# Optical Forums > General Optics and Eyecare Discussion Forum >  FL-41 & other "magic" tints...

## Uilleann

Just got a letter in the mail today from an MD up at the local teaching ophthalmology clinic at the university.  Stating he wants us to put "his" patient (who we incidentally have seen in our clinic for years now) in a special tinted lens.  In this case: FL-41.  As it happens, this is also a special formula that this particular doctor came up with to, as he puts it: "markedly attenuate the frequencies of the spectrum that are bothersome to migraine sufferers."  Further stating: "It is especially effective indoors where artificial light and computer screens can be very bothersome."

Now please feel free to jump all over me if I am off base here, but this just sends my B.S. meter through the roof!  Snake oil?  Or is there something to it after all?

To give a little bit of background, the female patient is in her early twenties, and is -0.75 SPH, OH.  She also works as a software developer.

We have her in a CR-39 lens with Crizal Avance presently.  But the MD thinks its all wrong and want to go the route of this "magic" tint instead.

I do know that the doctor/professor who is so strongly recommending this tint is the very same individual who "invented" this particular formulation.  So there is the very real question of personal interest in his own product.  I have never been one to believe in ONE fix for EVERYONE who shares a symptom.

I also know that the other big company who pushed tints for computer use, PRIO, several years ago stopped asking ECP's to tint their computer lenses, and instead to use a high quality A/R.  The visual results for them were much better.  

Now while I'm sure this particular doctor is a smart guy, and has done plenty of "studies" over the course of his career, I have worked directly with enough MD's to know that they also can hang on to some pretty strange and wild ways of thinking.  If this guy is right - then he's right.  I'd like to know of examples - real world mind you - not in studies, where patients have recently experiences massive and measurable improvement to their quality of vision and life.

What is your experience in such things?

Thanks.

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## Jacqui

May be "snake oil" For migraine sufferers (me included) I use a black gradient and sometimes a double with pink on the bottom.

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## Uilleann

Densities?  Frequency attenuations? 400 - 700 nm is a pretty wide pallate to be able to choose from.  Where exactly should one be looking - pinkish seems to be the general consensus.  Or at least it was 20 years ago.  Is there anything specific that you would recommend for a given type of migraine for example?  Working at an LCD computer screen vs. an older CRT (which almost no-one does anymore)?  It just strikes me as SO subjective and highly variable...

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## obxeyeguy

A couple years ago, I did some research into strange tints for a patient that suffered seizures.  They could be triggered by the effects of flickering lights,( crt's, fluorescents, etc).  One particular Doctor recommended cross polarized lenses, and if I remember correctly, in the color blue.

I will look for the info I had, as it very much sounds like its similar.

BTW, what color is this FL-41 lens?

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## Jacqui

> Densities?  Frequency attenuations? 400 - 700 nm is a pretty wide pallate to be able to choose from.  Where exactly should one be looking - pinkish seems to be the general consensus.  Or at least it was 20 years ago.  Is there anything specific that you would recommend for a given type of migraine for example?  Working at an LCD computer screen vs. an older CRT (which almost no-one does anymore)?  It just strikes me as SO subjective and highly variable...



As you indicate, different types of migraines need different densities, etc. When I use black I normally get to change it at least once, everyone seems to need something different. You would need to experiment with each patient.

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## chip anderson

Believe it or not one of the Ivy League College Medical Schools Did a study and reported that 80% of Migraine ceased upon having sex.
Think of those lucky _researchers. _ Think of the next time your _signifcant_ other says: "I have a headache."  You can offer to help.

Chip

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## rinselberg

> FL-41 is a rose-colored filter that we have found to be useful in patients with migraine headaches, blepharospasm, and other light-sensitive conditions.


http://uuhsc.utah.edu/MoranEyeCenter...are/FL-41.html





> Rose-colored sunglasses. Preliminary research at the University of Utah suggests that specially tinted lens may help some people with photophobia. Anecdotally, many photophobic patients prefer an FL-41 tint on their sunglasses instead of green or yellow. The FL-41 tint, which has a pinkish look to it, is a mixture of colors that blocks the blue-green wavelengths.


http://www.callbpi.com/support/fl-41.htm


Just a couple of links I pulled up with a Google search of "FL-41"

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## obxeyeguy

Thanks!

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## Uilleann

> http://uuhsc.utah.edu/MoranEyeCenter...are/FL-41.html
> 
> 
> http://www.callbpi.com/support/fl-41.htm
> 
> 
> Just a couple of links I pulled up with a Google search of "FL-41"


Yeah.

I found the same.

This University of Utah doctor is the same who sent our letter regarding this patient.  He has more than a small vested interest in this particular tint.  I called the lab, and found out that it is available by special order only and the cost of the tint bottle alone is over $100.  Which just keeps sending my BS needle even higher...

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## EyeFitWell

Why not recommend the pt return to dear Dr. to have the lenses tinted?  If he invented it, I'd assume he had some means of tinting and trying the results in his research...  $100 for a bottle of tint?  That's a lot.
However, I do find the theory fascinating and worth some merit that certain very specific tints can help aleveate some neurological symptoms.

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## tmorse

> Just got a letter in the mail today from an MD up at the local teaching ophthalmology clinic at the university. Stating he wants us to put "his" patient (who we incidentally have seen in our clinic for years now) in a special tinted lens. 
> 
> Now please feel free to jump all over me if I am off base here, but this just sends my B.S. meter through the roof! Snake oil? Or is there something to it after all? Thanks.


I don't think you have the standing to question an OMD over anything. Especially an OMD from a teaching hospital who has access to the leading
ophthalmology journals, cutting-edge procedures and may also be a publisher of research papers/studies.

And $100.00 for a bottle of tint? If it delivers, it would be a bargain. You all know how many tints yo can get from a single bottle. And $100.00 to an OMD won't put him/her in the next tax bracket.

I have heard of some advanced effective migraine remedies costing in the thousands of dollars per prescription.

So yes, I think you are off base here. However, it is nice to see that you have the best interest of the patient in mind.:cheers:

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## Uilleann

Because the Dear Doctor is an ophthalmologist.  Oh yes...and a "professor" of some flavor.  The U is a medical teaching school, and the Moran Eye Center more of the same.  They do indeed see a lot of sick eyes there - however, I am inclined to guess that this MD did NOT take the time to actually SHOW the pt. the tint in question, and further to actually test it for the patient in HER working environment to quantify properly if it would in fact do any good for her specific needs or not.

Now, to be completely fair, I could be completely wrong.  And I do not wish to discount or belittle any valid research the good doctor may have done years ago in this regard.  I would, however, find a great deal more credibility in his "diagnosis" if he were to have sent along extensive testing of the patient using a wide variety of different colored filters in her specific work environment.  More so again if he then sent on a detailed and highly specific request for a given density and color cast verified against some nationally or better internationally agreed upon color standard.

To the best of my knowledge however, such a standard does not exist.

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## chip anderson

Never fail to question. I remember once when I had lunch with a retinal specialist who had a tendancy to put sphere implants in. He did this in such a way that all his patient's had to have a prosthesis with a knife edge on one side, thick on the other and didn't move worth squat.
At the end of listening to me try to be diplomatic, he informed me (I had been making prosthetic eyes for 10 years, he had been practicing one) that I was in no way qualified to speak on the subject of surgical proceedures to an authority such as he.
It's been 30 years, we still don't get along, and if he tells me something, the answer is just "Yes, doctor."

There are a lot of "eminent authorities" out there that may be brilliant in parts of thier field (excellent at retinal repair for instance) but they may be totally clueless in other areas, contact lens fitting or ocular prosthetics for example.  I have attended seminars where such individuals were lecturing in areas where they were clueless, but "eminent".

