# Optical Forums > General Optics and Eyecare Discussion Forum >  Dr RX

## abocandy

Hey
You know when the Dr writes out an RX and they often make material suggestions?
Is it law to go by what the Doc has marked(suggested) on their or is it simply a suggestion and up to the Optician what is best.??
Please advise.
Thanks-
In the state of Florida..

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## For-Life

I always get a negative rep when I say this, but the doctor has no right making suggestions in the refraction room.  It is a major conflict of interest.

edit - I know that is not your question, but I needed to vent.

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## HarryChiling

Just a suggestion.

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## Johns

> I always get a negative rep when I say this...


I can see why!

(Do you consider it a conflict when a dr. tells a patient they need surgery as well?)

ABOCandy:

I approach it as a suggestion only.  Of course, if it doesn't work, and you didn't follow the suggestion...

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## For-Life

> I can see why!
> 
> (Do you consider it a conflict when a dr. tells a patient they need surgery as well?)
> 
> ABOCandy:
> 
> I approach it as a suggestion only.  Of course, if it doesn't work, and you didn't follow the suggestion...


Only if the surgery is completely elective, there are several other choices, and may not be the best person to make that decision.

The thing is, it is perceived by many patients that what is written on the script and what is mentioned in the exam room is not a suggestion but a prescription.  Prescriptions mean to must must not could.

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## MarcE

Don't know anything about FL, but just a suggestion.  How could it be anything else?

Our OD only puts a material when the patient has told her something in that dark room.  A suggestion, but you wouldn't be smart to go against it.

Another guy in town isn't so genuine.  He will "prescribe" the material, lens type, manufacturer, brand and style in the exam room.  Patient has had NO conversation about it.  For some opinionated fun review this thread:

http://www.optiboard.com/forums/show...+substitutions

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## Johns

> Only if the surgery is completely elective, there are several other choices, and may not be the best person to make that decision.


I see...so if a girls got a nose that she just can't stand, and she goes to a plastic surgeon, he can't make a reccomendation?

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## LENNY

> I see...so if a girls got a nose that she just can't stand, and she goes to a plastic surgeon, he can't make a reccomendation?


Not for Poly!:D

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## For-Life

> I see...so if a girls got a nose that she just can't stand, and she goes to a plastic surgeon, he can't make a reccomendation?


She is going to see him for cosmetics.  He is giving cosmetic advice.  They expect advice, because that is what they are looking for.  Now if I went to the doctor looking to help me with depression.  If he turns around and starts pushing an herbal tea that he owns a stake in, then it is unethical.  

Patients go see eye doctors for refractions and health of the eyes.  They give advice on coatings, type of PAL and materials.

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## Johns

> They expect advice, because that is what they are looking for.


'Nuff said.;)

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## chip anderson

Doctors have always been opinionated on this sort of thing.  Often depends on what seminar they last attended.  Some think everyone should have Poly, same doctor may not have heard about trivex.  Some insist on line type lenses because they have had negative results or heard negative opinions from colleges at meetings.
As to surgery we all know  those who are knife happy and those who will let cataracs go til the patient stumbling blind.
We all know we are in a bind whenever we have an opinion different than the doctor, especially some doctors.

You gotta know when to hold 'em and you gotta know when to fold 'em.

Remember rule #1 of the optical business and rule #2.

#1  Don't trust anybody.
#2 The doctor is always right.


Chip

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## abocandy

Hey everybody! Thanks for the info.
I always thought it was a suggestion.
But a local Optician had called a Dr and asked him to rewrite the script since he marked hi-index material and she wanted to put the pt in poly.
His argument was poly is hiindex.
I argue that even though it is a higher index then CR-39 to some Opticians to specify Poly would be more appropriate then just saying hi index.

Anyway,

Thanks

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## HarryChiling

I am curious now, with Duty to Warn and all, if the optician were to dispense high index as it was marked and the lenses were to shatter and damage the patient who holds the liability in that case?  Especially since the optician in some cases opticians may not be aware that it is only a suggestion.

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## opti-refractonator

As a rule,  I always go over with the patient what the doctor has written on the prescription.  This has two main benefits, firstly, the patient sees that I undrstand what the doctor has recommended and to show that I am a part of their visual success within the three O's.  Secondly, once I explain why the doctor has recommended something, I can let them know what other features may infact work better for them.  The more you can build a rapport with new customers, the more likely you are to pursuade into what you want.  ( obviously it benefits them to)

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## For-Life

Told you I would get dinged on this one.  Always happens.




> doctor has every right, and at times an obligation


Lets debate this anonymous comment that someone did not want to own up to.

The first question is do Doctors have the right to do this?  I do not think anyone is disputing it.  If they did not have the right, then we would not see this.  Though to have the right does not make it right.  I believe it confuses patients with subjective information.  I have had situations where I knew the OD was flat out wrong, but the patient believed him because it was written on the script.

Next part is obligation.  I have never heard that the doctor had the obligation to do this.  If anything, the doctor should have the obligation to not do this.  It is the Opticians obligation to inform the patient about glasses, not the ODs.

