OD and OMDs should not be allowed to sell eyeglasses

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Exactly, its not Optometry its YOU. People have been talking down on optometry since its inception.

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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
 
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/
 
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Optometry is, once again, a made up/legislatively purchased profession.

I understand that we are a legislated profession, but could you expand on the "made up" part.
 
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?
 
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
 
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.
 
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 :thumbup:
 
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 :thumbup:

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

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?
 
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?" :laugh: 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
 
wow, you and jason sound like two peas in a pod. Seriously if optometry was only what you describe I would have left long ago. While some of what you say does occur, it is by no means a "universal truth". Your perspective is limited, as is Jasons, by your own experience. I'll be the first to admit optometry has many challenges, but it is and has always been what you make of it (like anything else). If you want to go and spin and grin at the local refractohut then its YOU who is making that choice, if you want the challenge of private practice and offer the full scope of your license then its YOU who is making that choice.

What I say specifically relates to prospective ODs and their future in the profession. If you're someone who "would have left long ago," I'm assuming you're not a newly minted OD. There's a vast difference between the profession you entered X number of years ago, and the one a sophomore in college will enter in 6 or 7 years when he/she finishes. As I've said over and over, private practice optometry is a analogous to a lifeboat with limited seating. There's room for a few, while the rest of the thousands of passengers will go down with the ship. It's easy to focus and say "I'll be one of those few if I do this or that," and the reality it is, a few of them will be right, but most will go down with the ship. That's my point. If all the preops on here were saying "I'm psyched about a career in commercial optometry," then I wouldn't be on here. The fact is, most people entering optometry school are interested in private practice career. There is not room for any more than a small portion of them. That is a reality, not my opinion. If you disagree, that's fine, but they're the ones who will have to pay the price.
 
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I'm curious why this is, Jason. The optometrists I've spent time with over the years (I actually thought about becoming an optometrist, at one point) all seemed to have fairly low volume relative to your average ophthalmologist. Is this another facet of the oversupply? Are there other factors?

Personally, I think it has to do with a lot of factors, but mostly that ophthalmologists handle pathology while ODs tend not to handle it as the core of their practice. In most OD practices, patients are there for their routine eye care - primarily glasses and CLs, maybe a red eye here and there. More ODs are treating glaucoma now days, but the fact is, most people coming to their OD are not heavily diseased. In most MD offices I've been in or worked in, most patients are there for some sort of disease process. The MD is there to treat the problem medically or surgically (or both). Between the relative scarcity of ophthalmologists (compared to ODs) and the prevalence of pathology in older populations, there's plenty to do for MDs out there. The ODs have to divide up the rest of the spoils. If there were reasonable amounts of us out there, it would be fine. But considering that there are 10s of thousands more of us than are needed, it spells out the inevitable result - too few patients for each OD.
 
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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.

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.


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.
 
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"

:thumbup:
 
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.


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

:thumbup:

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.
 
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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 :laugh:). 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.
 
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:rolleyes:). 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.
 
Personally, I think it has to do with a lot of factors, but mostly that ophthalmologists handle pathology while ODs tend not to handle it as the core of their practice. In most OD practices, patients are there for their routine eye care - primarily glasses and CLs, maybe a red eye here and there. In most MD offices I've been in or worked in, most patients are there for some sort of disease process. The MD is there to treat the problem medically or surgically (or both).


I think Jason hit the nail on the head. This to me is the biggest difference between an OD's and an ophthalmologist's practice. During residency I rotated with an optometrist half a day a week for four months to learn about contacts and contact lens fittings. 90% of what I did was perform refractions and routine eye exams. It was the inverse of all of my other rotations as a resident in which 90-95% of what I did was medically or surgically treat patients with eye disease.
 
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.

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.
 
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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. :thumbup:

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 :thumbup: 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 :rolleyes:) 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?
 
wrong again, the ENTIRE premise of requiring professional guidance (ie an Rx) for eyeglasses is pt protection, and has NOTHING to do with "provider protection".
 
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:rolleyes:). 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)
 
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.

Your statement above is absolutely wrong. There is no requirement to prescribe overcorrection to lead to vision loss. I have no idea where you learned that. Lack of correction, overcorrection, and undercorrection can all lead to permanent vision loss in children if the risk factors are there. In fact, in the majority of refractive amblyopia cases I've seen, it's been a total lack of correction that lead to the problem. You're obviously a 1st year medical student. I suggest you read up on the topic, as I said earlier. It might benefit your patients some day.

