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After calling the VSP representative, I was told that the prescription was “too low” to be filled. The Representative stated that Rx was below the threshold of +/- 0.50 D as a “minimum revenue”. Although I don`t derive any income from optics, I was amazed that this assurance could dictate whether it was a “valid” recipe. If it were a business practice and the company dictated which regulations were “valid” or not, it would be both illegal and contrary to optometric regulations. But an “optometrically friendly” third party can and will determine what I can prescribe and that`s not wrong? The patient was a school-aged child. Their Rx was O.D. +0.25 ball and O.S. +0.75 ball. During a recent survey, it was found that the new regulation was -0.25 sphere O.U. – a change of -0.50 AD and -1.00 O.S. Those of us who are practicing clinicians have often seen this in this age group where children can change by 0.50D or more in a year. After more than 20 minutes of my time on the phone, I was granted a “one-time” exemption and the prescription was filled as prescribed.

At a time when optometric physicians can practise to the fullest extent of their licence, why is this practice permitted and tolerated? It is a prescription or not, and dictating the amount of the revenue should not be a function of an insurance company or a third-party company. —Robert Simon, O.D. Franklin, Tennessee. Hysterical vision loss I found Dr. Deborah Amster`s article “When Stress Strains Vision” (July 2011) very well done. When we work in a pediatric practice, we often see these problems. First of all, patients with hysterical vision loss are mainly female children/adolescents. One of the few male patients I have had with this disease was raped by a group. Once all tests have been done to rule out organic causes of vision loss, the doctor should be allowed to call the school nurse or psychologist. It is strange how often these children and their families are a concern of the school. In these cases, the input of the eye specialist will prompt the school to initiate a social services investigation, and the ophthalmologist may have to testify. Before the expected statement in one of these cases, I did a web search for hysterical vision loss and found no information about resolving the disease once stress was relieved.

Clinically, I have seen MVA return to normal in many of my patients. —William S. Waldman, O.D. Thornton, Colorado. Can third parties dictate the Rx? Recently, our optics department was contacted by VSP and explained that they could not fill a prescription. The optician drew my attention to this and asked me to intervene to find a solution. I was surprised at first because it was a valid prescription for a patient who actually had coverage. The manager of the PSV repeated several times that the recipe was too low. I said I thought a solution was needed, and she explained that VSP would call the patient. I asked them what they would tell the patient – that the prescription was not valid? This implies that the doctor is a charlatan or that insurance is worthless. VSP only covers lenses that meet the minimum prescribing criteria, unless the patient is eligible for the plan`s lenses.

Can third parties dictate the Rx? Recently, our optics department was contacted by VSP and explained that they could not fill a prescription. The optician drew my attention to this and asked me to intervene to find a solution. I was surprised at first because it was a valid prescription for a patient who actually had coverage. I asked, “What if I wrote you a doctor`s prescription for 250 mg of amoxicillin, and your insurance company said that only 500 mg or more could be filled, how would you feel?” What if her daughter had trouble seeing the school board – wouldn`t the insurance company fill her optical prescription because she was too low? VSP`s long-standing policy on minimum prescribing criteria, which is regularly reviewed by physicians on VSP`s Board of Directors, includes guidelines on when coverage is provided based on a threshold of what is visually necessary. This policy is listed below: Before the expected testimony in one of these cases, I did a web search for hysterical vision loss and found no information on how to resolve the condition once the stress was relieved. Clinically, I have seen MVA return to normal in many of my patients. —William S. Waldman, O.D. Thornton, Colorado. First of all, patients with hysterical vision loss are mainly female children/adolescents. One of the few male patients I have had with this disease was raped by a group. The first VSP representative was not willing to respond to the request and I was transferred to a manager.

The manager again stated that the Rx was too low and could not be completed according to the guidelines. Once all tests have been done to rule out organic causes of vision loss, the doctor should be allowed to call the school nurse or psychologist. It is strange how often these children and their families are a concern of the school. In these cases, the input of the eye specialist will prompt the school to initiate a social services investigation, and the ophthalmologist may have to testify. The combined force in a meridian is ±0.50 diopters or more in at least one eye, or one of the following exceptions: Sight Gags by Scott Lee, O.D. Surviving the fittest military optometry I thought a small enlargement of hysterical vision loss was justified because it may be due to physical/sexual abuse. In rare cases, such as in this case, we recognize exceptions to this policy. We respect and appreciate the clinical expertise that Dr. Simon and all independent optometrists provide to provide the best care to VSP members.

If you receive an order from a doctor for lenses that do not meet this requirement, please cancel the order and notify them. To send a letter to the editor, send an email to Amy Hellem, Editor-in-Chief ahellem@jobson.com, with “Letter to the Editor” in the subject line. • Required prism of 0.50 diopters or more in at least one eye • Anisometropia is 0.50 diopters or more • Cylinder power is ±0.50 diopters or more.