Legalized Sight Testing, Online Order of CLs, Mandatory PD with Rx, etc. in BC

[Optogal]

British Columbia is very "progressive" with its eyecare standards...

http://www2.news.gov.bc.ca/news_releases_2009-2013/2010HSERV0015-000286.htm

NEWS RELEASE
For Immediate Release
2010HSERV0015-000286
March 19, 2010
Ministry of Health Services


B.C. MODERNIZES REGULATIONS FOR SALE OF EYEWEAR

VICTORIA – The Province introduced a series of changes today that will modernize the way in which British Columbians get their glasses and contact lenses, and give them more choice, announced Health Services Minister Kevin Falcon.

"After lengthy consultation on some of these issues, and a recent court decision that caused us to take a broader look at all the existing regulations, now is the time to take action," said Falcon. "With advances in technology and more consumers turning to the Internet, it makes sense to modernize a decades-old system to give British Columbians more choice while maintaining public safety."

The Province is giving six weeks' notice that effective May 1, 2010, changes will be made to the regulations for opticians and optometrists under the Health Professions Act, including:

· Removal of most of the restrictions that allow only opticians or optometrists, or workers supervised by them, to dispense glasses or contacts.
· Allowing prescriptions issued by medical doctors and optometrists outside of the province to be filled within B.C.
· Allowing people to order glasses or contacts online without having to give the seller a copy of their prescription, sight-test assessment or contact-lens specifications.
· Requiring opticians and optometrists in B.C. to include in a prescription or sight-test assessment the measurement of distance between the client's pupils, which is required for the proper fitting of glasses.
· Requiring opticians and optometrists in B.C. to give clients, free of charge, a copy of their prescription, sight-test assessment or contact-lens specifications – whether or not it is requested by the client – and also to give a copy, free of charge, to a third-party eyewear seller or other person if requested by the client.

The initial fitting of contacts to determine the lens specifications will still be done only by an optician, optometrist or medical doctor, or workers supervised by them, using information contained in a prescription or sight-test assessment.

Also taking effect on May 1 is a change to optician sight-testing. Opticians will now be able to independently conduct sight-tests for healthy clients aged 19-65. This eliminates the extra step of having a sight-test reviewed by a medical doctor who then issues a prescription. Instead, a screening process will be put in place to ensure a client is healthy enough to be eligible for the sight-test, and is fully informed about the difference between a sight-test and an eye-health examination.

The screening process will also require the optician to refer a client to a medical doctor or optometrist if the client has a specified pre-existing condition or if certain test results occur. Regular eye-health examinations will still be recommended for all British Columbians, who should consult a medical doctor or optometrist about how often they should have an eye-health examination.

An October 2009 decision by the B.C. Court of Appeal found that Coastal Contacts, a B.C.-based online eyewear seller with approximately 120 employees, is contravening the regulations by dispensing contact refills without seeing a prescription. These regulatory changes will address the court decision.



---------------------------


Doesn't this effectively eliminate the need for a professional optician?

Isn't the last paragraph odd? It seems they changed the regulations in order to allow a vendor to continue selling his contact lenses that were in contravention with the regulations.

---

Members don't see this ad.

 

[ibalz]

British Columbia is very "progressive" with its eyecare standards...

http://www2.news.gov.bc.ca/news_releases_2009-2013/2010HSERV0015-000286.htm

NEWS RELEASE
For Immediate Release
2010HSERV0015-000286
March 19, 2010
Ministry of Health Services


B.C. MODERNIZES REGULATIONS FOR SALE OF EYEWEAR

VICTORIA – The Province introduced a series of changes today that will modernize the way in which British Columbians get their glasses and contact lenses, and give them more choice, announced Health Services Minister Kevin Falcon.

“After lengthy consultation on some of these issues, and a recent court decision that caused us to take a broader look at all the existing regulations, now is the time to take action,” said Falcon. “With advances in technology and more consumers turning to the Internet, it makes sense to modernize a decades-old system to give British Columbians more choice while maintaining public safety.”

The Province is giving six weeks’ notice that effective May 1, 2010, changes will be made to the regulations for opticians and optometrists under the Health Professions Act, including:
· Removal of most of the restrictions that allow only opticians or optometrists, or workers supervised by them, to dispense glasses or contacts.
· Allowing prescriptions issued by medical doctors and optometrists outside of the province to be filled within B.C.
· Allowing people to order glasses or contacts online without having to give the seller a copy of their prescription, sight-test assessment or contact-lens specifications.
· Requiring opticians and optometrists in B.C. to include in a prescription or sight-test assessment the measurement of distance between the client’s pupils, which is required for the proper fitting of glasses.
· Requiring opticians and optometrists in B.C. to give clients, free of charge, a copy of their prescription, sight-test assessment or contact-lens specifications – whether or not it is requested by the client – and also to give a copy, free of charge, to a third-party eyewear seller or other person if requested by the client.

The initial fitting of contacts to determine the lens specifications will still be done only by an optician, optometrist or medical doctor, or workers supervised by them, using information contained in a prescription or sight-test assessment.

