OD and OMDs should not be allowed to sell eyeglasses

Optometrists and ophthalmologists should not be allowed to sell eyewear in their offices just as we can't sell medications on the premise that it's unethical to sell what you prescribe. Discuss.

Ban derms from selling creams and lotions then too.

Originally Posted by Tippytoe

Optometrists and ophthalmologists should not be allowed to sell eyewear in their offices just as we can't sell medications on the premise that it's unethical to sell what you prescribe. Discuss.

while your at it, you may as well ban any doctor from "selling" any procedures, or tests, also. It is the exact same conflict. I like to think that most docs subscribe to an ethos that avoids such a conflict, so I dont think your topic has any traction.

BTW some docs DO sell medications "on the premises".

Originally Posted by PBEA

BTW some docs DO sell medications "on the premises".

yes, a lot of rural GP doctors do

It has been my impression for the last 20 years that MDs and DOs can not or do not sell Rx medications. At least I've never been to an office that sold Rx meds. They write the Rx and the patient takes it to the pharmacy. This is law? State by state? To keep the docs ethical? I don't know.

Seems to be the same with glasses. Must have been a loophole somewhere along the way. Sure would be easier (on both me and the pt) if I could sell him some Xalatan and Refresh drops as needed.

Seems we should all either sell meds and glasses/CLs or not sell meds and glasses/CL. Makes no sense one over the other.

http://www.kevinmd.com/blog/2011/01/...dications.html

Of course in hindsight, it's all mute. The internet is taking the profit out of both anyway.

Originally Posted by Tippytoe

It has been my impression for the last 20 years that MDs and DOs can not or do not sell Rx medications. At least I've never been to an office that sold Rx meds. They write the Rx and the patient takes it to the pharmacy. This is law? State by state? To keep the docs ethical? I don't know.

Seems to be the same with glasses. Must have been a loophole somewhere along the way. Sure would be easier (on both me and the pt) if I could sell him some Xalatan and Refresh drops as needed.

We have an ENT + ophtho office in town with its own mini-pharmacy - basically the top 15-20 drugs from each specialty.

I think an easy fix, and admittedly this isn't my own idea, would be to give every glasses/contact rx to the patient at the end of the exam. Its much easier to get glasses elsewhere that way as opposed to having to ask for it.

Originally Posted by Tippytoe

Optometrists and ophthalmologists should not be allowed to sell eyewear in their offices just as we can't sell medications on the premise that it's unethical to sell what you prescribe. Discuss.

OD and OMD should not be allowed to sell eyewear, yet retail opticals that hire people with very little training should be able to? This does not make any sense to me. I don't see anything unethical about the doctor selling " a product" if it is recommended to the patient that actually needs it or if the doctor thinks it will help the patient.

On the other hand, if the doctor just prescribes it and tries to force it upon the patient to increase their revenue when they know that that product is useless for the patient, then it becomes unethical.

The doctor can best make the necessary recommendation for the patient based on their visual/health condition and if you know you can provide them with the best product, the patient will be the winner and that's how it should be.

Originally Posted by NYCBlues

OD and OMD should not be allowed to sell eyewear, yet retail opticals that hire people with very little training should be able to? This does not make any sense to me. I don't see anything unethical about the doctor selling " a product" if it is recommended to the patient that actually needs it or if the doctor thinks it will help the patient.

On the other hand, if the doctor just prescribes it and tries to force it upon the patient to increase their revenue when they know that that product is useless for the patient, then it becomes unethical.

The doctor can best make the necessary recommendation for the patient based on their visual/health condition and if you know you can provide them with the best product, the patient will be the winner and that's how it should be.

Not intending to speak for another poster, I think what Tippytoe is getting at is the fact that many, if not all states, say it is illegal for ODs to sell prescription medications to patients. I can think of several states in which that's the case. (In fact, many even restrict free samples given to patients.) It is seemingly odd then, that we can sell all the glasses and CLs that we want since that is analogous to medication for refractive issues. There appears to be a conflict there. I doubt Tippytoe is calling for a grass-roots effort to ban optical sales in MD and OD offices, particularly in light of the fact that he owns his own office.