Of course one must remember that in a fight they are the ones with the thick armour and the big guns. So one should pick ones battles carefully.
Chip

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## Fezz

Are you sure that it is not a F*J*-41?


(FezzJohns-41)

;):cheers::cheers::cheers::cheers::cheers::bbg:

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## Uilleann

> I don't think you have the standing to question an OMD over anything. Especially an OMD from a teaching hospital who has access to the leading
> ophthalmology journals, cutting-edge procedures and may also be a publisher of research papers/studies.
> 
> And $100.00 for a bottle of tint? If it delivers, it would be a bargain. You all know how many tints yo can get from a single bottle. And $100.00 to an OMD won't put him/her in the next tax bracket.
> 
> I have heard of some advanced effective migraine remedies costing in the thousands of dollars per prescription.
> 
> So yes, I think you are off base here. However, it is nice to see that you have the best interest of the patient in mind.:cheers:


Oh, we have refit P-L-E-N-T-Y of the Moran patients.  Usually multiple times.  I think after nearly two decades of remakes and poor or vague diagnosis, that we, the actual fitting doctors and staff have every reason to at the least question the validity and testing methods used.  Further, the fact that this miracle tint is not widely used - indeed is not even KNOWN to the vast majority of dispensers in this city, state, country and in all likely hood the world increases suspicion.  If this particular _patented_ tint was this wonderful, no doubt we would all have at least heard of it and very likely be using it on a semi-regular basis.

I do hope the patient is able to manage the migraine situation.  Any dispenser, doctor or generally decent person would want that of course.  Adding to that - I have seen many GREAT things come out of the U of U medical programs over the years.  But I havn't seen so much from the eye center in particular.  That, coupled with my own direct and long history dealing with them, and the sales pitch tone of the letter prompted me to ask.

I'd still like to know how many of you have used this exact tint, if it worked, how well, and what the general conditions were of the pt. if possible.

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## tmorse

> Because the Dear Doctor is an ophthalmologist. Oh yes...and a "professor" of some flavor. The U is a medical teaching school, and the Moran Eye Center more of the same. They do indeed see a lot of sick eyes there - however, I am inclined to guess that this MD did NOT take the time to actually SHOW the pt. the tint in question, and further to actually test it for the patient in HER working environment to quantify properly if it would in fact do any good for her specific needs or not.


This OMD took the time and trouble to write a letter to an 'Optician'????. That in itself is remarkable. And I didn't hear that the patient was charged $200.00 for this letter writing. So why have the audacity to assume the OMD is padding his bank account.

You have no right to 'guess' anything of the sort... suggesting an unethical profit motive or unprofessional procedure is almost libellous???:finger:

So you too are 'WAY OFF BASE', IMHO.

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## MarcE

> You have no right to 'guess' anything of the sort... suggesting an unethical profit motive or unprofessional procedure is almost libellous???:finger:
> 
> So you too are 'WAY OFF BASE', IMHO.


 
I see your point.

However, he is entitled to "guess" whatever he wants.  He isn't WAY off base, but he is leaning pretty far.  IMHO

As far as the tint.  Ask your lab or BPI to do it.  I wouldn't buy a $100 bottle for one patient that will probably be asking for a redo (like Jaquie said).

I do think the letter from the OMD to the optician was professional and correct.  "Your" patient went to a teaching hospital for a second opinion or a specific problem. Even though it was a self-referral, the OMD must have asked who their optician was - that's how you got the letter and the referral back to your clinic.  Very nice on the OMD's part.  I don't think there is a profit motive because he referred to you for the materials and services.

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## Uilleann

> This OMD took the time and trouble to write a letter to an 'Optician'????. That in itself is remarkable. And I didn't hear that the patient was charged $200.00 for this letter writing. So why have the audacity to assume the OMD is padding his bank account.
> 
> You have no right to 'guess' anything of the sort... suggesting an unethical profit motive or unprofessional procedure is almost libellous???:finger:
> 
> So you too are 'WAY OFF BASE', IMHO.


No.  He took the time to dictate a letter as they always do here, to our office.  I was approached by both of our doctors asking if it sounded like his recommendation was common or usual among dispensers, and what my past experience was with this lens.  Our senior doctor was far more skeptical than I was.  Yes, he knows the MD in question as well, and is on good terms with him.  It was the tone and context of what was written that caused the greatest question.  I am glad you think I don't know what I'm doing, nor that I have the faculties to ask questions of a group more knowledgeable than myself.  I actually have several doctors, both ODs and MDs across the country that I converse with regularly as well as opticians.  Does any one of us have the perfect answer every time?  Absolutely not.  Thats why I asked.  And this board is one place I like to visit to get many and varied views.  Thanks for yours.  

But dear Morse, I'll happily send this patient on to you for you to spend the time and effort testing this MDs hypothisis.  Best of luck!  :cheers:

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## Uilleann

> Never fail to question. I remember once when I had lunch with a retinal specialist who had a tendancy to put sphere implants in. He did this in such a way that all his patient's had to have a prosthesis with a knife edge on one side, thick on the other and didn't move worth squat.
> At the end of listening to me try to be diplomatic, he informed me (I had been making prosthetic eyes for 10 years, he had been practicing one) that I was in no way qualified to speak on the subject of surgical proceedures to an authority such as he.
> It's been 30 years, we still don't get along, and if he tells me something, the answer is just "Yes, doctor."
> 
> There are a lot of "eminent authorities" out there that may be brilliant in parts of thier field (excellent at retinal repair for instance) but they may be totally clueless in other areas, contact lens fitting or ocular prosthetics for example.  I have attended seminars where such individuals were lecturing in areas where they were clueless, but "eminent".
> 
> Of course one must remember that in a fight they are the ones with the thick armour and the big guns. So one should pick ones battles carefully.
> Chip


Well said Chip, and this is basically my point.  This doc is a fine individual.  And I'm inclined to believe a pretty decent surgeon as well.  However, I will always question something when it doesn't seem to add up for MY patients.  I would hope any of my own health care professionals would do the same for me if the situation were reversed.

I'm certainly not looking to "battle" this guy.  Frankly, he could suggest all his patients be slapped into fluorescent green frames, lenses ground from the crystallized bones of an alien found in the Nevada desert, all while wearing a tin foil hat and dancing on one leg if he honestly feels it will help them.   But every time I get one of these requests, and it seems odd or outside of the norm, I'm going to question it.  EVERY time.

In case anyone's interested, we haven't remade anything for this patient.  Yet.  She is to call us later to go over options and costs.  So we'll see what the future brings.  Thanks all for the helpful posts.

STILL curious to know if ANYONE else has used this tint?!  :bbg:

And No Fezz...I think I'd trust your tint with a higher degree of credulity than this other.:cheers:

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## tmorse

> Just got a letter in the mail today from an MD up at the local teaching ophthalmology clinic at the university. Stating he wants *us* to put "his" patient (who we incidentally have seen in *our* clinic for years now) in a special tinted lens.
> 
> I have worked directly with enough MD's to know that *they also can hang on to some pretty strange and wild ways of thinking.* 
> 
> I'd like to *know of examples - real world mind you - not in studies*, where patients have recently experiences massive and measurable improvement to their quality of vision and life.


I've taken a closer look at this post and I am aghast. 

This poster knocks the OMD because *'his'* (the poster's) patient had the temerity to go to the University of Utah EYE center. Possessive, aren't we? Might loose a customer, perhaps?? 

*"know of examples - real world mind you - not in studies"* Here our poster indicates his preference for individual anecdotal reports rather than scientific double-blind studies. 

