# Optical Forums > General Optics and Eyecare Discussion Forum >  Optometry vs. Ophthalmology

## dleab

I've searched the internet trying to find an official explanation, and it boils down to the following statement:

"An optometrist receives a Doctor of Optometry (O.D.) degree, which involves the study of optics, and is licensed to practice optometry only, not medicine. The practice of optometry by definition is limited to examining the eye for the purpose of prescribing and dispensing corrective lenses. 

Beyond refractive errors, optometrists possess a limited educational exposure to patients with eye disorders or health problems. Their didactic training in medical, pharmaceutical and ocular subjects averages approximately one year. Compare this to what is required of an ophthalmologist. 

As a result of recent lobbied state-by-state legislation, organized optometry has been able to expand the powers of various state optometry boards, including those in Arizona, to where optometrists are now allowed to prescribe and administer diagnostic and therapeutic pharmaceutical agents. Organized optometry has politically self-defined an optometrist as a "primary eye care provider". "

I know I'm asking for heated opinion here, but what do the optometrists say about this.  Also, what is an "optician"?

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## wmcdonald

An Optician is a healthcare provider licensed to measure, fill, fit, adapt and dispense spectacles, eyeglasses, contact lenses and other optical devices from a written prescription of a licensed physician (typically an Ophthalmologist) or an Optometrist. An Opticians education consists of (2) two years at an accredited college or a lengthy apprenticeship, often paired with a formal educational component. Some states require national certification by the American Board of Opticianry and the National Contact  Lens Examiners. Then, to achieve state licensing, an optician must pass a State Board examination in states where a license is required. To maintain licensure or ABO/NCLE Certification an Optician must fulfill continuing education requirements.

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## Texas Ranger

dleab, 
 So, what is your question, as a chemical engineer; are you promoting Ophthalmology for some reason? and dissing Optometry? I'm an Independent Optician working in a state that deems it unnecessary to require "Opticians" to have ANY level of education and competency standards. Most of the MDs in my market do not perform patient exams themselves anymore, they employ a "tech" staff, with considerable variance in training. I am uneducated, formally, unlicensed, but not unqualified. I have filled the Rx's of "eye doctors" for 35 years, and I guess the best guage of the success of MDs vs. ODs is "results" in patient satisfaction with the glasses prescribed, Id' give it to ODs, hands down. I really don't care which one the patients go to, it's their choice; I have no business aligances to either one. I only work for our clients to create fashionble , comfortable eyewear that they see the best possible out of!  clients are quite upset when they have an appointment with an MD for an eye exam, then have someone else perform the exam "under the doctor's supervision",i.e. he's in the building!. they find the doctor running an hour or so behind schedule, because they're overbooked (intentionally), and then when they get their glasses, they can't see properly. so, it doesn't necessarily mean a load how much better educated and trained the MD is if he's not the one doing the exam, and charging the pt. double for the priviledge; these are just what patients tell us. then the MDs get into putting in their own "optical shops", and ethics just went out the window. So, most optometrists have their own shops too. But at least they're doing their own exams, and the dr. error remakes on their rxs are about 10% of an Ophthamologist practice...

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## dleab

I knew I'd be sorry I asked.  I'm not asking as a chemical engineer--that's just my job, which the registration page asked for.  I was asking as a consumer of eye care services.  I'm not "dissing" anyone--I'm just trying to figure out what the heck is going on.

To give you a background on my question, I've been searching the internet on info. about contact lenses, since I'm a new wearer.  I ran across some "optical" forums where O.D. after O.D. openly complained they make no profit on contacts and that they'd rather push eyeglasses and they were losing their butts to the wholesale marketers.  When I got my contacts, I went under VSP coverage for the exam and bought the first box from the O.D. (required).  Then I went to Sam's and asked myself whether I would really rather continue buying each box from the O.D. for $22/box versus $13/box at Sam's.  How am I compromising my eyecare by getting valid refills from anyone I darn well please?  How can any O.D. argue that yes, the same product is available cheaper elsewhere--sounds like basic market economy.  Anyway, the O.D. attitute here bothered me--seems not be based on the medical model.

During my exam, the O.D. explained that he had the LASIK correction done himself and recommends it to anyone, but he'd be happy to sell me $1500 worth of reshaping lenses that I'd wear each night and take out for a day's worth of corrected vision.  I left wondering why I wouldn't pay the extra $500 and just get a permanent correction and then it hit me that the O.D. has to go to an ophthalmologist to get LASIK.  The O.D. can only go the less invasive route.

So, I just wanted to get an idea of where the line is drawn.  I also understand from further reading that sometimes the O.D. and the D.O. open offices together.  Seems to make sense to me, since from what I can glean from this forum and others, the O.D. receives much more training on refraction.  What I'm trying to understand now is how the role of O.D. is shifting to the diagnosis (or perhaps just pre-screening?) of eye disease.  I have two friends who are recent O.D. grads who know how to diagnose retinopathy for instance, but have not real clue about the underlying disease of diabetes.  Seems like the D.O. has that training.  Maybe it's not important whether the O.D. knows about diabestes in depth--maybe it's enough to find retinopathy and send them to the D.O. for treatment.

I also noticed that our O.D. can bill my med. insurance for certain diagnostic stuff on my diabetic wife and rake in D.O. scale money (I don't really care, since I do have insurance).

Please be kind to me, folks.  I'm just trying to get educated here.

Thanks.

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## NC-OD

Your definition is one of a typical Ophthalmology propaganda machine.

