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Medical Forum / General / Vision / November 2007Contact Lens Trials
This is a follow-up to what I wrote in the last post to the thread: "Toric in one eye, multifocal in the other". I haven't done anything about this since then, as I have been very busy. I'm wondering what I should do to follow up? I'm not happy that my O.D. didn't want to give me trial lenses of the Purevision Toric in -5.0 power for the right eye, and a Purevision Multifocal for the left. As I wrote, he didn't think the multifocal in the left would be a good idea at all (although eye docs who write here thought it was feasible). He thought reducing the - power of the right eye (distance in monovision) to -5.0 (instead of -5.25) was a good idea, to improve near vision a little. Yet, he didn't want to give me a trial lens at the 5.0 power, but just wanted to order me a box. I said I'd "think about it", and left it open, and haven't called back since. (Please see that other thread for details.) What do the eye docs here think about that? Would you not want the patient to try a particular lens, before buying it? And if the patient wanted to try a multifocal in one eye, even if you didn't think it was the best idea, would you let him/her try it? Getting a good contact lens choice for an individual patient, especially a presbyopic one like me, requires a lot of trial and error, no? And the manufacturers give you free lenses to try on patients, no? As said, I quite likely will look for a new eye doc next year. (This one didn't even give me a glaucoma test. Isn't that a standard part of an eye exam?) (So, his unwillingness to give me more trial lenses is likely to lose him a patient.) But for this year, I have already assigned my VSP benefits to this doc, and had an exam with him, so I have to decide what to do for this year. Have any other patients here experienced that--eye docs who were reluctant to give trial lenses? Should I just accept it, and buy a box of the Purevision Toric -5.0 (cylinder .75) for the right eye, without having ever tried that lens (although I did try it, wearing right now, in -5.25), and Night&Day -4.5 (same as I have worn for years) in the left? Or, should I call again and speak to the doctor, perhaps catch him in a better mood, and be more insistent on getting the trial lenses mentioned, before deciding for sure what to order? Curious to hear feedback about this from other eye docs and patients. (Once again, for more details, look at the thread I cited at the beginning of this post.) Thank you for your feedback. :-) > This is a follow-up to what I wrote in the last post to the thread: "Toric > in one eye, multifocal in the other". [quoted text clipped - 12 lines] > left it open, and haven't called back since. (Please see that other thread > for details.) I expect his reluctance to trial the multifocal was because you didn't like it when you tried it previously. You are currently successfully wearing the -5.25 toric trial. Toric trials often have to be ordered, there is a cost in office time and sometimes shipping costs to do this and B&L has a generous return policy for lenses. From his point of view and knowing you and your eyes quite well he is likely very confident that the lower power will work so might as well order the lenses now and exchange later if need be. There is an expense to doctor and office time even if the trial lenses are free from the company. Dr Judy > I expect his reluctance to trial the multifocal was because you didn't > like it when you tried it previously. You are currently successfully [quoted text clipped - 8 lines] > > Dr Judy The question is--what does one mean by "successful"? With contact-lens-only (no reading glasses) fitting of presbyopic patients, whether monovision or multifocal or a combination of the two, there is always a compromise between near and distance vision, there is no perfect fitting. Of course, the goal is to get the best compromise between the two, for the patient's needs. That is often subjective, and has to be decided by the patient, regarding what level of compromise he or she finds works best for him or her. That takes trial and error, experimentation. So, you write that I am "successful with the -5.25 toric trial. Yes, I can get by with them, and my distance vision is better than before, when I did not use a toric lens. However, the near vision is a bit worse. So, I wanted to try to improve the near vision, without too much negative impact on distance vision. To know what is a successful compromise, I have to try it, no? I guess one could figure that a quarter diopter is a small amount, so the vision won't be too much different than now. So yes--changing to the 5.0 would probably work OK, I'm sure I could get by with them. But of course, from my perspective, I want to find the best possible compromise, before