Patient complains, and clinic sees the light

After Cindy Long got a new prescription for glasses recently, she didn’t see eye-to-eye with her HealthPartners optometrist.

Long, of New Richmond, Wis., was considering ordering glasses from a Web site; her husband, Dale, had done that and was happy with the result. But her prescription was missing information she needed to order online — a pupil-to-pupil measurement.

She said that when she asked the doctor for her “pupillary distance,” he said he hadn’t taken it. In the HealthPartners system, optometrists and ophthalmologists — the eye doctors — don’t use it in regular exams because it’s mainly used for making lenses for glasses, which is something opticians do.

So she went to a HealthPartners optical center, where the optician refused to measure between her eyes unless she planned to buy her glasses there. She and her husband went up the chain of command at the HMO, but ended up only with a complaint form.

So the Longs complained again — this time to the Watchdog.

“That’s what our premiums are paying for,” Dale Long said. “If there’s a prescription, that information should be on it.”

The Watchdog’s goal was to persuade HealthPartners to change its policy, but first she wanted to school herself in the medical and legal issues surrounding pupillary distance. She was surprised to find so much controversy over this small measurement, which takes less than a minute to determine.

In general, it’s the eye doctor who completes eye exams and prescribes the lens power to help you see clearly. It’s the optician who helps you select the lens — the design, material, thickness and tints that might work best for your prescription and your lifestyle.

As part of eye exams, some doctors measure pupillary distance. Others don’t. Dr. Kerry Beebe, chairman of the American Optometric Association’s clinical care group, considers the pupillary distance a standard part of the exam.

“We need that measurement to set some of our instruments so that when we do our exams, we have the patient looking through the right part of the lens,” he said.

However, the Brainerd, Minn.-based doctor acknowledged, not all eye doctors consider the measurement necessary.

By federal law, your prescription belongs to you; your eye doctor cannot require you to fill it with lenses he sells in his office. And while the Minnesota Health Records Act says you have a legal right to any information in your medical record, the act doesn’t cover opticians. They aren’t forced to divulge the information to the customer.

While the measurement is necessary for ordering glasses at many Web sites, Dr. Dhavid Cooper, chief executive officer of FramesDirect.com, says the point may be moot soon anyway — at least at his online store.

“The technology we’re working on in the next 90 days will allow you to upload your photo, and we’ll be able to determine your pupil distance for you” within 1 millimeter accuracy, he said.

Cindy Long felt the reason the HealthPartners clinic turned down her request for her pupillary distance measurement was to discourage her from buying online.

But Dan Nelson, an ophthalmologist and associate medical director for specialty care in the HealthPartners medical group, said HealthPartners had no real policy about giving patients the measurement and no official position about buying online.

Not giving out the measurement was just “tradition,” he said.

After the Watchdog brought Long’s request to HealthPartners’ administration, the nonprofit health care organization updated its policy: It will now take the measurement when requested and give it to the patient.

“I appreciate this coming to light,” Nelson said. “I can see why the patient would get upset.”

It still makes sense for doctors and patients to talk, Nelson said, especially about lens prescriptions that will be particularly challenging to fill.

The Longs, who have been HealthPartners patients since 1985, were pleased with the decision. Cindy Long received an e-mail from Nelson:

“I want to personally apologize for the inconvenience this has caused you and also to say thank you for calling this to our attention,” he said. “One request … I would be interested in how your experience in ordering lenses and frames on the Internet goes and how satisfied you are.”

Editor’s note: Feel like an underdog because of a problem with a business, government agency or school? To ask the Pioneer Press Watchdog to help, go to twincities.com/watchdog, call 651-228-5419 or e-mail watchdog@pioneerpress.com. Or, to ask other readers for their advice, post a comment on the Watchdog blog at blogs.twincities.com/watchdog.

BUYING GLASSES ONLINE

Here’s what some optometrists and ophthalmologists have to say about shopping for lenses and frames online:

You’re better off buying the most complicated lenses — bifocals with a big correction, for example — when you can work with an optician. Eyes needing less complicated lenses can tolerate less exacting work.

If you’re queasy about lens quality, buy the frames online and have the lenses put in locally.

Don’t expect glasses to be less expensive at all online stores than at bricks-and-mortar stores. For some, the main advantage of buying online is a wider selection of frames. Some brands are required to charge the manufacturer’s suggested retail price, no matter where they’re sold. Others may be markedly less expensive.

Make sure the Web site answers its phone. That’s an indication of professional customer service. Examine the site and look at the “About Us” information to see if the place seems professional.

You might find some online and discount stores aren’t a bargain. Frames priced exceedingly low could be damaged; exchanges or refunds might be a problem.

Even if you’re trying to save money, get the best lens for your prescription. If you have questions about whether what the optician has recommended is necessary or a frill, call your eye doctor.

Consider whether the glasses come with a warranty and what it covers.

Visit allaboutvision.com. to learn about various types of lenses and frames and the pros and cons of buying online.

Don’t try to measure your pupillary distance yourself; extreme accuracy is necessary to make lenses correctly. You may be able to get the measurement from the place you previously bought glasses. Or an optician might take the measurement for a nominal charge.

Sources: Dr. Dan Nelson, associate medical director for specialty care in the HealthPartners medical group; Dr. Kerry Beebe, chairman of the American Optometric Association; Dr. Dhavid Cooper, chief executive officer of FramesDirect.com.