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Medical Forum / General / Vision / July 2005

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How long does an RX last?

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timbirr@mailcity.com - 23 Jul 2005 00:18 GMT
Went to my opthalmologist in the spring and she decided I needed to
think about getting progressive lenses.

So, the doctor gave me a new prescription. Pre-printed on all the
prescriptions is the phrase "Not valid after four months."

I didn't really care, since I went off to get new glasses fairly
quickly. But, I was curious. I went to three different optical goods
stores -- all independent shops.

One is associated with a practicing opthalmologist. The second was
associated with two practicing optometrists, while the third store was
in a shopping center strip mall and has an optometrist available for
limited hours.

I really disliked the shopping center spot, but I asked the woman
helping me how long my prescription was valid for. She said four
months. No "ifs, ands or buts."

At the optometrist shop, I asked the same question. The woman told me
that the opthalmologist I consulted has the "four months" statement on
all prescriptions, but in our state, by law, Vision RX's are good for
two years.

At the final shop (where I ended up filling my RX), the one associated
with a different opthalmologist, the optican (and he was a certified
optican) told me that my opthalmologist was a fine doctor, but has a
thing about this four months, that it is a quirk and that they
routinely ignored the four month statement and If I needed it filled ,
say, seven months later, it would be no problem.

So, just curious about this expiring RX, what is the usual and
customary?
Mark A - 23 Jul 2005 02:04 GMT
> Went to my opthalmologist in the spring and she decided I needed to
> think about getting progressive lenses.
[quoted text clipped - 29 lines]
> So, just curious about this expiring RX, what is the usual and
> customary?

The laws in question are promulgated and enforced by each state. Most state
laws say that the Rx is good for 1 year (sometimes 2) from the date of the
exam, or the expiration date on the Rx, whichever is sooner.

The optical shop associated with a different ophthalmologist can legally get
around that since the different ophthalmologist can legally write his own Rx
(with or without giving you an exam).

Unless you have some special problem, the ophthalmologist is probably tying
to drum up more business by limited the Rx to 4 months. However, unless you
have some special eye problem, you are much more likely to get a better Rx
at an optometrist than an ophthalmologist, assuming that you make a slight
effort to find a respected optometrist.
timbirr@mailcity.com - 23 Jul 2005 07:13 GMT
As mentioned, the expiration was not really an issue with me, I was
just curious about the different interpretations of the "law."

I have ocular hypertension -- but no damage as of yet and no treatment
other than watchful waiting, so I see the opthalmologist regularly.

A bit curious why you would submit that an optometrist would give a
better exam than an MD. I would say they could give "just as good," but
I would be surprised if they consistently "beat out" the physician.
doctor_my_eye@msn.com - 23 Jul 2005 16:56 GMT
The can of worms that you have just opened has been debated for nearly
a hundred years.  The argument that an optometrist provides a better
glasses prescription is based on the premise that the two professions
are taught to view the eye differently.
An ophthalmology resident becomes an MD first, and then during his
residency he specializes in diseases and surgery of the eyes.  During
that two year residency he is expected to master his surgical
techniques and the diseases of the eye.  Refraction is often limited to
a couple of weeks study during a typical ophthalmology residency.
Opthalmologists training is based on the "medical model" of the eye.
That model of the eye views the eye like any other organ in the body.
When it breaks, you need to fix it.
An optometrist typically goes to undergrad for 4 years in any
scientific discipline, and then his entire 4 years of grad school are
dedicated to the eye.  An optometrist cannot do surgery on the eye and
never becomes an MD.  The optometrist views the eye with a different
orientation because he spends most of his 4 years on the "functional
model" of the eye.  The functional model is a series of beliefs that
view the eye as a gateway to the complex visual system, with an
emphasis on perception and interpretation of the image.  An optometrist
is more likely to prescribe prism in a pair of glasses before
strabismus surgery.  An optometrist is more likely to prescribe vision
therapy for a child who reverses his letters and numbers.  Refraction
is given much more emphasis during optometry school than during an
ophthalmology residency.

I often tell my patients that getting an eyeglass prescription from
your opthalmologist is like getting your physical from a cardiologist.
He can do one, but he probably hasn't done one for years and he doesn't
necessarily pay attention to all of the results.  You get your best
physical from a primary care doctor and your best refraction from an
optometrist.
William Stacy - 23 Jul 2005 18:43 GMT
> I often tell my patients that getting an eyeglass prescription from
> your opthalmologist is like getting your physical from a cardiologist.
> He can do one,

I like the analogy.  And he probably wouldn't want do do one and would
decline the request if he was worth his salt.

Same thing for your dental work.  Would you go to an endodontist for a
routine cleaning?  Unless the endodontist were very hungry (read that
unsuccessful), he would refuse anyway.

Having said that, sometimes an O.M.D. needs to do a refraction (e.g.
there seems to be no other obvious cause for a reduction in acuity than
refractive change), but then, he should let an O.D. (or maybe now a
refracting optician???) do the final refraction for prescribing. It
would save a lot of lab redos.

w.stacy, o.d.
Mark A - 23 Jul 2005 17:01 GMT
> As mentioned, the expiration was not really an issue with me, I was
> just curious about the different interpretations of the "law."
[quoted text clipped - 5 lines]
> better exam than an MD. I would say they could give "just as good," but
> I would be surprised if they consistently "beat out" the physician.

As I already said, if the "other" ophthalmologist owns the store where you
purchased the lenses, then the optician could legally get the "other"
ophthalmologist to extend the Rx expiration date even without giving you an
exam (but not past the default time for your state).

Ophthalmologists are medical doctors. They get the same general medical
training as all other doctors on a wide variety of medical issues. After
medical school, they go into residency for a specialty. When they open a
practice of their own, they spend most of their time dealing with eye
diseases, surgery, and only part of their time giving eye exams.

OD's are trained to give eye exams as part of their OD (Dr of Optometry)
schooling, and obviously eye care is the focus (no pun intended) of their
medical education. When they receive their OD degree and start working, they
spend almost all of their time giving eye exams.

Certainly, ophthalmologists are very intelligent people, but common sense
would suggest their on the job experience in giving eye exams (especially
for those without any eye diseases) is much less than an OD.

My own experience, having worn glasses for 50 years, has been that I have
had horrible Rx's from ophthalmologists, and generally very good Rx's from
OD's.
Dr. Leukoma - 25 Jul 2005 12:54 GMT
The answer to your question depends upon the laws of the state of
jurisdiction.  In Texas, there is no mandatory expiration date for a
spectacle prescription.  However, by the same token, it can be whatever
the issuing doctor says it is.  In the absence of an expiration date,
it is customary practice not to fill any prescription that is more than
two years/old.

With regards to eye examinations, an optometrist is held to the same
standard of care as an ophthalmologist in the eyes of the law.  In
Texas, it is quite common for MD's to delegate the refraction to a
technician.  In Texas, the rules governing optometry specifically
prohibit delegation of the refraction part of the exam.

DrG
 
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