Also taking effect on May 1 is a change to optician sight-testing. Opticians will now be able to independently conduct sight-tests for healthy clients aged 19-65. This eliminates the extra step of having a sight-test reviewed by a medical doctor who then issues a prescription. Instead, a screening process will be put in place to ensure a client is healthy enough to be eligible for the sight-test, and is fully informed about the difference between a sight-test and an eye-health examination.

The screening process will also require the optician to refer a client to a medical doctor or optometrist if the client has a specified pre-existing condition or if certain test results occur. Regular eye-health examinations will still be recommended for all British Columbians, who should consult a medical doctor or optometrist about how often they should have an eye-health examination.

An October 2009 decision by the B.C. Court of Appeal found that Coastal Contacts, a B.C.-based online eyewear seller with approximately 120 employees, is contravening the regulations by dispensing contact refills without seeing a prescription. These regulatory changes will address the court decision.



---------------------------


Doesn't this effectively eliminate the need for a professional optician?

Isn't the last paragraph odd? It seems they changed the regulations in order to allow a vendor to continue selling his contact lenses that were in contravention with the regulations.

That's just great...

 

[Optogal]

So opticians are now all refractionists. (what will they charge for a refraction?)

Patients can buy all their eyeglasses and CLs online, without even providing a prescription or CL specifications.

It's an eyecare free-for-all...

 

[ibalz]

So opticians are now all refractionists. (what will they charge for a refraction?)

Patients can buy all their eyeglasses and CLs online, without even providing a prescription or CL specifications.

It's an eyecare free-for-all...

It'll be optical anarchy in BC

 

[Optogal]

It'll establish new lows in terms of price for eyewear and CLs, since essentially anyone can sell them now.

 

[Mrseyedoctor]

Does this mean that British want to eliminate optometry field? Opticians can do refraction for healthy patient but if opticians don't look at the back of the eyes then how can they know if patient is healthy or not? Online sellers can sell glasses or contacts without a prescription?? Isn't this odd?

Is this source reliable? It seems like anyone can buy glasses or contacts because the buyers doesn't need to submit in their prescriptions to the sellers.

 

[Optogal]

It is the government of British Columbia website.

BC has always been on the forefront of opticianry scope expansion. A few years ago (not sure now), it's said the Minister of Health's sister was an optician. It was during this time BC began the legislation to allow optician sight testing.


What I don't understand is why contact lenses are permitted to be so freely dispensed. Don't people realize the risks of careless dispensing? A CL is a medical device with a risk of harm. Now, it seems any one selling bubble gum can sell CLs.

 

[physicslover]

Hopefully none of the other provinces, follow their lead.

 

[Optogal]

>Hopefully none of the other provinces, follow their lead.

I think Alberta is usually close behind, because their sight-testing laws are apparently quite similar to those in BC.

>What exactly is a 'sight test'? Is that just the optician shooting out an Rx for glasses with an autorefractor or half ass refraction and its ok without an OD or OMD?

Essentially yes, but usually without the half-ass refraction part. So a sight-test is typically an autorefraction followed by a VA with that autorefraction result. Assuming they see ~20/20, they are good to go with regards with a spectacle dispense.


It's really confusing how the laws were essentially all changed to eliminate all barriers to acquiring glasses/CLs - why do they think this is a good idea?

 

[itek2OD]

from the Vancouver Sun....
http://www.vancouversun.com/health/Buying+glasses+Internet+approved/2706539/story.html

 

[Katalio]

Sight Testing is actually done via a computerized system called "EyeLogic". Optical shops rent/buy these machines in order to do sight testing. The system include a phoroptor (not the manual ones) and a computer.

And yep, BC eye care just went down the drain
You wont' believe how many people do not know the difference between sight test and Eye exam even after a page long explanation.

 

[stonegoat]

"Sight-testing" by opticians has been wide-spread in BC for over 10 years. I have never practiced in a community that didn't have a sight-tester. Does it impact optometry? I guess...however, I am always fully-booked. Honestly, I really don't desire to have the type of patient in my practice that wants a "free" sight-test anyway. We actually tell patients where to go for a free sight test if they b!tch about the cost of an exam.

The BC Association of Optometrists has fought hard to try and get rid of sight-testing, however, the government has never really seen a problem with it.

Anyway, patients have been and will be harmed from missed pathology because of sight-testing, so it's regrettable, however the sky is not falling on optometry in BC.

 

[Haystack]

...But sight testing has not previously existed without a "signature from a prescriber". Now, this will be done without supervision by any optician who wants to. We essentially just gained another 1400 or so prescribers in the province. When they start charging a fee for that service and add things like NCT and fundus cams in addition to the biomicroscopy in their "screening for health problems", do we still expect the average person to know the difference?

 

[Optogal]

That is a big difference (not needing a doctor signature).

Teaching refraction to opticians will now be a big business. Imagine that - a 6-month course in opticianry in BC allows you to refract and dispense. Good deal.

 

[Dogod]

The problem is that most sight testers have advertised or claimed that their 5-10 min Rx check is an actual "eye exam" to keep people coming in the door for their ultimate eyewear purchase. All ECP's know that over 80% get their glasses where they get their eyes checked. People who have never experienced an actual complete eye exam will never know any difference.