deciding on what to settle with. Is that too much to ask? One would think doctors would want to keep their patients happy, in order to keep them. I have been there when the office staff has called the optical company to order a trial lens. it seems to proceed very quickly--no more than a minute or two. Not a lot of office time. The optical companies charge postage to the doctors, when they send them trial lenses? That surprises me, as it is in the optical company's interest to have patients try their lenses. Nevertheless, the postage charge to send one contact lens could not be very high (less than an ounce=41 cents first class mail), not a big expense. Again, one would think it is in the doctor's best interest to keep his patients happy. My two cents on that. > Nevertheless, the postage charge to send one contact lens could not be > very high (less than an ounce=41 cents first class mail), not a big > expense. Again, one would think it is in the doctor's best interest to > keep his patients happy. > > My two cents on that. Somehow the 41 cents turns into $5.95 when I order trials. Best compromise would be to wear the -525 into his office, then borrow a +0.25 trial lens (glass) and look around, out the window, etc. -MT > Somehow the 41 cents turns into $5.95 when I order trials. > -MT Do you mean that they charge $5.95 to ship each individual trial lens? I think that's outrageous! In fact, the actual material and manufacturing cost of one contact lens, plus the actual shipping cost, probably adds up to much less than that. So the manufacturers are actually profiting from trial lenses, which supposedly they are giving complementarily. I don't think that's a very wise business decision. If manufacturers really want patients to try their lenses, want doctors to prescribe trials of their lenses for patients, they really should provide the trial lenses for free. Regarding looking through a glass to see what the lessening of the right eye's minus power by a quarter diopter would be like, sure., I could do that. But looking through a glass for a moment, while sitting in the optometrist office, is not anything like wearing a pair of lenses for a week, in all different conditions, and seeing what one's vision is like in different conditions, both near and far. > "Mike Tyner" <mtyner@mindspring.com> wrote in message >> Somehow the 41 cents turns into $5.95 when I order trials. > > Do you mean that they charge $5.95 to ship each individual trial lens? No, that's misleading. It's true, if I order a single trial, the S&H is brutal, but with larger quantities the cost-per-item is pretty rational. The manufacturers aren't looking to make a profit off S&H as much as they're discouraging single-trial orders. The trial lenses also count against the doctor's allotment - most are at the mercy of a policy such as one trial per box sold, or similar restriction. Too many patients consume the doctor's trial allotment and then buy their boxes elsewhere, so it makes the doctor stingy with trials. It seems like the doctor was agreeing with you. He sounded confident you'd be happy with -5.00, and you didn't trust him. There are several reasons to believe -5.00 would work. > that. But looking through a glass for a moment, while sitting in the > optometrist office, is not anything like wearing a pair of lenses for a > week, in all different conditions, and seeing what one's vision is like in > different conditions, both near and far. Still, 20 feet is 20 feet. Observing with/without the +025 lens would give reliable information. -MT > > that. But looking through a glass for a moment, while sitting in the > > optometrist office, is not anything like wearing a pair of lenses for a [quoted text clipped - 3 lines] > Still, 20 feet is 20 feet. Observing with/without the +025 lens would give > reliable information. I'm with you here, Mike. Observing under controlled conditions, like a fixed distance and fixed illumination, tells a lot more than a week of random circumstances. Especially for .25D. Vision isn't my area of expertise, but human nature is the same. Have a good lunch? Everything works fine. Have a fight with your spouse? Nothing works right. > In article <zZSdna3qwvULJ9TanZ2dnUVZ_i2dnZ2d@giganews.com>, > I'm with you here, Mike. Observing under controlled conditions, like a > fixed distance and fixed illumination, tells a lot more than a week of > random circumstances. Especially for .25D. Vision isn't my area of > expertise, but human nature is the same. Have a good lunch? Everything > works fine. Have a fight with your spouse? Nothing works right. Dan---real life is full of "random circumstances", it isn't usually looking at everything with "fixed distance and fixed illumination". In one's daily life, one has to use one's vision for all sorts of purposes, seeing all different kinds of things, different sizes, different