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. :thumbup:

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

You're rambling on about nonsense here. Twelve patients per day, for ODs is not anywhere near the limit of possibility, but that's about what the average OD sees in his office. That is the only point I ever made in reference to daily patient counts. It was you who decided to start carrying on about how some physicians can see 12 patients and be "busy." Optometry is a profession in which patients are in short supply per OD. If you want to read into it by making other comparisons which are irrelevant, you're free to do so. MDs, on average, don't have shortages of patients. ODs do. If you fail to understand that, I can't help you.
 
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wrong again, the ENTIRE premise of requiring professional guidance (ie an Rx) for eyeglasses is pt protection, and has NOTHING to do with "provider protection".

yeah... I hear you say that. I just dont buy it :thumbup: I am not the first (nor the highest ranked) person in here to express those sentiments. jason called the profession legislated, east admitted to a job security angle...
 
yeah... I hear you say that. I just dont buy it :thumbup: I am not the first (nor the highest ranked) person in here to express those sentiments. jason called the profession legislated, east admitted to a job security angle...

I don't think you understand what it means to be a legislated profession...and if you did you would know that has absolutely nothing to do with glasses prescriptions and "provider protection"

just to clarify...there are cases where a glasses Rx is not essential. A 42 year old healthy presbyope with a plano distance Rx probably doesn't really need an Rx for a +1.50 DS OU readers.

As far as job security goes...5 years ago I would go to my GP to get an allergy Rx and pay 75 bucks for an office visit .now I just go to the wal-mart OTC section and purchase my medication without an Rx. Just curious if you extrapolate that out a little isn't there a job security angle there?
 
Your statement above is absolutely wrong. There is no requirement to prescribe overcorrection to lead to vision loss. I have no idea where you learned that. Lack of correction, overcorrection, and undercorrection can all lead to permanent vision loss in children if the risk factors are there. In fact, in the majority of refractive amblyopia cases I've seen, it's been a total lack of correction that lead to the problem. You're obviously a 1st year medical student. I suggest you read up on the topic, as I said earlier. It might benefit your patients some day.
Who will have more pronounced vision loss: 3 children with the same initial acuity
1 goes completely untreated
1 gets treated inappropriately and the correction actually worsens the myopia
1 gets treated inappropriately because the myopia is not fully corrected

expected relative changes in adult visual acuity?

You're rambling on about nonsense here. Twelve patients per day, for ODs is not anywhere near the limit of possibility, but that's about what the average OD sees in his office. That is the only point I ever made in reference to daily patient counts. It was you who decided to start carrying on about how some physicians can see 12 patients and be "busy." Optometry is a profession in which patients are in short supply per OD. If you want to read into it by making other comparisons which are irrelevant, you're free to do so. MDs, on average, don't have shortages of patients. ODs do. If you fail to understand that, I can't help you.

your reading comprehension is just phenomenal....
You keep reiterating points that I am not arguing and have explicitly said I have no issue with. You get 12 patients a day? holyfreakingcowzilla! superfun! :laugh:
You just dont seem to be able to keep this exchange in the context of the thread. We are talking about ODs selling rx lenses. Now, I am going to do what I have done in the last 4 posts and simply address your confusion. I am not on a soapbox "rambling". You are confused as to what my point is. I am approaching half your daily patient load in attempts just to address that, so here we go again... ok? :thumbup:

earlier you said:
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.
followed by

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.

Your argument seems to be that
1) OD Rx IS a profitable endeavor as opposed to MD Rx and that
2) this is OK because this is a significant means by which ODs support themselves because
3)it is an integral part of what the profession is and that
4)Rx sales is NOT a part of what MDs do nor is it a part of their "scope" so
5)the two (OD Rx and MD Rx) are not comparable

on this part we agree.

The only thing I was contesting was your assumption that billings are the same per pt. If an OMD were to see 10-12 patients a day, within a full scope of practice and not just vision checks and lenses, that doctor could still support himself comfortably (arguably with plenty of room to grow) on the basis that vision checks and lens sales are at the low end of the spectrum of what an OMD can bill out for. the $/pt goes up for just about anything else so by simple logic alone the income goes up " If MDs were trying to survive on seeing 10-12 patients per day". You are likely correct that they are most of the time seeing more, I was just saying this is irrelevant because the associated dollar value per head is also higher. Thats all... Im a little confused why this was so difficult and why we had to spend so much time on it... let it go man :thumbup: I really don't give a crap how many people specifically each profession sees, the only point of contention was the fallacy in the argument.
 
