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Medical Forum / General / Vision / January 2007Opthalmologist or Optometrist for prescription?
I've been having a lot of trouble getting a new prescription that is comfortable for me. I've worn glasses since second grade, have fairly bad astigmatism and have had a few corneal injuries which have left abrasions that get irritated from time to time. I have always used an opthalmologist and have full checkups yearly. However, in the past few years, my opthalmologist is in a hurry - no doubt the result of managed care and the pressures it places upon us all. Nevertheless, I feel that I have to decide about better/worse too fast and there really isn't any discussion about which lenses will best meet my particular needs under which circumstances etc. At this time in the history of medical care delivery would I be better off seeing an optometrist? Might the optometrist have more time and be able to pay more attention to me and the way I use my glasses (I have progressives, separate reading glasses and separate computer/workstation glasses). I would just leave my opthalmologist but he's been my doctor for over 20 years and my experience is that every physician is now in such a hurry it's hard for them to really take in the whole picture and the whole person. BTW, I'm in NYC, so the options are numerous - so numerous that I'm at a loss as to how to proceed. Thoughts? Louise > I've been having a lot of trouble getting a new prescription that is > comfortable for me. I've worn glasses since second grade, have fairly bad [quoted text clipped - 25 lines] > > Louise In my opinion and experience with both, you will generally receive a better Rx from an OD rather than an MD. If you have a eye disease, you may need to see an MD for that, but for the Rx and OD will usually give better results. Not only do most o.d.s do refractions and understand optics far better than the average o.m.d., for the most part, we often take better care of the minor medical problems, even glaucoma in many states, because we have to take so much concentrated continuing education in those things we are allowed to treat. Also, we are very careful in the detection and treatment of those medical conditions that we treat because the o.m.d. establishment is watching us like a hawk for any errors and omissions and we don't want to lose any such "priveleges". Obviously, there are many conditions we don't treat, and we certainly don't do much or any eye surgery, and for those things, the o.m.d. is the only choice. w.stacy, o.d. > > [quoted text clipped - 34 lines] > > Thoughts? Go see Dr. Stacy. He's an optometrist. DrG > I've been having a lot of trouble getting a new prescription > that is comfortable for me. I've worn glasses since second [quoted text clipped - 27 lines] > > Louise > Thoughts? Go see Dr. Stacy. He's an optometrist. > [quoted text clipped - 31 lines] >> >> Louise Where is he located - is he in NYC? Louise |I've been having a lot of trouble getting a new prescription |that is comfortable for me. If you are willing to travel Family Vision Care in White Plains is excellent. They are a father ,son and daughter, all Optometrists in business since the 1960's. On Westchester Avenue near the Hutch Pkway. They really know their stuff and have the right connections with specialists in NYC if needed a lot of mds (ophthalmol) would probably suggest you go to od for refraction for those reasons. > I've been having a lot of trouble getting a new prescription > that is comfortable for me. I've worn glasses since second [quoted text clipped - 27 lines] > > Louise You can't draw a general conclusion about opthalmologists vs. optometrists. It depends on the particular doctor. > You can't draw a general conclusion about opthalmologists vs. optometrists. > It depends on the particular doctor. Drawing a general conclusion works perfectly well ... as a general conclusion. Generally, ODs spend more of their time refracting patients than do ophthalmologists, no? > Drawing a general conclusion works perfectly well ... as a general > conclusion. > > Generally, ODs spend more of their time refracting patients than do > ophthalmologists, no? GW Bush spends more of his time deciding what to do for the US than do most of us. That doesn't mean that GW is a better decision maker. I've seen O.M.D.'s who are poor at refracting me. And I've seen O.D.'s who are more interested in selling expensive frames. My point is...you cannot argue O.D.'s are better at prescribing glasses or contacts than O.M.D.'s. There are good & lousy O.D.'s and O.M.D.'s. The best way to select a particular O.D. or O.M.D. is to rely on patients' opinions. I had had a few O.D.'s & O.M.D.'s before finding my current eye doc. He happens to be an O.M.D. I don't care if he's an O.M.D. or an O.D. as long as he takes care of my vision to my liking. There are good & lousy O.D.'s and O.M.D.'s. Now there's a truth you can take to the bank, just like there are good patients and there are lousy patients. > The best way to select a particular O.D. or O.M.D. is to rely on patients' > opinions. Even that method can go wrong. My mother went to a cataract surgeon