Story #1: This week I saw a patient who came in to to get a new eyeglass prescription. The lenses, or at least the anti-reflection coating on the lenses, were starting to scratch off. It was a bit worse on one lens and he thought that was the reason he didn't see as well with that eye.
He not only had the glasses with him, but the two year old prescription from which the glasses were made. With the glasses on his vision was 20/20 with the left eye and 20/25 with the right. When I compared the glasses to the written prescription I found the axis of the astigmatism correction was about 5 degrees different between the written Rx and the glasses that were supposedly made from that Rx. The written Rx had an axis of 100 in the right eye; the axis measured in the right lens in the glasses was 95. The amount of astigmatism in the right eye was significant enough that the 5 degree difference between the written Rx and lens could make a difference in his vision.
When I asked the patient if he had gotten the glasses in the same place as his exam he replied that he hadn't--after he had examination from his optometrist he had ordered the glasses on line from Warby Parker.
My exam showed that the axis in that eye was 105. With that axis the patient's vision was 20/20. When I put my prescription in a trial frame and had the patient compare the vision with vision in his previous glasses the patient could see the one I had created was better.
Although a 5 degree axis discrepancy in axis isn't much, the fact that his axis was really 105, the 95 degree axis of his previous glasses meant the glasses were really 10 degrees off from his true astigmatism axis. The result was he was missing one line of acuity.
Story #2: Today there was a call that had been left on my office voice mail at 2:00 a.m. this morning. Then there was another call at 5:00 a.m. They were both from 1800Contacts, each for a different patient contact lens order. The first one was for a contact lens prescription that was expired. The second was for a different contact lens than was prescribed for the patient. It was asking for lenses in the same base curve and power I had prescribed for the patient, but it was for a different brand lens, that was cheaper and isn't even available in the base curve I prescribed. This vender usually sets their automated calls for Friday evening or hours when most doctors are closed. The reason for this is because the Fairness to Contact Lens Consumers Act (heavily paid for and supported by 1800Contacts) gives prescribers only 8 business hours to respond to a prescription request from a seller (exact wording is below):
"Prescriptions are verified automatically if the prescriber doesn’t respond to the seller’s verification request within “eight-business-hours.” A business hour is defined as one hour between 9 a.m. and 5 p.m., Monday through Friday, excluding federal holidays, in the prescriber’s time zone. If a seller determines that a particular prescriber has regular Saturday business hours, the seller also may count those Saturday hours as business hours under the Rule.
"When calculating “eight-business-hours,” begin the verification period the first business hour after the prescriber receives a complete verification request and end it eight-business-hours later. For example, if the prescriber receives a request at 10 a.m. Monday, the prescriber must respond by 10 a.m. Tuesday. If there’s no response, the seller can provide the contact lenses at
10:01 a.m. Tuesday. If the verification request is received at 10 p.m. Monday, the response would be due by 5 p.m. Tuesday. If there’s no response, the seller can provide the lenses at 5:01 p.m Tuesday."
The cryptic after hours requests are done in such a way to make it difficult for a prescriber to respond (the beginning of the request has a minute of unnecessary information and the name of the patient isn't announced umtill the end of message) so that the lenses can be sold to the consumer whether they are appropriate or not.
Prescribers like me and my colleagues take time to decide on the proper eye glass prescription and contact lens prescription and the materials appropriate for those prescriptions. When we order either glasses or contact lenses from our laboratories we check everything to make sure it is correct and verify lenses before dispensing them to patients. We recommend anti-reflection coatings combined with anti-scratch features that have a 2 years warranty against scratching. Because we order our products from reputable companies it usually is correct, but in the rare instants when either glasses or contact come in wrong we send the job back to be redone.
When you order on line who checks the work?