In my mind, the difference between the two is that medications, philosophically at least, are not intended to provide the doctor with profit; only to implement his/her treatment plan. Optical sales, on the other hand, is undoubtedly a profit stream, although with all of the changes going on, that's changing too.

Originally Posted by NYCBlues

OD and OMD should not be allowed to sell eyewear, yet retail opticals that hire people with very little training should be able to? This does not make any sense to me. I don't see anything unethical about the doctor selling " a product" if it is recommended to the patient that actually needs it or if the doctor thinks it will help the patient.

Easy. Opticianary would become an associate's degree. We would quit fighting them every step of the way to allow them to become licensed (some states are/some aren't now) and we would be reasonably sure of competent dispensing.

I'm not against eye docs selling eyewear. Just wonder how it came to be that we do that and not the meds we prescribe. What's the difference between one and the other. That's all.

I do know that MDs thought it highly unethical to sell anything but their services for most of the 20th century. It was even unethical (and maybe illegal?) for MDs and ODs to even advertise. Somewhere along the way, it because much less unethical and most every OMDs started selling glasses after cataract surgery fees were cut and now full page color yellow page ads are the norm.

So as with most things.........ethics are closely tied to money. When in doubt, follow the money trail. It'll lead you to the truth every time.

Originally Posted by Jason K

Optical sales, on the other hand, is undoubtedly a profit stream, although with all of the changes going on, that's changing too.

Originally Posted by Tippytoe

So as with most things.........ethics are closely tied to money. When in doubt, follow the money trail. It'll lead you to the truth every time.

The selling of glasses by doctors should have never been. It probably started off fine, and then went downhill unethical after that. I've filled in at many different settings and see just how needy & greedy doctors and staff have become. After examining a presbyope with a simple +1.00 OU Rx, the doctor and staff all are disgruntled by the fact that the patient simply wants readers. No fancy free-form PAL, no AR/transition/clip-on's etc. Just readers.

Or the patient who's glasses Rx changed by a 0.25 and simply is fine with their current pair.

Unfortunately, at this point in time, the largest portion of the majority of private practice ODs income is based on the sale of glasses. Take away the sales of glasses and almost 95% of private practices would shutter. IMHO, this should have never been allowed. We should be making the majority of our income based on service, not product. Sadly this is not the case for ODs and will unlikely never return back to a service based profession.

Originally Posted by Meibomian SxN

The selling of glasses by doctors should have never been. It probably started off fine, and then went downhill unethical after that. I've filled in at many different settings and see just how needy & greedy doctors and staff have become. After examining a presbyope with a simple +1.00 OU Rx, the doctor and staff all are disgruntled by the fact that the patient simply wants readers. No fancy free-form PAL, no AR/transition/clip-on's etc. Just readers.

Or the patient who's glasses Rx changed by a 0.25 and simply is fine with their current pair.

Unfortunately, at this point in time, the largest portion of the majority of private practice ODs income is based on the sale of glasses. Take away the sales of glasses and almost 95% of private practices would shutter. IMHO, this should have never been allowed. We should be making the majority of our income based on service, not product. Sadly this is not the case for ODs and will unlikely never return back to a service based profession.

while there are exceptions, what you describe is not "the rule". If it does happen, that kind of behaviour is more likely to be found in the mall, IMO. Regardless of who does it, the same thing can be found in any doctors office (MD, dentist, OD, etc) when prescribing other kinds of treatments, and as such the sale of spectacles is not unique.

I think the polar opposite of your argument is to say that ODs or OMDs should not be allowed to associate, work for, or lease space from a retail corporation (like lenscrafters, walmart, etc). If there was any conflict of interest to be found, you are sure to find it in those settings.

Originally Posted by PBEA

while there are exceptions, what you describe is not "the rule". If it does happen, that kind of behaviour is more likely to be found in the mall, IMO. Regardless of who does it, the same thing can be found in any doctors office (MD, dentist, OD, etc) when prescribing other kinds of treatments, and as such the sale of spectacles is not unique.

I think the polar opposite of your argument is to say that ODs or OMDs should not be allowed to associate, work for, or lease space from a retail corporation (like lenscrafters, walmart, etc). If there was any conflict of interest to be found, you are sure to find it in those settings.