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## Barry Santini

Since its on the Rx, and you referred to it as a "suggestion"...well I think that that's what the whole Rx shebang is...a suggestion to start with that I refine with the help of the client.

Yes?

Barry




> Hey
> You know when the Dr writes out an RX and they often make material suggestions?
> Is it law to go by what the Doc has marked(suggested) on their or is it simply a suggestion and up to the Optician what is best.??
> Please advise.
> Thanks-
> In the state of Florida..

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## kws6000

> Told you I would get dinged on this one.  Always happens.
> 
> 
> 
> Lets debate this anonymous comment that someone did not want to own up to.
> 
> The first question is do Doctors have the right to do this?  I do not think anyone is disputing it.  If they did not have the right, then we would not see this.  Though to have the right does not make it right.  I believe it confuses patients with subjective information.  I have had situations where I knew the OD was flat out wrong, but the patient believed him because it was written on the script.
> 
> Next part is obligation.  I have never heard that the doctor had the obligation to do this.  If anything, the doctor should have the obligation to not do this.  It is the Opticians obligation to inform the patient about glasses, not the ODs.


Like it or not ,it is the DR's discretion whether to make eyeglass material and design recommendations or not.

As for the credibility gap ,that is part of the business .We face the same thing occasionally with some ophthalmologist recommendations that we dont necessarily agree with.

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## For-Life

> Like it or not ,it is the DR's discretion whether to make eyeglass material and design recommendations or not.
> 
> As for the credibility gap ,that is part of the business .We face the same thing occasionally with some ophthalmologist recommendations that we dont necessarily agree with.


and I never denied that the doctor has that discretion.  I said it is a wrong thing to do.

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## LandLord

It depends on the recommendation.  If the doctor is next to Lenscrafters and prescribes 4 separate pair of glasses, I'm going to take that with a grain of salt and let the patient decide.

If the prescriber writes slab-off, OS, I'm highly inclined to reinforce it.

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## AdmiralKnight

> I see...so if a girls got a nose that she just can't stand, and she goes to a plastic surgeon, he can't make a reccomendation?


Of course he can. He can't, however, say she HAS TO HAVE an entire face lift, nose job, boob job, and liposuction (NO SUBS!) when all she wanted was a little nose tweak.




> Like it or not ,it is the DR's discretion whether to make eyeglass material and design recommendations or not.


Sure, recommend. Recommend all you want. I welcome some recommendations, but don't dictate when there's no medical need for it. If I get a script saying a person needs a specific lens, or lens material, I'll call the OD to get a reasoning behind it, and as a professional courtesy, but if it doesn't make any sense, or they can't justify it, I'm going to take it as just a recommendation. I'll explain the advantages and disadvantages of using what was asked for, and leave the final choice to them.

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## chip anderson

I'm not sure there is a medical reason behind any lens with the possibility of those to correct strabismus.

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## Johns

> Told you I would get dinged on this one. Always happens.
> 
> Lets debate this anonymous comment that someone did not want to own up to.


I'm not getting where the comment is from.  Is this from another forum?

And no, I don't think there is an obligation to do anything beyond giving the exam, explaining the findings, and recommending the best way to correct the error.

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## For-Life

> I'm not getting where the comment is from.  Is this from another forum?
> 
> And no, I don't think there is an obligation to do anything beyond giving the exam, explaining the findings, and recommending the best way to correct the error.


it was an anonymous negative rep

I thought instead of going the negative route, we could debate it.

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## Johns

> it was an anonymous negative rep
> 
> I thought instead of going the negative route, we could debate it.


A regular "hit & run" huh?

I'll toss you a greenie to neutralize it!;)

I prefer the debate route as well.  

(Wanna bet it wasn't an optician? Now watch, I'll get smacked to!)

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## HarryChiling

If anyone gets a negative mark I will drop my big green hammer and make it right so no sweat.:cheers:

I think it undermines the doctor, let them focus that time and energy on provideing a accurate refraction and assesing the patients health, let e do the same with the frame and lenses.

I am still curious if a doctor recommends a lens such as CR, Hi-Index, or material other than Trivex or Poly who is held responsible for any potential eye injuries as a result of the material recommendation?

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## HarryChiling

Thanks docs it is esotropia, I mix phoria and tropia up all day every day, but I think the point was gotten which stonegoat pointed out.  

npdr,

AMD would be necessary, for instance I could use a higher base for added mag in any script (instead of the cosmetically better looking flatter lens), also I could also offer low vision devices to the patient if they have specific needs for it.  Heck there are occupational therapists that are evn talking up low vision because they can get rimbursed for th etime spent with the patient, but opticians can't but we can provide the service and we can provide the devices.  The point it it helps, also someone mentioned sjogren's I believe it is 710.2 or something I'll have to look it up to be or sure, but opticians can fabricate moisture chamber glasses, or make sure the glasses fit close and provide some barrier against wind that helps, I even suggest suns such as the wiley x that have the gaskets to prevent any evaporation.  What about a droopy lid proptosis we can solder on a crutch if we know it's an existing condition.

