Any optometrists here? I have a question about the exam routine.

[aside to mod: I hope this doesn’t sound too much like a rant, because I’m not looking for sympathy but information. If this does not qualify for GQ, please close instead of moving it, so I can pose a modified query.]

Every time I get my glasses changed, we spend a long time in the dark peering at the letter chart. Then the glasses arrive and the doc says: “Try them on and tell me what you think” While I’m in the fitting room, surrounded by dozens of glaring mirrors and no eye chart in sight.
I always insist I want to a least glance at an eye-chart before I declare the new prescription better. And they always resist and have to be bullied into this, which only takes a second.

So why is that?
I can only guess four reasons:
1 ) You have more patients stacked up in the waiting room. This is never the case with me because I’m retired and cruise the mall and only come in when I see I’m alone.
2) You are afraid that perhaps I won’t see as well as with the old specs and I will want a correction.(Yes, I would, and have.)
3) You don’t understand that prescriptions, particularly bi- and tri-focals, will be different for different frames. The new “small oval” look that all opticians are pushing this year are the pits for divided lenses, making it really hard to read with them. Some styles of glasses would change things. My same prescription would be made on two pair and the wire frames would be fine but the plastic ones not. The optician explained that the lenses on one pair were held a bit away from my face by the nose pads, but the plastic frames fit tight against my brow.

  1. Or maybe I’m just going to the wrong guys, and most practitioners do a post-fitting glance at the chart (not with the full headgear machine, just a DMV style test.)

Or am I looking at the exam all wrong?

Maybe going to the mall to get glasses is not the best way to go? I have always gotten a post-fitting “read the bottom line please” check-out after getting a new prescription.

Very good question, I’ve often wondered the same thing. Having worn glasses forever, I’m used to just taking a moment to wander about looking thru the new pair, staring out the windows to focus on stuff farther away, pull something out of my purse to read, etc. It’s like the doctor is involved in the scripting, but the picking up part involves just a fitting and good luck wishes from the non-medical folks out front.

[Worst case anecdote] My son has ADHD and Asperger’s syndrome, when he was young he got flagged on a routine checkup at school and it was suggested we follow up with his pediatrician for a real eye exam. The ped referred us to a pediatric opthamologist instead of just an optometrist, because “behaviorally-challenged kids are often uncooperative on exams.” One exhaustive exam later, I’m given a script to take to an optometrist for lenses. Frames are chosen and a few weeks later the glasses are in.
He immediately said he couldn’t see out of the new glasses, knowing he didn’t want glasses to begin with we had no way of knowing whether that was 'tude or real. I asked that he be re-examined with the new glasses on and they absolutely refused.
Two weeks later I found a different optometrist and paid for a whole new examination, finding out that the script was indeed way off and impairing his vision completely. Since the script came from the opthamologist specialist and not the optometrist, the glasses-providing office felt no responsibility to ensure they were correct. Granted,
Years later, he still doesn’t wear corrective lenses, although I get him examined every two years just in case.

I concur. Because your eyes will accomidate (refocus) as various test lenses are tried, optimizing a perscription is rather time consuming, and doesn’t fit well with the “make it up in volume” buisness model a lot of these places employ.

It took me a few tries but I finally found a fellow who takes the time to make absolutely sure my perscription is optimal…and he charges LESS than the places that spend so much on advertising and mall rent.

When I pick up my glasses, he takes me through the whole test-lens-machine thing. (too lazy to look up the real name) WITH the new glasses on. When I am sure it is optimal he sticks a pencle through each side to show me that the glasses are optimal.

If anybody in Albuquerque is looking for such, PM me…I gotta mention that he is probably THE quirkiest individual I’ve ever met though, the epitomy of “odd duck”.

When I get a new prescription, we spend a lot of time finding the right one, but when I pick up my glasses there is a quick check of a small chart (on paper, not across the room) as part of the final fitting, and that is done by an assistant, not by a doctor. If anything seemed blurry I’m sure there would be no problem getting a more rigorous check. I don’t use a mall store.

Heck, even Costco has you take a look around to see how you like your new glasses - whether it’s reading something at the counter, looking at the chart, or even just trying to read the menu at the cafe some 50 yards away.

Whenever I’ve gotten new glasses, even the assistant fitter has at least asked me to look out the window and across the street to make sure I could see clearly. Ditto with giving me something to read for the bifocals part.

IANAOptometrist. I’m a dispensing optician.

I would never dispense multifocals without giving the patient an opportunity to “take a look around, and see how things look in the distance”. Then, I hand them a card with large and “newspaper size” print, and ask if it looks better than before (without glasses or with their previous pair). I also ask if the bifocal “is in the right place” for them. I then instruct them to flip the card over and tell me what line is the smallest they can read. Most of the time, they can do J1 or J2. However, we get a number of patients who want new glasses just because they want them, and even though it is explained repeatedly to them, they can’t seem to understand that the new glasses will not improve their vision any more than their current glasses. Of course, we deal with a number of patients who have chronic eye diseases, so no amount of refraction will make the vision better. These are the patients who break my heart. I want them to not have macular degeneration (or whatever else the problem is).

In any case, taking a patient into an exam room and asking them to read “line 4” would be great, if they wouldn’t question “well why can’t I read line 6?” Sometimes, unreal expectations will cause a patient to lose confidence in their doctor. And that is not fair to the doctor or the patient.

And, just because you don’t see any other patients in the office, please don’t think that means the doctor isn’t busy. He/she could be dictating charts, doing continuing ed credits, researching something he’s not experienced in, or any number of other things doctors have to deal with.

However, if you are truly unhappy with your new glasses after you’ve tried them for a few days, under no circumstances should the doctor refuse to see you for a “refraction check” appointment. Just like any other doctor though, don’t expect chair time without an appointment.

The last time I had an optmetric exam it was done by a machine and is 95% or better. The Opthomologist fine tunes the script. No fooling the machine.

Now…Is that explanation better the first?




Don’t tell me you haven’t wondered about what it’s like with an Optometrist in bed:
Better like this?

Or like this?


Weird- I can tell when I lose 1/4 of a unit in each eye and schedule an appointment asap. Thankfully my eyes have been holding steady for two years (which I knew already, but which is confirmed at my annual appointment).

I can always tell immediately that the new prescription is an improvement over the old, and I sort of thought everyone worked like that- maybe it’s because with glasses I have better than 6/6 (20/20 if you’re not metric) vision.

You learn something new everyday.

I’m with irishgirl on this. I somehow scratched a lens on my current pair of trifocals and only yesterday went to the optometrist to get a new pair. He checked the script for my old pair, did an exhaustive exam and told me that my reading script was 2 steps different and my distance script slightly stronger. This accords with how I am functioning with my 8 year old pair - I can read most things but struggle with smaller print and up until last year I could pass the RTA (DMV) licence test without my glasses but now need them. So I know before I even get them that they will be fine.

My eye examination cost nothing of course, I merely had to sign a Medicare docket. I don’t think anyone in Australia pays for one.