Real Deal: The Case Of Provisional Progressive

Meticulous Doctor

What are the optical, legal and ethical concerns when an optician doesn’t follow the script?

This article originally appeared in the September 2016 edition of INVISION.

Working in Massachusetts, a licensed state, gave Marc extra motivation to become the best optician he could be, so in addition to being an LDO he had earned his ABO-M. His modest optical shop was in a sleepy strip mall and he enjoyed working alone, relying heavily on the patient referrals from local ophthalmologists.

Late one morning, Marc heard the door open. He left his bench to greet the middle-aged woman paused by the entrance.

“Come in! How can I help?” Marc smiled, waving his hand.

“I got my eyes checked before I moved; I wanted to wait to have glasses made near my new house so I didn’t have to travel back and forth,” she said, introducing herself as Lindsey.

“That’s a good idea,” Marc said. “Can I take a peek at your prescription?”

He first looked at the doctor and practice information; this was from an optometrist in Maine.


Real Deal is a fictional scenario designed to read like real-life business events. The businesses and people mentioned in this story should not be confused with actual eyecare businesses and people.


Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at

“Welcome to Massachusetts, I think you’ll like it here!” said Marc congenially. “It looks like this is for progressive lenses ....”

Marc was studying the script and trailed off when he noticed extra information scrawled below the add power. It listed an unfamiliar digital progressive lens design, brand-name AR treatment and material specifications, followed by the words “No substitutions.” Marc frowned, then remembered that Maine was an unlicensed state. He wondered if that was a common practice, for optometrists to help unlicensed opticians choose lenses.

“Is there a problem?” Lindsey asked.

“Oh it’s fine,” he said hurriedly, “Have a seat with me here, I need to ask you some questions about your job and hobbies.”

Marc helped Lindsey, a paralegal, select a beautiful frame. He reviewed which lenses he felt would meet her visual needs best.

When Lindsey was gone, Marc called the office of the prescribing optometrist; the doctor was with a patient, so Marc asked the receptionist if he could get a call back. It never came, and Marc didn’t follow up to ask why these recommendations were made.

Three weeks later, Lindsey returned to Marc’s shop. She had been wearing her new glasses for several days now and just wasn’t seeing well, but was having trouble verbalizing her issues. Marc inspected his work and found it to match the prescribing doctor’s prescription within ANSI standards, so he asked Lindsey if she would return to the doctor to have another refraction. He offered to remake her lenses if the doctor changed the prescription significantly, as long as she came back quickly.

Marc waited to hear from Lindsey, but after two weeks he assumed she had either adapted to the new script or the doctor hadn’t changed the prescription. Another week passed before Marc received two letters in the mail. One was from a lawyer’s office — the other from the State Board of Health.

Marc’s head swam as he opened the letter from the board, and found a summons to appear as part of an investigation regarding Lindsey’s prescription. The letter from the lawyer described the medical need for the lenses which had been specified by the optometrist. Lindsey was claiming that the lenses Marc made were dangerous, and accused him of unprofessional conduct. Marc’s eyes jumped to the end of the document to see the bad news: She was threatening to sue, for thousands of dollars.

It was clear the optometrist had neutralized the eyewear and told Lindsey that Marc had “messed up.” Marc truly believed that, as an optician, he was better qualified to select lenses. Regardless, it was clear he was in a sticky situation.


1. What could Marc have done differently to improve the situation?

2. Should opticians be required to provide patients with a product they don’t believe in, if the prescribing doctor specifies?

3. If Marc had followed the OD’s recommendations, he would be responsible for a product he didn’t believe in. Should he have refused?




Marc should have talked to the patient if suggesting another type of lens and let the patient choose the design she wanted. After all, it is her money and she should be the one deciding.



The optician in this story is really lucky that the federal laws regulating glasses and contact lenses have not been updated at this time. The only prescription parameters that mattered were the Rx — i.e. sph, cyl, axis, prism if any and add. The other info listed is just merely suggestions and not true Rx. So, he has nothing to worry about except baseless litigation that will still cost him time and money.



Marc should have looked at her old glasses and identified what brand of progressive she was wearing. If she was wearing the same progressive as prescribed he should have filled it as prescribed whether he liked that brand or not. Perhaps he didn’t know that this patient had already tried several brands of progressives and this was the only one that worked. Not everybody can graduate to the newer styles of progressives.



It's already been established that product recommendations are not part of the patient Rx. Marc was free legally to fabricate within that Rx as he saw fit.



Marc should have voiced his concerns over the Rx when she asked. Talk to the patient; she may have been able to explain the situation. Then when he called the doctor’s office, follow up. He had the right instincts but believed he knew best.



A prescription is a prescription is a prescription. Pharmacists are in violation if the Rx says “brand name necessary” and they substitute a generic. The optician should have called his local lab see if he could obtain the required lens. But he thought he knew better. He could have pursued reaching the doctor, but he did not. It all came back to bite him, and it could have all been avoided.



Marc could have simply explained his reasons for not typically using that product as well as his reasons for using the lens design that he chose. This could have led to the patient explaining why the particular lens was recommended by her doctor, even if Marc failed to ask her about it.



I bet I would have done what Marc did. The no substations part would give me pause. Seems like bad luck or almost a plant. Whenever I dispense progressives that are spot on RX and measurements, I think it's most often a personality problem more than lens details. I wouldn't worry about the lawsuit. Return the money and move on. Marc knows more about this stuff than the OD. We get a lot of new OD students coming through our center. Last week, one student recommended a specific base curve ... puh-leeze!



1. Marc should have started with explaining his concerns to the patient right away then he should not have made lenses until he had spoken with the Dr to find out the reasons behind those instructions. 2. An Rx is an RX. Pharmacists can't just change Rx's just because they don't like a medication. Communication is in the best interest of the patient. 3. If you can't stand behind a product, then yes. Just because Marc believes that he know lenses better than the Dr. does not mean that he knows this patient. Every one has a history and it is very seldom that they tell us enough to know everything that may have an impact.



Mark should not have fabricted the specs until he talked to the Dr to find out why he was recommending this product . He should have spoken to the patient about his concerns about using a product he was not familiar with and then together they should have discussed it with the OD. Mark should have called the patient back to follow-up before he got the letters. He should have either followed the doctor's RX or refused to fill it. The best interest of the patient is for the two professionals to come to a consensus and inform the patient what they come up with. For Marc to decide on his own to go against the doctor's recommendation was in my opinion at least a bad choice and at most maybe illegal. The doctor, not Marc, would have been responsible for the finished product had Marc followed his written direction. We risk liability each time we design eyewear for a customer. Be diligent!



Number one, prior to placing any order Marc should have discussed with Lindsey that her doctor had requested a specific digital lens that he didn't work with and was unfamiliar with. He should have then discussed the lenses he used and why, the benefits etc. Then prior to actually ordering her glasses he should have confirmed with the examining doctor why the specifications had been made. If he had been upfront about choosing a different lens then there would have been no issues regarding him having "messed up" when she went for her recheck with her doctor. Instead it would have been a decision they had both made to use the lenses he discussed with her rather than the doctor's recommendations. If there was truly a reason for the specifications, such as she had not adapted to multiple lenses and this was the only style she had done well with then Marc could have decided if he wanted to provide the specified product or explained to her why he would choose differently.



We all know that doctors recommend what they sell in their practice. I go over the RX with the patient to make sure of RX changes and specific items they have talked to the doctor about. "What would you like to change about your old glasses?", opens conversation about concerns that need to be addressed. We should always double check with the prescribing doctor if there are items hand-written. We aren't doctors. Doctors will always know more about their patient's concerns than we do — we have to respect that.