Tuesday, March 16, 2010

(Updated) Question on Prescription Problem

Question
Hi, Dr. Placentra Johnston,

I just had my eyes examined by a new eye dr (my old one isn't in the network anymore) for both an eyeglass prescription and contacts.  I went through a couple trial lenses before given the contact prescription (monovision lenses).  I had the prescription filled by Costco (one year supply) to save money (I have gotten lenses from here before).  However, when I put them in, I can't see close-up; I have to put on reading glasses.  I asked the dr to double-check the prescription (his wife had written it) and he called me back and said the prescription matched the file, and he didn't know what to tell me.  In the meantime I spoke with Costco who compared my old prescription (2 years ago) with this one and said they saw a significant change which they didn't understand, and that may be the problem.  Could you take a look at the prescriptions (old contacts, new contacts, new eyeglasses) and tell me what you think the problem could be.

Thank you very much.

Mary



Old contact lens prescription:  

Preference Toric; R  8.70, 14.40, -2.25, -.75, 110

                 L  8.70, 14.40, -.50, -1.25, 50



New contact lens prescription:  

Air Optix Toric; R  8.70, 14.50, -3.25, -.75, 120

                L  8.70, 14.50, -.50, -1.75, 40



New eyeglass prescription:  R -3.75; -0.75, 123

                           L -2.50; -1.75; 42

                      Add  R +2.25

                           L +2.25




Answer
It could be the axis shift in the reading eye.  The left eye went from axis 50 to axis 40.  But your distance eye, the right has gotten much more nearsighted, so that could also be it.  Try closing the right eye and see if you can read with the left (with contact lenses on.)  If so then the problem is in the right eye.  If you can't read well with the left contact lens, the problem would be because your right eye  changed so much.



But this should not be your job, or mine.  If a patient has a problem with the prescription written, most reputable doctors, will invite the patient to come back in and be re-checked, and usually at no charge.  Now, your chances of receiving that invitation decreases significantly when you buy your contact lenses at Costco.  In most cases, the doctor is counting heavily on the profit from selling the contact lenses to offset the usually rather low cost (or verylow reimbursement rate from the insurance company) of the eye exam.  Your coming back in for a problem visit without having purchased the lenses from him cuts into his profits significantly.  



Moreover, if the doctor did not supply the lenses, you are unlikely to be able to trade them back in at Costco if there is a change.  This is why it is always better to get your contact lenses from the office that wrote the prescription.  You are not just buying materials. There is significant service element that goes along with contact lenses and respect for the need for that service is why the doctor's office may charge a little bit more.  



You might ask the doctor to let you come back in for a check-up AND that in the future you will purchase the materials from him.