# Optical Forums > Canadian Discussion Forum >  Has sight testing been harmful to optometrists in BC?

## optio

Hi folks

I believe back in May 2010, BC permitted sight testing by opticians.  Was this change in any way a game changer for ODs?  What is the work/job scenario for optometrists in the province these days?  Is there less work now available for ODs compared to before the new law was implemented?  Or are ODs basically "equally" busy now, as before the rule change?  Would an OD moving to BC from another province find it difficult to find adequate work?  

Thanks in advance.

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## Chris Ryser

Kirsten North, president of the Canadian Association of Optometrists, says that automated sight tests aren’t comprehensive. “The main issue we have is that asymptomatic eye disease will go unchecked,” she says.

For some eye diseases, such as glaucoma, early detection is the only way to prevent permanent damage. Symptoms occur late and lost vision cannot be recovered.Sight tests are also unable to detect problems such as retinal tears, corneal scars and eye tumours.

Automated Sight tests, alone, aren’t an adequate basis on which to generate prescriptions, says North. Factors other than refraction, such as age and health status, must be considered. “Even something as simple as how tall someone is can affect a prescription,” she says.


see all of it:
*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882486*

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## wmcdonald

Of course there are factors related to health, but much of that is scare tactics, Chris, and not really what the OP was asking. Has it affected ODs in BC? I have not seen any indication it has but would be interested to hear from those affected on both sides of the issue.

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## Chris Ryser

> *Has it affected ODs in BC? I have not seen any indication it has but would be interested to hear from those affected on both sides of the issue.*



It for sure is affecting ODs as well as opticians because the sale of glasses is totally deregulated and opticians can test vision.

*PROVINCE/TERRITORY,     GLASSES,     CONTACT LENSES,        British Columbia.*
 A patient may obtain an eye glass prescription from an optometrist, physician or ophthalmologist. A patient may also obtain specifications for eye glasses from a sight testing optician. Both the optical prescription and sight test results must include a measurement of the interpupillary distance. 

The patient can either use the eye glass prescription or the sight test specifications to purchase eyeglasses anywhere that eyeglasses are available. Dispensing is deregulated in British Columbia.


A patient must have an optical prescription or specifications from a sight test to initiate a CL fitting. A patient must have an initial CL fitting done by an optometrist, physician, ophthalmologist or optician.

Initial CLs may only be dispensed by the above regulated professionals. Replacement CLs can be dispensed indefinitely by anyone including internet CL sites.


source:
https://opto.ca/sites/default/files/..._version_2.pdf

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## wmcdonald

Thanks, Chris. I knew of those details, but I wonder if it has hurt the bottom line if the ODs. Are they seeing less patients? I have not been able to find detailed evidence of that anywhere in the literature. Are Opticians seeing an increase? Has there been an increase of significant ocular events due to this change. And I don't mean individual instances of something that should have been caught but was not.........that has always happened. I mean significant evidence of issues. Based upon the typical scare tactics, one would think half of BC was probably blind by now. 

As always, I appreciate your insights.

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## optio

> It for sure is affecting ODs as well as opticians because the sale of glasses is totally deregulated and opticians can test vision.


I walked into a Vancouver Lenscrafters recently in a busy Cadillac Fairview mall and asked for the price of an eye exam. $125.  I walked by 3 times on different days and not once did I see a single patient waiting in the waiting area.  I don't think this qualifies as even an anecdote, much less data though.

Internet dispensing is everywhere, not just in BC.  But BC regulations are almost devised to encourage people to buy online, so you'd imagine online dispensing would affect brick/mortar stores there "at least as much or even more" than in other provinces.  So I wonder how brick/mortar opticals have been affected.  I was last in BC about 14 years ago, and I recall seeing more optical stores in malls then, compared to now.  I recall seeing the stores of a lot more optical chains that I had never encountered in Ontario, that I didn't really notice this visit.  At the time, seeing Pearle and Iris was new to me as they hadn't entered the Ontario market yet.  And there was at least another "smaller" chain or two that I recall too, that I didn't notice this visit.  But my survey isn't scientific of course.

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## optical maven

the BC health minister was a principle in clearly.com before Lux bought them.  Talk about a conflict of interest.

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## idispense

Dig deeper, to see the bigger picture, not just the provincial picture. Look at all the stakeholders, as well as all the shareholders.

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## rbaker

I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?

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## Chris Ryser

> *I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?*




Sight testing is a new definition on the new optical world market, and part of the revolution just about making its official start in 2 month by the Essilor/Luxottica merger. 

The USA is more than halfway deregulated and in Canada, BC and Quebec are done and they are working to do the same in Ontario.

see the latest trend:
https://health.economictimes.indiati...erjee/58744572

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## optio

> I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?


This is actually a good question.  I imagine it is legally defined in the jurisdictions where it exists (i.e. BC).  I'm assuming the BC optician governing body has outlined what constitutes a sight test.  What I don't believe it is, is simply the results of an autorefraction used as the basis for an eyeglass prescription.  Although speaking to pro-refracting opticians in the past (these folks took the optician refracting course offered in Barrie back in the day, like in 2005), my understanding is that that an auto-refraction --> eyeglass prescription was all they wanted from their lobbying efforts.

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## Chris Ryser

> *This is actually a good question.  I imagine it is legally defined in the jurisdictions where it exists (i.e. BC).  I'm assuming the BC optician governing body has outlined what constitutes a sight test.  What I don't believe it is, is simply the results of an autorefraction used as the basis for an eyeglass prescription. 
> *



The BC opticians website at http://www.opticians.bc.ca does not exist and is automatically diverted to the Canadian  Dispensing Opticians Association.

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## rbaker

In lieu of a formal definition I guess that I will just have to file "sight test" under "monkey business," "shenanigans" or "hankie-pankie" until something better comes along.

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## Chris Ryser

> *In lieu of a formal definition I guess that I will just have to file "sight test" under "monkey business," "shenanigans" or "hankie-pankie" until something better comes along.
> *



Welcome to the new age of deregulated optical retail operations in North America, South America, Europe, The Far East and Africa.

Unless you make a living from direct service to the customer, which is a highly needed commercial activity, retail sales prices will be more and more influenced by online sales.




> *
> Walmarts (WMT, -0.22%) massive e-commerce investments are starting to pay off.
> 
> The discount chain reported on Thursday that U.S. online sales rose a staggering 63%in the first fiscal quarter of the year, following last years overhaul of its online marketplace and a series of acquisitions of e-commerce companies since then, most notably its $3 billion purchase of Jet.com.
> *
> http://fortune.com/2017/05/18/walmart-online


*Welcome to Anno Domini 2018, and its coming surprises*

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## tmorse

> Thanks, Chris. I knew of those details, but I wonder if it has hurt the bottom line if the ODs. Are they seeing less patients? I have not been able to find detailed evidence of that anywhere in the literature. Are Opticians seeing an increase? Has there been an increase of significant ocular events due to this change. And I don't mean individual instances of something that should have been caught but was not.........that has always happened. I mean significant evidence of issues. Based upon the typical scare tactics, one would think half of BC was probably blind by now. 
> As always, I appreciate your insights.


Ontario opticianry programs were teaching 'sight-testing' since 2005, until stopped by the Ontario government in 2009. BC was following Alberta's lead, and both produced tens of thousands of successful sight-testings until BC formally deregulated Dispensing in 2010, and permitted formally trained Opticians to sight-test. Optometrists were permitted to dispense certain TPA and BC Opticians were permitted to sight-test under certain conditions. Both were considered expansions of each professions' scope of practice. In BC, the fitting of Contact Lenses remains a regulated act, but not the sale of CL lenses.
Optometrists are still found in abundant numbers in BC and Alberta, over ten years after sight-testing by Opticians was first introduced. So I too would like to hear some views from some BC Optometrists.

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## optical maven

Also thanks to the fact that the BC health minister had a financial interest in Clearlycontacts (now Clearly) at the time.

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## tmorse

> Also thanks to the fact that the BC health minister had a financial interest in Clearlycontacts (now Clearly) at the time.


Would you kindly provide what facts you rely upon for this financial interest allegation?

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## optio

The way I heard the conflict of interest allegation (back in 2004, regarding their eventual right to refract) was that the BC Health Minister's sister was an optician.

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## optio

I took this photo at the Richmond Centre (6551 No 3 Rd, Richmond, BC V6Y 2B6) in BC.  It's a high end mall with the Cadillac Fairview chain.
https://www.cfshops.com/richmond-centre.html 

They had an LC with a side-by-side optometry office, an Iris (though I can't say I identified the location of the OD office when I walked by it), and an Eyestar Optical (they have a locations in the Scarborough Town Centre and (IIRC) Square One as well, and probably others).  I didn't notice any other "opticals or optometrists" in the mall, though there may have been.  I took an image of a sign in front of Eyestar.  As you can see by the image, they offered "Sight Testing".

One observation:  In the sign, they use an image of someone being examined using a slit-lamp, which implies an ocular health check rather than a refraction.  A more appropriate image would be of someone being examined using a phoroptor.  I would normally be suspicious that the choice of the slit-lamp image was deliberately intentional, but I think they use the same image in the Scar TC location advertising eye exams, so it's probably more of a chain-store-same-sign-is-used than an attempt to mislead customers (patients) into thinking the sight test they are getting is an eye exam, but nonetheless, it deserves scrutiny.

One personal query: Iris and LC use optometrists.  This store uses sight testers. I wonder if that is a "choice" by the store to use ST as opposed to offering optometrist examinations? I'm curious if some opticals prefer the use of ST over ODs because they think an ST will make them more competitive than an OD would (e.g. perhaps they don't charge for the ST).  Or do such opticals use STs because they don't have easy/reliable access to an OD?

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## mike.elmes

> I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?


 Sight testing is an evaluation of refractive error of the eye. It is accomplished as a refraction done with an autorefractor, autophoropter, and lensometer. It is done by a trained technician, using  computer aided software. The final results (subjective) are compared to the clients existing glasses prescription.
The whole procedure uses Snellen charts to determined visual acuity. The final results are sent via fax to an eye doctor for final approval by an ophthalmologist. This system works nearly flawlessly. I have used mine for almost 10 years. Redo rate is maybe 1%. It is explained to the potential client as being a non medical exam. No determination of eye health. The client must sign a waiver stating that the procedure is strictly used to determine a prescription for eyeglasses or contact lenses.

