 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Vision / June 2006sick of astigmatism (soft torics)
Just got my frequency 55 soft toric trial contacts after two weeks. Again, they are Frequency 55's, which I really hate. I wore contacts several years ago, and it took several tries to "get it right." I haven't worn them for about 4 years. I went to Eyeland and my prescription was: Right Eye: -4.25 x -3.25 x 020 Left Eye: -4.50 x -2.75 x 155 I got those trial contacts and they were bad. The left eye felt good but the right eye didn't seem to fit right and had frequent blurriness. I wasn't happy with Eyeland so I went to America's Best about three months later. My prescription was: Right Eye: -4.00 -3.75 x 025 Left Eye: -4.25 -3.25 x 155 So, which prescription is right? Why the change after just 3 months? After two weeks I got my trial contacts and at first they seem better than Eyeland's first attempt. The right eye seemed a bit clearer and feels better in my eye. But... after awhile stills get blurry and out of focus far too often especially at longer ranges. No matter who fits my contacts, it feels like the right eye is always messed up, as if there's a blurry film over my vision. The left eye doesn't feel as sharp as it did with Eyeland's trial pair, but again, better than my right eye which causes the problem. Also, as with the other contacts, even with two eyes, if i'm seeing clearly it's just a matter of time before everything gets blurry for a second or two before I have to blink many times to clear it up. what's the problem? are they not staying in place? what can they adjust if my prescription is correct? is there another brand other than frequency 55 that i can use? i have to schedule another appointment for the doctor to check my vision and make an adjustment. i'm sick of this. > Just got my frequency 55 soft toric trial contacts after two weeks. Again, > they are Frequency 55's, which I really hate. I wore contacts several > years ago, and it took several tries to "get it right." I'm not sure why that means you should "hate" a particular brand. F55 torics are about as stable and predictable as other brands. They also come in two shapes, and you didn't say which. > I haven't worn them for about 4 years. I went to Eyeland and my > prescription was: > > Right Eye: -4.25 x -3.25 x 020 > Left Eye: -4.50 x -2.75 x 155 > I got those trial contacts and they were bad. The left eye felt good but > the right eye didn't seem to fit right and had frequent blurriness. It helps to deal with vision and comfort as two separate issues. I gather the right eye *felt* ok, but the vision varied. > I wasn't happy with Eyeland so I went to America's Best about three months > later. Not necessarily a step upwards. Torics are tricky and America's Best usually caters to price shoppers. > My prescription was: > > Right Eye: -4.00 -3.75 x 025 > Left Eye: -4.25 -3.25 x 155 Believe it or not, those two prescriptions are very similar. Notice in each case the first number goes down but the second number goes up. Those changes offset each other and if you figure the spherical equivalent (a standard measurement of overall strength) you find each eye stayed exactly the same. Also notice that the third number (axis) was identical in the left eye and only changed by 5/180 in the right. > So, which prescription is right? You'd probably be happy with glasses made from either pair. They probably represent accurate measurements at different ends of normal diurnal variation. > Why the change after just 3 months? As I said, it isn't a big change. And astigmatism doesn't typically change much. But readings vary by +/-025 on the same day with the same examiner, so a variance of 050 over three months is no surprise. And one meridian got 025 steeper and the other got 025 flatter; that's typical of the variation you'd see in an individual. Probably the biggest variable is examiner instructions and the patient's own sensitivity to cylindrical blur. Other causes for variation are dehydration eg antihistamines, exposure, climate etc., as well as hormonal skin changes, sleep, and lots of others. But yours didn't change much. With toric contacts ( and glasses) it's usually preferable to undercorrect astigmatism than to overcorrect it. So if you were making glasses, use the first prescription. If *your* contacts are made the same strength as your glasses, something is wrong. NO toric will stay in place 100% of the time. If it does it's too tight. So instead of looking for the "right" contacts, try to find the least annoying of them. With your prescription, it's unreasonable to expect torics to be as sharp as glasses. If you want perfection, you should check into gas perm contacts. Sometimes they work out better than glasses but we'd need to know more about you. -MT, OD But the right eye is always bad and blurry. Why would they prescribe me soft torics when gas perm contacts are better? I have another appointment tomorrow -- the eye doc there seemed better @ America's Best. She was syrian, and seemed to care a lot more than the doltz at Eyeland. I'm sick of wearing glasses, thus, I'm going for contacts. >> Just got my frequency 55 soft toric trial contacts after two weeks. >> Again, they are Frequency 55's, which I really hate. I wore contacts [quoted text clipped - 70 lines] > > -MT, OD > But the right eye is always bad and blurry. Why would they prescribe me soft > torics when gas perm contacts are better? Because you insist on going to discount optical stores for your eyecare instead of private practice doctors. Gas perms (sometimes) require more time and to fit than soft and more experience. They are not available to "take and run" as are soft lenses. They are often less profitable in the short term than soft lenses. Hence you will not find them at discounters. And as you've been told, soft toric lenses in your prescription don't always work all that well and do require adjustments to the fit and power to optimize acuity. That takes time and more time means less profit for discounters. Additionally, the discounters may not be able to offer you more than one or two manufacturers. >I have another appointment > tomorrow -- the eye doc there seemed better @ America's Best. She was > syrian, and seemed to care a lot more than the doltz at Eyeland. I'm sick of > wearing glasses, thus, I'm going for contacts. Then find a doctor who has the skills to fit you with lenses that will satisfy your needs. Some of us actually enjoy the challenge of finding "the right fit" of lens material and design to make the experience as rewarding as possible---for both the wearer and the fitter. Good PR, you know. LB, O.D. >are they not > staying in place? what can they adjust if my prescription is correct? is > there another brand other than frequency 55 that i can use? > > i have to schedule another appointment for the doctor to check my vision and > make an adjustment. i'm sick of this. ------------ its tough to fit toric lenses on people with high astigmatism. the slightest movement and rotation causes noticable blur. the only way to find the best prescription is to try a prescription for a time (several days to a week), go to a follow-up appointment with the doctor, and allow him/her to adjust the prescription based upon the lens