It's very similar to the medical optometrist hey focus more on the medical so there offices tend to focus on diagnosing and correcting issues, where as an optometrist in a walmart may only focus on refractive errors.  The skilled optician can use this information to fit the patient and hlp to eliminate some of the conditions that the patient suffers form, but it's odd when the optician asks for diagnostic information, but if it's relevent if the optometrist includes it they give their patient a better chance of getting great glasses.

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## npdr

Dear Harrychilling and renee1111,

As a low vision rehabilitation specialist for three medical centers, I can appreciate the significance of higher addition powers, but a random fashion in determining the appropriate magnification or aid is relatively inefficient. 

I don't even dispense low vision aids.  I just write out the aid I want "2.0x or +8.00D  half eye prismatic microscopics. Is there any equivocation here?

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## HarryChiling

> Dear Harrychilling and renee1111,
> 
> As a low vision rehabilitation specialist for three medical centers, I can appreciate the significance of higher addition powers, but a random fashion in determining the appropriate magnification or aid is relatively inefficient. 
> 
> I don't even dispense low vision aids. I just write out the aid I want "2.0x or +8.00D half eye prismatic microscopics. Is there any equivocation here?


 
Equivocation is almosta perfect definition, I don't understand how you come up wiht the correct mag without semi randomly trying out devices.  I would definately recommend at least a basic kit of low vision devices.  It amazes me that occupational therapists can perform low vision care and bill for it, but qualified opticians can't but that's probably a whole nother thread in and of itself.

So how do you determine that a 2x is appropriate, and does that mean the visual task being addressed and the specific type fo device necessary is left to someone else to chose?

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## npdr

> '... It amazes me that occupational therapists can perform low vision care and bill for it, but qualified opticians can't but that's probably a whole nother thread in and of itself.,,"


Harrychilling,

They do rehabilitation and that is why they can bill so much.

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## npdr

> '...So how do you determine that a 2x is appropriate, and does that mean the visual task being addressed and the specific type fo device necessary is left to someone else to chose?


There is a rule of thumb of 1x per every 20/50 vision increments. Thus if the best vision is 20/100 at the distance or at near (using reduced Snellen or Lighthouse cards) then that requires 2x. 

The target vision for most simple tasks is 20/50 (~Jaeger 4)

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## chip anderson

You got a good one, give him Super Bowl tickets or whatever he wants.

If he ever tires of his situation or the cold weather in OH,  tell him there is a place for him in Mississippi, or I'll re-locate wherever.  I haven't known but about four in 40 years like that and I have known over 300 or more.

Chip

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## renee1111

> As a low vision rehabilitation specialist for three medical centers, I can appreciate the significance of higher addition powers, but a random fashion in determining the appropriate magnification or aid is relatively inefficient. 
> 
> I don't even dispense low vision aids. I just write out the aid I want "2.0x or +8.00D half eye prismatic microscopics. Is there any equivocation here?


I don't understand how you could call yourself a low vision rehab specialist, if you do not dispense low vision aids. What exactly do you do? Most people who are visually impaired, don't have any idea of the products that are available to help improve their quality of life. Most visit a Low Vision Center as a very last resort. So by offering Low Vision services you should at least be well versed in all types of aids available for their condition. :finger:

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## npdr

> I don't understand how you could call yourself a low vision rehab specialist, if you do not dispense low vision aids. What exactly do you do? Most people who are visually impaired, don't have any idea of the products that are available to help improve their quality of life. Most visit a Low Vision Center as a very last resort..."offering.."


renee1111,

My apologies, I didn't comprehend that last post. I thought you were responding to my post regarding the wisdom of writing down something explicit on a prescription pad.

With your limited concept of low vision rehabilitation, do you want to enter a conversation about what low vision is? If so, do wish to start another thread. 

If you are so interested in practicing low vision or attacking me like a bull dog, may I interest you in the following before resuming our discssion:

*Foundations of Low Vision: Clinical and Functional Perspectives (Foundation Series)* by Anne L. Corn and Alan J. Koenig (*Hardcover* - Sep 1996)*Coping with Vision Loss: Maximizing What You Can See and Do* by Bill Chapman and Dr. Lin Moore (*Paperback* - Mar 30, 2001)*The Low Vision Handbook for Eyecare Professionals (Basic Bookshelf for Eyecare Professionals)* by Barbara Brown (*Paperback* - April 15, 2007)*Low Vision Rehabilitation: A Practical Guide for Occupational Therapists* by Mitchell Scheiman, Maxine Scheiman, and Stephen G. Whittaker (*Hardcover* - Dec 1, 2006)*Understanding Low Vision (Foundations)* by Randall T. Jose (*Hardcover* - Sep 1983*Low Vision: Principles and Practice* by Christine Dickinson (*Paperback* - Nov 3, 1998*Low Vision Manual* by Ian L. Bailey, A. Jonathan Jackson, and James S. WolffsohnIf you feel up to a tutorial, I'm available.

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## HarryChiling

npdr,

Thanks fro those resources, I will check into them when i get a chance.  If you get a chance check out a masters paper written by William Van Cleave, it is a great resource for opticiasn to learn the basics or fundamentals.
http://www.abo-ncle.org/pdf/van_cleave.pdf

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## npdr

LDO's, opticians, etc.

