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Medical Forum / General / Vision / August 2006I think my OD gave up on me
Tell me if I'm being an unreasonable patient. I asked to try RGP contacts. The first pair I got back gave good vision and I adapted to them in about a week. My primary complaint was/is that they hang low, and as a result, I get a lot of glare/flaring from above when walking under lights and such. I was told that the low hanging thing was not a big deal, although one was hanging a little lower than they'd like. So they steepened up the one lens, plus made both bigger to try to deal with the flare. The new set eliminated the flare, but the prescription was off such that it had an extra -0.75 in one eye and -0.5 in the other. My eyes were kind of bugging out by the end of the day. I'm not sure if it's because of the extra accomodation required, or because the power was mismatched between eyes. Anyway, they re-ordered again with an extra +0.75 and +0.5 to try to counteract this. When I got these back, my distance was blurry. I have a cheap little lens kit I bought, and an extra -0.25 in each eye makes things look good. At this point though, it seems they are tired of messing with me. They did an over-refraction and claim that I'm basically right on, even though, to me, it's unacceptably blurry. I figured we overshot for some reason and that we should try meeting in the middle by adding, say, -0.25 to each eye. Is that unreasonable? Is there something I'm missing? One thing that kind of bugs me is that unlike most offices I've been to, this office uses monitors in the exam room that are only about six feet away. I could see the chart clearly with the lenses that make me nearsighted because it's not far enough away. I asked about this and the doctor claimed that they compensate for that (extra plus in the lens setup?). I can't help but think that has something to do with the disconnect between what the exam found and what I peceive when I'm in the real world. Could I be right? I'm not sure what to do now, because I really think it's possible to get a better set of lenses if the doc would stick it out. Should I shop around for another OD? Give up? My other option is to simply ask them to order a new set with the extra -0.25 in it and pay for it myself. I don't mind paying my way, but I don't want to be a chump either. Thanks if you read this far. I'd be interested in any thoughts about not only how I should proceed, but possible reasons why the results seem to be so unpredictable. -- >Tell me if I'm being an unreasonable patient. The profit margin drops every time he has to have your lenses remade. Write a reasonably-phrased letter, indicate that you'd like one more adjustment and be QUITE CLEAR that you'll both dispute the credit card charge AND file a complaint with your state's regulatory board if he's unwilling to work with you. Then follow through. Chances are he'll give you a refund and send you packing. That whole monitor-for-refractive-purposes sounds hinky to me, but I'm just a patient... +++++++++++++ Reply to the list as I do not publish an email address to USENET. This practice has cut my spam by more than 95%. Of course, I did have to abandon a perfectly good email account... I am biting my tongue and am trying to refrain from dishing out constructive critism. I will tell you what you want to hear, perhaps it will make a good impression. Pay for another remake of your RGP contacts in the exact prescription that makes you happy. If he cant do this, seek a second opinion. >>Tell me if I'm being an unreasonable patient. > >The profit margin drops every time he has to have your lenses remade. Depends how the doctor charges for his services. However, judging by his responses, I would venture to say, how he is charging this patient, every time he does have to remake the lenses his profit margin does drop. >Write a reasonably-phrased letter, indicate that you'd like one more >adjustment and be QUITE CLEAR that you'll both dispute the credit card [quoted text clipped - 3 lines] >Then follow through. Chances are he'll give you a refund and send you >packing. That would probably work, but I think the method I suggested where you "catch more flies with honey than..." is a better approach. > "Charles" <nospam@nospam.com> spewed forth : > [quoted text clipped - 8 lines] > Then follow through. Chances are he'll give you a refund and send you > packing. My optician/RGP specialist stuck with me through 8 sets of multi-focal RGPs before he gave me the choice of a ~50% refund and nothing or a years's worth of soft lenses, many of which didn't fit through no fault of the guy. It doesn't always work the way it's supposed to.  