The official definition per the AOA:
--------------------------------------------------
 Optometrists are independent, primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions. 
Optometrists are an integral part of the health care team. As eye care practitioners, they are skilled in the co-management of eye health and vision care. They examine the structures of the eye to detect and diagnose: 

Vision conditions such as nearsightedness, farsightedness, astigmatism and presbyopia 
Binocular vision conditions such as convergence insufficiency, which can cause eye discomfort and difficulty reading 
Eye diseases such as glaucoma, cataracts and retinal disorders 
Systemic diseases such as hypertension and diabetes 
Optometrists prescribe and/or provide eyeglasses, contact lenses, low vision aids and vision therapy. They prescribe medications to treat eye diseases and perform certain surgical procedures. Optometrists also do testing to determine the patient's ability to focus and coordinate the eye, judge depth perception, and see colors accurately.
---------------------------------------------------------

With all due repect, engineers are typically our least preferred patients.  You might be trying to read between the lines a bit too much.  The worlds not out to get you.

Most OD's diagnose and treat all eye conditions minus major surgery.  Some are better than others.  Some OD's (typically older ones) refer more than normal.

Buy your contacts where every you want.  If your particular OD acts stupid because you want to buy elsewhere.....leave him for someone more ethical  and tell him your doing so.  There is no excuse for that.

And of course OD's bill medical (and vision) insurance.  I spend the better part of my day treating medical eye conditions.  Not sure what your point was there?

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## paw

Excellent explanation, NC-OD.

I feel that the person who posted may also be confused on what a D.O. is.

O.D. - Doctor of Optometry

D.O. - Doctor of Osteopathy

M.D. - Doctor of Medicine

An ophthalmologist is an M.D. (or a D.O.) who specializes in ophthalmology.  I'm not sure why "dleab" keeps referring to a D.O., because I'm pretty sure the vast majority of ophthalmologists are M.D.s.

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## Stopper

dleab,
Your definition of optometry is about thirty years old. THe profession has changed and advanced quite a bit since then. You are correct that many of the changes have come from legislative action. We don't like that way but this is how it works. If we had several hours I could fill you in on all the ugly details if you really want to know. A bunch of politicians aren't going to pass laws with out proof. We have the training and education to back it up. 

No offense is taken by your posts. Many people are confused about the difference betweenan optometrist, an ophthalmologist and an optician. Thanks for taking the time to ask the question.

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## PAkev

dleab,

I work with both OD's and MD's and echo some of the sentiments from previous posters.  I have a personal friend that works as a tech for an MD and I have greater confidence in the quality of a refraction he will give vs. the high profile Doc he works for.  Although MD's are indeed qualified to perfom refractions, many find it too time consuming and the exam fees less lucrative than other opthalmology services such as treating glaucoma, cataract procedures, etc.

I've found OD's a little more patient and understanding of the routine optical demands which patients have and therefore offer more appropriate solutions.

Now, It just wouldn't be fair to talk about the two software alternatives without giving some consideration to the hardware folks...........The OPTICIAN.

Ask an MD what the index of refraction is of a CR-39 lens and he will probably be looking for a 39 diopter lens in his trial lens set.  Opticians take the information from the MD and OD to offer the best solution to a patients eyewear needs.  So  what I am getting to here is what is a person accomplishing by seeing a highly educated professional such as an MD for a routine exam and then going to a value optical retailer where the sales persons only training is what their employer has offered compared to proven optical technology which is exchanged through competency, education, and experience?

The Bottom line is we all have a purpose in creating a positive experience to help you see better.  As a chemical engineer, I am sure you can offer a few reasons why we shouldn't mix sulfer, saltpeter, and charcoal together in our kitchen food processer to make our own gunpowder for a few  bucks less than buying it down at the local sporting goods shop.

"Once you THINK you know EVERYTHING ... You STOP knowing ANYTHING"

Kevin

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## Stopper

dleab,
As far as where you purchase your lenses, that should be your choice. That doc needs to lighten up. 

I'm not defending the OD that you saw but it does sound like he did present you with most of your options for vision correction. Sounds like his presentation and style need a little work. There are lots of good ODs out there, ask a friend for a referral and try to find one you are comfortable with.

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## vitalogy44

First off, LASIK is great, but it sure isn't a permanent correction for vision. Ask any presbyopic person if it's great or permanent--you'll still need glasses to read with. Plus, most LASIK consent forms specify that it is necessary to have a yearly eye exam after the surgery. I think the punishment for not heeding this is that you are responsible for paying for any enhancements. Actually, it is very ignorant to not have your cornea checked regularly after someone has cut it. And to add insult to injury--it truly is only cosmetic.

Next topic--contact lenses. ODs or any contact lens Rx prescribers will never be able to compete with the likes of Sam's or Costco on the basis of contact lens price--we realize this. What eats at us, though, is the uneducated majority out there thinking they get a contact lens prescription and buy all the lenses they want for the rest of their natural life without another check-up on the lenses. As far as price is concerned, sure the large corporates will be lower, but I bet the discrepancy on a year's supply of contacts isn't that much lower there vs. your OD.

Topic #3-Refraction--ODs hands down! I don't know anyone on this board, but I bet the majority of them would give you a better refraction than an MD or their tech. Lots of MDs won't give Rxs out because it isn't cost-effective for them--eats into their chair time.

As far as the definition of Optometry--NC-OD covered that. You got some bad infor with this comment "Their didactic training in medical, pharmaceutical and ocular subjects averages approximately one year". I can give you a comparison that might help out. In college, you normally vary between 12-18 hours per semester for full-time students. In Optometry school it is a lot more than that--I had more than one semester where I had over 30 hours of coursework. I also remember having 5 Ocular Disease courses. I went to a health professions school--the first two years there--I had various basic science classes with Osteopaths, pharm, dentistry, PT, OT, allied health, etc. students.

"Beyond refractive errors, optometrists possess a limited educational exposure to patients with eye disorders or health problems"--I don't necessarily agree with this statement. A high percentage of my patients have diabetes or high blood pressure and I check for retinopathy on each one of them.ODs are knowledgable on both of these common diseases, but if we had wanted to treat them--wouldn't we have gone to medical school. It is common, though, for patients with elevated or uncontrolled blood sugar be detected in an eye exam and it is also common for these patients to not have retinopathy and I will refer them to their MD for blood work-up because I suspect it -- based on patient complaint, refractive condition, or both.

