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Some dude came in today as I was leaving my commercial fill-in job to say he wanted a copy of his toric soft contact lens Rx so he could buy more contacts off the internet. Only one problem…it’s expired…by more than 6 months.

Sure, the doctor that was there before and long since moved away had noted that the Rx should expire in one year. The Dude kept saying, “Utah law says it’s two years.”

Now, I know the national law says one year minimum, so how come Utah law states the following?

the expiration date of the prescription, which shall be two years from the
commencement date, unless documented medical reasons require otherwise.

Could it be that Utah is home to the most widely known Internet reseller and that they have deep pockets for paying off politicians?

So, in the end I gave him a copy of his prescription, including the expiration date which has already passed. I wasn’t about to put my license on the line to extend an expiration without first evaluating the patient for myself. And Dude, do yourself a favor and get an eye exam to make sure the contacts aren’t doing any harm. After all, they are FDA-regulated medical devices. Do people go around to their psychiatrist expecting a refill on their meds without regular consultations to monitor their condition?

When you think about it, a lot could happen within just one year, so I think that’s more than fair to ask for regular contact lens follow up- especially the way I’ve seen individuals abuse their eyes through noncompliance with prescribed wearing time, replacement schedule, and lens care system. The bottom line is that I have the patient’s best eye health in mind, and the internet resellers with all their lobbying power just have their bottom line in mind.

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I’ve filled in at Big Box opticals where the staff tells me that the usual doctor doesn’t charge for follow ups on things like red eyes. Unbelievable. Not only are these doctors leaving money on the table, they’re making the rest of the profession look bad.

How come patients question optometrist fees so much? When they go to their PCP for a check-up on their HTN, do they expect to walk out without paying? Do they expect their PCP to refill their HTN meds indefinitely without a follow up exam?

Eyecare is healthcare, and I resent the insurance companies for making the illusion that it’s something separate (vision insurance vs. medical insurance).

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O2Optix, Renu MoistureLoc, Renu MP recalls and ClearCare shortages. Oh the frustration.

If I had prescribed a patient O2Optix contact lenses and them told them to use Renu solution, that patient would be out-of-luck. The opticals I fill-in at have had problems with patients who came in to order more boxes of O2Optix and were told they would have to be re-fit in another lens since the O2O is unavailable for the several months.

Then, there was the day the recall came out, I had fit a patient in O2O and ordered the lens to be shipped to their house. Two weeks later they called wondering where their lenses are. Oops, sorry. That lens has suddenly become unavailable.

So who gets the brunt of the patient frustration with these recalls? Not the manufacturers. It’s us on the front lines. Thanks a lot, you guys.

Of course, this could help us make the one year supply sale, “Just buy 8 boxes now because you never know if your lens will be recalled, making it unavailable for ordering refills.”

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There seems to be a small percentage of ophthalmologists that are vocal against optometry. This is unfortunate because most ophthalmologists work very well with optometrists and enjoy a fruitful relationship with co-management and referral networks.

But I know of a couple ophthalmologists who actively poison their patients against optometrists, especially their Medicare patients. Sure, when they eventually need cataract surgery, they’ll end up in the OMD’s office. If they get diagnosed with certain forms of AMD, then they’ll need a retinal consult. Otherwise, the O.D.s should manage most everything they see.

There are medical models for this. If you get rectal bleeding, do you automatically go to the proctologist? No, you go to your family practice physician. He’ll tell you either: 1) You just ate way too many nuts last night or 2) You’ve got a serious problem that requires more testing and a proctology consult.

So, optometry is the primary eyecare profession, and OMDs would do well to play nice, or we’ll send our referrals to someone who will.

Anyway, the above cartoon is based on a true story. Many OMDs delegate their refractions to their ophthalmic technician. Sure, if you play the averages, then it’s not going to come back to bite you a lot. You’ll recall that in optometry school, we had multiple courses on how to not only do a refraction, but also how to analyze binocular testing data and adjust the Rx accordingly. It’s important to know what symptoms and signs would lead you to do a binocular testing battery, and I don’t think techs are trained for that.

I once observed an ophthalmologist just off his refractive surgery fellowship and starting a new job. He was getting a lesson from his tech about how to use the phoropter. Seriously, can’t ophthalmology residencies spend some course time on this stuff? Would it kill an OMD to at least do a binocular balance instead of just Rx-ing monocular subjective best VA?

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Seriously, I’ve heard countless times, “The last obstetrician I saw gave me these glasses that…”
Or, “Optometrist…that’s an eye doctor, right?”
It’s hard to believe they aren’t sure. I know in the back of their mind that they are confusing it with an OB.

I think we should make a Greek/Latin course mandatory in High School.

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I’m not positive that solo private practice has an infinite future. It’s getting harder to compete without large volume. I think multi-doctor power practices and chain opticals with buying power are the only ones with a chance of staying in the game 20 years from now. Does anyone want to defend poor, little solo private practice optometry?

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I just got an e-mail invitation to join a Yahoo Group called, and I quote, “optometrysucks.” The body of the e-mail only says:

optometrysucks@yahoo.com has invited you to join the optometrysucks group!

Tell us about your experiences as an optometrist

First of all, I don’t hate optometry, and I definitely don’t think it sucks. Second, I wouldn’t even join a Yahoo Group called “Optometry Rules” or even “Optometry is okay” because I don’t like the closed door approach. That’s why I don’t participate in ODwire.com. I post my thoughts on my blog for everyone to see, not just select people.

Optometry as a profession can provide excellent eye healthcare delivery, and even in private practice, still provides excellent value in healthcare fees. We do much good. We perform all eye-related healthcare except surgery. We are making a difference in people’s lives every day. Today, I just saved a guy from getting LASIK because he’d never heard of Focus Night and Day lenses.

On the flip side, I think students considering optometry school should be more aware of what they can realistically expect for income in different modes of practice. I wish the general public understood our profession better. I wish more M.D.s respected what we do.

Sure, there are challenges in optometry, but it doesn’t suck.

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If you go to a certain contact lens retailer with deep pockets to pay off Utah legislators, you will find the following quote,

The One Year Myth
Some eye care providers tell you that they cannot issue an expiration date of more than one year. This is not true. One year is a minimum, not a maximum. You should discuss your wearing habits and eye health with your eye care provider to determine if you can have a longer prescription length.

Their whole website is information on how to boss an eye doctor around. If they really want to alter standard clinical practice then they should utilize peer reviewed studies instead of trying to turn consumers into ignorant bullies.

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Does anyone care to debate about this? Every time a read something by practice consultants, they invariably sneak a “raise your fees” quote in there somewhere.

I feel the cost of healthcare delivery is so high because of insurance companies. Insurance companies drive providers to set their fees higher than they would normally be because the insurance companies reimburse less than what the fees would normally be- plus they make us wait to get the money IF they decide they’ll pay at all.

Can’t we just cut out the middle man, a.k.a. the insurance companies? Then we can decrease the fee inflation so everyone can save.

And why is there vision insurance in the first place? That’s like getting haircut insurance or oil change insurance. The only ones getting rich are the insurance companies at the expense of both patients and doctors.

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