# Optical Forums > General Optics and Eyecare Discussion Forum >  how can this be legal...

## CNG

http://www.goblink.co/

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## rbaker

Hey, why not. It is legal until some court examines the situation and issues a cease and desist order. It appears to be a portable auto refractor and only tests for refractive error. You will probably have one of these gadgets in your store or near a mall food court near you real soon.

The times, they are a'changing.

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## iD

so the rx is not finalized until they send it off to one of their network of doctors for approval? 

I also love this on their replacement for the lensometer "..._Replaces traditional Lensometers: also big, require constant electricity, difficult to use, and don't work on scratched lenses."_

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## iD

just found out how it's legal

"Third, in a short "Terms and Conditions" paragraph, individuals are asked to check a box indicating that they understand that this is not a comprehensive eye exam, what a comprehensive eye exam means and how thats different from what Blink provides, and that a comprehensive exam with an optometrist is recommended every two years. This box must be clicked before vision testing may proceed."

http://www.goblink.co/for-optometrist/

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## HarryChiling

Revolutionary, amazing noone thought of it before.

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## EyeSore

> just found out how it's legal
> 
> "Third, in a short "Terms and Conditions" paragraph, individuals are asked to check a box indicating that they understand that this is not a comprehensive eye exam, what a comprehensive eye exam means and how thats different from what Blink provides, and that a comprehensive exam with an optometrist is recommended every two years. This box must be clicked before vision testing may proceed."
> 
> http://www.goblink.co/for-optometrist/


As an LDO can't I set one up in my office and have some of my OD friends sign off on the refraction via email or video-chat or whatever. This is interesting. I've heard they have things like this in local malls out in Cali. Not sure how true that is.

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## Robert Martellaro

Like this?

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## iD

> As an LDO can't I set one up in my office and have some of my OD friends sign off on the refraction via email or video-chat or whatever. This is interesting. I've heard they have things like this in local malls out in Cali. Not sure how true that is.


I'm sure you can as long as you don't identify yourself as an practicing OD. I'm sure there's technical jargon they use to find the loop hole in order to do this. I would want to know how they presented this as a business but not a practice. If that makes sense.

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## racethe1320

Reserving this post for future comments as this is just the tip of what's coming....

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## racethe1320

> As an LDO can't I set one up in my office and have some of my OD friends sign off on the refraction via email or video-chat or whatever. This is interesting. I've heard they have things like this in local malls out in Cali. Not sure how true that is.


https://vimeo.com/117414944

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## Jarhead Daddy

I think this is a great example of disruptive technology.  Remember, it is disruptive technology that makes the world better, not worse.  We simply need to adapt as technology advances.

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## Tigerclaw

"Disruptive technology" is TV dinners instead of healthier food. It's a "+1" in one column and a "-10" in many others.

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## braheem24

The most shocking part is the part that people consider this shocking, this is nothing new in medicine.

I considered doing this with an ophthalmologist over 10 years ago and have him sign off on an exam through emailed photos and an eyelogic type refractive system. 

I decided I didn't want to start a race
to the bottom of the barrel, I valued my time and knowledge too much to waste it becoming a fast order taker.

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## coupe

Does involve a double billing thought. First a payment $75.00 Blink and should you need further examination, your opto visit (full eye exam) adds another $75.00 -$ 150.00 to the cost. Much easier to just go to the opto that is willing to understand that not all people can afford the cost of a full eye exam.

If eye exam costs keep becoming prohibitive, systems like this  will start to gain hold in the optical world.

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## coupe

BTW, I think it it a great idea, and can think of many ways it could be used. The one major drawback is finding a foresighted optometrist, willing to be invoved. Thw whole system balances on the optometric world accepting and mbracing this program. No opto no program.

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## newguyaroundhere

> Does involve a double billing thought. First a payment $75.00 Blink and should you need further examination, your opto visit (full eye exam) adds another $75.00 -$ 150.00 to the cost. Much easier to just go to the opto that is willing to understand that not all people can afford the cost of a full eye exam.
> 
> If eye exam costs keep becoming prohibitive, systems like this  will start to gain hold in the optical world.


Some offices do offer patients an refraction only visit to obtain an Rx for glasses. 

Also lets not overlook the fact that this company adds an additional 25% upcharge every time you use them after the first visit they perform and you do not get a comprehensive eye exam done between visits by them. So if you use them the first time, its $75 bucks. If you call them a second time and didn't get the eye exam done, they ding you for $93.75 after the 25% upcharge

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## scriptfiller

Price-wise this is not competitive with comprehensive eye-exams by an OD in my city.  The practice I'm with charges U&C $60 for a comprehensive eye-exam, I've seen lower.  One still has to wait for the "blink OD" to review and sign-off on a refraction.  This wouldn't fly in my town.

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## braheem24

Sign off is only needed for dispensing.

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## drk

There are laws coming against this.

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## MikeAurelius

> There are laws coming against this.


"Smaller government"...why is it when people claim they want less regulation, and the results of less regulation come about, all of a sudden, more regulation is wanted?

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## Barry Santini

Forget the idea that eyeglass optics and buyer satisfaction are based in precise metrics. Vision is forever fluid, and nature has evolved us to adapt. 

B

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## braheem24

> There are laws coming against this.


More laws to handicap opticians with a license instead of regulating unlicensed activity online?

If that's the priority in which the professional associations see the industry's problems, God help us.

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## Chris Ryser

> Get your digital prescription.





> Our optometrists will prescribe you a fresh prescription for glasses.
> Or, if you have a complication they will refer you to a local optometrist for an in-person
> comprehensive eye exam.




Even the ODs are remote. Interesting, locals only if involved when there are complications.

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## ml43

What's stopping independent opticals from doing the same thing.  Just offer mobile appointments, as well as in person ones.

if the od feels a comprehensive exam is necessary, have them come into your practice rather than a referral. 

Plus, they can look at frames at the same time.

Might just be the answer to compete with online rx glasses sales.

if you believe they are the competition.

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## Tigerclaw

> "Smaller government"...why is it when people claim they want less regulation, and the results of less regulation come about, all of a sudden, more regulation is wanted?


Not entirely hypocritical when you consider that these laws would be at the state level, not the federal level. The federal laws are archaic and detrimental to everyone except for a handful of bullies. I always said I believe in government big enough to keep other entities from being bullies without becoming a bully itself.




> More laws to handicap opticians with a license instead of regulating unlicensed activity online?
> 
> If that's the priority in which the professional associations see the industry's problems, God help us.


Everything is being targeted, the difference is what can legally be dealt with. It is difficult or impossible to effectively regulate the internet's unethical or unqualified substitutes for cheap and ignorant people. Many of the sellers are from other countries or engaging in interstate commerce, putting them under the jurisdiction of the federal government that seems to favor the cheap and ignorant. State laws are easier to change. Look at 1800-CONTACTS - unethical and often illegal. You think they aren't at the top of most associations' s***-lists? Forums are nice for venting,but it is a little more effective to also write your representatives and file complaints with the FTC. I report 1800 at least once a year, for example.

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## MikeAurelius

> Not entirely hypocritical when you consider that these laws would be at the state level, not the federal level. The federal laws are archaic and detrimental to everyone except for a handful of bullies. I always said I believe in government big enough to keep other entities from being bullies without becoming a bully itself.


Then you haven't been paying attention to the states (and their residents) who continually call for less regulation, but insist on more when it directly affects them. Especially since you live in one of them.

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## drk

> "Smaller government"...why is it when people claim they want less regulation, and the results of less regulation come about, all of a sudden, more regulation is wanted?


Hardly Mike.

It's people disregarding the spirit of the law through loopholes that need tightened.

If you want unregulated health care, vote that way.

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## drk

> More laws to handicap opticians with a license instead of regulating unlicensed activity online?
> 
> If that's the priority in which the professional associations see the industry's problems, God help us.


Low hanging fruit gets picked.  

We all know internet commerce is interstate and apparently sacred.

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## drk

> Then you haven't been paying attention to the states (and their residents) who continually call for less regulation, but insist on more when it directly affects them. Especially since you live in one of them.


Ok, you got everyone with that one, Mike.  People are to be 100% for regulation or 100% against or suffer your charge of hypocrisy.   Tyranny or anarchy are our only choices.

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## MikeAurelius

Not true Dr. K. Not true at all. The hypocrisy is from the folks who call for regulation, then want it back when it turns out badly. I'm trying real hard to avoid the use of the "p" word, but it's difficult. 

But there has to be some admittance of the fact that when voters elect folks who want "small government", those who then claim that smaller government and lesser regulations have hurt their business, are usually the ones to be calling for more laws and more regulations. The common voter and the business man are usually two different people, and there are usually more of the common men than business men. So who is to blame?

Do you say "I told you so", take your bat and ball and go home? Do you play the game? Do you sit on the sidelines and sulk?

With smaller government and lesser regulation, some people are going to be hurt, usually those who "profit" or have an advantage given to them by the "large government" and "more regulations". You talk about the "spirit of the law". What is that precisely? Can you define it? Is it real? Does it really mean what you think it means?

Let's say you make widgets. There are onerous government regulations that prohibit the use of some chemicals you need to make widgets. So, you spend bazzilions of dollars to find a critter who will write a law, and vote the way you want, and convince his fellow critters to do the same. The law passes, and you can now make widgets for cheaper and faster, and you rake in a gazillion bucks. But...six months later, your employees start getting sick from the chemicals, and pretty soon, they are all in the hospital and no one will work for you as long as you use those chemicals. Point of the example: every decision has unintended consequences. There's no way to forsee them coming, they just hit you in the face. Small government and less regulation means just that. You can't unride the horse.

Less regulation usually means no laws creating new regulations will be written. Small(er) government means that even if the new regulations are written, there's no one around to enforce them.