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## Lab Insight

> Sight testing is an evaluation of refractive error of the eye. It is accomplished as a refraction done with an autorefractor, autophoropter, and lensometer. It is done by a trained technician, using  computer aided software. The final results (subjective) are compared to the clients existing glasses prescription.
> The whole procedure uses Snellen charts to determined visual acuity. The final results are sent via fax to an eye doctor for final approval by an ophthalmologist. This system works nearly flawlessly. I have used mine for almost 10 years. Redo rate is maybe 1%. It is explained to the potential client as being a non medical exam. No determination of eye health. The client must sign a waiver stating that the procedure is strictly used to determine a prescription for eyeglasses or contact lenses.


Well said. It's a beautiful accurate system.  And having an optician do the entire process is why it is 1% error vs. 10% coming from the OD offices.

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## Chris Ryser

> *Well said. It's a beautiful accurate system.  And having an optician do the entire process is why it is 1% error vs. 10% coming from the OD offices.
> *




........................just like to add one more thing on the subject.


This system is and has been used all over the world, just about forever, and is nothing new, and has worked fine just about forever.

The North American Continent is lagging behind the world in this field.

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## Lab Insight

> ........................just like to add one more thing on the subject.
> 
> 
> This system is and has been used all over the world, just about forever, and is nothing new, and has worked fine just about forever.
> 
> The North American Continent is lagging behind the world in this field.


Correct, and the lag is caused by the same group of innovators that are currently trying to take on the largest lens manufacturer in the world.  :Eek: 

The legislation and policies need to change to better serve the public.

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## optio

> Sight testing is an evaluation of refractive error of the eye. It is accomplished as a refraction done with an autorefractor, autophoropter, and lensometer.


I understand that this is how "you" have sight tested these last 10 years, but is this how "sight testing" is defined in BC?  What is permitted in BC as sight test?  Or does it require all the apparatus you describe?  Or can it simply be an optican who uses a mechanical phoroptor (or even just an autorefractor?) to refract?


Edit: I ask these questions because my understanding of the intent of sight testing has always been to simply "eliminate" the optometrist from the sale of a pair of glasses.  It wasn't intended to replace the him/her.

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## drk

The question isn't how it affects ODs in Canada, but the public health.

Statistics take a while to compile, but there will be an increase in prevalence of eye disease, guaranteed.

What's more immediate is the decrease in visual efficiency, which is more than guaranteed to happen.

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## drk

> Sight testing is an evaluation of refractive error of the eye.


  AKA "optometry".  




> It is accomplished as a refraction done with an autorefractor, autophoropter, and lensometer.


  In other words, you take the old glasses (probably determined by an OD), get a variably-accurate autorefractor reading, and you're done.




> It is done by a trained technician, using  computer aided software.


 "Computer-aided software"?  Is there another kind of software?  "Technician", huh?  Who trained the "technician"? Seriously.  Who?  




> The final results (subjective) are compared to the clients existing glasses prescription.


  Which tells you exactly....nothing.  What's the point?  Can you explain that to me?  




> The whole procedure uses Snellen charts to determined visual acuity.


  Ooooh.  _Snellen charts._ 




> The final results are sent via fax to an eye doctor for final approval by an ophthalmologist.


  Because ophthalmologists can turn crap into gold?  So he can look at a lensometer print out, entering acuities, an autorefractor print out, and new acuities?  Wow.  Amazing powers of vision care!  Some sleaze bag ophthalmologist is always available, it seems, to prostitute his license and his professional ethics.  Maybe it was "Larry Nassar, M.D.?"  What a farce.




> This system works nearly flawlessly. I have used mine for almost 10 years. Redo rate is maybe 1%.


  Bull-freaking-crap. 




> It is explained to the potential client as being a non medical exam. No determination of eye health. The client must sign a waiver stating that the procedure is strictly used to determine a prescription for eyeglasses or contact lenses.


"Non-medical exam".  That, sir, is a contradiction in terms.  

a. It certainly is NOT a medical exam.  It's not _any kind_ of an exam. It's a "non" exam.  Why bother calling it an exam? 

 When some auto mechanic hooks up a computer to your engine, is that a "non-medical exam", too?

b. The procedure is used to temporarily bridge the gap between glasses being Rx and non-Rx. 

c. I could author a Rx with my license with any information or no information, at all.  Garbage in, garbage out.  "Clients" are being ripped off by this.  You can get a new grad OD to really examine your eye for about $40.  Money well spent.

d. Just rid yourself of the pretense. This is a "fake exam".  Who are you trying to fool with all the lingo, and dog-and-pony shows?  Buy a freaking autorefractor and let everyone belly up to it, and make glasses off the print out.

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## optio

> Well said. It's a beautiful accurate system.  And having an optician do the entire process is why it is 1% error vs. 10% coming from the OD offices.


How do those with sight testing apparatus troubleshoot Rx failures?

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## optio

> The final results are sent via fax to an eye doctor for final approval by an ophthalmologist.


What is the role of the opthalmologist in the determination of the Rx? Is there any input by him or is he a rubber stamp? Could the MD role be performed by an OD, and if not why not? And if so, why is an MD involved and not an OD, or is the choice entirely a political decision?

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## tmorse

It is a personal sight-test, so try to get over the unfortunate use of the word exam.  

And nobody is being ripped off. When the BC government formally permitted licensed opticians to sight-test back in 2010, there were already tens of thousands of successful sight tests performed in BC and Alberta. And enough safeguards were put in place by government and the regulatory Colleges to adequately safeguard the public. Since 2010 there have been another tens of thousands of successful sight-tests. The public is very good at complaining when vision through their new eyeglasses, produced by a sight-test and performed by a specialty BC-licensed optician, is not effective.    

Personally, I like the Sight-Test model proposed by NY opticians many years ago when they lobbied government to permit sight-testing by NY opticians. They almost succeeded, but NY Optometry with better lawyers and deeper pockets prevailed.  
*Every sight-test by a NY licensed optician was to be followed 2-years later by a formal optometric eye examination.* 
Sure, there are medical issues that could arise in the interim, but that is what your family doctor is for.  

Still waiting for a BC Optometrist to chime in on the original issue raised.

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## optio

I'm pretty sure the sight test described by M Elmes in Alberta is different to the one in B.C.  Alberta apparently still requires a doctor to sign off on the prescription, whereas BC does not. (otherwise, why get an ophthalmologist involved, rubber stamp or not)

So a clarification of what a sight test actually is, in BC, would be informative as well.

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## tmorse

What would be informative is the subject matter of this thread: 

Has sight testing been harmful to optometrists in BC?

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## drk

> And enough safeguards were put in place by government and the regulatory Colleges to adequately safeguard the public.


Such as?

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## tmorse

> Such as?


Only permitted between ages of 19-65; no history of certain chronic diseases permitted; mandatory refer to OD/OMD if certain acuity not met. These are just some of the mandatory sight-testing protocols. And let's not forget a 20-years history of no medical or legal complications due to sight-testing process. Check with either BC or Alberta regulatory Colleges' website if you want further details.

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## drk

Age is verified, how?  (And of course we know no disease happens from 19-65?)

Chronic disease is verified, how?  Self-report?  That'll catch everything, right?  _"Sir, if you want to get glasses here today, please fill out this form carefully.  BTW, if you have any diseases, you're getting back into your Subaru."_

Referral is enforced, how? _ "Hey, you're 20/30 today.  You should see someone about that.  It's the law."

_But they're still getting those glasses, right?


In the better system, the doctor's butt is liable.   That works wonders.

Amazing how "third-world-style" Alberta, Canada decided to go with their health care.

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## optical maven

1) The customer walks into any store (online or BM)
2) The trained (highly)14 year old measures (computer assisted) PD and seg height
3) Results are faxed to ophthalmologist who confirms and glasses are sold.

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## tmorse

> In the better system, the doctor's butt is liable.   That works wonders.


I forget to mention... should any error or omission on the part of the sight-tester resulting in real loss, all specialty-licensed Optician are required by their regulatory Colleges to carry a minimum of $1,000,000.00 ($1M) Errors & Omissions liability insurance policy. In fact, every licensed Optician across Canada carries this same amount of E&O liability insurance.

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## wmcdonald

Yes, we will cause cancer by doing these kind of refractions, and Opticians are too stupid to be able to know when to refer based on established protocols, right? ODs have been accused of over-stepping for many years, and if one really understands the issue, the incidence of significant eye diseases is minimal in the ages described above. This is no more than a turf battle, and used properly these new refraction devices can be effective, and increase access. All these health concerns are nothing more than scare tactics. The MDs have no real issue here, and they are the folks ODs refer to when needed, so again, just turf. You can do a simple refraction on a cell phone today, and if patients are informed of the need for an eye health exam then they made a choice.

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## drk

> I forget to mention... should any error or omission on the part of the sight-tester resulting in real loss, all specialty-licensed Optician are required by their regulatory Colleges to carry a minimum of $1,000,000.00 ($1M) Errors & Omissions liability insurance policy. In fact, every licensed Optician across Canada carries this same amount of E&O liability insurance.


I find that amazing, if true.

You have an hourly employee professional-liability insured?  That's crazy.  

In other words, you are getting screwed.

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## drk

> Yes, we will cause cancer by doing these kind of refractions, and Opticians are too stupid to be able to know when to refer based on established protocols, right? ODs have been accused of over-stepping for many years, and if one really understands the issue, the incidence of significant eye diseases is minimal in the ages described above. This is no more than a turf battle, and used properly these new refraction devices can be effective, and increase access. All these health concerns are nothing more than scare tactics. The MDs have no real issue here, and they are the folks ODs refer to when needed, so again, just turf. You can do a simple refraction on a cell phone today, and if patients are informed of the need for an eye health exam then they made a choice.


There aren't any "established protocols" Professor McDonald.  And if they are, they're dog crap.  Trust me on that one, OK?  You're making yourself sound totally ignorant.  Your post is 100% incorrect.  100%. You don't even begin to know what you don't know.

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## tmorse

> I find that amazing, if true.


