# Optical Forums > Canadian Discussion Forum >  Ontario Opticians refracting?

## mike.elmes

Just noticed this has been posted on the COO website. Any thoughts from members in Ontario regarding this next step.

http://www.ontario-opticians.com/OOA...y_Nov_2007.pdf

----------


## Refractingoptician.com

> Just noticed this has been posted on the COO website. Any thoughts from members in Ontario regarding this next step.
> 
> http://www.ontario-opticians.com/OOA...y_Nov_2007.pdf


 
Yeah, gives me a headache reading it . The nuts and bolts of the whole thing indicate that a plan is in motion and is about to be played out in accordance with some master plan , which has not been revealed in it's entirety ... and won't be .

----------


## LandLord

Optician refracting is likely to happen.  It's one of those issues that has an underlying human rights feel to it.  It reminds me of the gay marriage issue here.  Many powerful groups may fight vigorously against it.  Some say it's evil.  But in the end, how can you stop it?

----------


## Excalibur

To better answer the direction the Ministry of Health in Ontario is heading with opticians and refraction, please refer to the following document (specifically pages 292-293):

http://www.hprac.org/en/reports/reso...il_2006_EN.pdf

HPRAC has effectively advised the Minister of Health that opticians refracting without direct OD or OMD supervision and independent of a complete ocular assessment is a no-no.

----------


## AdmiralKnight

I'm personally against it. I point to things like this when we wonder to ourselves why Optometrists fight so hard to keep their non-licensed people. Why are we pushing for this? You want to refract? Become an optometrist. Why do some think this is ok for us to do, then cry bloody murder when an Optometrist has joe blow off the street adjusting a pair of glasses? :\

----------


## wmcdonald

If you are against it, simply don't do it. No one is making you take the courses, etc. to learn to refract. For those who wish to do so, keep in mind it is not a free ride. It will require additional education and training, but it is a reachable goal if we work together with the other two Os to develop a model acceptable to all. ODs heard much of the same "I am against this" and "if you want to prescribe drugs, go to med school" baloney, but they studied for years and made things happen. It should not discourage those who want to do more. Learn and expand your mind. That is the way Opticians regain some lost ground. There will be a place for those who do not wish to participate, nuch like many older ODs did not take the theraputetic courses to allow them to utilize prescription pharmeutucals.

----------


## HarryChiling

I have said it before and I will say it again, I don't want to refract, but I do want our profession to have the ability too if we choose.  I would also take a class on refraction even though I don't feel my time is better spent doing other things int he practice.  

I congratualte the Canadians for pushing the envelope.  Here in teh states we worry about weather we are going to lose another licensed state or not while up north they are gaining ground, I envy our neighbors to the north.

----------


## Excalibur

I don't see any problems in patient care if an optician refracts as long as it is part of a complete assessment under the supervision of an OD or OMD.

----------


## HarryChiling

> I don't see any problems in patient care if an optician refracts as long as it is part of a complete assessment under the supervision of an OD or OMD.


I think that's the model, it makes sense to me too.

----------


## Excalibur

the conduct of Bruce Bergez (discussed elsewhere on Optiboard) is hurting the political position of opticians with the Govt of Ontario. In Canada, health legislation is largely dictated at the provincial level, and Mr. Bergez is not making things easier for his peers.

----------


## HarryChiling

> the conduct of Bruce Bergez (discussed elsewhere on Optiboard) is hurting the political position of opticians with the Govt of Ontario. In Canada, health legislation is largely dictated at the provincial level, and Mr. Bergez is not making things easier for his peers.


He is a bad example for an optician, didn't he get his license pulled?

----------


## Excalibur

I think he is still licensed in Ontario. Perhaps a fellow board member can clarify his status.

----------


## tmorse

> If you are against it, simply don't do it.


I cannot agree more!! 
British Columbia  took the Alberta 'refraction' model, tweaked it a bit, added public protection notice(s) and refraction exemptions, and then made education in refractometry mandatory for those engaged in this area. 
Proper 'Errors & Omissions' liability insurance is in place and the whole process is a credit to College of Opticians of BC, the Alberta Board of Opticianry and the Opticians Association of Canada, all of whom collaborated with the BC government to achieve something truly grand for Opticians. And the public interest is maintained. 

Ontario's COO would do well to emulate BC in this matter rather than try to re-invent the wheel. :cheers:

----------


## Excalibur

does the BC model permit self-standing/independent refraction by opticians, or does the OMD or OD have to see the patient at the same time the optician is conducting the refraction?

----------


## Stonegoat

I work as an OD in BC and opticians conduct "sight-tests" without any direct or indirect supervision by an OD or MD.  Essentially a refraction is performed without any ocular health assessment.  Is pathology missed?? Absolutely.  I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received.  They were NOT refered by the "sight-testing optician, but came of their own accord.

I completely aggree that opticians can and should be trained to refract.  I think it's inevitable, and a reasonable scope expansion.  I however, do not agree with the concept of fragemented eye care, and I think a refraction should always be in conjunction with an ocular health assessment by an OD or OMD.

----------


## Excalibur

Stonegoat-- great post. Thanks for the clarification.

----------


## Excalibur

which brings me to another observation....

refraction-only visits were the 'norm' decades ago. Going to this sort of scenario is regressive patient care. 

If you haven't looked inside the patient's eye, how can it be called an assessment? This is certainly is not in the patient's best interest.

There are many, many patients I see monthly that would be far worse off if all I counted on was refractive data to judge their eyehealth/visual prognosis.

----------


## Stonegoat

Exactly.....I would not sleep at night if a did refractions all day without assessing ocular health.  It is a rare day where I don't have at least one patient that presents to me thinking they only require new glasses, when the underlying etiology of their decreased vision is not refractive, but rather previously undiagnosed pathology.  What worries me is that many of these patients are correctable to 20/20.

Unfortunately, money is the underlying motivation for wanting to independently refract, and money is a powerful motivator.

----------


## tmorse

[quote=Stonegoat;215026]Is pathology missed?? Absolutely. I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received.  /quote]

What a canard!! Don't be mislead Optiboarders. Stonegoat and his OD colleagues already tried this gambit with the BC government, but government was not fooled. 

Refracting BC Opticians have various mandatory refraction protocols in place... no patients under 19 and over 65 allowed, and they reject patients suffering from glaucoma, diabetes, etc. These they DO refer to OD's/MD's (but obviously not Stonegoat) for proper eyehealth assessment and patients sign a Card indictating that they know they are not receiving an eyehealth assessment. Also, anyone who can't be refracted to 20/20 is automatically  sent to a Doctor. See www.cobc.ca for Sight-Testing Protocols mandated by the regulatory College of Opticians of BC.
A simple 'sight-test' refraction is not and has never been presented as a medical assessment or eyehealth diagnosis. Mandatory three (3)-million ($3,000,000.00) Errors & Omissions liability insurance is still only *$75.00/year*, only because of the paucity of caselaw on this issue. Three (3) years ago it was 10,000 patients who  received a free sight-test in BC. Today that figure is probably 15,000 satisfied BC's who haven't had any problems. 
But Stonegoat is correct about one thing... it is about the money.  :Rolleyes:

----------


## Excalibur

[quote=tmorse;215039]


> Is pathology missed?? Absolutely. I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received.  /quote]
> 
> What a canard!! Don't be mislead Optiboarders. Stonegoat and his OD colleagues already tried this gambit with the BC government, but government was not fooled. 
> 
> Refracting BC Opticians have various mandatory refraction protocols in place... no patients under 19 and over 65 allowed, and they reject patients suffering from glaucoma, diabetes, etc. These they DO refer to OD's/MD's (but obviously not Stonegoat) for proper eyehealth assessment and patients sign a Card indictating that they know they are not receiving an eyehealth assessment. Also, anyone who can't be refracted to 20/20 is automatically  sent to a Doctor. See www.cobc.ca for Sight-Testing Protocols mandated by the regulatory College of Opticians of BC.
> A simple 'sight-test' refraction is not and has never been presented as a medical assessment or eyehealth diagnosis. Mandatory three (3)-million ($3,000,000.00) Errors & Omissions liability insurance is still only *$75.00/year*, only because of the paucity of caselaw on this issue. Three (3) years ago it was 10,000 patients who  received a free sight-test in BC. Today that figure is probably 15,000 satisfied BC's who haven't had any problems. 
> But Stonegoat is correct about one thing... it is about the money.


Perhaps it's time for pharmacists to be permitted to dispense HBP meds on the basis of an automated BP measurement?

If a patient is sight-tested for a number of years and never has a retinal or glaucoma assessment... and the asymptomatic condition worsens due to delay, have we improved this individual's situation? Hardly.:finger:

Sight-testing has not been designed for the greater good of patients, but rather for the greater good of commercial interests. A hundred years ago, the ophthalmic professions moved forward by taking refraction out of the back of jewelery and optical shops and rightly association with a comprehensive oculo-visual assessment. Fragmenting this care into independent sight-testing does little to improve the evolution of eye care for patients.

----------


## Stonegoat

I have seen many patients post "sight-test" who have had problems.  I'm sure I'm not the only OD who has.  When a patient presents to an optometrist for an eye exam, they are evaluated under the SOAP (subjective, objective, assessment, plan) format.  This format, for the most part, ensures optimum patient care.  Without an ocular health assessment, the objective, assessment and plan will be incomplete, or completely incorrect.  

I understand sight-testing opticians will never understand what it is an optometrist really does during the course of an exam.  I would not expect them to.  

By the way, what is a "canard"???  Is that a term for a well-endowed, highly sophisticated, incredibly handsome man??  If so, when did we meet??

----------


## LandLord

I hear OD's use the term "fragmentation of eyecare" to describe refraction being performed as a solo service.  You also suggest it's a regression of care.  Quite the opposite, it's a progression of care if you look at the direction history has taken.

A better term would be "divergence of eyecare."

All disciplines diverge into new specialties over time.  It's a basic law of the universe.

In the old days, all medically related disciplines were practiced by general medical practitioners.

Today we have many disciplines.

Allergy & Immunology
Anesthesia
Cardiology
Dermatology
Emergency Medicine
Endocrinology 
Family Medicine
Gastroenterology
Geriatric Medicine
Gynecology
Gynecologic Oncology
Hematology
Infectious Disease
Internal Medicine
Neonatology
Neurology
Nephrology
Neurological Surgery
Obstetrics and Gynecology
Oncology
Ophthalmology
Orthopedic Surgery
Otorhinolaryngology
Pathology
Pediatrics
Physical Medicine and Rehabilitation
Plastic Surgery
Podiatry
Preventative Medicine
Psychiatry
Pulmonary Disease
Radiology
Radiation Oncology
Rheumatology
Sports Medicine
Surgery

Of course, this is only a partial list that doesn't include sub-specialists like

Chiropractors
Dental hygienists
Dental technicians
Dentists
Denturists
Dieticians
Hearing aid dispensers
Massage therapists
Midwives
Naturopathic doctors
Opticians
Optometrists
Pharmacists
Physical therapists
Podiatrists
Psychologists
Nurses

Of course this is also only a partial list that does not include sub-sub-specialities even within a speciality.


Within ophthalmology you have

Cataract specialists
Retinal specialists
Lasik specialists

Within optometry you have

Low vision 
Pediatric vision
Lasik center optometry

Within opticianry you have

contact lens specialists
sports vision
fashion eyewear


Why is this the case?  The more that is learned about the human body, the more specialists are needed to practice the new disciplines.  Imagine one medical practitioner trying to provide care in all of the above areas.  As ophthalmology branches off into new surgery fields and optometry expands its scope into medicine, there are more new eye-related specialties than there are eye-related specialists.  I repeat, THERE ARE MORE NEW EYE-RELATED SPECIALTIES THAN THERE ARE EYE-RELATED SPECIALISTS.  We need to add one more specialty to the list.  Refracting optician.

----------


## Golfnorth

> He is a bad example for an optician, didn't he get his license pulled?


Yes Bruce Bergez's liscence is has been revoked.

Regards,
Golfnorth

----------


## Stonegoat

I agree, I have no problem with opticians refracting.  But only with a concurrent eye health assessment.  There are many specialties, sub-specialties, etc.  However, if a patient has seen an oculoplastics surgeon, the patient has likely been triaged to that specialist by another individual, fully capable of determining the best treatment /referral options for the patient.  This is done by an exam under the SOAP format, irregardless of the specialty.  Treatment decisions made by an individual that cannot obtain all the neccessary objective data, such as an independent sight-testing optician, leaves an unacceptably high risk of missed pathology.  

Any statement otherwise would be a "canard"....new word of the day!!

----------


## LandLord

Stonegoat, can you please elaborate on "obtain all the necessary objective data?"

----------


## tmorse

> I have seen many patients post "sight-test" who have had problems. I'm sure I'm not the only OD who has.
> 
> By the way, what is a "canard"??? Is that a term for a well-endowed, highly sophisticated, incredibly handsome man?? If so, when did we meet??


I am sure the same can be said by many OMD's that have seen OD patients post "eyehealth assessments" who have had problems. You're also forgetting the role of the patient's primary health care provider, his/her family physician. Patient with all these listed medical ailments have no doubt already visited their own GP.

You're also forgetting recent advances in refraction technology, producing equipment that make for very accurate and consistent refractions. Just think...many years ago it was routine for a MD it taste a person's urine for sweetness in order to detect diabetes.  Bloodwork and strips can do it now. 

As for the word 'canard', obviously you are not overly 'erudite'. Perhaps you might request a dictionary for Xmas.:D

----------


## Excalibur

Let me take the liberty of providing some clarification. I think Stonegoat means retinoscopy, ophthalmoscopy/binocular and monocular, tonometry, pupillary tests, pachymetry, etc etc. This would cover most primary methods of acquiring objective data. There would of course, be other important clinical testing, such as binocular testing, visual field analysis, and other forms of imaging. Perhaps Stonegoat could expand on this if I missed anything.

----------


## Stonegoat

Tmorse,

If an individual, say 43 years old presents for a sight-test complaining of blurred vision, and you correct them to 20/20 with an increase in hyperopia of +0.50 D OD and +1.00 D OS, you will think that the person simply requires the hyperopic correction to alleviate symptoms.  I doubt you would refer this patient out, especially if their old Rx is several years old.

An OD would refer this patient out because during the course of the examination, while obtaining all of the objective data to formulate an appropriate assessment/plan, an amelanotic choroidal melanoma would have been detected in the left eye, the elevation of which was resulting in a hyperopic shift.

This is not a hypothetical patient, but one I saw last year.

I know that primary melanomas and secondary cancers are very rare in the eye, but they do happen.

Also, on numerous occasions I have sent patients to their GP for testing who had serious undiagnosed systemic disease. 

Anyway, I could give example after example of why eye care should not be fragemented, and I would not change any sight-testers mind.

----------


## Barry Santini

For me, however, I think that:

1. If you believe that opticians who refract (and/or the refraction itself) SHOULD NOT be separated from eye health assessments, then you MUST legislate out the "self-refraction" by the public for selecting their own OTC readers and (now) bifocals. This, of course, protects the welfare of the public's vision (and Dr.s practices?)

2. Or...As long as the lay public can "prescribe/refract" for themselves...well then so should I (with, of course, the proper accreditation).

My two cents

Barry

----------


## HarryChiling

Stonegoat,

I am glad you mentioned some of these issues as it seems the opticias are one step ahead of you.
http://www.cobc.ca/my_folders/Forms/Form%203%20Brochure%20Client%20Notice%20on%20Automated%20Ref  raction.pdf



> An automated refraction/sight test is not a regular eye health examination.
> 
> Because eye health conditions or other illnesses will not be found through an autmoated refraction/sight test, it is important that you have regular eye health examinations.


That is the first few lines from the client notice brochure. So the opticiasn like you have mentioned do see the need for the eye health assesment. The brochure also exaplains in more than one area in *BOLD UNDERLINED CAPS,* that a automated refraction/sight test is not and eye health examination. This brochure must be signed by the opticians that it was discussed with the p[atient and a copy must be provided to the client.

I don't agree that refractions being done seperately by an optician is fragmented eye care, I fell it is the opposite. More people will likely go to see their opticians for regular sight testing if they didn't have to go through all the other procedures which gives the opticians more of an opportunity to recommend an examination. It creates an enviornment where the opticians doesn't have to compete with the optometrist allowing them to work together more closely on making sure the cleint recieves the proper care.

----------


## HarryChiling

> Just think...many years ago it was routine for a MD it taste a person's urine for sweetness in order to detect diabetes. Bloodwork and strips can do it now.


mmmmmmmmmmmmm.............sweet urine, the perks of the job.:D  I had a buddy back in middle school who used to eat or drink anything for $1.00, maybe he's the guy they send urine to when they call for lab work.  He would be the designated tester.

----------


## Stonegoat

I really do agree Harry, that there are ways that ODs and opticians could work together.  I am all for that.  However, in BC it has been my experience that patients always underestimate the time since their last eye health exam.  In addition, some opticians disregard their own guidelines.  I have even seen patients who have received glasses from a sight test who have _never had an eye exam._

I had a monocular patient (had a prosthesis) who had glaucoma in the other eye who came to me for a second opinion on the glasses he received from a sight test.  He had not seen an eye Dr. in 3 years.

How do we solve this??  I'm not trying to stir-up sh!t, but this is the reality.

----------


## Stonegoat

By the way Harry, I have a licensed optician on staff, and pay her well for her expertise.  She and I work far more like partners than employee-employer.  My hunting partner is also an optician, and he owns his own lab, which, we as well as many others utilize.  I do respect opticians, but before they can perform stand-alone refractions, more effective checks and balances must be in place to ensure patients don't slip through the cracks.

A waiver just doesn't cut it, because patients might not have any idea of why an eye exam is important.

----------


## HarryChiling

> By the way Harry, I have a licensed optician on staff, and pay her well for her expertise. She and I work far more like partners than employee-employer. My hunting partner is also an optician, and he owns his own lab, which, we as well as many others utilize. I do respect opticians, but before they can perform stand-alone refractions, more effective checks and balances must be in place to ensure patients don't slip through the cracks.
> 
> A waiver just doesn't cut it, because patients might not have any idea of why an eye exam is important.


I am under the impression that sight testing is still a new thing in BC as well, their will be bugs to work out and unfortunately growing pains.  It's not perfect yet, but they are working on it and doing a good job.  I don't know if it would be realistic to catch every case coming through the door, I am sure none of the O's has a 100% batting average.  I would personally put more responsibility on the patient in the case you gave above, a patient with one eye and glaucoma in the other eye should know better.  The arguement could be made that the doctor didn't impress upon the patient the importance of routine health examinations, but that would be speculation.  The patient made a bad choice in that case and their shoudl be checks in place to prevent that, the form does ask if they have glaucoma, I guess the patient ignored that or the optician failed to go over the form properly.

I do like a checks and balance in place, but what suggestions could be made to improve the system?

----------


## Stonegoat

Harry,

As you well know, many patients are not particularily sophisticated when it comes to their eye health, or health in general.  Stating that a patient should know better, and seek the appropriate professional to address their issues is very much a "buyer beware" mentality.  It should not be the patients responsibility to ensure that they are receiving care from a qualified professional....thats what the various colleges and boards are for.