fit. with your prescription it isn't possible to simply run in for an exam and leave with perfect-fitting contact lenses. it doesn't work that way. you just need to accept that. gas permeable contact lenses are certainly a possibility but the reason that soft lenses dominate the contact lens market is that most people find the comfort (or lack of comfort) of the gas permeable lenses to be unacceptable. but you should try them anyway. if you are able to adapt to the feeling of gas permeable lenses they MAY provide you with better vision although, as you have been told, we do not have sufficient information about you to determine whether they might work or not. either get yourself in a mindset to take the time to find the optimal fitting contact lenses, or just wear your glasses. you are not going to be a simple patient to fit because of your high astigmatism and your impatience. also, I think it is irrelevant whether or not you go see a retail chain-based eye doctor or a doctor in private practice. I have seen good and bad doctors practicing in both situations. just find someone who is willing to invest the time it takes to best fit a patient like yourself, and then you need to accept that it is going to take some time too. Yeah, she said to be patient, it'll take a few tries. So, i'm going to do that. >>are they not >> staying in place? what can they adjust if my prescription is correct? is [quoted text clipped - 36 lines] > yourself, and then you need to accept that it is going to take some > time too. Well I went back and there was another doctor there. Some young guy. Seemed like a buffoon. Uh, I'll check the matrix and order a new pair and call you when they come in. Looks like I'm going to have to go to a contact lense specialist eventually. What would guy just out of college know about fitting high astigmatism soft torics. When he asked me to read the chart I couldn't see a thing lol. Letters were blurred like crazy. > Yeah, she said to be patient, it'll take a few tries. So, i'm going to do > that. [quoted text clipped - 39 lines] >> yourself, and then you need to accept that it is going to take some >> time too. > Seemed like a buffoon. If you want quality, why are you going to the optician-equivalent of a Wal-Mart? Your expectations and your choice of providers are simply not a good recipe for satisfaction. Didn't know it was the quality of Walmart. I specifically asked when I went in if they could prescribe proper contacts for me since i have a high astigmatism. They took the reading of my glasses and gave it to the female doctor, she said yes she can do it but it'll take a few tries. So I go back today to pick up the contacts and she's not there. Another doctor is there. I did not expect that since her name is on the door. I don't feel like its professional either. So far i'm only out $70 for the exam. Well, and $70 for the Eyeland contact exam a few months back which produced the same terrible results. Can nobody help me? >> Seemed like a buffoon. > [quoted text clipped - 3 lines] > Your expectations and your choice of providers are simply not a good > recipe for satisfaction. > Didn't know it was the quality of Walmart. I specifically asked when I went > in if they could prescribe proper contacts for me since i have a high [quoted text clipped - 8 lines] > > Can nobody help me? Duh. We've tried. LB, O.D. > So I go back today to pick up the contacts and she's not there. Another > doctor is there. I did not expect that since her name is on the door. I [quoted text clipped - 3 lines] > > Can nobody help me? I agree. $70 is what I would expect for an oil change, not for fitting a prescription like yours. Since you weren't charged a professional fee, I doubt you can expect to get professional service. DrG > Can nobody help me? Not to sound unduly sarcastic, but franchise-type optician outlets never give me a good sense of security. I did go to one for my last pair of glasses, but I got a scrip from my opthalmalagist who I'd been seeing for years, and my prescription has not changed in recent memory. I asked some very specific questions on why my practicioner's $500 glasses were qualitatively better than the $300 ones from the outlet. And their response did not satisfy me. So I felt little risk of shortchanging myself. And as it happens, the glasses I got from the outlet were perfectly fine. However: If I need an appendix removed, I won't go to Skalpels-R-Us. If I am having back spasms, I won't go to We-Krak-Em... I'll find a reputable practicioner with verifiable credentials, and ideally a track record with cases similar to my own, should my own be at all unusual. The same should hold for your vision, if it is important to you. No offense, but I don't think anyone here but you is surprised that you are unhappy. BD > > Can nobody help me? > [quoted text clipped - 18 lines] > > BD i think its irrelevant whether the eye doctor works out of his own private practice or whether he works out of a retail chain. i cant help but notice that the two doctors who spoke out in this thread have a biased against retail doctors-- i'm sure its because both are private docs. whats important is that you have a doctor who will take the time to properly fit you in the type of lenses you need. also-- whether you paid a high price or not is clearly irrelevant. personally, i have worked in both environments. currently i work part-time in a medical/surgical practice and also in a retail optometric business. my patients receive the same care in each location. i have the same access to the same materials in both locations except to costs for a simple refraction and contact lenses or glasses is MUCH less in the retail location. pardon my blunt comments short, but you need to quit whining about your situation. if you've found a doctor whom you like and you think will take the time to fit you well (and it doesn't matter whether she practices in a walmart or a private office!) then make sure you schedule your appointment with her and then follow her recommendations. expect it to take time. with high astigmatism you may not find a satisfactory fit with soft lenses and you may need to try a gas permeable hard lens. expect it to be uncomfortable initially but many people get used to it. ======== > Didn't know it was the quality of Walmart. I specifically asked when I went > in if they could prescribe proper contacts for me since i have a high [quoted text clipped - 15 lines] > > Your expectations and your choice of providers are simply not a good > > recipe for satisfaction. Two things, the first being FYI you posted a reply to this thread with no new text. And next....... Perhaps it's time to change the subject of this thread. > i think its irrelevant whether the eye doctor works out of his own > private practice or whether he works out of a retail chain. i cant > help but notice that the two doctors who spoke out in this thread have > a biased against retail doctors-- i'm sure its because both are private > docs. My bias is against the retail opticals, not necessarily the doctors who work for them. It is the opticals that commercialize eye health care and that is my primary issue. It matters not if it's optical or surgical or the fast-buck doc-in-the-box "urgent care" place. The "insurance" payers