I don't think you understand what it means to be a legislated profession...and if you did you would know that has absolutely nothing to do with glasses prescriptions and "provider protection"

just to clarify...there are cases where a glasses Rx is not essential. A 42 year old healthy presbyope with a plano distance Rx probably doesn't really need an Rx for a +1.50 DS OU readers.

As far as job security goes...5 years ago I would go to my GP to get an allergy Rx and pay 75 bucks for an office visit .now I just go to the wal-mart OTC section and purchase my medication without an Rx. Just curious if you extrapolate that out a little isn't there a job security angle there?

yes... a loss of job security.
 
Who will have more pronounced vision loss: 3 children with the same initial acuity
1 goes completely untreated
1 gets treated inappropriately and the correction actually worsens the myopia
1 gets treated inappropriately because the myopia is not fully corrected

expected relative changes in adult visual acuity?

Will you please stop trying to argue your point here? You have no idea what you're talking about. You obviously do not understand what risk factors are for refractive amblyopia and it's clear from your above example. I'm not going to hold a lecture on how lack of correction and/or inappropriate correction, in a child with risk factors for refractive amblyopia, can lead to permanent vision loss. I don't know why you're pulling myopia out of thin air here. We're not talking about under or overcorrecting myopic children. Now for the third time...please read up on the topic before blurting out your incorrect assertions which have no basis in visual science.


The only thing I was contesting was your assumption that billings are the same per pt. If an OMD were to see 10-12 patients a day, within a full scope of practice and not just vision checks and lenses, that doctor could still support himself comfortably (arguably with plenty of room to grow) on the basis that vision checks and lens sales are at the low end of the spectrum of what an OMD can bill out for. the $/pt goes up for just about anything else so by simple logic alone the income goes up " If MDs were trying to survive on seeing 10-12 patients per day". You are likely correct that they are most of the time seeing more, I was just saying this is irrelevant because the associated dollar value per head is also higher. Thats all... Im a little confused why this was so difficult and why we had to spend so much time on it... let it go man :thumbup: I really don't give a crap how many people specifically each profession sees, the only point of contention was the fallacy in the argument.

Look, chief, I never assumed anything related to the average ticket in an OD office vs an MD office. The services offered are vastly different in scope and in reimbursement. You show me a neurologist who sees 10-12 patients per day and I'll show you a guy who either really sucks at what he does, a guy who's unbelievably lazy, or someone who's in some unusual subspecialty. That's my point and it's the ONLY one I ever made. You came on here and started inserting nonsense interpretations. That's your issue - not mine.
 
Who will have more pronounced vision loss: 3 children with the same initial acuity
1 goes completely untreated
1 gets treated inappropriately and the correction actually worsens the myopia
1 gets treated inappropriately because the myopia is not fully corrected

expected relative changes in adult visual acuity?



your reading comprehension is just phenomenal....
You keep reiterating points that I am not arguing and have explicitly said I have no issue with. You get 12 patients a day? holyfreakingcowzilla! superfun! :laugh:
You just dont seem to be able to keep this exchange in the context of the thread. We are talking about ODs selling rx lenses. Now, I am going to do what I have done in the last 4 posts and simply address your confusion. I am not on a soapbox "rambling". You are confused as to what my point is. I am approaching half your daily patient load in attempts just to address that, so here we go again... ok? :thumbup:

earlier you said:

followed by



Your argument seems to be that
1) OD Rx IS a profitable endeavor as opposed to MD Rx and that
2) this is OK because this is a significant means by which ODs support themselves because
3)it is an integral part of what the profession is and that
4)Rx sales is NOT a part of what MDs do nor is it a part of their "scope" so
5)the two (OD Rx and MD Rx) are not comparable

on this part we agree.

The only thing I was contesting was your assumption that billings are the same per pt. If an OMD were to see 10-12 patients a day, within a full scope of practice and not just vision checks and lenses, that doctor could still support himself comfortably (arguably with plenty of room to grow) on the basis that vision checks and lens sales are at the low end of the spectrum of what an OMD can bill out for. the $/pt goes up for just about anything else so by simple logic alone the income goes up " If MDs were trying to survive on seeing 10-12 patients per day". You are likely correct that they are most of the time seeing more, I was just saying this is irrelevant because the associated dollar value per head is also higher. Thats all... Im a little confused why this was so difficult and why we had to spend so much time on it... let it go man :thumbup: I really don't give a crap how many people specifically each profession sees, the only point of contention was the fallacy in the argument.