distances, and with different illumination. Not "fixed" at all. Therefore, the best way to see if lenses will work for you in real life, is to try them in real life. Common sense. >Dan---real life is full of "random circumstances", it isn't usually looking >at everything with "fixed distance and fixed illumination". In one's daily >life, one has to use one's vision for all sorts of purposes, seeing all >different kinds of things, different sizes, different distances, and with >different illumination. Not "fixed" at all. -0.25 dptr is only going to make a difference in very specific and particular circumstances (e.g., extreme distance). In generic, random situations where you do all sorts of different kinds of seeing, -0.25 dptr is not going to be meaningful. >Therefore, the best way to see if lenses will work for you in real life, is >to try them in real life. As long as you are willing to pay up, then I see no reason a doctor couldn't accommodate you. > As long as you are willing to pay up, then I see no reason a doctor > couldn't accommodate you. You and others say that it costs an eye doctor more to try more lenses on a patient, even though they are complimentary. Assuming that is the case, even if looked at only from a business perspective (disregarding such characteristics as conscientiousness, caring, etc.), is it a wise business decision to save a few pennies (or even a few dollars) by denying a patient trial lenses, when the doctor might lose that patient as a result (as well might happen in my case)? Isn't it smarter to keep one's patients happy, so they keep coming back to you, even if that costs a few more dollars in trial lenses? Eye docs might want to lobby contact lens manufacturers, however (through their professional organizations) for a more liberal policy and allotment of trial contact lenses, since it is also in the manufacturer's best interests, to have more patients try their lenses. > Eye docs might want to lobby contact lens manufacturers, however (through > their professional organizations) for a more liberal policy and allotment > of trial contact lenses, since it is also in the manufacturer's best > interests, to have more patients try their lenses. Good luck with that. :) I vote with my feet. If they skimp on trials, I walk away. -MT >> As long as you are willing to pay up, then I see no reason a doctor >> couldn't accommodate you. > >You and others say that it costs an eye doctor more to try more lenses on a >patient, even though they are complimentary. Yep. But trial cost is (typically) not the major issue -- doctor/chair time is the big issue. Doctors gotta get paid in the real world for what they do. >Assuming that is the case, even if looked at only from a business >perspective (disregarding such characteristics as conscientiousness, caring, >etc.) Caring/conscientous is crap in the majority of cases. The majority of the cases involve, basically, patients not *wanting* to pay rather than not being *able* to pay. In cases of people truly being broke (homeless), I have no problem writing off free services/glasses. >is it a wise business decision to save a few pennies (or even a few >dollars) by denying a patient trial lenses I seriously doubt any doctor would deny giving you trial lenses; I think it would be more accurate to state the following: The doctor believes it is unlikely new trial lenses will make you significantly happier than you are right now or you have "used up" your chairtime allotment and if you need more, you are gonna have to pay for it. And, I speculate, he is unwilling/ashamed to be perfectly blunt with you. >when the doctor might lose that patient as a result (as well might >happen in my case)? Isn't it smarter to keep one's patients happy, so >they keep coming back to you, even if that costs a few more dollars in >trial lenses? It depends. I certainly have ate chairtime/lost money on a particular patient by bending over backwards to make them happy. It's done on a case-by-case basis and a lot it, frankly, depends on the patient attitude and expectations. >Eye docs might want to lobby contact lens manufacturers, however (through >their professional organizations) for a more liberal policy and allotment of >trial contact lenses, since it is also in the manufacturer's best interests, >to have more patients try their lenses. Again, I really don't think this is a case of a doctor not wanting to give out extra trials in general. I think it's a case of him not wanting to give YOU more trials for free because of your particular case. If the difference between what you were currently using and the trial lens was -0.25DS, I typically wouldn't give a new trial lens. I would hold a loose lens in front of the eye and see if things helped If you were sweet as pumpkin pie, paid cash, and wanted a trial, I'd give you one. If you were a pain in the butt