As for recommended checks and balances, I think that opticians must align with non-dispensing ODs or OMDs and arrange for patients to have an ocular health assessment within a short time of the refraction.  The ODs would be happy for the business, and their would be no competition, and the patient would be served well with no fragmentation of the eye care.

----------


## HarryChiling

> Harry,
> 
> As you well know, many patients are not particularily sophisticated when it comes to their eye health, or health in general. Stating that a patient should know better, and seek the appropriate professional to address their issues is very much a "buyer beware" mentality. It should not be the patients responsibility to ensure that they are receiving care from a qualified professional....thats what the various colleges and boards are for.
> 
> As for recommended checks and balances, I think that opticians must align with non-dispensing ODs or OMDs and arrange for patients to have an ocular health assessment within a short time of the refraction. The ODs would be happy for the business, and their would be no competition, and the patient would be served well with no fragmentation of the eye care.


Sounds good in theory but hasn't worked in the states, it's not buyer beware. The alternative is the patient doesn't go most of the time. I can't tell you how many times we have had patients avoid the examination because they hate the drops or applanation, or neumatic (even worst). So they avaoid their OD's or OMD's like the plague. If they were to see their optician for a refraction the arguement could be made that at least if they were not able to get them to 20/20 or they saw something on the form that didn't jive they would recommend they see a qualified professional for a full health evaluation. 

Both sides have a valid point, but you have to understand that both me and you are one sided as we both want whats good for our profession and often times we use the terms best for the patient, or better care as guise for best for our profession. I am not saying that this is your intention, but it sure does tickle a funny bone in my arm.

Who are we to say it's good for the patient, you see them as avoiding you because they have me. I see them as having another opportunity to see a you because they have me.

Let's just agree to disagree on this one as our professions haev always done in the past. I am lookign forward to the day when the US adopts some of these Canadian standards in our country, because in the states our biggest opposition (our beign opticians) has been optometry and it has not lead to better patient care, but the opposite.




> By the way Harry, I have a licensed optician on staff, and pay her well for her expertise. She and I work far more like partners than employee-employer. My hunting partner is also an optician, and he owns his own lab, which, we as well as many others utilize. I do respect opticians, but before they can perform stand-alone refractions, more effective checks and balances must be in place to ensure patients don't slip through the cracks.


It wasn't that long ago that opticians in the states had that same respect from OD's and OMD's, but the business changed. For one an optician relies on scripts to maintain a business.

Here are some things that don't benefit the patient that are law in many of our states:
Opticians cannot hire doctors.Doctors don't have to hire licensed opticians.Their are still loop holes in our Eyeglass Rx release rule that a few take advantage of. (similar arguement to the guy Burgez being an optician we don't like him, but he is one of us and he hurts us)Doctors in some states can prescribe lens options and it is considered part of the script. (this is often used as an advantage to keep scripts in house or avaoid the patient price shopping)I don't know of one advantage an optician in the states has over and OD or OMD and the advantages that the OD's and OMD's have over the opticians in the states is more centered around economicla advantages and often does nothing for the patient as far as care is concerned.

----------


## Stonegoat

Harry,

ok..lets agree to disagree.

Please do not assume that I am against opticians doing stand-alone refractions for economic reasons, although I am sure that many ODs are concerned about that.

There is a sight-tester in the town where I practice, but he has little or no impact on me.  I am almost always fully booked or over-booked, and do almost $1.5 million/year.  My biggest competition for dispensing, by a wide margin is an independent *non-sight-testing optician* who works down the street.  She sends patients to me who require a prescription and I *NEVER* offer to sell glasses to patients she sends to me.  I would say she makes about $20,000/month from my prescriptions.

The sight-tester isn't as busy as either of us.

----------


## HarryChiling

> Harry,
> 
> ok..lets agree to disagree.
> 
> Please do not assume that I am against opticians doing stand-alone refractions for economic reasons, although I am sure that many ODs are concerned about that.
> 
> There is a sight-tester in the town where I practice, but he has little or no impact on me. I am almost always fully booked or over-booked, and do almost $1.5 million/year. My biggest competition for dispensing, by a wide margin is an independent *non-sight-testing optician* who works down the street. She sends patients to me who require a prescription and I *NEVER* offer to sell glasses to patients she sends to me. I would say she makes about $20,000/month from my prescriptions.
> 
> The sight-tester isn't as busy as either of us.


It sounds like you are a very honorable guy/gal, I wish we had more like you.  I have worked in a practice where the doctor would say to us in front of the patient that we are sending them back to the doctor, but would scould us behind closed doors if we didn't try to sell them.

----------


## tmorse

> ... I know that primary melanomas and secondary cancers are very rare in the eye, but they do happen. Also, on numerous occasions I have sent patients to their GP for testing who had serious undiagnosed systemic disease... Anyway, I could give example after example of why eye care should not be fragemented, and I would not change any sight-testers mind.


Point taken... but as to serious undiagnosed systemic diseases missed by the GP, who knows all the facts...what symptoms were presented to the Dr. that were supposedly missed? My 86-year old neighbour would boast that he has never visited any doctor in his life. So the patient does need to accept some responsibility for his health. 

IMHO your insistence on a comprehensive eye health exam every time a person is tested for a change in Rx is similar to a GP insisting on a complete physical medical exam every time the patient presents at his office with the sniffles. 

Sight-testing protocols and procedures may need some tweaking from time to time, and I am sure our regulatory College of Opticians of BC will be up to the task. It's probably the same with your relatively new use of Therapeutic Pharmaceutical Agents (TPA's), that OD's were granted the right to use not so long ago.  

And you are probably correct when you suggest that nothing you say will change sight-tester minds, just as nothing they can say will change your
own mind.:cheers:

----------


## mike.elmes

Screening clients is key, and a part of the regiment used in either BC or Alberta. Part of the form we get the client to read and sign clearly states that:

A SIGHT TEST IS A TEST TO DETERMINE WHETHER GLASSES ARE NEEDED.
IF GLASSES ARE NEEDED A SIGHT TEST WILL DETERMINE THE NECESSARY PRESCRIPTION.

A SIGHT TEST IS NOT A MEDICAL EYE EXAMINATION AND WILL NOT DETERMINE THE PRESENCE OF EYE DISEASES.

IF YOU SUFFER FROM DIABETES OR HAVE ANY EYE DISEASE, A MEDICAL EYE EXAMINATION BY AN OPTOMETRIST AND OR AN OPHTHALMOLOGIST IS RECOMMENDED.

IF YOU ARE UNAWARE OF ANY MEDICAL CONDITION AFFECTING YOUR EYES, A MEDICAL EYE EXAMINATION FOR ADULTS IS RECOMMENDED BY THE AMERICAN ACADEMY OF OPHTHALMOLOGY AS FOLLOWS:

 Once or twice before the age of 40
Every two to four years from age 40 to 60
Every one to two years after the age of sixty
All criteria above applies to adults over the age of 18

We screen thoroughly and follow these exact guidelines.
We do not test children or seniors or anyone not previously tested in the past 4-5 years by an Optometrist or Ophthalmologist.
We do not test Diabetics or people with prismatic prescriptions.
It has worked with incredible success for us.

----------


## AdmiralKnight

You know, after reading this thread, I've realized it's been my ignorance on the subject more than anything giving me the opinion stated earlier... those guidelines sound great. I especially like the part about not testing anyone who hasn't had an exam from an OD for 4 years.

----------


## tmorse

> mmmmmmmmmmmmm.............sweet urine, the perks of the job.:D


LOL:D Harry... you are one sick puppy at times.

----------


## HarryChiling

> LOL:D Harry... you are one sick puppy at times.


So next time an optician tells you he used to have to grind lenses down by hand you can tell them it's a heck of a lot better than his doctor having to taste urine all day.:D

tmorse I can't help it that was just funny and a great example of why we don't do things the way we used to.

----------


## Barry Santini

> I would say she makes about $20,000/month from my prescriptions


Correction, I would say that she makes about $20K/mo _from her own sweat_ fulfilling those corrections.

Barry

----------


## Golfnorth

> It sounds like you are a very honorable guy/gal, I wish we had more like you.  I have worked in a practice where the doctor would say to us in front of the patient that we are sending them back to the doctor, but would scould us behind closed doors if we didn't try to sell them.


OK Stonegoat very honorable to send the patient back to the optical store down the street that referred the patient to you. My question is what happens in two years when the patient books an eye exam with you after your recall? Do you still send them back down the street or is it anything goes and you try to sell them glasses? If the latter is the case then you could be making the $20,000 per month back.

Regards,
Golfnorth

----------


## AdmiralKnight

I think that's an unfair question. For the first visit, the optical did the work to get those patients the exam. For the recall, the office did. Yes, the origional referral was from that optical, but if the optical was doing a proper job with THEIR recalls, then it wouldn't be an issue, and the patient should tell the office such.

----------


## Stonegoat

If the optician has created the kind of relationship with the patient that she should when she initially fills his Rx, then the patient will return to her without being prompted by myself.

----------


## tmorse

> If the optician has created the kind of relationship with the patient that she should when she initially fills his Rx, then the patient will return to her without being prompted by myself.


I agree with Stonegoat. The Optician had the opportunity to build the initial rapport. But if it becomes an issue, the Optician can always take the necessary training to offer in-house 'sight-testing.;)

----------


## HarryChiling

> I agree with Stonegoat. The Optician had the opportunity to build the initial rapport. But if it becomes an issue, the Optician can always take the necessary training to offer in-house 'sight-testing.;)


Ditto that, again it's hard to differentiate the business from what's good for the patient.  Choice is a good thing, if they went to the OD and liked their office better than maybe you need to update your office, if their staff was nicer then maybe you need to hire nicer staff.  I think stand alone refractions helps level the playing field a bit as the client no longer has to choose between the better refraction or the better glasses.

----------


## LandLord

The best way to solve the competitive advantage problem is for all opticians to go back to school to become OD's.  Then the only problem will be too many OD's.  Wait a second, we already have that problem so it's okay.

----------


## k12311997

> IF YOU ARE UNAWARE OF ANY MEDICAL CONDITION AFFECTING YOUR EYES, A MEDICAL EYE EXAMINATION FOR ADULTS IS RECOMMENDED BY *THE AMERICAN ACADEMY OF OPHTHALMOLOGY* AS FOLLOWS:
> 
> Once or twice before the age of 40
> Every two to four years from age 40 to 60
> Every one to two years after the age of sixty
> All criteria above applies to adults over the age of 18
> 
> We screen thoroughly and follow these exact guidelines.
> We do not test children or seniors or anyone not previously tested in the past 4-5 years by an Optometrist or Ophthalmologist.
> ...


It is just stupid little things that catch my eye.  In Canada you inform patients of the recommendations of the American Academy of Opthomology?

----------


## AdmiralKnight

We use ANSI standards too. :P

----------


## Stonegoat

Speaking of OD over-supply....I hear there is another optometry school starting in Texas.  I'm so glad I practice in Canada...we are much less saturated up here.  

With yet another optometry school, I wonder if ODs will start working at 7-11 or at gas stations.....maybe a free refraction with every fill-up??

----------


## wmcdonald

If there is such an over-supply, I wonder why salary levels continue to inch upwards, exceeding the cost-of-living index significantly? I do not see that heren in NC. On one hand, some indicate we do not have enough access to eyecare, and on the other we have an over-supply of eyecare oprofessionals of all types. What is that about?

----------


## HarryChiling

> If there is such an over-supply, I wonder why salary levels continue to inch upwards, exceeding the cost-of-living index significantly? I do not see that heren in NC. On one hand, some indicate we do not have enough access to eyecare, and on the other we have an over-supply of eyecare oprofessionals of all types. What is that about?


Too many OD's want to practice in the cities not enough want to provide eyecare in the boondies.  That's my take anyway.

----------


## eoptics

Surely, each professonal has its own roles.
Optician, Eye medical doctor and optometrist are  sharing its own  business area. Deciding its role, what should be considered primarily?
That should be the correction and cost in the side of vision patient.

Refinded vision check equipments have made opticians check vision more easily and correctly than any other.
That's why Ontario opticians got the role approved as their practice.
Also, in some other countries like South Korea, opticians have done vision exam for  fitting  spectacles.

In the side of  patients, if optician can do the vision exam correctly, the patient can save the extra cost because usually the cost will be resolved into spectacle's cost like South Korea. Also, it is very convenient for the patient to take all simple procedure on spot. 

In the U.S., I think that optician should have the role, also.

----------


## Oedema

I think many of you, particularly those outside of Ontario, are getting way ahead of yourselves.  The relevant documents from Ontario college and Association do no authorize _independent_ sight-testing by Ontario opticians.  Rather the document from the college merely lays out the standards of practice for opticians that do engage in refraction; part of that standard is _supervision_ either by an optometrist or physician and the requirement that patients undergo a full oculo-visual assessment by an optometrist or physician within the preceding 365 days.  If anything the standards of practice, as they stand, restrict sight-testing more than they enable it.

Now, what I find particularly peculiar is the patient consent form; according to the form is a patient has a family history of cataracts then the optician cannot proceed with refraction and must make an immediate referral to OD or MD.  Now, this alone would, given an accurate history from an informed patient, virtually eliminate all possible patients for optician performed refraction.

----------


## tmorse

> The relevant documents from Ontario college and Association do no authorize _independent_ sight-testing by Ontario opticians. ...the requirement that patients undergo a full oculo-visual assessment by an optometrist or physician within the preceding 365 days. If anything the standards of practice, as they stand, restrict sight-testing more than they enable it.


It appears like the Ontario College of Optometrists had a hand in the development of these Opticianry refraction standards of practice. 
Clearly the COO chose to re-invent the wheel, and NOT follow the BC/Alberta refraction model... who knows why. Too Bad. :Confused:

----------


## Oedema

> who knows why


B/c they are following the directive of the Minister of Health and the recommendations of the HPRAC report:




> That the Minister issue a new direction to the College of Opticians
> of Ontario requiring it to develop a standard of practice limiting
> the authority of members who perform refractometry to those
> circumstances where such refracting is undertaken in collaboration
> with an optometrist or a physician for the purpose of informing a
> comprehensive ocular assessment;

----------


## Refractingoptician.com

Why would anyone want an optician to refract them if they have already had an optometrist or MD or ophthalmologist do it within 365 days ?

Now just what possible kind of sense does that make ??

The only sense it can make is either political or BS. Whoops sorry , I thought the two were different , but then there is only one reason.

----------


## Barry Santini

> Why would anyone want an optician to refract them if they have already had an optometrist or MD or ophthalmologist do it within 365 days ?
> 
> Now just what possible kind of sense does that make ??


It makes perfect sense...especially if the refractionists around you are less than skilled:
1. ODs
2. MDs
3. Techs in #1 or #2

Since *I* have to do the clean-up and absorb the expense of when an Rx does not meet my client's satisfaction, then I think I should be able to derive the numbers myself.  Of course, I don't want my visual assessment taking the place of a proper, periodic eye *exam* done by a medical professional.

As I see it, there is no reason that a skilled Optician *should not* be able to refract in this type of context.

Barry

----------


## Refractingoptician.com

..

----------


## Just Optician

Opticians foot the bill for doctor's errors because if the doctor had them remade due to his/her error they would blame the lab and expect them to foot the bill.  This is where another conflict of interest exists.  If the doctor made an error it's the lab's fault or the optician's where you got them.  If I check the doctor's work and criticize it will be more difficult to get an rx from that doctor in the future.  So we just remake and expect the labs to foot the bill that we end up paying for in the end.   If we were to refract our office would be judged on our ability to refract and our ability to make a good pair of glasses.  It would be nice to be in control of my own destiny for good or for bad.

----------


## Barry Santini

> What you are describing is different


But, although I agree with you in principle, we all know that eyewear is sooo much more complex than just "filling the Rx", as commoditized pharmeceuticals do.

I think that a properly-trained, refracting optician is necessary today if opticians are going to keep eyewear with each-client's "sweet-spot".

Barry

----------


## tmorse

[quote=tmorse;215149]
Insistence by OD/OMD on a comprehensive eye health exam every time a person is tested for a change in Rx is similar to a GP insisting on a 'comprehensive physical' medical exam every time the patient presents at his office with the sniffles. /quote]

Obviously this point wasn't stressed to the Health Minister. Even requiring that every second (2nd) refraction be performed by a OD/OMD would have ensured a modicum of safety to the patient's eye health.

Given the terms of reference from HPRAC for three (3) O agreement on Optician refraction protocols, I am surprised that *any* Refraction Standards of Practice agreement was achieved at all. 
Its much like the farmer insisting that the fox be included in determining security arrangements for the henhouse. 
Clearly, the COO believes that a flawed refraction arrangement is better than no arrangement at all. Perhaps Bruce Bergez and his Great Glasses chain will find a way to make these refraction protocols workable. :idea:

----------


## HarryChiling

When I was younger my parents told us, "A bird in the hand is worth two in the bush"

As I got older I heard the true story about a state that was trying to get licensure and had everyone in agreement that it was a good thing, but then someone decided that opticiasn should also be able to fit contact lenses (whihc I agree with), then things got a little messy and they didn't get licensure for the state since optometry felt that opticians should not be allowed to fit contact lenses, apparently to this day they have no licensing. I forget who told me that and whihc state it was, but I am sure opticians here would know.

The way I see it is, thank goodness you got refraction no matter what the stipulations are, you iron out the details later.  Congratulations, this is the trickle bfore the dam breaks.:cheers:

----------


## Refractingoptician.com

With a willing student and a great teacher , how long would it take to learn to refract and at what cost and would it fit the present standards ?

----------


## HarryChiling

> With a willing student and a great teacher , how long would it take to learn to refract and at what cost and would it fit the present standards ?


Last I checked here in the states Dr Warren McDonald taught a two day crash course on the basics which would cover refracting procedures, from there of course you would need as much practice to gain the skills to be proficient (different for everyone).  I think it was $250.00 of course with a minimum amount of students.  I don't know if it would meet the requirements of your country though, but you could check with him he's a member of this board and listed in the speakers section.

----------


## Laurie

Hello,

While Warren and his course are both fabulous (Hi Warren!), it is unlikely that it would be enough time.

Here in the US, when OD's went for DPA and TPA privilages, they modeled a 100 hour course.

Years ago, I took the OAA refractometry course, and it was 100 hours, and cost $1,500.00.

Presently, I teach refractometry theory, lab I and lab II, and the total time I spend with students is 106 hours, over three semesters.

: )

Laurie

----------


## wmcdonald

The weekend courses I have been doing are introductory only. To adequately teach the subject matter, we will need somewhere between 80 and 100 hours, to include some outcome analysis (testing) indicating that the student has successfully gained an understanding of the material. 

That said, I have been generally pleased with the quick grasp large numbers of those at the Southeastern had of the material. I also was impressed with the quick understanding of those in Allentown.

----------


## tmorse

> ....I hear there is another optometry school starting in Texas.


Can you provide any details on this new Optometry school in Texas? :Confused:

----------


## Oedema

> Can you provide any details on this new Optometry school in Texas?


UIW (University of the Incarnate Word), Austin, TX

----------


## tmorse

> To adequately teach the subject matter, we will need somewhere between 80 and 100 hours, to include some outcome analysis (testing) indicating that the student has successfully gained an understanding of the material.


Number of hours is never mandated by accreditating agencies, including the COA, so that educators can be innovative and make good use of emerging technologies and such. 