Those are YOUR choices. With respect, of course!  :Smile:

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## Tigerclaw

> Not true Dr. K. Not true at all. The hypocrisy is from the folks who call for regulation, then want it back when it turns out badly. I'm trying real hard to avoid the use of the "p" word, but it's difficult. 
> 
> But there has to be some admittance of the fact that when voters elect folks who want "small government", those who then claim that smaller government and lesser regulations have hurt their business, are usually the ones to be calling for more laws and more regulations. The common voter and the business man are usually two different people, and there are usually more of the common men than business men. So who is to blame?
> 
> Do you say "I told you so", take your bat and ball and go home? Do you play the game? Do you sit on the sidelines and sulk?
> 
> With smaller government and lesser regulation, some people are going to be hurt, usually those who "profit" or have an advantage given to them by the "large government" and "more regulations". You talk about the "spirit of the law". What is that precisely? Can you define it? Is it real? Does it really mean what you think it means?
> 
> Let's say you make widgets. There are onerous government regulations that prohibit the use of some chemicals you need to make widgets. So, you spend bazzilions of dollars to find a critter who will write a law, and vote the way you want, and convince his fellow critters to do the same. The law passes, and you can now make widgets for cheaper and faster, and you rake in a gazillion bucks. But...six months later, your employees start getting sick from the chemicals, and pretty soon, they are all in the hospital and no one will work for you as long as you use those chemicals. Point of the example: every decision has unintended consequences. There's no way to forsee them coming, they just hit you in the face. Small government and less regulation means just that. You can't unride the horse.
> ...


No offense, I am no political novice, not by a long shot. You are comparing apples to oranges. Wanting government to get out of the way of small business owners by reducing the red tape and pointless hoops to jump through for the purpose of being able to point to the voters and say "hey look, we're doing stuff!" and to feed the narcissism of a dozen power-hungry bureaucrats isn't the same as saying we need to restrict the practices of medicine and optometry to doctors, especially those who can adequately do their jobs and not just crank out prescriptions by cutting the wrong corners.
As for Texas, the libertarian attitude you describe is still in second or third place, if not lower.

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## rbaker

> Hardly Mike.
> 
> It's people disregarding the spirit of the law through loopholes that need tightened.
> 
> If you want unregulated health care, vote that way.


A "loophole" is a point of law which does not benefit you.

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## Tigerclaw

> A "loophole" is a point of law which does not benefit you.


Doesn't mean that the law is written as intended. The spirit of the law is often ignored, regardless of how people who oppose loopholes are often the only ones pointing them out, which would make perfect sense.

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## rbaker

We might also consider the difference between laws and regulations.

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## rbaker

All of these opinions beg the broader question "is Administrative Law unlawful?" 

This provocative question has become all the more significant with the expansion of the modern administrative state. While the federal government traditionally could constrain liberty only through acts of Congress and the courts, the executive branch has increasingly come to control Americans through its own administrative rules and adjudication, thus raising disturbing questions about the effect of this sort of state power on American government and society.

We can extend this to the State Governments and to State Licensing/Regulating Boards.

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## MikeAurelius

> All of these opinions beg the broader question "is Administrative Law unlawful?"


A libertarian would probably say its not.

HOWEVER, let's stay away from politics, so this thread isn't closed down.

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## mervinek

I can see how this could be good for people who are homebound.  I just had a patient who is in the hospital and has end stage cancer, she only has months to live.  Family wanted to get her new glasses since all she can do now is watch TV and her old glasses aren't cutting it.  This would have been great for her.

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## drk

What would be better is an inpatient visit from a doctor, not a visit from a cellphone.

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## drk

Question to you opticians:

Will you fill "Blink" "Rxs"? (I use that term loosely, since it's really a cell phone measurement signed off on by an unscrupulous OD.)

I mean, most of this crap is designed to go straight to equally scrupulous "online opticians", but what if one walks into your office?  What's your policy on filling these dubious measurements generated by a cell phone?  

What should your state boards' policy be?

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## EyeCare Rich

Great question drk.  I am curious if the Rx actually looks different than a standard Dr signed Rx???  I guess this what would determine it for me.  If it is a signed, dated, within the expiration Rx, yes I would fill it.  If it does not have a signiture, date, expiration date, no way, no how.  How would we know any different from the printed rx?   Maybe I'm looking at the small picture here, being from the sticks and not the big city where these hair brained ideas come from.

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## CNG

> Question to you opticians:
> 
> Will you fill "Blink" "Rxs"? (I use that term loosely, since it's really a cell phone measurement signed off on by an unscrupulous OD.)
> 
> I mean, most of this crap is designed to go straight to equally scrupulous "online opticians", but what if one walks into your office?  What's your policy on filling these dubious measurements generated by a cell phone?  
> 
> What should your state boards' policy be?


I think the question that we have to really ask is if it equivalent in quality as a in person refraction. As a licensed optician, I care about the health of my patients as well as the quality of OMD or OD who is working in my store. I will bet that most independent opticians will embrace this technology but will continue to feed these patients to their in house Doctor for health evaluation at a later date. If this technology is dead on accurate then we will see this change otherwise it will fade... It may be legal to an extend in most locations since opticians need the prescription signed by the OD/OMD. Now the question is wil the in house doctor agree to it...I think he will or even be the one signing the scripts.

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## Jarhead Daddy

I think the question is, "To whom do one's eyes belong?"  If my eyes belong to me, then who are you to tell me I can or cannot purchase glasses or contact lenses without your permission (an Rx)?  On what basis do we deny that right to adult patients?

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## drk

You're not understanding.

You have the right to practice medicine upon yourself.  

But you do not have the right to practice medicine on others.

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## MikeAurelius

^^^+1000

They are in my head, I get to decide who takes care of them and who makes the eyewear.

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## drk

Would you restate, MA?

OK, I get it.  Your eyes are "in your head".  

You do have a right to do what you want, again, but you don't have the right to do it to others' eyes.

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## MikeAurelius

My eyes are in my head. *I* decide who exams them and who fills the Rx.

(My response was meant for JarHead)

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## acesrwylde

I don't want to be the devil's advocate here, however, I find that most people are up in a roar about this to be interesting. Basically what is going on is they are doing a refraction for a patient, and there is a technician on site to supervise. That technician then sends the information to the doctor and the doctor signs off on it. I have been in many ophthalmologist offices that basically do the same thing. They have one of their technicians work up the refraction and then have the doctor sign off on this. How is this any different? They make it clear on their site that this is not a full exam or comprehensive in any fashion. Not only that, but they are also charging a lot of money for a refraction. Most places that I have worked for will charge $30-$50 for just a refraction. So this company is charging you $20-$40 more for the convenience of being able to do it from your home. Honestly I think this is a great idea, however, we do need to make sure people understand that this is not the same as a full comprehensive exam. I think that us as opticians need to stop spouting out sarcastic remarks about our patients and their ignorance and instead spend that time talking with them and communicating with them about the reasons why something like this is risky and may not be the best choice for them. We had to do the same thing when contacts and glasses became readily available online, and for those of us that took the time and worked with our patients, we find that we still have a great patient base that is consistent and loyal.

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## EyeCare Rich

[QUOTE=acesrwylde;505480]Basically what is going on is they are doing a refraction for a patient, and there is a technician on site to supervise. That technician then sends the information to the doctor and the doctor signs off on it. I have been in many ophthalmologist offices that basically do the same thing. They have one of their technicians work up the refraction and then have the doctor sign off on this. How is this any different? They make it clear on their site that this is not a full exam or comprehensive in any fashion. Not only that, but they are also charging a lot of money for a refraction. Most places that I have worked for will charge $30-$50 for just a refraction. So this company is charging you $20-$40 more for the convenience of being able to do it from your home. Honestly I think this is a great idea, however, we do need to make sure people understand that this is not the same as a full comprehensive exam. I think that us as opticians need to stop spouting out sarcastic remarks about our patients and their ignorance and instead spend that time talking with them and communicating with them about the reasons why something like this is risky and may not be the best choice for them."

Most of your statement is correct acesrwylde, but when in the office of the OMD, or OD, the patient is getting a comprehensive exam.  I also think that along with the autorefraction (which is what this system is)the technician is doing an actual refraction based off of the autorefraction.  Unless this machine is way more accurate (which I sincerely doubt)than current high priced autorefractors, the patient/customer is not getting the best refraction possible.  I would have to also hear their verbage with the customer to be certain they are reccomending a comprehensive exam before I could be comfortable with the idea of the system they are creating.

Did anyone look at the "technicians" they are hiring for this???  This is where I find big fault in the system.  Just my 2 pennies.

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## acesrwylde

Rich, that is a good point. It worries me when they call their technicians "Visioneers". For a venture like this they should only be hiring certified technicians who have a long history of working with doctors on refractions. As long as the business owners are getting the correct people, then there is no reason why this idea couldn't work.

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## drk

> I don't want to be the devil's advocate here, however, I find that most people are up in a roar about this to be interesting. Basically what is going on is they are doing a refraction for a patient, and there is a technician on site to supervise. That technician then sends the information to the doctor and the doctor signs off on it. I have been in many ophthalmologist offices that basically do the same thing. They have one of their technicians work up the refraction and then have the doctor sign off on this. How is this any different? They make it clear on their site that this is not a full exam or comprehensive in any fashion. Not only that, but they are also charging a lot of money for a refraction. Most places that I have worked for will charge $30-$50 for just a refraction. So this company is charging you $20-$40 more for the convenience of being able to do it from your home. Honestly I think this is a great idea, however, we do need to make sure people understand that this is not the same as a full comprehensive exam. I think that us as opticians need to stop spouting out sarcastic remarks about our patients and their ignorance and instead spend that time talking with them and communicating with them about the reasons why something like this is risky and may not be the best choice for them. We had to do the same thing when contacts and glasses became readily available online, and for those of us that took the time and worked with our patients, we find that we still have a great patient base that is consistent and loyal.


1. I think before you get all gushy about it you should see if it works.  
2. Sloppy ophthalmology notwithstanding, at least there is supposed to be a physician or a highly trained technician in person.  Who are these "guys" going to be? Former pizza deliverymen?

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## drk

Plus, you guys are never, ever going to listen to me, but after doing this for several decades, I'm here to tell you that it's not going to work properly.  You can have an autorefractor, but you can't have an autodoctor.

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## Paul Smith LDO

The question we should all be asking, is who is doing the eye health evaluation.  If your state allows the LDO to fit contacts with a current EG RX, you should be damn clear that an eye health evaluation was performed.

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## Tallboy

> 2. Sloppy ophthalmology notwithstanding, at least there is supposed to be a physician or a highly trained technician in person.  Who are these "guys" going to be? Former pizza deliverymen?