who came highly recommended by a friend of hers. Turns out the guy had no stereopsis and not much more ethics. He botched her surgery, and now she's worse than blind in that eye. Fortunately, he's not practicing anymore... > GW Bush spends more of his time deciding what to do for the US than do > most of us. That doesn't mean that GW is a better decision maker. [quoted text clipped - 9 lines] > doc. He happens to be an O.M.D. I don't care if he's an O.M.D. or an O.D. > as long as he takes care of my vision to my liking. Yes I can argue that an OD is generally better than OMD at refracting, and I will continue to argue that. Anyone can make decisions, but it takes experience to give good eye exams and OD's have more experience. In addition to the issue of who spends more time refracting, there is my considerable experience as a patient of both OD's and OMD's, and the many other patients who have posted on this forum who have had problems with an Rx from an OMD. No one is saying that every OD is better at refracting than every OMD. But since it is very difficult (and expensive) to figure out which individuals are better, it is certainly reasonable to go to the provider who is statistically most likely to provide the best service. The only other really bad refraction I remember was a contact lens patient of mine who happened to be a nurse. She got a bad case of GPC and was treated at the hospital where she worked, taken out of the contacts, and given a new pair of eyeglasses. I saw her about 6 months later. The glasses measured about -7.00D. I looked at the prescription I gave her last year, and it read -2.50. I refracted her and got -2.50 again. Apparently, the prescription she was wearing was from an autorefractor. She had really good accommodation. DrG > > GW Bush spends more of his time deciding what to do for the US than do > > most of us. That doesn't mean that GW is a better decision maker. [quoted text clipped - 23 lines] > are better, it is certainly reasonable to go to the provider who is > statistically most likely to provide the best service. I've been practicing for over 20 years. During that time I have seen some bad refractions. But, on a percentage basis, it is miniscule. The refraction is a well-standardized practice that in some cases is a bit too perfunctory. My uncle was my optometrist, and he set the standard for the eye examination. Years later, as an engineer for a Fortune 500 company, I went to an OMD for what turned out to be an inflamed penguecula. The first thing I did was spend an hour waiting for my eyes to dilate. Then he took a look at the penguecula and mumbled something about doing radiation treatment if the drops didn't work. Then I went to the pharmacy to fill the prescription only to find out that the medication contained a sulfa drug after I distinctly listed sulfa as being the only drug I was allergic to (pharmacist had to call the OMD). Then, he did not indicate for how long I was to take the steroid drops, and I was still taking them a month later when I went for my follow-up appointment. "Stop taking them" he said rather nervously. Then, he proceeded to refract me using a trial frame with loose lenses, and not a phoropter like my uncle. No duochrome test, no meticulously refinement of the astigmatic axis -- actually, no astigmatic correction at all. I promptly threw that prescription away as soon as I left the office. Then I decided to go to optometry school. DrG > > Drawing a general conclusion works perfectly well ... as a general > > conclusion. [quoted text clipped - 15 lines] > doc. He happens to be an O.M.D. I don't care if he's an O.M.D. or an O.D. as > long as he takes care of my vision to my liking. My advice to the original poster: 1. Make a list of the practices near where you live, or easily accessible to you, since you will probably have to go back there for additional visits. Make notes on that list based on: 2. Talk to the receptionist about the doctors that are there. How many are there? How good are they (I know, this seems crass and unscientific, but you'd be surprised at what you might find out). 3. Ask her what kind of followup and redo policies the office has if the patient has a problem. 4. Ask her about fees. How much for the exam, do they work with this or that insurance. 5. Ask how soon you can be seen at this time, and is that a usual waiting time for this office? 6. Ask if the office has frames and lenses, and if they do, how much do the kind of lenses you wear cost? If they don't, whom do they recommend for obtaining eyewear? (if they say walmart, costco, lenscrafters, sears or penney's, or if they say "anywhere", scratch them off your list unless you happen to like the optical departments of those establishments). Then look at your list and notes and make your appointment. w.stacy, o.d. > You can't draw a general conclusion about opthalmologists vs. optometrists. > It depends on the particular doctor. Fine, if you have the time and money to visit 75 doctors. Insurance may pay for a second opinion, but not 75. So how do you decide? In this group, it's recommended by most to see an OD for refraction. I see an OMD every year. For some time, I