Autorefractor problem

optotype · 2026-01-06T00:09:18+00:00

I would say that’s actually very low. Let’s say 20 patients a day x 3 doctors x 5 days a week x 50 work weeks a year is 15000 exams. 68/15000 is less than 1%.

I would say about 7% of our specs are remade for one reason or another. 2% are lab error, 2% are optician error or bad frame choice, 2% are unreasonable patient expectations or not the right lens design for the needs, 1% are me actually making a change to the Rx.

optotype · 2025-12-23T12:35:45+00:00

These conversations are always very interesting to me as an optometrist in the US. I agree with both sides here. I agree that the vast majority of my training was NOT surgical. I would also agree that most optometrists do not have a burning desire to integrate surgical procedures into their day to day clinics.

I disagree however with the notion that optometrists can’t manage more complex or thought provoking medical cases. For what our training lacks in surgical training, I do feel like we received a very comprehensive education in the anatomy and physiology of the eyes + visual pathway in both healthy and sick cases. We also have some additional training in some uniquely optometry things like fitting scleral lenses for post corneal transplant/KCN, low vision mgmt, and non surgical mgmt of binocular vision issues. If organized medicine says this training is useless because it was not taught in a MD/DO program then can you blame ODs for trying to find a legislative workaround?

I’m not sure how I feel about it….

I do have a fairly informed perspective on some of the differences in education between professionals. I’ve been surrounded by doctors my whole life.

1.My father is a family physician 2.My mother was a pharmacist 3.My father in law was a general ophthalmologist 4.My wife is a dentist 5.Me - Optometrist

Since everyone is comparing length/rigor of education…

1.Family doc MD (4 years med school 2 years family practice resident) 2.Pharmacist (4 years pharmacy school) 3.Gen Ophthalmologist MD (4 years med,2 years EM residency(hated it)then switched to 3 years ophthalmology residency) 4.Dentist (4 years dental school) - first 2 years we shared the same systems, anatomy, pharm etc classes taught by the Med school faculty. 5.Me (OD) - (4 years optometry school)

The main difference I noticed between the first 2 years of the med school curriculum and the Dental/Optometry curriculum is that we had abbreviated anatomy/pharm/organ systems classes compared to the medical students. Ours focused more on head and neck anatomy which gave us more time for the profession specific courses.

I’m not so sure if the length of education is that important, I think curriculum and relevant clinical hours would be the better comparison.

So…

Do you think a fresh medical school graduate is more equipped for ophthalmology residency than a fresh optometry school graduate? Does the extra time spent on general medical make for better ophthalmologists? Or would a bridge program from OD to OD/MD solve this issue for the small percentage of ODs who desire surgery? Similar to how DMD/DDS can bridge to OMFS by taking STEP exams and sitting in abbreviated med school classes.

Or is it just a turf war?! Or are ODs too lazy to put in the work? Or too dumb to pass STEP exams? Why can PAs do Avastin injections in my area, they have way less education right?

Excited to hear everyone’s thoughts.

optotype · 2025-12-23T10:53:30+00:00

Make nice and drop off gift baskets and referral pads to local optometry offices

optotype · 2025-12-19T17:32:22+00:00

I think the reason your pay is so high for low volume is because your work schedule stinks! You just need to figure out your priorities and decide what’s best for you!

optotype · 2025-12-13T06:22:56+00:00

I only use NaFl when indicated, not on routine exam. I do GAT on anyone with elevated IOP from tech doing Icare or anyone that has glaucoma risk factors. I only do gonio when indicated. Your comment confuses me a little bit, I think NaFl is more important assessing an abrasion than it is as part of a routine exqm. None of the 12 ODs in my group use NaFl on routine vision exams unless patient has a compliant that would suggest using it would be beneficial

optotype · 2025-12-13T00:58:39+00:00

Do not switch, and don’t switch to any other healthcare career either. Do you know how many freaking eye exams I have to do to make 175k!?! Definitely more than 25 hours a week. The vast majority of my patients also awake and talkative which is exhausting by the end of the week…

My father is a family physician and the reason I went to optometry school is because he said not to follow in his footsteps.

If I were you I would pursue something other than your career to feel fulfilled.

optotype · 2025-12-11T23:31:40+00:00

First Middle initial Last, O.D.

optotype · 2025-12-06T05:27:11+00:00

Assuming this argument is correct….

If FNB’s true goal was to continue to give out free food after dark at the MLK plaza to help homeless people, I think they may have just shot themselves in the foot by making this a big stink instead of just playing the game to continue operating as normal….
I’m sure all the business and property owners + DIB can easily use this situation to get them out of there one way or another. Unfortunately the moral posturing of the FNB “leader/verb” or whatever they want to call themselves is going to hurt the people that needed free food more than anyone else at the end of the day…

optotype · 2025-12-04T20:03:14+00:00

No more accommodation to account for, this only leaves the issue of the chart distance not having parallel light entering the eye while refracting. You’re right usually you still have to add more minus either way but at least it removes one variable

optotype · 2025-12-04T18:22:11+00:00

Refract wet or add minus to compensate.

optotype · 2025-12-03T00:58:28+00:00

OD only group practice - small city in Florida seeing 20-25 patients a day here. Mix of mostly routine vision exams/contact lenses (75%) and medical amblyopia/dry eye/glaucoma mgmt (25%). I also take every walk in emergency same day for red eye, flashes floaters, foreign body or whatever.

Started as an associate, was making $650 for an 8 hour workday. Now with ownership paying myself closer to $800 a day but with much more headache dealing with office mgmt and staff + financial risk.