SignatureCheers, Bev ============================================= If you are going to try cross-country skiing, start with a small country. >My optician/RGP specialist stuck with me through 8 sets of multi-focal >RGPs before he gave me the choice of a ~50% refund and nothing or a >years's worth of soft lenses, many of which didn't fit through no fault >of the guy. My optician (20+ years back) fitted me 5x for hard lenses, then decided he didn't like what they were doing in my eyeballs and switched me to RGPs - a further 5 fittings. I miss customer service of that caliber. The "new guy" thought I should be happy with my RGPs as they came the first time and couldn't understand why I wanted him to try again...and again. He finally threw up his hands in disgust and told me I'm too picky. I told him I'd be as picky as I damned well please since we're talking about my vision and my comfort level. So I'm sticking with spectacles for a while longer. I've heard of two long-time competent fitters of RGPs in my area, but I can't get in with either one before my next round of seasonal allergies start... +++++++++++++ Reply to the list as I do not publish an email address to USENET. This practice has cut my spam by more than 95%. Of course, I did have to abandon a perfectly good email account... > The Real Bev spewed forth : > [quoted text clipped - 17 lines] > long-time competent fitters of RGPs in my area, but I can't get in > with either one before my next round of seasonal allergies start... I went to this guy because he specialized in RGPs and my friend said he got her prescription right the first time. God hates me. SignatureCheers, Bev ============================================================== Everyone crashes. Some get back on. Some don't. Some can't. >Tell me if I'm being an unreasonable patient. Ok. >I asked to try RGP contacts. The first pair I got back gave good >vision and I adapted to them in about a week. My primary complaint [quoted text clipped - 21 lines] >say, -0.25 to each eye. Is that unreasonable? Is there something I'm >missing? No, I don't think you are being unreasonable. If I were your doctor, I would verify the -0.25DS over your contacts really does improve your visual quality by going outside and have you look at distance targets while also showing you what it does to your near vision. I might have you come back in the later afternoon/early evening and re-verify again. If you definitely say that would make you happy, then I would do it. To add -0.25 to a RGP is simple to perform in the office or to send back to the lab and the cost to do that is minimal. However, if the lenses comes back the way you requested and you still have complaints, you should expect to either pay for any future contact lens follow-up visits or be told this is as good as it gets. In my experience, most offices will give you 2 follow-up visits included as part of the global contact lens fitting fee. Anymore than that, expect to be charged appropriately for the doctor's time. So, I would be willing to continue keep trying things in an attempt to make you happy as long as you are willing to pay and I think we are trying things that have a reasonable likelihood of success. IOW, I wouldn't want you wasting your money like a dog chasing his tail. >One thing that kind of bugs me is that unlike most offices I've been >to, this office uses monitors in the exam room that are only about six [quoted text clipped - 4 lines] >disconnect between what the exam found and what I peceive when I'm in >the real world. Could I be right? Lots of offices are like this and your experience is not unique to you alone. >I'm not sure what to do now, because I really think it's possible to >get a better set of lenses if the doc would stick it out. Should I >shop around for another OD? Give up? My other option is to simply ask >them to order a new set with the extra -0.25 in it and pay for it >myself. As I wrote, typically that -0.25 can be added to those existing lenses without remaking them and the cost would be minimal (from free to $30 is a fair and reasonable material charge). >I don't mind paying my way Tell him that. Most doctors will not refuse a patient who is willing to pay for that doctor's time. >, but I don't want to be a chump either. Thanks if you read this far. >I'd be interested in any thoughts about not only how I should proceed Ask the doctor how much he would charge you to have a follow-up appointment and to have him triple check that adding the -0.25 to your existing RGPs will make you a happy camper. Tell him you understand that his time is valuable, that you are willing to pay for that time, and you think he almost has it. Tell him you are certain that if the vision in the lenses is just like it is with the -0.25DS over the existing RGPs in your eyes, you will be happy. If the price he charges you is reasonable, do it. If he says he won't do it (even if you pay him), ask him why not. If the answer is reasonable (I don't see why it would be), then ask yourself if you will be happy with your vision as is. If it's not reasonable, then request a refund and go elsewhere. >but possible reasons why the results seem to be so unpredictable. It could be bad luck, your eyes are atypical, or you are just a really picky patient. Some doctors may be unwilling to invest a lot of time in someone like you because they are paid only a (low) global amount by an insurance company and cannot charge you any additional fee per the contract stipulation. Too much chair time with a patient like that and they start losing money. No doctor wants to lose