saw one every month. The nurse did the vision checking. > I see an OMD every year. For some time, I saw one every month. The > nurse did the vision checking. OK this is probably for very specialized care. For ROUTINE eye exams, refractions and eyeglass/contact lens prescribing, there is no doubt that o.d.s are by and large better at it. And NURSES doing VISION CHECKING? Well, I suppose they get more formal training in objective and subjective refraction than the o.m.d.s themselves do... w.stacy, o.d. (I'm sorry to admit that even optometrists are getting less optics and refraction education than they used to. Everyone seems to think that medical eye issues are more important than refractive ones. Maybe. But I think 90% of all vision problems are refractive/optical/binocularity problems. The other 10% are medical/pathological/surgical items. Seems to me that we ought to be educating more like we used to...) > > I see an OMD every year. For some time, I saw one every month. The > > nurse did the vision checking. > > OK this is probably for very specialized care. I had a retinal detachment. Actually two. Plus two cataracts. Plus other stuff. > And NURSES doing VISION CHECKING? Well, I suppose they get more formal > training in objective and subjective refraction than the o.m.d.s > themselves do... I don't know that I would call it refraction. They just check the vision, they don't attempt to determine a correction. I posted my horror story before. The nurse asked me which line I could see. None. I couldn't see the chart. How many fingers? No idea, I couldn't even see her hand. The doctor measured my IOP. It was 40. She relieved the pressure, in stages. When it got down to normal, I could see 20/40. It was the day after cataract surgery. OK I was right, you were getting VERY SPECIALIZED CARE, considering you had at least 3 different medical eye problems going on at one time. So if the nurses or the o.m.d. do a rough analysis of what you can or can't see, fine, especially if it was as bad as you say. What I was talking about is ROUTINE vision "checking", commonly known as refraction and/or vision analysis. This is where optometrists part company with o.m.ds and nurses. This is where things like retinoscopy, phorias, vergences, fixation disparity, stereopsis, auto-refraction, subjective refraction, cover testing, vertometry, pupillometry, keratometry, and even perimetry techniques, understanding and interpretation become important. To put it bluntly, in the above subjects: Optometrists get about 4 years of fairly extensive training. Ophthalmologists get maybe 3 years of fairly spotty training. Nurses get a few weeks of I'm not sure what kind of training. Now to be fair and complete, Ophthalmologists get 4 years of medical school learning all about all diseases of all parts of the body, followed by about 3 years of ophthalmology residency learning about and treating medically, surgically, and optically all diseases of the eye. During that residency they learn a little about optics, and might learn a bit of refraction technique. Optometrists get 4 years of optometry school learning quite a bit about diseases of all parts of the body, and learning about and treating many diseases of the eye and visual system. They also learn optics (both physical and ophthalmic), and are thoroughly trained in the theory and practice of refraction, eye examination and vision analysis. Opticians get a lot of practical and theoretical training in ophthalmic optics (sorry, but I'm not completely up to date on the extent of this, but I'm sure it's pretty good), and learn how to fit glasses, contacts and some are even learning refraction. Nurses get at least 2 years of study on diseases of all parts of the body and many vital treatment modalities. What they learn about optics, refraction, vision and the eye they learn mostly from the doctors for whom they work. Sorry if this sounds like a rant, but I've been around a pretty long time, and I don't much like what I see. I see ophthalmologists selling frames and lenses. I see optometrists doing minor eye surgery. I see nurses doing refractions. I see opticians trying to figure out what the above "professionals" are doing... w.stacy, o.d. >>OK this is probably for very specialized care. > [quoted text clipped - 15 lines] > stages. When it got down to normal, I could see 20/40. It was the day > after cataract surgery. Why not cut to the chase? Optometrists by and large provide better refractions because in most states they are not permitted to delegate that function to someone who may or may not have the training or the incentive. DrG > OK I was right, you were getting VERY SPECIALIZED CARE, considering you > had at least 3 different medical eye problems going on at one time. [quoted text clipped - 70 lines] > > stages. When it got down to normal, I could see 20/40. It was the day > > after cataract surgery. > OK I was right, you were getting VERY SPECIALIZED CARE, considering you > had at least 3 different medical eye problems going on at one time. This was over a period of 15 years. My point was that when I see the OMD at my HMO, a nurse checks the vision first. When the OMD thinks I need