have a part in this, too. It creates a mindset on the part of the health care consumer that ultimately degrades the management of their health. I have a problem with that. > whats important is that you have a doctor who will take the time to > properly fit you in the type of lenses you need. also-- whether you > paid a high price or not is clearly irrelevant. That is most certainly true. I'm certain there are bozo docs in private practice as there are in retail, but there's a difference in the retail establishments. You could have a fine, knowledgeable doc who simply does not have access to product, due to corporate decision makers limiting him/her to certain brands of lenses or lenses that exceed a certain cost/profit index. The corporate "deciders" (for those of you outside of Bushville, a new vocabulary word here in the USA, which is actually a old Middle English word but I'm sure he didn't know that when he spoke.) may also limit the amount of time that can be spent on any one service procedure. I'm not saying that is the policy at all retail opticals, or that some private practice docs don't do the same things to maximize the bottom line. I just think that a private practice doctor with competence, ethics and caring and depending upon good will and patient referrals is more likely to go the extra mile to satisfy a patient's needs and concerns. A corporate chain store is just a very different business model. > personally, i have worked in both environments. As did I, so I know. I tried to "to do the right thing" and was promptly told to do otherwise. I lasted a couple of weeks. In private practice, I try to profit from the time I spend making patients happy. Sometimes, a contact lens fitting takes a longer time than I feel comfortable billing the patient and I might make little or no real "profit" (there's not a lot of $$ in the actual lenses, folks), except from the many patients referred to me by the one who respects my work. In the end game, it is, of course, getting what you need from someone who is able to provide that in a timely and cost-effective, hopefully pleasant manner. And wherever you can find that.............. LB, O.D. LB, I am glad that you tried to clear this up. Frankly it needs a little clearing up from some of the remarks that have been made. Some clear pot-shots were taken at retail optical practices from doctors who are also clearly biased against them. The following statements were negative or contained misinformation at least regarding the optical chains I am familiar with (which is admittedly limited). quote: >Gas perms (sometimes) require more >time and to fit than soft and more experience. They are not available to >"take and run" as are soft lenses. They are often less profitable in the >short term than soft lenses. Hence you will not find them at >discounters. (every retail optical chain in the area I live in fits gas perms) >$70 is what I would expect for an oil change, not for fitting >a prescription like yours. Since you weren't charged a professional >fee, I doubt you can expect to get professional service. (the price may be on the low side but that says nothing about the quality of the care. I guess the only car that you consider is any good is a Mercedes) >If you want quality, why are you going to the optician-equivalent of a >Wal-Mart? (actually Wal-Mart has an optical division and in my opinion its one of the better retail outlets compared to others I know of in my area) unquote: I too work at both a private practice setting and an optical chain. So I know what I am talking about like the other poster. I fit gas perms when appropriate and have good access to suppliers at both locations. Where I work, the optical chain management does not dictate any policies to the doctor-- the doctors are totally independent. In fact they must be by state law. I know of a few private docs in town who I personally think give inferior care, and whose pricing is excessive. As you know, it is difficult for a private practicioner to compete with the pricing that retain chains can offer. So I would agree with what a couple of people have already said. Find a good doctor, and go to that doctor. Its not the location or the price you pay that determines how good your care will be-- its the doctor doing the exam. And to the original poster, you indeed DO need to be more patient and quit complaining. It is common for multiple doctors to practice at a location. Retail or private. Thats whats happening at both locations I work at. Simply ask for the working schedule of the doctor you prefer and make sure your appointment is with that person. RM ======== > Two things, the first being FYI you posted a reply to this thread with > no new text. And next....... [quoted text clipped - 54 lines] > > LB, O.D. RM, the only point being made is that this patient is in need of somebody somewhere who will spend the time and effort necessary to do provide the level of service they desire. That kind of service takes time, and time is money. It has nothing to do with commercial vs. corporate practice, at least in my thinking. How much time does $70 buy in your practice? I've been in private practice out of one location for more than 20 years in a state that gave birth to Royal Optical, Pearle Vision, Texas State Optical, and Eye Masters. I am thriving, thank you, on patients who are difficult to satisfy. But, I would have been out of business a long time ago if I charged $70 to fit that kind of prescription. In that kind of situation, neither the doctor nor the patient wins. DrG > LB, > [quoted text clipped - 109 lines] > > > > LB, O.D. in my office I charge $75 for a toric contact fit, or an RGP fit. that money buys enough chair time to be sure that the patient is properly fit and satisfied. regardless of the number of follow-ups required. even the patient with the high prescription that the original poster who started this thread has. it is you and others who keep suggesting that paying a higher price will get you better service. I don't need to charge a higher price. I don't have to pay overhead, business loans, utility bills, employee salaries, etc. my patients get as good a quality of care as they do at any private practice (and frankly I think better and so do many of my patients who have been to various doctors) and I can charge less because my costs are much less than private doctors. so to answer your question, a $70 fee (or pretty close to that) buys you a lot where I practice and I certainly wouldn't go out of business fitting high toric patients at that price. to get to the important point, i think that we are all violently in agreement that its the quality of service that is the important factor and not the practice location of the doctor. but exam prices DO NOT reflect the quality of care that a patient is getting as you seem to imply. A clinic down the street charges exam prices twice what I do and then tries to entrap the patients into buying their contacts from their office at a jacked-up price. the patient isn't getting any better care; what they are getting is ripped off. its the quality of the doctor that counts, not the location, OR the exam price. PS-- I practice in the US mid-west where pricing is overall quite low compared to much of the rest of the