money, especially if they feel they are dealing with a lost cause or a patient who is too picky. If that is the case with you, you may want to find a different doctor or go through that doctor on a non-insurance basis where you pay per each visit. Thanks for the reply. See embedded comments/questions below: > > Tell me if I'm being an unreasonable patient. > > Ok. ... > If I were your doctor, I would verify the -0.25DS over your contacts > really does improve your visual quality by going outside and have you [quoted text clipped - 5 lines] > To add -0.25 to a RGP is simple to perform in the office or to send > back to the lab and the cost to do that is minimal. Good to know. I was planning on ~$100 for new ones from scratch. > However, if the lenses comes back the way you requested and you still > have complaints, you should expect to either pay for any future > contact lens follow-up visits or be told this is as good as it gets. > In my experience, most offices will give you 2 follow-up visits > included as part of the global contact lens fitting fee. Anymore than > that, expect to be charged appropriately for the doctor's time. The thing about that is that it takes _some_ of the incentive away from the doctor to really get it right. Is it possible that a more competent or experienced doctor would have gotten this right already, but now I need to start paying because it's taking so many iterations? I don't know what the right answer is, because I also understand that unreasonable patients could jerk you around forever if there wasn't a limit. > So, I would be willing to continue keep trying things in an attempt to > make you happy as long as you are willing to pay and I think we are > trying things that have a reasonable likelihood of success. That's good. That might be the rub here, because I don't think we're on the same page in terms of how far off I think these ones are. He may think I'm being picky, but really I just want to be within 0.25D, erring toward extra minus power. I don't _think_ that's unreasonable. It may be related to the next thing: > > One thing that kind of bugs me is that unlike most offices I've been > > to, this office uses monitors in the exam room that are only about [quoted text clipped - 7 lines] > Lots of offices are like this and your experience is not unique to you > alone. Which experience? Thinking that it's weird, or actually not getting assessed correctly for distance? When he said they compenate for it, does that mean they just make the letters smaller? Ugh. If so, how can that possibly be acceptable? > As I wrote, typically that -0.25 can be added to those existing lenses > without remaking them and the cost would be minimal (from free to $30 [quoted text clipped - 4 lines] > Tell him that. Most doctors will not refuse a patient who is willing > to pay for that doctor's time. I'm not really paying with insurance anyway. I'm on sort of a catastrophic thing, so it's all out of pocket. $30 is not a big deal though. I'll ask about that, although the doctor might take offense since he didn't really present that as an option. The options were to deal with the flare on the small ones or put glasses over the big ones for driving. The latter is not acceptable, because they would bug me in a big conference room or long hallway too. ... > Ask the doctor how much he would charge you to have a follow-up > appointment and to have him triple check that adding the -0.25 to your [quoted text clipped - 10 lines] > yourself if you will be happy with your vision as is. If it's not > reasonable, then request a refund and go elsewhere. Thanks. > > but possible reasons why the results seem to be so unpredictable. > > It could be bad luck, your eyes are atypical, or you are just a really > picky patient. I was thinking of more esoteric stuff, like the big lenses originally flexed some more to induce the need for more + power, then when the plus was added, they got thicker and didn't flex as much... I surely am "picky" to some extent. I compare my vision to my 20/20 wife and I can't believe what she _can't_ see. Like "really, you can't read the address number on the house across the street?". I'm solidly 20/15 or better when corrected properly. But like I said before, I don't think I require Rx's within tiny fractions of a diopter to get this. 0.25D is fine. > Some doctors may be unwilling to invest a lot of time in someone like > you because they are paid only a (low) global amount by an insurance [quoted text clipped - 6 lines] > or go through that doctor on a non-insurance basis where you pay per > each visit. Like I said, I'm not paying through insurance anyway, so that shouldn't be an issue. But I am on some sort of track where they are responsible for reorders until I'm "happy" or something. They have a little pamphlet to that effect in the waiting room: "Specializing in the hard to fit patient". ;) -- [snip] >>However, if the lenses comes back the way you requested and you still >>have complaints, you should expect to either pay for any future [quoted text clipped - 5 lines] >The thing about that is that it takes _some_ of the incentive away from >the doctor