*I am shocked Sir, shocked I say, that you should doubt the veracity of my claim.
*
As you well know, Insurance companies use actuaries to determine level of risk and they have determined the possibility of real risk to the patient by Opticians fitting eyeglasses, contact lenses and performing sight-tests to be so low that the annual cost of E&O liability insurance for Opticians to be little more than insurance file-opening costs.
In Canada, part of registration process for licensure requires that every optician registrant must obtain $1,000,000.00 ($1M) Errors and Omissions liability insurance. Our National organization Opticians Association of Canada (OAC) offers this amount of E&O coverage as just one of the many  benefit that form part of annual OAC membership dues. An official certificate of $1M E&O coverage for the member is sent by OAC to each respective regulatory College in Canada. * And annual OAC membership is $125.00/yr (or about $100.00USD) + tax.
*
*Free Professional Errors & Omissions Liability Insurance*
Together with Western Financial Group, the OAC is proud to provide a FREE* $1,000,000.00 personal Professional Liability Insurance policy that protects its members from lawsuits for damages claimed by a third party, resulting from a professional error or omission or negligent act, committed during the course of their activities as an "Optician".
Many provincial regulatory colleges require that Opticians carry their own personal Professional Liability Insurance policy to obtain and maintain their license.
Opticians who wish to obtain more coverage can upgrade to a $3,000,000.00 or $5,000,000.00 PLI policy by contacting the OAC office at 1-800-847-3155 or email memberservices@opticians.ca

See www.opticians.ca and check under MEMBERSHIP (Benefits of membership)

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## drk

Well, that is very cheap.

Carry on, my wayward son.

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## tmorse

> Well, that is very cheap.
> 
> Carry on, my wayward son.


Thanks, Dads!

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## mike.elmes

Listen here, I am a licensed Refracting Optician. I am licensed for 35 years. I am in my own business for more than 20 years. You sir are an Optometrist from *another country*, if Ohio is where you do business. We do indeed have protocols that we adhere to for the best interest of the patient/client. We refer often. This is really a turf war issue. Optometrists and Opticians can be compared to dentists and denturists.... this gets old. Lets agree to disagree.

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## drk

Sure.  Whatever.  

This is an international forum.  I am the international OD of the webs.  Whatever.  I've been in the presence of Candian optometric smarties like Dumbledon and Jones.  They're awesome but they seem to put their lab coats on one leg at a time.

Unless you have different human beings with different physiology...

I am a refracting optometrist and therapeutic optometrist since 1989 (how long is that?), and a business owner, as if that affects the truth of what I'm saying, which it does not.

No protocols are sufficient.  They merely put lipstick on the pig that is sub-standard health care (by American standards, at least).  

I fear that our standards will slip as low as yours.  They probably will.

It's not a "turf war" and this is not 1975.  I don't need dentures yet, but you "old guys" seem to view the world through that prism.  It's about another subject altogether.

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## mike.elmes

As for the accuracy and subsequent acuity of my clients, I would say that in all cases where we do a refraction with the eyelogic system the client picks the RX we come up with and receives the subjective results they ask for.
I have seen so many doctors that wont give the patient what they say they see the best with. I'm just saying.

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## fjpod

So, after all these vision tests, you are handing to the patient a copy of their Rx so they can go shopping elsewhere, right?

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## Chris Ryser

> *The MDs have no real issue here, and they are the folks ODs refer to when needed, so again, just turf. You can do a simple refraction on a cell phone today, and if patients are informed of the need for an eye health exam then they made a choice.*



Reading this thread that now has exploded into the old argument as all others when the refraction becomes the heated argument, I would suggest that you read up on Warren McDonalds professional activities right here on the web.

See at:
http://www.methodist.edu/about-metho...arren-mcdonald

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## wmcdonald

> There aren't any "established protocols" Professor McDonald.  And if they are, they're dog crap.  Trust me on that one, OK?  You're making yourself sound totally ignorant.  Your post is 100% incorrect.  100%. You don't even begin to know what you don't know.


Ignorant? Hardly, and certainly not incorrect. I will not stoop to personal insults, and just agree to disagree. Have wonderful day.

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## optical maven

Didn't the BC government also deregulate the dispensing of glasses?  How has that affected opticians and optometrists?

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## wmcdonald

Not sure, but a good question!

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## drk

> So, after all these vision tests, you are handing to the patient a copy of their Rx so they can go shopping elsewhere, right?


Probably.  But they're releasing someone else's "Rx".

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## drk

What, Dr. Mac, is the "protocol" that would prevent glaucoma from being undetected?

I could go on.

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## Chris Ryser

> *Didn't the BC government also deregulate the dispensing of glasses?  How has that affected opticians and optometrists?
> *



very simple answer .........................................

...............opticians and optometrists have not sold the over 4 million pairs of Rx glasses that have been sold through their BC based online opticals so far.

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## drk

And, while that's probably at least partially true, I ask the idiot de-regulators from the Great White North:  when the field of professionals shrinks by 50% or more, are you going to be happy?

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## wmcdonald

Dr. K the average patient does not receive a complete exam every year, as suggested, only approximately every 2.3 years as you are aware. If they come in for sight testing, and at least have that done we can encourage them to have a complete exam and refer to a competent practitioner. A yearly exam is a good thing and I do not debate that but is someone breaks their glasses and needs a new pair, at least an updated Rx is not a bad thing either, and we can remind the of the importance of a full medical exam at the same time. We would not be seeing peds patients, teen nor old folks like me, where most of the significant eye disease exists. I can also tell you we are open to working with anyone to help us make it better, so rather than just shooting us down, tell us what we can do to improve.

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## wmcdonald

See Ted's post above again regarding more specific protocols.

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## drk

I'm here to tell it to you, straight.

1. There's no such thing as a "disease predicting protocol".  That's a fantasy or a lie.

2. Even so, it would be unenforceable. 

3. Emergency spectacle replacement is a canard.  The majority of this will be people diagnosing themselves as having refractive error change and self-directing their treatment (with the help of an optician).  Can I have you come into my office and see how many times the chief complaint is "blur" and the diagnosis is NOT refractive error?  To that end, it cracks me up (and makes me cry) when people come in--using some loser vision care plan--for "new glasses" (self diagnosis) when they have everything ELSE wrong with them.  It's the lot in life of an optometrist.  Ophthalmologists probably don't get that silliness.

4. ODs don't know ANYTHING and I mean ANYTHING (did I tell you...ANYTHING) about optics, anymore.  Nothing.  And they don't want to and they don't care to.  They wouldn't know an individualized PAL from a D-seg.  They wouldn't know 1.67 from crown glass.  It's PATHETIC.  This is where the need is.  This is where the opportunity lies.  Design the dang lenses.  

5. There's a GLUT of ODs and more to come.  You will never, ever, ever, never outcompete ODs for patient care.  They will always out-vision-care opticianry.  Forever.  Move on.  That ship never sailed.  It sunk.  

6. If I were a kick-butt optician, I'd form a nice optical and recruit an OD as an indy contractor and make hay.  Superb frame collection.  Top notch service.  Intensive optics knowledge.  Cool environment.  Maybe even skinny jeans.  Take control of the optical field.  No one knows it better than you guys, now.  Optometry has sailed for the island of "Club Med".  The door is open.

----------


## fjpod

Dr. K, calm down.  You're gonna have a stroke.  There are better ways to put it.

Let's not kid ourselves, technician/computer/optician refracting is not being moved forward for the benefit of the patient.  It is being done for the eyeglass sale.  When the independent opticians wanted it, we cited reasons why they couldn't do it.  Now the BIG BOYS, Ess, Lux, VSP, and the rest want the sale, and they will step over whatever dead bodys they have to to get it.  They will con the OMDs to sign the Rx's, and they will walk over the ODs and LDOs licenses regardless of state law.  Afterall..."it's on the internet".  That makes it valid and true and accurate.

There's almost no sense in complaining anymore.

Yes, optometry moved into ophthalmology's turf, medical treatment, decades ago... but, Optometry is an 8 or 9 year deal of Baccalaureate, Masters and/or Doctorate degrees.  Opticians, as of yet, do not have a standard two year program (yeah, I know wmMcdonald, it's Optometry's fault )... just like it's ophthalmology's fault that optometry is not doing surgery in every state by now.  (BTW, I am not necessarily an advocate of optometrists doing invasive surgery). 

So, cloak these eye tests any way you want...."computer assisted...optician supervised...invisible eye doctor approved"...  It is a reduction of care simply to get an eyeglass sale.

----------


## Chris Ryser

> *So, cloak these eye tests any way you want...."computer assisted...optician supervised...invisible eye doctor approved"... * *It is a reduction of care simply to get an eyeglass sale.*



Interesting ........................however nobody so far has mentioned the retail pricing of these eyeglass sales, and the difference between the one side or the other.

----------


## drk

> Dr. K, calm down.  You're gonna have a stroke.  There are better ways to put it.
> 
> Let's not kid ourselves, technician/computer/optician refracting is not being moved forward for the benefit of the patient.  It is being done for the eyeglass sale.  When the independent opticians wanted it, we cited reasons why they couldn't do it.  Now the BIG BOYS, Ess, Lux, VSP, and the rest want the sale, and they will step over whatever dead bodys they have to to get it.  They will con the OMDs to sign the Rx's, and they will walk over the ODs and LDOs licenses regardless of state law.  Afterall..."it's on the internet".  That makes it valid and true and accurate.
> 
> There's almost no sense in complaining anymore.
> 
> Yes, optometry moved into ophthalmology's turf, medical treatment, decades ago... but, Optometry is an 8 or 9 year deal of Baccalaureate, Masters and/or Doctorate degrees.  Opticians, as of yet, do not have a standard two year program (yeah, I know wmMcdonald, it's Optometry's fault )... just like it's ophthalmology's fault that optometry is not doing surgery in every state by now.  (BTW, I am not necessarily an advocate of optometrists doing invasive surgery). 
> 
> So, cloak these eye tests any way you want...."computer assisted...optician supervised...invisible eye doctor approved"...  It is a reduction of care simply to get an eyeglass sale.


Works for me.

----------


## fjpod

> Interesting ........................however nobody so far has mentioned the retail pricing of these eyeglass sales, and the difference between the one side or the other.


Of course, things on the internet are "cheaper".  If you buy an $89 pair of cheapie eyeglasses online and it doesn't work out, you say, "Oh well, I'm not going to jump through hoops to try and get a refund... I'll just manage."  But when you pay $229, you will be able to go back to the place of sale and talk it over with the professionals.  

So, I really don't have an objection to people looking for a bargain.  You get what you pay for.  

What I object to is people examining and dispensing without a license at the location where the patient is.  I'm OK with valid and true telemedicine, but what is going on now is not really lawful.

When we got our licenses, the State (Province) promised us a "franchise" of sorts, and we had to jump through many hoops to get there, and jump through more hoops to stay here.  Now big business feels they have the right to trample those laws using the internet as an excuse.

ehhh, what's the sense of complaining.

----------


## fjpod

> Probably.  But they're releasing someone else's "Rx".


