LETTERS & E-MAIL
High-Wire Hits a Nerve
| Other Letters and E-Mail
No-Rub Isn’t Necessarily the Safest Option One Size Fits All Doesn’t Fit for Patient Care Appreciate Non-Medical Tips for Allergies How We Can Refuse to Release Prescriptions |
Editor: Just a missive to comment favorably on your editorial “Optometry’s High-wire Act” (March 2001). While the profession must have a master plan for its future, it must also have a road map to guide itself.
But there is yet an additional element that is critically important: the public whom we are dedicated to serve. Legally, optometry is a 20th Century profession. The first statutory recognition was in Minnesota in 1901. In the span of 100 years, our profession has had one “public” study, the “Havighurst Study,” published in 1972 by the National Commission on Accrediting.
Three decades have passed since, and we have witnessed enormous changes in the profession and health care. Among these are DPA, TPA, ethnicity and gender changes in the workforce, technology revolutions and, of course, managed care. There are many more.
There is a critical need for a second public study. This would strengthen
our base and the understanding of our profession’s purposefulness. An editorial,
written 20 years ago, makes the same points. But, the compelling reason
for the study is succinctly expressed in your editorial comments.
—Alden N. Haffner, O.D., Ph.D., president, State University of New
York, State College of Optometry, New York.
Editor: Regarding the Editor’s Page, “Optometry’s High-wire Act”:
I’ve told you when you are wrong. Now, it’s appropriate to commend you
when you are right.
Optometry’s present situation of each state fending for itself in the
area of optometric privileges presents a profession with a split personality
to not only our detractors but also to our friends.
It is past time for our profession to unite in purpose and press toward one goal. Here’s a glimpse of what’s to come, if we don’t: In Washington State, we had to pull our orals bill so that opticians would not get their refractionist bill. Once opticians begin refracting, our profession, as an independent entity, will begin to die.
This is the next big battle for optometry, and one we cannot afford
to lose.
—Stan Pugh O.D., Tacoma, Wash., snpugh@accessone.com.
One Size Fits All Doesn’t Fit for Patient Care
Editor: As an old-timer (48-plus years in practice prior to my recent retirement), I’m inclined to give Dr. Walter D. West an “A+” for both professional and personal hubris, but a “C–” for adhering to the basic purposes and philosophy of optometric practice (“Which is Better? 1. Techs Performing Automation-Assisted Refractions,” March 2001 cover story).Dr. West states: “We, too, should concentrate on being physicians who
make decisions based on data as opposed to collecting it.” Correct me if
I’m wrong, but isn’t the word “physician” applicable only to those who
graduate from approved medical colleges with an M.D. or D.O. degree? We’ve
struggled to gain TPA privileges, but this does not convert us en masse
into physicians.
And, Dr. West can tell me that there are no problems with incorrect
spectacle Rxes when his technicians use automated refraction lanes, but
making me believe it is an entirely different matter. The smart O.D. will
double-check such Rxes with the phoropter.
Dr. West is entitled to believe that patients don’t return to a doctor “because of the quality of refraction that they receive.” What belies this, however, is the hundreds of times many of us have heard, “That’s the most thorough exam I’ve ever had, Doctor.” I don’t recall ever hearing that from a patient who just had an objective refraction on a completely impersonal automated device.
This represents a “one-size-fits-all” philosophy of practice that relegates the doctor-patient relation- ship to the background, except during the brief period of the eminent doctor’s counsel with the patient. This smacks of “show biz” and provides little occasion for the doctor to learn much about the patient as a person—that which, to me at least, makes the profession interesting and challenging.
And here all this time I thought optometry had something to do with
measuring refractive error, expertise which sets us apart from all other
health-care or vision-care professionals. How utterly gauche of me!
—Loren L. Pace, O.D., Findlay, Ohio.
Editor’s note: Actually, laws in at least three states—Florida, New Jersey and Washington—recognize optometrists as “optometric physicians.”
No-Rub Isn’t Necessarily the Safest Option
Editor: Eye-care practitioners have an obligation to counsel their patients not only regarding safe contact lens wear, but also on safe lens care. Over the years, manufacturers have brought to market care products that offer successively greater patient convenience. Though convenience plays an important role in patient compliance, optimal visual acuity, comfort and good eye health are keys in recommending a contact lens solution system.One new option for wearers is the “no-rub” regimen.” This is touted as more convenient than previous options. However, the advertising for the currently marketed no-rub product fails to mention the mandatory second rinse step after soaking. This step results in an extra 10 seconds per lens to complete rinsing.
When more convenient solutions encourage fuller lens care compliance, they are to be recommended. However, my concern is that practitioners who recommend the no-rub solution, in the hope that it will lead to better compliance, may not be considering industry data indicating the significant number (33%) of patients who do not comply with the rinse step in current rub regimens. The convenience of no-rub does not necessarily mean that it offers a faster way to clean lenses or a mechanism for better compliance.
Convenience should be only one element in evaluating a product’s overall
performance. The doctor must always be vigilant about compliance issues,
and provide patients with effective options that ensure a successful contact
wearing experience.
—Michael Pier, O.D., director of training and customer development,
Bausch & Lomb, Rochester, N.Y.
Appreciate Non-Medical Tips for Allergies
Editor: As an O.D. and a life-long allergy sufferer, I enjoyed your recent article about allergy treatment (“Lose the Cat …” March 2001). I especially appreciated that it covered non-medical solutions.I would like to add a bit of advice I’ve found very useful for myself,
and which I have passed onto innumerable patients with great results. If
your patient has a forced-air furnace system, advise him or her to use
high-efficiency,
pleated furnace filters. Using one of these filters and faithfully changing
it monthly dramatically reduces my allergy problems. Many patients have
reported similar relief.
—Eric A. Ahlvin, O.D., Galena, Ill., eahlvin@mahealthcare.com.
How We Can Refuse to Release Prescriptions
Editor: I just finished reading your article “Can You Survive the Ultimate Challenge?” (April 2001). It failed to address several key issues.1-800 Contacts admits in its prospectus that it purchases many contact lenses overseas, and that they may not conform to FDA standards. Recently, two patients complained about constant problems from replacement contacts and had to throw away all their contacts due to constant irritation. In a “gray market,” products such as cameras and VCRs may be cheaper, but they suffer by not having a U.S. warranty. The same applies to contact lenses.
Also, 1-800 Contacts admits in its prospectus that only a third of its orders have a “valid” prescription. Thus, any doctor has the right to refuse to release information to 1-800 Contacts when it is public information that they don’t require an eye exam or a valid Rx.—Steve Rafalowsky, O.D., Marlborough, Conn.
Return to this month's highlights
© Review of Optometry OnLine
June 15, 2001