My favorite one:
Phil is an opportunity hunter and award winning professional actor in  The Greater Boston Area who enjoys home brewing, bacon, and tending to  the insurmountable will of his Maine Coon cat, Winnie. 
http://www.goblink.co/our-visioneers

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## Jarhead Daddy

> You're not understanding.
> 
> You have the right to practice medicine upon yourself.  
> 
> But you do not have the right to practice medicine on others.


If I am prohibited from purchasing the things I need to cure what ails me (eyeglasses and contact lenses), then I have, in reality, been prohibited from practicing medicine upon myself.

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## Robert Martellaro

> Question to you opticians:
> 
> Will you fill "Blink" "Rxs"? (I use that term loosely, since it's really a cell phone measurement signed off on by an unscrupulous OD.)
> 
> I mean, most of this crap is designed to go straight to equally scrupulous "online opticians", but what if one walks into your office?  What's your policy on filling these dubious measurements generated by a cell phone?  
> 
> What should your state boards' policy be?


There's an old saying: You don't want to be the first, and you don't want to be the last. 

I'd rather deal with the trials and tribulations of permanent vision loss, than make and remake eyeglasses for a technogeek lacking life experience.  And because I can't turn iron into gold, I won't service eyeglasses that were not designed and dispensed by an ophthalmic optician.

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## Jarhead Daddy

I would also submit that when we stifle new ideas and methods, we stifle progress.  I agree with Dr. K that a hand-held self-refractor will probably not do as well as a trained professional.  But for many people, it may be adequate, and in their situation, it may be the best option.

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## Barry Santini

> Plus, you guys are never, ever going to listen to me, but after doing this for several decades, I'm here to tell you that it's not going to work properly.  You can have an autorefractor, but you can't have an autodoctor.


People's definition of what's "proper" is always going to be inversely proportional to the price paid.

The deal will always be the deal...at least in the USA.

B

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## drk

Yes, all that's good until something goes wrong and we will cry for oversight, financial penalties, and "someone we can trust".

You can't have it both ways.

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## Jarhead Daddy

Well said Barry.  From a patient's perspective (seeking CL after expiration), the OD is extorting them for exorbitant exam fees, especially for those who have had the exact same Rx for the past 5 years, and who are seeing just fine.  From the patient's view, the OD is using the force of law to keep them from taking care of themselves.  

And we must admit that this is true.  We charge our fees based on supply and demand.  The requirement that only LDOs, MDs, and ODs can prescribe is a barrier to supply (thus increasing the cost).  The requirement that patients possess a current Rx in order to take care of their eyes is an artificial boost to demand (thus increasing the cost).  Patients pay more than what the service is worth because the law requires it.  Anybody who seeks to get around the law can be fined or even jailed.  This is coercion.

Now don't read me wrong.  I am not saying that ODs are worthless.  I am saying that the system artificially boosts their marketability through well-intentioned, but poorly reasoned, laws.

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## Barry Santini

> Yes, all that's good until something goes wrong and we will cry for oversight, financial penalties, and "someone we can trust".
> 
> You can't have it both ways.


Like the pols say to us...

They'll have to deliver the bodies....

B

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## rbaker

> Yes, all that's good until something goes wrong and we will cry for oversight, financial penalties, and "someone we can trust".
> 
> You can't have it both ways.


That's why we have ferocious trial lawyers. If you have truly been harmed they will insure that you are made whole or obscenely recompensed for all the pain and suffering that the bogus Rx or glasses caused you.

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## drk

Well I can see I'm not convincing anyone.

I don't think you guys would feel as groovy about deregulating medicine.  

I don't think some of you guys really appreciate the importance of eye care.

Oh well.

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## Barry Santini

Oh, I do drk.

but I'm afraid everyone else doesn't.  And they are the deciderers.

B

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## Jarhead Daddy

Dr. K, I actually am in favor of deregulating medicine for consenting adults.  Nothing stultifies an industry like government regulation.

But this does not mean that I devalue eye care or eye doctors.  I think I value it more.  If you want to see an industry advance, get government out of the way.

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## ml43

> Dr. K, I actually am in favor of deregulating medicine for consenting adults.  Nothing stultifies an industry like government regulation.
> 
> But this does not mean that I devalue eye care or eye doctors.  I think I value it more.  If you want to see an industry advance, get government out of the way.


Stop listening to your Econ proffessors.

Look at other countries with better healthcare systems than the U.S.

They all have way more government regulation.
Maybe not in eyecare, but healthcare in general is highly regulated.

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## Chris Ryser

> *There are laws coming against this.*



There could also be some laws eliminated. If you would follow what is happening elsewhere on other continents, like modern India where soon millions of eyes will be tested by unemployed
young people. They will be using all automatic equipment. 

The delivery system for glasses is already in place and has been, and is tested in Canada and the USA.

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## drk

I hope the U.S. can catch up to modern India, with their millions of untested eyes and unemployed people.

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## Jarhead Daddy

Ml43, I simply disagree with your premise.  True, the US is overpriced.  But that is due to failed government regulation.  Thus, healthcare tourism.  As far as quality and advanced procedures, the US is top notch (if you can pay for it).

Dr. K, you are confusing status with progress.  True, India is third world.  But that is not the point.  India is using new technology to make progress.  The US has been top dog for a long time, but we should not rest in our status.  We must continue to make progress.  That means embracing new technologies without the stultification (love that word!) of overbearing government.

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## drk

Your libertarian slip is showing.  Don't get too deep, you won't like the water.

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## iD

> My favorite one:
> Phil is an opportunity hunter and award winning professional actor in  The Greater Boston Area who enjoys home brewing, bacon, and tending to  the insurmountable will of his Maine Coon cat, Winnie. 
> http://www.goblink.co/our-visioneers


my favorite is Gisela cuz she's cute.

----------


## Jarhead Daddy

> Your libertarian slip is showing.  Don't get too deep, you won't like the water.


True, I am into the whole freedom thing (is that bad?).  But you still conflated status with progress.  I think I made a cogent argument for liberty.  I think you made an erroneous argument against it.  

I value progress in eyecare, and I think that http://www.goblink.co/ is progress in that it is a highly-mobile solution for patients who do not require a comprehensive eye exam.  It may succeed, or it may fail.  But that should be dependent on patient satisfaction, not government interference.

----------


## drk

I love you, man, and thanks for serving.

Don't conflate change as progress, either.  Just sayin'.

What's more is that you should not confuse "government interference" with "law and order".

----------


## Jarhead Daddy

> I love you, man, and thanks for serving.
> 
> Don't conflate change as progress, either.  Just sayin'.
> 
> What's more is that you should not confuse "government interference" with "law and order".


Well put!  Thank you for serving patients, and I know you do it for more than the money.

----------


## drk

You mean I could be making money doing this?????!!!!!!! :Eek:

----------


## Boldt

We live in a society that can sue over the person being stupid and win. 
I see opticians getting sued for using these "rx's" because they should know better.
 It's not about freedom or "well informed adults". If you're not in this industry you can't be well informed, hell I'm sure we all know of a few "opticians" and "od's" who know jack and squat. We are the experts, we have the training and experience to do this.

----------


## fjpod

> just found out how it's legal
> 
> "Third, in a short "Terms and Conditions" paragraph, individuals are asked to check a box indicating that they understand that this is not a comprehensive eye exam, what a comprehensive eye exam means and how thats different from what Blink provides, and that a comprehensive exam with an optometrist is recommended every two years. This box must be clicked before vision testing may proceed."
> 
> http://www.goblink.co/for-optometrist/


That doesn't make it legal.  

The matter is being studied.  There is the issue of using unlicensed people, not directly under the supervision of a license.  If you operated your store with unlicensed people, and you only stopped in every so often to check on things, you would be disciplined by your state board (assuming you are in a licensed state).  

In addition, separating the refraction from an eye exam...while it is something many here would like to see, it is not specifically authorized in NYS.  

The future is here...

----------


## Paul Smith LDO

What's next, a phone call to Dionne Warwick's; psychic refracting hot line.

----------


## iD

> That doesn't make it legal.  
> 
> The matter is being studied.  There is the issue of using unlicensed people, not directly under the supervision of a license.  If you operated your store with unlicensed people, and you only stopped in every so often to check on things, you would be disciplined by your state board (assuming you are in a licensed state).  
> 
> In addition, separating the refraction from an eye exam...while it is something many here would like to see, it is not specifically authorized in NYS.  
> 
> The future is here...


That paragraph and the patient acknowledging what they are receiving is a basic loop hole that lets blink off the hook. unless the court/government steps in and says that those terms and conditions doesn't relinquish blink of blame/fault. I know some states like California that don't need licenses for opticians if the doctor is licensed or something like that. I'm not too familiar with the language of that.  I think this will quickly change once a few accidents happen (car crashes, falling down stairs, etc) because the blink member didn't do a thorough job.

----------


## iD

> What's next, a phone call to Dionne Warwick's; psychic refracting hot line.


Miss Cleo has all your answers.

----------


## Barry Santini

What is the exact "blame/fault" that is being alluded to here?

B

----------


## Barry Santini

> That doesn't make it legal. 
> In addition, separating the refraction from an eye exam...
> 
> The future is here...


Taking a look at the past, most doctor-opticals have separated the prescription from the eye exam for years. Although most will ask an 'ammetrope' when their last exam was before selling them Sunglasses, they never ask an emmetrope the same before fitting a new pair of Ray Bans.

Go figure.

B

----------


## Tigerclaw

> Well said Barry.  From a patient's perspective (seeking CL after expiration), the OD is extorting them for exorbitant exam fees, especially for those who have had the exact same Rx for the past 5 years, and who are seeing just fine.  From the patient's view, the OD is using the force of law to keep them from taking care of themselves.  
> 
> And we must admit that this is true.  We charge our fees based on supply and demand.  The requirement that only LDOs, MDs, and ODs can prescribe is a barrier to supply (thus increasing the cost).  The requirement that patients possess a current Rx in order to take care of their eyes is an artificial boost to demand (thus increasing the cost).  Patients pay more than what the service is worth because the law requires it.  Anybody who seeks to get around the law can be fined or even jailed.  This is coercion.
> 
> Now don't read me wrong.  I am not saying that ODs are worthless.  I am saying that the system artificially boosts their marketability through well-intentioned, but poorly reasoned, laws.


