ADOA Australasian Dispensing Opticians Association presents Optics More

ADOA Australasian Dispensing Opticians Association presents Optics More Than Meets the Eye AHIA Fraud Conference July 2008

Objectives To enable representatives of AHIA to; ¡ Interpret the basics of an optical prescription. ¡ Understand what a prescription requires and how it is dispensed. ¡ Gain a better understanding of the optical industry ¡ Insight into what a members health fund entitlement means to the member, the optical outlet and to the health fund. Suggestions on what else can be done to prevent fraud. ¡

A refractive error occurs when the shape of an eye is such that light does not focus sharply on the retina

diagram of an eye Diagram of the Eye

Normal Focus

Myopia or short-sightedness ¡ Distance vision is blurred, sometimes close vision also ¡ Squints to see more clearly ¡ Light focuses in front of the retina ¡ Corrects with a concave lens

Short-sighted focus

Short-sighted correction

Hyperopia or long-sightedness ¡ Problems focusing up close ¡ Can get headaches, eye strain ¡ Light focuses behind the retina requiring more effort to clear vision ¡ Corrects with a convex lens

Long-sighted focus

Long-sighted correction

Astigmatism Irregularity in the shape of the eye usually the cornea ¡ Shaped like a football rather than a basket ball ¡ Light focuses differently in different meridians ¡ Corrects with a toric lens ¡

Astigmatic focus Light in two planes focuses in two different points B 90 180 A

Astigmatism can be present ¡ with short-sightedness ¡ with long-sightedness OR ¡ by itself

Presbyopia ¡ Caused by ageing of the structures inside the eye ¡ Happens around 40 -50 years old ¡ Corrects with reading glasses ¡ Gradually decreasing near vision

Refractive errors can be corrected by ¡ ¡ Glasses l part-time l full-time Contact lenses l ¡ disposable, soft, RGP, extended wear Laser surgery

Glasses options Plastic or glass lenses ¡ Hi-index lenses ¡ Anti reflective coating ¡ Tints + UV ¡ Frame - something that suits your personality ¡

Contact lenses ¡ Better field of view than glasses ¡ No one has to know you wear glasses ¡ Better for many sports ¡ Can have tints for changing eye colour

Laser surgery Alters the shape of the front of the eye to help the light focus ¡ Quick, straightforward procedure ¡ Follow up is necessary to prevent complications ¡ Usually doesn’t mean you will never wear glasses again ¡

Common presentations of refractive errors to optometrists ¡ School children who can’t see board ¡ 17 -18 year olds going for their car licence ¡ Young children with reading difficulties ¡ 40 -50 year olds whose arms aren’t long enough

Refractive errors can run in families If you wear glasses it is important to have your children’s eyes checked regularly

Amblyopia “lazy eye” ¡ Vision does not develop properly in one or both eyes ¡ Usually due to uncorrected refractive error or strabismus (turned eye) ¡ Needs to be treated as early as possible for best chance of normal vision

Optometrists ¡ Detect and diagnose problems with eye health ¡ Prescribe glasses or contact lenses, if required ¡ Diagnose and treat problems with focusing

Optometrists ¡ Are university educated and regularly undertake continuing professional education ¡ Tests are covered by Medicare ¡ No referral is required

Optical Dispensers interpret and dispense prescriptions for optical appliances. ¡ Also called dispensing opticians overseas. ¡ Optometrists can dispense, approximately 50% choose to refract only. ¡

The Prescription or RX for glasses What should be on a prescription? o o o The details of the optical outlet. The clients name Date of test and expiry date. The prescription. The prescribers signature The prescribers provider no

The Prescription or RX for contact lenses What should be on a prescription? o o o o The details of the optical outlet. The clients name Date of test and expiry date. The prescription. The prescribers signature The prescribers provider no Type, curve and diameter of the lens

Spectacle Prescription Patient Name MR G Marsh Reference # 4461 SCRIPT DETAILS Right Eye Sphere +2. 75 ______X Cylinder -1. 25 Add 1. 75 Int. Add P. D. Near PD Prism 1 Prism 2 Stanhope Gardens Optical Today's Date 18/10/2007 Script Date 15/03/2007 Expiry Date 14/03/2009 Left Eye Sphere +2. 00 27 ____X 165 Cylinder -1. 50 Add 1. 75 Int. Add P. D. Near PD Prism 1 Prism 2 Comments MULTIFOCAL. Optometrist My test 00013 X Signed. . . . .