This is true. I stopped going to a dentist because they refused to listen to me and were constantly trying to upsell me on things I clearly don't need. I don't mind the initial sales pitch, every business (and salesperson) deserves the opportunity to make money, but stop pestering me.

After I had my braces taken off at 14, I had my canine teeth filed down to be flush with the rest of my teeth (incisors?) and my ortho had this in my chart and his office was downstairs from said annoying dentist. Annoying dentist and hygienist were clearly trying to get me to buy a $400 night guard since I "grind my teeth at night" which dental ins doesn't cover. This i politely declined at visit 1 and was documented. 5 visits go by and they are still annoying me. I finally give up and switch dentists. He does my exam, says at the end, "keep doing what you're doing, see you in 6 months" I ask new dentist (who is FABULOUS), "Do I have a teeth grinding problem?" and he says there was no evidence of this. Without me mentioning I had them cosmetically filed, he said they looked fine, but the fact that I told him that made more sense in retrospect.

The point of this rant was that I understand that there are some people who are probably post op Lasik patients who maybe need readers and just get their 1 year checks and +1.50s from CVS work fine. They don't need $400 PALs. The same mom who might be a -3.00 who develops -0.50 of cyl in one eye but has 2 kids in college and is paying cash for her exam and glasses probably won't get a new pair today. This is the kind of stuff that I think that is being debated. The reason I left that office was because of pushy salespeople.

Originally Posted by Jason K

You're neglecting one small detail. ODs cannot see the volume of patients that MDs/DOs enjoy. We're lucky to get 12 patients through the door each day and even if we billed medical on every one of those patients, you're talking about a bunch of level 3 and maybe a few level 4 office visit reimbursements and scattered tests here and there. It's not going to be a cash cow. MDs/DOs don't have the same problem getting patients in the door. If anything, they sometimes have to close their practices to new patients since they're "full." If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient to see a bunch of EyeMed, VSP, and Optum patients with a few Medicare visits billed to "dry eye" here and there. Wake up, dude - optometry is not medicine, not even close. If MDs were trying to survive on seeing 10-12 patients per day, they'd be in the same boat, but the fact is, they're not.

12/day can be a ridiculously busy day depending on the specialty. I dont think you know much about the other side of the fence that you keep trying to compare to...


Otherwise, there is no.distinct difference between peoples so to those saying MDs are greedy and that is the problem with them selling eye ware.... this just isn't a high yield service for MDs. so many other things could be done to pad the bank other than spectacle sales.

The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off. Not possible w NSAID overdose. The only thing I can come up with that doesn't sound eerily like "OD job security" is the man hours required to make a new set of glasses make it impractical to do OTC sales so you want to make sure you get it right the first time and the patient isn't fiddling with his prescription and making unnecessary work for the optometrist

Originally Posted by SpecterGT260

The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off.

I have a question to the ODs/OMDs: If you over-minus a patient with spectacles and they have a narrow space between the posterior medial iris and the anterior medial lens and they constantly accommodate, can they develop an iris bombe, an increased IOP and cause vision loss? Will this cause any pain or will it be without symptoms?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2330199/

Originally Posted by SpecterGT260

The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off. Not possible w NSAID overdose. The only thing I can come up with that doesn't sound eerily like "OD job security" is the man hours required to make a new set of glasses make it impractical to do OTC sales so you want to make sure you get it right the first time and the patient isn't fiddling with his prescription and making unnecessary work for the optometrist

wow

Originally Posted by SpecterGT260

The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off. Not possible w NSAID overdose. The only thing I can come up with that doesn't sound eerily like "OD job security" is the man hours required to make a new set of glasses make it impractical to do OTC sales so you want to make sure you get it right the first time and the patient isn't fiddling with his prescription and making unnecessary work for the optometrist

It is probably somewhat job security, but do you expect the average person will be able to convey to an ophthalmic lab the parameters of his/her glasses. A glasses Rx is more a recipe for how to grind lenses unique to the individual to allow them clear comfortable vision. Comparing a spectacle Rx to a medication Rx is apples and oranges. How would you suggest someone go about making their own recipe for glasses? The danger factor is immaterial.

Originally Posted by SpecterGT260

12/day can be a ridiculously busy day depending on the specialty. I dont think you know much about the other side of the fence that you keep trying to compare to...

