Why don't optometrists believe their patients?

I wear contacts. I need some form of corrective lens in order to really function, and contacts work better. I discover I am running low on spare lenses, and need to order more. This means I need to make an appointment with an optometrist.

I do so and show up and say, “I need new contacts. Here is the prescription I am wearing. They work great and I’m quite happy with them. I am not having any problems whatsoever. These lenses are comfortable and correct my vision perfectly, I just need a new prescription written because otherwise, I cannot order new lenses, because the System is stupid.”

“Great,” the optometrist says. “I’m going to do a full eye exam anyway, because…”

Well, they never explain why. I asked and he said, “It’s a good idea,” and would say no more. Do they think I’m lying when I say my current prescription is fine? Do they just enjoy lording their power over their clients? Is it purely a CYA thing advised by their lawyers?

I think it is to make sure you don’t come back and complain when your new lenses don’t work right.

They get to charge your health care service for performing the exam?

I have no particular eye problems myself, but from my wife (and friends), your prescription may gradually change over time, so slowly that you don’t notice you could use something a little different until it comes up in the eye exam. It’s probably not that they think you’re lying, but just because you think (or perceive) everything to be fine doesn’t mean it really is.

Sight, and the proper/ideal corrective prescription, can change over time. The change is gradual and is not always recognized by the individual. So in believing that your current prescription corrects your vision perfectly, your perspective is that you’re right about that, and an optometrist’s perspective (shaped by dealing with many patients over the years) is that you may be wrong about that. It’s not that they think you’re lying, but that they think you may be mistaken.

Simulpost! troub’s wasn’t there when I composed mine.

They have boat payments due. That’s why they don’t “trust” you.

In most places, prescriptions expire - those for contact lenses expire after a year or two. The optometrist is required to do a complete exam and issue a new Rx. In many places, they’re also required to give you a written prescription, so you can buy your own lenses wherever you want.

Could there be legal consequences?

Suppose you’re given the refills without any checking, then you complain and the optician* says “NinjaGirl said all was fine” and you** reply “No I didn’t!”

*this is who checks my eyesight here in the UK

**I am certainly not suggesting that you would behave like this. But if somebody did, the optician wouldn’t have a leg to stand on…

It’s also a chance for them to run screening tests such as for glaucoma, which can go undetected until damage is done otherwise.

That’s how my glaucoma was detected (and then 15 minutes later declared a false alarm, but what if it hadn’t been?


That’s what I kind of figured, but I was hoping there was a more meaningful answer. I know that vision does change, but generally it stops changing in my age bracket (early 20’s; my vision got worse throughout childhood but has finally stabilized), so I don’t buy the universal “Well you might not notice that you can’t actually see” thing.

But again, I’m a 22 year old with no complaints beyond “My prescription expired.” If I said, “Oh, and my vision’s been a bit blurry” or “I’ve been seeing strange flashes of light” or “I’ve been having some other problem”, then, sure. But the chances of someone my age, with no symptoms and no relevant medical history

(The question popped into my mind because I just discovered that the glasses prescription he gave me is not just incomplete (lacking the pupil distance) but also completely wrong, correction-wise, so I’m possibly going to need to pay for another freaking exam so I can get glasses that I can actually see with.)

They make you go back to the gynecologist every year if you want your birth control prescription, because otherwise you’re never going to get those pap smears.

Don’t know where you got that. I’m 57 and my vision has been changing throughout the years. In fact, my most recent exam (last year, with the previous one being a couple years before) was the first time I remember not needing a prescription change. Other middle-aged folks I know also have found their prescriptions continuing to change over their lifetimes.

And to nitpick, it’s not “notice that you can’t actually see,” it’s “detect that there has been some change in how well you see.” It’s not like you can flip a switch and experience perfect vision so as to compare it to your current visual acuity. With the change being gradual and your vision still being good enough to get by, you really have no way of knowing where you stand.

The problem with glaucoma is that once there are recognisable symptoms (to the patient, that is), damage has already occurred. It would be very rare (impossible?) for a person to notice raised intraocular pressure and the resulting neuropathy. That’s why regular screenings are vital.

From here:

This may be true for you, but don’t generalize it.

I had 20/20 vision my whole life. I saw an optometrist once at 14 just to verify. I noticed some difficulties in college, but I was 19 before I saw a doctor and my vision had deteriorated to 20/200. It had to get that bad before I realized there was a problem and made the time to go see someone. Turns out I had keratoconus, so there’s not much early detection could have done, but there are other eye problems like glaucoma where early detection matters. And, for reference, keratoconus typically sets in between the late teens and early twenties.

So… think of it like PAP smears or mammograms. Maybe only one procedure in a hundred finds cancer, but the risks to that one person are big enough to justify the inconvenience of the other 99.

I’m 38, and my nearsightedness actually got better as of my latest exam. (As in, the amount of correction I required had reduced - not that the condition had completely gone away.)

I had not noticed that my glasses were now too strong, but I can tell the difference now that I have new lenses with an updated prescription; the “minimum distance” at which I can comfortably focus without having to remove my glasses is noticeably lower now.

The Optometrist is required to do the exam and that is the way it should be. You do not want them issuing prescriptions otherwise.

Your beef is not with the Optometrists but with “the System”. and up to a point I can agree with you but Americans want to have it both ways: they want someone else to blame when things go wrong but they do not want to pay for it. What you have is a society which is protecting people from themselves because when they harm themselves through their own stupidity or ignorance they sue others; they do not accept the consequences as those of a risk they took themselves.

Eye exams are desirable no matter what but I take your point that you may prefer to avoid the cost. This is a risk management decision which is fine and well if you are ready to assume the consequences.

Not that Optometrists and other collectives do not have an interest and lobby to make things and keep them that way. I remember when in Spain you could only buy saline solution in pharmacies at highly inflated prices because it was a “health care thing” and who knew what disaster might occur if it were sold anywhere else for half the price.

One thing I like about China is that none of this is in place and you can get pretty much whatever you want. But, believe me, Americans do NOT want this system.

Well, it’s what I was always told as a kid, that most people who have bad vision to begin with kind of level out shortly after they finish growing, and things stay pretty stable until you start getting old. And my personal experience has followed that.

And I know it’s not like flipping a switch, but I know that in the past I’ve noticed when my prescription wasn’t quite cutting it, and I don’t think it’s reasonable to say that people who depend as totally as I do on corrective lenses are in tune with their own vision.

I’m strictly a four-eyes, but I think that Gary T is right. For years, every eye examination would reveal a change in my eyesight, and I’d get a new prescription that was good for one year. Only recently, on the eve of my 38th birthday, did I finally reach some kind of plateau–for the first time, my eyesight was unchanged since the last exam.

That bought me a prescription good for TWO years.