And then concludes...
*"they also can hang on to some pretty strange and wild ways of thinking".*  Here the pot is calling the kettle black. 

We might remember that we 'opticians' are the lowest 'O' of the three 'O's,
and although we may form part of a eyecare team, we have no business knocking the other 'O's without valid cause. Obviously this poster's superiors at "his clinic" would not condone such behaviour.     

Yes...WAY OFF BASE!!:finger:

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## Uilleann

> I see your point.
> 
> However, he is entitled to "guess" whatever he wants.  He isn't WAY off base, but he is leaning pretty far.  IMHO
> 
> As far as the tint.  Ask your lab or BPI to do it.  I wouldn't buy a $100 bottle for one patient that will probably be asking for a redo (like Jaquie said).
> 
> I do think the letter from the OMD to the optician was professional and correct.  "Your" patient went to a teaching hospital for a second opinion or a specific problem. Even though it was a self-referral, the OMD must have asked who their optician was - that's how you got the letter and the referral back to your clinic.  Very nice on the OMD's part.  I don't think there is a profit motive because he referred to you for the materials and services.


I can't say if there is a direct profit motive or not.  I only wondered.  As this tint is NOT a blend.  Nor is it something every lab has on their shelf.  It is a special order product.  It is VERY specific.  Not saying that it couldn't easily be duplicated by many decent lab techs...but to be a "true" FL-41, it has to be ordered as such, and that is precisely what this doctor was asking us to do.  And as this doctor was directly involved in the development of this particular color formulation, and it is now available for sale as a special order item, the bells and whistles went off.

The tint was NOT tried with the patient.  The tint was furthermore not tried with the patient, in her current Rx, and in her work environment.  Without some sense of how well it will perform for her there, unless the patient wants to pay for it all - upfront, and under the express condition that no refund or further remake would be available in this case, Our doctor doesn't wish to take the risk.  I agree.

I am surprised that the MD didn't simply have the pt use his own dispensary so that he could monitor and control the tint process that he developed personally.  That would seem to make the most sense given his direct involvement it it's development and use yes?

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## tmorse

> Just got a letter in the mail today from an MD 
> 
> this just sends my B.S. meter through the roof! 
> 
> Snake oil? 
> 
> this "magic" tint instead.
> 
> I do know that the doctor/professor who is so strongly recommending this tint is the very same individual who "invented" this particular formulation. *So there is the very real question of personal interest in his own product*. I have never been one to believe in ONE fix for EVERYONE who shares a symptom.


He was just "wondering"??? 

Well, I too am 'wondering'. Wondering why this poster boy is not wondering why the OD's in "*his"* clinic who wrote this lady's Rx, also had him sell her the finished Rx eyewear product. No *"very real question of personal interest in (their) own product"??* involved here?  :Confused:

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## Giorio

I had a customer that wanted this tint for the same reason, rather than buying the tint, I had BPI provide me with one pair of lenses already dyed.
 The cost was reasonable and the patient left happy. 
My charge to the patient was in line with what I charge other tinted lenses.
The important thing is that the patient felt it had the effect that he/she needed.

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## Uilleann

> I've taken a closer look at this post and I am aghast. 
> 
> This poster knocks the OMD because *'his'* (the poster's) patient had the temerity to go to the University of Utah EYE center. Possessive, aren't we? Might loose a customer, perhaps?? 
> 
> *"know of examples - real world mind you - not in studies"* Here our poster indicates his preference for individual anecdotal reports rather than scientific double-blind studies. 
> 
> And then concludes...
> *"they also can hang on to some pretty strange and wild ways of thinking".*  Here the pot is calling the kettle black. 
> 
> ...



LOL

Wow.  Way to take *EVERYTHING* out of context there!

I am not a doctor.  Nope - don't even play one on TV.  But I do know how to fill an Rx.  I think just about all of us can do that practically with out eyes shut.  I have also worked in many many different offices and optical settings over the years.  Do I know everything?  Nope - not even close.  But you better believe I absolutely LOVE to learn.  I was hoping to learn from some other dispensers direct experience with this tint.

To address your accusations:

I didn't knock anyone.  I DID say the "cure-all" nature of the tint in the letter raised suspicion.  So I asked for clarification.  I am not afraid of loosing a patient.  Quite the opposite.  We get far more from them as the cost alone of their dispensary prevents even those with U of U insurance from using their services for glasses.  And I really don't mind either way.  If they can better serve this patients needs than we can - may she use them evermore with my sincere blessing.

Yes.  What a concept!  Let's ask folks in the real world who may have actually USED this tint.  Just because Essilor, or Shamir, or Transitions says a lens is great, doesn't mean it is.  I'd like to get some feedback from actual users and dispensers before I can possibly understand how to fit it into my palette of lens options.  No study, no matter how large, can replace or offset real world experience.  I was hoping to learn of the latter to augment the former.  Sorry you missed that.

And wow - did you EVER take this one and run with it!  LOL  I also presently work for doctors right now - today, who have some pretty strange and wild ways of thinking.  Hell, I play bagpipes - that's about as odd as it gets.  Throw me on the top of the strange and wild heap.  BUT, in context, what I was saying was that in our day to day practices, we can get stuck on a small selection of treatment practices, and that's just what we do.  Regardless of other options that may exist not that may be as good or better.  I've certainly been guilty of that.  Though I try hard not to be.

And as for my "superiors"...well good sir, it was they who questioned in the first place, and asked for my knowledge on the subject.  I have learned a great deal about this tint, and what it may or may not offer our mutual patient.  I hope you have too.  I certainly don't consider myself the lowest of any perceived hierarchy.  I am a member of a team and of a world-wide group of medical professionals.  Doesn't make me in any way greater or lesser than anyone else - no matter how many initials they choose to carry after their name.

All the best!  :cheers::cheers::cheers::cheers::cheers:

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## Uilleann

> He was just "wondering"??? 
> 
> Well, I too am 'wondering'. Wondering why this poster boy is not wondering why the OD's in "*his"* clinic who wrote this lady's Rx, also had him sell her the finished Rx eyewear product. No *"very real question of personal interest in (their) own product"??* involved here?


No.  Question of convenience for the patient, and vision insurance benefits.  That was it.  And the patient still left with the best pair of glasses she ever had in her life.  And she was happy.  And I'd still be happy for this patient to allow Moran's dispensary to assist with the tinting of lenses for this patient to see if it will help her given situation.:)

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## Uilleann

> I had a customer that wanted this tint for the same reason, rather than buying the tint, I had BPI provide me with one pair of lenses already dyed.
>  The cost was reasonable and the patient left happy. 
> My charge to the patient was in line with what I charge other tinted lenses.
> The important thing is that the patient felt it had the effect that he/she needed.


Hi Giorio, 

Did they send you tint samples?  Or were they able to provide you with tinted finished lenses in your pt's Rx?  That would be a great option if the cost were kept as low as a typical tint.  Thanks for your reply - All the best!

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## tmorse

> No. Question of convenience for the patient, and vision insurance benefits. That was it. And the patient still left with the best pair of glasses she ever had in her life. And she was happy. And I'd still be happy for this patient to allow Moran's dispensary to assist with the tinting of lenses for this patient to see if it will help her given situation.:)


I don't believe you understand the nature of a scientific double-blind study ... perhaps you should *GOGGLE* it. 

As to your 'question of convenience' answer... hah, straight out of Optometry 101's answer to the question of 'perceived conflict-of-interest'.

This patient was obviously less than happy, as she subsequently the time and effort to travel to the top OMD specialists in your area for her migraine assistance. 