What do you define as low vision?What do you define as the minimum equipment necessary to be successful?

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## Barry Santini

> LDO's, opticians, etc.
> What do you define as low vision?What do you define as the minimum equipment necessary to be successful?


A:

1. Anything that will take far more time than you'll ever be compensated properly for, and the client's expectations are rarely met, let alone surpassed.
2. A moderate assortment of conventional magnifiers, and a good assortment of the latest portable, video-display magnifying devices.

I tried LV twice in my career, and I feel I have officially met my lifetime quota in this vision endeavor

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## rdcoach5

> You got a good one, give him Super Bowl tickets or whatever he wants.
> 
> If he ever tires of his situation or the cold weather in OH, tell him there is a place for him in Mississippi, or I'll re-locate wherever. I haven't known but about four in 40 years like that and I have known over 300 or more.
> 
> Chip


Chip, the only thing I worry about is an accident happening to him. We about had a heart attack when we heard a drunk driver had run over a local physician riding on a route we know our Dr. frequents. Turns out our Doc came upon the accident scene moments after it happened. You never know.

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## Dannyboy

To me low vision is when an individual wishes to be able to see at a certain level and cannot do it with regular eyeglasses, contact lenses or surgery. So lets say if someone is 20/50 and they wish to see 20/20 that is low vision for that particular individual. Low vision has many models.
The medical model involves generallly the ophthalmologists who makes the dx, the ophthalmic technician/technologist who performs the low vision refraction and low vision assesment, the occupational therapists who works with the devices reccomended by the ophthalmic technician/ophthalmologists in improving living skills and the orientation and mobility specialist. Most models do have loaner systems of the magnifiers and the CCTVs. Obviously the microscropes/telescopes that incorporate the cylindrical correction cannot be loaned. Interesting subject worth another thread. 

dannyboy

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## npdr

> To me low vision is when an individual wishes to be able to see at a certain level and cannot do it with regular eyeglasses, ..."


Interesting. Did you come up with this definition or did you read it somewhere? 

Theoretically that may be correct, but in general low vision means a disability. I doubt that 20/50 vision or better is a disability, but it is the functional target for all patients who have 20/100 or worse vision.

To say that 20/40 to 20/25 vision are disabled would both be far fetched and trivializes those who are more in need.

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## renee1111

> LDO's, opticians, etc.
> What do you define as low vision?What do you define as the minimum equipment necessary to be successful?


1. Come-on now, we've all been in school, we all know what Low Vision means...but I'm more interested in the second question... 

2. I would say, if your truly offering Low Vision Services, than you should have an assortment of magnifiers:
-Illuminated Hand Held .+8D, +12D, +16D, +20D, +39D. 
-illuminated Stand Magnifiers in the above listed powers. 
-An assortment of task specific magnifiers
-Video magnification systems:CCTV and a portable cctv. 
-A few distance aids such as Beechers binoculars and telecopes.

That would be a good start, although many times the customer has specific needs such as needing computer software or daily non-optical living aids. 




> With your limited concept of low vision rehabilitation, do you want to enter a conversation about what low vision is?


I find your views regarding low vision rather cut and dry. I have been running a low vision center for the past 2 years and I help people with low vision, everyday. My experiences have been: The patient sees Optometrist, gets referred to Ophthamologist who then refers to me. Nowhere along the way, was low vision solutions discussed. By the time I see this person, they have somewhat given up hope of ever living a normal life. The point of my earlier post was that, if you call yourself a low vision rehab specialist, just writing out 2.0X or +8.00D half-eye prismatic microscopics doesnt help the person who is visually impaired. Knowing what is available to help them in _all manners of life_does.

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## npdr

That is because I've evaluated their need and am prescribing an aid.  I'm not interested in someone else interfering with the plan.  I find that 'random walks' (a mathematical concept) by the patient are less inefficient and less effective.

1.Do you do movement analysis?
2. Readin rate training?
3. post stroke and TBI evaluation and rehab?

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## Dannyboy

I guess this OD believes Opticians should not be doing any type of low vision. Low vision can be done 90% with already made devices. Frankly we are better prepared to do the low vision analysis than occupational therapists. We are state licensed, we are knopwledgeable with optics and have time to do it. Colleges in Florida (Hillborough) has given or offered low vision courses (Several college credits) that are really not a sales pitch from any of the major low vision manufacturer...and even that course given by the manufactures is excellent. Low vision belongs in Optics not with Occupational therapists. The occupational therapists are excellent in increasing the rate of reading or in living skill improvement but licensed opticians are better in Optics. Low vision requires all types of experts because there are not to many of them.

Dannyboy

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## Stonegoat

My hat off to any who offer low vision services, irregardless of designation.  Definately a much needed service, but one that ODs and OMD are typically too busy to provide, at least adequately.

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## npdr

> I guess this OD believes Opticians should not be doing any type of low vision. Low vision can be done 90% with already made devices..."


It is true that a plethora of low vision aids are needed, but I do not recommend that patients do the "random walk" approach to selecting their aids. Because opticians might not know the visual acuities or visual field limitations, I doubt that an efficient paradigm for selecting a field can be done.