I don't really know what you're looking for dleab--hope this helped--if didn't maybe it bored you enough to forget..........

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## dyip

dleab,
You must be thinking "What a warm welcome to a new comer from the O's!". Finally, there is another CL consumer who speaks up like me. You should have joined this forum several months earlier. If the other optical forums that you referred to are the VisionCare Forums, then I know what you are talking about; otherwise, please let me know the links to the other forums. I basically was as curious as you in the beginning, and these forums have plenty to offer. You definitely are at the right place. You should first read my thread Disposable CL may last much longer than the CL makers want you to know (http://www.optiboard.com/forums/show...?threadid=6760) to give yourself some confidence. Then just gather your thought and share it with everyone. I think we may have something in common, at least our membership IDs kind of rhyme with each other.;) 

vitalogy44 said,



> . ..What eats at us, though, is the uneducated majority out there thinking they get a contact lens prescription and buy all the lenses they want for the rest of their natural life without another check-up on the lenses. As far as price is concerned, sure the large corporates will be lower, but I bet the discrepancy on a year's supply of contacts isn't that much lower there vs. your OD.


In my case, one box of CLs for each eye is already too many. You will know what I mean after reading Disposable CL may last much longer than the CL makers want you to know 



NC-OD,
What did you mean by saying " engineers are typically our least preferred patients"?

There are many types of engineers in this country. Have you seen a lot of them already in your small town during your brief career? Why are you so sure about engineers in general are least preferred patients? Since you also used the word our, did you base your conclusion on your own experience or some other ODs or Os? Do you want to share your thought with us on this topic? Sounds interesting. BTW, who are your most preferred patients, the people who dont know how to figure out the change of your good day meal or some overpaid MDs or dentists?

Sometimes it is dangerous to be a man of few words, like when you said 



> Naw.......there just plain lazy! It's just easier to let someone lead you around by the neck.


 in the thread MD and OD earlier.

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## hcjilson

Optometry vs Ophthalmology, lets not start a debate on engineers here, give the folks at "Just Conversation" something to talk about by starting something over there!:D :D 

hj

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## NC-OD

Sorry dyip,

I'm too busy to play with you.

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## vitalogy44

dyip,

"One box of contacts for each eye is too much for you"--what does this statement mean?? One of the things that drives me crazy are the patients that unknowingly compromise their eye health because they try to make one box of contacts last for an entire year. I have had too many patients agree with me that a 2 week disposable worn for a month is not nearly as comfortable as a new lens--also, the vision is not as good--that is a fact. Just because you think you see fine is not good enough. It is too easy to lose that point of reference--clarity, I'm saying. Dropping from 20/20 to 20/30 is very common with old lenses. Why patients wear an uncomfortable lens is a mystery to me.
Contacts are medical devices and the reason they are regulated so closely is because the general public has no idea the damage they can cause to themselves with them.
Finally, think about this--most, if not all, eye doctors care for your vision and don't want you suffering a central corneal ulcer. So, please don't feel like everyone is out to get you beacause we want you to dispose of lenses--it is so much safer to just change the lenses and not to lose vision because you were trying to save a buck. The sad thing is that some patients have trouble with lenses or lose vision because of their ignorance and blame the OD.

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## dleab

Thanks to all for your replies.  I certainly mean no disrespect to you O.D.s out there (and I'm sorry for using D.O. to refer to ophthalmologists)--my ignorance there.

I'm satisfied with my eyecare.  I plan to get a checkup from from O.D. every year just as he requested.  My eyes are too precious to screw around with when it comes to skipping exams.  I can also assure you I'll be replacing my 2-week Acuvue 2's with fresh ones at the prescribed intervals, or whenever I feel like a fresh pair--whichever is SOONER.  Again, my eyes are more important that any $13 box of contacts.

Also, on another note, my friend who's an O.D. (at least I attended her graduation at Southern College of Opt.) recently found a brain tumor in a routine exam and referred her patient to an oncologist--probably saved her life.  She had been going to her regular M.D. (general practicioner) for months trying different headache and migraine remedies.  Thought I'd share a good story about someone who is certainly giving O.D. a good name.

Thanks alot, folks.

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## vitalogy44

> *dleab said:* 
> Thanks to all for your replies.  I certainly mean no disrespect to you O.D.s out there (and I'm sorry for using D.O. to refer to ophthalmologists)--my ignorance there.
> 
> I'm satisfied with my eyecare.  I plan to get a checkup from from O.D. every year just as he requested.  My eyes are too precious to screw around with when it comes to skipping exams.  I can also assure you I'll be replacing my 2-week Acuvue 2's with fresh ones at the prescribed intervals, or whenever I feel like a fresh pair--whichever is SOONER.  Again, my eyes are more important that any $13 box of contacts.
> 
> Also, on another note, my friend who's an O.D. (at least I attended her graduation at Southern College of Opt.) recently found a brain tumor in a routine exam and referred her patient to an oncologist--probably saved her life.  She had been going to her regular M.D. (general practicioner) for months trying different headache and migraine remedies.  Thought I'd share a good story about someone who is certainly giving O.D. a good name.
> 
> Thanks alot, folks.


Sounds like you found out some useful info, dleab. You can buy your lenses wherever you want and at the cheapest price you can find--it's ok to do that, on the prescribed product, but we're holding you to your word--keep up with those regular eye exams--we only make you return because we care--most people don't realize this. What most people don't realize is that if they are in a 2 week disposable contact--go ahead and change it every two weeks--it is tons more comfortable, gives better vision, and why have 6 months of a years supply left after a year's time--to get two years out of it--these are the people that drve us nuts--compromising their vision for an entire 2 years for what ($13/box=) a measly $104--now that is ignorance. If you have any more questions--just ask--you're the only chemical engineer around to pick on!!
:p ;) :p ;) 
PS-glad to hear your friend was able to diagnose her patients tumor.