to really get it right. I understand that, but the truth of the matter is that chair time (especially with the doctor) is costly to a practice. Doctors, in general, don't want to milk a patient by intentionally not giving good effort in treating their patients. The little money one might make by doing that is not worth the potential loss of goodwill/trust. And if you don't trust your doctor, then you should find another one. >Is it possible that a more competent or experienced doctor would have >gotten this right already, but now I need to start paying because it's >taking so many iterations? I don't think it has taken so many iterations. I realize we live in a world of instant gratification, but to do certain things well, it just takes time and both you and the doctor need to be patient. Cases like you happen from time to time. And, from what you wrote, it certainly doesn't appear that your problems are due to doctor inexperience or competancy. >I don't know what the right answer is, because I also understand that >unreasonable patients could jerk you around forever if there wasn't a >limit. Right. That is where a doctor uses his good judgement -- deciding when it's time to say this is as good as it will get. >> So, I would be willing to continue keep trying things in an attempt to >> make you happy as long as you are willing to pay and I think we are [quoted text clipped - 4 lines] >may think I'm being picky, but really I just want to be within 0.25D, >erring toward extra minus power. Well, that's fine, but you find the contacts are over by +0.25D when they are redone, you need to be happy or you are too picky for RGPs. There is an acceptable tolerance for RGPs and 0.25D is normally about it. >> Lots of offices are like this and your experience is not unique to you >> alone. [quoted text clipped - 3 lines] >does that mean they just make the letters smaller? Ugh. If so, how >can that possibly be acceptable? Lots of offices use a mirrored system and what they do is compensate for the distance. So they might refract you and add -0.50 to the result (because you are say 2M optically from the image) to determine what you prescription needs to be to make you see as perfect as possible in the distance. [snip] > Lots of offices use a mirrored system and what they do is compensate > for the distance. So they might refract you and add -0.50 to the > result (because you are say 2M optically from the image) to determine > what you prescription needs to be to make you see as perfect as > possible in the distance. I really wonder if he did the compensation. It's almost impossible for me to believe that he didn't detect what is so obvious to me in the real world. That's good to know anyway. In other offices I've been to, I'd swear that with the mirror system the letters really were 20 feet away. The rooms were generally kind of long, and the patient would look at letters on the back wall via mirror, effectively achieving almost double the length of the room. -- > Tell me if I'm being an unreasonable patient. Based upon what you revealed in another thread on OrthoK, your prescription is basically mixed hyperopic astigmatism, with low plus and low cylinder. This, combined with the fact that CORNEAL RGP lenses do not center well, would seem to make you a very marginal, if not poor candidate for traditional RGP lenses. I would probably try a cornea-scleral lens that covers the entire cornea like a soft lens, thereby staying centered. But, in any event, the low prescription does pose challenges. DrG How ironic it is that so many treatment options are degraded or invalidated because I'm not myopic enough. I didn't really think of 1 diopter of astigmatism as "low". If it is, I'm glad. > > Tell me if I'm being an unreasonable patient. > [quoted text clipped - 9 lines] > > DrG -- > How ironic it is that so many treatment options are degraded or > invalidated because I'm not myopic enough. Now, that's a poor choice of words. I would use "inappropriate" instead of "invalidated." The point is, just expect a more difficult time of the fitting process, as well as a less satisfactory outcome. > I didn't really think of 1 diopter of astigmatism as "low". If it is, > I'm glad. It is. And you should be glad. It's enough to be somewhat annoying, though. Have you tried toric soft lenses, such as Acuvue Advance for Astigmatism, Proclear Torics, Purevison Torics, etc.? DrG > > How ironic it is that so many treatment options are degraded or > > invalidated because I'm not myopic enough. [quoted text clipped - 13 lines] > > DrG In the case of "invalidated" I was thinking of OrthoK. Although the jury _might_ still be out. I'm certainly far from the ideal candidate due to "lack of myopia". I have not tried soft torics in a few years. Maybe things have improved significantly since then? I have to admit that I'm enjoying the "OrthoK effect" I'm getting from these RGP's. My left eye is 20/20 after wearing them, and my right is almost that good. I haven't tested how long the effect holds, but it's at least until noon the following day - the longest I've gone. -- |
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