 

[Katalio]

I thought previously Opticians were not allowed to charge for a sight test; however, I guess that will change very soon. Sooner or later, BC residents won't be able to tell who's who!

@StoneGoat: Where do you practice? I'll join you!

 

[lnh]

from the Vancouver Sun....
http://www.vancouversun.com/health/Buying+glasses+Internet+approved/2706539/story.html

Interesting article, itek2OD.

Excerpt from the link:

However, Victoria optometrist Stephen Taylor said he is concerned about what he sees as a pattern of deregulation. "Regulations are put into effect for a reason. A lot of things are there for public safety."

Taylor said someone could renew a glasses prescription for the next 50 years without having his or her eyes examined. "Or people actually change their prescriptions when they call into these places because there's nothing in place to verify the prescription. ... This is the problem.

"Right now, you can go online without a prescription and order something -- and how safe is that?"

But Hardy argued that consumers are better served when optometrists are distanced from the marketing of eyewear.

"Your eye doctor tends to have a conflict of interest," Hardy said. "He's both a retailer and a prescriber. When you have somebody who's prescribing contact lenses to you on a profit-per-patient basis, it's not necessarily the same as when a doctor chooses a heart medication for you.

"That's the challenge for optometrists and opticians. They profit from what they prescribe."​

I wonder: Which is the greater evil?

 

[Dogod]

Dentists also profit from the appliances and services they prescribe. However, their services and appliances are much more specialized and custom fit for the patient - technically impossible for a commercial retailer to provide and make a profit.

 

[stonegoat]

That is a big difference (not needing a doctor signature).

Teaching refraction to opticians will now be a big business. Imagine that - a 6-month course in opticianry in BC allows you to refract and dispense. Good deal.

Sight-testing opticians have not had their prescriptions signed by an OD or OMD in quite a few years, despite their own regulations. Not much will change.

I am not trying to convey indifference to sight-testing....I don't agree with it at all. I'm just not worried about it's impact. I get a few patients here and there who have had sight tests, but eventaully they feel the need for a thourough exam and see me.

Also...the experience of a sight-test and a full oculo-visual assessment performed by an OD is quite different (or at least it should be). I have many patients who return to me after being sight-tested. They felt like something was missing...which is true.

Free sight tests will attract people who place low price over quality. Not great patients for a private practice OD anyway.

If price were the only motivation for patients, how do high-end private clinics compete with America's Best?? The truth is they don't compete...not really anyway. The same holds true for sight-testing. Believe me, I know, as I have always practiced in comminities with sight-testing. In fact, the local sight-testing optician is a patient of mine, as is her mother. Even they know the difference.

Sight-testing WILL spread to other provinces and even the USA, because now Walmart is involved. They have a store in Terrace, BC with sight-testing, rather than an OD. Think about it...no more trying to recruit ODs that take 8 years to train. They can now recruit in-house, put someone through 6 months of training and away they go selling glasses like crazy.

 

[Dogod]

When Walmart and other retail optical chains realize they OD can be replaced with a less expensive refractionist, there will certainly be an oversupply of OD's which is not good for the profession.

 

[Fnick]

I personally am okay with sight testing if the operator is properly trained, for the simplest cases at least. Refraction is not rocket science nor witchcraft. It is really the consumer's option whether or not they want to pay significant (yet reasonable) amount of money for their eye exam by an optometrist.

 

[Mrseyedoctor]

I personally am okay with sight testing if the operator is properly trained, for the simplest cases at least. Refraction is not rocket science nor witchcraft. It is really the consumer's option whether or not they want to pay significant (yet reasonable) amount of money for their eye exam by an optometrist.

Of course nothing in this world is impossible to learn and that's why there is medical school, engineer school, and of course optometry school (if one wants to do refraction).. It is not just refraction but there is a thing call the "art of prescribing". One have to go to school and learn what and when is appropriate for the patient. It is not as simple as flipping the dials and write an Rx for the patient (if you are a good doctor). Inappropriate Rx can harm your eyes more than helping. Optometrist (and all other professions) have to pay staff, malpractice insurance, equipment, tuition, time sacrifice in school etc, therefore, the exam price is in consideration to those factors too and not that optometrist/any professional just want to rip you off. Good luck...

 

[Katalio]

Of course nothing in this world is impossible to learn and that's why there is medical school, engineer school, and of course optometry school (if one wants to do refraction).. It is not just refraction but there is a thing call the "art of prescribing". One have to go to school and learn what and when is appropriate for the patient. It is not as simple as flipping the dials and write an Rx for the patient (if you are a good doctor). Inappropriate Rx can harm your eyes more than helping. Optometrist (and all other professions) have to pay staff, malpractice insurance, equipment, tuition, time sacrifice in school etc, therefore, the exam price is in consideration to those factors too and not that optometrist/any professional just want to rip you off. Good luck...