Spectacle Prescription Patient Name MRS D Marsh Reference # 4455 SCRIPT DETAILS Cylinder Add Right Eye Sphere 0. 00 ______X -1. 50 Int. Add P. D. Near PD Prism 1 Prism 2 Stanhope Gardens Optical Today's Date 18/10/2007 Script Date 15/03/2007 Expiry Date 14/03/2009 Left Eye Sphere -0. 50 75 ____X 85 Cylinder -1. 75 Add Int. Add P. D. Near PD Prism 1 Prism 2 Comments Optometrist My test 00013 X Signed. . . . .

Spectacle Prescription Patient Name MRS THERESA Test Reference # 5511 SCRIPT DETAILS Right Eye Sphere 0. 00 ______X Cylinder -1. 50 Add 3. 00 Int. Add P. D. Near PD Prism 1 Prism 2 Stanhope Gardens Optical Today's Date 18/10/2007 Script Date 15/03/2002 Expiry Date 14/03/2004 Left Eye Sphere +0. 50 35 ____X 145 Cylinder -1. 00 Add 3. 00 Int. Add P. D. Near PD Prism 1 Prism 2 Comments Bifocal Optometrist My test 00013 X Signed. . . . .

Spectacle Prescription Patient Name MISS A Test Reference # 2455 SCRIPT DETAILS Right Eye Sphere -0. 75 ______X Cylinder -0. 25 Add Int. Add P. D. Near PD Prism 1 Prism 2 Stanhope Gardens Optical Today's Date 18/10/2007 Script Date 15/03/2007 Expiry Date 14/03/2008 Left Eye Sphere -0. 75 ____X 27 Cylinder Add Int. Add P. D. Near PD Prism 1 Prism 2 Comments SV Distance only Optometrist My test 00013 X Signed. . . . .

Spectacle Prescription Stanhope Gardens Optical Patient Name MISS ERIN Test Today's Date 18/10/2007 Reference # 1455 Script Date 15/03/2007 SCRIPT DETAILS Expiry Date 14/03/2008 Right Eye Left Eye Sphere +4. 50 +2. 50 ______X 90 ____X 110 Cylinder +1. 50 Cylinder +1. 75 Add Int. Add P. D. Near PD Prism 1 Prism 2 Comments Constant Wear Optometrist My test 00013 X Signed. . . . .

Spectacle Prescription Stanhope Gardens Optical Patient Name MISS E FRAUD? Today's Date 18/10/2007 Reference # 1455 Script Date 15/03/2007 SCRIPT DETAILS Expiry Date 14/03/2008 Right Eye Left Eye Sphere -0. 25 ______X Cylinder Add Int. Add P. D. Near PD Prism 1 Prism 2 Comments Distance Optometrist My test 00013 X Signed. . . . .

Who gets what lens? & Why they need that type of lens? Single Vision Lenses - Item 212 0 r 222 Are for reading, computer or distance vision only. o Are for all ages. o Easiest to use. o Most limited focus of all lenses. o

Bifocals- Item 312, o Two focuses only, near and distance or near and intermediate or distance and intermediate. o Easier adaptation particularly for the elderly o Cost effective o Older technology

Trifocals – Item 412 o Three main focal area’s distance, intermediate and near. o Hard to adapt to. o Older technology. o Rarely Used

Extended focus- Item 512 o No line blended style of lens o Replacing SV lens for reading o Great for all ages o Better visual performance than a SV lens good for vocational use.

Progressive – Item 512 o Suitable for all ages. o Mainly used by 40+ to 70 year olds. o All focal points from infinity to near. o Greatest range of applications and solutions. o Most progressive lens in terms of development and research.

Spectacle Lens Types and % of Usage Source My practice Eye talk Leading Lens lab LENS TYPE & ITEM CODE (in pairs) Single Vision 212 & 222 72% 49. 20% 55% Bifocal 312 6% 18. 20% 23% Trifocal 412 1% 1% 1% Multifocal 512 21% 31. 60% 21% 100%

Power Usage Curve – distance prescriptions.

Why Is There A Difference ? Location & Demographics ¡ Type of Practice ¡ Prescribers Preference ¡ Clients Expectations ¡ Competition ¡ Health Fund Penetration ¡

Why I believe fraud occurs? Opportunity. ¡ Persuasion from health fund member. ¡ Economic reasons. ¡ Socio/Demographics. ¡ Greed. ¡ Seemingly little chance of getting caught. ¡ WHAT PUNISHMENT WHEN CAUGHT? ¡

What can be done to prevent fraud? Education. ¡ Appropriate and public punishment. ¡ All stakeholders working together. ¡ Reward for providers and members that abide by the system. ¡ Only paying on claims of qualified providers. ¡ Continue relationship with ADOA & OAA ¡

Questions?

Thankyou for the opportunity to present to you today. ¡ I trust that you have a better understanding of the optical industry and the role that you play in it. ¡

Acknowledgements OAA Victorian Division for their presentation on refractive errors. ¡ Eye talk Magazine ¡