I very much doubt they are releasing the Rx.  My son, who is also an OD, called one of these online CL places doing an "exam" for free, and then you buy the CLs...  So, at the end of the exam, he asked for the Rx, and the person on the other end could not comprehend what he meant.  He then quoted the FTC regulations requiring the release of prescriptions.  They had to scramble and get a supervisor.  Bottom line, he got a CL Rx emailed to him in a day or so.  They Rx'd toric CLs for him something like +0.50 -0.75 x 180, but he is young and doesn't wear glasses.  

So, you see, they will find anything they need during the "exam" to make the sale.  It's all about making a sale.

----------


## mike.elmes

With all the self diagnosing and online eyewear sales going on I hardly believe that a small percentage of refracting opticians are causing ANY lapses in eye health....and as for accuracy. I see way more redo's from the other O's than my Eyelogic system.

----------


## Lab Insight

> With all the self diagnosing and online eyewear sales going on I hardly believe that a small percentage of refracting opticians are causing ANY lapses in eye health....and as for accuracy. I see way more redo's from the other O's than my Eyelogic system.


+1.  And as an optician you know how to dispense properly and accurately unlike most OD offices.

----------


## Lab Insight

> AKA "optometry".  
> 
>   In other words, you take the old glasses (probably determined by an OD), get a variably-accurate autorefractor reading, and you're done.
> 
>  "Computer-aided software"?  Is there another kind of software?  "Technician", huh?  Who trained the "technician"? Seriously.  Who?  
> 
>   Which tells you exactly....nothing.  What's the point?  Can you explain that to me?  
> 
>   Ooooh.  _Snellen charts._ 
> ...


DRK, we get that you're passionate and protective about your profession.  However, call it what you want...the Eyelogic system is proven to have a 1% error rate regardless of where the prior Rx originated, which yes was most likely an OD.  

What angers the OD's is the fact it can eat your lunch, produce an amazing accurate Rx within a few minutes, even with a 'chimp' pressing the buttons.  Surprisingly, Eyelogic also has no ego, feelings or emotions of anger, remorse, frustration or interest in industry politics.     

The same cannot be said with optometry (subjective Rx human intervention) and is much higher, most likely around 10%, but hey OD's always pass the redo cost along to the vendors so the other 9% doesn't really count right?  God forbid they would ever admit there was a mistake and eat it themselves.

The numbers don't lie. The entire eyecare system needs to be imploded and rebuilt into three categories:

1. Visual acuity eye test (done by any of the three O's including Eyelogic)  Believe it or not, a full ocular health exam is not required every time a customer/patient needs a new pair of glasses or CL's.

2. Full exam - ocular health, IOP, retinal scan etc.....OD or Ophthalmologist

3. Surgery or Pharma - Ophthalmologist only.  Why the heck some of the OD's have ever been allowed to prescribe is beyond me.  It's like a holistic approach to voodooism. Last time I checked, there's still no MD abbreviation upon graduation from optometry school.

----------


## fjpod

Lots of professions prescribe meds without an MD abbreviation, and without as many years of graduate courses as an OD.

----------


## optio

Edit. Nevermind. Don't want to wade into this useless OT argument that will lead nowhere.

----------


## Lab Insight

> Edit. Nevermind. Don't want to wade into this useless OT argument that will lead nowhere.


This is a forum after all where professionals are free to voice their opinions, which welcomes both support and debate.  Nobody is right and nobody is wrong.

----------


## mike.elmes

In the new age society, all professionals strive to _increase their scope of practice_....which is beneficial to the public. Pharmacists now routinely give injections, Optometrists prescribe medication and Opticians can do refractions. For example, I used to work for an Optometrist. I was trained to do the retinal photography, Tonometry and to do Field testing along side my dispensing and manufacturing of eyeglasses. These things I was trained to do _increased my scope of practice. Surely we're all able to upgrade our training to do more_

----------


## Lab Insight

> In the new age society, all professionals strive to _increase their scope of practice_....which is beneficial to the public. Pharmacists now routinely give injections, Optometrists prescribe medication and Opticians can do refractions. For example, I used to work for an Optometrist. I was trained to do the retinal photography, Tonometry and to do Field testing along side my dispensing and manufacturing of eyeglasses. These things I was trained to do _increased my scope of practice. Surely we're all able to upgrade our training to do more_


That's a good point Mike. If the additional scopes of practice were shared equally with the appropriate training provided would be beneficial to consumers.  But that's not the case in the regulated parts of Canada and the U.S. where OD's aren't willing to let refracting go to opticians.

----------


## drk

> DRK, we get that you're passionate and protective about your profession.


Only to the degree that we serve the public's health.



> However, call it what you want...the Eyelogic system is proven to have a 1% error rate regardless of where the prior Rx originated,


Maybe you can explain what "Eyelogic" is.  What is "99%" accurate?  Because I think the world needs to know.



> 1. Visual acuity eye test (done by any of the three O's including Eyelogic) Believe it or not, a full ocular health exam is not required every time a customer/patient needs a new pair of glasses or CL's.
> 
> 2. Full exam - ocular health, IOP, retinal scan etc.....OD or Ophthalmologist
> 
> 3. Surgery or Pharma - Ophthalmologist only. Why the heck some of the OD's have ever been allowed to prescribe is beyond me. It's like a holistic approach to voodooism. Last time I checked, there's still no MD abbreviation upon graduation from optometry school.


Here you go, again. Knowing all this stuff _that you don't know_, _and not knowing all this stuff_ that you do know.

I should probably quit trying to get it through your noggin'.  

Suffice it to say, anyone who practices optometry or ophthalmology is embarrassed for you.

----------


## drk

> OD's aren't willing to let refracting go to opticians


What on God's green earth are you jabbering about?  

You mean, I, I am holding back refracting opticians?

What...are...you...smoking?

----------


## Lab Insight

> Only to the degree that we serve the public's health.
> 
> Maybe you can explain what "Eyelogic" is.  What is "99%" accurate?  Because I think the world needs to know.
> 
> 
> Here you go, again. Knowing all this stuff _that you don't know_, _and not knowing all this stuff_ that you do know.
> 
> I should probably quit trying to get it through your noggin'.  
> 
> Suffice it to say, anyone who practices optometry or ophthalmology is embarrassed for you.


Exactly my point.  Have you ever managed to listen to yourself with those big ears and tiny noggin' Bugsy???

----------


## optio

I'm going to be specific and address the personal long-time experiences brought forth by Mr. Elmes.   Despite their appearances, the "evidence" he shares is (1) basically irrelevant and (2) completely contradictory to his central position that opticians should be allowed to refract. 




> Listen here, I am a licensed *Refracting Optician*. I am licensed for 35 years





> Sight testing is an evaluation of refractive error of the eye. It is accomplished as a refraction done with an *autorefractor*, autophoropter, and lensometer. It is done by a trained *technician*, using computer aided software.


I'll first say I don't know much about the Eyelogic system, and I asked a few pertinent questions earlier that has so far have been ignored.  That may be a sign that the significance of the questions aren't understood by those here.  I'll get back to them at some point.  

(1) Your 35 years working as a refracting optician is no evidence at all that optician refraction is "safe", or "effective", or "justified" or whatever.  You aren't even refracting.  Refraction is a procedure used (using your own words) to  "evaluat(e the) refractive error of the eye".  You aren't "evaluating" anything.  You are just moving buttons and levers as told to you by a computer.  By your own words, you are simply a "technician".  There is no analysis being done.  So though you are licensed as a refracting optician, you aren't actually refracting.  You are just autorefracting.  Your evidence doesn't support optician refraction.  It supports "anyone at or above a technician" refracting.  You can also use your experience to argue that computer refraction is sound.  But specifically optician refraction?  No.  The fact you are an optician is irrelevant in your argument.




> The final results are sent via fax to an eye doctor for final approval by an ophthalmologist.


(2) Does the "final approval" mean a signature?  If so, then if you were really "refracting", then why are you sending your work to an OMD to be signed?  It's not your refraction if it's not your prescription.  It's his (or hers).  It's his signature on that piece of paper.  So again, you haven't been refracting.  You've been the messenger.  That's it.  Unless your goal is to define optician refraction as being simply teching under a doctor.  But if that's the case, then you're arguing refracting opticians shouldn't be independent service providers.  Just like you haven't been all these 35 years.  You've just been a cog under the thumb of an OMD.  Why is that an argument for opticians to refract (independently)?  I don't think it is.  Who knows, maybe between you using an autorefractor, and all "your" RXs actually being the OMD's RXs, you don't actually know HOW to refract.  Nothing you've said here indicates that you do.  Everything you've said suggests you could've gone all these 35 years just following instructions turning dials and getting prescriptions signed.

----------


## optio

Put another way.  You're a licensed refracting optician.  I'm a (refracting) optometrist.  Why is it nothing you do resembles what I do?  I don't need an Eyelogic system.  I just need a phoroptor.  To me, Eyelogic systems are for people who don't know how to refract.  Does this make sense to you?  So if that's the case, then you aren't a refracting optician.  And this isn't about expanding one's scope.  This is simply you wanting to remove the OD from a sale of glasses.

Now don't get me wrong.  If you can get the laws to agree with you.  Then that's great.  But call it or what it is.  I am not falling for this lipstick on a pig.

----------


## mike.elmes

The eyelogic system prompts you with the questions to ask during the refraction.... if you want them, I don't need them, you can turn that stuff off.. The system provides very consistent and reliable refractive results. We offer this service to adults who have Healthy eyes, as determined by a doctor within the last 3-4 years at the longest. The consumer has this choice available to them and they are made aware of the risks. We guaranty the satisfaction of clear comfortable vision no matter who's RX is used. So many people don't even get an eye exam...they spend years in Costco readers. Those are the people who are in the gravest danger. We refer all of them.

----------


## King of the Lab

I am very much enjoying this thread. There has been some pretty logical and irrational points made. As an optician in a typical office setting, it is very encouraging to wear different hats in the optical field. 

From the auto refractor to the retinal camera, the OCT, NCT and topography, surfacing, dispensing, finishing..... the list goes on. But it is important to remember that everyone's demographic is different, laws are regional specific, and private offices vs. retail franchises can matter too. I guess depending on all these factors, then and only then, you can make the argument that a particular scenario works best for you.

I don't refract, its not my job. I know plenty of refracting opticians/ophthalmic techs, but they do not work for OD's. They work for MD's, or they work for these small Warby Parker wannabe's (i.e. JINS) who have opticians/techs who refract in a small space within the brick n mortar and then video in an OD on stand by to verify the final RX. This works for them I guess, but it works for them because of all the scenarios I listed above, plus they found some kind of loophole that I am sure will be regulated eventually. 