who had a third party-payor that either paid horrible or forbid charging extra chairtime, and just overly anal in your expectations, I might not. Instead of tacitly calling the doctor heartless or money-hungry, what is YOUR resistance to offering to pay the doctor for more of his chairtime/trials? > Yep. But trial cost is (typically) not the major issue -- > doctor/chair time is the big issue. Doctors gotta get paid in the > real world for what they do. It really doesn't take any chair time, for the doc to order another trial contact lens. He hasn't examined my eyes again with each contact. > Caring/conscientous is crap in the majority of cases. The majority of > the cases involve, basically, patients not *wanting* to pay rather > than not being *able* to pay. In cases of people truly being broke > (homeless), I have no problem writing off free services/glasses. I don't know what you are talking about. I didn't say anything about patients not paying. But I don't consider being caring and conscientious as "crap". In my work as a teacher, I am very caring and conscientious. My main concern certainly isn't money, but doing the best I can for my students. I don't see that as "crap". > Instead of tacitly calling the doctor heartless or money-hungry, I didn't at all call the doctor heartless or money-hungry, tacitly or otherwise. Don't put words in my mouth, please. (It's you who keep bringing up money, by the way. My doc didn't say anything about money.) >> Yep. But trial cost is (typically) not the major issue -- >> doctor/chair time is the big issue. Doctors gotta get paid in the >> real world for what they do. > >It really doesn't take any chair time, for the doc to order another trial >contact lens. He hasn't examined my eyes again with each contact. Sure it does. Doctor has to figure out the lens, write that info in the chart, tell his staff to order the lens, etc. -- that amount of time it takes to do that is time he does not have available for other patients to use as chair time. >> Caring/conscientous is crap in the majority of cases. The majority of >> the cases involve, basically, patients not *wanting* to pay rather [quoted text clipped - 6 lines] >concern certainly isn't money, but doing the best I can for my students. I >don't see that as "crap". You *tacitly* stated that if a doctor who doesn't give out free trial lenses is not caring or conscientous: "disregarding such characteristics as conscientiousness, caring, etc." > Yep. But trial cost is (typically) not the major issue -- > doctor/chair time is the big issue. Doctors gotta get paid in the > real world for what they do. I'm sure my former OD lost a bundle on me. I was typically there for an hour. I paid $10, I don't know what the insurance company paid. I wasted a lot of his time. That just goes with the territory. Doctors know their business, the patient doesn't. Still, eventually the doctor has to cut it off. Too many visits, when the doctor only gets paid for one exam, doesn't work. I never reached that point. My doctor was always happy to see me. I was "interesting". > > In article <zZSdna3qwvULJ9TanZ2dnUVZ_i2dnZ2d@giganews.com>, > [quoted text clipped - 12 lines] > Therefore, the best way to see if lenses will work for you in real life, is > to try them in real life. Common sense. Common sense sucks. Under controlled conditions, common sense is sometimes wrong. Trusting other people's common sense is a bad idea. Show me. > Common sense sucks. Under controlled conditions, common sense is > sometimes wrong. Trusting other people's common sense is a bad idea. > Show me. Not talking about "other people's common sense". I would trust my own judgment, in trying different lens combinations (in conjunction with an eye care professional) to deal with my myopia-presbyopia, to determine which combination works best for me. No one else could make that determination. > > Common sense sucks. Under controlled conditions, common sense is > > sometimes wrong. Trusting other people's common sense is a bad idea. [quoted text clipped - 4 lines] > care professional) to deal with my myopia-presbyopia, to determine which > combination works best for me. No one else could make that determination. I suspect that I am finished with this thread. I'm in over my head. I'm no expert. I certainly wish you my very best in getting the best vision possible. >Not talking about "other people's common sense". I would trust my own >judgment, in trying different lens combinations (in conjunction with an eye >care professional) to deal with my myopia-presbyopia, to determine which >combination works best for me. No one else could make that determination. Who determines when enough is enough? I guess in your opinion, it is you rather than the doctor. Well, in your current doctor's practice, I bet it is the doctor. A typical contact lens service fee doesn't allow people