Ignorance in the truest sense of the word.

----------


## drk

> Taking a look at the past, most doctor-opticals have separated the prescription from the eye exam for years. Although most will ask an 'ammetrope' when their last exam was before selling them Sunglasses, they never ask an emmetrope the same before fitting a new pair of Ray Bans.
> 
> Go figure.
> 
> B


This is going to be hard for you to understand, guys, but I'mma gonna take a crack at it.  You'll learn something that even many ODs haven't thought through.

Statement: You can't "separate" a "refraction" from an "eye exam".

Explanation: An exam has three elements: history, exam, and medical decision making (which also involves patient education and answering questions, etc.)

Stipulation: Let's leave out the standard EXAM aspects of a comprehensive eye exam as defined by CPT: neurological evaluation (EOM, pupils, CVF), tonometry (only as needed, of course) and structure evaluation (usually via SLE and ophthalmoscopy).  Let's leave off every per se "health test".

Contention: You *still* have an exam of some sort when you arrive at a spectacle prescription.

By way of illustration.  Setting: The Old West.

History: 
"Why ya here, Joe?"  
"Need new double bar with double Ds for get-alooong-lil'-doggie duty."
"How you seein' with them old pups?"
"Fair-to-middlin', I reckon."
"Then, let's a-git 'er started."

Exam:
(BRAND SPANKING NEW I-PHONE AUTOREFRACTOR BABY!  NOTHING BUT THE BEST FROM BEST BUY.)
"Now read the chart, Joe."
"I-W-E-A-R-C-H-A-P-S-W-I-T-H-O-U-T-T-R-O-U-S-E-R-S"
"Mighty fine."

Medical decision making:
("Shoot.  Ole Joe ain't a-gonna like that extra buck cyl x 45.  Better cut it down, some, or he'll buck like a cayuse when he puts 'em on!")
"Joe, I'm not changin' yer perscription all that much."
"Why not, doc?"
"Causin' you might get all wobbly like after a Saturday night at the Silver Dollar Saloon.  You said yer seein' pert good already."
"Right. How about them extry-wide bifocals that go all the way across?  And Photograys. And a Durango collection frame."
"High-tail it over to Miss Sally to talk about all that stuff."


Ok.  All the elements of an eye exam are there.  So you can't just refract and go.  

Now, you opticians have given away all services since the beginning of time; that's your business.  But if a service is provided (history, exam, and MDM), there should be a fare.

So, Barry, please...

----------


## Tigerclaw

Yep, if I took his approach why should I hire a trained optician or other experienced stylist/dispenser when all I need is some high school kids to come in and give "good enough" service? Good enough is not good enough.

----------


## Barry Santini

Drk

you know I agree with your viewpoint. But...

Plano is just as valid an "Rx" as -0.25cyl. Yet, all the king horses, etc., will not get a doc to write a Plano Rx.

if they did, then every one of your points would become crystal clear for all.

B

----------


## ml43

> Ml43, I simply disagree with your premise.  True, the US is overpriced.  But that is due to failed government regulation.  Thus, healthcare tourism.  As far as quality and advanced procedures, the US is top notch (if you can pay for it).
> 
> Dr. K, you are confusing status with progress.  True, India is third world.  But that is not the point.  India is using new technology to make progress.  The US has been top dog for a long time, but we should not rest in our status.  We must continue to make progress.  That means embracing new technologies without the stultification (love that word!) of overbearing government.


There is no current U.S. government regulation on the price of medical services, hence why things are the way they are in the U.S.

The U.S. also does not subsidize medical students.  So in the U.S., graduate healthcare students incur huge amounts of debt.

The U.S. also makes it so the patient can sue anyone who touches them, should they think something went wrong.
The doctors and hospitals pay for this.


If your answer to progressing the medical field in the U.S. is to use technology and untrained/unskilled individuals to deliver this service, 
then I'm afraid we highly disagree on your definition of progress, as that would be a huge regression, IMO.

It's the equivalent of corporations using out of state/country call centers to handle much of their day to day services.
Do more people get helped? Yes
Is the service better? No

----------


## drk

> Drk
> 
> you know I agree with your viewpoint. But...
> 
> Plano is just as valid an "Rx" as -0.25cyl. Yet, all the king horses, etc., will not get a doc to write a Plano Rx.
> 
> if they did, then every one of your points would become crystal clear for all.
> 
> B


You're a sophist.  

A plano lens has no therapeutic ability with regards to refractive error.

And light filters do not need an Rx, nor a license to write one.

Nor do you need a prescription to tell your patient "cut back on the ding dongs, get some exercise, and fer heaven's sake lay off the vodka."

Prescribing authority is for potentially harmful ergo controlled treatments.

----------


## wmcdonald

> Yep, if I took his approach why should I hire a trained optician or other experienced stylist/dispenser when all I need is some high school kids to come in and give "good enough" service? Good enough is not good enough.


Most ODs do not hire anyone trained, and pay the lowest salaries in the industry......as reported by most salary surveys historically. Read the local want ads.......no experience necessary, will train. And even worse, they often leave the office and allow these "trained" folks to dispense eyewear to the public. It should be illegal. So do not sit on any high horse when it comes to ODs and their relationship with Opticians. You have done all you can do for as long as I have been involved in this industry to hold Opticians back. Now I understand your point quite well, but do not get on this board and talk about how ODs show benevolence to us poor Opticians.......it just isn't so!

----------


## wmcdonald

> There is no current U.S. government regulation on the price of medical services, hence why things are the way they are in the U.S.
> 
> The U.S. also does not subsidize medical students.  So in the U.S., graduate healthcare students incur huge amounts of debt.
> 
> The U.S. also makes it so the patient can sue anyone who touches them, should they think something went wrong.
> The doctors and hospitals pay for this.
> 
> 
> If your answer to progressing the medical field in the U.S. is to use technology and untrained/unskilled individuals to deliver this service, 
> ...


Sorry, but the US spends billions annually subsidizing medical and allied health professionals. If one were to serve in underserved areas, this costly education can be completely free! If you really want to know the truth about liability issues, do some research on the number of people who ever gain from suing a medical professional. You will be surprised,, and the number of people who sue ODs is miniscule compared to the number of patients seen. All this malarkey is about dollars and cents. Who has control. It is not about who gives the best "service"......whatever that means. Can this kind of technology be employed and used effectively, and at a much lower cost? We do not know, because there has been no study on its efficacy. I suspect the OD political machine will do all it can to see that there is none, as they did with Opticians. The constant barrage of articles and comments regarding all of the dangers of allowing the lesser-trained Optician to refract was very effective, and remains so in this thread. No study on how it could be accomplished, just all of the negative comments on why it should not. But now we have major corporate heads with astronomical funding Opticians do not have wanting to provide a similar service via technology. Lets see what happens. If it works well, why not.

----------


## drk

> Most ODs do not hire anyone trained, and pay the lowest salaries in the industry......as reported by most salary surveys historically. Read the local want ads.......no experience necessary, will train. And even worse, they often leave the office and allow these "trained" folks to dispense eyewear to the public. It should be illegal. So do not sit on any high horse when it comes to ODs and their relationship with Opticians. You have done all you can do for as long as I have been involved in this industry to hold Opticians back. Now I understand your point quite well, but do not get on this board and talk about how ODs show benevolence to us poor Opticians.......it just isn't so!


1. Most ODs don't hire anyone trained?  You'd better back that up, buddy.
2. If they do hire someone untrained, they train them.  How is it bad to receive an "apprenticeship" for pay?  You want schools but there aren't any/many for us to choose from.
3. We may pay less than chains, but they have to pay higher wages because it devours your soul.  What other "industry" positions are paying "higher than ODs"?
4. "Often leave their offices and leave untrained staff dispensing".  You'd better back up that libel, too, Mr. I-Hate-Optometry-So-I'm-Going-On-A-Public-Forum-And-Throw-Bombs-Not-Caring-One-Whit-About-What-Damage-I-Do-To-Patients-Who-May-Read-This-And-Question-The-Care-They-Get.  So professional.  So professional.
5. I've only been doing this 25 years, and maybe you've been doing this 50, but you're fighting a 1960-70's battle against optometry.  We used to have old Chip Anderson on this board, and he was a great guy but he was a dinosaur like you who had nothing but an axe to grind against optometry.

 Look, as I see it, commercialism leveled opticianry, not professionalism.  Optometry isn't "the massa that kept you on the plantation" for a heck of a looonng time.  The modern era started when you got your lunch money stolen by Lenscrafters and other superopticals in the '80s and it continues today with vision care plans and monsters like Essilor.  That's sad for all of us.

----------


## drk

> I suspect the OD political machine will do all it can to see that there is none, as they did with Opticians. The constant barrage of articles and comments regarding all of the dangers of allowing the lesser-trained Optician to refract was very effective, and remains so in this thread. No study on how it could be accomplished, just all of the negative comments on why it should not. But now we have major corporate heads with astronomical funding Opticians do not have wanting to provide a similar service via technology. Lets see what happens. If it works well, why not.


I sincerely hope that our "political machine" gets it's head out of it's @$$ and does lobby to protect quality eye health care in America.  No need to personalize it.

I get it with some of you: you think this autorefracting phone crap or autorefracting computer crap will allow patients to self-refract and you'll make a bundle.  But you won't.  

We've had autorefractors for, like, thirty years.  They're tools in the hand of a professional AND NO PROFESSIONALS PRESCRIBE OFF OF THEM!  WHAT DOES THAT TELL YOU?  Just because there is some cheap and available autorefraction technology coming, that doesn't mean:
1. That it's going to be good.
2. That it's going to release the floodgates of pent up refraction demand, held back by that pesky, evil optometry/government complex.
3. That you're going to be able to prescribe and be this super-new independent profession.
4. That you're going to make all this new money selling all these glasses.

Get real.  It just means that there's more crap to wade through.  Crap online glasses.  Crap online refractions to go with them.