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## dyip

hcjilson,

You said:



> lets not start a debate on engineers here


The issue is not about  a debate on engineers. It is about what kind of people/professional personnel are the least/most preferred patients to the Os. I think that this is a very relevant topic in this forum. Wont you yourself and many Optiboard members be interested too?

Good post about NC-ODs remark in the thread MD and OD. :bbg: Sometimes old habit dies hard. My previous post is just another friendly reminder to the Doc in choosing words more carefully. If he doesnt even bother to stand behind his own words, it is better not to say them in the first place.



vitalogy44,

You said:



> I have had too many patients agree with me that a 2 week disposable worn for a month is not nearly as comfortable as a new lens--also, the vision is not as good--that is a fact. Just because you think you see fine is not good enough. It is too easy to lose that point of reference--clarity, I'm saying. Dropping from 20/20 to 20/30 is very common with old lenses. Why patients wear an uncomfortable lens is a mystery to me.


I have been wearing the same pair of  Encore Toric for 10+ months already. Thanks to my GOOD daily care, they still look and feel like new. I just had my vision checked a few weeks ago during a routine health check up. My vision was/is at least 20/20 per eye with the CLs on. I still have 5 pairs of brand new CL unused. Unless my vision changes substantially over time, I think that I will stick with the same boxes of CLs for a while.  



You said:



> Finally, think about this--most, if not all, eye doctors care for your vision and don't want you suffering a central corneal ulcer.


What is the root cause for central corneal ulcer? How is it related to the replacement period of the CLs?



You said:



> So, please don't feel like everyone is out to get you beacause we want you to dispose of lenses--it is so much safer to just change the lenses and not to lose vision because you were trying to save a buck.


My own experience tells me that the $200+ soft toric lens(daily wear) 10+ years ago was much much more inferior to todays $5 daily wear CL  (usually disguised as 7 day or 2 week disposables by propaganda) in term of comfort and clarity. I never liked my old soft lenses and RGP's(red circles around the pupils with the soft lenses and almost full time constant discomfort with the RGP's). I did not give up was because I had a high discomfort tolerance when I was much younger. When I get older, CL comfort becomes very important to me. I would rather go back to full time eye glasses in a heart beat if my new CL give me the same old bad feeling. In my opinion, the key thing determining CL wear comfort and vision health is to keep good maintenance of the lens. If I follow the No Rub MPS disinfection instruction 100%, I will not hesitate to throw away the Encore Toric after 2 weeks because there is no way to just rinse off the deposit accumulated on the lens surface, no matter how much solution I pour on the lens. I will also end up buying a lot of CLs and MPS solutions too. Now, I am not just talking a spending a few more bucks a year. It is about  hundred of dollars from my pocket and billions of dollars for the whole CL industry. Id tried disinfecting according to the MPS instruction and did not like the feeling on the eyes the next day. I end up using daily cleaner and rub each lens very thoroughly at the end of the day in combination with saline and MPS solution. This way the CLs can be worn like daily wear (Encore Toric is the same material as the daily wear Sunsoft Toric )CL and last for a long time. 



You said:



> The sad thing is that some patients have trouble with lenses or lose vision because of their ignorance and blame the OD.


The general consensus is that for those CLs wearers who do not take good CL maintenance care, deposit will keep accumulating on the lens surfaces, hence disposing the CL every one or two weeks will help to reduce infection or other complication risk. To me, wearing the disposable lens(at least Encore Toric) for one week, one month or one year is just a matter of personal preference as long as good CL maintenance is practiced(including rubbing the lens). How would my eye care maintenance habit jeopardizes my vision? What is my ignorance? I really do not want to repeat what had been discussed in the thread Disposable CL may last much longer than the CL makers want you to know (http://www.optiboard.com/forums/show...?threadid=6760). Just see it for yourself.

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## BobV

Probably the one thing that may "annoy" an optom the most from engineers is questioning.  An engineer is analytical.  You are not happy being pushed through the mill without answers to some well thought questions.  Questions are time consuming, and when the doc's schedule has four patients per hour, you are eating into chair time.

I have seen engineers with graphs and charts trying to explain their particular vision disorder.  I must say that our docs listen and try to work with them to the best of their abilities.  Then it's our turn.  I personally have spent over an hour working with some engineers as to getting their best vision out of a pair of specs.  I welcome the questions because to me it's a challenge, not a waste of time.

Bob V.

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## dyip

BobV,

Good diplomatic answer.

If an engineer is analytical, then what about a dedicated scientist, a fundamentalist? An engineer will probably just *USE* other peoples charts or graphs as long as the sources are reliable.  A scientist will probably develop his/her own theories and *CREATE* his/her own graphs and charts or even bring some SEM (SCANNING ELECTRON MICROSCOPE) photos of his/her contact lens to your office to prove a point. If you/OD are a good listener, the conversation (possibly lopsided) can even lasts for hours, forget about seeing 4 patients an hour. 

At one point, I almost wanted to bring an article regarding toric lens fitting and chat with the OD about the lens rotation due to wrong axis for my CL. But I respected his experience and didnt want to second guess his judgement, so I changed my mind. Even though I liked to dwell on certain CL topics with the OD in the office, I knew when to stop when his chair time with me was up, especially when there were other patients waiting impatiently in the waiting room. That was the reason why I had so many unanswered questions after leaving the OD office and needed to seek help from the web. 

Next time, if you meet a curious engineer/scientist, you should recommend him/her to post the questions in a forum like this. The responses from all experts will sure make him/her satisfied.