to make unlimited switches and try different combinations to their heart's content. Healthcare resources are not unlimited, especially when a third party payor is involved This doctor is, evidentally, unwilling to lose money on you and make it up elsewhere. Take a good hard look in the mirror. Perhaps this doctor really doesn't care too much if you move on? > Who determines when enough is enough? I guess in your opinion, it is > you rather than the doctor. Well, in your current doctor's practice, > I bet it is the doctor. Of course it is the doctor's practice. But if I am not happy with his care, I can vote with my feet and go to a different eye doctor next year. > A typical contact lens service fee doesn't allow people to make > unlimited switches and try different combinations to their heart's > content. Healthcare resources are not unlimited, especially when a > third party payor is involved Please. Doctors(including eye doctors) make a lot of money, I'm sure in six figures. Much more than I make as a teacher. I'm sure they are not going broke from contact lens trials. Of course, no one makes "unlimited switches", silly argument. But finding the right lens combination for a presbyopic patient does take trial and error, no? > This doctor is, evidentally, unwilling to lose money on you and make > it up elsewhere. Silly thing to say. Doctors "lose money" on contact lens trials? Absurd. > Take a good hard look in the mirror. Perhaps this doctor really > doesn't care too much if you move on? Why should I take a look in the mirror? (I do so every day, while shaving, by the way.) Another silly thing to say. I don't know how much this OD would care if I left his practice next year (which is quite likely). If he doesn't care if he loses patients, I would say that is not very bright. (He also is the doc who told me that the Acuvue Advance has a much higher dK than Purevision, that the former is approved for EW and the latter is not. He also didn't give me a glaucoma test (I may still ask about it), which is supposed to be part of an eye exam.) Perhaps you, "Dr. Anonymous", don't like patients who are inquisitive, who ask questions, who read up on the field, might make suggestions, etc. Would you rather just have "easier" patients who take less time, don't ask questions, etc.? >> Who determines when enough is enough? I guess in your opinion, it is >> you rather than the doctor. Well, in your current doctor's practice, >> I bet it is the doctor. > >Of course it is the doctor's practice. But if I am not happy with his care, >I can vote with my feet and go to a different eye doctor next year. Of course. >I'm sure they are not going broke from contact lens trials. Not the point. Doctors need to get paid for their service. >Silly thing to say. Doctors "lose money" on contact lens trials? Absurd. It costs doctors money to order trial lenses. If they don't get paid for them, they lose money. >He also didn't give me a glaucoma test (I may still ask about it), >which is supposed to be part of an eye exam.) There is no one "glaucoma" test. I presume you are talking about getting your intraocular pressure checked -- that is part of a routine eye examination and I would be surprised if he didn't do that. >Perhaps you, "Dr. Anonymous", don't like patients who are inquisitive, who >ask questions, who read up on the field, might make suggestions, etc. Would >you rather just have "easier" patients who take less time, don't ask >questions, etc.? I actually like informed patients. How many total visits did you have at this doctor's office? > It seems like the doctor was agreeing with you. He sounded confident you'd > be happy with -5.00, and you didn't trust him. There are several reasons > to believe -5.00 would work. > -MT No, it is not a matter of "not trusting him that 5.0 would work". In fact, it was I who suggested that. Only, that I think it would be best to try it out, to see if that particular compromise (between near and far) is right for me. Actually, I'm sure too that it would "work", if by work you mean acceptable, passable, able to get by. But as said, in coming to a compromise between near and far vision, one wants to find the best possible compromise, not just settle for anything that "works". If you were prescribing a presbyopic contact lens solution for yourself, or someone in your family, wouldn't you want to experiment to find the best solution for that person? Would you order a box of lenses for yourself, without having a trial of that particular lens and strength first? > someone in your family, wouldn't you want to experiment to find the best > solution for that person? Would you order a box of lenses for yourself, > without having a trial of that particular lens and strength first? Yes, indeed I have, based on the confirmation of hand-held +/-025 lenses. But then I use those a lot. In the -500 