country. ================= > RM, the only point being made is that this patient is in need of > somebody somewhere who will spend the time and effort necessary to do [quoted text clipped - 125 lines] > > > > > > LB, O.D. > in my office I charge $75 for a toric contact fit, or an RGP fit. that > money buys enough chair time to be sure that the patient is properly > fit and satisfied. regardless of the number of follow-ups required. > even the patient with the high prescription that the original poster > who started this thread has. Let me see if I have this right. A reasonable fitting/follow up appointment schedule for a somewhat difficult high toric or RGP fit is: minimum two fittings and two follow up visits. IF all goes well. Add an extra fitting and a follow up for it. So that's between 4 or 6 office visits. How about 20 minutes for each---a stretch in my book, but for the sake of discussion, not unreasonable......... OK, that's 80 to 120 minutes. You're making $40 bucks an hour before overhead? You're in the midwest but I bet after real life expenses it still costs more than that for the gas to get to work! > but exam prices DO NOT > reflect the quality of care that a patient is getting as you seem to > imply. A clinic down the street charges exam prices twice what I do > and then tries to entrap the patients into buying their contacts from > their office at a jacked-up price. the patient isn't getting any > better care; what they are getting is ripped off. No doubt sometimes people get ripped off and even taken advantage. But are you going to tell me that the same money and time buys the same examination services? Does that $35 10-15 minute exam include a dilated fundus exam, screening visual fields, applanation tonometry (surely not pachometry), a sitting behind a slit lamp----geez. It takes that much time to write it all down! Entrapment? My patients, after successful contact lens fitting are entitled to buy their contact lenses from me or whoever else they desire. I thought that was a US FTC law, not to mention the right thing to do. LB, O.D. > > in my office I charge $75 for a toric contact fit, or an RGP fit. that > > money buys enough chair time to be sure that the patient is properly [quoted text clipped - 33 lines] > > LB, O.D. I don't know about you, Larry, but I haven't made any comments about commercial vs. private practice quality of care. On the other hand, look at who IS. It's the commercial ODs, who are seemingly making the boast that they do more work for less money. Interesting business model. How can they ever learn about economics without having any costs to manage or a payroll to meet? DrG > in my office I charge $75 for a toric contact fit, or an RGP fit. that > money buys enough chair time to be sure that the patient is properly > fit and satisfied. regardless of the number of follow-ups required. > even the patient with the high prescription that the original poster > who started this thread has. Interesting math. $75 divided by a higher integer is still the same hourly rate. > it is you and others who keep suggesting that paying a higher price > will get you better service. I don't need to charge a higher price. I [quoted text clipped - 6 lines] > practice and I certainly wouldn't go out of business fitting high toric > patients at that price. My aren't we being defensive today! I said that a professional needs to charge a professional fee in order to be able to provide professional service. I didn't say that a higher fee automatically gets you better service. However, that perception does exist quite apart from me having to mention it. But, I think you pretty much answered the question of how you can charge so little, which is that the corporation (Cole Vision, etc.) pays for everything, including the electricity, so that you are free to dispense the highest level of care. Come to think of it, where are you so I can send you my difficult cases? > to get to the important point, i think that we are all violently in > agreement that its the quality of service that is the important factor [quoted text clipped - 4 lines] > their office at a jacked-up price. the patient isn't getting any > better care; what they are getting is ripped off. Let's quit flogging this dead horse, shall we? You've already made your point, which is that commercial optometry really hasn't changed that much in the more than 20 years since I got out of optometry school. Frankly, you've convinced me that I must be insane for trying to maintain a private practice surrounded by all of these high quality chains within a 5 mile radius. At last count there were about 10 of them: 2 Walmarts, 1 Costco, 1 Sams, 2 Pearl Visions, 2 Eyemasters, 1 Sears, and one other smaller chain. All of them accept most vision plans. > its the quality of the doctor that counts, not the location, OR the > exam price. What convenient measure can the public use to determine that nebulous quality? > PS-- I practice in the US mid-west where pricing is overall quite low > compared to much of the rest of the country. In other words, lots of competition, not so unlike my area. I think there must be something wrong with at least one of your premises. I'm not suggesting that you raise your fees considering the situation you are in. DrG this is my final remarks on this topic but I can't say anything for the other doctors who reacted negatively to your remarks about retail optometrists-- are you trying to say we are ALL being defensive? just think. Here are the derogatory remarks said about retail optometry. I won't put the names by who said them because they can be easily looked up and you'll recognize it yourself: -------------------- > But the right eye is always bad and blurry. Why would they prescribe me soft > torics when gas perm contacts are better? Because you insist on going to discount optical stores for your eyecare instead of private practice doctors. -------------------- > Seemed like a buffoon. If you want quality, why are you going to the optician-equivalent of a Wal-Mart? Your expectations and your choice of providers are simply not a good recipe for satisfaction. -------------------- > Can nobody help me? I agree. $70 is what I would expect for an oil change, not for fitting a prescription like yours. Since you weren't charged a professional fee, I doubt you can expect to get professional service. -------------------- I have nothing more to say beyond what I have said as well as the other 2 guys who spoke out. And Larry, noone ever said YOU try to entrap patients into buying their contact lenses from you, it was just said that another practice down the road does that. of course we are all aware of the recent federal contact lens laws. its just that some heed them more than others. And DrG, I think its pretty obvious how a patient finds out who the best practitioner is in their area. they go to them and then compare their experiences, they talk amongst themselves, and they develop a consensus about who is "good" and who isn't. thats how you try to build your practice and thats how I do mine. I'm done, but feel free to continue if you wish. I still believe that the responses to the original poster tended to make it sound like he would get better care at a private doctors office and paid a high