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## Susan Henault

I have been waiting patiently for someone -- ANYONE -- to stand up and defend NC-OD's comment about working with engineers!  Will no one on this forum admit that they cringe at the thought of dealing with an engineer as a patient?  Come on, I know many of the ECP's in the Pacific Northwest who do NOT refer to tough fits as "the patient from H---", but "the patient from ... Boeing!" lol :D  Be HONEST -- you guys are being NICE.  I'm going to try and be BOTH, so here goes:  Engineers would be just fine if they just asked a lot of questions and took a little more of our time.  Heck, my MOM does that, and she -- well, suffice to say that she's no engineer (sorry Mom).  

First off, it's NOT ALL engineers.  But the fact is enough of them come in TELLING, and not asking.  They show up in the office fully armed with a few snippets they pulled off the internet (generally having no idea in what context the information was originally intended), and they start TELLING, not asking eye care professionals what THEY think they know about this and that.  WE KNOW IT IS NOT INTENDED, but at best it comes off a little rude.  At worst it comes off as condescending or disrespectful.  I truly believe that this is an experience just about every "O" has had to endure at least once in their career.  But it does stick with you, so I completely understand why NC-OD would throw it out there.  Hey, it's only my opinion (please do NOT take my comments as coming in any way from my employer -- heck, we have hundreds of engineers on the Shamir team in Israel).  I guess it's kind of like "used car salesmen".  As engineers, I'm sure you guys LOVE dealing with sales people, right?  Yeah, RIGHT ... I throw that in there because as a sales professional, I am used to being stereotyped.  It's a drag, but a reality of the trade.  It's up to ME to change my customers' view of what a sales person really is -- a business partner.    

Just a few final comments and I'll get gone.  I totally disagree with any consumer (that is not thoroughly educated in eye care) who tries to influence other consumers to jump on board with what they have independently concluded is right for them.  The overwhelming majority of consumers have told us that they WANT care free contact lenses, and the industry has responded with disposables.  While daily wear lenses are still available for those who prefer to go through the daily routine of rubbing and scrubbing and enzyming and blah, blah, blah -- MOST consumers LOVE and greatly prefer a disposable regimen.

Lastly, I feel it absolutely necessary to clarify that the distribution of contact lenses, solutions and related supplies IS NOT A MULTI-BILLION DOLLAR business, let alone a multi-billion dollar scam.  According Jobson Research's annual report on the State of the Industry, last year (2002 U. S. A.) the entire eye care industry generated a modest $22.8B in sales, *of which, CLs and related accessories only comprised $0.2B.*  FYI

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## AGM

The biggest complaint from the OD's in my area is that the "price club" type places have *******ized the contact lens industry. Being able to purchase huge quantities of lenses wholesale for a national chain, knock the independent practitioner out of the arena. Our practice "expects" that patients will probably get their lenses elswhere, once appropriate fitting and F/U are finished.

Which places the "focus" on earning your pay on delivering services, where it should be. I think most OD's would agree that the independent practioner has barely any mark up on CL's. The expertise in CLfitting, follow up, and signing their name to a valid CL RX is where an OD is earning their keep, as far as CL's are concerned.

The general public, engineers included, need to be reminded that the fee that OD's deserve to make to fit and F/U on CL wearers is no longer built in to the price of the lenses, even at 22$ a box. Patients are generally receptive when reminded of this. 

Also, an OD generally does not get reimbursed by insurance Companies the same $$ fee as MD's. The U/C fee allowed by insurance co. is lower for OD's than for MD's, at least in my neck of the woods. (and except for VSP, which our MD will only see patients on if absolutely necessary.) VSP patients are scheduled with our OD, the reimbursement is not near what the MD usually gets for a Comprehensive eye Exam. 

MD's in our area typically do no CL fits, leaving that to a staff OD or tech certified by the NCLE.

my 2 cents worth

AGM

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## dyip

Susan,
Did you do a sanity check of your math or you just blindly used other peoples number?:finger: :finger: 

Your $.2B sales number for CLs and related accessories(in US) must be quoted from this source:www.optistock.com/jobson-som-2002-12.ppt

If there are more than 20+ millions in this country wear some kind of disposable CL(see the sources below), and if every CL wearer complies with the replacement schedule, the annual CL sales should be at least $5B just in this country, assuming annual CL cost of  $250 per person. You are the *Account Executive* of a big corporation, how can you trust the $.2B number so unconditionally?  Maybe you should contact Jobson Optical Research that someone made a stupid error in that file. 

As the OD Jon22 once said,  Just because you saw it on the internet doesn't mean that it's true. You should really check multiple sources before you believe in the internet. 


There are 4 other sources confirming that the CL and related products is a multi-billion business worldwide. Unless they are all wrong; otherwise, I still believe that my multi-billion number is valid.


1)http://www.optistock.com/jobson-som-2002-q3.pdf
This article was also prepared by Jobson Optical Research. The pie chart shows that CL is a $2B market in US

2)http://www.optistock.com/trends_cont...s_2001_dec.pdf
This article was also prepared by Jobson Optical Research. In the Vision Care Market Grows section, it mentioned that at the year end 2000, some 36million Americans wore CL.


3)http://www.optistock.com/spotlight5.htm

I also referred to the above article in the first post of the thread, Disposable CL may last much longer than the CL makers want you to know (http://www.optiboard.com/forums/show...?threadid=6760) 



> A complying CL (disposable, planned replacement) wearer can easily spends $400 to $600+ a year on the CL care ($80-$100 for CL fitting, $350 for daily disposable CL or $250 CL + $100 to $200 solution for planned replacement, another $50 for rewetting drops for those who still need it). According to the same article(http://www.optistock.com/spotlight5.htm ), there are 80million people in the whole world wearing CL in year 2000, and around 70% of the 33million US CL wearers use either 1-2 week disposable or planned replacement CL. *If every one of the 23 million wearers complies with the replacement schedule, the US CL (just the disposable and planned replacement) market alone should be at least $5.8 billions ($250*23millions) a year and not just the $3 billions for worldwide CL market that the report said. These numbers shows that the compliance rate is really much less than the reported 50% (probably around 20% or less)*


The following is the breakdown of CL wearers as of year 2000 from the same article



> Roughly five percent of contact lens wearers in the United States use daily disposables, and we estimate that 40 percent use one- and two-week disposables. Twenty-five percent use planned replacement, and 30 percent remain in conventional lenses


Of course the breakdown will be different today. Article (2) has a more recent stat. 