If you and your superiors at your clinic really has the best interests of this patient in mind, you would have sprung for the "magic tint" cost yourselves, or given here a 'price' reduction. You would then have been able to discover for yourselves (only) if this particular person could benefit from this "magic" product. It may well work for another migraine sufferer.

I also have to wonder if your tone and negativity towards this "snake oil" casued her to turn away from even trying this product. So she remains plagued with her migraines. If so, you did her no real service.  

And you still really don't know if this advanced product can work as intended. Shame!!:finger:

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## obxeyeguy

> We might remember that we 'opticians' are the lowest 'O' of the three 'O's,
> and although we may form part of a eyecare team, we have no business knocking the other 'O's without valid cause. Obviously this poster's superiors at "his clinic" would not condone such behaviour. 
> 
> Yes...WAY OFF BASE!!:finger:


Wow!  I prefer to believe that I am below no one, period. An OMD, OD, who ever. I will respect them for their knowledge, and expect the same, but never think of myself as "lower" than them. That doesn't mean I forfeit my right to question them. 

Uilleann: You are doing a stand up job here, and truly looking out for your client/patient. It also seems that some of us may just learn something from what our collegue is doing here. Others will never learn, and just tow the line.

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## Uilleann

> I don't believe you understand the nature of a scientific double-blind study ... perhaps you should *GOGGLE* it. 
> 
> As to your 'question of convenience' answer... hah, straight out of Optometry 101's answer to the question of 'perceived conflict-of-interest'.
> 
> This patient was obviously less than happy, as she subsequently the time and effort to travel to the top OMD specialists in your area for her migraine assistance. 
> 
> If you and your superiors at your clinic really has the best interests of this patient in mind, you would have sprung for the "magic tint" cost yourselves, or given here a 'price' reduction. You would then have been able to discover for yourselves (only) if this particular person could benefit from this "magic" product. It may well work for another migraine sufferer.
> 
> I also have to wonder if your tone and negativity towards this "snake oil" casued her to turn away from even trying this product. So she remains plagued with her migraines. If so, you did her no real service.  
> ...




I must say - I'm entertained!  :D

The harder you try to be a schmuck - the easier it becomes it seems?  LOL

I understand the whole study process just fine thanks.  Have both participated in and assisted directly in undertaking several over the years as well.

I have NO idea where you're getting any conflict of interest here.  We have lost no money.  The MD has gained a fair chunk as well.  You also have NO IDEA if the patient was happy or not, you know nothing about the details of this patient's case history, you were not present for her work-up and exam with us, nor for her work-up and exam with the MD.  You really just don't know exactly WHAT the circumstances were that saw her from one chair to another now do you.  Nice try I guess.  But try at what?  :finger:

The MD's office at the Moran is less than a ten minute drive down the road as well, so that would also make sense for the pt.  in the case of a referral etc.  I'm curious to know EXACTLY how you reached the conclusion that the Moran docs are in any way better or more qualified to treat a given patient than any of the hundreds of other MDs and ODs in the immediate area?  What EXACTLY is it that quantifies them as "TOP"?

Since we DO in fact have our pt's best interests at heart, we have chosen NOT "spring" for anything without _doing our homework first_.  And I will remind you this was our senior doctors question first - not mine.  Cost reductions are not allowed under her insurance plan.  Co pays are set by them...not us.  You are of course welcome to ask them to lower their patient required fees.  You'd be the very hero of every one of their insureds (sp?) if you can pull it off.  But I would think probably far less so of the practices that would then receive even lower payouts as a result.  But perhaps that bone of contention would be better left for another thread if you care to explore that as a viable eye health care related issue.   :Cool: 

We fit our patient with what we believed was (and is) the best solution to her visual problems.  If we had everything to do over again, we would proceed _exactly_ as we have done.  Unfortunately we have not yet been able to accompany her to her physical workplace to ascertain if there is more we can do for her.   I, for one, would greatly enjoy that opportunity if it becomes available.   I would undoubtedly learn a great deal - and would happily share any of my/our findings with the community here in the hopes that perhaps it wold offer another bit of useful information that we could all use to better ourselves - and our level of patient care.

As to this "magic" tint working well for another migraine sufferer - well of COURSE that's true.  That's precisely what the study from England has shown.  And that is G-R-E-A-T!  But sadly, our current patient was not a participant in that study.  And given the cost of this very specific tint, and the doctors personal involvement in it's development, it raised questions.  Add to that the fact that this filter has not been used by the patient in her working environment and the end result is a best guess scenario.

And in order to be PERFECTLY clear - the patient has yet to contact our practice expressing any form of displeasure with our level of care, her current glasses, nor with any intention or desire to "test" the suggested tint.  If she does contact us, we will be far more knowledgeable and able to help her to make the best decision for HER, not for us, or the MD.

Thanks once again to everyone who has provided useful information in this discussion, both here and in PM's.  Yous guys is da best!

----------


## Giorio

> Hi Giorio, 
> 
> Did they send you tint samples? Or were they able to provide you with tinted finished lenses in your pt's Rx? That would be a great option if the cost were kept as low as a typical tint. Thanks for your reply - All the best!


I've replied by PM  but let me repeat here for the benefit of all others that might be following this discussion

They were able to tint the finished lenses, that way I did not have to worry about density, as I said earlier, the cost to me and the charge to the patient was in line like any other tinted product

----------


## tmorse

> 1) You also have NO IDEA if the patient was happy or not, you know nothing about the details of this patient's case history, you were not present for her work-up and exam with us, nor for her work-up and exam with the MD. You really just don't know exactly WHAT the circumstances were that saw her from one chair to another now do you. Nice try I guess. But try at what? :finger:
> 
> 2) I'm curious to know EXACTLY how you reached the conclusion that the Moran docs are in any way better or more qualified to treat a given patient than any of the hundreds of other MDs and ODs in the immediate area? What EXACTLY is it that quantifies them as "TOP"?
> 
> Co pays are set by them...not us. You are of course welcome to ask them to lower their patient required fees.


I am pleased to respond..

1) Yes...  am guessing, or maybe it's wondering, or whatever mental process you go through to justify your slurring some OMD's work and achievements because he invented some "snake oil, magic tint" and YOU great POOBAH are not entirely convinced it has any merit. 

2) These MORAN OMD's are connected to a 'teaching hospital' at the University of Utah. These extra credentials put them in the vanguard of Ophthalmology, IMHO.

3) Who said their insurance should pay??? I want YOU and your clinic dr's to pay for this stinkin' $100.00 bottle of tint ,to help increase your level of knowledge. Don't you ever do anything _pro bono_?? :D

----------


## Uilleann

> I am pleased to respond..
> 
> 1) Yes...  am guessing, or maybe it's wondering, or whatever mental process you go through to justify your slurring some OMD's work and achievements because he invented some "snake oil, magic tint" and YOU great POOBAH are not entirely convinced it has any merit. 
> 
> 2) These MORAN OMD's are connected to a 'teaching hospital' at the University of Utah. These extra credentials put them in the vanguard of Ophthalmology, IMHO.
> 
> 3) Who said their insurance should pay??? I want YOU and your clinic dr's to pay for this stinkin' $100.00 bottle of tint ,to help increase your level of knowledge. Don't you ever do anything _pro bono_?? :D



1. No slurring from me.  Now YOU on the other hand...:finger:
When you can show the specific results of these studies, couple that with ANY form of first hand involvement in this particular patients case, and specific previous health history, and then marry the two seamlessly...THEN I'll listen to anything you might have to say about helping this patient with this particular tint.  As I have said before - I'm sure the doc is great in many respects.  So are almost ALL docs to some degree.  Some far more than others of course - just as with opticians.  And I never said this doc was "BAD" or "WRONG".  Only that this particular expensive tint was suspicious due to the reasons already posted about above. If the entirety of his "work and achievements" revolve solely around this tint and some old studies then perhaps we would have a serious problem with this doc.  But they don't - nor was that said or even remotely implied.  I asked for more information on this tint - and I got it.