I totally agree with you Mrseyedoctor for the most part; however, basic refractions are not very difficult. With proper training in refraction, lessons on Binocular vision and knowing where to stop trying, I think properly trained opticians may do a pretty darn good job. Only when it comes to refraction requiring prisms, or ADD for Eso, or dealing with high anisometropia, it takes more training/knowledge. Having said that, there are more to the eyes than just refraction. They are required to sign some forms acknowledging refraction isn't eye exam, but I doubt anyone going to care about that!

Sight Testing in BC is actually more than just an AR actually.
It actually takes a LOT longer (approx. a good 20-30 minutes) for the sight test.

 

[Fnick]

I totally agree with you Mrseyedoctor for the most part; however, basic refractions are not very difficult. With proper training in refraction, lessons on Binocular vision and knowing where to stop trying, I think properly trained opticians may do a pretty darn good job. Only when it comes to refraction requiring prisms, or ADD for Eso, or dealing with high anisometropia, it takes more training/knowledge. Having said that, there are more to the eyes than just refraction. They are required to sign some forms acknowledging refraction isn't eye exam, but I doubt anyone going to care about that!

Sight Testing in BC is actually more than just an AR actually.
It actually takes a LOT longer (approx. a good 20-30 minutes) for the sight test.

Very well said Katalio. I figure as much as ODs want Opticians to understand their POV, vise versa holds true. I encourage opticians to seek further training in refraction and understanding of basic eye health. Opticians should present themselves as trained eyecare professionals, not merely sales representatives.

 

[Mrseyedoctor]

aren't there enough battles between the 3 O's already?? I can understand an optician supervise by an optometrist but an optician train to work independently is not a good idea.. if optician is train or going to school for refraction then eventually they will charge the same fee as an optometrist so what's the point? why not just go to optometry school? this doesn't make sense to me at all.. maybe someone can help me clear the purpose of it...

 

[Kane2000]

well it's pretty easy to see their intent. BC is simply trying to erode the status of optometrists and make things much cheaper for patients (albeit at a high risk).

So right now I don't see the point of going to optom school. I mean if a diploma qualified optician is allowed to do the things that takes up a majority of an optometrist's time, what the hell is the optom going to do? I suppose a lot more internet surfing time. Depressing world.

I blame the damn internet. And the ophthals for not letting optoms not do minor surgery.

 

[Dogod]

Coastal Contacts and big business has significantly influenced the politicians; the legislation is so obviously written to benefit internet vendors even going so far as to legislate what an ECP has to write on the Rx. Nothing in it truly benefits the public. There is nothing in it regarding Rx verification. Interesting that rx requirements for ophthalmologists or refracting MD's were omitted.
This scheme is counting on the free services currently provided - opticians providing "free" sight tests, ECP's providing free eyewear services such as frame adjustment. This way the government can pitch it to the public that this is a free/more affordable eyecare.

 

[IndianaOD]

Very well said Katalio. I figure as much as ODs want Opticians to understand their POV, vise versa holds true. I encourage opticians to seek further training in refraction and understanding of basic eye health. Opticians should present themselves as trained eyecare professionals, not merely sales representatives.

Opticians better not be allowed to make any assessment of ocular health. If they start doing IOP measurements and photos etc this is practicing optometry/medicine.

Refracting opticians doing stand alone care moves opticians from eye care colleagues to competitors.

BC ODs better start getting refunds on their education and $100k for each year of school they wasted.

 

[dontlikephysics]

This comment really annoyed me...
"Your eye doctor tends to have a conflict of interest," Hardy said. "He's both a retailer and a prescriber. When you have somebody who's prescribing contact lenses to you on a profit-per-patient basis, it's not necessarily the same as when a doctor chooses a heart medication for you.
"That's the challenge for optometrists and opticians. They profit from what they prescribe."

Okay, so granted a heart medication and contact lens are not the same, but they serve the same purpose as being prescribed to patients to improve their quality of life. Optometrists are not just prescribing contact lenses to people because they need the money, it is a judgment they are making based on their education and results of the eye exam.

 

[Danae00]

.

 

[Penguin2012]

Why stop just with glasses and CLs? While we're at it, let's make it legal for me to order Ritalin for my son without a prescription. Who the hell needs a doctor/pharmacist?

Stupid regulations always getting in the way. I can read the instructions on how much dosages to take and when. And it's MY choice as to when I want to take them, I shouldn't have to go to a doctor. He's only there when I need to go to the emergency room.

 

[KHE]

This comment really annoyed me...
"Your eye doctor tends to have a conflict of interest," Hardy said. "He's both a retailer and a prescriber. When you have somebody who's prescribing contact lenses to you on a profit-per-patient basis, it's not necessarily the same as when a doctor chooses a heart medication for you.
"That's the challenge for optometrists and opticians. They profit from what they prescribe."

Okay, so granted a heart medication and contact lens are not the same, but they serve the same purpose as being prescribed to patients to improve their quality of life. Optometrists are not just prescribing contact lenses to people because they need the money, it is a judgment they are making based on their education and results of the eye exam.

As a practicing OD for 10 years, I would like to say a couple of things about that:

First of all, the profit margin on materials, contact lenses in particular is so razor thin that it makes no sense for any doctor to "prescribe" something for the benefit of the doctor to make money because there's really no money to be made.

