PD or No PD

Andrew KarpPD or no PD, that is the question posed by Barry Santini in this month’s L&T feature, “The Power and Politics of the PD.”

Although I doubt Hamlet was on Santini’s mind when he wrote this article, the question he explores—whether or not an optometrist should provide a patient’s PD along with their prescription—arises from a drama that’s almost worthy of Shakespeare. It’s a conflict that plays out every day in eyecare practices around the country, as more consumers ask their eye doctors for their PD measurements so they can then go purchase eyeglasses online.

As Santini notes, tensions build between doctor and patient when ODs are reluctant to release a patient’s PD because it means they are “losing a bit more of their historical control over the sale of prescription eyewear.” Times are changing though, as consumers demand more transparency in all their interactions with health care professionals. Because of this, Santini believes that ODs are bound to lose the struggle over PDs, and he marshals a formidable array of facts to support his argument.

I agree with Santini. Consumers are not going to stop demanding what they believe is rightfully theirs. In today’s consumer-centric world, you swim against the tide at your own risk.

Instead of balking when a patient asks for their PD, why not use the opportunity to talk with them about their pending online eyewear purchase? Perhaps the deal they’re seeking or the eyewear style they want is not so different than what you can offer them, either through your brick- and-mortar dispensary or perhaps your own online dispensary. Don’t be afraid to remind patients that your skilled staff can help them select the best-looking and best-fitting eyewear, and that you can offer them a range of options too.

You may not persuade every patient to abandon their online purchase, but you’ll certainly get some to think twice about it. More importantly, they’ll see you as an ally, not an antagonist.

We hope “The Power and Politics of the PD” will get you thinking about how you can do better to serve your customers, even if meeting their needs may feel uncomfortable at first.

Andrew Karp, Group Editor, Lenses and Technology

About James Spina
20/20 Editor-in-Chief

58 Responses to PD or No PD

  1. Stewart Gooderman says:

    I have *always* written the PD on my prescriptions and I’ve been in practice for over 35 years. I’ve done it because it binds the filler to the proper PD. I’ve been sensitive to that all my professional career when I learned, when in professional school, that a pair of glasses I received as a teenager had a totally incorrect DBC and may have contributed to visual problems I had later on.

    My experience has been that when a patient is specifically asking for a PD, they have made up their minds and nothing I say will dissuade them. I just tell them to make sure that the person who is filling the prescription also adjusts the glasses properly, and that it their responsibility to do so. This gives them the hint that I’m not going to do it as I didn’t supply the eyewear to them. Now, if they have purchased in the past, I will consider courtesy, which is what I tell them it is. But if it happens more than once, then I say there will be a charge for the adjustment, say $25

  2. Barry Santini says:

    Composing this article has changed my own responses to PD requests and how I think about them. Instead of thinking “They want only cheap (by going online)”; “They’re lost to me”, or “Nothing I say will change their minds”, I now see opportunities to recommend services unbundled from the online transaction. “Wherever you decide to purchase your eyewear, I want you to know that I will be glad to make all our services, including adjustments, repairs and replacement parts, available to you a la carte for your convenience.” This generally opens up the dialogue about what services you can’t get with an online purchase….(yet).

    • Wendy DeLaunay says:

      I agree with you.

    • Jeffrey E. Kapp says:

      As an ABO Optician of 30 years,I see both sides of this issue..I think putting aside all selfish desires to keeps ones Rx’s in-house,,we,as professionals should provide patients with their PD’s..These days here is no telling what kind of “America’s Best” or “Wal-Mart” yahoos may be providing to our patients eye-care!! We must,as professionals count on the fact that our Superior service and product will convince our patients we are worth the extra money!! Once the thrill of two-pairs of glasses for $69 has passed and they are getting their frame replaced for the third time in 6 mos.. all respectable patients will return to our practices…We need not be so trivial as to deny them what they have come to rely on us for…Courtious,and Professional service,,it is getting harder and harder to find!! And if they are that cheap,,do we really want their business?? J.E.Kapp ABOC

  3. Greg Williams says:

    At our ophthalmic practice the doctors own the optical and they prefer NOT to give a PD. If a patient requests their PD they are referred to the optical and there is a $20 charge for giving the patient their PD

    • drsfg says:

      I am assuming you do not measure PDs when you do your exam?? I always do in order to make sure I am not inducing prism that will cloud the results of my 21 point exam. So, if you do take PDs, they should be written on your exam. And if they are written on the exam, then the patient has a right to that info. If you don’t give it, you risk losing the patient. They have a right to a copy of the exam. You can charge them for photocopying the exam, but I believe that’s $2 per page. You will not win here.