4)http://www.clspectrum.com/archive_re...277&iss=1/1/03 , titled:Contact Lenses: Where now and where to, Jan , 2003 issue




> Nearly 100 million people worldwide wear contact lenses, 4 to 5 percent of the number that wear spectacles. Contact lenses are big business, worth over $6 billion at the supplier level, including accessories and solutions. The greatest number of wearers live in North America (36 million) followed by Asia (24 million) including Japan (14 million), and Europe (20 million). Asia, with its burgeoning middle class and more than 1 billion myopes, is likely catch up to North America within 10 years.




You said,



> The overwhelming majority of consumers have told us that they WANT care free contact lenses, and the industry has responded with disposables. While daily wear lenses are still available for those who prefer to go through the daily routine of rubbing and scrubbing and enzyming and blah, blah, blah -- MOST consumers LOVE and greatly prefer a disposable regimen.


You should know that there are many kinds of disposables, and only the daily disposable is really CARE FREE. Other so called 7-day, 2-week, monthly, quarterly disposables/Planned Replacements should still preferably require the daily routine of rubbing and scrubbing and enzyming and blah, blah, blah for best comfort. Sure, a lot of people wear daily disposables, but how many of them really throw the lenses away at the end of the day? Just look at the statistics above.


There are good OD and bad OD in any practice as Pete Hanlin pointed out in the thread MD-OD. The consumers have no way to know if the ODs in the private practice is any better than the ones in the chain stores, except that the private ODs most likely charge more on just about everything. You should also agree that the opticians come from all kinds of background and qualifications. I bet you that if I ask a simple vision related question to 10 different opticians in this country, they may come out 10 different answers, depending on their background. There are also good consumers and bad consumers, so you can replace the word engineers to just about any profession in your engineer bashing above, and your paragraph will sound just as good/bad. Dont just pick on the engineering profession just because dleab is an engineer. The engineers, as well as the average consumers need to be more cautious in accepting other peoples opinions, especially when they are related to eyes. The average consumers are better informed today than a decade ago, so do not assume that they are willing *to let someone lead them around by the neck* anymore. 

Today, it may be the engineers who are asking a lot of questions. Tomorrow, it can just be anyone who walks into your office. So be well prepared at all times!

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## Susan Henault

dyip:

First of all I want to thank you for calling me out on not checking my number(s).  I recently attended a "State of the Industry" presentation, prepared by Jobson Research (one of the most respected providers of industry stats of which I am aware), and all I remember is being shocked by the CL sales figure.  Therefore it really stuck in my mind and I felt compelled to bring it up.

My bad, and yes, my mistake.  Thanks to your feedback, I went back and checked the seminar file for accuracy.  Indeed the information is accurate, but it refers to the sales of CL to the consumer from non-optical channels (a small detail that the speaker failed to mention when presenting this information, and amazingly no one in the audience challenged).  

While I have not taken time to follow up on your lengthy list of internet links to verify the accuracy of your assertions, I trust that your extensive research well proves your point.  One thing is for sure dyip, I won't make this particular mistake again, although I do reserve the right to make other mistakes -- and as always, learn from doing so in the process :).

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## Joann Raytar

> *dyip said:* 
> 
> Sure, a lot of people wear daily disposables, but how many of them really throw the lenses away at the end of the day? Just look at the statistics above.


The numbers make a good point about folks not throwing out disposable lenses on schedule.  I have noticed a similar trend in our 1-2 month disposable wearers, especially those new to the lenses.  They receive a free trial set at fitting and don't return for their follow up then request a supply six months to a year afterwards without ever finding out if the lens really fit them well.

In our office, problems with not following care instructions seem to be higher with new wearers than experienced wearers.

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## aaron

Reg engineers,

Most of the people in this general profession usually just need to be given an in-depth explanation.  Like Bob V said, it is usually a challenge but it is certainly not one that is out of this world.  If they are given the curtosy of an explanation not given to the general public they are usually happy and as long as they trust you the will let you do your job.  Hey I work for an Opthalmologist that has an engineering degree.  If you want to talk about a nightmare.......


As with any problem patient the issue is usually that the individual has a small amount of info and a large amount of distrust.  ie; "What is the axis on these?" and "Are my centers right?"  This just happens to be the case with some engineers because of their analytical nature.



Dyip,

     I recognize the fact that you seem to be an intelligent individual that is very "studied" in reguards facts and figures.  This serves you well when trying to make a specific point in line with your feelings about the contact lens industry.  

     There are no doubt that many doctors, opticians, and other business men and women are greedy and unscrupulous.  But your feeling about not needing to change lenses because of the coruption of the CTL industry is wrong!

Upon actually having the time to read through one of your posts I came across a startling fact.  My wife wears the same type of ctl's that you do!  This cosmic connection aside there is a specific point in this story.  My wife takes better than excellant care of her CTL's by doing all that is neccesary and then some, to keep them clean.  She happens to have a fairly high protein content in her tears.  Even with the  best enzymatic cleaners she developes deposits.  This is also besides the fact that she has some allergies and works in a dryer that usual enviroment.  All these factors and more dictate her wearing schedule.  She changes them as frequently as recommended and sometimes more so.  She recently has switched lenses types all together.

