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And another thing

U2.3.4 “And another thing…” (2012)

You may remember a couple of months ago I answered a question about dispensing plano lenses without a prescription. That brought more queries on a similar theme I thought I could answer here. The original question was specifically about supplying a single plano lens, without a prescription, after cataract surgery. My argument was that as a temporary measure with full explanations given to the patient it was both legal and professional. The theory has never been tested in court or at an FtP hearing but I felt it was a professional course of action. The further query raised the problem of dispensing a pair of plano lenses to a patient without a prescription; was that too legal?

The law does not class plano lenses as an optical appliance and, as such, they are not covered by the legislation that governs the sale and supply of spectacles; but is it professional?

A customer walking in to your practice has every right to buy a frame and have it glazed with plano lenses, without a prescription, and you have every right to sell them to him. It becomes a little greyer when you ask the question: why would they want to do that? It might be an actor wishing to look the part or someone wishing to be fashionable or look more intellectual, all good reasons. But what if it was a vulnerable adult or young teenager? Would that still be professional?

I would take the view that such patients have the right to spend their money on whatever they wish, unless there is some legal restriction on their finances. Stiletto shoes with four inch heels? Tattoos? Body piercings? It is all a question of personal choice. Great tact is needed to suggest that they may like someone else to come in and look at the frames with them, giving a carer the chance to say: “That’s a lot of money to spend, are you sure it’s what you want?”

If your records can show that you took all reasonable steps to ensure the customer was not coerced in any way to make an expensive purchase, there is nothing unprofessional in such an action.

Another possible scenario is when a sight impaired or severely sight impaired patient wishes to have spectacles when there is no improvement to their sight with or without the appliance; the lenses could be plano or any other power. May you dispense that patient? Most definitely yes; only a registered practitioner may dispense to SI or SSI patients by law. Together with any family or carers, a discussion can be had, sensitively explaining that spectacles may be worn or not; there is no visual improvement with or without them.

This is where it is so useful when the eye examination has been conducted in house; you have the benefit of seeing the records and understand the limits of the acuity. Of course, what often happens is that a Hospital Eye Department will simply say, glasses are no use to you, you don’t have to wear them.

A patient who has been a spectacle wearer all their lives will feel naked and vulnerable without their specs, they may feel their eyes look unsightly and wish to hide them, or a filter may not give them useable sight but may well give some relief from glare. All of the above are good clinical reasons to dispense plano lenses but only a registered professional would have the knowledge and skill to be of help to such patients. A registered DO is in an ideal position to help in such situations. You have the knowledge and training to ensure that all spectacles dispensed are correct for the individual, whatever their situation.

#plano lenses #prescriptions