I don't know any ophthalmologists who would cringe at seeing 12 patients a day. Perhaps one could chime in if I'm off base, but most of them could crank out 12 patients in half a morning without breaking a sweat. I'm not sure what you're getting at here. Obviously, if you're talking about non-eye-related specialties, you're stating the obvious. I'm not referring to those specialties.

Originally Posted by SpecterGT260

Otherwise, there is no.distinct difference between peoples so to those saying MDs are greedy and that is the problem with them selling eye ware.... this just isn't a high yield service for MDs. so many other things could be done to pad the bank other than spectacle sales.

I don't know where you think I said MDs are any "greedier" than anyone else so I think you may have been thinking of another poster. What I've said is that MDs, ODs, DPMs, DDS,...all of us are seeing out bottom lines drop. We're all doing things that might be considered "shady." It is not unique to optometry.

Originally Posted by SpecterGT260

The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off. Not possible w NSAID overdose. The only thing I can come up with that doesn't sound eerily like "OD job security" is the man hours required to make a new set of glasses make it impractical to do OTC sales so you want to make sure you get it right the first time and the patient isn't fiddling with his prescription and making unnecessary work for the optometrist

Children with inaccurate/inadequate prescriptions can end up with permanent vision loss. Adults running around with inappropriate Rxs can be a road hazard. It's as simple as that.

Originally Posted by SpecterGT260

I dont think you know much about the other side of the fence ...

You make an excellent point....reflect.

Originally Posted by Shnurek

I have a question to the ODs/OMDs: If you over-minus a patient with spectacles and they have a narrow space between the posterior medial iris and the anterior medial lens and they constantly accommodate, can they develop an iris bombe, an increased IOP and cause vision loss? Will this cause any pain or will it be without symptoms?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2330199/

It could potentially be similar to a closed angle glaucoma, and I would expect similar symptoms if that were the case.... otherwise why was I quitted there?

Originally Posted by SpecterGT260

It could potentially be similar to a closed angle glaucoma, and I would expect similar symptoms if that were the case.... otherwise why was I quitted there?

You have no idea what you are talking about. It would be nothing like angle closure. Then angle is wide open, in fact the iris is bowed posteriorly, not anteriorly. That is the mechanism of pigmentary dispersion / pigmentary glaucoma. Not the over minus part, but chafing of the anterior lens capsule rubs pigment off the posterior iris which gets clogged in the TM. In answer to the prior question, sometimes patient can feel it , usually after exercise , most cannot but have elevated IOP which can lead to GON. The test answer is young, myopic males.

Originally Posted by PBEA

wow

care to elaborate?

Originally Posted by SpecterGT260

care to elaborate?

sorry your response was just a very uninformed one, but you are still a student so I dont mean to beat you up about it. To answer in summary its pretty simple, in some cases the wrong spectacle rx can "injure", or cause harm to someones eyes...........permanently. Amblyopia is a perfect case in point. The comparison to a pharm script is the same in this respect (although not nearly as common). That a person could "withdraw" from wearing the wrong spectacles is true.....if they new that it was causing harm, and that's the problem, there is no way for them to tell, and as such is irrelevent.

Originally Posted by PBEA

sorry your response was just a very uninformed one, but you are still a student so I dont mean to beat you up about it. To answer in summary its pretty simple, in some cases the wrong spectacle rx can "injure", or cause harm to someones eyes...........permanently. Amblyopia is a perfect case in point. The comparison to a pharm script is the same in this respect (although not nearly as common). That a person could "withdraw" from wearing the wrong spectacles is true.....if they new that it was causing harm, and that's the problem, there is no way for them to tell, and as such is irrelevent.

The mechanisms involved in visual development in children seem to all center around the degree of refractive error. The assumption I am running on is that in order to actually cause harm (and I am not talking about failure to avoid a problem. As a provider, "harm" is typically understood to mean "you made things worse") you must provide glasses which increase the refractive error from the baseline. The second assumption is that with further reduced vision the patient would remove the glasses.