    • Greg Yauck says:

      Greg, We do the same at our opthalmic practice. Although our charge is $25.

  4. Michael says:

    If state law requires it… Done deal… If not , how about when writing the prescription asking the patient do they want the script with or without the pd… No charge (obviously) for script without but charge an additional fee for with… May not have any takers but then the patient knows there’s a fee involved when they come on for the measurement… It could even be different for sv vs multi vs monocular

  5. Optic says:

    If you want to provide the patient with any measurements for free you are more then welcome!
    We will provide the measurements that we are paid for either by insurance or the patient!

  6. Linda Louis says:

    We want to keep one foot in medical and one foot in retail.. no one would ask what KVp and mAs their x-ray would be shot at so they could compare and get a better price on their x-ray when they go elsewhere..or even question if NPH insulin is the right choice. No, we go to a medical Doc and they use their training and give us the best information they have.. so we use our information- measurements and training to get the person the best glasses.. I say they can get their PD from the person giving them their glasses..

  7. Shelton Green says:

    Just thinking back 40+ years ago, grinding glass execs, even with ground in or out prism we may have gotten 1 in 10 PD’s correct. Didn’t seem to be a problem. Today with PAL’s it would be a problem, not so much with SV or Flat-Tops, I’m thinking…what about drug store readers?

    • Greg Williams says:

      Drug store readers are just magnifiers, no cylinder at all, so that is not a problem. If you surfaced execs and got maybe 1 out of 10 PD’s correct then you really suck at surfacing lenses, or at laying them out for finish work. With execs you use the distance PD and decenter it accordingly for surfacing since you can place the OC anywhere on the lens that you want it.

      • Shelton Green says:

        Well you may not remember glass execs of 40 years ago. The lens blanks were a max of 60mm at that time and thin, the frames of the time were in the 52-58 mm with ED’s of 56mm+. So as far as sucking…

      • drug store readers use a frame pd and they are spherical, same power all the way across so it doesn’t matter, does that mean all of the millions of glasses donated and distributed through Lion’s club should not be distributed since the recipient in Africa or elsewhere shouldn’t wear them since the pd’s were not measured for them? NO of course not. The
        optical industry is a service based industry, It is shocking how many people on this blog are so stingy with their services that they cannot provide anything without a buck changing hands, how do you think you retain your business, it would be a glorious day to sell a pair of blue jeans and never see them again. Eyewear is not the same you have to stand behind what you sell and YES, that includes service even if they didn’t buy them from you. From the looks of the upper comment people are starting to get a bit snarky, that does nothing for customer service, I guess everyone who has gotten a measurement slightly or grossly off just plain ‘sucks’ ! do we have to pay for the sucky pd too !

  8. jesse says:

    I am a licensed Dispensing optician and I see no problem with it. Most people dont understand optics and they understand that polycarbonate and Trivex materials require a monocular PD and otical center. Bifocal and progressive lenses require special mesurements based on how the frame fits the patient and special require measurements. They dont understand that trivex material does its best with a a power of -3.00 to + 3.00 or that its is good for those who have astigmatism or that hi-index is not only for those whom have a a hi power but for those with high astigmatism aswell becuase of the flat aspheric material. When these people finally bring themselves to an optical place with a LDO they first thing they say to me is ( I see so clearly, I can’t believe it). In actuality I see this as a good thing, because it always an optical a chance to actually shine and make a difference.

    • Greg Williams says:

      Who cares if you are licensed? Doesn’t mean you are any smarter than anyone else working in optics. I have been working in optics for over 30 years, in labs, dispensing, teching, store manager, sales manager, GM for Essilor Labs, so that means nothing to me being licensed. I am ABO certified and have seen many state licensed opticians that couldn’t even convert a plus cyl into a minus cyl to make the lenses, so tout your “license” elsewhere. All opticians should know how to decenter a PD to the pupil, and if it doesn’t look right most likely it isn’t and should be adjusted accordingly.

      • drsfg says:

        Would you say the same thing about Optometrists and Ophthalmologists?

      • jesse says:

        greg:
        LOL guys its about making a yes out of a no about a customers right to a comprehensive exam with A PD not about how long we have been opticians and or Dr’s about all the negativity its about good customer service and what ever brand promise we stand for or for that matter corporate practice. If not an argument its a SURVEY. : -)

        Reply

      • Brent says:

        Greg, I do agree.