I also took the 100 Hour OAA Refractometry program and it was a wonderful experience. However, a significant portion of that program included 'retinoscopy'. While retinscopy is used for babies or the bed-ridden, today's sight-testing protocols in Canada preclude these categories of patients. And todays automated refractors provide an accurate and consistent starting point for a phoropter refraction, so that refining of the RX can take place.

So maybe Warrens 80-100hrs could be pared down to 60-80hrs... who knows. The important determination should be 'demonstrated competencies', and the number of hours in a particular program should not be an issue. In Warren's words, the program..."to include outcome analysis (testing)". If the students can do it, then the refraction program has merit, regardless of length. :cheers:

----------


## wmcdonald

Some students may be able to read a textbook and do a bit of experiential learning and go do a competent refraction. In my experience however, it is important to teach some of the ancillary things surrounding the refraction in addition to spinning dials. We review anatomy and physiology, and basic optics among other things. Retinoscopy is one of the things we teach and is the most widely used objective technique employed by refractionists in the US. It takes time to become proficient, and I do feel some minimum time is required to achieve a thorough understanding of the process.

I also understand that in Canada Opticians are using automated systems to refract, but I also think that learning the history and additional methods will only support their knowledge of the process. I have more of an interest in developing professionals than technicians.

----------


## tmorse

> Retinoscopy is one of the things we teach and is the most widely used objective technique employed by refractionists in the US.


 

Well Optiboard optometrists, let's hear from you... is retinoscopy still so widely used in your practice, or do you start from the person's previous Rx or from an automated Rx?

----------


## tmorse

> I have more of an interest in developing professionals than technicians.


If you think the Canadian sight-testers are non-professional, why are you shilling for the NAIT program in Texas and who knows where else. Get off your high-horse.:hammer:

----------


## Excalibur

> Well Optiboard optometrists, let's hear from you... is retinoscopy still so widely used in your practice, or do you start from the person's previous Rx or from an automated Rx?


Depends on several factors such as the age of patient and the age of practitioner. Younger patients can yield better data with a retinoscope, and older practitioners are often better at using retinoscopy to determine an objective refraction than a younger doctor. 

Anyone can learn to refract. Anyone can learn to take blood pressure. It's how the data you collect 'fits in' to the whole management plan that matters most.

----------


## Stonegoat

I use my retinoscope every day.  I find it more accurate than the autorefractor.  I am also able to glean other valuable information from retinoscopy such as clarity of the media, latent hyperopia, corneal ectatic disorders, etc, etc.  I think those who are proficient in retinoscopy would agree that it is a very useful tool.

JP

----------


## wmcdonald

> If you think the Canadian sight-testers are non-professional, why are you shilling for the NAIT program in Texas and who knows where else. Get off your high-horse.:hammer:


NAIT's program teaches the materials I described, and in fact is a well-developed program of study. I do not, in any way, feel that Canadian Opticians trained in sight-testing are not professional; far from it! I feel they are ahead of us here in the US. I do consulting in the US for NAIT, and think they have a program that may be valuable to states in the US without an academic program, if that is any of your concern. 

Technicians are those who do things in rote fashion, and often do not have an understanding why. Professionals are well-versed in their field of study, and have a broad and deep understanding, the why, instead of just the "what" related to their work. I have often complimented Canada's Opticians on this forum, and in my many lectures in Alberta, so I do not in any way mean to say they are not professional.

----------


## Laurie

Hi Ted,

I agree with Warren, that basic prinicples in retinoscopy are essential. Once opticians learn the basics of with/against motion/sissor motion/ect., getting an objective starting point is quick and efficient. We can spend a couple of weeks on the principles, show streak/spot (does anyone do spot anymore?) retinoscopic reflexes, and add appropriate lenses (in the phoropter) to neutralize motion. Many optical professionals can get to neutrality as fast as it takes to set up the auto-refractor and click. Either method can yield a decent objective finding.

As you know, the patient (brain) cannot tolerate lenses based on objective findings...we need subjective refinement. (thank goodness, or we could be replaced by vending machines).

The Brain needs to be asked:

Which is better, one or two.

Automation cannot replace the human discernment of the brains' comfort in vision.


This is why additional time to practice this skill is essential... This is an art and a science.

All the best to you, 

Laurie Pierce (Hillsborough Community College)...

...funny chatting with you here...look forward to seeing you at a future NFOS meeting...

: )

----------


## tmorse

> Many optical professionals can get to neutrality as fast as it takes to set up the auto-refractor and click. Either method can yield a decent objective finding.


Hi Laurie: Nice to hear from you, too.
I dont teach sight-testing here at BCCO but I am familiar with the workings of the EYELOGIC system, which is used by most sight-testers here in British Columbia (and no, I dont own any shares). After the objective starting point is found with an auto-refractor, the sight-tester does a subjective refraction with the EYELOGIC system, using the same procedure you use with a manual phoropter, Which is better, #1 or #2' , duochrome, binocular balancing, etc. This EYELOGIC instrument was developed by a Calgary Ophthalmologist. Ive even seen the Topcon V1000? self-tester in use, and it proved to be a very accurate sight-testing instrument, too. 
The very young, the bed-ridden, the profoundly mentally challenged and those that cannot communicate... sure, use of a retinoscope is essential. But sight-testers do not and never will deal with such patients. And sure, the older, very experienced Optometrist may still use Copelands 1887 technology but as you indicated, an auto-refractor can give you a good objective starting point for your refinement, too. And as you know, some phoropters even have the capacity to automatically load the auto-refractor reading(s) to begin refinement.
I still remember the NFOS meeting when adding refraction to the 2-year AAS program was discussed. Some instructors were in a quandary... "What do I take out... to fit in refraction?"
So I must assume some nice to know topics were sacrificed to make room for 100+ hours of refraction, leaving the must know and should know opticianry topics alone. 

So I respectfully submit that, speaking from an sight-testing point of view, the day of retinoscopy has passed. As has mandating the number of hours to be taught in any topic.:cheers:

----------


## Laurie

Hi Ted,

The great thing about life is we can agree to disagree, and still be friends.

Prior to teaching refractometry, I spent a great amount of time shadowing refractionists and doctors ...the retinoscope is not dead. I believe it is important to include retinoscopy in a course, as the basics of retinoscopy mirror the basics of hand neutralization, which engages the opticians understanding. 

No, dear, we did not eliminate any of our curriculum to add refractometry. We increased our credit hours. Our AS is 72 credits, and I will tell you, that, in my opinion, it is all 'must know', none of it is 'nice to know'. I wouldn't waste my students, or my time teaching objectives that are not necessary for a well rounded optician.

Yes, technology has made great strides, I strongly believe, however, that we need the human discernment factor for quality results.

: )

Laurie

----------


## Stonegoat

Retinoscopy is NOT dead...not by a long shot.  I am a 2003 grad, and I use mine every day.  Once a practitioner gets proficient with retinoscopy, he/she will reach for it often.  
I use it on many, but not all patients.  However, if I'm having a difficult time refracting a patient, I always grab my retinoscope to see what is going on.

----------


## tmorse

> I use my retinoscope every day. I find it more accurate than the autorefractor. JP


More accurate??? How much more? 
And so what, you're *still going to refine the RX subjectively, aren't you, using your Phoropter?*  :Confused:

----------


## Stonegoat

Lets put it this way...I would prescribe my retinoscopy findings with good confidence if necessary...I would never prescribe off the autorefractor findings.

----------


## tmorse

> Hi Ted,
> 
> The great thing about life is we can agree to disagree, and still be friends.
> 
> I believe it is important to include retinoscopy in a course, as the basics of retinoscopy mirror the basics of hand neutralization, which engages the opticians understanding. Laurie


We will disagree on some things, and that's OK too. Personally I think including hand neutralization in your program does add 'nice to know' material to your course of instruction. We mention it here, but don't train students in its use. 

With respect to refraction, we have a couple of excellent 1 hr videos, in fact the same ones used in our OAA Refractometry course, so that our students know how the RX is determined, and one of these videos includes use and theory of the retinoscopy. We feel this exposure is adequate for a non-refracting Optician.   
So I agree, let us disagree but still remain friends.:cheers:

----------


## tmorse

> Lets put it this way...I would prescribe my retinoscopy findings with good confidence if necessary...I would never prescribe off the autorefractor findings.


Just so you realize that sight-testers here in BC have BOTH autorerafractors and EYELOGIC as a package. So they too do not 'prescribe off the autorefractor findings'.

----------


## Excalibur

> Lets put it this way...I would prescribe my retinoscopy findings with good confidence if necessary...I would never prescribe off the autorefractor findings.



And I doubt you would ever perform a refraction on a new patient without looking into their eye. 

Anyone can learn refraction. But separating a refraction from a comprehensive evaluation is inadequate and regressive care.

----------


## tmorse

> Anyone can learn refraction. But separating a refraction from a comprehensive evaluation is inadequate and regressive care.


I think I said it best in an earlier post...OD's requiring a comprehensive eye exam *every time an asymptomatic* person presents for a simple Rx update (good for business, isn't it) is like a GP requiring a comprehensive physical (along with the rubber glove:() every time a patient presents with the sniffles.;)

----------


## Oedema

Is a patient that presents for an "rx update" really *asympomatic*?  Blurred vision sounds like a a very real symptom to me - a symptom with many pathological differentials.

----------


## tmorse

> Is a patient that presents for an "rx update" really *asympomatic*? Blurred vision sounds like a a very real symptom to me - a symptom with many pathological differentials.


Ya...ya...ya...  Even government decided to no longer pay Optometry for most eye exams. They're not fooled by your 'blurry' rhetoric.:finger:

----------


## AdmiralKnight

A headache could be a brain tumor... or it could be just a headache. If your headache continues after aspirin, then you go get a more extensive exam. Blurry vision, more often than not, is just going to be an Rx change... if the blurriness continues after the new glasses are received, then you get a more extensive exam.

----------


## Oedema

> Ya...ya...ya...  Even government decided to no longer pay Optometry for most eye exams. They're not fooled by your 'blurry' rhetoric.:finger:


What does government insurance coverage have to do with anything? :hammer: It seems to be a favorite argument of yours, but it proves nothing more than the fact that provinces are only obligated by the Canada Health Act to pay for "medically necessary" care, this does _not_ include preventative care.

----------


## Excalibur

> What does government insurance coverage have to do with anything? :hammer: It seems to be a favorite argument of yours, but it proves nothing more than the fact that provinces are only obligated by the Canada Health Act to pay for "medically necessary" care, this does _not_ include preventative care.


Most of those who lobby for independent refraction have little or any clinical knowledge or experience. Opticianry would be far more ahead if these people placed accredited and credible education first, and legal changes second -- much like optometry did over the last 50 years to expand into ocular therapeutics. If they really wanted to do good for the people they see, they would learn refraction, learn pathology and become optometrists or ophthalmologists. Pharmacists are not lobbying for independent blood pressure diagnostic care so that they can measure BP and start rxing anti-hypertensives, yet some opticians lobby for independent refraction with the interest of providing better care. Nonsense.

A century ago, having a refraction only and calling it an 'eye exam' was all that we had. In the 21st century separating this procedure from an ocular pathology assessment does not do the patient any good. And don't give me the argument that if you have sniffles, why do a complete physical? Nonsense. Looking through a dilated pupil is hardly more invasive then getting your prostate massaged during a physical -- or so they tell me.

The independent refraction lobby is far more interested in commercialism rather than solid patient care and improving standards of care. They want to generate a quick lens power result, get people on their way and damn the consequences and damn what really is right to ensure that person is not in harm's way. :finger:

----------


## Just Optician

I assume then "Excalibur" that your are not in it for the money.  Why do you think we all do it.  You make assumptions that opticians haven't taken any courses on anatomy and pathology.  I have picked up on things here by talking to a patient about their symptoms,  this after they spent a half hour in a chair with an optometrist who missed the boat because they were intent on selling glasses ahead of doing what was best for the patient.  As well sometimes when an emergency arises (contact lens or otherwise) an appointment can't be had with an optometrist so they seek out opticians for their advice on how to proceed.  In our store if the patient has not had an exam in a long time we do strongly suggest to get their eyes re-examined before purchasing new eyewear with the knowledge that the optometrist will probably sell them new glasses.  We do provide an important service and many of us already have a lot of the underlying knowledge, we are only looking to exacting some control over our future while using this knowledge to it's full advantage.  Of course this is assuming that all opticians would know to refer when something is out of their league just like all optometrists are eager to do the same.

----------


## HarryChiling

> Most of those who lobby for independent refraction have little or any clinical knowledge or experience. Opticianry would be far more ahead if these people placed accredited and credible education first, and legal changes second -- much like optometry did over the last 50 years to expand into ocular therapeutics.


That's what's happening.  They are getting educated in refraction and yes from what I understand they do learn about pathology just not to the extent that optometrists do.  You could say the same about therapuetics optometrists don't get the same education in it that ophthalmologists do but you can now prescribe them.  I enjoy hearing an optometrists thoughts about opticianry but they are just that thoughts.  As an optometrists you have no place in saying what is in our scope of practice and your are naive to think that your scope will continually expand while opticians and all other professions will remain stagnant.

----------


## Excalibur

> I assume then "Excalibur" that your are not in it for the money.  Why do you think we all do it.  You make assumptions that opticians haven't taken any courses on anatomy and pathology.  I have picked up on things here by talking to a patient about their symptoms,  this after they spent a half hour in a chair with an optometrist who missed the boat because they were intent on selling glasses ahead of doing what was best for the patient.  As well sometimes when an emergency arises (contact lens or otherwise) an appointment can't be had with an optometrist so they seek out opticians for their advice on how to proceed.  In our store if the patient has not had an exam in a long time we do strongly suggest to get their eyes re-examined before purchasing new eyewear with the knowledge that the optometrist will probably sell them new glasses.  We do provide an important service and many of us already have a lot of the underlying knowledge, we are only looking to exacting some control over our future while using this knowledge to it's full advantage.  Of course this is assuming that all opticians would know to refer when something is out of their league just like all optometrists are eager to do the same.



The 'money' is not the carrot at the end of my motivational stick. Principle, professionalism and interest in eye care is what motivated me. During university I was fortunate to have been accepted into med and dental school, but choose optometry because my optometrist had a role in providing me with great care. True story.

Independent refraction is not in the best interests of PATIENTS, but may (in some cases) be in the best interest of CUSTOMERS. There is a fundamental difference between the two. For those of you who don't know the difference between a customer and a patient, think this one through.

Opticians need to have accredited, credible and standardized university-based education programs. If that isn't possible and you wish to refract, there are approximately 20 optometry programs that will allow you to provide excellent first-line primary eye care rather than be a sales person. This will allow you to refract, diagnose and treat patients rather than help customers choose lenses and frames. You will be able to provide high quality primary care safely and be thorough.

Suffice it to say, opticians do provide a valuable service to their customers, when it comes to assisting in designing a pair of spectacles. But let's not be disingenuous and say that you are performing an independent refraction to improve your client's quality of life, whilst furthering the advancement of eyecare provision in your community.

----------


## Barry Santini

> Most of those who lobby for independent refraction have little or any clinical knowledge or experience. Opticianry would be far more ahead if these people placed accredited and credible education first, and legal changes second -- much like optometry did over the last 50 years to expand into ocular therapeutics. If they really wanted to do good for the people they see, they would learn refraction, learn pathology and become optometrists or ophthalmologists. Pharmacists are not lobbying for independent blood pressure diagnostic care so that they can measure BP and start rxing anti-hypertensives, yet some opticians lobby for independent refraction with the interest of providing better care. Nonsense.
> 
> A century ago, having a refraction only and calling it an 'eye exam' was all that we had. In the 21st century separating this procedure from an ocular pathology assessment does not do the patient any good. And don't give me the argument that if you have sniffles, why do a complete physical? Nonsense. Looking through a dilated pupil is hardly more invasive then getting your prostate massaged during a physical -- or so they tell me.
> 
> The independent refraction lobby is far more interested in commercialism rather than solid patient care and improving standards of care. They want to generate a quick lens power result, get people on their way and damn the consequences and damn what really is right to ensure that person is not in harm's way. :finger:


I have to say, I agree with many of your points.  I can only hope, however, that you & other ODs share such passion when the subject of cessation of OTCs comes up...

Like I've said before, I see this issue from both sides

FWIW

Barry

----------


## tmorse

> A headache could be a brain tumor... or it could be just a headache. If your headache continues after aspirin, then you go get a more extensive exam. Blurry vision, more often than not, is just going to be an Rx change... if the blurriness continues after the new glasses are received, then you get a more extensive exam.


*Couldn't have said it better myself!!*

Get off your altruistic pot(s), Optometrists. What percentage of your gross receipts are generated by the optical dispensary in your office, 
40-60%? So unless you are employed by another, more-business savy Optometrist, this sight-testing dogfight is about the money. In most cases your patient becomes your CUSTOMER, you merchant!!! :Rolleyes:

----------


## HarryChiling

> *Opticians need to have accredited, credible and standardized university-based education programs.* If that isn't possible and you wish to refract, there are approximately 20 optometry programs that will allow you to provide excellent first-line primary eye care rather than be a sales person. This will allow you to refract, diagnose and treat patients rather than help customers choose lenses and frames. You will be able to provide high quality primary care safely and be thorough.
> 
> _Suffice it to say, opticians do provide a valuable service to their customers, when it comes to assisting in designing a pair of spectacles._ But let's not be disingenuous and say that you are performing an independent refraction to improve your client's quality of life, whilst furthering the advancement of eyecare provision in your community.


I love the way you chgange from patient to customer here.  I find it interesting that many OD's hire untrained staff and hand them a PD ruler and send them out on the dispensing floor with little knowledge.  That my friend is not improving the quality of the clients life.  I don;'t know if that happens in CA but it happens in the states.  The reason it happens is purely motivated by money.  I agree that to refract the education must be there, but again it is highbrow and plain ignorant to assume that only the optometry schools can teach refraction and since a full eye health examination can be performed without even spinning one lens in the phoropter it is a stretch to keep trying to group the two together like it can't or hasn't been done another way.  

I am glad OD's got their TPA and I am sure OMD's are a bit upset about it, and the arguement can be made that you should have went to med school (BTW it is very snobish of you to bring up that you could have went to med school but choose not to) and since you didn't you shouldn't be able to prescibe therapeutics.

The same arguements that have gained optometry expansion in scope of practice are now the same tools opticians are using to gain expansion in opticians scope.

----------


## HarryChiling

> In most cases your patient becomes your CUSTOMER, you merchant!!!


Hey hey hey, wait a minute there, you can't go around calling people merchants.:D

----------


## Barry Santini

> this sight-testing dogfight is about the money.


No...I disagree.  If "sight-testing was about money, then most places wouldn't:

1. Give away the exam *free*
2. Discuss *capture* ratios
3. Finagle Rx "hand-offs"
4. Discuss how Dr.s can/should recommend from the chair...or on the Rx.

No, it's really about the who sells the eyewear...where the real money is.

Exams (or more properly, refractions), for me, are about getting the best vision I can for my clients.

Barry

----------


## HarryChiling

> No...I disagree. If "sight-testing was about money, then most places wouldn't:
> 
> 1. Give away the exam *free*
> 2. Discuss *capture* ratios
> 3. Finagle Rx "hand-offs"
> 4. Discuss how Dr.s can/should recommend from the chair...or on the Rx.
> 
> No, it's really about the who sells the eyewear...where the real money is.
> 
> ...