Glasses are a bit more profitable I guess but even then, it makes little sense for me to say to someone if they ask me (and they do all the time) "yes, you MUST get this $300 pair of glasses" for a miniscule change in an Rx. I guess it's conceivable that I could tell them to do it and they will because I said so but I never do because what happens is that the patient pays $300 for a pair of glasses and then rather than seeing a whole heck of a lot better, they only see slightly better or perhaps not even better at all. Then they're furious with me for having spent $300 for no benefit. What good is that? How is that helpful to anyone, including me? Now I've got an aggitate patient running all over town telling people that they spend $300 at my office and they don't see any better. Lovely.

And while a heart doctor may not profit from medications he prescribes, he certainly would profit from say, a pacemaker, or a recommended bypass, or an angioplasty.

In our own field, ophthalmologists profit from cataract surgery, lucentis injections, fundus photos etc. etc. and those things are far more "profitable" than 4 boxes of acuvues.

Fact is, that ANY professional of ANY type stands to make some sort of profit from what they recommend to you, whether it's your doctor, your plumber, your car mechanic or whatever.

So I've never quite gotten the fuss about all of that. Part of the social contract that doctors have with the general public is that we won't be pigs about it and abuse what is essentially a position of power. And for the most part, I think doctors do a very excellent job of that. There's always a few bad apples in every barrel but I think those are few and far between.

 

[scvcstar]

My classmate is from Vancouver and urged the entire optometric community at UC Berkeley School of Optometry to write to the legislators in Canada. You can help out too:

Dearest colleagues,

I'm usually not the lobbying kind, but recently I've learned about a disturbing new legislation that is being passed in my native British Columbia, Canada. If it is allowed to come to fruition it could set a dangerous precedent for optometry everywhere. In this legislation, people will be able to get eyeglasses from online vendors with the results from a sight test ALONE, without any input from an optometrist.

As you are all very aware, this is an endangerment to public health and safety, with many eye diseases such as glaucoma and AMD easily slipping under the radar without a comprehensive eye examination being performed.

I am asking for your help to tell the BC government that this is a unwise move on their part!! The official news release from the BC Association of Optometrists is available here: http://www.optometrists.bc.ca/code/navigate.aspx?Id=156

The two people who are most in charge are the Hon. Gordon Campbell ([email protected]), the premier of the province and the provincial political leader; and Hon. Kevin Falcon, the Minister of Health Services ([email protected])

Other people that have a say in this matter are local Members of the Legislative Assembly (if you don't want to email the people above, then pick a name below that you like):
Kash Heed ([email protected]) – minister of public safety
Mary Polak ([email protected]) – minister of children and family development
Jenny Kwan ([email protected]) – local constituency member
Carole James ([email protected]) – local constituency member
Moira Stilwell ([email protected]) – local constituency member

Like in the USA, the population of Canada is rapidly aging and more at risk for eye diseases. These convenience "incentives" lead people to think eye exams aren't important, with dire consequences.

Help protect optometry in North America!! There are sample letters available on the website.

Sincerely,
AS (Class of 2011)


Here's my personal letter, feel free to copy it and adapt it for your own school/experiences:

Dear Hon. Gordon Campbell and Hon. Kevin Falcon,

As an optometry student in training at the University of California, Berkeley, School of Optometry, it is with apprehension and dismay that I have learned about the recent legislation proposing that "sight testing" be sufficient to obtain vision correction in the form of glasses or contact lenses without an eye examination by a trained eyecare professional in British Columbia. It is not in the general public's best interest to allow this breach of health safety, and passing this legislation will cause great harm. Please take the time to read my perspective on why comprehensive eye examinations for all individuals are just as important, if not more, than regular physical examinations.

First of all, automated testing devices cannot accurately predict a person's eyeglass and contact lens prescription. The actual prescription depends on many other factors, including how a patient plans to use their eyewear. Eyecare professionals often use automated devices in clinic to get a rough measurement, but this measurement must be fine-tuned with other tests and integrating the patient's desires in order to design the best prescription for each individual patient. Contact lens prescriptions and eyeglass prescriptions are also usually different from each other, and only a trained eyecare professional is capable of determining the best prescriptions for a patient's needs. It is especially important for a trained eyecare professional to evaluate contact lenses on the patient's eyes, because this is a medical device that has the potential to adversely affect eye health, leading to permanent vision loss if not used properly and monitored yearly. There are many different types of contact lenses, and determining which one is best for a particular patient can only be done by the eyecare professional, not by any automated devices.

In addition to numerous studies, my own patient care experiences have shown me that many common eye conditions, such as diabetic retinopathy, glaucoma, and age-related macular degeneration, can progress asymptomatically for many years until the damage to vision is severe and irreversible. As a clinician, it is troubling any time that I must tell someone that their vision loss is permanent – and that it was preventable. The eyes are also the window to the body as a whole, and because the eyes are the only place where blood vessels can be viewed by non-invasive procedures, many systemic conditions such as high blood pressure and high cholesterol are often first manifested in the eyes before they cause any noticeable problems in the body, because the eye contains the most fragile and vulnerable blood vessels. Caught early, these systemic conditions can be treated early and prevent vision loss as well as major health problems and even early death.