----------


## Tigerclaw

> I sincerely hope that our "political machine" gets it's head out of it's @$$ and does lobby to protect quality eye health care in America.  No need to personalize it.
> 
> I get it with some of you: you think this autorefracting phone crap or autorefracting computer crap will allow patients to self-refract and you'll make a bundle.  But you won't.  
> 
> We've had autorefractors for, like, thirty years.  They're tools in the hand of a professional AND NO PROFESSIONALS PRESCRIBE OFF OF THEM!  WHAT DOES THAT TELL YOU?  Just because there is some cheap and available autorefraction technology coming, that doesn't mean:
> 1. That it's going to be good.
> 2. That it's going to release the floodgates of pent up refraction demand, held back by that pesky, evil optometry/government complex.
> 3. That you're going to be able to prescribe and be this super-new independent profession.
> 4. That you're going to make all this new money selling all these glasses.
> ...


Exactly. Anyone who uses that poor quality refraction for glasses is going to get their glasses online, probably from China.

----------


## Tigerclaw

> Most ODs do not hire anyone trained, and pay the lowest salaries in the industry......as reported by most salary surveys historically. Read the local want ads.......no experience necessary, will train. And even worse, they often leave the office and allow these "trained" folks to dispense eyewear to the public. It should be illegal. So do not sit on any high horse when it comes to ODs and their relationship with Opticians. You have done all you can do for as long as I have been involved in this industry to hold Opticians back. Now I understand your point quite well, but do not get on this board and talk about how ODs show benevolence to us poor Opticians.......it just isn't so!


Somebody hired you, right? Are you as cheap as a fresh-off-the-street employee? My point was you get what you pay for, not that all OD's understand this concept when it comes to hiring staff. There is always someone willing to work more cheaply than you are as an optician, and the same applies to me. Cheap refractions are worse than a cheap measurement in the vast majority of cases, which means the OD's job is more crucial than the optician's (no offense, that's just the facts). If the OD's importance can be minimized then you can be darn sure yours will be, and in case you haven't noticed, it already has been. This does NOBODY any good except the few lucky idiots who get their glasses online that actually DO fit correctly and the corporate hacks who profit from it - you know, the  same guys you seem to be cheering on. You will cut off your nose to spite your face.

----------


## wmcdonald

> 1. Most ODs don't hire anyone trained?  You'd better back that up, buddy.
> 2. If they do hire someone untrained, they train them.  How is it bad to receive an "apprenticeship" for pay?  You want schools but there aren't any/many for us to choose from.
> 3. We may pay less than chains, but they have to pay higher wages because it devours your soul.  What other "industry" positions are paying "higher than ODs"?
> 4. "Often leave their offices and leave untrained staff dispensing".  You'd better back up that libel, too, Mr. I-Hate-Optometry-So-I'm-Going-On-A-Public-Forum-And-Throw-Bombs-Not-Caring-One-Whit-About-What-Damage-I-Do-To-Patients-Who-May-Read-This-And-Question-The-Care-They-Get.  So professional.  So professional.
> 5. I've only been doing this 25 years, and maybe you've been doing this 50, but you're fighting a 1960-70's battle against optometry.  We used to have old Chip Anderson on this board, and he was a great guy but he was a dinosaur like you who had nothing but an axe to grind against optometry.
> 
>  Look, as I see it, commercialism leveled opticianry, not professionalism.  Optometry isn't "the massa that kept you on the plantation" for a heck of a looonng time.  The modern era started when you got your lunch money stolen by Lenscrafters and other superopticals in the '80s and it continues today with vision care plans and monsters like Essilor.  That's sad for all of us.


I think you read me wrong. I certainly do not hate ODs, and in fact many of my best friends are ODs, but it is common practice in most states for ODs to leave their offices with no licensed person on duty. It is called delegation. Read the NAO and other salary studies, and it is clear who pays less and it is private OD offices. The same is true for OD associates......they pay less than other places. Nothing wrong at all with apprenticeships, but they are not "trained" people. They are people in training and the very nature of apprenticeship is direct supervision. 

Now to your tone......it does not have any affect on me to be called a dinosaur! I am harder on Opticians than and our purported "leadership" than anyone, and I do not see ODs as the enemy. But as one who has sat in legislative hearing after hearing and heard ODs limit our ability to advance, which is common knowledge, I do not see a need to argue the point. It is inter-professional turf, and I understand it completely. They are not the only ones......Opticians have been their own worse enemies, and I am well known for saying so here and in lectures across the nation and publications......so if you wish to discuss fine but do not think you will find I am an enemy to Optometry at all. When I was still lecturing I spoke at many OD and MD meetings, and addresses similar issues. 

Now relax......I am not your enemy. I responded to Tigerclaw who asked a specific question related to the hiring of trained people. Do some research, and you will find I am correct in my assertion. Commercialism has been a real issue, and one we agree on, but it affected ODs differently. You all had the foresight to develop a solid education and licensure process back in the 40s, while we continue to wonder what happened.

----------


## wmcdonald

> I sincerely hope that our "political machine" gets it's head out of it's @$$ and does lobby to protect quality eye health care in America.  No need to personalize it.
> 
> I get it with some of you: you think this autorefracting phone crap or autorefracting computer crap will allow patients to self-refract and you'll make a bundle.  But you won't.  
> 
> We've had autorefractors for, like, thirty years.  They're tools in the hand of a professional AND NO PROFESSIONALS PRESCRIBE OFF OF THEM!  WHAT DOES THAT TELL YOU?  Just because there is some cheap and available autorefraction technology coming, that doesn't mean:
> 1. That it's going to be good.
> 2. That it's going to release the floodgates of pent up refraction demand, held back by that pesky, evil optometry/government complex.
> 3. That you're going to be able to prescribe and be this super-new independent profession.
> 4. That you're going to make all this new money selling all these glasses.
> ...


Lets see what the research says once it is around for a while. MDs used to say (and some still do) that you folks should not be doing "medicine." Time will tell what uses we can find for such technology.

----------


## wmcdonald

> Somebody hired you, right? Are you as cheap as a fresh-off-the-street employee? My point was you get what you pay for, not that all OD's understand this concept when it comes to hiring staff. There is always someone willing to work more cheaply than you are as an optician, and the same applies to me. Cheap refractions are worse than a cheap measurement in the vast majority of cases, which means the OD's job is more crucial than the optician's (no offense, that's just the facts). If the OD's importance can be minimized then you can be darn sure yours will be, and in case you haven't noticed, it already has been. This does NOBODY any good except the few lucky idiots who get their glasses online that actually DO fit correctly and the corporate hacks who profit from it - you know, the  same guys you seem to be cheering on. You will cut off your nose to spite your face.


Fine, but your initial comment, which started this ongoing conversation from my perspective, asked about why you should hire trained people. Typically ODs do not, and salary survey after salary survey support my assertion. I am not against you here, but you also need to know ODs are historically lower paying than every other area, and the same is true for new OD associates.

----------


## Barry Santini

> You're a sophist.  
> 
> A plano lens has no therapeutic ability with regards to refractive error.
> 
> And light filters do not need an Rx, nor a license to write one.
> 
> Nor do you need a prescription to tell your patient "cut back on the ding dongs, get some exercise, and fer heaven's sake lay off the vodka."
> 
> Prescribing authority is for potentially harmful ergo controlled treatments.


Not at all. Do NOT tell me that mild ametropia...say up to 0.50D SPH and/or Cyl, is NOT routinely "prescribed", i.e., "your eyes are fine...healthy."

Yet I chase my tale with suns that "impact their vision."

BULL****!

You are refracting them...And collecting a co-pay for such. Everyone deserves their findings.

If we did the optical thing in general medicine, then when someone's "numbers" were normal, we simply wouldn't tell them.

B

----------


## Tigerclaw

If we did the same thing in general medicine we would hand them a blank prescription sheet. Besides, there's lots of normal findings we don't explicitly mention. If the issue is whether or not vision plans will cover plano sunglasses, take it up with the vision insurance or even medical (since they'd be footing the bill for surgeries or chronic disease treatment).

----------


## Robert Martellaro

> Do NOT tell me that mild ametropia...say up to 0.50D SPH and/or Cyl, is NOT routinely "prescribed", i.e., "your eyes are fine...healthy."


The surgeons in my area routinely send their patients to the local pharmacy to obtain OTC readers, declaring that their cataract surgery was so successful that they'll never need eyeglasses for distance again, and that OTCs are all that they'll ever need.  It's not uncommon to see ± .50 to .75 sphere equivalents, and/or cyls over .75. I don't know what their thinking, probably a combination of a God complex and ignorance.

----------


## drk

> Fine, but your initial comment, which started this ongoing conversation from my perspective, asked about why you should hire trained people. Typically ODs do not, and salary survey after salary survey support my assertion. I am not against you here, but you also need to know ODs are historically lower paying than every other area, and the same is true for new OD associates.


If you look up what an average OD makes via the BLS instead of the "B.S" that the AOA puts out, you'll see very few ODs are getting rich. What you'll see is, perhaps, inefficient staff-heavy practices that may slice the pie too thinly, but there just ain't that much to go around, Dr. Mac. 

I literally get $40-$60 per exam with VCPs. I won't have to discuss margins on optical goods and services or contact lenses. 

Who's driving these prices low? You know it: VCPs. (Don't let someone like Racethe1320 blow sunshine up your backside.) Next it will be online DIY.

Now, how much can anyone afford to pay an optician with dispensing fees through the floor? Look up the BLS data on opticianry, again. It ain't pretty. 

The only way to make money in opticianry is to own an optical or three or to move up the corporate ladder at Luxottica. It is what it is.

----------


## drk

> Not at all. Do NOT tell me that mild ametropia...say up to 0.50D SPH and/or Cyl, is NOT routinely "prescribed", i.e., "your eyes are fine...healthy."
> 
> Yet I chase my tale with suns that "impact their vision."
> 
> BULL****!
> 
> You are refracting them...And collecting a co-pay for such. Everyone deserves their findings.
> 
> If we did the optical thing in general medicine, then when someone's "numbers" were normal, we simply wouldn't tell them.
> ...


You do not get it. 

A. I'm not a refracting machine. I'm a problem solver.
B. Everything is complaint-driven. No complaint, no treatment. 
C. That's what doctors do for their daily bread.

