The $1.99 ruler that measures pupillary distance (so you can order eyeglasses online)


#21

And assiduously avoiding any discussion of the economic consideration that creates the experience everyone else here (in at least two countries) is discussing in regard to getting PD. It’s a bad practise that relies on ignorance (not everyone knows they need the PD) and is driven by commercial considerations (in many in-store ODs it isn’t provided if you ask, at any fee, because they know you’re asking in order to buy on-line).

Since you don’t want to discuss that I’ll end the discussion here.


#22

It seems pretty important to know. My eyes are so close-set that some pairs of binoculars cannot be moved close enough together for me to look through both sides at once.


#23

A few years ago, I learned this: Most Optometrists and Ophthalmologists will not measure the Pupil Distance as part of their exam, because then it becomes part of the patient’s Medical Record and patients have the legal right to access it. Instead, they took the position the PD should be measured by whomever fills the prescription they write up to customize the glasses for them, and is not part of the exam but ordering the glasses. After a lot of lawsuits by their lobbyists over this, several states passed laws or “Administrative Rulings” by licensing bodies that made eyeglass lens orders Medical Records and available to patients.

In many (most?) states you can simply ask an eyeglass store/md/do for the last prescription you had filled WITH the PD and they must give it to you. While a prescription changes, your PD reliably doesn’t change after you stop growing (early 20s). There are some edge cases, sure, but your PD when you were 25 is 99.9% likely to be your PD when you are 75.

You can also ask the doctor to include the PD as part of your exam, and if they refuse then choose another doctor. (A good line to use is: “I’m here to see you as a doctor. If I don’t like the frames you offer, I’m not going to buy them”).


#24

I’ve gone into a random eyeglass store and the optician has measured my PD for free while also fitting my internet-purchased eyeglasses for free.

Edit to add: the official measurement was 0.5 mm different from what I had measured myself. Enough of a difference for me, personally, to get optic migraines from my glasses with the wrong PD. My eyeballs are delicate flowers apparently.


#25

No roasting by me, and I’ve never bought my glasses online. My vision is horrible. I have VSP insurance, so I save a bit of money. The last glasses I bought a couple years ago cost me $988, because they are trifocals with invisible lines and a few coating options since I spend most of my time looking into a computer screen for work.

So I certainly see the appeal of something like this, but I could never partake.


#26

I did not get an email about your response gracchus or I’d discuss it. I have a lot of experience with OD world, but am not part of it. “Considerations” has a specific meaning in business, but it looks like you mean forces and concerns and such. That’s great we can work with that. This is going to sound high handed because I am trying to answer your concern in a neutral formal way.

Measuring PD incurs a risk for the party making the measurement. They are responsible for the device if the PD measurement is wrong or if there is an assumption not made that was necessary for the specific device. – The risk is tiny and an OD should measure and provide the measurement if they think it would be used. Not a contact exam.

The Doctor does not get paid for this measurement - In most cases the cost of an eye exam is the same with or without the PD measurement. PD is often then (but not always) measured at the Optical (dispensary) this increases the likelihood of getting payment directly to effort and risk. – This does not seem to be a bad idea, but can obviously cause issue if the expectation that the service is included in the eye exam.

Heath records are owned by the doctor, not you. The PD being included on the record and not the prescription (which is also owned by the doctor, but they have to provide once by law) means that a patient is asking for free something that is not theirs. – This is a serious point of contention for patients and the law is clear, but if a Doctor values clientele over customers they should provide this information.

I forgot the term, but healthcare is a product that you do not really know what you are getting till you got it. This means Doctors need to learn how to manage expectations of their staff and clientele. Unfortunately, Doctors are often TERRIBLE at this. Sometimes that open their own shop and get bitter and annoyed at people going for the discount options. More often, they just do not see the issue. Complaints are made to the staff and are watered down or changed in tone by the time they reach the Doctor. The Doctor are often happy to let the staff handle it are never really asked to consider the larger implication for patient care and practice image. If a Doctor does not do PD for every patient (visits tend to fall under about a 6-8 categories) it is often just habit not maliciousness. Yes, I am aware the bitter ones exist.

Patients -

Obviously, if it is your first visit or the first time needing glasses you may not know the ask for the PD or if it is provided automatically.
Do not return to an OD (a DO is a different type of doctor in America) if they do not meet your expectations.
Most states have a board the manages optometry. Make a complain if you feel the Doctor acted improperly.
Some Doctors are paying more attention to online reviews, but be prepared to be “fired” as a patient is that is your first route.
Also make it clear that you like the Doctor, but their stock does not work for you. Some may even have discount code for you at online suppliers. (this is much more common with contacts, though.)