  9. Lindsay says:

    I work for an independent Optician. We offer the PD measurement for many customers at no charge. Customers come to us because their Doctor didn’t provide the measurement or wanted to charge for it. One of our local doctors has been reported to charge $65 to measure. 9 out of 10 come back unhappy with their online purchase because, quite frankly, they have no idea what they are doing when they order them. We have found on most occasions, the next pair they purchase comes from our office because of how ill fitting the pair they got online was. Service is something we pride ourselves on and thankfully, it’s paid off!

  10. Missy Houston says:

    In my opinion, the PD is a given. To me, it is all about patient care. If your staff is giving proper patient care, the patient will stay with you 99% of the time. ‘Fighting’ over giving the patient this measurement would make it appear that the place of business cares more about the dollar than the patient. I have been an optician / contact tech for 20+ yrs …. if you give patient care properly, you will not lose your patient to an online vendor. Service and knowledge still hold a very high hand.

    • drsfg says:

      And if they go online, do you want them in your practice?

      • jesse says:

        yes their are several Patients who come to our practice and get a CL exam to purchase on 1-800-contacts I give them 20% off the retail price and manufacturer rebates and show them how much more they save with us and tell them if they buy a 6month supply we give them 50% off on a pair of eye glasses. If its eyeglasses our company always have 2pair deals as well as 1pair deals and we go out of our way to help them find frames that look good on them. So the answer is yes we want them in our practice

        • drsfg says:

          Am I to assume you are doing your own cutting and edging? If not, unless your markup is very high, you can’t be making enough money to justify the effort. I practice in San Francisco and my patients are extraordinary savvy. They find deals that are far less even than any 50% discount you give. And many times, the work is superb.

    • Mike Riville says:

      Totally agree Missy, give good patient care/customer service, and build relationships and your customers will return, time and time again.

  11. Michael says:

    Why not be proactive – in a state where the PD is defined as part of the SpRx it’s a done deal but in most states it is optional. When you write the SpRx for the patient ask the patient would they like the SpRx with or without the PD. If they want it without, then there is no fee – it’s included in the fee for the examination. On the other hand, if they want the SpRx with the PD, there is a fee for the measurement (which may be different if it is SV, BF or monocular). You may find most patients do not want the measurement included but now they know there is a fee attached to the measurement and that it is not included in the standard SpRx.

  12. Dr. Craig A. Miller says:

    Unfortunately the PD is part of the prescription. I often prescribe small amounts of prism and may even alter the PD to add the prism to the Rx. For accurate binocular testing, particularly on a high plus or minus Rx, what the Doctor sets the phoropter PD at is very important and that setting should be the one noted on the patient’s prescription.

    • Barry Santini says:

      Some dispensing ECPs would see this practice as problematic. I know I would, unless the prescriber indicated that, for SV Rxs, the Dr. PD integrates desired prism.

      • drsfg says:

        I don’t agree. This is the PD that the practitioner asked the fabricator to use. If another ECP takes the PD and it’s different, I assume he/she is adding prism. I’ve been in practice for more than 35 years, and that’s the way I’ve always understood it.

    • drsfg says:

      I totally agree with you. Totally.

  13. If a patient asks us in a respectful manner we will usually give them a binocular pd measurement at no additional cost if they did their exam with us. However, if they did it elsewhere then i refer them back to the prescribing Dr. I take the opportunity to discuss online purchases and the problems that could arise from such purchases. Many understand and quite frankly will come back to me when they get glasses with prismatic error induced in them,

  14. magui says:

    I think every optometrist should include the patients pd as part of their prescription. First of all, i will have to agree to this article some patients believe Its their right because they have paid for an eye exam.Also because make it easier for opticians to fill rx in their office or ir the patient goes online…not only that tus important information if the patient looses his or her flashes..