I agree, it is nice to hear that and it is a great perspective.  It would be nice to have an optician who cares to refract.

I have had cases where I have made lenses for high myopes (-21.00 and above) I will often use lenticulars on high index stock and send them out for AR coat.  The labs I use woud charge a fortune for these so I do them in house and send them out.  The patients reactions are usually one of joy since they often get lenses that look better than anything they have ever seen.  I am usually proud of the work and like to dispense these personally and ask they only come in when I am there to dispense.  Sometimes and it happens more than I would like, the atient immediately puts them on and has issues seeing, now keep in mind if I am going to spend that much time on the lenses I have sepent that much time on the fit as well (VD, mono PD's etc.) when the doctor changes the Rx and I have had ones change the Rx by (0.50, or 2% which meets ANSI standards), I have had doctors opps wrote the cyl wrong.  If I was allowed to refract this person would immediately get re-refracted just so that I can be confident that the Rx meets or exceeds the patients expectations.

Oh, it's about money alright.  I lose money and the patients confidence when a doctor just gives a haphazard refraction.  And when I make a lens that requires my time and effort I get really really PO'd that some nitwit playing doctor is messing up my craft.

RANT MODE OFF

(All OD's or OMD's don't fall into the above mentioned boat just as all opticians don't fall into the untrained boat so lets stop with the generalities and accept reafraction for what it is the neutralization of optical errors)

----------


## Excalibur

"(All OD's or OMD's don't fall into the above mentioned boat just as all opticians don't fall into the untrained boat so lets stop with the generalities and accept reafraction for what it is the neutralization of optical errors)"


Of course refraction is the neutralization of optical errors. That is not in dispute. It is the act of routinely separating this act from the rest of the diagnostic procedures that are part of the management plan that is not in the patient's best interest. 

Laws are written to protect the majority of individuals from the harmful acts of a minority. Thus, preventing independent refraction by law or regulation is necessary and should continue. Routine independent refraction is not designed for the 'better good' and does not, in the big scheme of things, improve patient welfare and care.

Sorry... got a run now and spin some dials... after all, isn't this what optometrists only know how to do?? :hammer:

----------


## HarryChiling

> Laws are written to protect the majority of individuals from the harmful acts of a minority. Thus, preventing independent refraction by law or regulation is necessary and should continue. Routine independent refraction is not designed for the 'better good' and does not, in the big scheme of things, improve patient welfare and care.


Just to give you a heads up, no educated individual is going to use this as a valid or even logical reason.  You can't argue that since it's a law it shoudl be a law that in itself is assinine.  If we were to use your same logic, since now refraction is being allowed and the law is changeing then it should be allowed and since OD's are now the minority fighting it from happening, the majority (opticians) that is fighting the minority (optometry) to prevent harmfull acts.:hammer:

I'd stay stick to spinning dials, it may be the only thing you know how to do.:D

----------


## HarryChiling

BTW, to end the arguement about the harmfull for patients, clients, customers.

http://www.canlii.org/eliisa/highlig...00bcca296.html

Apparently the arguement that it is harmfull didn't fly.

----------


## LandLord

> many OD's hire untrained staff and hand them a PD ruler and send them out on the dispensing floor with little knowledge.


This happens on every streetcorner in Ontario and its exactly the reason that so many opticians are pushing for refraction.  It's not about making MORE money, it's about optometrists taking away OUR money and at the same time spitting in our faces with the so-called optometric assistant.

Any opticians ever see a want ad that states:


"Busy optometric practice seeks full time optician/optometric assistant/receptionist.  No experience necessary."

How does that ad make you feel?

----------


## Oedema

> BTW, to end the arguement about the harmfull for patients, clients, customers.
> 
> http://www.canlii.org/eliisa/highlig...00bcca296.html
> 
> Apparently the arguement that it is harmfull didn't fly.


Did you even read the judgment?  :hammer:The judge did not rule of whether or not there is harm to patients by sight testing, the judgment, in summary, says that under BC law, the BC Optometry regulator does not have the authority to seek injunctive relief against someone who is not an optometrist.

----------


## Excalibur

> Just to give you a heads up, no educated individual is going to use this as a valid or even logical reason.  You can't argue that since it's a law it shoudl be a law that in itself is assinine.  If we were to use your same logic, since now refraction is being allowed and the law is changeing then it should be allowed and since OD's are now the minority fighting it from happening, the majority (opticians) that is fighting the minority (optometry) to prevent harmfull acts.:hammer:
> 
> I'd stay stick to spinning dials, it may be the only thing you know how to do.:D


A law that keeps routine independent refractions as illegal is sound practice and in the standards of care. I understand that this is difficult to get this point across to anyone not directly involved in clinical care. That is also why I don't waste time debating matters with children or the mentally handicapped or insane. It's like trying to pee against a hurricane. 

Governments will not take opticianry seriously until it standardizes its education requirements and regulations, creates credible university-based clinical programs and regulates itself. Perhaps a small donation from one known as Bruce Bergez will create an honorable opticianry training program to advance independent refractions!

----------


## Excalibur

> This happens on every streetcorner in Ontario and its exactly the reason that so many opticians are pushing for refraction.  It's not about making MORE money, it's about optometrists taking away OUR money and at the same time spitting in our faces with the so-called optometric assistant.
> 
> Any opticians ever see a want ad that states:
> 
> 
> "Busy optometric practice seeks full time optician/optometric assistant/receptionist.  No experience necessary."
> 
> How does that ad make you feel?


It tell us that dispensing is generally a pretty simple thing to do... that's what it tells us. :D

----------


## Stonegoat

Qiulk question to independant sight-testers.  Yesterday I had a 53 years old male patient complaining that his vision seemed a bit "off".  His last exam was less than one year ago.  He was correctable to 20/20 OD, OS with a low minus Rx.  Examination of the fundus OS revealed clinically significant macular edema. This is a serious ocular condition.  How do you handle this situation?  This is serious stuff and it's real.

----------


## Excalibur

> Qiulk question to independant sight-testers.  Yesterday I had a 53 years old male patient complaining that his vision seemed a bit "off".  His last exam was less than one year ago.  He was correctable to 20/20 OD, OS with a low minus Rx.  Examination of the fundus OS revealed clinically significant macular edema. This is a serious ocular condition.  How do you handle this situation?  This is serious stuff and it's real.


You know their answer to that..... it's rare, it almost never happens, yada yada.  Don't get me started on this because I can give them case after case after case.

Problem is that they don't know what they don't know. :hammer:

----------


## HarryChiling

> Did you even read the judgment? :hammer:The judge did not rule of whether or not there is harm to patients by sight testing, the judgment, in summary, says that under BC law, the BC Optometry regulator does not have the authority to seek injunctive relief against someone who is not an optometrist.


Yes, and after the optometrists did not get their way (haveing and injunction placed on the optician) they retorted with:




> After these reasons were released the appellant sought leave to re-open argument to bring to the courts attention the *Health Professions Act*, R.S.B.C. 1996, c. 183, and the *Health Professions Statutes Amendment Act, 1993*, S.B.C. 1993, c. 5.  The submission was that those Acts should lead to a different result on the standing issue and the appellant should succeed.  On this submission to re-open argument, the judge concluded:
> _I am satisfied that, having heard full submissions and having regard to the refusal of the Attorney-General to become involved in this litigation as a party, the original decision is correct._


The attorney general never got involved beacuse it was not harmfull to the public and the judge agreed.

----------


## HarryChiling

> It tell us that dispensing is generally a pretty simple thing to do... that's what it tells us. :D


Amazing that many of the OD's I talk to argue about the nuances of refraction and the difficulty in mastering it, yet the fabricateing of the powers prescribed from that all important skill are trivial at best from these same OD's.  Like it or not we are tied together dependent upon each other.  Opticians are trying to change that, which means as an OD you can differentiate yourselves by provideing better refractions and better eyeware or you can try and stop change from happening.  The weak in their field will try and stop change, don't let it be you.

----------


## AdmiralKnight

Of course it is. No one here is talking about having people stop going to get their health checkup. Chances are, if someone has had an eye exam (new glasses too?) less than a year ago, they're not going to go get a refraction, they're going to go back to their OD to get a partial checkup. No on here is saying this should stop. From what I know of macular edma (which isn't everything, I won't lie) Is that it's most common cause is Diabetes, eye surgery, etc. Serious things that would, in themselves, call for eye health checkups. I think the problem you're having is thinking that it's just going to be joe blow flippin a phoroptor. As Mike.Elms pointed out earlier in this thread, the patients will go through a screening process to deem wether they'll be fine with just a refraction, or wether or not they should go get a full medical exam. It's not going to be some random person, who's only worked in the optical field for 2 days spinnin the dials... unlike some of the people working in ODs offices. It strikes me as very hippocritical for ODs to take this stance when they reap so many financial benifits of hireing non-licensed opticians to do A licensed Optican's job... then complain about what's best for their patients when we want to refract.

*edit* Post was in reply to Stonegoat's last post

----------


## Excalibur

> Yes, and after the optometrists did not get their way (haveing and injunction placed on the optician) they retorted with:
> 
> 
> 
> The attorney general never got involved beacuse it was not harmfull to the public and the judge agreed.


The judge was a moron. As someone stated earlier in the thread... some laws make no sense. This is one of them!

Opticians often don't know what they don't know.

----------


## Excalibur

> The judge was a moron. As someone stated earlier in the thread... some laws make no sense. This is one of them!
> 
> Opticians often don't know what they don't know.



Q:what's the difference in skill level b/w a licensed optician and a non-licensed optician? 

A: NONE! :)

----------


## HarryChiling

> The judge was a moron. As someone stated earlier in the thread... some laws make no sense. This is one of them!
> 
> Opticians often don't know what they don't know.


If you look at the bottom of the brief 2 other judges signed off, so that's 3 judges that obviously don't know what they don't know but you do know. Again maybe just stick to flippin dials, these are grown folk talkin in here. :D

----------


## Oedema

> Of course it is. No one here is talking about having people stop going to get their health checkup. Chances are, if someone has had an eye exam (new glasses too?) less than a year ago, they're not going to go get a refraction, they're going to go back to their OD to get a partial checkup. No on here is saying this should stop. From what I know of macular edma (which isn't everything, I won't lie) Is that it's most common cause is Diabetes, eye surgery, etc. Serious things that would, in themselves, call for eye health checkups.


But you're assuming that these patients, like the case stonegoat describes, know that they have diabetes.

However, it is estimated that up to one half of all Diabetics in Canada (about 1 million people) and the  United States do not know they have the disease.  

See how so many of these patients go years undiagnosed, without medical care, and then think when their vision gets blurry (b/c of macular edema) that glasses are the solution when in fact they need intensive medical managment?  If you dispense a pair of glasses that patient may have their 20/20 vision, but now you've failed to identify and delayed treatment of a condition that has major consequences, on vision, life and limb.

----------


## HarryChiling

> But you're assuming that these patients, like the case stonegoat describes, know that they have diabetes.
> 
> However, it is estimated that up to one half of all Diabetics in Canada (about 1 million people) and the United States do not know they have the disease. 
> 
> See how so many of these patients go years undiagnosed, without medical care, and then think when their vision gets blurry (b/c of macular edema) that glasses are the solution when in fact they need intensive medical managment? If you dispense a pair of glasses that patient may have their 20/20 vision, but now you've failed to identify and delayed treatment of a condition that has major consequences, on vision, life and limb.


You've convinced me that every patient needs a eye health evaluation, but that is no tthe point here since they need one before they can have a refraction either way so why are we still argueing.

----------


## AdmiralKnight

That's exactly my point. No one here is saying patients shouldn't have a medical exam. THEY SHOULD. And it should be in the law (or whatever it becomes) that to get an independant refraction, they need to have had a medical exam within a certain time period.

----------


## Oedema

> Yes, and after the optometrists did not get their way (haveing and injunction placed on the optician) they retorted with:
> 
> 
> 
> The attorney general never got involved beacuse it was not harmfull to the public and the judge agreed.


I suppose that is why the judge came to the conclusion with "considerable reluctance." :Rolleyes:  

Safety of sight testing was never the issue before the court, the issue was enforcing the optometry act as it is written.

When the judge states that the original judgemnt is correct, he is not concerned about whether or not sight testing is right or wrong, it is a matter of whether the association has standing to discipline or seek an injunction against someone that is not a member (ie not an optometrist).

----------


## AdmiralKnight

> Q:what's the difference in skill level b/w a licensed optician and a non-licensed optician? 
> 
> A: NONE!


 
So, basicly, you're saying to everyone here, instead of argueing your point logically, you're just going to revert to name calling, and insult more than 2/3 of the people on this board. Wow.

----------


## Excalibur

> If you look at the bottom of the brief 2 other judges signed off, so that's 3 judges that obviously don't know what they don't know but you do know. Again maybe just stick to flippin dials, these are grown folk talkin in here. :D



95% of North America permits ODs to rx meds to their patients.

2% of North America permits opticians to independently sight test.

Looks like the optoms are doing just a LITTLE bit better convincing the courts and legislators whose services are more important to the public.

----------


## Excalibur

> So, basicly, you're saying to everyone here, instead of argueing your point logically, you're just going to revert to name calling, and insult more than 2/3 of the people on this board. Wow.


name calling? huh?

also... please set your spell checker to the 'ON' position.

Thank you.

----------


## HarryChiling

> I suppose that is why the judge came to the conclusion with "considerable reluctance." 
> 
> Safety of sight testing was never the issue before the court, the issue was enforcing the optometry act as it is written.
> 
> When the judge states that the original judgemnt is correct, he is not concerned about whether or not sight testing is right or wrong, it is a matter of whether the association has standing to discipline or seek an injunction against someone that is not a member (ie not an optometrist).


And when that didn't work he did not even consider the harmful ploy.  The judge saw right through that.  And so did the Attorney General who represents the public by refusing to show in the first place and the judge acknowledges that by not even considering revisting the judgement.

The fact that it's harmfull to the public not being the first case presented by the plaintiff shows that it obviously wasn't a concern untill after the judge ruled against the college of optometry.  Keep digging and eventually you will either dig up a bone or I'll throw you a chew toy, but optometry didn't have a leg to stand on then and it only has a leg to stand on now in a online forum where the teeth don't leave marks.

----------


## Excalibur

> So, basicly, you're saying to everyone here, instead of argueing your point logically, you're just going to revert to name calling, and insult more than 2/3 of the people on this board. Wow.



so what is the skill level difference b/w a licensed and unlicensed optician??

----------


## Stonegoat

The patient that I decribed previously was not aware of having any systemic disease.  I was very surprised to see the edema...not what I was expecting.  There were no "red flags" to suggest any problem other than refrective error.  It was only because the pateint was having his vision complaint adressed by a doctor rather than an optician that the condition was detected.  His prognosis is excellent.

So what if he had been sight-tested?  What is a reasonable interval between eye health assessments.  Remember he had a full exam less than a year ago.  According to BC opticians he would not require another exam for another 4 years.  Macular edema can get pretty ugly in a few weeks, let alone 4 years.  

The truth us, he simply would have slipped through the cracks of flawed eye care delivery.  There would be no way to prove that he had the edema at the time of the "sight-test", so recourse would not be possible.  

Why can't opticians see the problem with this?!?!?

Opticians SHOULD be able to refract...but only within the framework of a full eye exam in association with an OD or OMD.

----------


## HarryChiling

> so what is the skill level difference b/w a licensed and unlicensed optician??


HUGE, consider yourself lucky that you don't know the answer to this question.  Their was recently a fox 45 report in TX an unlicensed state in the US where a repoter took the same Rx to multiple stores and the only one that was made correctly was the one from COSTCO (COSTCO's has a policy where they only hire certified or licensed opticians).  What does that say, although you could be doing the best job in providing the most competent and pristine care the end result is the same the patient can't see.

----------


## tmorse

> You know their answer to that..... it's rare, it almost never happens, yada yada. Don't get me started on this because I can give them case after case after case. *Problem is that they don't know what they don't know*. :hammer:


I will tell you what I do know... that every Optician in Canada carries a minimum of one (1) million dollars ($1,000,000.00) Errors & Omissions Liability Insurance to cover themselves, including contact lens practioners and sight-testers.
Professional insurance *Actuaries* are utilized by insurance companies to properly assess the risk of actually having to pay out on any 'negligence' claim. 
Mandatory Liabiliaty Insurance is available at two (2) different sources, our BC Provincial Association and our National body, the Opticians Association of Canada.

TOTAL PREMIUM COST for one (1) million ($1,000.000.00) to the Opticians is $65.00/$75.00 per year. Three (3) Million ($3,000.000.00) in coverage increases TOTAL PREMIUM by $12.00-13.00/yr and five (5) million is also available for an additional $13.00. So for one (1) hundred dollars ($100.00) in premiums, Opticians are covered for five (5) million ($5,000,000.00) per occurance.

Our Courts haven't commented on this insurance premium anomoly, but I think it safe to say that risk of harm for anything an Optician does can be deemed minimal. So much for risk to patient in simple sight-testing.

There is an old adage that "Doctors bury their mistakes". Does this also apply to Optometry? :Rolleyes:  What is Optometry's E&O Liability insuranc premium per year as determined by Actuaries? Not your office insurance premium or lost income insurance, but just the professional negligence coverage portion.

----------


## Excalibur

> HUGE, consider yourself lucky that you don't know the answer to this question.  Their was recently a fox 45 report in TX an unlicensed state in the US where a repoter took the same Rx to multiple stores and the only one that was made correctly was the one from COSTCO (COSTCO's has a policy where they only hire certified or licensed opticians).  What does that say, although you could be doing the best job in providing the most competent and pristine care the end result is the same the patient can't see.


So if an optician decides to not be licensed and work in an optometric office, they become incompetent. Hogwash!

----------


## wmcdonald

Ladies and Gentlemen,
We are getting a bit heated. This is a sensitive subject and one that cannot and will not be settled here. I understand the ODs perspective, and want to say to them that I have respect for their training and education, and appreciate what they do for the public. Unfortunately, we are juxtaposed in our positions, but can find common ground. Opticians want to move forward, just as ODs moved more to the medical model. It is a logical progression, and one I am deeply involved in. Let me assure all that their are specific guidelines dictating what those involved in "sight-testing" can and cannot do. We do not want to do harm to anyone, just level the playing field a bit. No one is suggesting that Opticians just begin to refract; quite the contrary. Education and training must come first. I would LOVE to see the Schools and Colleges of Optometry work with us to design curricula and offer programs that can help us all along the path to higher levels of practice. I see advanced practice Opticians functioning much like Nurse Practioners, and can certainly be a great asset to ODs and MDs. I hope we can carry this discussion further, with some civility, because we can accomplish a great deal more that way.

Warren

----------


## HarryChiling

Not to mention that most sight testing opticians have 6 years of education, 2 eyeglass, 2 contact lens, and 2 sight testing.  To call them uneducated would be a weak arguement.

----------


## Oedema

[quote=HarryChiling;217100]And when that didn't work he did not even consider the harmful ploy.  The judge saw right through that.  And so did the Attorney General who represents the public by refusing to show in the first place and the judge acknowledges that by not even considering revisting the judgement./quote]

You and I both know that you're now just speculating...  Show us where in all of this the lawyers for the association went before the court whining that sight-testing was going to hurt people and b/c of that the injunction should be granted irrespective of the legislation and common case law.