Except tmorse...NOT from you.  Why IS that do you suppose??  :Rolleyes: 

2. I find your lumping of "anyone who works in an instructional setting" into the veritable heights of untouchables very intriguing.  I myself come from an optical and scientific education background.  Funny...I'm not asking you to bow before me.  And even the minds that history tells us were the VERY best and brightest in that field - names like Einstein and Hawking...heard of them? - were WRONG more than once about certain ideas they had worked on.  Sometimes even after decades.  It IS completely possible to be smart - and still to be wrong sometimes.  Again, this very specific and highly suggestive suggestion for a tint that almost NO ONE has heard of - let alone actually used in practice is what prompted the original request for information.

3. I'm really very sorry.  But this isn't about what YOU want.  LOL  It's about what's BEST FOR OUR PATIENT.  And until you can provide me with your own personal data pertaining directly to patients YOU have helped, and we have a chance to compare the specifics of their entire health history and how it relates to each case individually to support the properly indicated usage of this particular tint, I will have to rely on others for their direct experience instead.   And no - we will not be purchasing ANY tint at ANY price until we hear from the patient, and work out our best solution to move forward - if indeed we need to change anything at all.  Though I do admire your assertiveness, I'm not sure why you feel the continued need to kvetch about it ad nauseum.  And so far _nothing_ you have yet provided to this conversation has done anything to help the patient.  Pro bono or otherwise.

Off for the night.  Thanks all who have helped out so far.  :cheers:

----------


## HarryChiling

Yes I think these special type tints can have a significant effet on patients, I watched a 12 year old boy walk into our office with a cane and leave happy he can see.  Achromotopsia, we used the monochrome 600, other office had been putting him in the darkest black tints that they could and he still was having a hard time.  The first thought from everyone in the office was this will never work, they saw a dark red and some even commented that they could see right through those lenses they weren't dark enough, the point was they selectively absorbed the spectrum with a specific wavelength being allowed through.  It could be this tint does have some effect, but as anyone that has helped a LV patient knows sometimes good vision isn't good enough to the patient even when it's the best they're gonna get.

----------


## Chris Ryser

What a hectic and heated discussion about a useful soothing tint, versus the so called best..............an AR coated clear lens.

Have you ever heard that one can also AR coat a tinted lens ? If Uilleann would do that, he would make the MD happy and still a happy camper for having sold the best and probably most expensive and profitable lenses.

Anybody that was around in the old glass days will remember that the old pink shades like AO's Cruxite A and AX as well as the B&L Softlite 1, 2, 3 were the most popular add ons over clear white lenses.. These colors became not only fashionable but also served for light sensitive people and cut out the blue green light. Similar to the descriptions of this FL41 color.




> *This University of Utah doctor is the same who sent our letter regarding this patient. He has more than a small vested interest in this particular tint. I called the lab, and found out that it is available by special order only and the cost of the tint bottle alone is over $100. Which just keeps sending my BS needle even higher...*


Of course the lab will charge you accordingly to the high price of the dye, but this indicates that you do not do any tinting yourself. If you would , you would be in the most profitable add on business the optical retail can provide, and the issue of this thread would be a non issue.

----------


## tmorse

> What a hectic and heated discussion about a useful soothing tint, versus the so called best..............an AR coated clear lens.


To my mind the issue wasn't what was best for he patient. 
Rather, it was his apparent pre-judgement that this OMD's new product could be an overpriced scam. This pre-judgement was based on guesses, the fact that *he* hadn't heard of it before. He also made much of the fact that the inventor was also the prescriber. This, he reasoned, created an unprofessional conflict-of-interest situation.
So he decided to play the funny-man, and attempted to smear this OMD's reputation by referring to his new tint in the jargon of scam-artists... _(possible) snake oil??? magic tint???_ 
And after all these posts, he can't see/understand the error of his way(s)... such as his preference for anecdotal evidence over clinical double-blind studies before he will even consider using this new tint. And he makes a big issue over the $100.00 price of a bottle. Yet $100.00 for alleviating the symptoms of a migraine sufferer should be considered chickenfeed. Some migraine sufferers are willing to pay MANY $1000.00's for the chance to get potential relief.
So it was his attitude and apparent pigheadedness that provokes my RANT. He just doesn't get it, and now quite frankly, "I don't give a damn". My RANT is now OVER. :cheers:

----------


## Uilleann

Chris,

To address your questioning of my experience, knowledge and ability (again...didn't we do this same dance in an older thread?)

Yes.  I know what can and can't be done with tints and A/R.  And I am also aware of the fact that many of the beneficial effects of either are degraded when they are combined.  And yes, I am also well aware of the old Crux tints and the Prio P20M etc.  I am also aware of fact that these tints were developed primarily to help alleviate CVS symptoms brought on from older CRT monitors.

This tint was described very specifically as THE tint to use - not a tint "similar" to it.  If it was just a question of it being close, there are any number of rose 1 variants that would fit that bill comfortably no doubt.  There is of course the added question of the patients perception and the idea that this specific tint may be the "golden bullet" in the doctors - and therefore the patients mind to offer the perfect cure for a given symptom.  And I am all about trying it if so.  But again not without doing a good deal of questioning and research about the tint beforehand regardless.

And while maintaining a profitable practice is important to ANYone in business, as you are with your lens coating business, we do not need to carry a full finishing lab to do so.  We are fine and extremely happy with our current labs and the level of knowledge, quality and cost effectiveness they provide.

tmorse,

If you look again, you'll find that this is NOT a new product.  It's been around for years.  And it is almost never used.  How many times have you used it?  Exactly how has it worked for your patients?  Why are you so vigorusly defending something you've never seen or used?  Or are you just holding out on us?  ;)

The question of the doctor's direct involvement in a course of treatment that is: 1. expensive for the patient  2. virtualy unheard of  3. was suggested without specific environmental testing beforehand were the reasons that my doctors here and then myself questioned this course of treatment.  We always have our patients best interests in mind.  For you to flatly accuse otherwise IS slanderous.  It also doesn't do a THING to help any patient - yours our ours.

And yes - we are asking for real-world useage and results from real opticians and doctors working directly with real patients IN ADDITION TO any information we find relating to the actual tests.  You may be intreested to learn that in at least one of the original studies, the results were obtained through use of a questionaire subjects filled out after wearing two different types of sunglasses, one containing the FL-41 tint.  Doesn't sound any better than real world use reports from our peers in the field to me.  Though, undoubtedly, ymmv.

So be grouchy - be trolly - be whatever you need to take care of your patients.  We'll continue to do the same in our own way for ours.  And I will continue to learn as much as I can every day I crawl out of bed.  Good luck with your ranting.  Next time however, I do suggest actually contributing something useful to the discussion as everyone else has.  All the best! :Cool:

----------


## chip anderson

Actually the old Crux and soft-lite (pink) tints were around long before computers (at least before most of us even knew what they were) they were developed to reduce glare off of paper.  Especially for newspaper workers and proof-readers.
I am not old enough to know if they were really effective for this but fortuantely I am old enough to have worked for some people that were around when they were brought out and know what they were for.