As an alternative, I could supply that information, but I'm not sure that it would be of benefit to the optician? 

How do you select the aid to first choose?
1. "Random walk" or let the patient try until one works?
2. You choose and choose until one works

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## HarryChiling

npdr,

The choice can be made with very simple calculations, if the patient is currently seeing 20/100 and the goal is to get him/her to 20/50 then 100/50=2x  if the patient is seeing 20/200 and the goal is 20/50 then 200/50=4x and you could go on and change the acuities as necessary.  It's not very random and in most cases the optician can take the prescribed Rx and trial frame then get acuities, but it woul dbe easier to get it from the doctor.  Anyway like I mentioned before I respect the fact that you provide a service that most fee is not profitable enough or is too time intesive, it really shows you care for your patients, cause let's face it you could probably be making more money and have more succesfull patients in other areas of optometry.  Like steff, my hats off to you.




> The occupational therapists are excellent in increasing the rate of reading or in living skill improvement but licensed opticians are better in Optics.


I agree, and I don't understand how they provide the services and get reimbursed by insurance companies, but they do.  I would be more interested in finding out why opticians cannot be reimbursed fro provideing low vision evaluations?  It is rather insuting that a profession with little optical knowledge can pick up and recommend these devices without any further training or skills yet and optician versed in this area of optics cannot.

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## npdr

HarryChlling et al.

1. OTR (Occupational Therapists, Registered - are in CA, licensed by the state. See http://www.bot.ca.gov/about.htm. 
2. If you didn't know the visual acuiteis, would you still be able to choose the Aid.  This is especially true if you get the patient into your office serendipitously.  But if you don't, do you take their visual acuity by a chart in your office? If so, are you using the LOGMAR, ETDRS, Sloan or Feinbloom charts? Do you do the translating between the charts? In other words, a patient comes in with ETDRS 20/100. Is it the same as 20/100 standard Snellen chart?
3. Since opticians dispense but do not rehabilitate, then they aren't qualified to bill under rehabilitation laws. 
4. In my opinion, the OTR are higher up the food chain than the optician. 
5. The optician is important, though, as a purveyor of the goods.
6. In the absence of ODs or OTRs interested in low vision, then, of course, an interested LDO can perform some of these tasks, but certainly not LV evaluation or rehabilitation. I would hesitate to recommend and LDO for either of these duties.

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## obxeyeguy

Wow! Do you get nosebleeds up on that pedestal?

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## npdr

> Wow! Do you get nosebleeds up on that pedestal?


No, but I regret I see the callouses of the optician trying to get on their own pedestal.

By private message, I know only 1 or 2 here that understand Low vision to some extent and that I would entrust a patient. Of course, patients can go any where, but if was working with them as a rehab team that would be different.

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## npdr

Look,

I believe that opticians can fit glasses well, pick out the best lenses for a patient, make them look good and fit contact lenses well. 

But rehabilitation is different. You cannot separate the rehabilitation from the low vision. Of course you will get results but you want to do rehabilitaiton without doing the sweat to get certified (as OTR). You also don't want to go to OD school so you can better understand low vision diagnosis and etiology.

Most of the OJT low vision that LDOs get are superb in optics and picking out an aid. But it is the picking out process that will be hard.

Some will go only with handheld, some willl go with headborne, some will go with electronic magnification and some more will try to do rehabilitation. But I have met few who can do all or match the patient easily with these options.

You believe that if you have a roomful of aids that th is is the best for the patient. That kind of thinking leads me to believe that the patient is choosing rather than the provider.

Most often the patient is choosing on cosmesis rather than on function. If you let them, they will never be truly rehabilitated and they will be constricted and restricted in their daily lives. 

But go ahead, I'm not stopping you guys if you want to say you understand Low Vision. I just don't see it by the posts so far.

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## npdr

I know that someone on this list confused esophoria and esotropia. There would be very few ODs that would confuse the effect of a subjective and objective angles of deviation in configuring glasses. 

I know it is a stretch, maybe, but how can you say you understand low vision?

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## HarryChiling

> I know that someone on this list confused esophoria and esotropia. There would be very few ODs that would confuse the effect of a subjective and objective angles of deviation in configuring glasses. 
> 
> I know it is a stretch, maybe, but how can you say you understand low vision?


That was me that mixed the terms up, but not the condition. Don't get it twisted I have sat through the same training that OCT get on low vision and can confidently say we both don't have a clue as to what we are doing, to an extent. I at least have knowledge in the optics. I am amazed that you would find an OCT more qualified than an optician for LV. Not to say that all opticians are qualified, but I have not meet any OCT that are qualified, it's just another area to bill for them. By the way the training I attended was more focused on billing than on provideing the correct optical aids and when questions came up from OCT their lack of knowledge in the field was disgusting.