----------


## tmorse

> Q:what's the difference in skill level b/w a licensed optician and a non-licensed optician? 
> 
> A: NONE! :)


Here in BC, 'Optician' is a restricted title indicating someone who has successfully complete an approved course of instruction and passed a National Competency exam. Of course the one (1) week 'wonders' that some OD's hire wouldn't tell you that. :bbg:

----------


## HarryChiling

> 95&#37; of North America permits ODs to rx meds to their patients.
> 
> 2% of North America permits opticians to independently sight test.
> 
> Looks like the optoms are doing just a LITTLE bit better convincing the courts and legislators whose services are more important to the public.


North America huh. I guess when someone asks you whihc country you live in you say North America. So why even visit the CA discussion forum and discuss Ontario opticians refracting? 50% of opticians in the US don't have licensing so refracting for them is a pipe dream. The educated opticians in CA who have gone above and beyond to gain the privledge to sight test have earned it and to lump them in with the rest of north america is a folly on your part as it shows your bias and shows that you are neither going to discuss the case with an open mind or be fair in your judgements. No wonder your are so worried about pathology your eyes are diseased. :D

By the way 7 Canadian provinces and 50 states in the US, that's 57 in North America.  2 allow sight testing 2/57 = 0.035 that's approximately 4%, you should stay away from the math it can cause headaches, opps I mena tumors go see an OD for that. :D

----------


## Stonegoat

Would an optician please address what they would have done with my patient specfically??

----------


## Excalibur

> Would an optician please address what they would have done with my patient specfically??


I told you they would ignore your valid question. They would do nothing because they would not detect the problem. They can't diagnose what they don't look for -- so what would you expect? :hammer:

----------


## HarryChiling

> Would an optician please address what they would have done with my patient specfically??


This question is made with an assumption that all opticians are now qualified to sight test.  I am not, so I cannot answer your question.  I do also want to hear what a sight testing opticians would do but they are an advanced trained optician and as such only the best and brightest will attain that level of practice.




> I told you they would ignore your valid question. They would do nothing because they would not detect the problem. They can't diagnose what they don't look for -- so what would you expect? :hammer:


Same to you as above.  You guys really need to get off this kick it's going to happen with or without your venomous input, it would be nice to see optometry embrace it and help create something better for the patients, but it's not about that, apparently.

----------


## Excalibur

> North America huh. I guess when someone asks you whihc country you live in you say North America. So why even visit the CA discussion forum and discuss Ontario opticians refracting? 50&#37; of opticians in the US don't have licensing so refracting for them is a pipe dream. The educated opticians in CA who have gone above and beyond to gain the privledge to sight test have earned it and to lump them in with the rest of north america is a folly on your part as it shows your bias and shows that you are neither going to discuss the case with an open mind or be fair in your judgements. No wonder your are so worried about pathology your eyes are diseased. :D
> 
> By the way 7 Canadian provinces and 50 states in the US, that's 57 in North America.  2 allow sight testing 2/57 = 0.035 that's approximately 4%, you should stay away from the math it can cause headaches, opps I mena tumors go see an OD for that. :D


Sorry to burst your bubble Mr. Geography, but Canada has 10 provinces and a few territories on top of that. So your calculation is incorrect. 

Also, take another look at your post above. Spelling and grammatical mistakes galore, and you are giving ME a math lesson? Give me a break. 

Furthermore, I practice in Ontario where HPRAC saw through the optician lobby on independent sight testing and flushed it pronto. Read their decision on independent refraction here:

http://hprac.org/en/reports/resource...il_2006_EN.pdf

It seems that this wise panel of health policy academics knew what they were talking about. :D

----------


## HarryChiling

> I suppose that is why the judge came to the conclusion with "considerable reluctance." 
> 
> Safety of sight testing was never the issue before the court, the issue was enforcing the optometry act as it is written.
> 
> When the judge states that the original judgemnt is correct, he is not concerned about whether or not sight testing is right or wrong, it is a matter of whether the association has standing to discipline or seek an injunction against someone that is not a member (ie not an optometrist).





> _Health Professions Act_[/b], R.S.B.C. 1996, c. 183]
> *Part II — Public Interest Criteria**Criteria for designation of health professions*
> 
> *5* (1) For the purposes of section 10 *(1) of the Act, the minister must consider the extent to which the practice of a health profession may involve a risk of physical, mental or emotional harm to the health, safety or well being of the public, having regard to*
> (a) the services performed by practitioners of the health profession,
> (b) the technology, including instruments and materials, used by practitioners,
> (c) the invasiveness of the procedure or mode of treatment used by practitioners, and
> (d) the degree to which the health profession is
> (i) practised under the supervision of another person who is qualified to practise as a member of a different health profession, or
> ...


The appeal was based on a provision that concerns the health of the public and the judge decided that since the attorney general didn't show that it was obviously of no concern. My sister works on the appealate level and the amoutn of homework that goes into these briefs is redonkulous, the judge has seen any arguement that you are trying to mak eand considers them moot. So again if your digging for a bone try diggin somewhere else.

What else you got. :p

----------


## Excalibur

> This question is made with an assumption that all opticians are now qualified to sight test.  I am not, so I cannot answer your question.  I do also want to hear what a sight testing opticians would do but they are an advanced trained optician and as such only the best and brightest will attain that level of practice.
> 
> 
> 
> Same to you as above.  You guys really need to get off this kick it's going to happen with or without your venomous input, it would be nice to see optometry embrace it and help create something better for the patients, but it's not about that, apparently.


If independent refraction was the norm and the right thing to do, we'd all still be refracting in the back of jewellery shops like they did a century ago. We (optometry, ophthalmology) have progressed from this, and you want to go backwards to this again? Shame shame.:finger:

----------


## tmorse

> I would LOVE to see the Schools and Colleges of Optometry work with us to design curricula and offer programs that can help us all along the path to higher levels of practice. 
> Warren


YOU MUST BE JOKING... You want to empower Optometry to propose curricula so that Opticians can do independant refractions to reduce OD incomes? Just re-visit the recent Ontario Refraction model that was recently developed by Ontario Opticians in conjuction with Optometry, and then compare it to the BC/ALBERTA model. Sight-testers in Ontario are now effectively hamstrung.

On the other hand, New York proposed a compromise that could work... Simply that every *second* refraction *must* be performed by an OD or OMD, along with the other present sight-testing safeguards already in place. 

As to danger to the patient?  In my mind, minimal. It has already been proven in surveys that 70% of all contact lens patients fail to follow the safety and hygiene protocols that both Opticians and OD's have stressed... and yet the hospital wards are not crammed to the rafters with eye complaints. If a patient is so concerned about safety he has an  option... simply chose to forgo sight-testing services by Opticians and go to his OD every time for a Rx update.

----------


## HarryChiling

> If independent refraction was the norm and the right thing to do, we'd all still be refracting in the back of jewellery shops like they did a century ago. We (optometry, ophthalmology) have progressed from this, and you want to go backwards to this again? Shame shame.:finger:


If you are going to use history at least use it correctly it was opticians and they were esentially selling ready made glasses from outside of jewelry shops.  OD's as a profession stemmed from those brighter opticians in the back of jewelry shops who felt they could provide more accurate, so they educated themselves in refraction and called themselves OD's.  Due to refractions not causeing any harm to the public over the years optometry has gained an incredible increase in scope of practice.  Optometry of today is nothing at all like the optometry of your forefathers, and Ophthalmology was fighting it then like they fight now for therapeutics and other privledges.  

If optometry was left to refractions alone that would be regression, but opticianry refracting is progress and as such should be embraced.  Bakc then 2 years was adequate for refractions, and due to the success optometry as a profession has acheived I would tend to agree, that's is why opticians are now stepping up to the plate for that additional 2 years of education to learn refraction.

----------


## tmorse

> Qiulk question to independant sight-testers. Yesterday I had a 53 years old male patient complaining that his vision seemed a bit "off". His last exam was less than one year ago. He was correctable to 20/20 OD, OS with a low minus Rx. Examination of the fundus OS revealed clinically significant macular edema. This is a serious ocular condition. How do you handle this situation? This is serious stuff and it's real.


Another canard!!:D You know that sight-testers don't use an ophthalmoscope, don't examine the fundus and don't diagnose. If he still complains that his vision seems a bit "off" after the sight-test, using the excellent logic of Admiral, send him pronto to an Ophthalmologist, which I assume YOU also did. :hammer:

----------


## Oedema

> The appeal was based on a provision that concerns the health of the public and the judge decided that since the attorney general didn't show that it was obviously of no concern. My sister works on the appealate level and the amoutn of homework that goes into these briefs is redonkulous, the judge has seen any arguement that you are trying to mak eand considers them moot. So again if your digging for a bone try diggin somewhere else.
> 
> What else you got. :p


Try again Harry, the appeal is based on section 52 of the Health professions act which gives powers to seek injunction: 



> *Injunction to restrain contravention         * 
> 
> *52*  (1)  A board or a person may apply to the Supreme Court for an interim or permanent injunction to restrain a person from contravening any provision of this Act, the regulations or its bylaws. 
>           (2)  A contravention may be restrained under subsection (1) whether or not a penalty or other remedy has been provided by this             Act, the regulations or the bylaws.


And again, all I'm saying here is that your argument that sight testing is safe b/c of this case is disingenuous. The judge in this case did not render an opinion on whether or not sight testing is safe.  That is not the role of the court in this case.

----------


## tmorse

> If independent refraction was the norm and the right thing to do, we'd all still be refracting in the back of jewellery shops like they did a century ago. We (optometry, ophthalmology) have progressed from this, and you want to go backwards to this again? Shame shame.:finger:


Hey... Rolex watches at wholesale!! And it would solve the slow season between November and February. Excellent idea!!!:D

----------


## Stonegoat

Tmorse,

The correction of the myopia would have eliminated most of the visual complaints.  I doubt he would have returned anytime soon claiming his vision was again "off", until he suffered from significant vision loss from the edema.  Why should he have to wait a few more weeks to get a "prompt" referral?? More damage would likely occur while the patient spent time deciding if he just needed time to get accustomed to his new Rx.  After all, he was correctable to 20/20.

As an aside, I saw a patienty about a year ago who had recently received a sight-test.  She was not happy with her vision, and complained to the optician.  He stated her vision is as "good as it gets"??  She came to me, of her own accord, with a 20/50 cataract (easy fix) and advanced glaucoma (not so easy).  

There is NO WAY that fragmenting eye care is in the best interest of the patient...it's such an absurd idea it's hard to believe we are even debating it.

----------


## tmorse

> What is Optometry's E&O Liability insuranc premium per year as determined by Actuaries? Not your office insurance premium or lost income insurance, but just the professional negligence coverage portion.


Stonegoat... Now where's my answer. What's your, or if you like, an average OD's E&O liability insurance premium per year?

----------


## tmorse

> The correction of the myopia would have eliminated most of the visual complaints. I doubt he would have returned anytime soon claiming his vision was again "off", until he suffered from significant vision loss from the edema. Why should he have to wait a few more weeks to get a "prompt" referral?? More damage would likely occur while the patient spent time deciding if he just needed time to get accustomed to his new Rx. After all, he was correctable to 20/20.


He 's got a GP, doesn't he? And if more damage is likely to occur, then... my answer is "C'est la vie!" , Tough luck, Charlie, S*it happens... take your choice. Last year I developed an acoustic neuroma and I didn't blame anybody. 

If all the protocols were followed, and the sight-tester achieved 20/20,  all is well. I would suggest that he should have told his GP that his vision is "off" before attending at your office. How long did he sit on his hands? 

I hope your GP puts on the rubber glove next time you present with the sniffles.:D:D

----------


## Stonegoat

Once again a sight-tester puts the blame on the patient for not seeking the appropriate level of care.  Pathetic.
Just so you know, Tmores, most GPs don't even know how to use an ophthalmoscope.  And most patients don't complainto their GP and complain of blurry vision.  They come and see me...or, regrettably, some sight-testing @ss like yourself.

----------


## HarryChiling

> Try again Harry, the appeal is based on section 52 of the Health professions act which gives powers to seek injunction: 
> 
> 
> And again, all I'm saying here is that your argument that sight testing is safe b/c of this case is disingenuous. The judge in this case did not render an opinion on whether or not sight testing is safe. That is not the role of the court in this case.


Serve and volley:




> [14]   As can be seen from the above the case for the appellant is that the nature of the Act, *being one in part to protect the public*, coupled with the investigatory powers of the inspectors under the Act, necessarily leads to the inference that the Board has the power to enforce the Act through injunction proceedings as is sought here.
> [15]   _With respect, I cannot agree._
> [16]   Nothing could have been easier than for the Legislature to include such a power in the *Optometrists Act* but that was not done.  It has been done in the *Health Professions Act*, R.S.B.C. 1996, c. 183, s. 52.


It may not be explicitly stateing that harm to the health can occur, but it was obvioulsy not sufficent evidence to allow optometrists to one stop him from provideing sight testing, and two when that failed from allowing optometrists from seizing his equipment. (that was just uncalled for to even try and seize his equipment, you guys behave like barabrians).

Hey Ted got anymore fo those rolex's, I could see it now FREE ROLEX WITH EVERY SIGHT TEST.:D

----------


## Oedema

> He 's got a GP, doesn't he? And if more damage is likely to occur, then... my answer is "C'est la vie!" , Tough luck, Charlie, S*it happens... take your choice. Last year I developed an acoustic neuroma and I didn't blame anybody. 
> 
> If all the protocols were followed, and the sight-tester achieved 20/20,  all is well. I would suggest that he should have told his GP that his vision is "off" before attending at your office. How long did he sit on his hands? 
> 
> I hope your GP puts on the rubber glove next time you present with the sniffles.:D:D


C'est la vie, Mrs. Jones, that really is too bad you've had a macular detachment.  Why did you trust me anyways?  Oh well, it really is your fault for not talking to a doctor when they could have saved most of your vision isn't it.:hammer:

Pathetic

----------


## tmorse

> Once again a sight-tester puts the blame on the patient for not seeking the appropriate level of care. Pathetic.
> Just so you know, Tmores, most GPs don't even know how to use an ophthalmoscope. And most patients don't complainto their GP and complain of blurry vision. They come and see me...or, regrettably, some sight-testing @ss like yourself.


I don't do sight-testing nor teach sight-testing, Stonehead.:hammer:

----------


## HarryChiling

> C'est la vie, Mrs. Jones, that really is too bad you've had a macular detachment. Why did you trust me anyways? Oh well, it really is your fault for not talking to a doctor when they could have saved most of your vision isn't it.:hammer:
> 
> Pathetic


Since sight testing has been in place for some time now, name one incident where a patient has been harmed?  And it is unprofessional of you to use a patients name outside of the office to the public shame on you. (oh wait a minute that's a made up patient, that's Ok then carry on)

I will give you time to contact your associations and colleges to compile the lists and lists of data. Untill then why don't you try and get yourself some fo those half priced rolex's Teds got. :D

----------


## tmorse

> Once again a sight-tester puts the blame on the patient for not seeking the appropriate level of care. Pathetic.


Yes I do believe a person must take responsibility for his actions (or in this case, his inactions). OD's also will blame the patient when it suits their purpose. 
Many tears ago I had customer come in one day, who appeared a little drunk, but I fit him using an across-town OD Rx. When glasses arrived he said they didn't work. I double-checked again and they were spot-on, so I said," These glasses have been properly dispensed. You will have to return to your Doctor". Comes in later again still looking hung-over with new (and different) Rx from this same Doctor, so I reorder at no charge. Again they arrive, he tries them on, and again says "they don't work". After these two (2) redo's, I called this Doctor for an explanation and he says' "I can only go with answers he gives me during the refraction." Reasonable, but this time I send him to my own OD, who gives me a third (and again different Rx).

Customer doesn't return to pick up despite many weeks of phone calls. Finally, I remembered that his son was also on file, so I called him... was told his Father had died three (3) weeks ago... apparently he was an undiagnosed diabetic and despite appearing drunk/hung over, both OD's refracted him without catching it. 
Sorry, but I do blame the patient for not seeking appropriate care. His GP would probably caught it. True Story.

----------


## Excalibur

"If all the protocols were followed, and the sight-tester achieved 20/20,  all is well."

                    -----------

All is well? Really. 

Shows how little you know about asymptomatic eye disease.:finger:

----------


## tmorse

> C'est la vie, Mrs. Jones, that really is too bad you've had a macular detachment. Why did you trust me anyways? Oh well, it really is your fault for not talking to a doctor when they could have saved most of your vision isn't it.:hammer:
> 
> Pathetic


Listen OD... Opticians are trained NEVER to give a diagnosis... so stick your ridiculous story, you know where.

----------


## Excalibur

> If you are going to use history at least use it correctly it was opticians and they were esentially selling ready made glasses from outside of jewelry shops.  OD's as a profession stemmed from those brighter opticians in the back of jewelry shops who felt they could provide more accurate, so they educated themselves in refraction and called themselves OD's.  Due to refractions not causeing any harm to the public over the years optometry has gained an incredible increase in scope of practice.  Optometry of today is nothing at all like the optometry of your forefathers, and Ophthalmology was fighting it then like they fight now for therapeutics and other privledges.  
> 
> If optometry was left to refractions alone that would be regression, but opticianry refracting is progress and as such should be embraced.  Bakc then 2 years was adequate for refractions, and due to the success optometry as a profession has acheived I would tend to agree, that's is why opticians are now stepping up to the plate for that additional 2 years of education to learn refraction.


Good for you.

But first get your own house in order until you start trying to dictate how the rest of the ophthalmic world must practice. Get your licensure procedures straightened out (a significant number of jurisdictions are unregulated). Take your programs out of community colleges and night schools where they teach janitorial sciences and put them in more credible institutions. Start attracting higher caliber students with something more than a C grade level in high school. Act like professionals and less like merchants. Don't try to dumb down the evolution of eye care by justifying independent refractions as being acceptable. 

Don't get me wrong. I like opticians, and I think everyone should own one.... or at least employ one. :D

----------


## LandLord

To my fellow opticians. Don't answer the trick questions about eye disease. Only doctors know the answers. The OD's want you to give a wrong answer so that you can look stupid.

To the optometrists. You'll appear more intelligent and professional if you admit that opticians are better at dispensing than your receptionist is. If you are really honest, you'll admit that opticians are better at dispensing than you are.

There's been some constructive dialogue in this thread. Let's boil it down to the real issue here:

Optometrists want to make more money, so they hire a receptionist to dispense (because they can.)

Opticians sit alone in their stores waiting for a customer that will never come because he's at your office being fitted for glasses by your receptionist. 

The above scenario causes opticians a great deal of anguish. This feeling is amplified when the optician observes an OD driving by in a Porsch Boxter.

Solution:
For optometrists: hope for TPA's or even Lasik so you can trade in the Boxter for a Ferrari.

For opticians: a) hope for refraction so you can better fit the guy who saw the receptionist last year. Let's face it, you don't really want to spin dials. You just want what's yours.

b) hope optometrists will quit dispensing. Then there would really be justice in the world.

c) become an optometrist.