Chip

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## Uilleann

Thanks for the clarification Chip.  I never had a doc prescribe that tint for anything other than CVS related issues, but that does make perfect sense.  An existing product used to fill a need - it's great it worked for some of those patients.

As I'm digging further into the history of the FL-41 saga, it's suggested use for years was both as an indoor and outdoor sunglass.  Though, there are some pretty wild variations in what one doc or the next seems to understand the tint to actually be (anything from red to rose to deep amber), and the best density to use for a given patient.  It also seems that the resultant reduction in patients symptoms can vary a large amount as well.  Though there doesn't seem to be a solid consensus that it either does or does not provide a consistant benefit.

This seems to be best addressed on a single patient by patient basis with heavy lifestyle questioning and if possible a physical evaluation of the patients work and/or living space.  If possible, a selection of tint samples in varying densities may provide the best insight into what feels the most comfortable for a given patients needs.  Our outside vision therapist is in office today, so I will ask her for any additional she might be able to provide also.

Thanks again!

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## Dougfir8

BPI and other companies sell the tint just like they sell other colors.  It costs a little more, but no $100!  A large lab should be able to generate enough business to make it worth while.  Medicaid was willing to pay us $25/pair for the tint compared to $10 for regular tints (required a Prior Authorization).  If the doc prescribes it, and someone will pay for it, you don't need to judge its value before filling the order.  You can discuss it all you want, but unless you have reason to believe it is harmful to the patient, don't sweat it.

----------


## Uilleann

> BPI and other companies sell the tint just like they sell other colors.  It costs a little more, but no $100!  A large lab should be able to generate enough business to make it worth while.  Medicaid was willing to pay us $25/pair for the tint compared to $10 for regular tints (required a Prior Authorization).  If the doc prescribes it, and someone will pay for it, you don't need to judge its value before filling the order.  You can discuss it all you want, but unless you have reason to believe it is harmful to the patient, don't sweat it.


 Checked with five labs across the country.  Each one said this particular tint was very near or over $100.  They also said they n-e-v-e-r did it and it would need to be special ordered.  At least this is what we were told.

Medicaid doesn't pay for hardware in our state anymore (As of Nov. 1st.) for non-pregnant, adult patients.  Regardless this patient wasn't covered under Medicaid, and her vision insurance hardware benefit was previously used.  Would have been nice though!

The MD did not write any form of Rx for this patient.  He only sent on his dictation as a letter that read as much like a sales pitch than a recommendation.  Hence the hesitation to rush out with our hair on fire trying to change something that may or may not be the root of the problem.

The dispensary at Moran is listed as a provider for this tint so should the patient desire it we will kindly refer her to them for 100% proper application and follow-up.

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## nickrock

Uilleann,
I apologize for jumping in kinda late in the thread here, but I ran the SOC retail optical lab in SLC for 5+years and we would get referrals from Moran patients who frequently wanted an FL-41 tint. I believe it was mentioned before in this thread, but BPI does make this.  It is not very cost effective for any lab to produce this tint on a single "here and there" basis, but we would do 1 a month or so.  It would make sense that labs would charge a premium price for something that they have either never done or done infrequently.  We came up with a solution for this infrequent request without single handedly keeping BPI in business.
-Tell TB I said Wass Up...

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## HarryChiling

The office I worked in where we used the special tint's and had no lab I would send the bottle of tint in the box with the frame and they would tint the lens and charge us a bit above normal for tinting them and then send the bottle of tint back. You'd get away with this about 3-4 times with the bottle if they created a small pot and used it sparingly. It really depends on how good your relationship is with your lab if they're gonna work with you on these kinda things. You could probably also call BPI and ask them if they have any labs that use the therapeutic tints if a lab has reason to use them regularly the cost comes down a bit.

Nick dude what's up been a while.

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## Ian Jordan

Does it not embarass the optical professionals on this site that they do not understand how to prescribe tints or what the physiological effects of tints are.

What a shambles - and the public deserve better....

Just wait until the public find out

All tints have physiological effects on some people - and this thread has shown just how bad knowledge levels of filters are.

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## Uilleann

> Does it not embarass the optical professionals on this site that they do not understand how to prescribe tints or what the physiological effects of tints are.
> 
> What a shambles - and the public deserve better....
> 
> Just wait until the public find out
> 
> All tints have physiological effects on some people - and this thread has shown just how bad knowledge levels of filters are.


You paint with an overly wide brush good sir.  There are MANY of us here who know EXACTLY what a given tint and a given density have on _some_ people.  Tinting has been proven to offer therapeutic effects for a myriad of conditions and situations certainly.  That was never the question.  It was the precise nature as well as the associated costs involved with a very particular tint.

Interestingly enough not a SINGLE optiboarder has used FL-41 with regularity and most not at all given the response to the initial request for further information.  I've learned quite a bit about what it's uses are, and how it is recommended now.  And we now have more information to treat a given patient in a given situation.  Thanks for your thoughts all the same!  :cheers:

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## Ian Jordan

As someone involved in research and development of the physiological, pathological and cognitive effects of visual stimulus I am pleased that someone knows how to prescribe filters - fl41 is often prescribed empirically but this is NOT a good method. To prescribe tints professionally it is rarely appropriate to do this.
We normally work to CIE standards - the internationally recognised ones - we convolve for metamerism and undertake a series of tests to determine which is the absolute illuminant in 3D colour space for optimum physiological performance. Then the tint can be calculated taking into account ambient lighting. 

there are over 100 physical effects of tints, some obscure but 20% of patients are effected - some of the effects may come to "bite" optical professionals - I see at least a person a month that has a legal claim in the UK - and we are a LOT less litigious than in the states.

a simple question - what is the difference between comfort 41 and fl41 - see how many really know about tints

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## obxeyeguy

Oh.  Oh.  Please tell us 'ol holy one.  I for one have no idea what a comfort 41 tint is, and didn't know what a fl41 was either, but I learned.   

But your condesending tone tells me nothing other than " you are way smarter than me".  Who cares??  I don't.

Read to learn, or post to teach.

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## Uilleann

> ...Read to learn, or post to teach.


Absolutely agree!!!  :)

As for prescribing anything, as you incorrectly imply Ian, the answer is no.  I did not prescribe anything.  I am legally unable to.  As it should be.

But since practically NO one knows ANYthing about these tints, and the EXACT frequencies of light they attenuate, and how EXACTLY that may relate to a given patients visual or other physiological needs on a case by case basis, we're not really moving forward here are we?

The intent of this post was to find out much more information about a highly specialized tint hue.  Furthermore, it was to gain a greater understanding as to how this might affect our patient.  So far, we've discovered that FL-41 is "a rose tint".  That's about it really.  NO other useful information on how to properly prescribe or even recommend it's use in a perfectly effective manner.  I have learned a great deal about what tints like this can sometimes achieve in a very general sense.  I would love to learn more.

Please feel free to educate all of us in any way you are able.  We would ALL appreciate it!  All the best!

----------


## rbaker

> Actually the old Crux and soft-lite (pink) tints were around long before computers (at least before most of us even knew what they were) they were developed to reduce glare off of paper.  Especially for newspaper workers and proof-readers.
> I am not old enough to know if they were really effective for this but fortuantely I am old enough to have worked for some people that were around when they were brought out and know what they were for.
> 
> Chip


When I started in the business nearly all of the lenses that we used were glass and perhaps a third of them were Cruxite. It seems that once you wore it you loved it. Of course, tinting glass lenses in those days was a major hassle, you had to send them out. With the increase in plastic lenses in the late sixties and the ability to dye them right in the office their use increased dramatically along with the claims made for their use.