In addition, it is important that patients monitor the progression of their presbyopia (a condition that affects everybody past the age of 45, necessitating the prescription of reading glasses, which cannot be automated) and cataracts. Furthermore, it's not just adults that need eye examinations. It is equally important for children to receive regular eye examinations to rule out risk for amblyopia or other causes of vision loss or visual deficiencies in young people. This new legislation would endanger patient safety in that more members of the public, while they may "feel healthy," will put themselves at risk for severe ocular disease and vision loss if they do not pursue regular eye examinations.

In the same way that every individual should monitor their cholesterol, suspicious moles, and blood pressure, it is important that people not only look for new developing diseases in their eyes that can compromise their general health, but also for changes in pre-existing conditions. What can present as "normal" one year could very well be problematic the next. "Sight testing" is only a test of sight that one currently has, and not an indicator of more sinister or developing problems.

For the safety of the public I implore you to rethink this legislation and the harm that will be done to the health of the public if it is passed. Your constituents will thank you.

Sincerely,
EY
Third Year Optometric Intern
University of California, Berkeley
School of Optometry

 

[IndianaOD]

You could also ask the BC people why barbers and hair stylists need a license but you can play eye doctor all by yourself.

 

[Dogod]

Last year Coastal Contacts donated $10,300 to the BC Liberal party between Arpil 20 and Dec. 13, 2009. Their only other donation was in 2005 for $7500.
This out of the blue change in policy even goes against what the gopverning liberal party just approved.

Who is minister Falcon's eye doctor? He wears spex. Is he actually wearing specs he bought off the internet?

 

[serenmoon]

This is great news for Canadians! If we want the health of our eyes checked then go to a doctor, pay extra for picture of your retina and Goldmann visual field testing etc. If not, just buy glasses and contacts online, particularly those of us whose prescriptions are stable. If OD's want to be seen as doctors then I think they should be primarily concerned with eye health, NOT being the person who sells me eyeglasses.

Business for ODs will not change much considering people with private health insurance plans will still go for the whole exam, don't you agree?

Before you remind me, yes I am a med student and yes I know about the threat of NPs. This issue also affects you as optometry students. How long before NPs are completing extra training and becoming qualified to perform eye exams?

 

[Mrseyedoctor]

Serenmoon!

Are you sure you in Med school? The point here is not about optometrist not being able to sell glasses or contacts anymore but it's wrong and harmful for people to order contacts or glasses WITHOUT a prescription from an optometrist or an ophthalmologist. Obviously you need to take some optic and physic courses. If this law pass then you need to be careful whenever you are in BC because you might get hit by car (if you know what I mean). Also, there is no way I will let my surgeon do surgery on me if he buys glasses online.

 

[PBEA]

Very well said Katalio. I figure as much as ODs want Opticians to understand their POV, vise versa holds true. I encourage opticians to seek further training in refraction and understanding of basic eye health. Opticians should present themselves as trained eyecare professionals, not merely sales representatives.

"further training", that's funny in most parts of the country all the "education" an "optician" requires is to have a high school diploma, or GED. You do realize that there is NO formal training process required of opticians. That being the case for the most part the exact job description for an optician is indeed "slaes representative".

I'm sure the public will love having their "sight tested" by someone who just got back from the prom.

 

[stonegoat]

Although "sight-testing" is not good for patients, I don't really think it will have a noticable impact on private practice ODs. I've always practiced within 10 minutes of sight testers and am always super busy. Again I reiterate, the type of patient that wants a free sight test and $69 glasses, is NOT the type of patient most ODs want anyway.

The bigger threat to optometry as we know it, is unregulated internet dispensing of CLs and more importanly, glasses. It's impossible for an optical lab in Canada or the US to match prices with a lab in Pakistan, where the labour are paid maybe $1.00/day.

Personally, I think in the next 7-15 years, we will see a lot more non-dispensing ODs in practice. With the low over-head of non-dispensing practices it's very possible to make a lot of money with fewer headaches.

Darwin stated that it's not the strongest or largest species that survive over time, but those that are most adaptable to change. Wise words for optometry over the next decade or so.

 

[tralin78]

This is great news for Canadians! If we want the health of our eyes checked then go to a doctor, pay extra for picture of your retina and Goldmann visual field testing etc. If not, just buy glasses and contacts online, particularly those of us whose prescriptions are stable. If OD's want to be seen as doctors then I think they should be primarily concerned with eye health, NOT being the person who sells me eyeglasses.

Business for ODs will not change much considering people with private health insurance plans will still go for the whole exam, don't you agree?

Before you remind me, yes I am a med student and yes I know about the threat of NPs. This issue also affects you as optometry students. How long before NPs are completing extra training and becoming qualified to perform eye exams?

