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

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.

p.clar...@gmail.com wrote:

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

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.).

============

I agree.

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.

Same here.

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.

Man you guys just keep stepping in it don't you.

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:

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.

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.

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.

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.

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.

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
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?

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.

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.

------------

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.

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.