If someone is in for a routine exam without symptoms and I find a low refractive error, we'll discuss the findings but let the symptoms dictate the treatment. A prescription is a treatment plan for a problem.

And of course if they want the medical records they're theirs to take in any event.

There's no "findings release". You don't ask your OD to "write down my C/D ratio" or your PCP to "write down my BP measurement". You don't ask your PCP "Hey, will you prescribe an antihypertensive even though I have borderline HTN?" Likewise, you don't ask your OD "Well, I know I'm seeing just fine, but will you prescribe glasses for me, just so I can have a written prescription on hand?" That's nonsense.

(You really don't know the difference between a finding and a treatment plan and what a prescription's for?)

----------


## Tigerclaw

I joined this board to find out things from experienced opticians and other similar positions because I trust many of them to know what they are doing from the real world perspective besides the training I received in optometry school in their work. It would be nice if they would similarly understand that most of them have no idea what we do and why. We should learn from each other, not presume that they know more about our job than we know of theirs.

----------


## drk

> The surgeons in my area routinely send their patients to the local pharmacy to obtain OTC readers, declaring that their cataract surgery was so successful that they'll never need eyeglasses for distance again, and that OTCs are all that they'll ever need. It's not uncommon to see ± .50 to .75 sphere equivalents, and/or cyls over .75. I don't know what their thinking, probably a combination of a God complex and ignorance.


It's simply expectation management.  

What we're seeing today is OMDs selling upgrades on IOLs, refractive procedures during cataract surgery, and now even laser-assisted paracentesis, incisions, capsulorrhexis, and phacofragmentation.

1. Medicare don't pay what they used to.
2. Shiny new toys
3. More shiny new toys
4. More shiny new toys.

In order to get out-of-pocket contribution of several thousand samolians, they have to sell something.  Now, are you going to tell Mr. Senior that you're off a half-diopter and he's 20/25 so he needs distance Rx, or are you going to watch his face when he reads the eye chart and see who blinks first?

----------


## drk

> I joined this board to find out things from experienced opticians and other similar positions because I trust many of them to know what they are doing from the real world perspective besides the training I received in optometry school in their work. It would be nice if they would similarly understand that most of them have no idea what we do and why. We should learn from each other, not presume that they know more about our job than we know of theirs.


Don't worry, Tigerclaw.  This is an in-family feud here.  All is good.  You'll see.

----------


## Paul Smith LDO

I would not take an Rx generated by, goblink.  The reality is that most of us would not see their Rx's, as most people utilizing these services will be purchasing on line.  Many of us will end up seeing the net result, when these people are forced to the B&M because they can't see thru their new glasses.  If you haven't had enough of WP, this may be the breaking point.

----------


## Barry Santini

I would, and am used to, taking all sorts of Rxs.  Meh. Nobody's perfect. If my Rx redo rate stays below 10-12%, I think that's the best you can expect.

Ever.

B

----------


## Robert Martellaro

> It's simply expectation management.  
> 
> What we're seeing today is OMDs selling upgrades on IOLs, refractive procedures during cataract surgery, and now even laser-assisted paracentesis, incisions, capsulorrhexis, and phacofragmentation.
> 
> 1. Medicare don't pay what they used to.
> 2. Shiny new toys
> 3. More shiny new toys
> 4. More shiny new toys.
> 
> In order to get out-of-pocket contribution of several thousand samolians, they have to sell something.  Now, are you going to tell Mr. Senior that you're off a half-diopter and he's 20/25 so he needs distance Rx, or are you going to watch his face when he reads the eye chart and see who blinks first?


Yeah, there's no  money in refractive error, except when there is. 

Maybe that's being overly cynical; the eye surgeons in my area are very conservative- they don't recommend the riskier procedures, and I compliment them for that. But they really don't pay very close attention to how well people see. I guess that's how it should be- MDs cut, ODs manage and prescribe, and opticians sort it out optically.

----------


## Jarhead Daddy

> Well said Barry. From a patient's perspective (seeking CL after expiration), the OD is extorting them for exorbitant exam fees, especially for those who have had the exact same Rx for the past 5 years, and who are seeing just fine. From the patient's view, the OD is using the force of law to keep them from taking care of themselves. 
> 
> And we must admit that this is true. We charge our fees based on supply and demand. The requirement that only LDOs, MDs, and ODs can prescribe is a barrier to supply (thus increasing the cost). The requirement that patients possess a current Rx in order to take care of their eyes is an artificial boost to demand (thus increasing the cost). Patients pay more than what the service is worth because the law requires it. Anybody who seeks to get around the law can be fined or even jailed. This is coercion.
> 
> Now don't read me wrong. I am not saying that ODs are worthless. I am saying that the system artificially boosts their marketability through well-intentioned, but poorly reasoned, laws.





> Ignorance in the truest sense of the word.


Tigerclaw, if you disagree, tell me why so I can be relieved of my ignorance.  How is it that artificially increasing demand does not raise prices?  From the patient's perspective, how is this not a legal form of extortion?

Also, just to clarify what I am saying, I am a licensed optician, work for a licensed Optometrist, and have a lab manager who is also a licensed optician with an Associate's degree in ophthalmic dispensing.  I highly value these professions.  I just don't think that, in a free society, government should require free people to go through an Optometrist or Optician in order to purchase contact lenses or eyeglasses.

I am skeptical that the Blink system will work for most patients.  If I were to receive a Blink Rx, I may require the patient to sign a waiver stating that our 60 day Rx sat guarantee does not apply to non-O.D./M.D. Rx's.  But this should be the patient's choice, not the government's.

----------


## Tigerclaw

> Don't worry, Tigerclaw.  This is an in-family feud here.  All is good.  You'll see.





> Tigerclaw, if you disagree, tell me why so I can be relieved of my ignorance.  How is it that artificially increasing demand does not raise prices?  From the patient's perspective, how is this not a legal form of extortion?
> 
> Also, just to clarify what I am saying, I am a licensed optician, work for a licensed Optometrist, and have a lab manager who is also a licensed optician with an Associate's degree in ophthalmic dispensing.  I highly value these professions.  I just don't think that, in a free society, government should require free people to go through an Optometrist or Optician in order to purchase contact lenses or eyeglasses.
> 
> I am skeptical that the Blink system will work for most patients.  If I were to receive a Blink Rx, I may require the patient to sign a waiver stating that our 60 day Rx sat guarantee does not apply to non-O.D./M.D. Rx's.  But this should be the patient's choice, not the government's.


Seeing as how you agreed with the patient's perspective, let's omit that qualification from the beginning. You agree that A. we charge exorbitant fees, B. that patients know what their prescription is and how well they are seeing, and C. the implication that we are using "coercion" and "the force of law" to drive up demand. 
A. Our fees are rarely, if ever, "exorbitant". Some doctors charge less for a full exam than I pay my specialist as a co-pay. Your perceived value of an eye exam is where you get this opinion from, which tells me you really don't know what you are talking about. Eye exams are one of the best values from a provider in all of health care. 
B. Do you know how many times I have changed patients' prescriptions from what it had been for years? Patients don't know they are losing vision half the time any more than a glaucoma patient is aware that their peripheral view has decreased 3 degrees in one eye over the course of a year.
C. Yes, yes, I hear all kinds of this rhetoric from people who woke up one day and decided to get into politics because libertarian ideals were simplistic enough for them to digest and instantly became the smartest guys in any room they entered, at least from their own perspective. Do you think the FDA should be able to prevent stores from selling horse meat as beef? Do you think medication should be enforced by government to be at the advertised dosing? We don't give people carte blanche to do whatever they want to themselves in wisely limited categories, and anyone who knows anything about the eyes knows that you can cause harm with poorly fitting and poorly prescribed eyeglasses and contacts. The fitting and power determination are not available knowledge to people without special training, which is why people get LICENSES. You get a license to drive a car, you get a license to sell meat (I guess you consider this is artificially driving up the price of beef, since you can't mix in some horse meat to extend it), you get a license to sell medicine (artificially driving up the cost of medicine, I suppose, since you actually have to put in all 1000mg of the drug). Licenses aren't an issue of freedom. They are an issue of safety. For all the freedom I have to prescribe any kind of lens under the sun, I also have penalties not available to the general public: I must renew my licenses, renew my DEA, attend CE, maintain records, etc. You can extend the "artificially increasing demand" argument until we all end up in the unemployment line. It is a weak argument and quite dishonestly values the burden of a few bucks annually over the potential life-saving services we offer.

----------


## Jarhead Daddy

> Seeing as how you agreed with the patient's perspective, let's omit that qualification from the beginning. You agree that A. we charge exorbitant fees,


  I do not say that our fees are exorbitant.  They are market rate, but the market is artificially inflated. 


> B. that patients know what their prescription is and how well they are seeing,


Clinically, patients do not know what their Rx is and if a new Rx, cataract surgery, other procedure might improve their VA.  However,  most sense when they are, and when they are not seeing well.  Isn't that why you see many of your patients?  You ask for chief complaint, and they say, "I just don't think I am seeing as well as when I first got these glasses." 


> and C. the implication that we are using "coercion" and "the force of law" to drive up demand.


 The law bars people from acquiring contact lenses without a current Rx from an Optometrist, MD, or LDO (in some states).  Thus, the patient is coerced by force of law to pay for an exam if they need contact lenses.  This creates artificial demand (demand that would not be there apart from the law).  Because of this artificial demand, prices are higher.



> A. Our fees are rarely, if ever, "exorbitant". Some doctors charge less for a full exam than I pay my specialist as a co-pay. Your perceived value of an eye exam is where you get this opinion from, which tells me you really don't know what you are talking about. Eye exams are one of the best values from a provider in all of health care.


  Our fees are based on market rates, but the market is inflated due to coercive laws.  I hold a high value for regular eye examinations, and I am a licensed professional who runs an optometric practice.  Your disdain for me is misplaced.  An argument for liberty is not an argument against the value of professional eyecare.  I think you unnecessarily conflate the two.



> B. Do you know how many times I have changed patients' prescriptions from what it had been for years? Patients don't know they are losing vision half the time any more than a glaucoma patient is aware that their peripheral view has decreased 3 degrees in one eye over the course of a year.