I believe in a full comprehensive exam, and ultimately as opticians/health care professionals, our most important job is to educate our patients regarding the best way to take care of their health/eyes. What they choose to do after that to obtain an RX or buy glasses or whatever, is truly up to them and whatever we think the process should be is a matter of opinion that sometimes can be also kind of bias.

----------


## Lab Insight

> I am very much enjoying this thread. There has been some pretty logical and irrational points made. As an optician in typical office setting, it is very encouraging to wear different hats in the optical field. 
> 
> From the auto refractor to the retinal camera, the OCT, NCT and topography, surfacing, dispensing, finishing..... the list goes on. But it is important to remember that everyone's demographic is different, laws are regional specific, and private offices vs. retail franchises can matter too. I guess depending on all these factors, then and only then, you can make the argument that a particular scenario works best for you.
> 
> I don't refract, its not my job. I know plenty of refracting opticians/ophthalmic techs, but they do not work for OD's. They work for MD's, or they work for these small Warby Parker wannabe's (i.e. JINS) who have opticians/techs who refract in a small space within the brick n mortar and then video in an OD on stand by to verify the final RX. This works for them I guess, but it works for them because of all the scenarios I listed above, plus they found some kind of loophole that I am sure will be regulated eventually. 
> 
> I believe in a full comprehensive exam, and ultimately as opticians/health care professionals, our most important job is to educate our patients regarding the best way to take care of their health/eyes. What they choose to do after that to obtain an RX or buy glasses or whatever, is truly up to them and whatever we think the process should be is a matter of opinion that sometimes be also kind of bias.


I am enjoying this thread also.  I love how the OD's wind up so easy and get so defensive over nothing.

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## mike.elmes

My store, with a finish lab and site test office, is in a retail mall with Optometrists at the other end of the mall. When I first started do Eyelogic testing the Dr. at the other end of the mall was concerned and came for a visit. He is now totally fine with it.
I refer hundreds of people to his practice every year. We can co-exist with Optometry. There is nothing to be threatened by. In a good month, I might use my setup a dozen times. It's not like I have a neon sign flashing free eye testing. 
I wouldn't do that to the Dr. at the other end of the mall.

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## drk

You think it's nothing because you don't know what you don't know.

----------


## drk

> My store, with a finish lab and site test office, is in a retail mall with Optometrists at the other end of the mall. When I first started do Eyelogic testing the Dr. at the other end of the mall was concerned and came for a visit. He is now totally fine with it.
> I refer hundreds of people to his practice every year. We can co-exist with Optometry. There is nothing to be threatened by. In a good month, I might use my setup a dozen times. It's not like I have a neon sign flashing free eye testing. 
> I wouldn't do that to the Dr. at the other end of the mall.


Your concern is misplaced.  Screw the OD at the other end of the mall.

It's the people to whom you are giving bad/fake eye care that you should be concerned about.

But again, ignorance is bliss.

----------


## mike.elmes

> You think it's nothing because you don't know what you don't know.


Do you have a dispensary at your shop?
Do you employ an Optician? Many of the best Optometric practices do. Many don't. Many have their receptionist, optometric assistants filling that roll. If your biggest worry is glaucoma, maybe I should buy a non contact tonometer. Shucks those were the days when I worked for an optometrist....The clients *we test* have been cleared by the local doctors for medical problems with their eyes. Why would I have to. They just want to see clearly. I provide that.

----------


## drk

If you get an NCT, then you'd be closer to doing a good job for those people.  But still far away.

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## Lab Insight

> You think it's nothing because you don't know what you don't know.


Ahh, poor little Bugsy is offended.  Do you really have any patients or friends for that matter?

----------


## fjpod

ohhhh, too many slippery slopes here....
The OP wanted to know if sight testing is harmful to optometrists in BC.  While he/she has every right to ask a question, it is the wrong question.  It is the patients we all should be worried about.  Dr. K. expresses that, but perhaps not in the most eloquent of terms.  

Some of the sight testers, somewhat eloquently, express why they are doing what they do, and justify it with the "approval" of the medical community...but, it is not within their bailywick to delegate someone elses profession.  Only laws and regulations can allow this.  Lack of such is just a convenient excuse.

Everybody's mad...OMDs hate that ODs are taking medical care.  Opticians hate that the internet is stealing business.  ODs feel squished from both ends......

There are many biases in this world but one of them is the fact that OMDs don't even want to give our profession (ODs) the satisfaction of saying, "yeah, they do know how to refract".  They would rather see us fade away....replaced by a machine, or whatever.  Anyway they can move this along is a good thing in their minds.  BTW, this old line thinking is not shared so much by the newer OMDs who see ODs as a partner in medical eyecare.

The emphasis should not be on what is good for our chosen professions, but what is best for the patient.  Sorry to say, but this discussion is going to go nowhere because everyone thinks what they are doing is best.  Laws are written, and laws will be skirted.  We all just have to deal with it.

There is really more I would like to say....but none of it really matters.  I wish everyone well in what they choose to do, but please do it ethically.

----------


## optical24/7

Some perspective to add to this conversation;

 Should a person not be allowed to buy aspirin without an Rx because his head hurts? Should he be forced to see a neurologists 1st to get tested for possible tumors?

How are simple refractions and purchase of eye wear different? 

Also, Wasn't it Charles Prentice that successfully argued and lobbied the legislators in NY many years ago that refraction was not practicing medicine, but the bending of light?

----------


## throughalensdarkly

optical 24/7 I love your response!  I made a similar analogy somewhere else on optiboard, if a guy doesn't go in for his full physical regularly he shouldn't be restricted from buying tylenol for his headache.  Someone who (unwisely) doesn't bother with a full comprehensive eye exam similarly shouldn't be precluded from buying glasses to improve his vision.  We can't make these people take care of their health, but we can sell them glasses.  Getting a pair of specs with a bad rx doesn't do any damage as far as I know, it just costs the optical to do a redo - so who's being harmed? What's needed to get people in for an exam is a healthcare system that covers it - I live in Canada and our healthcare system is alright, but in the States... most people don't want to pay $100 for an exam that may find nothing and produce the exact same prescription as last time.  I think they'd be better off getting the exam but I don't know their budget, they do.

EDIT: also - drk needs to relax, on this thread and all others I've seen them post on.  Maybe a glaucoma specialist could prescribe you something that would help...

----------


## optio

> While he/she has every right to ask a question, it is the wrong question.


No. It isn't the wrong question if the purpose of me asking it, is because I'm considering a move there.  As an OD, I want to know if I can make a living there under the local regs.  Re-read the OP.  It wasn't about patient care.  And yes, in my situation, it is the right question to be asking.

----------


## fjpod

> No. It isn't the wrong question if the purpose of me asking it, is because I'm considering a move there.  As an OD, I want to know if I can make a living there under the local regs.  Re-read the OP.  It wasn't about patient care.  And yes, in my situation, it is the right question to be asking.


Ok

----------


## drk

> Ahh, poor little Bugsy is offended. Do you really have any patients or friends for that matter?


Not anymore.  They have all moved north for the 99% accurate refractions.

----------


## drk

> Some perspective to add to this conversation;
> 
>  Should a person not be allowed to buy aspirin without an Rx because his head hurts? Should he be forced to see a neurologists 1st to get tested for possible tumors?
> 
> How are simple refractions and purchase of eye wear different? 
> 
> Also, Wasn't it Charles Prentice that successfully argued and lobbied the legislators in NY many years ago that refraction was not practicing medicine, but the bending of light?


Issue 1: OTC medication.  Your logic: since OTC medications exist, then glasses should be OTC.
The rebuttal: Since you have to have a Rx for antihypertensives, then glasses should be Rx only.
The conclusion:  That reasoning doesn't really work.  Are glasses aspirin or lisinopril? 

Issue 2: Charles Prentice.  Your logic: since Charles Prentice said something, we have to be held to what he said.
The rebuttal: He also said you're fat.
The conclusion: You're fat, or who the heck cares what Charles Prentice said.

----------


## drk

I never "relax", darkly.  

I'm like Batman, the Caped Crusader.

----------


## optical24/7

> Issue 1: OTC medication.  Your logic: since OTC medications exist, then glasses should be OTC.
> The rebuttal: Since you have to have a Rx for antihypertensives, then glasses should be Rx only.
> The conclusion:  That reasoning doesn't really work.  Are glasses aspirin or lisinopril?
> 
> That’s not where I was going. Aspirin: Class one medication, little chance of harm, BUT, you can od on them, get ulcers, etc. Glasses: Class one medical device, least chance of harm, can’t od on them, can’t cause permanent damage (unless really jacked to the point of being un-wearable).
> 
> Issue 2: Charles Prentice.  Your logic: since Charles Prentice said something, we have to be held to what he said.
> The rebuttal: He also said you're fat.
> The conclusion: You're fat, or who the heck cares what Charles Prentice said.


Where I was going is that over-testing is part of the reason for the astronomical cost of health care. How come can’t a person opt for a refraction only? They are required to get extra testing they either don’t want, need, or can afford. Why does a healthy 30 year old have only a one year window to obtain eye wear until their Rx “expires”? 

Why are tens of thousands of lay people allowed to self refract and “prescribe” daily for readers? Heck, we’ve all seen hyperopes wear readers for years for Drx glasses! Why is lens duplication legal in almost all states? Why?... Because of a lack of evidence of harm...

 So, once again, why can the public self prescribe a drug (aspirin), which can cause permanent harm, but they can’t obtain a simple refraction for a product with literally no harm?

----------


## Lab Insight

> I never "relax", darkly.  
> 
> I'm like Batman, the Caped Crusader.


You're actually more like Robin.

----------


## drk

That one hurt.

----------


## drk

> Where I was going is that over-testing is part of the reason for the astronomical cost of health care. How come can’t a person opt for a refraction only? They are required to get extra testing they either don’t want, need, or can afford. Why does a healthy 30 year old have only a one year window to obtain eye wear until their Rx “expires”?


1. The way it should be with expiration dates:  If the patient is progressive in their refractive error, there should be an appropriate expiration date, and it should be followed.  If it's stable refractive error, there should be a longer expiration date.  Expiration dates are for the benefit of the patient.  Who's expiring a stable 30 yo's expiration date in one year?  There should be a reason if so.

2. If a patient wants a "refraction", I ask, "why"?  If their vision's changed, they need to know why.  That's what a doctor's for.  A loss of vision shouldn't be ignored.  