I think you're underestimating what an OD actually does do. You say it's perfectly fine for someone with a stable prescription to get a new Rx this way.. Who's to say your prescription is stable? You? The optician? You're taking the decision making out of the doctor and putting it in your own. It's the exact same thing as people not getting routine physicals because they feel "fine" when in reality they're completely unhealthy.... the difference is a lot of conditions in the eye might mask themselves as just simple "blurry vision" when in reality it's a far more serious problem.... you're neglecting the entire point of a comprehensive eye exam. People don't generally go to an OD thinking they have a disease in the back of the eye, they go because they feel like they need glasses. Through the comprehensive exam, a disease might be discovered that otherwise wouldn't if people just go get a quick refraction and go on their way. An optician might get someone's best corrected VA at 20/40 and that person might actually be happy with it... but why are they only correctable to 20/40? They're not going to know that they have diabetic ret, ARMD, etc... Not to mention contacts aren't something you should just throw on your eye and do what you want with them. There are many health risks associated with using contact lenses. There are also many, many conditions where contact lenses are contraindicated and can actually lead to permanent decreased vision.

 

[Haystack]

Although "sight-testing" is not good for patients, I don't really think it will have a noticable impact on private practice ODs. I've always practiced within 10 minutes of sight testers and am always super busy.

Its just that kind of complacency that has made it possible for sight-testing to proliferate in B.C. in the first place. They have used the argument of "we've been doing this safely for years" to push for the increased scope. Never mind the fact that most of them have been using unsigned prescriptions for most of this time because the College of Physicians took a stand against the practice early on.

I have many patients that think the examination is over after some quick pre-testing and a refraction so what would they think they have received at a sight-test? i.e. to many, eye exam = phoropter in front of face, regardless of what you tell them. I also get a lot of mystified looks when I tell patients that the sight-tester that they saw last was not an eye doctor.

There will be many consequences if this dangerous legislation goes through and we will all see the effects at some point. I think its more about our health care standards in B.C. than everyone's individual bottom line.

 

[stonegoat]

Its just that kind of complacency that has made it possible for sight-testing to proliferate in B.C. in the first place. They have used the argument of "we've been doing this safely for years" to push for the increased scope. Never mind the fact that most of them have been using unsigned prescriptions for most of this time because the College of Physicians took a stand against the practice early on.

I have many patients that think the examination is over after some quick pre-testing and a refraction so what would they think they have received at a sight-test? i.e. to many, eye exam = phoropter in front of face, regardless of what you tell them. I also get a lot of mystified looks when I tell patients that the sight-tester that they saw last was not an eye doctor.

There will be many consequences if this dangerous legislation goes through and we will all see the effects at some point. I think its more about our health care standards in B.C. than everyone's individual bottom line.

You couldn't be more wrong. I find it annoying that you assume the BC Association of Optometrists has been "complacent" offering no resistance to sight-testing. The BCAO has spent YEARS fighting sight-testing, with many individuals sacrificing massive amounts of personal and professional time trying to educate government and get them to enforce standards of eyecare. It has been a long-fought battle, and your assumption is insulting.

Do I think sight-testing is good for patients...of course not...but I also know that once patients have has a full eye exam with me, they will never be satisfied with a sight-test. All I was trying to say was that from a financial standpoint, it's not a threat.

 

[Haystack]

You couldn't be more wrong. I find it annoying that you assume the BC Association of Optometrists has been "complacent" offering no resistance to sight-testing. The BCAO has spent YEARS fighting sight-testing, with many individuals sacrificing massive amounts of personal and professional time trying to educate government and get them to enforce standards of eyecare. It has been a long-fought battle, and your assumption is insulting.

Do I think sight-testing is good for patients...of course not...but I also know that once patients have has a full eye exam with me, they will never be satisfied with a sight-test. All I was trying to say was that from a financial standpoint, it's not a threat.

I'm not assuming anything. I'm well aware of the efforts of the BCAO and have done my share of investigating and letter-writing from the very beginning. Sadly, the government has turned a blind eye to this for ten years. There is no "teeth" in the current regulations, the government doesn't care, and that has allowed sight-testing to potentially move to the next level. The past BCAO efforts have failed categorically.

I'm insulted by the complacent attitude that we can just live with sight-testing and that the further legalization of it will have no impact on private practice ODs. Maybe if you practice in an isolated rural location with established and habitual patient flow you won't feel it financially, but I can assure you that this will hurt the average OD in this province even more than it does now once it goes mainstream. This is not benign. This is a government-advocated gutting of our profession.

 

[Optogal]

All I was trying to say was that from a financial standpoint, it's not a threat.

I think you are being too loose with your generalizations.

Not a threat? To what? You're right if you don't think you'll end up on unemployment.

Aren't you in a pretty remote place in BC? I agree certain high-end medical private practice optometrists will likely be less affected by online retailing and/or sight-testing, but are you saying this won't affect ANY optometrist at all, in any way whatsoever?

Can you claim with 100% certainty that you've never lost a single patient to a sight-tester?

I don't think you can honestly claim that.

 

[KHE]

I think you are being too loose with your generalizations.

Not a threat? To what? You're right if you don't think you'll end up on unemployment.