A decent argument could be made that failure to properly address vision in the first place and allowing the patient to progress with sub-optimal correction to the point where the errors are permanent could constitute "harm", but again, this gets into hair splitting when the initial point of the post (aside from counter-douching J-bo up there) was to say that a major function of OD Rx is to protect the provider (as was confirmed and eluded to a few times above)

Originally Posted by SpecterGT260

The mechanisms involved in visual development in children seem to all center around the degree of refractive error. The assumption I am running on is that in order to actually cause harm (and I am not talking about failure to avoid a problem. As a provider, "harm" is typically understood to mean "you made things worse") you must provide glasses which increase the refractive error from the baseline. The second assumption is that with further reduced vision the patient would remove the glasses.

A decent argument could be made that failure to properly address vision in the first place and allowing the patient to progress with sub-optimal correction to the point where the errors are permanent could constitute "harm", but again, this gets into hair splitting when the initial point of the post (aside from counter-douching J-bo up there) was to say that a major function of OD Rx is to protect the provider (as was confirmed and eluded to a few times above)

you are out of your depth. If you are truly interested in the topic, your best bet would be to ask questions. Debating something you have no understanding about is......odd behaviour.

Originally Posted by east

It is probably somewhat job security, but do you expect the average person will be able to convey to an ophthalmic lab the parameters of his/her glasses. A glasses Rx is more a recipe for how to grind lenses unique to the individual to allow them clear comfortable vision. Comparing a spectacle Rx to a medication Rx is apples and oranges. How would you suggest someone go about making their own recipe for glasses? The danger factor is immaterial.

No, I do not expect the average person to be able to handle their own appropriate eyeglasses Rx. That is why I said the last part about the work necessary to make a new set of lenses and the impracticality of a trial and error system which would be unavoidable if a patient didn't require the Rx. Also without this standard you would be forced to receive your lenses from the guy who did your exam only which would drive up pt costs.

The whole statement was centered around the idea that there is a similar conflict like there is with physicians and Rx meds. The two Rx systems serve completely different ends. THAT was my point

Originally Posted by SpecterGT260

the impracticality of a trial and error system which would be unavoidable if a patient didn't require the Rx. Also without this standard you would be forced to receive your lenses from the guy who did your exam only which would drive up pt costs.

The whole statement was centered around the idea that there is a similar conflict like there is with physicians and Rx meds. The two Rx systems serve completely different ends. THAT was my point

This kind of reminds me of the titration that happens when a doc rxs medications. The dosage is trial and error.

Originally Posted by SpecterGT260

No, I do not expect the average person to be able to handle their own appropriate eyeglasses Rx. That is why I said the last part about the work necessary to make a new set of lenses and the impracticality of a trial and error system which would be unavoidable if a patient didn't require the Rx. Also without this standard you would be forced to receive your lenses from the guy who did your exam only which would drive up pt costs.

The whole statement was centered around the idea that there is a similar conflict like there is with physicians and Rx meds. The two Rx systems serve completely different ends. THAT was my point

I guess I was just confused by the first sentence where you asked "why do glasses require an Rx to begin with?" were you just being rhetorical?

Originally Posted by Shnurek

This kind of reminds me of the titration that happens when a doc rxs medications. The dosage is trial and error.

Maybe its the lack of sleep from finals but I can't tell if you are agreeing with, disagreeing with, or trolling me.....

I suspect that there is substantially more medication adjustment done on a shorter time frame than there is adjustment of glasses rx. You guys have an immediately available outcome (acuity). I won't say that there isn't a possibility that the rx isn't quote right, but it isn't like I can inject different levels of insulin into someone going "number one.... or number two?" as east suggested it isn't like you guys just go back to a box and pull a couple of lenses out like you are picking bowling shoes and call it a day. Unless I am missing something I view an OD rx more like a certificate of authenticity than a medical rx. It is meant more to protect the OD than to protect the patient. I'm not suggesting there is anything wrong with this

Originally Posted by Jason K

I don't know any ophthalmologists who would cringe at seeing 12 patients a day. Perhaps one could chime in if I'm off base, but most of them could crank out 12 patients in half a morning without breaking a sweat. I'm not sure what you're getting at here. Obviously, if you're talking about non-eye-related specialties, you're stating the obvious. I'm not referring to those specialties.