price rather than go to a commercial practice and pay a lower price. and the horse has been beat to death, but that is simply a misconception. Yes, but I did not read the entire thread, and my comments have nothing to do with those other comments, and they stand alone. Sorry if you took offense, but none was intended vis-a-vis the commercial/independent decades-old argument. My only observation was that $70 did not seem to be enough of a fee to justify the amount of time and effort necessary to satisfy this particular patient with that particular prescription. I honestly thought that a $70 fee was an anomaly. Instead, it appears to be the "going rate." And, if that is so, then I am indeed sorry for the profession. DrG > this is my final remarks on this topic but I can't say anything for the > other doctors who reacted negatively to your remarks about retail [quoted text clipped - 50 lines] > rather than go to a commercial practice and pay a lower price. and the > horse has been beat to death, but that is simply a misconception. > particular prescription. I honestly thought that a $70 fee was an > anomaly. Instead, it appears to be the "going rate." And, if that is > so, then I am indeed sorry for the profession. Not my rate. But at $113 it's cheaper than it was in 1985. -MT > this is my final remarks on this topic but I can't say > anything for the other doctors who reacted negatively to [quoted text clipped - 57 lines] > the horse has been beat to death, but that is simply a > misconception. Just my 2 cents (from an outsider) and I'm not sure I've got my thoughts clarified yet. You all seem to be focusing on the individual practicioners. I thnk it's the context in which they practice that should be the focus. Well, OK, with an exception. On average, how much does a doc/optom make working for a retail chain as opposed to private practice? I realize there are a slew of advantages and disadvantages to both and it depends on the individual's goals, values, and priorities and there are a good number of exceptions... but... I think it's a fact of our society that the best move towards the money? Or is this strictly a business end factor? I would guess there are significant barriers to entry into private practice that don't exist in order to work for a retail chain and so maybe the great majority enter into practice there and move from there to private practice. Defense laywers come to mind. I would expect a public defender attorney to be competent. I would expect to be able to find better in private practice. Any validity in this? Back to my other thought, Am I correct that the retail chains operate on economies of scale? in order to provide services at the prices they do? I believe there will be some conditions imposed by that. For example, in general it seems that I buy goods at Costco for less but there may be a limited selection or limited sizes. It's not so much that the goods offered are any different quality than the same goods offered elsewhere. So I would expect middle of the road good quality products at a retail chain. Nothing at the bottom end and nothing at the high end. Generally targeted at the large portion of the bell curve. I would expect perfectly adequate care. I would not expect the doc there to ask if I would like to experiment with something that was new but looked very promising. Or be offered the very latest materials, etc. I would not expect to be able to go to a retail chain and say I want to try gas perms. I want to try translating trifocal gas perms made by Fused Kontacts. I know they are not recommended for my application (heavy computer user) but I want to try them and I'm willing to pay even if it doesn't work out. I went to one private practice and it was bad. I didn't know what I really wanted and his intention was to give me the $300 package exam plus soft contacts with a year's supply and out the door. At the end of about 4 visits I did not have confidence in him and he was frustrated. "Well, 90% of contact wearers would be happy with your vision". So, sure, there is good and bad in both places. No, I don't think I received "bad" care. I think it more that was what he offered and I didn't fit the mold. I looked around and found (turned out to be *excellent*) another doc. He was willing to try fitting the rgps that I wanted even though he had never done so before and had never dealt with Fused. He first had me try a couple of different soft designs. In addition to *many* visits with chair time we must have spent a total of 4 or 5 hours discussing parameters, options, products, etc. I was very involved in the process and decision making. It cost more. (No where near as much as I expected but it cost more going in). I don't think I would have been able to get that sort of care or options in a retail chain. I didn't get that sort of care or options at the first private practice but I don't think I could have found it in any retail chain. *Personally* I perceive retail chains as a place to go if you know what you want and you know they have it or if you're will to accept what works or is best for the majority of cases. ...I'm still not sure if I have a point... -Quick [snip] >And to the original poster, you indeed DO need to be more patient and >quit complaining. It is common for multiple doctors to practice at a >location. Retail or private. Thats whats happening at both locations >I work at. It is NOT common for this to happen in a private practice. Typical private practices may have multiple doctors, but follow-ups are typically scheduled with the prescribing doctor so a patient has continuity from eye exam to contact lens exam to completion of fitting. A "private practice" where a patient has one doctor perform the exam, another perform the contact lens exam, another doctor perform the contact lens dispense and another doctor perform the follow-up is a wolf is sheep's clothing. As far as the other comments by Dr. Leukoma regarding private practice vs retail chains, I find them to be *generally* true. Sorry RM. >I'm certain there are bozo docs in private practice as there are in >retail, but there's a difference in the retail establishments. You could [quoted text clipped - 5 lines] >word but I'm sure he didn't know that when he spoke.) may also limit the >amount of time that can be spent on any one service procedure. These "corporate deciders" are a codeword for MBAs and other non doctors making doctor decisions. I was told by a nurse practitioner at a Kaiser (big HMO out here in CA) that bean counters mandated that only OMDs were allowed to prescribe ZYMAR there. >As did I, so I know. I tried to "to do the right thing" and was >promptly told to do otherwise. <sarcasm> What's wrong? Can't you do a 15 minute exam on every patient? And what are you doing dilating patients on a routine basis? </sarcasm> Man you guys just keep stepping in it don't you. > I just think that a private practice doctor with competence, > ethics and caring and depending upon good will and patient referrals is > more likely to go the extra mile to satisfy a patient's needs and > concerns. Don't you think thats how retail chains do it too? Giving bad service and rushing through exams will kill anyone's practice. At the retail chain I work at, we are TOLD by the company to