> Why are tens of thousands of lay people allowed to self refract and “prescribe” daily for readers? Heck, we’ve all seen hyperopes wear readers for years for Drx glasses


1. People don't "self refract".  They try on readers.  No refracting involved.  No prescribing involved.  

2. Nobody presumably gets amblyopia or crashes a motor vehicle when sitting down with a book and their OTC readers.

3.There should be a law against wearing OTC readers for drivers licenses.  But they don't know how to do it.  There used to be minus readers available but they took them off the market.  

4. I think OTC readers are grandfathered in.  I don't love them, to be honest, but it is what it is.




> Why is lens duplication legal in almost all states? Why?... Because of a lack of evidence of harm...


I think that's bad policy.  Good opticians don't like to duplicate.  I don't duplicate.  You know it's just working around the better method of calling the practitioner for the prescription.  

For that matter, online contacts are a public health hazard, as well, but we see that a lot of money goes a long way in Washington.  So "legal" is not evidence of "good".  




> So, once again, why can the public self prescribe a drug (aspirin), which can cause permanent harm, but they can’t obtain a simple refraction for a product with literally no harm?


1. You can't get a "simple refraction".   There are no "simple refractions".  Do I have to do a bunch of scenarios?

2. A refraction is not a prescription.  There has to be a practitioner making a treatment plan for a vision problem.

3. You can only imagine the number of people with loss of vision that think "magic glasses" will solve their problem.  

4. Even so, in America you have a right to be stupid and self-treat.  If one want's to grind one's own lenses, somehow, more power to them.  But in presumably an advanced society, there are protections against OTHER PEOPLE hanging out a shingle and taking money for providing cures that they don't know anything about.  It's called "quackery".

If someone comes to my office with reduced vision, and I diagnose macular degeneration, and I put them on a high-carb diet and recommend yoga, I'm a quack.  My license to practice optometry on people will be yanked.  

If someone comes to your office with reduced vision, and you "diagnose" refractive error, and you put them in glasses but they really have a branch retinal vein occlusion, you're a quack.  You need a license to be yanked.  If you don't have a license, then the person doesn't have protection other than "buyer beware", like they have to do with a flea market.

I suppose somewhere along the line society decided that on matters of health care, "buyer beware" isn't good enough.  Check out the credentialing that ODs have to go through to be providers for VCPs and health insurances and to maintain licenses and board certifications and maintenance of said certifications (C.E.).  

It's not my problem if you undervalue your role in health care and see yourself as a glasses peddler.

----------


## Lab Insight

> That one hurt.


Forgive me, I've now had my early morning java. :Biggrin:

----------


## Chris Ryser

> *Everybody's mad...OMDs hate that ODs are taking medical care.  Opticians hate that the internet is stealing business.  ODs feel squished from both ends......
> 
> 
> There is really more I would like to say....but none of it really matters.  I wish everyone well in what they choose to do, but please do it ethically.
> *




Good point..............................

In a few weeks from now the big merger ESSI - LUX will be approved or rejected by the European authorities which will be a historic date in our professions of working in eyesight correction.

You all fight for a space in the whole business of eyesight correction in the USA and Canada while the whole world outside is working in different setups.

For example in India which has a population of  1.324 billion (2016) and the USA 323.1 million (2016), Essilor has and is training 3,000 young people to refract, and they are then set up in their own small stores in poorer areas, selling and delivering eyeglasses. 

Essilor and Lux will own by far the biggest block of online opticals world wide after the merger.

Glasses are something that is needed by everybody sometimes during their lifetime, so it is a very safe profession for anybody to be in it, but the big question is in what position will you end up.

The service garage around the corner with a couple of gas pumps is gone, and has been replaced by a Fuel Corporation run gas station and store on this Continent.

It could very well be that the optical retail business is on a similar path.

----------


## optical24/7

> 1. The way it should be with expiration dates:  If the patient is progressive in their refractive error, there should be an appropriate expiration date, and it should be followed.  If it's stable refractive error, there should be a longer expiration date.  Expiration dates are for the benefit of the patient.  Who's expiring a stable 30 yo's expiration date in one year?  There should be a reason if so.
> 
> ​Though I mainly work with OMD's, 1/4th of our volume comes from walk-ins with OD Rx's. Not one of the 20+ OD's in my area vary expiration's. Every single one has a 1 year expiry, no matter what. One wouldn't perform a new exam on a pregnant patient of his OR release the latest Rx, even after being told she had busted her only pair. ( I duplicated her busted ones... Call me Gypsy Glasses Peddler..)
> 
> 2. If a patient wants a "refraction", I ask, "why"?  If their vision's changed, *they need to know why*.  That's what a doctor's for.  A loss of vision shouldn't be ignored.
> 
> Why do they need to know why? If you get a headache, do you need to know why? Should everyone with headaches go see a neurosurgeon? ( I could say yes to that question, I've know 3 people in my life with brain tumors. One, a 34 yr old OD I worked for that died in the early 80's.) The point is, there are no laws mandating doctoral care. Folks can go buy meds that have the potential to kill them, yet, they can't buy a device, with absolutely no history of nor likelihood of causing harm.
> 
> 1. People don't "self refract".  They try on readers.  No refracting involved.  No prescribing involved.
> ...


Doc, I have the highest respect for you, and your profession. My Mom was an instructor at UHCO. I know a ton of OD's and would love to see your profession advance more into the medical side with surgical privileges. You go though a ton of training, like Dentists. They can perform oral surgery, you should be able too on eye problems ( with training of course..)

I'm merely playing devil's advocate here. I also think Opticianry should be allowed to advance too. ( With high quaility, extensive training and certification...)

----------


## throughalensdarkly

> 1. People don't "self refract".  They try on readers.  No refracting involved.  No prescribing involved.


Doesn't a phoropter just "try on" different lenses?  Doesn't an OD's refraction rely on patient feedback?  Seems fairly similar to someone trying on readers until they find a pair that works.  Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works.  Not saying OD's can't do a better job of refracting or that there aren't other benefits to having a proper doctor such as yourself take a look at your eyes, just noting the broad similarities. A person isn't going to try (or at least wouldn't be successful at) suing the company that made the readers when they find out that they have glaucoma or something.  Why is it so different for glasses that aren't off the shelf ready readers?  Again, people should get proper eye exams from proper medical professionals.  But if they don't want to do that, why shouldn't they be able to buy a pair of glasses?  It isn't providing substandard medical care to duplicate an old pair of glasses - it isn't providing medical care of any kind.

----------


## drk

> Doesn't a phoropter just "try on" different lenses?


 No



> Doesn't an OD's refraction rely on patient feedback?


 Yes



> Seems fairly similar to someone trying on readers until they find a pair that works.


  No



> Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works.


 That's practicing optometry.



> Not saying OD's can't do a better job of refracting or that there aren't other benefits to having a proper doctor such as yourself take a look at your eyes, just noting the broad similarities


.  So broad as to be meaningless



> A person isn't going to try (or at least wouldn't be successful at) suing the company that made the readers when they find out that they have glaucoma or something.


  Product liability doesn't equal professional liability.



> Why is it so different for glasses that aren't off the shelf ready readers?


 Do you work for Warby Parker or something?  Is your argument to de-regulate spectacles?  
Try not to be so "glasses" focused.  You, being an optician (I think) can only see a pair of specs.  Look at this from the perspective of a patient with a health problem (yes, vision loss is a health problem): Don't people need trained, licensed professionals to fix their health problems?  Or, just anyone?



> Again, people should get proper eye exams from proper medical professionals.  But if they don't want to do that, why shouldn't they be able to buy a pair of glasses?


 They can buy a pair of glasses as it is, now, can't they?  Can't people buy glasses?  There's a whole lot of glasses buying going on, out there.  

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




> It isn't providing substandard medical care to duplicate an old pair of glasses - it isn't providing medical care of any kind.


  Yeah, you're quite wrong on that one.  I don't know your background or who trained you, but you're shockingly ignorant of your role.

----------


## throughalensdarkly

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

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

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

EDIT: Oh yeah! Almost forgot, when you quote me and reply
_Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works.
_

That's practicing optometry.

Doesn't that reduce your role to just refracting?  Shouldn't you include all the medical knowledge/training/skills in your definition of optometry?  If you don't, I suspect you may become obsolete in the near future.  That's a pretty myopic view for an optometrist to take.  Oh well, back to the grind!

----------


## fjpod

> Doesn't a phoropter just "try on" different lenses?  Doesn't an OD's refraction rely on patient feedback?  Seems fairly similar to someone trying on readers until they find a pair that works.  Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works.  Not saying OD's can't do a better job of refracting or that there aren't other benefits to having a proper doctor such as yourself take a look at your eyes, just noting the broad similarities. A person isn't going to try (or at least wouldn't be successful at) suing the company that made the readers when they find out that they have glaucoma or something.  Why is it so different for glasses that aren't off the shelf ready readers?  Again, people should get proper eye exams from proper medical professionals.  But if they don't want to do that, why shouldn't they be able to buy a pair of glasses?  It isn't providing substandard medical care to duplicate an old pair of glasses - it isn't providing medical care of any kind.


Just had a patient today, his vision in the left eye had gone down about six months ago.  His VA had dropped from 20/20 to 20/40- OS.  He didn't rush right in because he figured his Rx had changed and he would come in next time he was eligible for new glasses under his plan.  He comes in, we are able to improve the VA OS to ALMOST 20/20...  Meanwhile, dilated exam showed vitreo-macular traction with an epi-retinal membrane.  The cause of his refractive error shift was due to retinal traction and separation.  

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

----------


## throughalensdarkly

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

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

----------


## fjpod

> Good point, not going to argue with you.  That's why you guys are infinitely more valuable than an autorefractor.  Again, I think we should all get eye exams regularly, just like we should have a regular checkups with a doctor for the rest of our bodies.  But if someone doesn't want to have those checkups, what can we do? Do these people not deserve to be able to at least treat their symptoms?
> 
>  Something I should have added was that it's important sight testing isn't marketed/advertised/made to see like a real eye exam.  Maybe it should be required that at every sight testing the patient is told "You should really see an optometrist for a proper exam, this procedure won't find any medical problems you might have. I can recommend Dr. so-and-so, here is their phone number"?


People should be able to get copies of their old glasses at will.  They should not, however, be given an incomplete "exam", or sight test and told, "well, it's alright to get a new Rx because you read the eye chart OK".  Passing the test implies the eyes are "alright". (Actually, you don't have to tell them that.  No matter what you tell them, they will assume that their eyes are alright if you fix them up with new a new glasses Rx.).  

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

----------


## throughalensdarkly

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

----------


## mike.elmes

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

----------


## fjpod

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


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

Anyway....