----------


## HarryChiling

> Good for you.
> 
> But first get your own house in order until you start trying to dictate how the rest of the ophthalmic world must practice. Get your licensure procedures straightened out (a significant number of jurisdictions are unregulated). Take your programs out of community colleges and night schools where they teach janitorial sciences and put them in more credible institutions. Start attracting higher caliber students with something more than a C grade level in high school. Act like professionals and less like merchants. Don't try to dumb down the evolution of eye care by justifying independent refractions as being acceptable. 
> 
> Don't get me wrong. I like opticians, and I think everyone should own one.... or at least employ one. :D


If you were a real man I would invite you outside, but I guess I will have to settle for a virtual braw strap snap **** THWAP. My house is in order I make sure to always voice my opinions and make sure to never believe that OD's have the patients best interest at heart and above all else, I won't work for schmucks liek you so it ensures that when opticians do get sight testing in all states and provinces (it's a reality honey) you won't have th advantage of haveing a highly skilled optician in your office. Might as well trade you prosche in for a hyundai or just keep cryin like a little *****.

OWN AN OPTICIAN, your views are sick and warped. Untill you trade that silly OD up to a rela deal MD you are just playing doctor. Why go see you for any pathology when all you can do is give drops and then pray it works. If you were concerned abotu providing REAL care to your patients you would call yourselves refractionists instead of doctors, and kick all the pathology up to the real docs the OMD's.

(hows that for a post with some hot sauce on it):D

PS - Who's your daddy, huh, huh, for real that stung a bit didn't it? Are you adjusting your g-string? Panties in a bunch?

I get such a rise out of an individual such as yourself with supposedly so much education stoopign to my level.  t is obvious I can discuss a poitn intellectually with you, but after you have realized that you are no intelectual match, you resort to name callign and general nonsense.  I love it, that's what I do.  I can talk junk with the best of them so keep 'em coming, sweetheart.

----------


## Oedema

> Since sight testing has been in place for some time now, name one incident where a patient has been harmed?


http://www.optometrists.bc.ca/webupl...studies_04.pdf

----------


## HarryChiling

> http://www.optometrists.bc.ca/webupl...studies_04.pdf


Thanks, that was very infomative.  How could things be changed to prevent these occurences from happening?

----------


## Excalibur

> Thanks, that was very infomative.  How could things be changed to prevent these occurences from happening?


Uh Duh... how can you minimize the risk to the public he asks? SIMPLE. Stop independent sight testing!:hammer:

----------


## Excalibur

> If you were a real man I would invite you outside, but I guess I will have to settle for a virtual braw strap snap **** THWAP. My house is in order I make sure to always voice my opinions and make sure to never believe that OD's have the patients best interest at heart and above all else, I won't work for schmucks liek you so it ensures that when opticians do get sight testing in all states and provinces (it's a reality honey) you won't have th advantage of haveing a highly skilled optician in your office. Might as well trade you prosche in for a hyundai or just keep cryin like a little *****.
> 
> OWN AN OPTICIAN, your views are sick and warped. Untill you trade that silly OD up to a rela deal MD you are just playing doctor. Why go see you for any pathology when all you can do is give drops and then pray it works. If you were concerned abotu providing REAL care to your patients you would call yourselves refractionists instead of doctors, and kick all the pathology up to the real docs the OMD's.
> 
> (hows that for a post with some hot sauce on it):D
> 
> PS - Who's your daddy, huh, huh, for real that stung a bit didn't it? Are you adjusting your g-string? Panties in a bunch?
> 
> I get such a rise out of an individual such as yourself with supposedly so much education stoopign to my level.  t is obvious I can discuss a poitn intellectually with you, but after you have realized that you are no intelectual match, you resort to name callign and general nonsense.  I love it, that's what I do.  I can talk junk with the best of them so keep 'em coming, sweetheart.


I have certified staff trained under the following program:
http://www.opto.ca/en/public/03_opto...assistants.asp

Our local opticians seem to be out to lunch. Maybe you can teach them about lenses like Sola Access, Free Forms or even materials like Trivex. They don't seem to know about them!  How tough is that? My certified staff seems to know about these products better than our local lens grinders. And I bet my staff is also better looking in their g-strings than you! 

Intellectual match with you? Please first learn how to spell! Your posts are quite comical and pedantic.  Typical Grade C level education!

Most eye diseases can be treated very effectively with gtts and oral meds. Check this link: www.eyeupdate.com if you wish to learn more about how effective primary eye care can be with gtts.  To think that surgical skill is required to cure most eye disease is stupid. Don't get into arguments on ocular pathology, or I'll tie my g-string around your long tongue.

I don't usually like to mud-wrestle with swine, but with you I'll make an exception.

----------


## Laurie

Landlord,

You hit the nail on the head.

Warren,

Looks like our dream of the 3 O's working together will take a little longer than we thought.

Excalibur,

I am embarassed for you.  What if your patients got a glimpse of who you really are?

Laurie

----------


## Excalibur

> Landlord,
> 
> You hit the nail on the head.
> 
> Warren,
> 
> Looks like our dream of the 3 O's working together will take a little longer than we thought.
> 
> Excalibur,
> ...


Embarrassed for me? Please.

I have one of the more frequent posting board members saying "whose your daddy" and claiming he will 'slap me around', and you expect me to stand pat and take that? Give me a break.  And he can't spell either which makes his posts even more comical.

----------


## Excalibur

> Landlord,
> 
> You hit the nail on the head.
> 
> Warren,
> 
> Looks like our dream of the 3 O's working together will take a little longer than we thought.
> 
> Excalibur,
> ...


So, what do you make of this?

http://www.optometrists.bc.ca/webupl...studies_04.pdf

You want to make light of this too? 

Are you a graduate of the Sight Tester's School of Denial?

----------


## Laurie

Excalibur,

One thing for sure,

I am not in denial about appropriate behavior, especially in a professional forum.

The pathology piece has been discussed at great length...there will be pathology checks by a doctor. I would likely connect with an OMD, and the patient would get the best of both worlds. In fact, in the cases you posted, this model would have protected the patients, as the opticians would have been mandated to be sure of a pathology check, within one or two years, depending on the age of the patient.

I am not against ODs...I have had the pleasure of meeting and spending time with the greatest of all: Irving Borish, Theodore Grosvenor, Clifford Brooks, Frank Fontana, and others. Some of the greatest people I've met. And, with all of their amazing accomplishments, they remain humble.

Let's try to continue this dialogue in the same professional manner that our patients would expect.

: )


Laurie

----------


## Excalibur

Laurie-- I agree with the last line in your post.

How did these cases occur?

http://www.optometrists.bc.ca/webupl...studies_04.pdf

Evidently there is no 'safety mechanism' in place, and I surmise that if there was one it would be impossible to enforce.

----------


## Laurie

Excalibur,

Your link is a repeat from the last one, which I read and responded to.

This thread is about Opticians refracting in Ontario. Let's bring it back to that.

The College of Opticians of Ontario have a specific standard of practice in place which includes mandatory pathology checks. Enforcing any mandate in the health sciences requires assumed integrity. I believe that we are all in this for the good of the patients, as well as for the money, and thats OK. I also believe that we can accomplish this with integrity, and the patient will be well served.

: )

Laurie

----------


## Stonegoat

Laurie,

I agree with you...I think.  I have said it before, and I will say it again.  I think opticians should be trained to refract (including retinoscopy), but only be permitted to do so within the framework of a full eye exam.  Yes, that will mean that closer relationships with ODs and OMDs will need to be established.

Stand-alone refractions by opticians (or optometrists for that matter) will result in missed pathology resulting in blindness, and in rare cases, death.  It's as simple as that.

And Harry,  I do not have my receptionist dispensing eye wear.  I employ an optician, who is extremely competant.  She knows more about dispensing and what technology is coming down the pipe than I do, which is expected as that's her job.

----------


## AdmiralKnight

> Laurie,
> 
> I agree with you...I think. I have said it before, and I will say it again. I think opticians should be trained to refract (including retinoscopy), but only be permitted to do so within the framework of a full eye exam. Yes, that will mean that closer relationships with ODs and OMDs will need to be established.
> 
> Stand-alone refractions by opticians (or optometrists for that matter) will result in missed pathology resulting in blindness, and in rare cases, death. It's as simple as that.
> 
> And Harry, I do not have my receptionist dispensing eye wear. I employ an optician, who is extremely competant. She knows more about dispensing and what technology is coming down the pipe than I do, which is expected as that's her job.


In an ideal world, that's how things would work. But we're talking about Ontario here, the province where it's Illegal for Opticians to work with ODs, unless they willingly give up their license. There's a lot of talk about taking steps back in care for the patient. What good does it do for them to lobby to make it WRONG for OD's and DO's to work together? Doesn't make sence to me, but this is what has happened in this province.

----------


## HarryChiling

> post #8 Excaliber - I don't see any problems in patient care if an optician refracts as long as it is part of a complete assessment under the supervision of an OD or OMD.
> post#15 Stonegoat - I work as an OD in BC and opticians conduct "sight-tests" without any direct or indirect supervision by an OD or MD. Essentially a refraction is performed without any ocular health assessment. Is pathology missed?? Absolutely. I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received. They were NOT refered by the "sight-testing optician, but came of their own accord.
> I completely aggree that opticians can and should be trained to refract. I think it's inevitable, and a reasonable scope expansion. I however, do not agree with the concept of fragemented eye care, and I think a refraction should always be in conjunction with an ocular health assessment by an OD or OMD.
> post#16 Excaliber - Stonegoat-- great post. Thanks for the clarification.
> post#17 Excaliber - which brings me to another observation....
> refraction-only visits were the 'norm' decades ago. Going to this sort of scenario is regressive patient care. 
> If you haven't looked inside the patient's eye, how can it be called an assessment? This is certainly is not in the patient's best interest.
> There are many, many patients I see monthly that would be far worse off if all I counted on was refractive data to judge their eyehealth/visual prognosis.


Excaliber,
It's hard to take your posts as serious, your original posts indicated that you were for opticiasn refractign with the right safe guards in place.  Then when your peers say otherwise you immediately change positions which leads me to believe that you are more likely a follower than a leader.  Your credibility on this issue is nil in my book, but what do you care I'm just an optician meant o be owned. :D




> So, what do you make of this?
> 
> http://www.optometrists.bc.ca/webupl...studies_04.pdf
> 
> You want to make light of this too? 
> 
> Are you a graduate of the Sight Tester's School of Denial?


I could have easily dismissed this as a document compiled strictly for amuniton against opticiasn and refracting so is therefore biased, but since I asked for the data and Oedema took the time to research and find this data I would rather take it for face value and discuss what this means.  I am curious as to why it only covers incidents from 2002-2003, if it was that these are the only years that the optometrists were compiling data then it boils down to 5 cases per year average, if it is every case that has happened since the inception of opticians refracting then it boils down to even less.

Also, what the data does not provide is:  How many cases is this out of, if these cases are 10 out of 20 then that is an alarmign trend, but if these cases are 10 out of thousands then they become statisticaaly less significant.  Then it would also be nice to see a comparison of this data to OD's and OMD's comapreing the percentage of cases of pathology that get missed.

These are question that could be helpfull for both OD's and for opticians.  I am sure if the time was taken to provide more objective data the name callign and the back and forth banter would be less likely to happen (which stinks, cause I'm the love to argue and call names type individual;)).

----------


## HarryChiling

> And Harry, I do not have my receptionist dispensing eye wear. I employ an optician, who is extremely competant. She knows more about dispensing and what technology is coming down the pipe than I do, which is expected as that's her job.


Good for you and it only benefits your patients and gives you the right to argue the case of "what's good for the patient", but I would suggest you poll your collegues as to what their opinions on the matter are?  If every OD's office staffed educated and trained personel then their would be no need for stand alone refractions, but sadly many see the labor costs as a place to save a buck and it comes at the patients expense, that has always lead to my doubts when OD's mention "it's not good for the patient for an optician to refract".

Obviously you do not fall into this boat, and liek I mentioned every Optician, OD or OMD is nt built the same.

----------


## Laurie

[quote=Stonegoat;217252]Laurie,

I agree with you...I think. I have said it before, and I will say it again. I think opticians should be trained to refract (including retinoscopy), but only be permitted to do so within the framework of a full eye exam. Yes, that will mean that closer relationships with ODs and OMDs will need to be established.

Hi Stonegoat,

Of course you agree with me.

C'mon, its me! ; )

We can find a way to be autonomous and still protect the public. I have confidence in us.

Laurie

----------


## Excalibur

> Excalibur,
> 
> Your link is a repeat from the last one, which I read and responded to.
> 
> This thread is about Opticians refracting in Ontario. Let's bring it back to that.
> 
> The College of Opticians of Ontario have a specific standard of practice in place which includes mandatory pathology checks. Enforcing any mandate in the health sciences requires assumed integrity. I believe that we are all in this for the good of the patients, as well as for the money, and thats OK. I also believe that we can accomplish this with integrity, and the patient will be well served.
> 
> : )
> ...


Fair enough.

It appears, however, from the HPRAC document cited earlier in the thread that the Ontario government will not be convinced of independent sight testing anytime soon -- with or without any alleged 'controls'.

----------


## tmorse

[quote=HarryChiling;217269]  ...I am curious as to why it only covers incidents from 2002-2003, if it was that these are the only years that the optometrists were compiling data then it boils down to 5 cases per year average, if it is every case that has happened since the inception of opticians refracting then it boils down to even less.

Also, what the data does not provide is: How many cases is this out of, if these cases are 10 out of 20 then that is an alarmign trend, but if these cases are 10 out of thousands then they become statisticaaly less significant. Then it would also be nice to see a comparison of this data to OD's and OMD's comapreing the percentage of cases of pathology that get missed.  quote]

Excalibur: I was going to respond in the same vein. 
In 2002-3 the sight-testing safeguards were still at the developmental stage.  
*TODAY??*... as of October 1st, 2007 one *must be a* *graduate* of the NAIT sight-testing program administered by the Opticians Association of Canada to pefroms sight-tests in BC. As you know, the BC sight-testing protocols are now quite thorough, and the tens of thousands of successful sight-tests both here in BC and in Alberta will attest to their effectiveness. 
Further, the BC Government has already been presented with this same OD list of sight-testing impropriaties. They balanced them against the *benefit of sight-testing by* *trained opticians* to the public interest. Result??... Sight-testing ibn BC with new safeguards and protocols to continue. It is of course up to our regulatory College of Opticians of BC (COBC) to monitor compliance by sight-testers and so far, they have done a stellar job.:)

----------


## Stonegoat

Harry,

Have you ever tried setting-up a practice and successfully hiring a licensed optician in rural Canada??  Not so easy.  Most ODs probably won't even get a bite, so they must train dispensers from "scratch".  Most opticians are like optometrists...they want to be in larger urban centres.  They may be *****ing about their job at Wal-Mart, but for some reason unwilling to relocate to the rural locations where both $$ and professional satisfaction will be better.  Same holds true for ODs.

----------


## HarryChiling

> Harry,
> 
> Have you ever tried setting-up a practice and successfully hiring a licensed optician in rural Canada?? Not so easy. Most ODs probably won't even get a bite, so they must train dispensers from "scratch". Most opticians are like optometrists...they want to be in larger urban centres. They may be *****ing about their job at Wal-Mart, but for some reason unwilling to relocate to the rural locations where both $$ and professional satisfaction will be better. Same holds true for ODs.


That happens in the US as well, the OD's want jobs in the big city, so the schools keep pumping out OD's cause their is a need in the rural areas but those OD's just flock to the city createing and oversupply.

I have never had any experience in CA, but would guess that opticians would be less likely to want to work in the rural areas. From my point of view imagine an OMD trainign an OD and saying he couldn't find one that wanted to work in the rural parts. It may be true but it cheapens your profession none the less. 

Why do we all share the same issues yet we still bicker, how do these issues get solved? My wife is a teacher and if she works in a school that has a need for her area of study a portion of her college costs are cancelled, I have alwasy thought that this could be a great way of equalizing the issue of need and oversupply. But who picks up the tab is always a real issue?

The money part is questionable, some times the more rural jobs are better paying other times they are far below the norm.  I do agree that the enviornment is often times more professional and more gratifying.

----------


## AdmiralKnight

Stonegoat definatly has a point. But it doesn't always hold true. I work for a pratice about half an hour out of the city. Not as rural as it was 5 years ago, but still. We have 3 licensed opticians, including myself, as well as a student. It can be done, but it's all about incentives. This holds true for every field out there though, not just Opthalmics. Open a dentists office in a rural area, but can't find a dental hygenist? Same deal.

----------


## LandLord

1) Harry:  How many languages do you speak?

2) Anyone know the current fee ophthalmologists receive for a routine ocular health exam without refraction?

If stand alone refractions were widely performed by opticians, in collaboration with OD's performing fundus exam, the OD would still stand to lose money.  An ocular health exam fee would be much lower than the current package price of $70 to $110.  Ergo, it would be a tough battle.

----------


## HarryChiling

I speak fluently 2, I can comprehend spanish and when I was younger arabic a bit. Why?

PS - Do programming languages count. :)

A local pediatric Ophthalmologist charges $250.00 for a routine health examination.

----------


## LandLord

Harry,

I thought so.  The Jackass who criticizes your spelling probably only speaks one language.  He certainly isn't fluent in graciousness or class.

Surprising about the $250 fee.  I would think OHIP only pays a very nominal fee for a routine asymptomatic exam with no treatment plan.

----------


## AdmiralKnight

It could go either way. They'd charge less for a health-check only, but could fit more patients in, as the exam would be quicker than one with a refraction as well. So depending on the pratice, they could even potentially make more, if say for instance they charge $20 less for a health-only check, but can see twice as many people in a day.

----------


## HarryChiling

> Harry,
> 
> I thought so. The Jackass who criticizes your spelling probably only speaks one language. He certainly isn't fluent in graciousness or class.
> 
> Surprising about the $250 fee. I would think OHIP only pays a very nominal fee for a routine asymptomatic exam with no treatment plan.


Thanks for that, but like I have said before when I am writing for money I spell check when I am on a forum I could care less, for someone to criticize something like spelling when the issue is obviously far greater than complex than spelling shows they have nothign intelectual to contribute so I welcome frivelous comments such as those.

$250, of course is in the US so no one's regulating the cost.

----------


## Excalibur

> Thanks for that, but like I have said before when I am writing for money I spell check when I am on a forum I could care less, for someone to criticize something like spelling when the issue is obviously far greater than complex than spelling shows they have nothign intelectual to contribute so I welcome frivelous comments such as those.
> 
> $250, of course is in the US so no one's regulating the cost.


Frivolous? Intellectual? Nothing?

Yes, that is how they are spelled.

I just love reading this sort of stuff. It's like watching the 3 Stooges poke each other in the eye!  :Eek:

----------


## LandLord

Just ignore him, Harry.  He probably refracts at Wal-Mart.

----------


## Excalibur

Wrong. Community care practice. Multi-disciplinary, high rate of referral from local family docs and great rapport with my surgical colleagues. :D

Also regulated dispensing fees, unlike your exorbitant mark-up fees.

----------


## HarryChiling

> Embarrassed for me? Please.
> 
> I have one of the more frequent posting board members saying "whose your daddy" and claiming he will 'slap me around', and you expect me to stand pat and take that? Give me a break. And he can't spell either which makes his posts even more comical.


My response was in reply to your previous inuendos and a reference to opticians being equivalent to slaves.