I don't know where you think I said MDs are any "greedier" than anyone else so I think you may have been thinking of another poster. What I've said is that MDs, ODs, DPMs, DDS,...all of us are seeing out bottom lines drop. We're all doing things that might be considered "shady." It is not unique to optometry.




Children with inaccurate/inadequate prescriptions can end up with permanent vision loss. Adults running around with inappropriate Rxs can be a road hazard. It's as simple as that.

The statement was in regard to the larger comparison to medical practice in general. However the ophtho clinic at our hospital employs ODs for lenses and MDs for pathology. 12 pts /day is quite comfortable, but they aren't just billing out for vision scans either.

2nd quote: not directed at you. See "to those saying"

3rd quote: nobody said that improper lensing was inconsequential. See "but you can just take them off"

Originally Posted by SpecterGT260

The statement was in regard to the larger comparison to medical practice in general. However the ophtho clinic at our hospital employs ODs for lenses and MDs for pathology. 12 pts /day is quite comfortable, but they aren't just billing out for vision scans either.

If your MDs are seeing 12 patients per day, there's something horribly wrong there. If your ODs are seeing 12 patients per day, they're seeing about what the average OD in private practice sees. Most ODs could see double what actually comes through their doors, they just don't have the volume to make that a reality. I'm not sure what you're saying here. I'm arguing that 12 patients per day is too few. You seem to be indicating that it's "comfortable," as if I were saying it was too many. Believe me, 12 patients is not too high of a volume for any OD on the planet unless he's a new 3rd year intern or someone who is fabulously slow.

Originally Posted by SpecterGT260

3rd quote: nobody said that improper lensing was inconsequential. See "but you can just take them off"

A 10 diopter myope can take his glasses off and see nothing but shadows and indistinct shapes. A child who has a 2 diopter hyperopic anisometropia can end up with significant vision loss in the more hyperopic eye if left uncorrected. Most kids in this situation have no visual complaints and it has to be found on refraction. I'm not disagreeing with the fact that most adults could get by with an autorefraction Rx, but I can see why there is a legal requirement. As it stands, British Columbia citizens can go online and buy whatever glasses they choose without an Rx and they're not killing each other in the streets. I see your point, but there are underlying reasons why it should be required.

I won't even get into why CLs absolutely should be covered by an Rx. There are too many reasons to list, but most of them lead back to the risk of permanent vision loss if a lens is fit incorrectly and worn for any significant length of time.

Originally Posted by Jason K

If your MDs are seeing 12 patients per day, there's something horribly wrong there. If your ODs are seeing 12 patients per day, they're seeing about what the average OD in private practice sees. Most ODs could see double what actually comes through their doors, they just don't have the volume to make that a reality. I'm not sure what you're saying here. I'm arguing that 12 patients per day is too few. You seem to be indicating that it's "comfortable," as if I were saying it was too many. Believe me, 12 patients is not too high of a volume for any OD on the planet unless he's a new 3rd year intern or someone who is fabulously slow.




A 10 diopter myope can take his glasses off and see nothing but shadows and indistinct shapes. A child who has a 2 diopter hyperopic anisometropia can end up with significant vision loss in the more hyperopic eye if left uncorrected. Most kids in this situation have no visual complaints and it has to be found on refraction. I'm not disagreeing with the fact that most adults could get by with an autorefraction Rx, but I can see why there is a legal requirement. As it stands, British Columbia citizens can go online and buy whatever glasses they choose without an Rx and they're not killing each other in the streets. I see your point, but there are underlying reasons why it should be required.

I won't even get into why CLs absolutely should be covered by an Rx. There are too many reasons to list, but most of them lead back to the risk of permanent vision loss if a lens is fit incorrectly and worn for any significant length of time.

Yes, I understand you are saying it is too few. Your original post (the one I quoted) said that
"We're lucky to get 12 patients through the door each day"
and
" MDs/DOs don't have the same problem getting patients in the door"
and
" If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient "
To which i said
"12/day can be a ridiculously busy day depending on the specialty"

I guess I mixed in some of the other comparisons people were making to MDs in general when I opened it up to different specialties, but the average OMD is not seeing 40-50 pts/day within a full scope of practice. If they have opened up a private vision clinic somewhere and do nothing but lense scripts maybe... but that still doesnt seem likely with the 9.6min/patient this leaves in an 8hr private practice work day..... What I was saying is that the average OMD will not see nearly that many patients in a day, but doesnt need to because they are able to bill out for quite a bit more than a vision check (if they are running a full practice). That is all I was getting at with the comments about 12 patients.