----------


## fjpod

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


The signed papers may lessen your "guilt" legally in the event something happens, but the patient will still walk away with the perception that everything is OK.

----------


## drk

> Do these people not deserve to be able to at least treat their symptoms?


Uh, yes they do.  Go to the doctor.  




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


There are one hundred and forty seven unenforceable requirements to make these stupid "sight tests" safe.  What's the point?  Just...go...to...the...doctor already.

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


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

----------


## drk

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


Oh boy, I bet they're really going to do that.  

Enabler.

----------


## drk

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


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

----------


## Lab Insight

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


And a 'real' doctor is an MD.

----------


## drk

Maybe in Canada.

----------


## throughalensdarkly

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

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

----------


## drk

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

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

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

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

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

----------


## throughalensdarkly

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

----------


## drk

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

You're amazing, you know?

Sheer logic!

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

I cannot begin to thank you enough.

We've witnessed greatness, here.

----------


## throughalensdarkly

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

----------


## uncut

> There must be a bumper crop of straw in BC this year...so many straw man arguments...
> 
> Hey, it's free, right?  What's the harm, right?
> 
> You don't need a doctor to diagnose and manage your eye and vision disorder...because...because...OTC GLASSES THAT'S WHY!!!!
> 
> Don't worry, maam, this "exam" is a "non-medical exam".  You know, it's that "other kind" of exam...
> 
> ...the kind that's free, that's not done under the supervision of any licensed doctor or anything, and the kind that doesn't really solve your eye issues, so you have to get a "real one" if you want that, but it sure is the kind that will let me sell you a pair of nifty glasses!


 
Logic and truth evades the Pacific Palisades, doc.

----------


## Lab Insight

> Maybe in Canada.


Sorry, but even in the states, optometry school upon graduation does not designate an MD Doc.

----------


## drk

Didn't say that Mr. Straw Man.

Said ODs were "real docs". 

And we are.

You should try to be a "real optician".  

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

----------


## throughalensdarkly

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

----------


## Lab Insight

> Didn't say that Mr. Straw Man.
> 
> Said ODs were "real docs". 
> 
> And we are.
> 
> You should try to be a "real optician".  
> 
> Maybe darkly can post more than 13 times and learn something, too.  That is, if Coastal Contacts is allowing that kind of time on the internet at work.


You wind up so easily its actually entertaining.

----------


## drk

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

But I sure doubt it.

----------


## uncut

> Well DrK you are in the Canadian forum... also I'd take Canada's healthcare system over the USA's any day of the week, even though my eye exams are no longer covered.  By the way, this is the second time I've seen you assume a gender for someone you're talking to on the board, and the second time I've seen you guess wrong.  I'm a gent, and I don't understand your problem with analogies.  Maybe because you don't seem to understand them?  You talk about referring someone to a chiropractor.  As far as I remember subluxation theory has been discredited and chiropractors pose as real medical professionals - any good they do can probably be chalked up to placebo effect.  You're comparing that to a sight test that is clearly labelled as a non-medical exam, the recipient has to sign a paper saying they understand this, and using theory that hasn't been discredited (I think guys like Mike.Elmes stand a pretty good chance of producing a working pair of glasses using these sight tests because THEY WORK).  Most importantly, the Chiro might cause harm or let something go undiagnosed while posing as a medical professional.  The glasses aren't gonna hurt anyone, and the client understands that they aren't receiving medical care.  Apples and oranges, your analogy doesn't work/is misleading/etc.   I guess you don't have to understand logic or be able to read critically to become an OD in Ohio.  
> 
> I know good OD's, I don't question the value of the role.  But if it's just refracting then OD's days are numbered.  Evolve or die! Technology is going to get better, not worse, and people DO NOT NEED A COMPREHENSIVE EYE EXAM TO GET GLASSES (they need it for other reasons).  I've seen bad OD's refuse to give PD's for fear of onliners and prescribe 1.67 for patients with less than -3 myopia OU.  You think the fact that they sell those pricey lenses to the patient didn't influence the decision to "prescribe" them?  Don't you think the fact that it comes from a doctor makes the patient think they "need" 1.67 when they definitely do not?  A system where a medical doctor also sells what they prescribe is open to abuse, and I've seen it abused. The exam costs $100+ in most offices I've seen, and I've seen sight testing offered free.  If the recipient of a sight test has to sign a paper saying they understand this isn't a medical exam, due diligence has been done.  They know they aren't seeing a doctor, and they know that they aren't adding hundreds of dollars to the cost of getting their family the glasses they need (they don't need an eye exam every single year, and can't afford it!).  I don't think you have legitimate medical concerns about this, I think your concerns are financial.  In which case welcome to the world of business (a place where doctors shouldn't be in the first place, not your fault just a stupid system).  If over the counter readers are OK, even though they are mostly for people in an age range where it's even more important to get an eye exam, then other spectacles should be too.  Get over it - it's happening.



.....because it's current year, right?

----------


## Lab Insight

> I just hope you guys are as good of opticians as you are as trolls.
> 
> But I sure doubt it.


When does your Dr. Phil guest appearance air?

----------


## Lab Insight

+1 uncut.

----------


## optio

Delete.  Not the best thread for this.

----------


## Tallboy

Gender assumption? Really? Good lord

----------


## Chris Ryser

I see the insults are flying ..........................................

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## optimensch

So here are some of the "SIGHT TESTS" I do, without getting into all the ocular health stuff (not even intraocular pressure and without an ophthalmoscope) - binocular vision testing, pupil testing, checking for opacities, suppression, diplopia,  field testing, phorias, tropias, cycloplegic refraction (especially for younger population), deciding if that new hypermetropic shift is due to serious pathology, corneal health (dystrophies/degenerations/keratitis) all of which can AFFECT REFRACTION AND ACUITY...not an exhaustive list  but if you think "SIGHT TESTING" is  just taking a refractometer printout and reading a snellen chart, you are very highly mistaken about what "SIGHT" is and what "TESTING" it is. You can "see 20/20" on a snellen chart and have the completely WRONG prescription and have VERY DISEASED eyes, despite the "20/20". PURE TOTAL IGNORANCE.

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## optimensch

I don't think you have legitimate medical concerns about this, I think your concerns are financial.

Actually it seems to me that YOUR concerns are financial, and that a fake "sight test" which does in fact endanger people's health, is to facilitate a sale. Please pot, don't call the kettle black. You don't give glasses away, I presume. And yes, eyeglass prescriptions do in fact involve people's health for reasons too many to explain to you in this setting. I have plenty of physicians as clients, among them top surgeons in the city, and they know that a glasses prescription and ocular exam involves PROFESSIONAL judgment, and know where to go to get their own eye health checked. Point is, there are VERY frequently health issues which come into play when there is a patient with a changed or new prescription sitting in your exam chair. My physician patients, who have no stake in the optical industry, but who are MEDICAL HEALTH experts, would completely disagree with your nonsense statements.

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## optimensch

So a person comes for a prescription change that is a significant myopic shift due to cataract, or hyperglycemia, and with a prescription change does get acuity to "20/20" , so the "sight tester" goes and makes new glasses. If you think this is acceptable and normal, that the person is told that now their vision is 2020 and they should be all smiles and go about their business with no clue that something else may be going on , well, you are completely nuts, and do not give a hoot about ANYTHING but your own bottom line. It is not the ODs who are all about the money. It is the glasses peddlers and their fake and ignorant sight test. ODs I know, and myself included, very often defer glasses changes in order to get the CAUSE of the rx change sorted out BEFORE selling or prescribing new glasses. And, we have the professional responsibility and liability to act in this fashion, we cannot "cover our arses" and say oh we only did a sight test and didnt check to see why the vision changed, or hide behind some signed consent nonsense.

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## Chris Ryser

> *
> It is not the ODs who are all about the money.** It is the glasses peddlers and their fake and ignorant sight test**. ODs I know, and myself included, very often defer glasses changes in order to get the CAUSE of the rx change sorted out BEFORE selling or prescribing new glasses. And, we have the professional responsibility and liability to act in this fashion, we cannot "cover our arses" and say oh we only did a sight test and didn't check to see why the vision changed, or hide behind some signed consent nonsense.*



I could get along with above statements, if the doctor optometrist would not act like a medical doctor who has his own drugstore out front and sells top brand medications at the highest possible price.

So far I have not met any OD operating his own office that is not making more money by selling the glasses at the standard pricing multiplier, than checking the eyes.

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## optimensch

Chris
With peace and love, you seem like an affable guy, but what the heck are you talking about?
Should an ophthalmologist who diagnoses a cataract not also do the surgery due to a perceived conflict of interest since he gets paid a lot for the surgery? Should an orthodontist who decides a kid needs braces not install them because it is lucrative, and should advise them to go online and get some cheap china braces?
Unlike those 2 scenarios, people have more options than ever and more price transparency than ever on where to buy glasses, and how much to pay for them. 
You can buy $10 glasses on zenni or go to a big box or anywhere the heck you want. ODs have no monopoly on glasses - somehting you point out incessantly by the way.
WHat huge multiplier are you talking about???
As a dispensing OD I actually see PLENTY of "my scripts" walk out the door to buy elsewhere and/or shop around, despite a well-stocked well-priced dispensary of 2000+ frames. By the same token I see PLENTY of outside scripts walk in, folks who had an eye exam at a big box or a competing optician or OD practise who purchase from me. People are mobile, and there are gazillions of options, more than ever. 
No, I do not need to ONLY do exams and refrain from eyewear sales, there is ZERO conflict of interest, this is the way the industry evolved and it works pretty well. Consumers have NEVER EVER had it so good with so many options. In fact what you are saying above is total, pure, unadulterated nonsense.  Peace.

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## Michael I. Davis

In an ideal world, the ophthalmologist would not be diagnosing the cataract. The OMD should be the surgeon the OD the primary care eye doctor, and then the optician would have more work then they could handle filling all the prescriptions.  Everyone working to the top of their profession.

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## optimensch

> In an ideal world, the ophthalmologist would not be diagnosing the cataract. The OMD should be the surgeon the OD the primary care eye doctor, and then the optician would have more work then they could handle filling all the prescriptions.  Everyone working to the top of their profession.


 And what about contact lenses in the ideal world?

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## Michael I. Davis

In an ideal world, ODs would fit the contacts write an Rx that would be filled at an optician or a pharmacy. See that patient for follow up as necessary.  

Of course reimbursement rates would have to change to make up for loss of income from product.

