bundle bringing refractions to all those underserved people will be realized. In the meantime you should recognize that the ONLY reason to perform such is...to....make...money...by taking advantage of the publics total lack of understanding.
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Nowhere in this or in any other thread in history have I ever advocated for stand alone refractions.
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No, I didn't, because I don't agree with it. Just because I don't agree with something, doesn't mean I should be able to impose my beliefs on others, even if it's for their own good. I don't believe aborting a 10 week old fetus is ok, but I don't think it should be illegal. I don't think stand alone refraction is the right thing to do for me, but that doesn't mean that everyone else has to follow my rules, just because it's what I prefer to do myself.
lmao! please re-read your post again
you don't think you should be able to impose your beliefs on people yet........wait for it..........wait for it...........your belief is that offering stand alone refractions is wrong and you require your pts to undergo full ophthalmic exam in order to obtain a refraction.
Hello kettle my name is pot.
(snicker)
its ok Jason, i get your point, case closed.
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lmao! please re-read your post again
you don't think you should be able to impose your beliefs on people yet........wait for it..........wait for it...........your belief is that offering stand alone refractions is wrong and you require your pts to undergo full ophthalmic exam in order to obtain a refraction.
Hello kettle my name is pot.
(snicker)
its ok Jason, i get your point, case closed.
You missed a major point that undermines your entire argument. My decision to require an exam is rooted in two things:
1) My employer requires it
2) It affects me in terms of risk protection
I am not forcing anyone to get an exam or refraction. There are 40,000 other ODs in this country (and climbing), and any patient has a choice to see someone else.
Forcing someone to do something is saying "You must do this and you have no other choice." I'm not saying that, I'm saying "Here's how I do it. If you don't like it, you can see someone else." There's a BIG difference there, and that's what you missed.
wait, there's risk? I thought you said there was no risk in providing stand alone refraction?
why is it "risky" to provide stand alone refraction?
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I never once claimed there was no risk or no potential harm in doing a stand-alone refraction. Please show me where I said that.
Because I can be sued if something is missed. Again, I'm not arguing that patients are better off without an exam. I'm saying that if someone wants glasses, and that's all they want, they should be able to get it, just like they can get a pair of shoes without a podiatrist's exam. With current law, dispensing an Rx without an exam would put me at risk. I think that point is obvious.
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Jason, you provide proper examination because you know better. By default the public is subject to your ethical responsibility to them. So either we pony up a little money in the name of prevention (I think its a bargain relatively speaking) or we pony up alot of money (and regret) in the name of treatment after the damage is done. Pretty easy decision imo.
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Again, the decision is easy...for me. That doesn't mean that every person in the country should be forced to do things according to how I think it should be done. Part of having freedom is the ability to do harm to yourself, if you so choose. Our government could enact restrictions that would keep us all safer, but that doesn't make it right. I wear my seatbelt, but I personally don't think it should be illegal to not wear one, and yet some states have that on the books.
It's our legal system that's inconsitent, not me.
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If the law allowed for stand alone refraction testing, would you offer it?
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No. Like I said, I don't agree with that mode of practice, but that doesn't mean I think people should have to be forced into doing what I think is right for them. People should have the freedom to be irresponsible if they choose.
If someone wants to buy glasses and they don't want to pay for an eye exam, they should have the freedom to do that. If the Rx/exam mandate were really rooted in public health concerns, then we'd see a requirement for reading glasses as well, but those are available at the local Walmart for $3.00. There are plenty of old gaffers who buy otc readers and never get their eyes examined by an OD or ophthalmologist. Smart? No, but that's their choice.
If you start taking people's freedoms away, even small ones, they start to add up.
OTC reading glasses have been hotly contested and still are to some degree, so yes OTC readers is kind of synonymous with stand alone refraction and they are obviously both public health issues. Even you seem to concede this point by saying that stand alone refraction is "irresponsible", "stupid", and "risky" so much so that you have refused to provide such service yourself....3 times in 3 posts!. So while I understand that you want to defend the public from losing their rights from the mighty optometrists
, you will have to do me a favor and stop saying its not a public health concern, because that is exactly what it is and is ENTIRELY about that.
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OTC reading glasses have been hotly contested and still are to some degree, so yes OTC readers is kind of synonymous with stand alone refraction and they are obviously both public health issues. Even you seem to concede this point by saying that stand alone refraction is "irresponsible", "stupid", and "risky" so much so that you have refused to provide such service yourself....3 times in 3 posts!. So while I understand that you want to defend the public from losing their rights from the mighty optometrists
You can keep trying to put words in my mouth, but it's not working. I never once said this was not a public health issue. What I said was, the law is not rooted in the public health issue; it's rooted in ODs and ophthalmologists wanting revenue. The public health issue is there, but it's not the driving force. My OTC example proves that.