----------


## chip anderson

Somewhere in my great store of amassed junk, I have a book with a table that shows: 1) The refractive index of everything (even stuff I thought was opaque).     2) The light frequency that passes through everything, every filter.  Of course it's an old book and doesn't show much on what goes through tinted plastic.    I will try to find, but I don't know if it's in an old optical book or other reference source.    If and when located I will share.

Chip

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## tmorse

> there are over 100 physical effects of tints, some obscure but 20% of patients are effected - some of the effects may come to "bite" optical professionals - *I see at least a person a month that has a legal claim in the UK - and we are a LOT less litigious than in the states.*


I too have read about research into various coloured-filters providing benefit to those suffering from dyslexia, autism, migraine, etc.

Please provide us with a legal citation for a British (or any other jurisdiction) case where such a legal claim has been successful and resulted in a judgement.:cheers:

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## Ian Jordan

Nearly all legal cases are settled before court (plaintiff against LEA). The only two that I know of that actually have got to court have had "gagging" clauses - ie settlement has taken place subject to confidentiality.

However, the precident in this area is the Phelps case, where damages were awarded due to vicarious responsibilty in dyslexia. 

But duty of care legislation means that all professionals have to perform to an adequate level subject to reasonable levels of expectation and what is currently standard practice. I wonder what would happen if an optical professional stood up in court and said "I have given X some tinted specs and have no idea of whether the tint has an effect" Expect crucifixion.

----------


## tmorse

> Nearly all legal cases are settled before court (plaintiff against LEA). The only two that I know of that actually have got to court have had "gagging" clauses - ie settlement has taken place subject to confidentiality.
> 
> However, the precident in this area is the Phelps case, where damages were awarded due to vicarious responsibilty in dyslexia. 
> 
> But duty of care legislation means that all professionals have to perform to an adequate level subject to reasonable levels of expectation and what is currently standard practice. I wonder what would happen if an optical professional stood up in court and said "I have given X some tinted specs and have no idea of whether the tint has an effect" Expect crucifixion.


I asked for a cite... that is, a legal citation that I can look up. Full name of both principals, date, court level, location of trial, which Reports/'Journal/Edition, something more than 'Plelps'.

----------


## tmorse

> Does it not embarass the optical professionals on this site that they do not understand how to prescribe tints or what the physiological effects of tints are.
> 
> What a shambles - and the public deserve better....
> 
> Just wait until the public find out
> 
> All tints have physiological effects on some people - and this thread has shown just how bad knowledge levels of filters are.


*Well write a book, why don't you.;)*

----------


## Uilleann

> ...I wonder what would happen if an optical professional stood up [in court] and said "I have given X some tinted specs and have no idea of whether the tint has an effect" Expect crucifixion.


While it wasn't in court, it was our patient and this is exactly what the recommendation we were given said.  And that, of course, was what propted my doctors, and myself as well to ask for greater information about this particular tint.  Thanks for the message and link you sent in PM.  I do appreciate the info.  would it be something you'd be interested in sharing in general with the board here at all?

Thanks again - all the best!

Brian~

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## Ian Jordan

> *Well write a book, why don't you.;)*


Have done - 5 to be precise - and 3 others on commission.

Also have produced DVD with UK university, CD rom, lecture at numerous world level conferences, have specialist optometric practice, have designed ranges of tints for clinical usage, lens types, award winning instrumentation that can assess which tint to use (at absolute levels) - and have been asked to write post grad course on subject fo UK university. 
I am currently involved with a number of research projects in this area, it is complex - to explain it even at a basic level requires a great deal of information to be given.

You might like to start by going to practice website www.jordanseyes.com - 2 books (published in UK by Desktop Publications) can be downloaded free. 
The DVD can be purchased from Coventry University - but it European format - but the website shows a number of interesting videos e.g. one I made with the BBC in using filters in autistic spectrum disorders

As for the fl41 - its design was to reduce the effects of flicker from flouresecent lights. Unfortunately, it has been sold as an empirical method of prescribing - Px analysis is much better

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## chip anderson

Now that this can of worms is publicly open.
How long before we are held liable for adding a tint?  
Theoreticly one could not only alieviate some problem with tint, we could also cause (or at least be blamed for causeing" some sort of problem with tints.
We all know that we have been tinting contact lenses and spectacles forever based on little more than "the patient wanted it."
Other than a few surveys that for the most part we have ignored, like Salvatore's findings that blues depressed patients and reds do actually cheer them up).
Any lawyers out there looking for a whole new way find work?

Chip

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## Ian Jordan

Evidence is emerging of prescribing tints incorrectly causing problems. But, in most cases it would be difficult to sue (as yet). 
It's only a matter of time - but if optical professionals do a good job - then they have nothing to worry about.

There is also an opportunity - but I suspect the majority won't move until forced to. Eventually, stimulus control will be as important as the refraction, in our practice (and a number of others in GB and Ireland) it already is - and the results we get are so much better than possible with old fashioned techniques!

Anyone for training?

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## Chris Ryser

> *Now that this can of worms is publicly open.*
> *How long before we are held liable for adding a tint?* 
> Chip


I don't think Ian is trying to prevent you from doing what you have done the last hundred years. 

He is talking of special cases. I just did a little searching and found a description that probably classifies his arguments.

*---------->* 
*Encyclopedia > Orthoscopics*
*Orthoscopics* is a treatment using computerized assessment and colored lenses to treat migraines and vision-related reading problems. The system was developed by Ian Jordan, a British optician who has promoted his program widely as a way of treating a condition he has labeled _visual dyslexia_. Jordan's theories and work appears to parallel that of Helen Irlen and the use of colored lenses to treat Scotopic sensitivity syndrome; and the TintaVision program of colored overlays to treat asfedia. It should be noted that these are each competing commercial systems for dispensing optometric products and services, and are based on theories and diagnostic labels that are unique to each system. 


 
7-year-old boy wears a corrective lens


Jordon considers "visual dyslexia" to be as much a physical condition as myopia and hyperopia[1]. Treatment to address the physical symptoms may also include eye exercises or corrective lenses. 

The child with vision problems may underachieve in academic work or in social environments. Self-esteem is lowered and antisocial behaviour is common. At school, reading and comprehension tests will cause problems and psychometric testing may not be reliable unless visual perceptual problems have also been considered and addressed. 

Jordon's use of the phrase "visual dyslexia" has a different meaning than the more common usage of the phrase to refer to a subtype of developmental dyslexia, which is considered to be a disorder of neurological origin rather than a problem with vision.


from: 
http://www.nationmaster.com/encyclopedia/Orthoscopics

----------


## Ian Jordan

To give an *accurate* brief synopsis of Orthoscopics  

Orthoscopics is the name given to a system of analysing and managing the effects of stimulus on the visual and other systems.
It utilizes instruments (development funded by UK government) that can effectively separate the retinal cone cell pathways and the ganglion cell responses. It allows us to assess the effects of colour / flicker / pattern and the physiological responses. Prescribing tints becomes as accurate as Rx.
This can be done objectively as well as subjectively.

We always work to CIE (the only internationally recognised) standards, can emulate any light / tint combination and assess the envelope within colour space in which optimum performance is achieved. We can also assess envelopes in colour space in which negative effects are found.

The optometric effects are diverse, medical and physiological responses can be dramatic, and cognitive processing is found to be problematical.
There is a continuum of effect, from negligible to profound - virtually everone can be shown to be affected to some extent.

About 20% of patients have significant difficulties due to visual stimulus.
Many problems caused by visual stimulus are not obvious and current methods of addressing them are often inappropriate.