The point here is that if she was a person that decided to come to the board for advise and stumbled upon your advertisements for the famous thread that you began,  she may feel inclined to stretch out the wearing of her lenses to the almost definete tune of GPC.  

Congratulations on being able to wear your lenses longer than  the average person.  Perhaps you have other super powers you wish to explore.  But for the current time it would serve you well to try to be more responsable in giving such black and white advise.  Reading a few articles does not give you years of experiance in face to face interaction with CTL wearers and the problems they sometimes face.  Careless comments could give someone an impression that would eventually cause them some harm.



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## dyip

dleab,
I apologize to use your thread as an extension of the dead thread. I just feel the urge to set the record straight if other posters misinterpreted my messages.



aaron,

If you read my posts closely again, you will find out that you had drawn the wrong conclusion about my opinion. 

I stated my point very clearly at the *beginning* of the post in the Disposables dead thread that :



> .I have done enough research to convince myself that the Encore Toric (and probably many other brands) can last much longer than the manufacturer claims. I believe that the lenses will last as long as other daily wear lenses and may not need to be replaced unless they start to have wear and tear. However, the different replacement lenses in the market are made of many different types of materials. *I must emphasize that there is no guarantee that other brands' replacement lenses can be used longer than the planned schedule. Your eyes may also have more than normal protein build up on the CL that prevents you from prolonging the CL lifetime. You just have to do your own research to find out.* Your OD *may be* very tight lips about this issue because of conflict of interest. The Internet is a very good source to start your own research.


Also, I said in my previous posts in this thread,



> My own experience tells me that the $200+ soft toric lens(daily wear) 10+ years ago was much much more inferior to todays $5 daily wear CL  (usually disguised as 7 day or 2 week disposables by propaganda) in term of comfort and clarity.. In my opinion, the key thing determining CL wear comfort and vision health is to keep good maintenance of the lens. *If I follow the No Rub MPS disinfection instruction 100%, I will not hesitate to throw away the Encore Toric after 2 weeks because there is no way to just rinse off the deposit accumulated on the lens surface, no matter how much solution I pour on the lens.*


and




> The general consensus is that for those CLs wearers who do not take good CL maintenance care, deposit will keep accumulating on the lens surfaces, hence disposing the CL every one or two weeks will help to reduce infection or other complication risk. *To me, wearing the disposable lens(at least Encore Toric) for one week, one month or one year is just a matter of personal preference as long as good CL maintenance is practiced(including rubbing the lens).*



How on earth did you make the conclusion that 


> But your feeling about *not needing to change lenses* because of the coruption of the CTL industry is wrong!


based on what I said?


You said,



> But for the current time it would serve you well to try to be more responsable in giving such black and white advise. Reading a few articles does not give you years of experiance in face to face interaction with CTL wearers and the problems they sometimes face. *Careless* comments could give someone an impression that would eventually cause them some harm.


If your wife read my post closely and paid attention to what I wrote in the above quote, then she would find out that she might not be a good candidate to prolong the CL lifetime as other people can. Isnt my advice in the quote responsible enough? 

*Careless is you who overlooked my careful comments.* 



Encore Toric are very good lenses. Has your wife considered the following tips (based  on my own CL experience) already before she gave up on Encore?

*1)* For CL wearer with heavy deposits, merely rinsing the CL with the No Rub MPS before disinfection will not be enough. Try using CIBA vision MiraFlow Extra Strength Daily Cleaner. I like the 15.7% alcohol with the detergent like ingredients. Two drops per lens per cleaning serves my CLs very well.  Need to digital rub both lens surfaces diligently to guarantee the deposit removal.

*2)* Try Alcon Opti Free Express No Rub MPS for disinfection. There is a world of difference between the Alcon No Rub and the WM Equate No Rub MPS on Encore Toric in lens comfort. You can check out my thread Alcon Express MPS and No Rub MPS have same ingredients but different prices (http://www.optiboard.com/forums/show...?threadid=6708) in this forum for an account of my own experience. After using the Alcon MPS, I do not need any artificial rewetting drops (besides my own tear) throughout the whole wearing period. Using the wrong solution may have the feeling of foreign particles under the lenses and cause discomfort. 

*3)* Wearing sunglasses in the great outdoors tends to alleviate/eliminate the feeling of dry eyes as the sunglasses help to block the air flow around the CL areas. 

*4)* Wearing sunglasses while driving also help to alleviate/eliminate the feeling of dry eyes especially when the air vents in front of the dashboard are in full throttle in the middle of the hot summer.

*5)* Make sure your wife deflect the air vents away from blowing directly to the face while driving and not wearing sunglasses; otherwise, the dry eyes feeling will be a constant torture.

*6)* If your wife works in a relatively closed environment like a medium size room, I believe that a humidifier may help to increase the RH of the room and relieve dry eyes. However, this is just a suggestion. If the room is temperature and humidity controlled by central air conditioning, a portable humidifier will not do much to change the RH of the room.


If your wife has tried everything and cannot live with any type of CL, just do her a favor and ask her to quit wearing CLs. It is not worth the torture.

You dont need to acquire super power to wear the Encore Toric as long as I do; a good CL maintenance will do the job.

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## paw

dyip,
"A little bit of knowledge is a dangerous thing."

Just because you've read articles and wear CL does not make you an expert.  If I were you, I would stop giving advice regarding CL.  You are not a licensed practitioner.

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## aaron

Dyip,

Thank you for getting back to me so quickly.  I appreciate your advise reguarding my wife and her experiance with her contact lenses.  Although you have provided no new information for me, it is always nice to recieve a reminder.

If you would please take note that I did not quote you in my post.  The specific reason for this is that to take a few sentances out of the context of a general discussion, is to not be true to the spirit of the discussion itself.  The spirit of your thread is one of discontent, a lack of trust,  and of bad advise to "contact lens consumers" which many of us opti-boarders like to refer to as patients.