Dude you're probably a cool kid, but as far as your knowledge of treatment and management of amblyopia...well you're just embarrassing yourself. Also you need to talk to some Ophthalmologists (not in academia). They would vomit if they only saw 10-12 patients a day. Your knowledge of billing and coding also needs some work if you think Ophthalmologists can just "bill out" more and make 10 to12 patients per day work in a private practice setting.
 
yeah... I dont know how many times I have to say it.. There is a vast difference between arguing a point and trying to clarify to someone who has consistently misunderstood where you are coming from.

Sincerely,
Chief :)
 
Dude you're probably a cool kid, but as far as your knowledge of treatment and management of amblyopia...well you're just embarrassing yourself. Also you need to talk to some Ophthalmologists (not in academia). They would vomit if they only saw 10-12 patients a day. Your knowledge of billing and coding also needs some work if you think Ophthalmologists can just "bill out" more and make 10 to12 patients per day work in a private practice setting.

that also wasn't really the point but apparently we are too fixated at this point to get past it. So i am dropping it.

I would still like to know you and J-bo's answer to the question on outcomes between the hypothetical patients
 
I am happy to indulge, but your question is asked with such a convoluted frame of reference that it is really not answerable in its current form.. demonstrating how little you know about the subject
 
I would still like to know you and J-bo's answer to the question on outcomes between the hypothetical patients

You can't participate in an intelligent discussion of refractive amblyopia until you understand what it is and how it occurs. Your above example and your other comments on the topic, demonstrate that you don't understand the basics of the condition. As I've suggested, now for the 4th time, you need to go read up on the subject and you'll understand why your statements are wrong. In particular, there is absolutely no requirement for overcorrection to cause any sort of amblyopia in a child. If you took 5 minutes to read the wikipedia page on amblyopia, you'd stop pushing this point. Your above "comparisons" have little to do with anything related to refractive amblyopia. Please take the 5 minutes. Furthermore, you'd stand to gain a lot by refraining from making assertions about medical conditions with which you are unfamiliar. At worst, it could get someone killed. At best, it might lead to some kid running around with a 20/100 eye due to your lack of understanding of a medical condition related to refractive error.
 
here's a hint ...think less myopia and more anisometropia.....
 
I'm not trying to beat up on you man..I'm sure you're gonna be a great doc but you should just let this one go
 
You can't participate in an intelligent discussion of refractive amblyopia until you understand what it is and how it occurs. Your above example and your other comments on the topic, demonstrate that you don't understand the basics of the condition. As I've suggested, now for the 4th time, you need to go read up on the subject and you'll understand why your statements are wrong. In particular, there is absolutely no requirement for overcorrection to cause any sort of amblyopia in a child. If you took 5 minutes to read the wikipedia page on amblyopia, you'd stop pushing this point. Your above "comparisons" have little to do with anything related to refractive amblyopia. Please take the 5 minutes. Furthermore, you'd stand to gain a lot by refraining from making assertions about medical conditions with which you are unfamiliar. At worst, it could get someone killed. At best, it might lead to some kid running around with a 20/100 eye due to your lack of understanding of a medical condition related to refractive error.

I think you are set enough in your interpretation of what I have said that you think I have already looked at the wikipedi... er.... well shoot ;)

For the above examples to be irrelevant you are stating that the rate of pathway development is completely independent of some degree of how "correct" the image is. I suppose I should have used anisometropia instead of myopia (even though myopia was the initial talk of the majority of the discussion up until east brought up amblyopia)

http://www.ncbi.nlm.nih.gov/pubmed/9622955 unfortunately I cannot get full text....
http://www.iovs.org/content/41/12/3775 that one is a little better.