Optometric conditions which respond well include

strabismus - including alternating and incomcomitant
amblyopia / acuity reduction
visual field reduction
convergence insufficiency
fixation / tracking problems
relationships between magno parvo systems
poor accommodation
visual processing disorders eg visual dyslexia

We now know of over 100 physiological effects of visual stimulus.
Orthoscopics can be amazing with neurological difficulties - but you need to know how to assess, prescribe and manage problems. 

We are not like Irlen / tintavision at all - reading problems are just one of a lot of symptoms

Hope this clarifies

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## Uilleann

Ian,

That is some GREAT information.  THANK YOU!  I think we're all a lot more informed now.  If our MD here would have taken even a shred of a step in this direction I (and my docs) would have felt far better about his diagnosis and treatment plan.  As it stands after only one visit, his letter didn't give us any information apart from his feeling about one tint that was not shown to the patient in the first place, nor tested.

Our VT doc is also interested in learning more about the research you've been a part of as well.  Thanks again for posting this info.

All the best!

Brian~

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## drk

Brian, FWIW, I think you are correct to question tinting.

1. It's been a scam before, and it is still a scam.
2. Not all "lens-tint" is a scam, but a lot of it is.
3. Some of it is simply well-intentioned yet unscientific.

It strains my credulity as well.

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## Uilleann

#3 was our concern.  Though I do agree wholeheartedly with Ian that it has a proper time and place in eye care, and even general health.  But that was not how this doctor presented his recommendation to us.

Thanks again to all who contributed!

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## Jaltman

I just purchased FL-41 for a patient from BPI for $37.00 per bottle. Theyre trying to scam you at 100 bucks a bottle. It took two weeks to get though.

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## Ian Jordan

it is a pity that the science of stimulus control is not taught to optical professionals - perhaps if they understood the science........

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## Chris Ryser

> *it is a pity that the science of stimulus control is not taught to optical professionals - perhaps if they understood the science........*


Ian.....................do not forget that in 50% of all US states the profession of an optician is not regulated, and that in those states somebody can be a car salesman or a shoe salesman and be a specialized  optician the next day.

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## Ian Jordan

optical professionals also includes ophthalmolgists, optometrists and orthoptists

look on it as an opportunity - please

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## drk

Ian, I am curious.

Let's assume that certain retinal pathways are more sensitive to certain wavelengths than others, and that there are functional consequences to messing around with them.

Now, I ask you: if I'm wearing a special, highly accurate tint and looking at a white sheet of paper with a solar spectrum illumination source, I'm getting a certain predetermined wavelength of light.

But what about a warm white fluorescent source?  A cool white?  Natural light on a cloudy day?

What about a light blue piece of paper?  The reflectance off the page passing through the special tint has just changed the net result.

What about a monochrome monitor?  

What about color receptor/neural pathway fatigue or even neural accommodation after looking through the special tint for so long?

How long until the tint leaches to a less effective selective absorber?

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## Ian Jordan

This subject is extremely complex and all the above points raised are valid and can be addressed. But far too complex for a post,they require explanation - would take about 20 pages!

feel free to come and visit when in UK - will happily show and demonstrate science / effects

I did give presentation at US academy of optometrists national conference about a month ago in anaheim, it was clear that training in this area was generally very limited

We use assessment techniques which any optometrist would find exciting - the effects on the dorsal stream can be extraordinary. 

best wishes
Ian

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## LolaMarigolda

I realize the thread is ancient, but the OP wanted real world success stories...

I've been a migrainuer for the last 25 years.  As such, I'm constantly  photophobic even when not in the midst of a migraine attack.  Over the  years, I collected the darkest, most light blocking sunglasses  available, but nothing helped.  In 2004, I accidentally stumbled onto  the benefits of rose tinted lenses in the form of a pair of moderately  cheap sunglasses.  Imagine my surprise when they made the office  florescent lights somewhat tolerable.  They were also light enough I  could wear them while driving at night.

In 2007, I scored a pair of Oakleys that were superior as far as overall  quality and something about the coloring worked better as well, but I  have always felt a color tweak could make it "better".  DRK's question  about light source or focal point (certain shades of paper, computer  screen, ect) changing the effectiveness) made me giggle.  Yes, it does,  but you guys are missing the point.  For someone like me, even when the  overall effectiveness is reduced, it is still 100X better than not  having the tint/glasses.  If I can get 5 more minutes of work done while  surrounded by migraine triggers, it is worth it.  

I didn't learn about the FL41 tint until recently; someone on a service  dog forum mentioned that it has been a tremendous help in reducing both  the  frequency and intensity of her migraines.  

I will be pursuing a pair on the economy over here on Monday morning.   It should be an interesting undertaking as the laws concerning  prescription and non-prescription eyewear are much different than in the  US.  Should that fail, I will be looking at US retailers.  It's not  like they could really make the situation any worse...  I'm already  paired with a service dog to not only alert to these attacks before  hand, but to also guide me when I have temporarily lost vision in one  eye and it is significantly impaired (again, only temporarily) in the  other.

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## Uilleann

I would ask out of curiosity then, what did your prescribing physician specifically prescribe for you regarding this FL-41 tint?  In particular, I am most interested in density, and whether or not you were instructed to wear full-time vs. activity specific wear only.  Do you have the information on the wattage and color temp of your work fluorescent lighting?  Is it uniform?  These may seem "trivial" to a non eye care professional, but as Ian points out, are quite critical in assessing the true clinical value of a given tint transmission and density for a prescriber/dispenser.  Thanks.

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## MikeAurelius

Speaking strictly for myself, also a migraine sufferer, mine usually come at night without warning, however, I do occasionally get hit during the day. For my own use, I made up a pair of Schott ACE (S-8817a) lenses in my distance rx. ACE filters yellow plus a couple of other spectrum lines ( http://www.auralens.net/ACE.htm ). I am particularly sensitive to yellow light during my daytime episodes and the ACE filter has worked for me. However, as the episode progresses, I become highly photophobic and then it's time for the dark bedroom with the sleep mask.

ACE is considered a 'next-generation' didymium filter. 

And yes, it's glass...

(and what kills me the most about my day-time migraines is the complete loss of my peripheral vision.)

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## sharpstick777

I would also like to chime in. I managed an Opthalmology clinic for many years where we would frequently treat many post-trauma accident victims, many with head and eye injuries who were hyper-photophobic after their accidents. The OMD asked us to try many things to help these patients as he was at a loss for what to do. In research and experimenting we came across a set of colored lenses made by Corning. The kit had 4 different tints varing from Rose to Orange. 

About 70% of our patients noticed imediate relief from at least one of the colors. We would then tint the lenses to match, and fine tune as necessary. On a few, they were so photophobic they even had the tint and over the top wore Fit-Overs (even indoors). Although it was very unscientific in many regards, it did help tremendously and most of our patients had some degree of relief from mild to incredible. Only about 30% reported no improvement what-so-ever.

We did have some migraine patients who also benifited but since were treating mostly accident victims with eye or head injuries we didn't track for migraines. There regretably very little information on photophobia and its causes and treatments. However, I can say that color tints can have a huge impact in accident victims with photophobia or headaches of possible occular complexity.

The cost of a tint= very small  The potential benefit to a few= huge

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## lab fly

The tint works have used it on 2 patients and it was instant relief for both of them.

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## One science

I remember to have met more details about this information. I'll do my best to find out where i saw it. Let me know if you finde out more.

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## One science

> I asked for a cite... that is, a legal citation that I can look up. Full name of both principals, date, court level, location of trial, which Reports/'Journal/Edition, something more than 'Plelps'.


Maybe you should ask a lawyer about this. He will tell you exactly what you need, the part that you want to hear it from the law.

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