If it works for you than by all means continue as you are.  But putting one sentance that is a sort of disclaimer inserted into your post does not qualify you as being responsable.  I am certain that as a reasonable individual you would agree that not everyone on this board is bowing at the alter of the almighty dollar.  Many of the doctors and opticians  here have years of capable and caring experiance in dealing with CTL wearers.  I happen to work in an Opthalmology practice where we see many of the bad effects of contact lens abuse.  Once again it is a beautiful thing to have a forum where all opinions count and we are free to express ourselves.  I am not trying to discourage an open discussion, only to encourage responsable commentary.



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## dyip

paw,


You said,



> "A little bit of knowledge is a dangerous thing."
> 
> Just because you've read articles and wear CL does not make you an expert. If I were you, I would stop giving advice regarding CL. You are not a licensed practitioner.


It is really irritating that a lot of posters like to make empty statements like you did without being specific. Which CL advices that I mentioned in previous posts/threads is dangerous? The CL tips in the previous post to aarons wife were based my personal experiences. They are just some friendly reminders to some CL wearers who may overlook these quick fixes and result in unnecessary torture.  I dont need to be an expert to share my CL experience, do I? 

Please check all my posts/threads carefully. I usually gave out CL tips as a CL wearer/consumer/patient, not as a licensed practitioner. Sure the doctors know which medicine can cure certain diseases, but it is the feedback/reactions from the patients that really determines the effectiveness of the medicine. Dont tell me that a patient cant make comment about the medicine that the doctor prescribed. I am sure that any responsible doctor will love to hear just about any feedback from the patients about his/her diagnosis, dont you agree? This is how *little knowledge snowballs*.

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## dyip

aaron, 
It is amazing that how some people have a built in mental filter that can block out certain information and create their own version of information, kind of like color- blind people who can see only certain colors.

You said,



> If you would please take note that I did not quote you in my post.


so you ended up saying something like



> But your feeling about *not needing to change lenses* because of the coruption of the CTL industry is wrong!


That is exactly how you misinterpreted my messages.

Do you know that *not needing to change lenses* can mean:
1) Wear the lenses(can be any disposable) like extended wear CL for as long as possible without taking them out at the end of the day

and/or

2) Wear the lenses(can be any disposable) for as long as possible without throwing them away after the advertised replacement period

If you read the quotes in my previous post *CAREFULLY*, you will conclude that I suggested none of above. Your statement is too broad and too distorted from my original view.



You also mentioned that,



> .I happen to work in an Opthalmology practice where we see many of the bad effects of *contact lens abuse*.


Ive never suggested *contact lens abuse* in any of my posts/thread. I am trying to advocate the otherwise.



You said,



> Although you have provided no new information for me, it is always nice to recieve a reminder.


Everyone knows that a circle is round, and this is nothing *NEW* since ancient history. But the real genius was the person who first took advantage of this observation and invented the wheels which have such a great impact to mankind. My point is *NOT* to say that I am a genius because of the Micky mouse CL tips that I offered in various posts. I just want to point out that knowledge(information) is useful only if you know how to apply it and improve your quality of life.

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## Susan Henault

dyip:

You said:




> It is amazing that how some people have a built in mental filter that can block out certain information and create their own version of information, kind of like color- blind people who can see only certain colors.


If you read your own words of wisdom very carefully -- over and over, perphaps you will "see" that among the many individuals that have contributed to this thread, there is ony ONE who "sees" your assertions the way you do.

You are right afterall (which I sense is your true purpose - to be right), all of us must be colorblind!

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## paw

Dyip, on these beautiful summer nights I have so many better things to do, but I will take time to give you one example.  This quote came from a post about rewetting drops being a waste of money.

"In my opinion, if your CLs are fitted correctly, and if you use the right disinfection solution or MPS, you eyes should feel comfortable for the whole day and should not require rewetting drop. If you need frequent rewettings throughout the day, maybe your CLs and/or the solution is not right for you (check out another thread in this forum titled Alcon Express MPS and NO MPS have same ingredients but different prices for my own personal experience). If you have tried everything(different solutions, different brands and different fits of soft CL, RGP, etc), and you still need the rewetting drop frequently, stop wearing CL. Dont let your eyes suffer."

This is a case where you know that you know some things about CL, but you also DON'T KNOW that you DON'T KNOW some things about CL.  (And I know people will have to read that 3 times to get what I'm saying!)

Specifically, this sentence:  "In my opinion, if your CLs are fitted correctly, and if you use the right disinfection solution or MPS, your eyes should feel comfortable for the whole day and should not require rewetting drop."  

Sure, you preface this with "in my opinion," but you sure come across as sounding knowledgable and expert and giving advice.  The truth is, your CL can be fitting correctly and you can be using the correct solution, but your eyes can still feel uncomfortable and you will need a rewetting drop.

How can this be, you ask?  There are occasions where people's eye will dry out from environmental factors, smoking, hormonal factors, dry eye syndrome, etc, etc.  Solutions to dry eyes range from rewetting drops to punctal plugs and probably more.  There is so much you don't know, and doing research on the net only tells you about what you are researching.  It doesn't tell you about a whole host of other related matters.

I'm sure you will have a rebuttal to this, since you always do.  Don't bother.  I'm not replying to any rebuttal you come up with.

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## chip anderson

Dyip:

Whenever I get a patient who is as lazy, cheap or stupid as you, I always give them my card and underline the part about prosthetic eyes which I also make.   For the most pig-headed kids, I have them close their eyes and pick out an artificial eye near in color to thier own, and put it in thier hand.  Then I tell them that's what they are taking a chance on.   With the exception of the really, really stupid ones who probably pay most of thier money for white powders, this cures them.

As for you, who cares.

Chip

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## Steve Machol

*sigh*

Since this has now entered the realm of name-calling I'm going to close this thread.

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