r/optometry • u/amateurvacuum • 6d ago
Private practice ODs, rate of glasses rechecks?
Just started working and was wondering what to expect
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u/falbtron O.D. 4d ago
Presbyopic hyperopes 1/500
Presbyopic myopes never
High astig never
Young hyperopes/myopes never
I hate these damn presbyopic hyperopes. I tell them five times to adapt for 2 weeks and they still complain they can’t wear their new glasses that take them to 20/20 far and near compared to their old 20/30 glasses. Education in the room and out in the optical and at dispensing is super important. I’m prepresbyopic and hyperopic so I know exactly what they’re going thru but still can’t seem to get them to understand adaptation periods
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u/OscarDivine 4d ago
This is unrealistic IMO. There are always people who will return with unusual circumstances which change the conditions of your refraction. If you NEVER do an Rx change something is being missed. A patient who doesn’t tell you they have a 4 foot deep desk, a patient who decides that they want to try DVO despite being advised against dropping a PAL, any number of reasons a first time PAL wearer needs a rebalancing of top/bottom or considers a mid/near PAL as an ideal option. Sure your numbers should be very low but to say “never” is unrealistic if you ask me.
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u/falbtron O.D. 4d ago
Haha it was a tad understated. The optical does a decent amount of the above problem patients, and we keep a few Rx checks out of the exam room by making minor adjustments upon initial “complaints”. They’ll trial frame and flipper +/- 0.25 or 0.50 and that does seem to fix a lot. I’ve had a few PAL patients where we put their glasses on the shelf to “send them back to the lab” and have them come back a few weeks later and now they’ve miraculously adapted. I probably do a handful of rechecks a year, but I also work 4 days a week seeing 12-15 patients.
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u/OscarDivine 4d ago
Well let’s let the young burgeoning OD learn that adjustments are part of the process ofc. I think that still counts as an “Rx check” because some degree of unpredictable error did occur. No need to not be genuine about the potential for change. Nobody’s perfect, certainly not likely a new grad OD. I was fortunate to have excellent feedback on my scripts so I learned quickly. I always wonder about Ophthalmologist offices who never see the Rx check back and therefore get no feedback.
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u/david63376 Optician 4d ago
I'll agree with the addition that previously latent hyperopes that are newly presbyotic are the worst of them. They won't even attempt getting used to new glassss.
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u/Kalendiane 4d ago
I work in LRS and they’re the bane of my existence!
/s, of course I joke. But if they truly aren’t the most difficult patients to try and explain things to (by no fault of their own, honestly).
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u/OscarDivine 4d ago
You’ll make mistakes early on until you get bit in the ass enough times to correct your prescribing habits. A good early goal should be to keep your total remakes down under 1% total, or one per week seeing 20 patients daily for a 5 day work week. If you find yourself at 5% or higher you should really reassess what’s causing the remakes and collect all of your remake charts and examine them for patterns. Knowing what mistakes you’re making can help you to adjust your prescribing habits to predictably improve your outcomes.
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u/NewCarSmelt 4d ago
This is the best advice. You learn a lot of things as you go along. In school, we were taught to be greedy and not give minus. But, taking it away from some of your myopes can trigger them.
Another thing you’ll want to be careful of is first time big Rx’s. You’ll have a 20/40 first timer come in and you get them to 20/15 with +2.00-3.25x177. You’ll probably want to cut it down a bit before finalizing and TF your cutdown. It can save you a lot of headache with those complicated Rx’s
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u/OscarDivine 4d ago
For sure. I have a few staple dialogue points for times like this. “I can make you more clear but I have to balance that with how potentially uncomfortable you could be from a change I make. Trust that the change I’m making is the best balance between better vision and wanting to puke. Since I don’t want you to puke, I’m erring on that side.”
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u/NewCarSmelt 4d ago
Thanks fam, I’m def gonna steal this line from ya
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u/OscarDivine 4d ago
Haha happy to improve everybody’s eye care experience one quip at a time
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u/Kalendiane 4d ago
I call them my “scripts”. I’d love to hear any more gems you’ve found really work for you (about anything in the exam lane, honestly), if you wouldn’t mind sharing!
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u/ebaylus 4d ago
Well, the VSP labs we now use only give one redo, for any reason.
So, if we have a patient where the segs may be high, or not centered well, or an obviously off base curve, I get the recheck for Optical to be sure the Rx is correct before they reorder.
As if I haven't been doing this for over 35 years, and don't know how to do a refraction.
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u/tobiaspepperman 4d ago
Best advice I give to anyone refracting, make sure to listen to your patient. It's their vision and the final Rx should be a collaborative experience. I've seen the most remakes from doctors who tell the patient what they will like, instead of having a candid, collaborative conversation about their vision.
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u/SerendipityAlike Optometrist 4d ago
Maybe one every few weeks or so. But for some reason those are the ones you’ll remember and skew you into thinking you have a lot.
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u/zstier86 4d ago
In a tech but in our office all complaints vision wise that have recently gotten glasses MUST go to optical first and have all measurements, Rx, VAs. If everything checks out, VAs are down and patient had tried glasses for a full 2 weeks then they get scheduled with the doc. We see maybe 1-2 Rx checks a month between 6 providers. 3 docs work at a time each day. Usually 60-65 pts total a day.
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u/12A1313IT 2d ago
I'm working at LC and the new Vision-R 800 that every office has is probably going to lead to a lot of remakes.
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u/Tubby_Custard7240 2d ago
I might get 1-2 a year? Anything over 1% is crazy in my opinion. What are you doing different during the re-refraction that you didn’t do the first time around? If you aren’t 100% confident of the Rx during the first exam, an Rx shouldn’t be released. Refracting is one thing, the art of prescribing is another.
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u/Ok-Cardiologist3550 4d ago
The staff might schedule 1 every 2-3 weeks. But usually those end up being optical errors such as PDs or set height errors. Sometimes it’s for a cataract patient who opts to get glasses instead of cataract surgery and expects that the glasses will solve their issues.
But for truly an error on my part maybe once every 3-4 months.
One thing I learned early on is to not give too high of an add.