I’m giving commercial a (little) break

on June 18th, 2005 | Filed under Optoblog

If you’ve been reading this blog at all, then you know I give the whole commercial practice a very hard time. This was shaped from my perception of the only detailed view of commercial practice that I observed: a certain optical confined to a certain state. It was awful- no visual field machine (or any other special testing equipment), a curtain instead of a door, and an exam room the size of a closet. The worst thing were the opticians constantly complaining that the doctor isn’t fast enough (those darn dilated exams. . .). The doctor was there for only one reason: give out glasses prescriptions.

I visited a different chain this last week, and now I am willing to cut some of them some slack. The reason being I visited a doctor who runs 3 stores for a big box retailer. He has a digital non-myd camera and manages tons of eye disease in addition to the Rx-ing of glasses and contact lenses. I can now respect some commercial optometrists because they actually dilate most every adult and look for and treat eye conditions instead of “referring to a specialist” if the optic nerve looks suspicious for glaucoma.

If I was a patient, how would I know if I got the good commercial doc or the lens flipper? Look for the special testing equipment: digital camera, visual field machine, pachymeter. The biggest sign would be dilated exams: lens flippers don’t do them on most every adult and good docs do. Sure, I recognize that not every patient requires dilation every year, but there are some good guidelines published by the American Optometric Association,

“Pharmacologic dilation of the pupil is generally required for thorough evaluation of the ocular media and posterior segment. The results of the initial examination may indicate the appropriate timing for subsequent pupillary dilation.”
-Page 10 of OPTOMETRIC CLINICAL PRACTICE GUIDELINE- COMPREHENSIVE ADULT EYE AND VISION EXAMINATION

The first time the doctor sees you, it’s a good bet that you should get your pupils dilated. An optometrist pressured by the optical department to keep kicking out the glasses prescriptions as fast as possible will tend to dilated less, in my opinion. As a patient, how can you know if the doctor has your best interest in mind if he decides not to dilate? I would look for conflicts of interest. If the doctor is an employee of the optical, then there is an obvious conflict of interest. The chain employee will undoubtably get pressure to keep examination time down (and thus, not dilated as much).

There is another class of chain optometrist who is an “Independent Doctor of Optometry.” This lingo means that the doctor is not an employee but rather leases space adjoining the optical. These doctors have more autonomy, but at the end of the term their lease could not get renewed if they are consistently slow, people don’t like them, or any number of reasons- including no good reason.

This is why I still feel that commercial chains are not good for optometry or patients. Continuity of care is better if one can go to the same doctor year after year. If a patient moves away, (s)he knows where the records can be found. (See my previous post on this issue.) I would encourage all patients to visit the private practice optometrist of their choice. If they go to commercial practices, then “buyer” beware. There are good ones, but patients would have to know what to look for.

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