a refraction, I am referred to an OD. > So if the nurses or the o.m.d. do a rough analysis of what you can or > can't see, fine, especially if it was as bad as you say. It was only that bad for a few minutes. I had a patch on my eye prior to the exam. > What I was talking about is ROUTINE vision "checking", commonly known as > refraction and/or vision analysis. This is where optometrists part [quoted text clipped - 3 lines] > keratometry, and even perimetry techniques, understanding and > interpretation become important. I understand about 10% of those words. :-) > >>OK this is probably for very specialized care. > > [quoted text clipped - 15 lines] > > stages. When it got down to normal, I could see 20/40. It was the day > > after cataract surgery. > You can't draw a general conclusion about opthalmologists vs. > optometrists. It depends on the particular doctor. Yes, you can draw a general conclusion, but it may not apply in every single case. One thing I notice about all doctors, is that they almost always draw general conclusions when diagnosing a situation. If you exhibit a set of symptoms that 90% of the time point to a particular diagnosis, but you are one the 10% that points to a completely different diagnosis, then you will be screwed by most doctors. Doctors, just like everyone else, draw general conclusions, even they turn out to be wrong in some cases. > One thing I notice about all doctors, is that they almost always draw > general conclusions when diagnosing a situation. If you exhibit a set of > symptoms that 90% of the time point to a particular diagnosis, but you are > one the 10% that points to a completely different diagnosis, then you will > be screwed by most doctors. There is a term "probability." I always make a list of all the possible diagnoses and then try to narrow it down with additional tests, etc. Sometimes we just don't get it right. There is another term "fallible." DrG > However, in the past few years, my opthalmologist > is in a hurry - no doubt the result of managed care and the > pressures it places upon us all. sigh... I totally understand. I have a wonderful car mechanic that truly cares for each customer and vehicle that he works on, and spends 5+ minutes reviewing the condition of my car with me when I go to pick it up. The sad thing is that every time, I wish that my doctor/dentist/optometrist spent that much time and cared about me as much as my car mechanic. But most of the ones that I've had make me feel like they just want to make as quick of a diagnosis as possible and get to the next patient. It's hard to blame them, since they probably do have overloaded schedules and pressures, etc. anyways, like others said, I don't think it's about OD vs MD, I think the only way is to get a personal referral from a friend. Ask your optometrist how many insurance plans s/he accepts, and then ask him how much he gets reimbursed. He might say something like 50 cents on the dollar. Now, would you pay out of pocket for someone who gave you the kind of service you wanted...like you do your car mechanic? The vision plans I am on pay me less than it costs me to provide the service for the amount of time I like to take. DrG > > However, in the past few years, my opthalmologist > > is in a hurry - no doubt the result of managed care and the [quoted text clipped - 12 lines] > anyways, like others said, I don't think it's about OD vs MD, I think > the only way is to get a personal referral from a friend. > Ask your optometrist how many insurance plans s/he accepts, and then > ask him how much he gets reimbursed. He might say something like 50 [quoted text clipped - 20 lines] >> anyways, like others said, I don't think it's about OD vs MD, I think >> the only way is to get a personal referral from a friend. I am very familiar with that problem; I am a psychotherapist and suffer the same difficulties except the amount of time for my sessions is pre-determined. I can't "rush" and make more money. It has been very demoralizing and continues to be so. I had a very successful practice in which I was able to see a few people, who needed it, for a very low fee, while still maintaining a decent lifestyle and position in the community. I am now a "provider". My additional 8 years of post-grad training allow me to charge no more than someone who has just gotten their license yesterday. Nevertheless, I have also found that physicians who refuse all insurance are equally bitter. They don't have enough patients and they too have been robbed of the "careers" they were building. They tend to "overcharge" (in my opinion), to make up for the lack of patients. Their careers, for the main part, have been robbed in a different way. The patients are robbed of good care and the doctors, of decent reimbursement - only the stockholders are ahead. Louise Thanks for speaking out, louise. I'm thinking more and more that "providers" are just going to have to unionize. DrG > > Ask your optometrist how many insurance plans s/he accepts, and then > > ask him how much he gets reimbursed. He might say something like 50 [quoted text clipped - 42 lines] > > Louise |
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