And yes, (once again) nobody said that inaccurate or insufficient scripts were inconsequential. But the end result is not the same as over administration of another drug because the patient can immediately "withdraw treatment" and end up right back where they were. I only mention this because (once again) comparisons were made to MD script writing. The predominant effect of the OD script is not patient safety. If we were to remove this we would not have death, maiming, and otherwise harm incurred by the patients (maybe barring those patients who decide to force themselves as pre adolescents to wear grossly wrong scripts rather than to just take the damn things off ). What we WOULD have is ODs who have to constantly remake lenses as people give inaccurate "recipes" or simply shoot from the hip without having an actual eye exam performed.
It may not seem like it exactly, but this is still directly related to the OP and is suggesting that yes, ODs and OMDs SHOULD be allowed to sell glasses and it is inappropriate to compare the Rx for glasses to the Rx for meds because they have completely different goals in mind. To rustle up a few exceptions where maybe something negative could happen to the patient (like driving without glasses or a kid allowing his eyes to do what they were going to do anyways....) is just grasping at straws.

Ophthalms can get through ridiculous amounts of patients in a day.

They have techs that do everything barring indirect fundoscopy.

Originally Posted by SpecterGT260

To rustle up a few exceptions where maybe something negative could happen to the patient (like driving without glasses or a kid allowing his eyes to do what they were going to do anyways....) is just grasping at straws.

A few exceptions? That what many laws are in place to protect - the exceptions. It is apparent from your above post that you do not understand high risk refractive error and its role in permanent vision loss or amblyopia in children. I suggest you read up a little on the topic as even the first year OD students could explain why your statement demonstrates incredible ignorance.

Originally Posted by SpecterGT260

Yes, I understand you are saying it is too few. Your original post (the one I quoted) said that
"We're lucky to get 12 patients through the door each day"
and
" MDs/DOs don't have the same problem getting patients in the door"
and
" If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient "
To which i said
"12/day can be a ridiculously busy day depending on the specialty"

You’re inserting an argument that really doesn’t have any opposition so I’m not sure why you’re perpetuating it. The fact that some physicians can be “busy” with 12 patients is completely irrelevant. The big picture is, physicians face their own struggles, but their primary complaints are not related to low patient volume. I had to see an orthopedic surgeon a few months ago and he was booked out 3 months. Dermatology, several months out. Neurology, 3 months or more booked out. Most of the ophthalmologists in my area, even the truly awful ones who’s surgical train wrecks I could spot from across the room, are booked out for weeks or months for non-emergent appointments. You’d have a hard time finding a competent MD out there who offers same day appointments for non-emergent care. Not so with ODs. Most can offer same day appointments or a few days out at most. You’re missing the big picture here. The point is, MDs face a lot of struggles, no doubt about that, but they are not primarily rooted in not having enough patients. Optometrists cannot say the same. All this other stuff you’re referring to irrelevant. If there’s some guy in an ICU who’s loaded with 12 patients, fine, I think anyone can see that, but it has little relevance to this discussion.

Originally Posted by Jason K

A few exceptions? That what many laws are in place to protect - the exceptions. It is apparent from your above post that you do not understand high risk refractive error and its role in permanent vision loss or amblyopia in children. I suggest you read up a little on the topic as even the first year OD students could explain why your statement demonstrates incredible ignorance.