Their was recently an OD on this board in another thread that said some pretty dumb things concerning prism and you think they would know better, right. I brought up more than a few instances in this thread where the patient could be better served by the doctor provideing more information to the optician who provides a very valuable and necessary service based on the information gathered by the OD, but rather than discuss the merits of those issues they were picked apart for semantics or lack of the proper term. In reality, the information does not belong to you, it belongs to the patient. If you really believe that by holding information hostage for the patient you are doing them a favor or provideing better patient care then this thread has really outlived it's use and I am disgusted. Lately the more I talk to OD's the more arrogant and self serving the attitudes seem to be getting.

Last time I get smacked in the face with an olive branch I try to extend.

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## npdr

HarryChilling,

Back to the thread. If you were doing low vision, what kind of information would you want on the script?

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## HarryChiling

> HarryChilling,
> 
> Back to the thread. If you were doing low vision, what kind of information would you want on the script?


I explained to you before I am not qualified to do low vision, but I am qualified by experience to say without VA, VD, and ceratin conditions I can't perform my role in the process adequately.  That is why i have commonly taken a stance that OD's are greedy.  I have heard your professions battle cry all my years, "That's not good for the patient".  Yet with holding relevent patient information while beign told that this information can and will provide your patients with better care seems to fall on deaf ears.  It is not for you to decide what iformation I need to perform the best for the patient, it is your job to provide the patient with the relevent information to get good care so do it and shut up already, or don't and stop with the holier than thou crap.

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## Stonegoat

NDPR...you do come across as pompous.  The problem with low vision care, at least in my region, is inadequate personell to deliver services.  I would be more than happy if a qualified LDO was interested in providing those services in my area...I simply don't have the time.

Harry...why do you always bash ODs as a group rather than take issue with those individuals that you have a problem with.  The majority of ODs that I know are good and honest people, who try to do what's best for their patients.  Sure there are a few that are only interested in $$, and maybe those individuals have been problematic for you.  However, I can name more than one LDO who offers horrible service with inferior products and shady sales tactics...should I paint you with the same brush as those distasteful individuals??

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## obxeyeguy

> 5. The optician is important, though, as a purveyor of the goods.


You assume you know our educational backround, and continually talk down to us.  Do you really believe that all we have  is a 20 minute correspondence course from the university of phoenix?  Just do as I the doctor says, no questions.                                    

Personally, I don't, and have never done low vision, so I can't debate that equally with you.  But your condescending attitude towards opticians is becoming more transparent.  Now we are purveyors,  kind of like the kid that served your happy meal, right?   Move on doc.

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## npdr

Only when talking about low vision, that's all. I said the LDO's do a great job on the other stuff.

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## HarryChiling

> NDPR...you do come across as pompous. The problem with low vision care, at least in my region, is inadequate personell to deliver services. I would be more than happy if a qualified LDO was interested in providing those services in my area...I simply don't have the time.
> 
> Harry...why do you always bash ODs as a group rather than take issue with those individuals that you have a problem with. The majority of ODs that I know are good and honest people, who try to do what's best for their patients. Sure there are a few that are only interested in $$, and maybe those individuals have been problematic for you. However, I can name more than one LDO who offers horrible service with inferior products and shady sales tactics...should I paint you with the same brush as those distasteful individuals??


I get painted with that brush every day.  In the previous posts I was painted with that brush, the term optician when refered to in this thread is not the same optician I refer to, npdr seems to want to refer to the mctician who barely knows his a$$ from a hole in the ground.  I am refering to the many opticians I have meet and look up to that are so far engrossed in optics they make me feel retarded.

I hav not meet very many good OD's, mainly becuase of the competitive nature of our work.  Low vision is tied hands down to the optical devices their are no if ands or buts, the opticiasn that provide this service are not just handing people different magnifying glasses and hoping for the best as npdr would like to make it out to be.  I have however meet OCT that do this, they have no clue how the optics work or how to provide the right device for the right situation.  I have seen patients come into our office with large heavy magnifiers that they were given when their need was reading a book.  How do we know that this was the need when they saw an OCT, we sent them there.  In the previous example of prescribing a 2x lens how does that help int he slightest?  The problem is more compicated than that.  The rehabilitation comes in the fact that the person provideing the service needs to show the patient the correct use and the correct illumination, the correct scenario where the particular device is to be usefull and also the areas in which the device would be contraindicative, and yes if the patient is reading a book with a heavy a$$ magnifier then they are going to quit.  




> But rehabilitation is different. You cannot separate the rehabilitation from the low vision. Of course you will get results but you want to do *rehabilitaiton without doing the sweat to get certified (as OTR).* You also don't want to go to *OD school so you can better understand low vision diagnosis and etiology*.


It is somehow assumed OK for the OCT to dabble in optics without the certification (ABO) or whatever, but the other way around isn't OK.  That's ridiculous.

OD School, that is insulting again I don't want to be an OD.  I can't understand how any OD can have spectacles in their offic an accuse me of trying to be them when they are trying to be me.  Opticians provide eyewear and optical devices, we are the best suited to perform these services.  As for the diagnosis, I don't want to diagnose it I want you to provide the patient with the diagnosis so that I can help with the proper devices.  npdr has a problem writing down the proper information, heck why not just leave the add, and minus or plus signs off of all the scripts so we can't find out any of the refractive conditions as well.