I am intimately involved in similar situations on a daily basis, and I promote regular eye examinations by a qualified Optometrist.



> C. Yes, yes, I hear all kinds of this rhetoric from people who woke up one day and decided to get into politics because libertarian ideals were simplistic enough for them to digest and instantly became the smartest guys in any room they entered, at least from their own perspective. Do you think the FDA should be able to prevent stores from selling horse meat as beef?


This is an example of false advertising.  That if fraud.  Governments should protect citizens from fraud.


> Do you think medication should be enforced by government to be at the advertised dosing?


This is another example of false advertising.  It is exactly what governments are to protect us from. 


> We don't give people carte blanche to do whatever they want to themselves in wisely limited categories,


I think this is the real source of our disagreement. 


> and anyone who knows anything about the eyes knows that you can cause harm with poorly fitting and poorly prescribed eyeglasses and contacts.


  I am in absolute agreement with you here.  That is why I work with a highly qualified Optometrist, and our lab is run by a highly-qualified Optician. 


> The fitting and power determination are not available knowledge to people without special training, which is why people get LICENSES.


I think the big heartache with Blink is that some machines are beginning to encroach into this territory.  Do I think Blink will serve most patients well? No.  But do I think it will blind them or get them killed? No.  Do I think that machines may someday perform a large portion of our functions?  You bet.  That would be great progress, and government should not stand in the way. 


> You get a license to drive a car, you get a license to sell meat (I guess you consider this is artificially driving up the price of beef, since you can't mix in some horse meat to extend it), you get a license to sell medicine (artificially driving up the cost of medicine, I suppose, since you actually have to put in all 1000mg of the drug).


Again, you are confusing fraud and licensure.  Licensure does not have much to do with false advertising.  It is a validation of one's professionalism by the state, and a ban on others practicing in that field. 


> Licenses aren't an issue of freedom. They are an issue of safety.


There has always been a tension between freedom and safety.  It is precicely this that we are discussing, and it is highly relevant to our field.


> For all the freedom I have to prescribe any kind of lens under the sun, I also have penalties not available to the general public: I must renew my licenses, renew my DEA, attend CE, maintain records, etc. You can extend the "artificially increasing demand" argument until we all end up in the unemployment line.


I think you just tipped your hand.  Labor has always feared advancements in technology.  Robots replace welders.  Computers replace secretaries.  There is always a pushback.  But overall, quality of life keeps getting better, and people adjust to meet the demands of an ever-changing market.  I don't think that a hand-held, patient-operated refractor will ever take the place of a qualified Optometrist.  But it may make him more efficient, and it may reduce the cost per patient.  We should not fear this.


> It is a weak argument and quite dishonestly values the burden of a few bucks annually over the potential life-saving services we offer.


This is the argument of every special interest seeking for the government to help them "advance their profession".  Great argument when you are receiving the extra few bucks.  Poor argument when you are paying them.

I completely agree with you that a refraction is not an exam, and that a patient-held lens-flipper is not even a refraction.  But let's not go crying to Uncle Sam (or the NY Board of Optometry) about the new kid on the block.  Let's see what he has to offer, use what we can, and reject what is counterproductive.  The market will reward the best ideas, and the world will continue to be a better place.

----------


## ml43

> I do not say that our fees are exorbitant.  They are market rate, but the market is artificially inflated. 
> 
> Clinically, patients do not know what their Rx is and if a new Rx, cataract surgery, other procedure might improve their VA.  However,  most sense when they are, and when they are not seeing well.  Isn't that why you see many of your patients?  You ask for chief complaint, and they say, "I just don't think I am seeing as well as when I first got these glasses."  
> 
> The law bars people from acquiring contact lenses without a current Rx from an Optometrist, MD, or LDO (in some states).  Thus, the patient is coerced by force of law to pay for an exam if they need contact lenses.  This creates artificial demand (demand that would not be there apart from the law).  Because of this artificial demand, prices are higher.
>   Our fees are based on market rates, but the market is inflated due to coercive laws.
> 
> I completely agree with you that a refraction is not an exam, and that a patient-held lens-flipper is not even a refraction.  But let's not go crying to Uncle Sam (or the NY Board of Optometry) about the new kid on the block.  Let's see what he has to offer, use what we can, and reject what is counterproductive.  The market will reward the best ideas, and the world will continue to be a better place.


I implore you to please reread whatever econ book you have.  
I believe you will find that medical services are exempt from supply/demand shifts.

As for patients knowing when their VA has decreased, I will challenge that.  
I would also suggest you ask your optometrist why annual eye exams are so important(not just refractions).

The law protects people from purchasing contacts without an annual exam, as wearing contacts without yearly exams can cause permanent damage to the cornea among other things, like infection. 
Contacts are almost never "needed" 99% of the time, glasses are enough to treat ametropia.


This isn't about crying to anyone, this almost goes against everything practically every medical board stands for.
Protecting the public by ensuring only licensed/trained professionals deal with patient care.

What will they offer next? mobile "examineers" with ipads and webmd apps, and a 2 min facetime with a physician to refill hydrocodone?

edit:
I'd also like to mention that nothing they are doing is anything "innovative" or "revolutionary"
The technology has been around for at least 5-10 years. 
This is pure marketing and clever wording to side step the law.

no different than this situation, except being implemented by optometrists/marketing instead of an optician
http://www.optiboard.com/forums/show...scribe-Glasses

----------


## Tigerclaw

Not going to go line-by-line to refute every point you made, but I will hit the big ones:
I don't fear technology. Just because some labor has feared some technology does not mean all labor fears all technology. I learn from history and see what ridiculous entities are allowed to operate online to the detriment of patients' health. If you have any experience with 1800-CONTACTS you know that they operate out of spite and create burdens specifically designed to reduce verification denials. 
Also, it's not just an issue of fraud, but the very nature of giving out prescriptions or eye wear that are not within acceptable margins of their actual prescription is fraud, the same way putting horse meat into beef is fraud. Sure, they both may or may not actual harm, yet we understand that lack of harm is not a justifiable standard for regulations.  
If you don't agree that our fees are exorbitant, then you may want to edit your post where you say you agree with the patients' perspective, which included our fees being "exorbitant".

Is the world a "better place" with online sales? Of course not. Like I said early on, people don't make the best choices, like when TV dinners and other pre-cooked food came out. Cheap and convenient and now we are suffering from all kinds of maladies related to nutrition and metabolic disorders. There are some areas where the consumer has no business having complete control. Oh you'll say "why not? America and personal freedom and liberty" and I agree in many cases, but you have to exert wisdom and realize that not every single aspect is subject to this standard, especially when the impact is not isolated to the "free" individual. We all pay for people's bad decisions all the time. Why take a wait-and-see approach with things like this? Do you have to touch the stove every time to see if it burns?

----------


## Jarhead Daddy

> I implore you to please reread whatever econ book you have.  
> I believe you will find that medical services are exempt from supply/demand shifts.


Are we exempt from gravity as well?  Just because some textbooks wish a particular industry is exempt does not make it so.




> As for patients knowing when their VA has decreased, I will challenge that.  
> I would also suggest you ask your optometrist why annual eye exams are so important(not just refractions).


  Again, I think you misunderstand what I am saying.  I believe in annual eye exams (not Blink exams).




> The law protects people from purchasing contacts without an annual exam, as wearing contacts without yearly exams can cause permanent damage to the cornea among other things, like infection. 
> Contacts are almost never "needed" 99% of the time, glasses are enough to treat ametropia.


If they are wearing according to instructions, and if they are exercising good hygiene, the threat is very minimal (especially if they have a long history of uneventful wear).  Also, most patients will self-report a problem before it gets out of hand.  I think you are being overly-alarmist here.





> This isn't about crying to anyone, this almost goes against everything practically every medical board stands for.
> Protecting the public by ensuring only licensed/trained professionals deal with patient care.


  It is about control.  Who should control the patient's eyes?  I say the patient, and I would advise (not demand) an annual comprehensive eye exam with a qualified optometrist.




> What will they offer next? mobile "examineers" with ipads and webmd apps, and a 2 min facetime with a physician to refill hydrocodone?


I can't wait to see what they offer next!  It may be a game-changing technology that is more mobile, more efficient, more effective, more economical, etc.  Downside?  It may put a few of us out of business.  But I would gladly seek new work if a system were devised to eliminate the need for eyeglasses and contact lenses in the world.  Go progress!




> edit:
> I'd also like to mention that nothing they are doing is anything "innovative" or "revolutionary"
> The technology has been around for at least 5-10 years. 
> This is pure marketing and clever wording to side step the law.
> 
> no different than this situation, except being implemented by optometrists/marketing instead of an optician
> http://www.optiboard.com/forums/show...scribe-Glasses


Agreed.

----------


## wmcdonald

Jarhead......I know where you are coming from, brother, but patients do not have the background and understanding needed to make some of these decisions. That is why we have ODs and Opticians to write and fill Rxs. My only issue here is that we immediately threw water on this new technology without fully understanding how it might be used.

----------


## Barry Santini

Drk
I would respectfully submit that refractive findings...even plano...are important to write out in tge current age of anywhere fulfillment.

----------


## drk

Could you give me a more concrete example as to why you think so?  Maybe I'll better understand your perspective.

----------


## EyeSore

> Most ODs do not hire anyone trained, and pay the lowest salaries in the industry......as reported by most salary surveys historically. Read the local want ads.......no experience necessary, will train. And even worse, they often leave the office and allow these "trained" folks to dispense eyewear to the public. It should be illegal. So do not sit on any high horse when it comes to ODs and their relationship with Opticians. You have done all you can do for as long as I have been involved in this industry to hold Opticians back. Now I understand your point quite well, but do not get on this board and talk about how ODs show benevolence to us poor Opticians.......it just isn't so!


If you think hiring someone with experience is expensive wait till you hire an amateur.

----------


## Jarhead Daddy

Well said, EyeSore.  BTW, I work for an Optometrist who employs two licensed opticians (even though he does not have to).  He is sending an apprentice through college (Associates in Ophthalmic Dispensing) as well.

