A few list items for your consideration:
- Optometrists who fit one contact lens during the initial lens evaluation, but on the follow-up visit (if they even have one) write a prescription for 4 or 5 different contact lenses. If you don’t try them on their eyes, why even bother charging for an exam? Once I changed only the spherical power on a toric lens, and it caused the patient to have ghosting, so we went back to the original trial power and no ghosting. I can’t imagine not doing a trial of for each brand of lens that you want to prescribe when even different powers of the same brand can cause problems.
- Optometrists who don’t dilate anyone, or if they do, they don’t have a BIO. It’s deplorable how many practices I’ve observed without a decent BIO (if they have one). If you don’t dilate, it’s gonna catch up to you. If you dilate, do it right and use a BIO. Go buy a nice BIO. ‘Nuf said.
- Optometrists who give 5 minute eye exams. Everyone knows it’s not possible to give a good eye exam in five minutes, even your patients. A case history takes 5 minutes. If you’re entire basic eye exam takes five minutes, I have no idea what you’re doing, but it’s probably not ethical and/or legal. Step up your exams to 45 minutes (patient time) and do a thorough job. I like to do initial 15 minutes for case Hx, entrance skills, refraction, and IOP. Then let patient’s dilatation activate for 15 minutes, then return for last 15 minutes for eye health evaluation, recommendations, and patient education. Throw in an extra 10-15 minutes if they wear contact lenses.
- Eye doctors who prescribe old material contact lenses. We have PC-hydrogel and silicone hydrogel now-a-days. Wake up and smell your retirement, you old fogy, if you’re not prescribing them as your main lenses. They are much more healthy on the eyes. I think people with corneal neovascularization should sue if their doctor keeps them in plastic hydrogels if silicone hydrogels are available.
- Eye doctors who tell their patients that it’s okay to stretch their contact lenses beyond what is recommended by the manufacturer. I can’t count how many patients were astonished when I told them that all Acuvue lenses are 2 week replacement. They think I’m the liar, when it’s their prior sleazy optometrist who said it’s okay to wear an AV lens for a month. Don’t you realize that what ever you tell your patient regarding disposal frequency, they’ll probably double it?! Do you think you’re doing them a favor? You’re not because I’ve seen the corneal neovascularization, GPC, and the infections to prove that it IS a huge problem.