range, it's easy to wind up with lenses that are stronger than necessary. I like to confirm the final rx by assuring that +025 is worse and -025 is not better. -MT [snip] >I'm not happy that my O.D. didn't want to give me trial lenses of the >Purevision Toric in -5.0 power for the right eye, and a Purevision [quoted text clipped - 8 lines] > >What do the eye docs here think about that? My first impression of you is that you are too anal about your vision -- the stereotypical "engineer". I would probably, just like the other person mentioned, have you hold a loose +0.25 DS lens over the -5.25 DS contact you are wearing and see what you thought rather than give you another lens to try. It should not require, in the vast majority of cases, more than a minute or two of looking in the distance, at a VDT and at near with a +0.25 DS loose trial lens over your existing CL to "see" if that is what will make your vision more comfortable. >Would you not want the patient to try a particular lens, before buying >it? I can usually feel out whether another trial CL needs to be dispensed or if I can just get the necessary information from a loose trial lens over the CL after doing this stuff for a while. >And if the patient wanted to try a multifocal in one eye, even if you >didn't think it was the best idea, would you let him/her try it? It depends. If I thought it had a low chance of success, I would make sure I charged the patient an appropriate, extra contact lens examination fee for that if I did. It helps to "weed out" those who are serious from those who just want to experiment. >Getting a good contact lens choice for an individual patient, >especially a presbyopic one like me, requires a lot of trial and >error, no? Usually not. >And the manufacturers give you free lenses to try on patients, no? Nothing is usually free. We typically get charged a shipping fee to receive them. Additionally, most manufacturers give you a certain allotment of trial lenses based on the actual amount of boxes of dispensed boxes you sell. If you use too many trials without selling the real product and you can "run out" of trials. >As said, I quite likely will look for a new eye doc next year. (This one >didn't even give me a glaucoma test. Isn't that a standard part of an eye [quoted text clipped - 5 lines] >Have any other patients here experienced that--eye docs who were reluctant >to give trial lenses? I get relunctant to continue to try different trials when, based on years of experience and with dealing with patients like you, the likelihood of success is small. I charge a standard contact lens examination fee based on the amount of time/lenses I typically will need to try. Bottom line is the more lenses and chair time you want, the more it will cost the doc and unless you are willing to reimburse him for that extra time/expense, many doctors are going to be unwilling to do what you want -- especially if they consider your expectations to be unrealistic. Even more so if a third-party payor is involved where he is getting paid pennies on the dollar of his usual & customary fees. >Should I just accept it, and buy a box of the Purevision Toric -5.0 >(cylinder .75) for the right eye, without having ever tried that lens [quoted text clipped - 7 lines] >again, for more details, look at the thread I cited at the beginning of this >post.) There is a real easy way to get more trial lenses. It would go something like this: YOU: Doc, I want you to be blunt and totally honest with me -- do you think I am unrealistic or overly picky about my vision with CLs? If the doctor says "Not at all", then ask him why he won't give you the trials you want. If the doctor says "Yes", or is hesitant, then try the following: YOU: Doc, I really want to try this and I am willing to pay you to keep trying various trial CLs until I think this ain't gonna work. How about you charge me for each visit/for trials whatever makes it worth your while to keep trying lenses on me? >Have any other patients here experienced that--eye docs who were reluctant >to give trial lenses? In my first exam, my OD gave me Acuvue Advance, Focus N&D, B&L PureVision, and Acuvue Oasys, across three visits. On my recent second exam, I didn't need to try new lenses (though I may try the Biofinity lenses next year). Yet he gave me a pair of Oasys so I didn't have to bother putting the ones I was wearing in a case after taking them out for parts of the exam. I only know the side of the story you're sharing here, but I'd certainly go to a new OD based on what you've said. Doesn't know the facts about lenses. Doesn't give a glaucoma test (that sounds like malpractice to me). I'd ditch right now, and pay out of pocket if necessary (which I do in any case, since I live in the only industrialized nation without universal medical care).  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