  15. magui says:

    I think every optometrist should include the patients pd as part of their prescription. First of all, i will have to agree to this article some patients believe Its their right to have their pd added to their rx because they have paid for an eye exam.Also because it make it easier for opticians to fill rx in their office or ir the patient goes online…not only that tus important information if the patient looses his or her glasses…

  16. Caryn West says:

    Our EMR doesn’t have a field for the PD on the Rx, so it is not printed on the Rx. However, there is a field for this data in the EMR and we are happy to supply the PD at no charge. This gives us a chance to educate the patient on bundled services that are included with a glasses purchase from our office. We also ask that they bring in their glasses no matter where they purchase them so that we can verify the Rx. I believe this shows we care about the patient and have respect for their purchasing choices even when it is not our office. We also give them a nicely printed sheet that explains what services we offer at no charge for Rxs filled elsewhere and all of the services we offer (seg hts, pantoscopic tilt, vertex, distance, advanced measurements, A&B, temple lenghts, etc. – I actually bundle some of these) with their corresponding fees for RXs filled elsewhere. We hope that this helps to avoid disappointment if things don’t go as planned with their purchase and we are happy to help them if it doesn’t work out as planned. Great discussion. We all need to develop business policies and train our staffs on how to handle these questions and situations.

  17. Dr. Kellar says:

    Why don’t we all just agree to give up on the retail aspect of optometry all together and turn it over to the opticians? that way, the corporate chains will fire their optometrists and replace them with opticians, and optometrists can get out of managed vision plans and the competition from online and big box retailers Imagine being able to make a decent rate on an exam again and not having to worry about capturing eyewear sales to make up for the crappy exam reimbursement. It would be fun to see the corporate optometrists get fired, too:)

    • jesse says:

      LOL guys its about making a yes out of a no about a customers right to a comprehensive exam with A PD not about how long we have been opticians and or Dr’s about all the negativity its about good customer service and what ever brand promise we stand for or for that matter corporate practice. If not an argument its a SURVEY. : -)

  18. drsfg says:

    My question to all is: Okay, your patient went online and bought a pair of glasses. The frame is to small or too big, the temples are too long or too short, the bridge is incorrect. You know you can work on the glasses to make them better. And they have been a patient for 10 years. What do you do?

    • Barry Santini says:

      You observe. Discuss. Summarize. Quote. Ask if they want to proceed. Perform. Collect fee. Nothing here has a punitive color. Just business.

  19. Mike says:

    I do not agree that a PD should be considered a “part” of the exam. An eye exam is one thing, and measuring a PD, seg height, checking a proper fit of frames, etc. is a completely different component of the overall fitting of eyewear. As an Optician, I prefer to take my own PD and other measurements. OD’s are frustrated by the idea that someone might get the PD and go to the internet or elsewhere for glasses…so, in many cases they don’t want to release the actual prescription which IS the property of the patient so they can go where they wish…so PD, RX, whatever should not be withheld if the Patient wants it.

  20. 20/20 girl says:

    I say it is “part of the service” and “completes” the exam. If the O.D./M.D. and staff and service are on par- there should be little worry of losing the sale. Lets take the higher road and those patients worth keeping are savvy enough to catch on.

  21. Steve says:

    In California, a certified optician is required to be on staff to dispense prescription glasses. When a patient orders glasses on the internet, there is no dispenser physically present and therefor should be illegal. The person fitting the glasses and filling the rx should be the one responsible for obtaining the PD. The Dr. should not be required to provide the PD, it should be the responsibility of the dispenser.

  22. Celia Arce says:

    I believe a PD should be given, its part of the refraction.

  23. Julie ABO says:

    It is a time to reinforce your relationship . Explain why it needs to be correct and ask them to bring them in to be verified and fit. This gives you the opportunity to meet their needs if possible and to expand their ideas on multiple pairs. You can’t sell them every pair anymore than one shoe store sells all the shoes one person buys. Build a relationship and you will build loyalty.

  24. Albert Nemiroff says:

    Will you also provide the height of the major reference points, the base curves, lens thickness, transmission or absorbance of the lens, color of the tint particularly if yellow orange or red blue blockers , the vertical distance between the segments in a double bifocal or quadrifocal, the vertical displacement of the segment optical center, pantoscopic angle, vertex distance height and angle of a telescope or microscope lens, balance lens, depth of occlusion of a lens, and on and on and on? A prescription for an ophthalmic appliance specifies the frame or mounting. When 35 mm flat top bifocals were introduced, if the lens powers were sufficient one could decenter up to about 6 mm. to create or diminish prismatic effect. It saved time of delivery and cost. So did specifying the resultant power and angle of horizontal and vertical prism. There is more to an ophthalmic spectacle prescription than, sphere, cylinder and axis.

    As an aside the was mention of OTC readers, but none has commented on what passes or sunglasses for kids, with wafer thin lenses that if broken could inflict serious injury.