Doctors
Give the damn PD and learn how to educate your patients on their exposure if they purchase through a third party. (As in do not complain us and No, will will not fit those glasses.)

gracchus - I hope that is what you were looking for. I do not mind talking about it all. I am not part of Big Eyewear - though I guess that is just Luxotica now. :grinning:


#27

I worked as a film library clerk in a major teaching hospital during college. The rules concerning materials vs data were very clear, but as digital advances are made, people can obtain copies for free or relatively cheaply. However, the data/information is theirs.
When the term medical records is used, it generally means a hard copy.

In the United States, the data contained within the medical record belongs to the patient, whereas the physical form the data takes belongs to the entity responsible for maintaining the record[11] per the Health Insurance Portability and Accountability Act.[12] Patients have the right to ensure that the information contained in their record is accurate, and can petition their health care provider to amend factually incorrect information in their records.[10][13]

There is no consensus regarding medical record ownership in the United States. Factors complicating questions of ownership include the form and source of the information, custody of the information, contract rights, and variation in state law.[14] There is no federal law regarding ownership of medical records. HIPAA gives patients the right to access and amend their own records, but it has no language regarding ownership of the records.[15] Twenty-eight states and Washington, D.C. have no laws that define ownership of medical records. Twenty-one states have laws stating that the providers are the owners of the records. Only one state, New Hampshire, has a law ascribing ownership of medical records to the patient.[16]


#28

Sorry I forgot to caveat “in Texas”:

Texas Administrative Code 165.1
Medical records may be owned by a physician’s employer, including include group practices, professional associations, and non-profit health organizations, provided records are maintained by these entities consistent with medical records laws in the state.

The Doctor owns and may sell the record, but does have to provide it if requested. They can charge a fee. This is why PD being in the record is important. The script they HAVE the give you (once, in Texas) they could charge you for the PD because that is part of the record they own. I guess I was not clear on why the record/script designation mattered, m’bad.


#29

Medical record refers to the physical copy. The regulations would include updated terminology for data/information, if that was what they were talking about. We were carefully instructed to make this clear to patients to prevent theft and/or destruction.

IANAL, but not allowing patients access to their own data sounds very unconstitutional.


#30

I am not sure how that would be unconstitutional, it is in the law you cited.

Providers can charge a reasonable amount that relates to their cost of providing the copy, however, no charge is allowable when providing data electronically from a certified EHR using the “view, download, and transfer” feature which is required for certification.

Most people are not equipped to receive these e-records.


#31

At this point I believe you are being willfully obtuse in your refusal to admit there is a difference between hard copies and pure data.

Sure, patients can always request copies of their records, but I cannot remember a time we were ever able to refuse a request unless someone else had power of attorney.


#32

No, I am not. If a patient wants their record for free without reservation they must request an electronic copy. If they get a hard copy they might expect a fee. I, honestly, did not realize we were arguing about anything. If you “took” your record to another doctor, I could still sell the old copy and give the money to the Doctor. If you “owned” that record would that not be stealing?
And yes, digital ownership is all messed up legally. You own your likeness, but if some takes your picture (within parameters) they own that that instance of your likeness. It is a boondoggle. DMCA anyone?

You added something after I wrote this. If someone was willing to pay the (often) $25 fee for a hard copy of their record and the Doctor refused. The Doctor would be breaking the law, yes. I know of no instance a patient may fully remove his record (the data) from the Doctor. Somewhat because there are other laws too.


#33

This is your concept I differ with…

The data belongs to the patient. The hospital/medical office is the caretaker, by law, because if someone needed access to their records for (obviously) medical reasons, it should be stored in an accessible place guarded by a capable and competent agent.
You keep speaking of the cost of information, which is simply ideas, communication, when it’s clear you mean copies, hard records.

The PD is a concept (technically arrived at by paying an expert to determine). Concepts are free in and of themselves. This concept is recorded in the medical record, which may cost money to reprint, reproduce, or transmit electronically.
Medical Record as a term is used loosely and interchangeably, and most people understand the difference.

Just to be clear, we’re talking about vision health and general health here, not mental illness, where physicians can be restricted in how much information they share with patients.


#34

Yes, patient owns the data. If they want the data on a piece of paper they may have to pay. If they want it read they may have to pay an office fee. If they want is electronically it is free. If they want to take it all and erase the Doctor’s copy, they cannot. If the Doctor sells it, the proceeds do not have to be shared. Ownership as defined in this law (which is more of a civil rights approach) does not match ownership defined in business law.

I really did not mean this as a legal primer for medical law (I am not an attorney), more of a practical understanding for patients as to why it happens and how to deal with (also for the random OD.) If an Doctor is refusing to give you access to your records definitely enlist the help of your new Doctor or the Board that oversees that Physician.


#35

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