> Harry...why do you always bash ODs as a group rather than take issue with those individuals that you have a problem with.





> Lately the more I talk to OD's the more arrogant and self serving the attitudes seem to be getting.


That was the only thing directed at OD's and it has been true from my recent experiences.

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## HarryChiling

> Only when talking about low vision, that's all. I said the LDO's do a great job on the other stuff.


The threads not about LV, it was only steered that way to stroke your ego and give you examples from you verylimited area of practice and now your so arrogant we can't talk about that because you are the LV god right.

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## npdr

> The threads not about LV, it was only steered that way to stroke your ego and give you examples from you verylimited area of practice and now your so arrogant we can't talk about that because you are the LV god right.


You're correct about the direction of the thread going this direction. But it was about prescribing information. Even if we added it, there wouldn't be enough room. 

Ok Well said.

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## steff

> . Lately the more I talk to OD's the more arrogant and self serving the attitudes seem to be getting.


Harry,

I find this quote insulting.  I believe there are good opticians, and bad opticians.  Just like I believe that there are good ODs and bad ODs.  I think it is unfair that you have just decided that ODs are arrogant, greedy and self serving... ? 

I have found a lot of your posts insightful, and thoughtful, and have certainly learnt lots from them, however the last few posts about a profession in general, I have found a little spiteful.

Have a great day.

steff

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## steff

NPDR,

I'm with Stonegoat on this one.  You are coming across as arrogant, and pompous...

purveyor of goods???  That makes them sound like a haberdasherer!!!


Come on everyone... let's go with MUTUAL respect and recognition.  I know for a fact, that if I had to make a Franklin bifocal, I'd be up the creek without a paddle.  

If Harry mixes up a trope and a phoria, give him a break!

Have a great day everyone!!

steff

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## npdr

Steff,

Point taken

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## Dannyboy

NPDR you'll be amazed what an optician can accomplish in low vision.
As for "measuring the field of vision" you'll be surprised what a patient can describe. If your talking about using field expanders such as prisms for those with limited VF or using excentric fixation or trying some how relocate the image to areas of the macula that are healthy you are not the only one that has tried that, in fact there was an outfit in Tampa that did that an they were not even opticians. I guess if it was for you even a pair of readers would need to be "prescribed". In Florida and in many other states Opticians are helping people see with low vision aids. I do not understand why you are so against opticians helping people. Low Vision does not provide good income as eyeglasses. Maybe you are complaining because the CCTVs mark up is no longer that great. I dont know what is your problem but there are not to many ODs trained in low vision and if anyone can help the better. Better a trained Optician than a mere receptionist working for you. People with low vision need help and your arrogancy toward opticians that do help seems unexplainable.

Dannyboy:(

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## steff

Thanks NPDR...

Have a fantastic day!

steff

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## HarryChiling

> Harry,
> 
> I find this quote insulting. I believe there are good opticians, and bad opticians. Just like I believe that there are good ODs and bad ODs. I think it is unfair that you have just decided that ODs are arrogant, greedy and self serving... ? 
> 
> I have found a lot of your posts insightful, and thoughtful, and have certainly learnt lots from them, however the last few posts about a profession in general, I have found a little spiteful.
> 
> Have a great day.
> 
> steff


Sorry, I find myself more and more offended from patients and then I come onto a board that is supposed to be professionals and I see where my clients get their disrespect from.  I didn't mean to offend you, I have always found you open minded.

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## npdr

> '.... People with low vision need help and your arrogancy toward opticians that do help seems unexplainable.
> 
> Dannyboy:(



I'm waiting for them to show up. I'm waiting for the LDO who can talk more about an aid. I'm talking about the rehab portion. That is all. If the LDO can talk rehab, I'm with t hem. Any LDO want to talk about testing and rehab? If not then accept the fact that LDOs do 1/3 of the low vision pie and if they do that well. Great. And if they are the only ones doing it, great. More power. But please don't try to tell me that you know what low vision is in its entirety. Please don't try to tell me why you don't know why OTR' s make more money on low vision than either you or I. Yes, they can bill up to 2500 /year where I can only bill maybe 500/year.

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## HarryChiling

> I'm waiting for them to show up. I'm waiting for the LDO who can talk more about an aid. I'm talking about the rehab portion. That is all. If the LDO can talk rehab, I'm with t hem. Any LDO want to talk about testing and rehab? If not then accept the fact that LDOs do 1/3 of the low vision pie and if they do that well. Great. And if they are the only ones doing it, great. More power. But please don't try to tell me that you know what low vision is in its entirety. Please don't try to tell me why you don't know why OTR' s make more money on low vision than either you or I. Yes, they can bill up to 2500 /year where I can only bill maybe 500/year.


Wow, we're not even 1 full day into 2008 and Mr. Donkey of the year emerges, take a bow and accept this award.

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## npdr

Thanks. Gladly taken. last message on this thread.

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## Teamwork Marketing

The debate here exemplifies the difficulties faced by our partially sighted senior citizens. The fact is that ECPs have a responsibility to apply their training and a caring approach toward diagnosing, treating, and rehabilitating these patients. Those who bemoan the compensation and/or continually fail to meet patient expectations should consider another profession or team with multiple ECPs who are trained to provide the specialized services these patients need to acquire independent living tools and skills. 