  25. Al Cappara says:

    If you are a PROFESSIONAL OPTICIAN, maintain PROFESSIONAL INTEGRITY! Many of us have expert skills and advanced technology through education and serious engagement in performing excellence in our field. If you give any of those attributes away, you diminish our relevance and position in eye health care. What we do is very important in our field, as a matter-of-fact, I always looked at our profession as being like the eye doctor’s pharmacist, they write the scripts, and we advise what optimizes pinnacle visual acuity in material, lens designs with enhancements, and all the associated intricacies necessary to provide success for the patient and ourselves. Why give that away?

    • lana says:

      Beautifully said. Couldnt agree more.

      • Jeffrey E. Kapp says:

        If a patient is going to go elsewhere for glasses,,,let them,I am a Professional too!! But I think Integrity includes, not being so ,,,Um,,,,for lack of a better word,,paranoid that you are going to lose business! Trust me,,I have worked at the cheap places,,people do not have a relationship with those un-educated wannabe’s…Have faith in your practice,,they will be back..The cheap glasses won’t last…And I do charge out the wazoo for repairs on those korean pieces of junk!!Be a true professional,,advise them and when they come back with problems,,,make them pay…Would’nt you rather have them with the correct PD than some wal mart “eh it’s @ 60mm??

  26. Barry Santini says:

    Some of the posts here appear to be only responding to Mr.Karps’s blog-lead in to my article. Everyone is invited to read the original article here: http://www.2020mag.com/l-and-t/46893/
    Thank you.

  27. Andrew Karp says:

    Yes, by all means, please read Barry’s article to get his take on the PD issue.

  28. h says:

    as up to shins we’ve been giving things away for so many years adjustments screws advice all in the hopes of gaming some business which we seldom really guess I think whoever is making the glasses should take the PD at the optometrist includes it in his rx that’s his business but as an optician working for a large Medical Group where the doctors do not take a PD it’s almost like a slap in the face when someone says can you write down the measurements for me then goes and buys glasses online brings them back to you to have them checked and adjusted were acting like fools and hence don’t get the respect we deserve or have earned all this talk about professionalism is b******* people are looking to save money at our expense and when we give them their PD we are helping them does the mechanic tell you how to fix your car it’s a simple as that

    • Jeffrey E. Kapp says:

      When they bring them in (the cheap a@@ glasses ),,that is when you put the charge on,,as well as make them sign waiver to release you of responsibility when the piece breaks!!

  29. Don’t really think it makes much difference. Customers can quite easily measure from point A to point B themselves, it only takes a ruler and a friend/mirror.
    May as well give it to them and be seen to be a good guy, than not and be seen to be the bad guy.
    Give customers what they want…

    • Jeffrey E. Kapp says:

      Amen!! If you show them the difference between an OPTICIAN,, and a Salesperson,,,they will usually come to the correct conclusion….Charging them for trivial tasks will only tell them you only want their money!!
      JEK ABOC

      • Barry Santini says:

        Cant say I entirely agree here. To be clear, giving their PD from their record should be no charge. Taking their PD anew, upon request…charge. Actual Services must have pricing to establish value in a consumers mind. Think anout how many people you’ve loaned money to who forgot to pay you back. No interest, no cost= no value

        • PD should be an industry standard on all RX. I agree upon charging for a service but I believe in giving as much as possible for that service, it builds better, stronger relationships. The customer who is sat in the chair ‘is’ being charged so a 3 second job doesn’t really add to the workload. Just my opinion though!

  30. JBow says:

    Ummmm, There are some very intense feelings going on with issue. I found it very interesting to see the various takes on the “PD situation”. The practice I am have been working with has 3 MD’s and 4 OD’s, and when I approached them with this topic, they told me it was up to me….YIKES! After dealing with the same patient base for well over a decade, I asked some of my patients what they thought. In most of their eyes, their impression was it was up to me to figure out that measurement (I’ve trained them well). Some of the patients explained that they had tried other places that were cheaper in the beginning, and for the value and customer service they received with us, the cheaper places weren’t worth it. With the issue of me charging them for the PD if they wanted to try other avenues….the attitude was that of extreme displeasure. They explained that, that should be part of the general prescription.

    After all these discussions, our office decided to go ahead and supply the PD if the patient asked and at no charge to them. We do explain that unfortunately we can neither adjust them or guarantee that the prescription will be made to our optical standards. We have tried to educate them as much as possible.

    When it comes right down to it, every office is different, only you know your market and area. We can all argue until the cows come home but as many people have said, “It’s all about Patient Care”. If your practice and its patients are better suited to charge for the PD, then go for it. If your practice see things differently, then don’t.

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