----------


## ml43

> Are we exempt from gravity as well?  Just because some textbooks wish a particular industry is exempt does not make it so.
> 
> 
>   It is about control.  Who should control the patient's eyes?  I say the patient, and I would advise (not demand) an annual comprehensive eye exam with a qualified optometrist.
> 
> I can't wait to see what they offer next!  It may be a game-changing technology that is more mobile, more efficient, more effective, more economical, etc.  Downside?  It may put a few of us out of business.  But I would gladly seek new work if a system were devised to eliminate the need for eyeglasses and contact lenses in the world.  Go progress!


if you don't understand economic theory and the rules that govern them then there's no reason in debating over an economic thoery.

there's a lot of complex math that goes into formulating supply/demand curves, and the proof is implicit.  Meaning, if certain given conditions aren't met, then the whole proof falls apart.  This is part of the reason why medical services do not follow supply and demand curves.  Because the given assumptions driving the proof do not hold true for the healthcare/medical services market.  


it's not about control, it's about liability.  
no one is twisting the patients arm to see anyone or buy anything.  

however, would you not agree that an incorrect rx can do just as much harm, if not more harm than no rx at all? 
again, liability.


and again, you and I have quite different definitions of progress.
I see progress as the whole industry moving forward and everyone in that industry more educated and better trained.   

This "technological progress" you seem to believe in would put a lot of skilled workers out of jobs, and the money into a small handful of corporations.   

if that's what you want/believe in, fine.
but don't expect the rest of us to jump into your boat while it sinks and smile the whole way down.

----------


## Barry Santini

> Could you give me a more concrete example as to why you think so?  Maybe I'll better understand your perspective.


Ex: "your eyes are fine. You don't need glasses!"

But the have a small refractive error as noted above.

Try doing the following:

1. Finding a sunglass they can see through, but is dark for glare
2. Fit them with an OTC
3. Fit them with a (Plano?) /reading add bifocal, or worse, progressive
4. Explain why they get headaches after wearing "any" sunglasses rather than none.

List goes on. Ditto for small monocular changes not "prescribed"

b

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## Jarhead Daddy

ML43, I suppose "it's only you and me, and we just disagree."  Peace to you.

----------


## ml43

> ML43, I suppose "it's only you and me, and we just disagree."  Peace to you.


I am fine with different opinions, 

I'm not ok with bad logic and misinformation. 

If you are going to use economic theories to basically call doctors ripoffs and scam artists, please use the right ones.
I will gladly PM you a simple and elegant proof of supply and demand curves.  As long as you understand basic calculus, you'll easily see why they don't apply to healthcare, and that they stand on a poor leg as it is.

----------


## DylanDavis

> Not at all. Do NOT tell me that mild ametropia...say up to 0.50D SPH and/or Cyl, is NOT routinely "prescribed", i.e., "your eyes are fine...healthy."
> 
> Yet I chase my tale with suns that "impact their vision."
> 
> BULL****!
> 
> You are refracting them...And collecting a co-pay for such. Everyone deserves their findings.
> 
> If we did the optical thing in general medicine, then when someone's "numbers" were normal, we simply wouldn't tell them.
> ...


Barry,
Is what you're asking for is, for a lack of a better term, a more comprehensive eye exam? If so, I agree with you. I can't see why new tests couldn't be developed to test the benefits (and necessity) of tints and what not.

Drk, your old west story is wonderful. Thanks for brightening my Saturday up.

----------


## Fatesjoke

Jarhead Daddy, you are exhausting, man. I wish I could assume patient compliance and self education, that would have made the past 14 years of my life so much easier. 

The fact is the VAST majority of patients I have seen (chances are that we have ALL seen) know next to nothing about how their lenses work in the most basic sense. People routinely do not understand how vision quality changes over time and even with annual comprehensive exams they forget the value of sunglasses year to year (and living in AZ the sun is a constant concern). 

People cannot be trusted with their own health, American culture and history proves that to be true. Americans in particular have very little respect for the value of their vision, until it is too late. I've had people select a designer frame with a high price tag over quality lenses and AR countless times. 

Providing Americans a service that equates to McDonalds in regards to eyecare is less "disruptive" and more destructive to the public perception of the importance of quality care.

----------


## Fatesjoke

I wrote an article about EyeNetra and Blink a little while back that can be found here.

The article will be picked up by a national optical blog on the 9th and they have requested I write a follow-up exploring VSP's involvement in the project. I am in communication with a PR person for VSP to get more information and answers from them. I am also in communication with someone at Blink trying to get some sort of meaningful response to my original article.

If anyone feels inclined to read what I have written and comment, I am excited to discuss it.

----------


## Barry Santini

> Barry,
> Is what you're asking for is, for a lack of a better term, a more comprehensive eye exam? If so, I agree with you. I can't see why new tests couldn't be developed to test the benefits (and necessity) of tints and what not.
> 
> Drk, your old west story is wonderful. Thanks for brightening my Saturday up.


No. All I want is to "write" what you find. I'll do the rest. Discretion here is NOT the better part of valor

B

----------


## optical24/7

> I wrote an article about EyeNetra and Blink a little while back that can be found here.
> 
> The article will be picked up by a national optical blog on the 9th and they have requested I write a follow-up exploring VSP's involvement in the project. I am in communication with a PR person for VSP to get more information and answers from them. I am also in communication with someone at Blink trying to get some sort of meaningful response to my original article.
> 
> If anyone feels inclined to read what I have written and comment, I am excited to discuss it.


Interesting read. Interesting that VSP has a minor stake in Blink also. I'm sure panel doc are thrilled by that info.

----------


## Fatesjoke

> Interesting read. Interesting that VSP has a minor stake in Blink also. I'm sure panel doc are thrilled by that info.


Yeah, I've shared the article with a few ODs that I have worked with and while they had heard of Blink none of them had really considered it enough of an issue to look into. Now they are though and giving others a heads up. 

I'm sure the information I get from VSP will be interesting. Blink seems to be ignoring further attempts at clarification.

----------


## fjpod

I understand if you go to the Blink website and try to schedule a visit,  you can't.   You get a message that there are no appointments available at this time.

----------


## drk



----------


## smallworld

My doctor/medical system now offers online physical exams for certain complaints ie: sore back, cold symptoms, ect.  $35 paid by credit card.  Must have web cam or cell phone with video calling.  If the doctor feels you need to be seen in person they send you in to the office and do not collect the $35.  This just started a month ago.  I know this is somewhat unrelated, but it seems the world is changing for everyone, not just OD's.

----------


## drk

The age of bad medicine.  Sheesh.

I have a grocery-store "minute clinic" in the neighborhood.  Amazing how many "corneal abrasions" they see.

----------


## fjpod

> My doctor/medical system now offers online physical exams for certain complaints ie: sore back, cold symptoms, ect.  $35 paid by credit card.  Must have web cam or cell phone with video calling.  If the doctor feels you need to be seen in person they send you in to the office and do not collect the $35.  This just started a month ago.  I know this is somewhat unrelated, but it seems the world is changing for everyone, not just OD's.


At least the patient is being "seen" by the doctor, or licensed PA, etc.

----------


## mervinek

> The age of bad medicine.  Sheesh.
> 
> I have a grocery-store "minute clinic" in the neighborhood.  Amazing how many "corneal abrasions" they see.


 unrelated- but it bothers me to see a "minute clinic" in the grocery store.  How many people have the flu and go into the grocery store to be seen?  Ewwww

----------


## Paul Smith LDO

> unrelated- but it bothers me to see a "minute clinic" in the grocery store.  How many people have the flu and go into the grocery store to be seen?  Ewwww


Adequate medical care.

----------


## smallworld

> At least the patient is being "seen" by the doctor, or licensed PA, etc.


I like to be touched by my doctor.  If I'm spending my hard earned money I wouldn't waste it on a web cam conversation.  My insurance co pay is $45.  I'll spend the extra ten to have the complete exam, and I'm sure I'm not the only person who doesn't want to conduct their healthcare (including eye health care) over Skype.

----------


## Fatesjoke

http://www.dnainfo.com/new-york/2015...e-coming-bronx

SUNY college has the right idea for people unable to make it into the office for eye exams. We need more programs like this to pop up, at least they are addressing one demographic that might otherwise fall for sub-standard care.

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## optical24/7

> I like to be touched by my doctor.....




Fighting.....hard....to not....post response........

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## Paul Smith LDO

> Fighting.....hard....to not....post response........


I feel you.  Is it too soon to throw in a Samantha Fox reference.

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## smallworld

> Fighting.....hard....to not....post response........


Glad I could lighten the mood.  But than I can only speak from a woman's POV when it comes to the physical exam experience.   :Giggle:

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## Dr. Bill Stacy

Apropos to this thread I got an email on my iphone this morning at 6:00 from a patient who said she had this red splotch on her eye, and attached a selfie that showed a beaut of a subconjunctival hemorrhage, wondering what if anything she should do.  

I replied by asking her if there were any discomfort or blur associated.  She said no.  I responded then no, it's a common problem and will clear, maybe in 1 week maybe as long as 2, and it may get brown and/or yellow before completely absorbing.  

Then she re-e-mailed me that well, maybe she was getting a little double vision in that eye.  

So I mailed her back (from my couch, in my jammies) that maybe I should take a look.  Come in any time today between 10 and 7. 


I'm adding here the picture she attached: 




This got me thinking, I should charge for that exchange of info and prof. service.  I don't see anything wrong with it.  It is the coming thing.  

In the end, I may charge her insurance for a virtual exam/consultation by e-mail and if she comes in today, a regular office visit.  

It is, after all, what I did do.

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## Dr. Bill Stacy

One more addendum, she did come in today and it turns out she did have a minor abrasion on that cornea as well as the SC Heme, may or may not be related, but she ALSO has bilateral infiltrates in the lower corneas at the sites of old LASIK incisions.  

sometimes simple stuff gets complicated...

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## Paul Smith LDO

The old saying, no good deed goes unpunished.

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## opticalsource

how do you log in ?

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## KevinAndrew

It appears to be a portable auto refractor and only tests for refractive error. You will probably have one of these gadgets in your store or near a mall food court near you real soon.    https://comparecourierinsurance.co.u...ery-insurance/

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## gaspoweredrobot

The web domain on this site has expired. Surely that's intentional, I'm sure they're doing just fine.

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