put the customer first. These companies aren't stupid. The customer has to be taken care of and is "alway right". As the doctor I not only want to personally do the best job I can but the retail company I work for expects me to do so or might not be working there next year. There is an incentive that you guys don't have to deal with! And in another post in this thread you wrote: >Let me see if I have this right. A reasonable fitting/follow up >appointment schedule for a somewhat difficult high toric or RGP fit is: >minimum two fittings and two follow up visits. IF all goes well. Add an >extra fitting and a follow up for it. So that's between 4 or 6 office >visits. How about 20 minutes for each---a stretch in my book, but for >the sake of discussion, not unreasonable......... It doesn't take ME 4-6 office visits to fit a toric contact, or gas perm (at least only RARELY). Its easy to look in a slit lamp and measure lens rotation, and assess lens fit. I can see the patient, evaluate fit, and take any notes faster than 20 minutes times 4-6 visits so I guess I can work faster than you. I charge a little more than $70 for a toric contact lens exam but not much more. And it does include a visual field assessment, tonometry, and dilation. I too am going to let this thread die but I agree with DrPClark that the remarks made earlier in this thread made it appear that a couple of people were recommending that the solution to this patients problem was to go to a private doctor and forget the retail chains. I disagree. Thats not the issue at all. Its the doctor that you go to and how much he/she desires to satisfy the patient thats the issue (as you say). And I don't think there is any better chance of finding such a doctor in private practice versus retail practice. I've seen lazy doctors in both locations. But in the retail chain I work for, those kind of doctors are GONE after awhile. >Thats not the issue at all. Its the doctor that you go to and how >much he/she desires to satisfy the patient thats the issue (as you >say). I agree. >And I don't think there is any better chance of finding such a doctor >in private practice versus retail practice. I disagree, based on personal experience and anecdotal experience from other patients. I hear patients all the time compliment me on the thouroughness of my exam or tell me the reason they came to me was because they were disastified with a retail chain doctor. It is a much rarer occurance for a patient to state they left a private practice doctor for me because they were not satisfied with them. >I've seen lazy doctors in both locations. Same here. >But in the retail chain I work for, those kind of doctors are GONE >after awhile. Is it because they were truly "lazy" or didn't work fast enough/did "unnecessary tests"? I know of a "retail doctor" who was given a lot of flak because he was writing scripts recommending TRIVEX over polycarb because the lab right next door which was run by the corporation who was leasing him space had to special order it. He was basically reminded by a MBA bean counter that his lease is reviewed every 30 days. Back to polycarb it was. your experiences are clearly different from mine. i have heard other docs talk about retail chains mandating certain behaviors from their doctors, but where i work it isn't that way. they in fact are very careful to stay at arms length, almost as if they are fearing some kind of conflict of interest accusations. they trust me to do the thing thats right for the patient, and they do that as well. can't say whether your experience is more representative of retail outlets overall, or whether mine is. i've only worked at one retailer. but my view of many private doctors is not that they are doing a better job. in fact it oftentimes seems to me that many patients who come to me after having previously been to a private doctor have had their wallets lightened to a significant extent unnecessarily (e.g. sold $400 progressives when simple OTC readers would have sufficed, etc.). ============ > >Thats not the issue at all. Its the doctor that you go to and how > >much he/she desires to satisfy the patient thats the issue (as you [quoted text clipped - 32 lines] > bean counter that his lease is reviewed every 30 days. Back to > polycarb it was. p.clar...@gmail.com wrote: > but my view of many private doctors is not that they are doing a better > job. in fact it oftentimes seems to me that many patients who come to > me after having previously been to a private doctor have had their > wallets lightened to a significant extent unnecessarily (e.g. sold $400 > progressives when simple OTC readers would have sufficed, etc.). Ummm, wait a minute. I CHOOSE to wear Hoya ECP progressive lenses with AR coating OVER my contact lenses. Why do I do that? Because I once used OTC readers and this is a heck of a lot better. If my patients can afford to pay for it, why shouldn't I offer it? Drg >p.clar...@gmail.com wrote: >> [quoted text clipped - 8 lines] >once used OTC readers and this is a heck of a lot better. If my >patients can afford to pay for it, why shouldn't I offer it? I'm preaching to the choir here, Dr. Leukoma, but... You should offer it, depending on the person's complaints. There are advantages to progressives with A/R coating over OTC readers (and visa-versa). A patient should be informed of the pros and the cons of the various lens options. I always recommend the vary best and let the patient let me know what want/need and what they can/can't afford. When a person walks into a restaurant, a hamburger might suffice, but if the patron asks what the waiter recommended and the waiter said "Filet Mignon", is the waiter attempting to unnecessarily lighten the patron's wallet? When a person walks into a Mercedes dealer and asks what car the salesman recommends and the person said a SL 600 when a C 230 would get a person from point A to point B, is that salesman unnecessarily trying to lighten that customer's wallet? Realize there is a difference between recommending the best (being a good doctor) and trying to pressure sell/cram something to a customer (being a salesman). Likewise, when a patient has a complaint and asks what I recommend, I state what I recommend based on what I think would work best. If you bring preconceived notions as to what that patient can/can't afford, you are doing him a disservice. And by offering the very best, it is good for the patient and the practice. Good for the patient as they have the opportunity and are exposed to the very best in eyecare. Good for the practice as in the best options are typically have the largest profit margin. Good for the practice as in happy patients with high-end spectacles refer in their friends for the same. People who want nicer clothes with superior service go to places like Nordstrom's rather than WalMart. Likewise, those who want superior eye care go to private practice ODs rather than, say, a WalMart OD. Can't we be honest with ourselves here? It's pretty clear why people go where they go for eyecare. You could make the same arguments for the people who go to $499 LASIK factories versus $5000 LASIK surgeons. Some people are driven primarily by cost, others are driven primarily by quality. I enjoy all my patients and I take equally