as i have been suggesting, the depth of amblyopia is related to the degree difference between the two eyes (and in a broader sense (and this is what i was saying earlier) the degree of refractive error). if that is the case, then getting the eye closer to "normal" will decrease amblyopia. Leaving it alone will have no effect will....well... have no effect (i.e. the amblyopic eye will progress to whatever state it was denstined to originally) and if you increase the refractive error the depth will be worsened.
The same thing can be assumed if we expand to talk about visual defects in uncorrected myopia. If you correct all the way you are good. If you leave alone you are bad. If you are in the middle you are less good or less bad (depending on how you prefer to fill you cups :thumbup:) and if you correct in the opposite direction (which is what I originally said, and this should not be understood as "overcorrected") you are worse off. The extension to myopia is an assumption. But the conclusions concerning depth of amblyopia indicate that degree of initial visual deficit and depth of amblyopia are directly related. And here is where I would normally plug that back into what I have said previously, but I have spent enough time on the eye and that one isnt a shelf exam anyways :thumbup:
 
I'm not trying to beat up on you man..I'm sure you're gonna be a great doc but you should just let this one go

I actually dont feel beat up at all. I just think emphasis has been put on the wrong points in the post. See above. Being fast and loose with terminology is a result of inexperience (my bad :oops:), but J-bo's assumption that I am incapable of having a conversation about this has more to do with his mood (is he always this grumpy? :eek::D), his previous assumption that I'm making everything up, and a complete lack of attempt to assume anything else.

The underlying assumption in the earlier posts was that degree of permanent vision loss is directly related to degree of refractive error.
 
yes you definitely have spent enough time on the eye...:)
 
(is he always this grumpy? :eek::D)

yes, he feels cheated by his profession. Probably didn't shadow enough or a wide variety of ODs before he went into opto school.
 
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.
 
The underlying assumption in the earlier posts was that degree of permanent vision loss is directly related to degree of refractive error.

Wrong again - this is not true. You need to understand risk factors for refractive amblyopia. Overcorrection or undercorrection of myopia, in all likelihood, would not lead to refractive amblyopia unless it was egregious in prescriptive error. If not for the sake of the people on this forum, then for your future patients, learn what the risk factors are and you'll see why you're not making sense. You are assuming that the amount of refractive error is the primary cause for refractive amblyopia. It is not. A child who is emmetropic in the right eye and a 1.50D hyperope in the left eye, is at risk for amblyopia due to the anisometropia. A child who is -4.00D in the right eye and -5.50 in the left is not considered at risk for refractive amblyopia, despite the same amount of anisometropia. Take some time, read up on it, and you'll understand something that none of your classmates know. But for god's sake, please stop arguing with practicing ODs about a topic which you clearly do not understand.
 
yes, he feels cheated by his profession. Probably didn't shadow enough or a wide variety of ODs before he went into opto school.

Shnurek, you've just made an accurate, concise statement that is based almost entirely in fact. Kudos to you. The slight error is that I'm not always this "grumpy." I only get that way when I read nonsense about refractive amblyopia. Or when you start talking about "going rural." That's pretty much the only thing on Earth that gets me grumpy.
 
Alright fine. Even upon futher reading over the last couple hours. About a dozen accessmed tabs, uptodate, and a half dozen pubmed articles, where exactly is the reasoning wrong? - keeping in mind the origin of this debate. i.e. OD Rx is a vital necessity to patient health because of the drastic and dire consequences of inappropriate lens strength (that may be slight hyperbole, but that is basically where this started). We started on myopia, amblyopia got mixed in there about 45 min ago or so.... In my completely uneducated point of view, the -4/-5.5 kid listed above probably doesnt favor either eye because they are both crap so there isnt the opportunity for degradation of the pathway as there is with a kid with 1 good eye who will subconsciously favor it. is that the case? (seriously asking) Whatever confounders aside.... the 2 papers I linked indicate a trend between severity of visual defect and degree of permanent damage. If you require 1 good eye in order to develop amblyopia (i really wish you guys had easier to type vocab, btw) then whatever. This also does not address the issues with permanent damage when correcting simple myopia which is where this all started. But we are now way way down the rabbit hole as far as the OP goes
 
spectargt, let me get this straight you are a medical student who comes to optometry forums to explain ODs about the effects of incorrect prescription. You my friend have way too much time on your hand. Just let it go, I don't think any OD here will be continuing this debate with you any further, well at least in a way you would like to.
 
spectargt, let me get this straight you are a medical student who comes to optometry forums to explain ODs about the effects of incorrect prescription. You my friend have way too much time on your hand. Just let it go, I don't think any OD here will be continuing this debate with you any further, well at least in a way you would like to.

no, it was an example that got taken down 9 different tangents as a part of a broader point which related directly with the OP. but what can ya do, amirite? :confused::rolleyes:
 
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