You’re inserting an argument that really doesn’t have any opposition so I’m not sure why you’re perpetuating it. The fact that some physicians can be “busy” with 12 patients is completely irrelevant. The big picture is, physicians face their own struggles, but their primary complaints are not related to low patient volume. I had to see an orthopedic surgeon a few months ago and he was booked out 3 months. Dermatology, several months out. Neurology, 3 months or more booked out. Most of the ophthalmologists in my area, even the truly awful ones who’s surgical train wrecks I could spot from across the room, are booked out for weeks or months for non-emergent appointments. You’d have a hard time finding a competent MD out there who offers same day appointments for non-emergent care. Not so with ODs. Most can offer same day appointments or a few days out at most. You’re missing the big picture here. The point is, MDs face a lot of struggles, no doubt about that, but they are not primarily rooted in not having enough patients. Optometrists cannot say the same. All this other stuff you’re referring to irrelevant. If there’s some guy in an ICU who’s loaded with 12 patients, fine, I think anyone can see that, but it has little relevance to this discussion.

well... a few optomotry students and practicing optomotrists have already weighed in and not said so. It is beside the point anyways. and no, you are missing the big picture. That is why I tried to re-outline it so you could see what brought us from point A to point B.... I am "perpetuating" it because you seemed confused (and still do) about why I brought it up to begin with.
first, because I didn't think your comparison about patients was really that valid in terms of ability to support a practice. If you want to say "ODs dont get enough, and MDs do get enough" fine. That I can agree to. But you centered it around some arbitrary number 12 while outright douching on about 4 other posters simultaneously so I figured I would just let you know your comparison was in error.

Thats really it. Bringing it up again was because the comment seemed to confuse you. I mean... you were there when you posted this:

I'm not sure what you're saying here. I'm arguing that 12 patients per day is too few.

werent you?


and if we are going to talk big picture: the "big picture" is still in reference to the OP. If you want to talk about "harm" by faulty or inappropriate scripts, fine. That is not the major issue and it is restricted to a specific subset of the patient population with only specific types of correction errors. If you want to think that the OD prescriptive power is to promote patient health and wellness then there isnt much I can probably say to effect that But in a "big picture" sense, that is not really its purpose. It is not as simple as "job security", but it is protective for the industry. However to incur any "harm" you need to stick a kid in glasses in which the "correction" exceeds the original refractive error to begin with.

The only point here is to dis-equate lens Rx with medication Rx thereby addressing the concerns brought up on page 1 about the ethics of profiting off of a prescribed health aid. That is the "big picture". This wasn't intended to get caught up in technicalities or minority exceptions. And you said it yourself by emphasizing the exceptions. Rx drugs are not controlled to protect exceptions. They are controlled because the majority of people would harm themselves, others, or overall wellness with them without professional guidance. To get back to the OP (agian ) I do not see a conflict with ODs and OMDs selling Rx lenses because the Rx plays a larger role in provider protection than it does in pt protection. How long does it take you to make lenses for a new patient or to make new lenses for a patient who needs an adjustment? what is the profit margin on a set of glasses? what if every tom dick and harry could ask for glasses without a legit eye exam and without an Rx?

It's quite ironic that Walmart is weak on its home turf. Opthlamologist/Optometrist/Optician have a strong lobby. They pushed for some laws that are very restrictive on retail optical.

Walmart is closing most of it's optical centers in the state - when a store is set for remodeling - they are turning them into WalmartConnect Centers(cell-phones).


Apprenticeships are years longer at retail.
Retail Opticians can't dispense CL, at all. Doctor only.
Most manufacturers are pressured to go to independent doctors for safety glasses and
supply insurance benefits. I was told by several people that their insurance will pay an independent doctor for glasses, but will only reimburse them for retail purchases - so free glasses/CL at an independent doctors office.
They can't keep fulltime liscensed ODs or Opticians, if the doctor or the optician isn't there - then the customers can't pick-up there prescriptions.


BTW, the problem with the no-sell argument is - when people buy their glasses/CL they can immediately tell if they are working. They came there specifically for that purpose.
They can afford or they can't - their insurance will pay for it or it won't.

Also, retail opticals w/independent docs (like Walmart) don't have the conflict - when I worked there non of the docs cared if you bought your glasses there, but they would sell the heck out of contact lenses - since they were the only ones allowed to dispense them.

Originally Posted by rockyprogress

BTW, the problem with the no-sell argument is - when people buy their glasses/CL they can immediately tell if they are working.

without commenting on your entire post, I just wanted to point out the fallacy of the above statement. Even if that were always true (which it very definitely is not), it would do nothing to address the problem of asymptomatic eye disease, which is pretty common in the population (although I'm off topic I think )

I agree. Optometrists should not sell eyeglasses anymore, but rent the display space to commercial or frame manufacture.