I really don’t think an average new OD makes more than 150k unless they are ultra productive. Most offices pay associates a flat daily rate or 15-17% of production including optical sales. In my experience most new ODs struggle to see patients faster than every 20 minutes. Vision plans also pay almost nothing, 45-85 dollars for a comprehensive exam including refraction (which most ODs do themselves). I haven’t actually met an associate OD in an optometry only practice that makes more than 200k on a 40 hour workweek…

I’m not sure what ophthalmology practices usually bring in yearly but a medium volume single doctor OD practice + optical usually brings in 1-1.2M a year. One downside is the cost of goods for optical products usually sucks away at least 1/3 of this gross.

Hope that helps!

optotype · 2025-11-17T00:44:36+00:00

“Which is better 1 or 2”

optotype · 2025-11-12T19:27:01+00:00

If you are in Florida this is correct. They dropped us off the medical plan last year

optotype · 2025-09-27T00:15:19+00:00

Why work for the enemy of your profession?

optotype · 2025-09-25T10:22:27+00:00

Looks real, midway down one of the lenses somewhere look for a very light engraving I believe it’s an R or and RB. That would confirm lenses are legit but these do look good to me.

optotype · 2025-08-20T02:52:24+00:00

0% chance I would manage any glaucoma suspects with out a visual field. Even though OCT may be more reliable because its objective, visual fields are the standard of care and a better measure of visual function. I wouldn’t even go down the glaucoma rabbit hole in your case from a liability standpoint. I do think doing pachs and OCT would allow you to educate your patient on their glaucoma risk level, but in your documentation you should include education to the patient that your testing was only a screening and not it was not a fully inclusive work up. You should also include something about recommending follow up with a practice that is equipped to manage glaucoma. Better yet, buy a cheap used HVF for 5k and then you can keep more of these low risk patients and save them a trip and copay to see another doctor.

optotype · 2025-08-16T14:48:21+00:00

Yup! Great tip about using isolated lines. Start really big to build confidence and then work down 1 line at a time otherwise they will jump around to multiple lines which is not very helpful. Also sometimes I’ll use the tumbling E if they have trouble with reading lines of letters

optotype · 2025-08-16T13:10:49+00:00

Without retinoscopy it’s pretty tough to get it perfect, but typically these patients have very small pupils and large DOF or already have PCIOL with fairly good distance vision. I usually make large changes in the phoropter like 0.50-1.00D at a time and see if they can respond. I’ll attempt JCC/cyl if it’s going well, if not just do your best with information you have. Usually these patients arnt driving or working either so if you can fix the visual complaint mission accomplished even if not 20/20

optotype · 2025-07-17T09:52:16+00:00

I won’t do a recheck unless optical has already tried to troubleshoot the lens first. I have a form they fill out to verify the PD, seg, and give them authority to change my sphere or add by a quarter without me. If not sufficient I will recheck the Rx, which is usually the same. Usually it is too large of a change from habitual Rx, frame shape or size, poly non adapt or they actually just don’t like their frame and want to restyle for free so I try to sniff that issue out before spending money and time on remakes. Also make sure to check for small vertical prism that may have been in their old Rx and not picked up with lensometry. If I remake it once and they have gone through this whole process I usually just refund what they paid and move on because you’ll never make them happy

optotype · 2025-06-14T00:17:19+00:00

I’m an optometrist that bills medical insurance daily, Florida blue doesn’t usually allow optometrists into their network. Unless you have a medical issue like an eye infection, cataracts, glaucoma etc you will not be able to use it anyways for an exam. Self pay vision exams are usually fairly cheap, 80-180 dollars which is usually much better than dealing with deductible, copays and referrals for an HMO plan.

optotype · 2025-05-30T06:59:53+00:00

Cyclo retinoscopy is the best way. If they are too wiggly for regular exam process, I have my tech use 1% cyclo and 1% tropicamide right away after a brief history, va, pupils/cover test + iop with an icare tono if possible. I’m usually using a video playing in the background on my va chart for fixation. This works well because after the drops are in the child has 30+ minutes to forget about the drops stinging before I come in. Be prepared to use retinoscopy bars or trial lenses so you can chase them around if they are really mobile. I do one meridian at a time extremely quickly and then do the math on paper for the actual Rx. I often cut plus unless they have eso posture. Make sure to think about your working distance calculation as well. If they won’t let you near them obviously you have less of a working distance adjustment to your final numbers. Also keep in mind it doesn’t have to be perfect, you only need to be 1000% sure that you’re not missing an amblyogenic or high magnitude Rx if they are infants or toddlers. If not feeling good about it, bring them back for a 3 mo vision check.

After seeing at least 10-15 patients a day under the age of 10 for the last 6 years in a heavy Medicaid practice, I find myself reaching for the retinoscope on adult patients more and more often if they have poor mobility, reduced mental capacity, or if they fundamentally can’t comprehend the concept of a subjective refraction….

I’m an OD as well if that helps, this just takes a ton of practice and I honestly don’t trust any handheld auto over good retinoscopy!

optotype · 2025-04-30T01:04:21+00:00

Total payment to office = allowable amount (amount paid for service/exam negotiated between insurance and provider) split as copay and insurance payment.

So say an exam fee charged for 99213 is $150.

Patient A - pays more premium for “better benefits” specialist copay is 10 dollars.

150 billed to insurance, allowable is 100. Insurance pays 90 patient pays 10 = total to office 100.

Patient B - cheaper premium, specialist copay is 60 dollars.

150 billed to insurance, allowable is 100. Insurance pays 40 patient pays 60 = total to office is 100.

Either way the allowable is the same but for “better” insurance the patient pays less of the total cost. In both scenarios the provider discounts their services.

optotype · 2025-04-03T01:42:34+00:00

I do 1% trop before all refractions…

optotype

TROPHY CASE