good care of them, but to be honest, I would rather have my schedule filled with those who prefer quality over cost. It makes no difference to a retail OD because he makes the same no matter what he recommends. Private practice ODs certainly need to watch themselves to make sure their recommendations are not based primarily on profit. And retail ODs need to watch themselves to make sure they don't get lazy and make recommendations based on what is easiest for the OD. I'm not so sure this much preaching was necessary, and I think that there are other more subtle arguments to be made, but what in the heck is the point? Are you trying to prove how "wise" you are? This has to do with somebody being able to find someone who is willing to spend the time to do the job that is necessary. Time is money and I don't care where you practice. If it isn't your money it is somebody else's. If somebody goes through 8 years of professional training, I would expect that they should be able to earn more than $35/hour. If you are happy with that, fine. Otherwise, go do something else. Personally, I would go do something else. DrG > >p.clar...@gmail.com wrote: > >> [quoted text clipped - 61 lines] > ODs need to watch themselves to make sure they don't get lazy and make > recommendations based on what is easiest for the OD. sure. if the patient is informed that they have a negligible prescription and that OTC readers will work fine for them, and they choose to pay a high price for expensive progressives, thats fine. but i've encountered quite a few patients who were simply told "they need bifocals now" and were fitted with an overpriced set of no-lines. they were surprised to hear from me that they could use OTC readers. likewise i've encountered patients who are low myopes who see well at near without any correction who are also wearing bifocals and were never told they could just use single-vision glasses and take them off to read. I think as doctors we need to fully inform our patients of all their options including the ones that don't involve us making as big a profit. in my current retail situation, i don't make any profit on sales of glasses or contacts by the optical staff in the office. my only concern is that the patient got the best treatment they could when the left my exam room. motivations can be very different in some private offices since their income comes from exam fees AND mark-up on materials. i'm not saying thats what YOU do, or thats what Larry does, but I've seen it happen a significant number of times. and I'm sure it can also happen at retail locations by doctors who are more influenced by their retail company than I am. ---------------------- > p.clar...@gmail.com wrote: > [quoted text clipped - 10 lines] > > Drg > i'm not saying thats what YOU do, or thats what Larry does, but I've > seen it happen a significant number of times. and I'm sure it can also > happen at retail locations by doctors who are more influenced by their > retail company than I am. By virtue of the fact that you would even consider it is resprehensible to me. Getting back to overhead. If you aren't paying overhead, the optical shop is paying it for you, and if you aren't generating enough patient revenue for the optical shop, then you are as worthless as tits on a boar to them. The more you say, the worse it gets. DrG > If you aren't paying overhead, the optical shop is paying it for you, > and if you aren't generating enough patient revenue for the optical > shop, then you are as worthless as tits on a boar to them. Possibly good performance could generate good will. Grifting to enrich one's employer might be a disservice to one's employer as well as one's customers. (I don't think people who purchase eyeware are patients. If you want patients, I think you need a medical degree.) But perhaps I am too naive. -- Dicky > > If you aren't paying overhead, the optical shop is paying it for you, > > and if you aren't generating enough patient revenue for the optical [quoted text clipped - 3 lines] > enrich one's employer might be a disservice to one's employer as > well as one's customers. Good performance gets return business. Most of the patients I encounter cannot remember the name of their last optometrist. Good performance also minimized liability. Good performance is always desirable, now, isn't it? > (I don't think people who purchase eyeware are patients. If you > want patients, I think you need a medical degree.) > > But perhaps I am too naive. You're not naive. Just deliberately unpleasant. If I treat someone for glaucoma and they go out and purchase a pair of eyeglasses from my "shop," is that person a 'partient' or a 'customer' or both? If that same person walks into Walmart with my prescription and purchases a pair of glasses, then they are obviously viewed as a 'customer' by Walmart. By the same token, the optometrist located in a Walmart still has to meet the requirements for state licensure, which means that they can indeed treat glaucoma. I just don't know how many of them do. I think that some chains don't really want their OD's to "waste" their time doing medical treatment. I could be wrong on that, but I don't think so. DrG > ... I think that some chains don't really want their OD's to "waste" > their time doing medical treatment. I think I should be able to straightforwardly get eyeglasses which allow me to read highway signs at night, to recognize faces on the other side of the street, and, if I am a student, to read what is written on the blackboard. (Don't care about the conditions of employment -- mosly my eyecare people have been employed my medical groups.) > ... Most of the patients I encounter cannot remember the name > of their last optometrist. I remember the names of 2, of possibly 7, phoropter operators who, in the last several decades, upgraded my prescription in such a manner that I did not need to return for repeat measurements or new "glass". Both were on-the-job-trained ladies who worked for Dr.s (both OMDs). I could ask for them next time, but it was not my choice. Those two times I could finally read the 20/15 line. (There was one OD who did a good job, but he did not last. I have his name written down, but could not find out where he went next. Probably was taking to long with the refractions.) > You're not naive. Just deliberately unpleasant. Just tellin' it like I see it. (With 20/15, sometimes) I think it is fine when ODs or technicians check pressure, but I'd presume that treating glaucoma would be one of the things that the OMDs should do. -- Dicky > I think it is fine when ODs or technicians check pressure, but I'd > presume that treating glaucoma would be one of the things that the OMDs > should do. Not that anyone here cares what YOU think or presume, mostly because you are so often wrong or just ignorant. But for the remaining readers who do have the ability to learn things, I write......... Here in the 21st century, ODs, doctors of optometry are trained and licensed to treat a variety of eye medical conditions using medical techniques and prescribing pharmaceutical agents. The scope of medical practice for ODs varies to some degree in some USA states and other countries. The services available from a competent, ethical and professional optometrists range