Aren't you in a pretty remote place in BC? I agree certain high-end medical private practice optometrists will likely be less affected by online retailing and/or sight-testing, but are you saying this won't affect ANY optometrist at all, in any way whatsoever?

Can you claim with 100% certainty that you've never lost a single patient to a sight-tester?

I don't think you can honestly claim that.

I too do not see this as a particularly strong "threat."

The fact is, people can go online RIGHT NOW and order all kinds of glasses, contact lenses, vicodin, oxycontin, viagara, phentermine, adderal et al. without prescriptions or without doctors consult or care.

And you don't even have to be that savvy or smart to "circumvent" prescription requirements.

Just discussing contact lenses, because that has been much more prevalent in the online world than spectacles, I've had dozens of patients over the years get lenses without exams for years and years for any one of the following reasons:

1) Companies fill Rx without verifying

2) Company intentionally "calls" to verify after hours and then fills Rx when you don't respond in 8 hours. (Gee, if you call at 8 at night and I don't respond by 4am...)

3) Because my last name begins with an E, some of the websites list doctors in a particular town in drop - down boxes. In my town, I'm listed first because no other OD nearby has a last name with A, B, C, or D. So numerous patients who aren't even MINE just click on my name because it appears first in a drop down menu.

4) I've had patients over the years who we HAVE been able to deny a prescription on and what they do is just re-order, but enter as the doctor's contact information, their OWN fax number. They then just either sign the form and fax it back themselves or don't sign it at all, and the prescription becomes "passively" verified.

This type of crap has been going on for YEARS. "Sight testing" doesn't seem likely to make it any worse.

 

[Optogal]

It'll affect some folks - fewer patients for those ODs in big-box opticals.

Not to mention, these opticals now have the legal standing NOT to put an OD into their store - they can do it themselves.

 

[stonegoat]

I'm not assuming anything. I'm well aware of the efforts of the BCAO and have done my share of investigating and letter-writing from the very beginning. Sadly, the government has turned a blind eye to this for ten years. There is no "teeth" in the current regulations, the government doesn't care, and that has allowed sight-testing to potentially move to the next level. The past BCAO efforts have failed categorically.

I'm insulted by the complacent attitude that we can just live with sight-testing and that the further legalization of it will have no impact on private practice ODs. Maybe if you practice in an isolated rural location with established and habitual patient flow you won't feel it financially, but I can assure you that this will hurt the average OD in this province even more than it does now once it goes mainstream. This is not benign. This is a government-advocated gutting of our profession.

:


I practice in a rural location with one sight-tester about 5 minutes walk from my office and another about a 45 minute drive. Being "rural" doesn't insulate from sight-testing.

There are currenlty almost 160 "sight-testing" locations in BC...they advertise in the paper, yellow pages, etc..how much more "mainsteam" can you get. People already think it's legit.

Don't get me wrong...I don't support sight-testing, but it is here to stay, in one form or another.

Rather than complain on this forum, why don't you volunteer to put in your time with the BCAO as either a councillor or executive?? Maybe you will have better luck dealing with governement that all those before you...

 

[Optogal]

While it may be "prevalent" now, it doesn't have a history. i.e. the folks going to sight-tests know they aren't getting an eye exam, because they've had an eye exam before.

What about the generation of kids growing up now, whose parents only bring them to sight-testers?

The potential here is for an entire generation of kids growing up who will be trained to think that sight-testing IS an eye exam. THAT will have an affect in the future, since they might think a visit to the eye doctor is only needed for those with eye disease. The corollary is that they may think that sight-testing is the "main" primary-care eye test for refractive error - and not a means of skimping on the costs of an eye exam, which is how people treat sight testing NOW.

The idea is - there is the risk that more people will begin to view the sight-test as standard of practice, particularly those folks who will grow up in an environment where they are never exposed to an eye examination.

 

[stonegoat]

While it may be "prevalent" now, it doesn't have a history. i.e. the folks going to sight-tests know they aren't getting an eye exam, because they've had an eye exam before.

What about the generation of kids growing up now, whose parents only bring them to sight-testers?

The potential here is for an entire generation of kids growing up who will be trained to think that sight-testing IS an eye exam. THAT will have an affect in the future, since they might think a visit to the eye doctor is only needed for those with eye disease. The corollary is that they may think that sight-testing is the "main" primary-care eye test for refractive error - and not a means of skimping on the costs of an eye exam, which is how people treat sight testing NOW.

The idea is - there is the risk that more people will begin to view the sight-test as standard of practice, particularly those folks who will grow up in an environment where they are never exposed to an eye examination.

Children up to 19 are NOT eligable for sight-tests...they will have to see an OD or OMD for their exams, so will know the difference.

I suggest that all ODs maintain membership to their state/provincial associations. The dues and special levies are important to help fund advertising campaigns designed to educate the public. Many of my patients present for an eye exam simply because they saw an advertisment on TV that educated them on all the diseases/disorders an eye exam can detect.

Educating the public is a win/win for ODs

 

[Optogal]

Children up to 19 are NOT eligable for sight-tests...they will have to see an OD or OMD for their exams, so will know the difference.

That's true. Although that could change.

Are children covered for eye exams by the provincial insurance?