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## drk

> I could get along with above statements, if the doctor optometrist would not act like a medical doctor who has his own drugstore out front and sells top brand medications at the highest possible price.
> 
> So far I have not met any OD operating his own office that is not making more money by selling the glasses at the standard pricing multiplier, than checking the eyes.


That's an idiotic analogy, Chris.

When your gizzard had something caught in it, you went to a surgeon with your symptom and he got paid to extract it.

When your halitosis flared yet again, you went to your dentist who removed your rotten molar.

When your toenail fungus kept you from wearing shoes and only Birkenstocks, you went to a podiatrist with your symptom and he got paid to laser it.

When you couldn't see your breakfast gruel, you went to an optometrist with your symptom and he got paid to fix it.


Why am I penalized because my treatments include lenses?  Shouldn't gizzard-removers, podiatrists, and dentists be disallowed to provide treatment?

POPPYCOCK, SIR!

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## drk

Dr. Davis, you should re-examine your philosophy regarding CLs.

To wit, Dr:  How many "unnecessary contact lenses" have you fit in your lifetime? 

How many times has a person come in for a routine exam and you've told them "Hey, you have mild, emerging myopia.  You must now have contacts."

That's your surgery analogy; someone getting unnecessary cataract surgery.  Who gets "unnecessary contacts"?

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## drk

_Hey, Joe, I have a rattle in the trunk._

Eh, it's a loose gas tank strap.

_Fix it, please._

Can't do.  Wouldn't be ethical.

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## drk

_My bank account is low._

Well, you have a poor rate of return on your investments.

_What's a better choice?_

Hush! You'd better talk to someone else before I lose my CFP license!

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## drk

My tummy is rumbling.

Are you hungry, toots?

That must be it.  How about some bacon?

I can't serve you any because I diagnosed you as "hungry".  Try Denny's.

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## drk

I'm shooting in the high 90s.

Well, your swing is laughable.

Can you give me a few lessons?

Nope.  The PGA disallows me--for ethical purposes, of course--to analyze your swing and then give you lessons to fix it.  You have to get them on-line or something. $100, please.  That will be cash. TA TA!

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## drk

You see, what you numbnuts don't get is this:

Which is better, ONE or TWO?

One: 
"Doc, I can't see right."  
"OK, you probably need glasses.  Try these -1.00's.  Fill it somewhere else.  That'll be $75 and pay Sally up front."  
"I still can't see."
"Eh, they probably screwed it up.  Try these -1.12's.  Take it back for a refund.  That will be $50 and pay Sally up front."
"Nope"
"Well, you probably have cataracts, then.  See if you can get another refund from Glasses Shack.  Go to Sidney, MD, who will diagnose your cataracts and then you can find an unaffiliated surgeon.  That will be $50 and pay Sally up front."

"OH THANK YOU, MR. ETHICAL DOCTOR!"


Or, two:
"Here is your problem, I think.  It's probably cataracts.  Since you are not interested in surgery just yet, let's go into the optical and Sally will make you a new pair of glasses with more distance vision.  We're going to be following up with you, if this approach doesn't make you see better.  We'll be with you all the way."

"YOU MONEY-GRUBBING BASTAGE!"

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## Don Gilman

Whoa! Let the dander fly

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## AngeHamm

> "YOU MONEY-GRUBBING BASTAGE!"


Mad props for the _Johnny Dangerously_ reference.

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## optical24/7

Dr K, curious what you think of Stark Law, and why OD/OMD’s shouldn’t be held to the same standard.

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## drk

https://www.beckershospitalreview.co...aw-021717.html

I don't say that physicians haven't been bad boys and girls.  I know it happens.

Does it require a law?  I doubt it, but whatever.  

How about this FCLCA crap?  It's a scam beyond scams.  

The government is no more/less moral than the citizens they deign to regulate.  

However, there HAS TO BE some degree of reasonableness.  Why treat ODs (of all people...ODs who are on the absolute lowest end of the health care totem pole, below podiatrists and dentists and maybe just above accupunturists and chiropractors) like we're a bunch of freaking criminals?

One reason, and one reason, only:  Opticians (yes, many axe-grinders on this site) and way more prevalently: retailers and online retailers want a cut of the vision-correcting device market.  That's all. 

So, take a big crap on Optometry.  Go ahead.  Evil docs making barely six figures.  Evil docs getting shafted day in and day out by Eyemed/Luxessilor and VSPMarchon.  

Yeah, we're the problem.  

I hate myself.

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## optical24/7

IMHO, OD’s shackled themselves with some of their own rules and regs. You can delegate pre-tests but not refractions. In almost, (if not all states) OD’s have to perform that test themselves while OMD’s can delegate staff to perform that end of the test. Delegation of duties is the main reason OMD’s can see and book many, many more patients a day. If you, as an OD want to grow your practice and see more patients you have to hire or partner with another expensive doctor. 

You guys are highly trained to perform complex medical exams. OD’s should be able to delegate and write-off on your trained personnel.

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## drk

Old laws, written by state boards from a different era.  Some rules written by PP ODs on the board to police the profession from the outside.  Stupid stuff by today's standards.

Not so with MDs, who have been large and in charge forever, and probably always will be and more power to them.

The delegation issue is non-existent, however.  That's not a real life issue at all.

What's more, a vast majority of ODs would prefer to refract.  It's kind of what we're good at.

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## Lab Insight

> What's more, a vast majority of ODs would prefer to refract.  It's kind of what we're good at.


Agree, so let the opticians do the selling of glasses.  It's what they do best.

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## optimensch

> Agree, so let the opticians do the selling of glasses.  It's what they do best.


Who is stopping them?

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## optimensch

is costco an optician or an optometrist? how about warby parker, which are they? and zenni? walmart? are they both? just wondering.

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## optimensch

While optometrists and opticians argue about who should do ONLY eye exams and NOT sell glasses, and who should have EXCLUSIVE domain over selling eyeglasses and contact lenses (total nonsense of course) the biggest RETAILER of eyeglasses  on this particular planet is NEITHER an optometrist nor an optician. Leonardo Del Vecchio would LAUGH HYSTERICALLY at this thread. Chris and all his (and other's) "OPTOMETRISTS MUST ONLY DO EYE EXAMS" utter nonsense posts totally miss the ELEPHANT crapping in the room, namely, LUXOTTICA who sells at RETAIL all the glasses one could dream of, and is NOT AN OPTICIAN and NOT AN OPTOMETRIST. Please. Thread over. Officailly.

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## optimensch

Chris - for all your posting about HUGE MULTIPLIERS taken by optometrists - how about Luxottica and Essilor's "Mutlipliers"??? They manufacture and retail eyewear. You think my EBITDA is anything similar to Essiliux? What is your MUTLIPLIER selling micro tints and other chemicals? You sell for cost plus a few pennies? What is the markup on your chemicals? Just wondering....who the arbiter of what "multiple" is accpetable....let me know at your earliest convenience please. How about opticians? do they work on super narrow markups and "multiples" ? thanks in advance for adding some clarity. Again, thread officially over!....for now.

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## optimensch

Chris you should sell your chemicals at cost plus a fitting fee, a small amount for your expertise. This is the future of chemicals selling, as people will buy all chemicals from chemicals.com .. ,maybe a dollar or two ? what do you think is fair?

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## optimensch

Chris - my lawyer charges around $275 per hour ( I think a lawyer's hour is about 42 minutes, sort of like a 1 hour tv show, gotta account for commmercials) and I think ophthalmologists in my neck of the woods get around $90 or so for a patient visit (5 minutes? 10?) .... just wondering, what is their "multiplier"?  is this a good and fair mutliplier? Does my rent get figured into my multiplier? my assistant's salaries? What is Warby Parker's multiplier? My kid is in McGill Management, I asked him to ask his professor what my Multiplier should be. I'll get back to you with answers ASAP.

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## optimensch

go ahead DRK , you have the floor.

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## drk

> Agree, so let the opticians do the selling of glasses.  It's what they do best.


I have an optician and we work together, as it should be.

But we don't "sell glasses" in my practice.

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## Lab Insight

> I have an optician and we work together, as it should be.
> 
> But we don't "sell glasses" in my practice.


Professional providers are still sales people.  The product or service provided in exchange for payment is a sale and we are people.  We are all one, so no need to be ashamed.

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## AngeHamm

> I have an optician and we work together, as it should be.
> 
> But we don't "sell glasses" in my practice.


Does your optician receive money from patients and provide them with glasses commensurate to those fees? If so, s/he sells glasses.

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## drk

I don't see it that way.

"Selling" is very little of what we do, if at all.

Are you "sold" treatment for hypertension?  If so, then yeah, we sell.

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## Chris Ryser

> *Chris - my lawyer charges around $275 per hour ( I think a lawyer's hour is about 42 minutes, sort of like a 1 hour tv show, just wondering, what is their "multiplier"?  is this a good and fair mutliplier? 
> 
> What is Warby Parker's multiplier? My kid is in McGill Management, I asked him to ask his professor what my Multiplier should be. I'll get back to you with answers ASAP.
> *



Your kid will come back from McGills Management course with the following answer:

1. You figure your personal works multiplier according to professional degrees and ability for the work done on a patient.

2. if your office works on new glasses, as lab work on lenses from surfacing to grinding inserting and checking you calculate the selling price including a decent profit, or you go to 3.

3. if you purchase the finished glasses from an outside  laboratory who does all the work, you should not be entitled to a use multiple markup of one, because you did nothing else than checking the incoming Rx and adjust them on the patient.

Now that the merger of Essilor and Lux, who own the largest group of online opticals, and with that also the greatest benefactors of you colleges, you will face a very new period of adaptation of your professional life.

You can easily change and lower your selling pricing, and up your professional ones.

The only losers in that type of competing will be the dispensing opticians that took the easy way of not doing their lab work on site. I am referring to the way the optical retrail is handled in Europe, were opticians purchase finished or surfaced lenses from their labs.

Online glasses delivered are a semi-finished product. They have not been checked for the prescription and they have not been adjusted to the consumers face. They have to rely on the maybe fit or not fit, and have to go to an optician who will adjust them for a charge, or some good prayers at church, and will buy that pair again next time.

The new generation that enters advance age is now fully internet savvy, no wonder that *Toys-R-Us* just went bankrupt and Amazone want buy the locations for their food stores online business.

I might not be fully right but I can see the direction we are heading very clear.

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## Chris Ryser

> *I have an optician and we work together, as it should be.
> 
> But we don't "sell glasses" in my practice.
> *



If you have an optician and work together, you are selling glasses ............................

Which one pays the other,.............or which one pays more taxes ?

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