from optical prescriptions for spectacles, contact lens fitting, to the diagnosis of systemic and eye health issues, including treatment eye health issues and proper referrals to medical specialists as necessary. LB, O.D. > [ ... ] > The services available from a competent, ethical and > professional optometrists range from optical prescriptions for > spectacles, contact lens fitting, to the diagnosis of systemic and eye > health issues, including treatment eye health issues and proper > referrals to medical specialists as necessary. Me, I'd gladly settle for "competent" when it comes to optical prescriptions. Well, "willing", too, and having some time left for refractions, after all the professional and ethical strutting around is done. > Not that anyone here cares what YOU think or presume, mostly > because you are so often wrong or just ignorant. Sticks and stones ... : ) -- Dicky > Possibly good performance could generate good will. Grifting to > enrich one's employer might be a disservice to one's employer as > well as one's customers. thats the point. when you take your car to be worked on somewhere and they tell you there's just a slight problem and its quick and inexpensive to fix, then you respect that person and you feel good about going back and recommending them to others. people appreciate getting treated well, having things explained to them, and not getting ripped off. it builds business by gaining trust. > (I don't think people who purchase eyeware are patients. If you > want patients, I think you need a medical degree.) they are patients and they are also customers. eye health is what is tested in an examination as well as refractive error. thats a medical examination but i don't belief there is any "semantic rule" that states only medical customers can be called patients. And you keep stepping in it again! So you are arguing that he should rip off his patients to generate more revenue for the optical shop? Then you are just validating his arguments against you and other private doctors who might prefer to sell people things they don't need just to maximize their revenue. I suggest you wise up and quit posting now. =========== >> i'm not saying thats what YOU do, or thats what Larry does, but I've >> seen it happen a significant number of times. and I'm sure it can also [quoted text clipped - 12 lines] > > DrG > And you keep stepping in it again! > [quoted text clipped - 4 lines] > > I suggest you wise up and quit posting now. C'mon, RM. Show me where I either said that or implied it. For goodness sake get the chip off your shoulder. If somebody gives you office space, equipment, and utilities free of charge and there is an optical shop outside of your door, or next door, need I draw the inference for you? Not only that, but if your employer just so happens to be selling low end eyewear, they've got to make it up on volume, which means that you cannot afford to make your exam too long, or too expensive for that matter. Y'know, RM, it's one thing to imply(which I didn't) that a commercial optometrist gives a quick exam for low price, but it is quite another to accuse your colleagues of unethical behavior, which is about the only arrow you have in your quiver. DrG Okay! You said this: -------------- Getting back to overhead. If you aren't paying overhead, the optical shop is paying it for you, and if you aren't generating enough patient revenue for the optical shop, then you are as worthless as tits on a boar to them. In reply to him saying this in the message you responded to: ----------------------------------------------------------- in my current retail situation, i don't make any profit on sales of glasses or contacts by the optical staff in the office. my only concern is that the patient got the best treatment they could when the left my exam room. motivations can be very different in some private offices since their income comes from exam fees AND mark-up on materials. Maybe I've taken something out of context and if so I'm sorry. But regardless I'm tired of wallowing in this smelly gutter with you so have your fun insulting people without me. You're showing your a.s but apparently you don't realize it. > C'mon, RM. Show me where I either said that or implied it. > Okay! > [quoted text clipped - 19 lines] > your fun insulting people without me. You're showing your a.s but > apparently you don't realize it. Let's review the situation, shall we? My first remark was that $70 did not seem like a professional fee. Frankly, I didn't have any particular image of any particular OD...it's just that I could not figure out how a person with a difficult-to-fit prescription was going to be able to be properly serviced by someone whose fee seemed incommensurate with the time required. What followed was a stream of inferences and innuendo about the lack of professional ethics of private practice OD's. Personally, I have nothing against the 10 or 12 commercial OD's who practice within a 5 to 6 mile radius of me. I can only control what goes on inside of my office, and what I do with my head and my hands. The ethics or lack thereof of the OD down the street, and who they work for is the least of my concerns. My comments above describe the business model, and not the ethics of the O.D. You are employed by your company to generate prescriptions for the optical shop. You are not there as a public service. There is nothing illegal or unethical in that business model. It is simply a reality. And, yes, you do have to walk a tightrope. But, as an O.D., you did take the same oath that I did, which is always to put the patient first. So, let's leave it at that and agree to disagree about fees and not question our ethics. DrG > I think as doctors we need to fully inform our patients of all their > options including the ones that don't involve us making as big a [quoted text clipped - 4 lines] > private offices since their income comes from exam fees AND mark-up on > materials. This is about as patronizing as anybody has ever been to me on this or any NG. The plain fact is that we keep a display of OTC, non-prescription reading glasses on the counter at the checkout. They are way cool. Since when are you unmotivated by making a profit? Don't be a hypocrite. DrG > > I think as doctors we need to fully inform our patients of all their > > options including the ones that don't involve us making as big a [quoted text clipped - 13 lines] > Since when are you unmotivated by making a profit? Don't be a > hypocrite. What am I saying? According to you, every dollar you make is profit thanks to the optical shop who pays the bills. Let's not get all tied up in our conflict of interest, now. You talk like your employment is a public service. DrG [snip] >likewise i've encountered patients who are low myopes who see well at >near without any correction who are also wearing bifocals and were >never told they could just use single-vision glasses and take them off >to read. Every single presbyopic myope who was able to do that has been able to figure that out on their own. Without exception. > Every single presbyopic myope who was able to do that has been able to > figure that out on their own. Without exception. really? without exception?
|
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.