"live by the sword dye by the sword" - If you were man enough to dish it I assumed you were man enough to take it, I guess I was wrong, I will be more gentle with you.

----------


## HarryChiling

> Just ignore him, Harry. He probably refracts at Wal-Mart.





> Wrong. Community care practice. Multi-disciplinary, high rate of referral from local family docs and great rapport with my surgical colleagues. :D
> 
> Also regulated dispensing fees, unlike your exorbitant mark-up fees.


Yeah LandLord, he stocks the oil and the cereal boxes there too, multi-disciplinary.:D

----------


## opti-refractonator

I would like to welcome myself to the board.  I have been reading for the last little while and finally had the availability to post.

To the gentlemen who are constantly battling each other, let me inform both of you that you are right in your own terms.

As an optician, i do not think that opticians should be allowed to refract in today's open market without strict guidelines.  As an optician, I think it is very  important to raise the profile of our profession before we start demanding that we should be able to refract.  Our regulatory college has both dumbed down the program and relaxed the standards we once followed.  Doing this does not increase the likelyhood of opticians getting refraction but rather opens up the disparities between us and the od's.

The biggest battle we face is not the od's, but rather the special interest groups that are slowly but effectively gnawing away at the fabric that holds our profession together.  Opticianry will never be deregulated, however, we have begun to slowly hand over our power to others in the name of delegation. Lets edumacate and armour ourselves before we go into the battle.

I Look forward to posting and being criticized by all.

----------


## Excalibur

> I would like to welcome myself to the board.  I have been reading for the last little while and finally had the availability to post.
> 
> To the gentlemen who are constantly battling each other, let me inform both of you that you are right in your own terms.
> 
> As an optician, i do not think that opticians should be allowed to refract in today's open market without strict guidelines.  As an optician, I think it is very  important to raise the profile of our profession before we start demanding that we should be able to refract.  Our regulatory college has both dumbed down the program and relaxed the standards we once followed.  Doing this does not increase the likelyhood of opticians getting refraction but rather opens up the disparities between us and the od's.
> 
> The biggest battle we face is not the od's, but rather the special interest groups that are slowly but effectively gnawing away at the fabric that holds our profession together.  Opticianry will never be deregulated, however, we have begun to slowly hand over our power to others in the name of delegation. Lets edumacate and armour ourselves before we go into the battle.
> 
> I Look forward to posting and being criticized by all.


Good post. No debate from me. Surprise!

----------


## AdmiralKnight

I suppose I should have posted this here first, and linked to the second thread, but oh well. It's applicable for both.

http://www.optiboard.com/forums/show...2&postcount=50

----------


## HarryChiling

> I suppose I should have posted this here first, and linked to the second thread, but oh well. It's applicable for both.
> 
> http://www.optiboard.com/forums/show...2&postcount=50


I agree that it is not professional for the two sides to bicker like this back and forth, but I think that the public does have a right to see this.  A lot of what was said here has been said and felt before.  The arrogance displayed, the childish behaviour (both sides Ok me are included :D).  As a consumer I would be shocked to find out that my doctor was crying "for the good of the patient", but then would decide to hire non-professionals to provide one of the most important services in the office.  Let's face the reality here their is a reason why glasses cost way more than an eye exam and it is because the patient sees more value in it.  Now we all know that the value in the glasses comes form the prescription that goes into it, so the optometrist is a necessary evil (my opinion).

----------


## tmorse

> Stand-alone refractions by opticians (or optometrists for that matter) will result in missed pathology resulting in blindness, and in rare cases, death. It's as simple as that.


Kindly advise what a sole-practitioner OD paid each year for what amount of liability insurance. I am not interested in todays premiums since TPA's have been added to the scope of practice of Optometry a few years ago. Simply, what was the annual premium for E&O Liability insurance pre-TPA and excluding any other office insurance coverage?

----------


## tmorse

> Kindly advise what a sole-practitioner OD paid each year for what amount of liability insurance. I am not interested in todays premiums since TPA's have been added to the scope of practice of Optometry a few years ago. Simply, what was the annual premium for E&O Liability insurance pre-TPA and excluding any other office insurance coverage?


Since OD's are unwilling to divulge their pre-TPA Optometry Association group rate for Errors & Omissons Liability insurance rate, I must assume they have someting to hide. 

It has been suggested in an OD-inspired list that certain British Columbian members of the public have been 'harmed' after undergoing a sight-test. OD's therefor have both a moral and ethical (perhaps even legal) duty to assist their patients in recovery of damages against sight-testers for  negligence if, indeed, actual harm has been occasioned.

All sight-testers have a MINIMUM of $1,000,000.00 E&O insurance policy in place. Actuaries (experts at assessing risk have determined there is minimal risk to patients of sight-testers as demonstrated by their $100/yr insurance premiums.) If OD's feel they are better at assessing potential for risk than these acturarial insurance experts, let them come to court as expert witnesses for their so-called 'harmed' patients. Governments in BC and Alberta have already determined on balance to accept whatever risk sight-testing presents as being outweighed by the benefit(s) received, but that certainly doesn't preclude an civil action in negligence against a  sight-tester. 

So I propose that we have the courts determine this issue of 'harm'. BUT until this issue is brought before the courts, let's not have any more OD self-serving 'hypothesis' about certain patient 'harm' from simple sight-testing.:p

----------


## opti-refractonator

If we want to have sight testing or refraction included in the duties of opticians, we must find out from our regulatory college what the process entails.  Once we find out the process, lets together as a group (opticians) overcome the obstacles that we may face.  Obstacles such as education, assessed risk of harm to the public, legislation, etc..  As opticians we all want to have the opportunity to be able to make more money by offering more services to the public.  We cannot simply offer refraction to the public without having formal training.  The last thing we need is to insist that we do not need education because we have systems like eyelogic.  Today's consumer has enough respect for the profession of opticians to believe that we can perform refractions.  Opticians must make our case on both a PR and legislative standpoint rather than a "well they can do it so why can't we".    Opticians are not doctors.  There may be some doctors (or there staff) who don't know sh*t about selling a pair of glasses.  At the same time, there may be opticians who couldn't take a pd if the license depended on it.  Let's not fight with each other.

----------


## HarryChiling

Sight testing opticians have gone through 6 years of education and training, another 2 years and they could be OD's, another 8 and they could be OMD's.  Before the content of the program is mentioned this is to illustrtate that a sight testing optician doesn't necessarily have it easy and it's not something that every opticians is going to acheive.  It is a long and tough road and along the way there are way way to many naysayers and oposition, but it is a long time coming.  The opticiasn that have chosen this path have heard the "educate and then legislate" thing for far too long and tehy went and educated then legislated and now the professions that made up this "educate then legislate" motto are now cryign foul ball.  

The truth is that refractions are not welcome by OD's or OMD's as they consider this their turf or whatever.  If the data is looked at more objectively, the risks that are present don't account for the amount of alarm that is being presented to the public.  It's the equivalent to a modern day witch hunt, the propoganda that has been reffered to here has some very major flaws.
10 cases were presented from the years 2003 - 2004.  If I were to say 1,000,000 sight test were performed then that would be 0.001% in the form of complications.  Lets be more realistic, 100,000 sight test performed 0.01%.  Let's get stupid, 10,000 sight tests performed 0.1% and that's overa  two year period.  Now lets look at the numbers from the other end of the spectrum 10 sight tests performed 100%, 100 sight tests performed 10%, 1000 sight tests performed 1%.  The data is useless in this form except as propoganda.In every case the diagnosis was given by the opposing side to independent sight testing.  This means that the data is beig provided by biased sources.

----------


## jameselex

The Doc is right! Money is indeed a motivator, but for everyone,not only opticians.
I am not going to talk about opticians should or should not do " sight test" " refraction" " eye exam", people want to use differents term for their purpose( I am with " sight test" though); because money is a motivator. 
There is a conflict of interest here for ODs selling eyegllases ,there are a lot of them, and with unlicensed staff; I don't konw how did the goverment let this happen( maybe oneday I will run for board of opticians' college to do something about it). MDs don't sell drugs, they'd make money if they start doing that! Once I asked a friendly OD, " it won't be a problem if a OD is ethical" he replied. 
There won't be any problem if everyone is ethical! will it?

----------


## Oedema

> Thanks, that was very infomative.  How could things be changed to prevent these occurences from happening?


I think to prevent occurances such as theses, what needs to happen is practioners offering refractive services also need to be competent in the evaluation of the entire visual system.  Practioners need to be personally responsible for the care of their patients and they should be meeting the community standard of care.

----------


## Excalibur

> Sight testing opticians have gone through 6 years of education and training, another 2 years and they could be OD's, another 8 and they could be OMD's.  Before the content of the program is mentioned this is to illustrtate that a sight testing optician doesn't necessarily have it easy and it's not something that every opticians is going to acheive.  It is a long and tough road and along the way there are way way to many naysayers and oposition, but it is a long time coming.  The opticiasn that have chosen this path have heard the "educate and then legislate" thing for far too long and tehy went and educated then legislated and now the professions that made up this "educate then legislate" motto are now cryign foul ball.  
> 
> The truth is that refractions are not welcome by OD's or OMD's as they consider this their turf or whatever.  If the data is looked at more objectively, the risks that are present don't account for the amount of alarm that is being presented to the public.  It's the equivalent to a modern day witch hunt, the propoganda that has been reffered to here has some very major flaws.10 cases were presented from the years 2003 - 2004.  If I were to say 1,000,000 sight test were performed then that would be 0.001% in the form of complications.  Lets be more realistic, 100,000 sight test performed 0.01%.  Let's get stupid, 10,000 sight tests performed 0.1% and that's overa  two year period.  Now lets look at the numbers from the other end of the spectrum 10 sight tests performed 100%, 100 sight tests performed 10%, 1000 sight tests performed 1%.  The data is useless in this form except as propoganda.In every case the diagnosis was given by the opposing side to independent sight testing.  This means that the data is beig provided by biased sources.


There are many obstacles that must be overcome before opticians are able to gain independent refraction privileges across North America. Educational requirements must be standardized, and legislators must be convinced that public safety is met. I do not believe legislators can be convinced of this at this time. 

I think the safest and most effective method for gaining future independent refraction by opticians is to gear your education to allow more collaborative work with ODs and OMDs. The problem, however, may well be that the optometry/ophthalmology lobbies may not cooperate with your associations. There is no monopoly on education, but it is imperative that opticians standardize their education, create affiliations with university programs and admit the best students into their programs, and promote research to further the development of a greater knowledge base.

----------


## HarryChiling

> With the acceptance of extremely accurate Automated Refracting Instrumentation, the basic refraction in many busy OD and OMD offices are being managed by Ophthalmic Technicians. These individuals, in most cases, have minimum Optometric Professional Education and their technical skill is developed by on the job training.
> 
> In most private offices, the licensed OD or OMD decides the final eyeglass prescription. This improved automation has reduced the patient time with the OD and OMD on the tedious and time-consuming aspect of the refraction. Now more doctor time is available to the important eye health evaluation and case analysis.
> 
> 
> As long as there is Optometric or Medical supervision of the minimally professionally educated Refracting Technician there is little threat to quality patient care. But now there is an attempt to change this established mode of practice. 
> 
> 
> The US Ophthalmic Dispenser would now like to have the opportunity to upgrade their status to become Refracting Opticians. They point to fact that with advanced automation refraction is a very routine straightforward procedure. They can point to the fact that there are Refracting Opticians world wide, including Canada. Why not the USA? 
> ...


This text comes from a very well known OD named Paul Farkas, optometry has set the way for refracting opticians.  The idea of an uneducated optician refracting is as scary to me as it is to you.  Many of the currently refracting opticians in CA have 6 years of education invested and they are knowledgeable opticians.  They have paid there dues, opticians have tried and still try to work with OD's and OMD's to come up with an acceptable standard for opticians refracting, OD's don't want to see it appen so they request almost the impossible to make it happen.

I am sure most opticians would prefer to not refract if we could go back to the days where OD's and OMD's didn't dispense.  In the US there was a need for legislation to make it illegal for OD's and OMD's to release Rx's because there was such and issue with doctors holding the information hostage.  Still to this day there are issues with this.




> There are many obstacles that must be overcome before opticians are able to gain independent refraction privileges across North America. Educational requirements must be standardized, and legislators must be convinced that public safety is met. I do not believe legislators can be convinced of this at this time. 
> 
> I think the safest and most effective method for gaining future independent refraction by opticians is to gear your education to allow more collaborative work with ODs and OMDs. The problem, however, may well be that the optometry/ophthalmology lobbies may not cooperate with your associations. There is no monopoly on education, but it is imperative that opticians standardize their education, create affiliations with university programs and admit the best students into their programs, and promote research to further the development of a greater knowledge base.


Welcome back I almost thought you were going to meltdown and explode and then you post something very rational.  I agree with everythng in that post especially the legislation part, neither OD or OMD is going to cooperate, especially when their is such a geat financial benefit to not cooperateing.  I honestly don't think cooperation is going to do opticians any good.  Matter of fact I think the drive for cooperation has probably lead to more wasted time and dollars.  Cooperation involves both parties being on the same page, but often what is seen on the surface is different than what is said and happens behind closed doors.  

For example the only places in North America that allow independent sight testig are those places in which opticians took it upon themselves to educate then legislate and do it without cooperation of the other O's.

Opticians in general have always had the numbers, so legislatively I think opticians hold the most potential as far as legislative clout, but in general opticiasn as a whole do also have less motivation, less funds, less education.  The education is not hard to overcome, it is almost impossible not to be able to find money to attend college if you so choose.  The motivation, that's the part I see as the biggest obstacle and the cooperation of opticiasn with the other O's in the past I think has lead to a great void in our leadership which is slowly but surely being rebuilt, IMO.  The funds to the association is the interesting part that I have mentioned before, we all scramble for the same dollars from the same companies.  Since OD's have done such a great job of expanding their profession while at the same time stopping opticiasn from expanding ours companies have generally funded the optometry associations way way better tha they have funded the opticians association.  There are other issues with state societies and such that need to be addressed as well, but opticiasn can and will get more organized as time goes on.

In the US the biggest problem facing the eyecare industry is the fact that opticians are not licensed in every state.  The best thin optometry can do for their patinets is to ensure that they have no choice but to purchase eyeware in this country without seeing a professional.  Opticiasn in many states have tried to legislte this and optometry has been the opposition in many cases.  This does far more harm to the public in our industry than any other issue.  It is interestign to note that while optometry wants independent refraction by opticians to never occur they also don't want opticiasn licensed so their labor costs don't go up.  Heck many won't hire licensed professionals, I have even found that most OD's are intimidated by having highly trained opticiasn on staff.  For example when I put my resume out their I have found that more often I will get more responses if I leave things off my resume and ask for the same money, where as if I include everything and ask for the same amount of money I hear things like we weren't lookign to pay that much or your overqualified.  Which makes it hard for opticians to educate when the doctors don't want to hire educated personel, they don't want to pay a decent wage, yet they want to cooperate.

----------


## Excalibur

There are numerous hurdles opticians have to acquiring increases in scope of practice as cited in my previous email.

One other obstacle is that many opticians consider themselves as competitors rather than colleagues. Commercialism is rather strong in opticianry, and this is hurting the building of a sense of collegiality.

Opticians must try to build stronger clinical education that would allow them to work in a clinical environment with ODs and OMDs, rather than entirely independently doing sight testing.

----------


## HarryChiling

> There are numerous hurdles opticians have to acquiring increases in scope of practice as cited in my previous email.
> 
> One other obstacle is that many opticians consider themselves as competitors rather than colleagues. Commercialism is rather strong in opticianry, and this is hurting the building of a sense of collegiality.
> 
> Opticians must try to build stronger clinical education that would allow them to work in a clinical environment with ODs and OMDs, rather than entirely independently doing sight testing.


I would have agreed with that if this were the '60s or '70s, but in todays day and age spectacles are looked at as a fashion item.  I have people come in and shop for frames and then get upset at me because their -15.00 won't fit in a rimless pair of glasses, like somehow I am responsible for getting them into the frames that they want.  Eyeglasses have evolved past a medical or clinical device.  That's the part that is hurting most of the optometry and the ophthalmology practices that I have seen struggle, they still want to hold onto this old and outdated model.  Patients don't even want that model anymore, they are purchaseing their eyeware online, their contact lenses online, and some are even purchaseing plano colored lenses at beauty supply shops.

No one seems to want to look at the numbers realistically.  The pathology cases that walk into the average office are a small percentage and when you count the young and elderly out the numbers get even lower.

The point of independent refraction by opticians is not to do it under an optometrist or an ophthalmologist.  The point is to seperate the dispensing from the clinical and the medical side of things.  I don't want opticiasn to always have to rely on an OD or an OMD to make a decent living, because history has shown that an average OD and OMD does not value the optician for their skills.  You know the interesting thing is that their is a position in ophthalmology as an OMP called an orthoptist, they specialize in visual disorders and in many ophthalmology offices write scripts and perform various diagnostic tests.  These professionals have 6 years of education.  The OMP's have an option where the individual can be trained on the job with a correspondence course and refract.  These are all already happening under supervision, and any optician with a little bit of knowledge would generally fit into and fill these positions very well.

----------


## tmorse

[quote=Excalibur;217769]There are numerous hurdles opticians have to acquiring increases in scope of practice as cited in my previous email.
One other obstacle is that many opticians consider themselves as competitors rather than colleagues. Commercialism is rather strong in opticianry, and this is hurting the building of a sense of collegiality.quote]

This is a Canadian forum and all Canadian Opticians are formally trained and evaluated. The USA faces state licensing and other issues that should not cloud whether Ontario opticians can or should sight-test. 
Remote regions of BC and Alberta were not being serviced by Optometry and Opticians were precluded from setting up shop because they had to rely on an updated Rx. Government examined its options and decided to allow sight-testing if certain mandatory protocols were instituted. They were, and sight-testing in these western provinces is fluorishing. 
Perhaps the COO became so caught-up in the Bruce Bergoz sight-testing scandal that it overreacted, and now contemplates Standards of Practice that are both overly-onerous and unworkable. But now it can be sure that Bruce Bergoz will not get sight-testing privileges anytime soon. 
Unfortunately, few Ontario Opticians will find it worthwhile to add sight-testing to their skill-set under the proposed Ontario protocols. I can only hope I am wrong in my assessment. 
The COO might have tried to start, say, a 2-year sight-testing pilot-project uing the proven BC and Alberta protocols. The Ontario Health Ministry might have been willing to give that a chance, given the obvious benefits to the Ontario taxpayer that sight-testing offers and given that Ontario also has many remote regions that OD's don't service.
Forget any co-operation from Optometry now or later. They want to dominate sight-testers and keep them in the $15-20/hr bracket, using scare tactics and other fictions to bolster the case that sight-tesing cannot be divorced from a full eye assessment exam. Popycock!!
Unfortunately, strong leadership is required on the part of the COO. I think Ontario should withdraw its sight-testing initiative for now, re-assess its position, and then deliver a more palatable option to its registrants in a few years.:idea:

----------


## Oedema

> Sight testing opticians have gone through 6 years of education and training, another 2 years and they could be OD's, another 8 and they could be OMD's.


By my accounting minimum requirement for sight-testers is anywhere from 0.5FT+2PT years of education, to 6 years PT.