A multidisciplinary patient-centered approach involving the appropriate combination of specialists: Ophthalmologists, Retina Specialists, Optometrists, Opticians, CLVTs, and/or low vision trained Occupational Therapists, is best. It greatly helps to properly identify specific patient needs and puts them in the hands of those best skilled in each step of the process.

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## HarryChiling

> A multidisciplinary patient-centered approach involving the appropriate combination of specialists: Ophthalmologists, Retina Specialists, Optometrists, Opticians, CLVTs, and/or low vision trained Occupational Therapists, is best. It greatly helps to properly identify specific patient needs and puts them in the hands of those best skilled in each step of the process.


I could agree with that, but when the when a link in the chain believes he/she is the bees/knees and belittles every other profession that could possibly offer assiatance you end up with qualified and competent people that may be turned off from even ventureing into this area of opticianry.  What if the arrogance of this guy here causes someone to think they would never be qualified to provide these services?  This is not patient care.  Our office does not provide LV, however we have available many resources and can point patients in many directions and provide assistance along the way even thoguh I can't bil for it.  In many cases their are "LV Specialists" OCT that refer to them selves as specialists that are just in it to bill for it.  Opticians can and do provide this service very well to many people in this country and it's a shame that someone who deems himself a specialist is so arrogant.

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## Teamwork Marketing

WOW!
I had no idea that my suggestion for a multidiciplinary approach for the benefit of the patient would be viewed as arrogant. I think I'll stick with my consulting business and let you guys go at it. Clearly, with over 3,500 OptiBoard posts (compared to my 2), this Harry Chilling is preoccupied. 

The fact that he directs patients as he does is positive. However, his view of low vision trained Occupational Therapists is bias and unfair. They are highly trained medical professionals who see patients that must be referred by an Ophthalmologist or Optometrist. OTs provide and routinely bill for prescribed Medicare services: 97003 OT Evaluation, 97530 Therapeutic Activities (eccentric viewing), 97532 Development of cognitive skills, 97533 Sensory integrastive techniques (use of low vision aids), 97535 ADLs (Activities of daily living), 97537 Community/Work integration, and more.... all proven as beneficial Medicare services for seniors. Call me arrogant.

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## HarryChiling

> WOW!
> I had no idea that my suggestion for a multidiciplinary approach for the benefit of the patient would be viewed as arrogant. I think I'll stick with my consulting business and let you guys go at it. Clearly, with over 3,500 OptiBoard posts (compared to my 2), this Harry Chilling is preoccupied. 
> 
> *The fact that he directs patients as he does is positive. However, his view of low vision trained Occupational Therapists is bias and unfair. They are highly trained medical professionals who see patients that must be referred by an Ophthalmologist or Optometrist. OTs provide and routinely bill for prescribed Medicare services: 97003 OT Evaluation, 97530 Therapeutic Activities (eccentric viewing), 97532 Development of cognitive skills, 97533 Sensory integrastive techniques (use of low vision aids), 97535 ADLs (Activities of daily living), 97537 Community/Work integration, and more.... all proven as beneficial Medicare services for seniors. Call me arrogant*.


Sorry if that came off as directed at you it was not, the previous posts would give you a bit of explanation, I do like a multidiciplinary approach like you mentioned. I pretty much iked the entire idea, my previous post was just pointing out that sme in the profession believe that only their particular part of the patients care is important. Ophthalmologist, Ocupational Therapists, Optometrists, Opticians, and even Ophthalmic Medical Professionals all cn and do provide care in LV. Again if I came off as directing my statement towards you I apoligize.

I understand that Ocupational Therapists are professionals, however when it comes to devices an optician that provides low vision services is just as capable if not more capable in this area, IMO.

3,500 posts, just goes to show you my addication for this board nothing more.

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## Teamwork Marketing

Harry,
Your generalization of OT capabilities is wrong. A Certified Low Vision OT has a degree in Occupational Therapy and has been trained and tested in a full array of rehabilitation services that go far beyond that of an Optician (see Medicare Codes in my earlier post). They are trained to identify activities of daily living (ADL) goals, detect and teach eccentric viewing skills needed to use devices, and only then help patients select and use the best devices for achievement of their goals.... often in the patient's home. Don't be too quick to compare their skills to yours.

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## Oedema

I think the problem we're seeing in this discussion is that there are possibly three different, yet somewhat overlapping  and contiguous aspects of providing low vision care.  I haven't by any means put much though into this...but I'm thinking there is the;

1. LV evaluation
2. Provison of LV aids + adaptation
3. Rehabilitation 


Some of the posters here are speaking mainly about #1,2 or 3 and not realizing the importance of the other steps along the way.  I think that this is were much of the conflict is coming from.

It might be helpful to step back and think about all of the services needed by patients that are on the continuum between partially sighted and totally blind - not all of these people will be helped by an optical aid, but there certainly are things we can do for them or services we can refer them to for  improved activities of daily living.

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