The NAIT sight-testing program is a two year independent/distance learning program
- admission to it requires that that applicant be licenced to dispense eyeglasses

Licensure to dispense eyeglasses can be achieve in 6months full time at BC college of optics, 1 year full time at douglas college , or 2 years of distance education.

----------


## opti-refractonator

In ontario, there was a course initiated by the college of opticians through georgian college the taught refraction.  I was a part of this first ever (ontario) course that started in 2003.  The course is part-time one phase in the spring and one phase in the fall.  The course was an in depth look at refraction and the visual system.  I don't know about the course in NAIT, but let me tell you, this course was intense.  Walking away from this course, I can very aptly perform a refraction with retinoscopy and phoropter.  We were taught to be able to recognize any symptomatic or asymptomatic indications or contraindications of a refraction only.  Doctors are using their education as a tool to hold opticians back from refracting, however, we have the necessary educational requirements in place.  Doctors are a whining group of professionals that were unable to get tpa's years ago so they decided to start dispensing.  Doctors in my area routinely give misguided rx's so the patient will return to buy from them.  The apple-bottom staff working in the offices don't know sh*t about eyewear.  The monoply of od's is coming to an end, and we need every optician in ontario, canada, to fight for our right to openly refract.

----------


## Excalibur

> In ontario, there was a course initiated by the college of opticians through georgian college the taught refraction.  I was a part of this first ever (ontario) course that started in 2003.  The course is part-time one phase in the spring and one phase in the fall.  The course was an in depth look at refraction and the visual system.  I don't know about the course in NAIT, but let me tell you, this course was intense.  Walking away from this course, I can very aptly perform a refraction with retinoscopy and phoropter.  We were taught to be able to recognize any symptomatic or asymptomatic indications or contraindications of a refraction only.  Doctors are using their education as a tool to hold opticians back from refracting, however, we have the necessary educational requirements in place.  Doctors are a whining group of professionals that were unable to get tpa's years ago so they decided to start dispensing.  Doctors in my area routinely give misguided rx's so the patient will return to buy from them.  The apple-bottom staff working in the offices don't know sh*t about eyewear.  The monoply of od's is coming to an end, and we need every optician in ontario, canada, to fight for our right to openly refract.


Oops.... and I thought my posts were inflammatory!

Generally, the logical conclusion to a refractive evaluation is a prescription. To prescribe, one must be able to:

1. collect proper refractive data
2. make a diagnosis
3. issue a prescription

Although 1 is possible at this time for any optician who has learned to refract, 2 and 3 are not possible (certainly in Ontario this is not possible). The most recent HPRAC findings certainly do not support independent refraction, and the findings are detailed in the report cited earlier in this thread. Reading this report would be necessary to obtain a good sense of how the Ontario government is treating this issue. 

Until opticians can communicate effectively using solid statistical data that can be verified by an independent academic source appointed by the government, independent sight testing in Ontario will not happen, will it as you may.

----------


## opti-refractonator

And od's were given tpa's because they could "communicate effectively using solid statistical data that can be verified by an independant academic source appointed by the government",  i don't think so, od's *****ed and gave the health minister a reach-around and got tpa's.  Make it sound as statistical or academical or philosophical or intellectual as you want, but realize that we will refract.  You can get all the midget od's together and jump as high as you want to stop us but you can't.  The movement has already started.

----------


## LandLord

What's a reach-around?

----------


## Excalibur

> And od's were given tpa's because they could "communicate effectively using solid statistical data that can be verified by an independant academic source appointed by the government",  i don't think so, od's *****ed and gave the health minister a reach-around and got tpa's.  Make it sound as statistical or academical or philosophical or intellectual as you want, but realize that we will refract.  You can get all the midget od's together and jump as high as you want to stop us but you can't.  The movement has already started.


The document can be found here:
http://hprac.org/en/reports/resource...il_2006_EN.pdf

refer to pages 119 and 123 to read the salient points on TPAs, which conflict with your arguments. Dr. Denis Grant is the Chief of the Dept of Pharmacology at the University of Toronto, and in essence his independent findings, as commissioned by the Govt of Ontario, demonstrated the need for permitting TPAs for Ontario optometrists. 

If the government is dissatisfied with how the College of Opticians is regulating its members, it may appoint its own members and regulate it itself rather than independently. This would not be good for Ontario opticians, and would hurt your profession greatly.

----------


## HarryChiling

> Oops.... and I thought my posts were inflammatory!
> 
> Generally, the logical conclusion to a refractive evaluation is a prescription. *To prescribe, one must be able to:*
> 
> *1. collect proper refractive data*
> *2. make a diagnosis*
> *3. issue a prescription*
> 
> Although 1 is possible at this time for any optician who has learned to refract, 2 and 3 are not possible (certainly in Ontario this is not possible). The most recent HPRAC findings certainly do not support independent refraction, and the findings are detailed in the report cited earlier in this thread. Reading this report would be necessary to obtain a good sense of how the Ontario government is treating this issue. 
> ...


The steps to prescription you mentioned are outdated and only apply from an OD's perspective so of course no one other than a doctor can prescribe given your steps as the rule, that's why we need new rules, to get out of the 19th century with the model.

Solid statistical data, the prrevoius posts had reference to solid data compiled by the National Eye Institute at NIH in Bethesda, MD.  The number of pathology cases in the age group that opticians would want to sight test would be statisticaaly low and pose very little risk.  Of course the data depending on interpretation can be used to both support or refute opticiasn sight testing, whihc is why optomtrists would want to have optician go down that pointless unfruitfull road.  

Politicians are not interested in the raw data, they are interested in the highest dollar contribution and backing along with some data interpreted any old way you want.

As far as make a diagnosis, every time a patient put's on a pair of readers they are self diagnosing themselves with presbyopia or hyperopia.  When a patient walks into the office and says I am having a hard time seeing street signs guess what myopia, I can't read hyperopia.  Sure there may be other underlying conditions but as a sight tester you would eliminate those patients from the start anyway.

I self diagnose myself with aesthenopia at the end of a hard day staring at equipment screens.  I self diagnose myslef with conjunctivitis after a night of drinking with Fezz.

----------


## Excalibur

Harry-- a diagnosis by a licensed professional requires collection of data, analysis of data and prescribing if required. Certainly we can all self-diagnose, but that does not permit us to prescribe things for ourselves in all cases. 

As I've stated before, I do believe that opticians should be able to learn refraction. Why not? but generally, separating this refractive data independently of other data is not beneficial to the management of patients. My experience clinically is that doing so would do the public more harm than good, and any attempt to create waivers/disclaimers is unenforceable. Doctors across North America have been obligated to release Rxs for specs and CLs, and I think that is generally a good idea. There are practitioners who do make it difficult for dispensers, but I do think they are a very small minority.

----------


## HarryChiling

> Harry-- a diagnosis by a licensed professional requires collection of data, analysis of data and prescribing if required. Certainly we can all self-diagnose, but that does not permit us to prescribe things for ourselves in all cases. 
> 
> As I've stated before, I do believe that opticians should be able to learn refraction. Why not? Generally, separating this refractive data independently of other data is not beneficial to the management of patients.


I understand what you are saying, I don't see it as part of a health evaluation as you do though.  A simple refraction can in no way help to diagnose any medical condition, the reason for keeping it part of the health evaluation seems to be becuase then patients will get the health evaluation.  That's like all opticians saying I can't sell you lenses without a frame purchase sorry.  I gotta make sure the frames are in good shape.

I know the fear is that patients will skip health checks, which means that optometrists don't have much faith in opticians screening, so then how do you make sure screenings are adhered to?  I think that's the real question.  Personally I think every time I say something you hear:

_Blah Blah Blah I want to refract Blah Blah_

Then I hear you talkign adn I hear:

_Blah Blah Blah No you can't refract Blah Blah_

The details of good for the patient and diagnosis and we could go over that all day long and both side can make an arguement for why each side should or shouldn't do it, I think that is why opticians should not try and work with OD's on this.  Let the public and the marketplace decide, if optometry has doen a good job in convincing the public that it would be detrimental to their health for opticiasn to refract then you have nothing to worry about, but if opticians have doen a better job convincing the public that it would be in their best interest to sight test then whalla sight testing it is.

I don't think a model where opticians refract for OD's is going to be acceptable to opticians, we can do it now under OMD's abnd if any opticians feels that they would like to sight test under a physician then that avenue is available today here and now, but opening up that door for optometry means that we will truly d*mn our profession, I don't think there is any way back from that.  I would rather no law for refraction then a law where it was done under the direct supervision of an OD, but that's just my opinion.

----------


## Oedema

> Doctors are a whining group of professionals that were unable to get tpa's years ago so they decided to start dispensing.  Doctors in my area routinely give misguided rx's so the patient will return to buy from them.  The apple-bottom staff working in the offices don't know sh*t about eyewear.  The monoply of od's is coming to an end, and we need every optician in ontario, canada, to fight for our right to openly refract.


Where did you get your history lesson from?  Optometrists have always, since the inception of the profession, dispensed eyewear.  TPA's have absolutely nothing to do with whether an OD dispenses or not.  If anything, the proportion of OD's that dispense has been in dramatic decline.

In my experience, in the practice I've worked with in Ontario, the optometric assistants are always knowledgeable and very capable of caring out their duties.  The attack on this board against them, is I feel, akin to the kettle calling the pot black.  Like many Canadian opticians (ie. NAIT graduates) optometric assistants learn on the job and through distance education.  Their education may not be equivalent, but they are certainly not apple-bottom, they do know their sh*t.

----------


## HarryChiling

> In my experience, in the practice I've worked with in Ontario, the optometric assistants are always knowledgeable and very capable of caring out their duties. The attack on this board against them, is I feel, akin to the kettle calling the pot black. Like many Canadian opticians (ie. NAIT graduates) optometric assistants learn on the job and through distance education. Their education may not be equivalent, but they are certainly not apple-bottom, they do know their sh*t.


I don't think there was ever a need for a group such as optometric assistants.  The creation of the profession optometric assistant was done by optometrists, in the past it was opticiasn that were more interested in the optometric side of things that filled these positions.  It' just another way of createing a rift between opticians.  If they fall under optometric rule they will never expand their scope of practice and will always be enslaved to the optometrists.  Many of the optometric assistants I know are very bright opticians that chose to gain that additional educaton and cert here in the US.  I don't hink any of them would want to pigeon hole themselves as optometric assitants alone though as generally that is a dead end job and in our profession usually falls below an optician and above a receptionist.  Never the less I think their entusiasm for the optometric side can lead to them becomeing a great contact lens technician as an optician.

----------


## Excalibur

> I don't think there was ever a need for a group such as optometric assistants.  The creation of the profession optometric assistant was done by optometrists, in the past it was opticiasn that were more interested in the optometric side of things that filled these positions.  It' just another way of createing a rift between opticians.  If they fall under optometric rule they will never expand their scope of practice and will always be enslaved to the optometrists.  Many of the optometric assistants I know are very bright opticians that chose to gain that additional educaton and cert here in the US.  I don't hink any of them would want to pigeon hole themselves as optometric assitants alone though as generally that is a dead end job and in our profession usually falls below an optician and above a receptionist.  Never the less I think their entusiasm for the optometric side can lead to them becomeing a great contact lens technician as an optician.


I disagree on several points. Opticians could play a valuable role in any optometry practice -- operating the dispensary, lab, CL technician, etc., but in some jurisdictions (including mine) you can't legally hire an optician due to the regulations. I understand this limitation will be changed shortly in Ontario, and that is a good thing. It will give a practice the option of hiring an optician. Certified optometric assistants do excellent work in a practice, however, I understand that they could upset opticians due to how they have been used in practices.

----------


## Stonegoat

Harry,

As I've stated before, I value the skill-set of opticians.  However, I notice that you alway talk about the crap that non-opticians dispense.  I think that is an inaccurate generalization.  The two sight-testers in my area are bottom-feeders and tend to dispense low-end products.  They are the "buy a new pair of glasses for $59.00 and receive a cowboy hat and a whistle absolutely FREE!!  In the last month, I had a very unhappy pateint who received their glasses from one of the sight-testers. The Rx was about plus 5.00, with a space between the frame and lens edge that I could slide a paper-clip through.  Total  crap.  Does this level of quality apply to all sight-testers?  I doubt it....just the ones in my area.

----------


## tmorse

> I disagree on several points. Opticians could play a valuable role in any optometry practice -- operating the dispensary, lab, CL technician, etc., but in some jurisdictions (including mine) you can't legally hire an optician *due to the regulations*.


Are these not *your own OPTOMETRY Regulations*, set by and for Optometrists? As to why there were conceived, perhaps to weaken Opticianry, or to keep the wage scale for Opticians and Optometric Assistants as low as possible? 

Oh, I forgot... it was a means intended to protect the public!!:hammer:

----------


## Oedema

It is a conflict of interest regulation set by the Ontario College of Optometrists.  The new draft regulations have repealed it, allowing optometrists to employ registered opticians, however it has not come into effect b/c the ministry has not yet approved the revised regulations.  

This is basically one the reason why the college is going after the OD's involved with IRIS in Ontario for professional misconduct.

----------


## Barry Santini

at least at this time. There are too many commercial interests that would NOT like to see a higher standard of optician education (and resultant higher salaries), and I'm not talking about ODs here.

I believe, and continue to believe, that refraction *can* be safely separated from a medically-comprehensive eye-exam. Agree or not, so many *medical* insurances no longer cover the refraction fee, stating it is a "routine" procedure that is not medically necessary.

I don't agree: Refraction *is*, IMHO. a *necessary* part of a complete eye exam, but a desire to be refracted does NOT mean a complete eye exam is warranted. 

I think the public welfare is *not*compromised at all if refractions were available separately from a complete exam, as long as they are educated as such. If you think the public is too _____(dumb?, insert your fave word here) to understand the difference, then, for my money, they certainly too _____ to select their own OTC ANYTHING (readers, Bifocals, dive/snorkel masks, etc.)

"John Q" knows that vision is fluid. That's why they want a refraction just about any and every time they want to buy Rx eyewear & sunwear. "Why not have the latest *numbers* before I make this purchase?" 

Is their eye or general health threatened by such a desire? Yes, but only if you continue to feel that only a complete eye exam should be done when a refraction would suffice.

In fact, I think that the twin inconveniences of having to schedule an eye exam and/or determine whether insurance coverage is available ARE THE TWO BIGGEST FACTORS THAT PREVENT SALES IN THE EYEWEAR MARKET FROM REAL GROWTH AS WELL AS MOVEMENT AWAY FROM A MEDICAL PURCHASE BASED ON NEED, TO A FASHION ONE BASED ON WANT.

Trained and qualified opticians that refract do nothing to take away from optometry and ophthalmology as gatekeepers of vision health and care, unless opticians allow the public to continue to think that the refraction _is the eye exam_ (as most of the public does now).

Bottom line: If you believe that the highest quality care can only be ensured with refracting done in an Dr.s office, then just common sense and logic alone dictate that the public SHOULD NOT BE ALLOWED TO REFRACT themselves.

I think congressmen and politicians will never buy the idea that the present public vision health is compromised by the availability of OTCs. Heck, they don't even think that internet refills of Contact Lenses (NOW THERE"S A MEDICAL-VISION APPLIANCE IF I EVER DID SEE ONE!) harm the public, and we all know better than that...

So just what is the harm when a qualified optician, with proper licensure and training (as in NYS), refracts John Q, _as long as its clear that no medical eye exam is implied in the procedure?_

I may not be able to refract as well as other, great ODs on this board (and elsewhere), but...most of their dispensing skills are also not nearly as good as mine (and others here)...and which one do you think really impacts the general satisfaction level of the public and their eyewear the most?

I sincerely hope I have *not* instigated anyone to flame-on with this thread. We need good discussions and exchanges like these.

Barry

----------


## AdmiralKnight

I never really understood this regulation. What exactly was the worry (conflict of interest) that caused this to be pushed for in the first place?

----------


## tmorse

> Harry,
> 
> The two sight-testers in my area are bottom-feeders and tend to dispense low-end products. They are the "buy a new pair of glasses for $59.00 and receive a cowboy hat and a whistle absolutely FREE!! In the last month, I had a very unhappy pateint who received their glasses from one of the sight-testers. The Rx was about plus 5.00, with a space between the frame and lens edge that I could slide a paper-clip through. Total crap. Does this level of quality apply to all sight-testers? I doubt it....just the ones in my area.


The College of Opticians of BC is the appropriate venue for customer complaints on lab quality of eyewear. You didn't mention the sight-test accuracy as being problematic, so don't change the focus (heh heh) of this thread.;)

----------


## tmorse

> at least at this time. There are too many commercial interests that would NOT like to see a higher standard of optician education (and resultant higher salaries), and I'm not talking about ODs here.
> 
> I believe, and continue to believe, that refraction *can* be safely separated from a medically-comprehensive eye-exam. Agree or not, so many *medical* insurances no longer cover the refraction fee, stating it is a "routine" procedure that is not medically necessary.
> 
> I don't agree: Refraction *is*, IMHO. a *necessary* part of a complete eye exam, but a desire to be refracted does NOT mean a complete eye exam is warranted. 
> 
> I think the public welfare is *not*compromised at all if refractions were available separately from a complete exam, as long as they are educated as such. If you think the public is too _____(dumb?, insert your fave word here) to understand the difference, then, for my money, they certainly too _____ to select their own OTC ANYTHING (readers, Bifocals, dive/snorkel masks, etc.)
> 
> "John Q" knows that vision is fluid. That's why they want a refraction just about any and every time they want to buy Rx eyewear & sunwear. "Why not have the latest *numbers* before I make this purchase?" 
> ...


 
*GOOD POST!!*

----------


## LandLord

> at least at this time. There are too many commercial interests that would NOT like to see a higher standard of optician education (and resultant higher salaries), and I'm not talking about ODs here.
> 
> I believe, and continue to believe, that refraction *can* be safely separated from a medically-comprehensive eye-exam. Agree or not, so many *medical* insurances no longer cover the refraction fee, stating it is a "routine" procedure that is not medically necessary.
> 
> I don't agree: Refraction *is*, IMHO. a *necessary* part of a complete eye exam, but a desire to be refracted does NOT mean a complete eye exam is warranted. 
> 
> I think the public welfare is *not*compromised at all if refractions were available separately from a complete exam, as long as they are educated as such. If you think the public is too _____(dumb?, insert your fave word here) to understand the difference, then, for my money, they certainly too _____ to select their own OTC ANYTHING (readers, Bifocals, dive/snorkel masks, etc.)
> 
> "John Q" knows that vision is fluid. That's why they want a refraction just about any and every time they want to buy Rx eyewear & sunwear. "Why not have the latest *numbers* before I make this purchase?" 
> ...


Very complete and well expressed. This is the kind of logic the refractometry killers fear most. Have you considered becoming a lobbyist?

----------


## LandLord

By the way, what's a reach around? :)

----------


## opti-refractonator

I am sorry that i have to tell you this.
a reach around is when one  person is standing in front of another person, similar to a line, and the person from behind reaches around the person in front and gives him a 'full release'  (chocking the chicken).  (if you dont understand this by now, i don't think that i can help you anymore.)

----------


## AdmiralKnight

I don't think that was necessairy :\

----------


## LandLord

some questions are rhetorical

----------


## opti-refractonator

My sincerest apologies

----------

