Know Your Duty
The popularity of higher-impact-resistant lens materials may have pushed Duty to Warn to a back burner, but ECPs still have a responsibility to inform patients of their lens options
By Susan P. Tarrant
Image courtesy of Transitions Optical, Inc.
Duty to Warn is a term that has been the focus of seminars, and Duty to Warn programs sponsored by industry organizations have brought information and sample documents to ECPs. Raising awareness of higher-impact-resistant lens materials better serves and protects those at risk of injury from broken lenses.
A LITTLE HISTORY
The term Duty to Warn in optical dates back to the 1980s and stems from court cases involving patients who were injured when their eyeglasses broke. Several cases delivered large settlements when it was found patients had not been told about the higher-impact-resistant lenses (polycarbonate was just entering the scene).
Courts were ruling that ECPs had a legal responsibility to tell consumers about proper use and safety issues associated with ophthalmic products. The Optical Laboratories Association (now the Optical Lab Division of The Vision Council) started a Duty to Warn program, which armed member labs with materials to build compliance.
Image courtesy of Transitions Optical, Inc.
As the optical industry progressed and the choices of lens materials grew, formal Duty to Warn programs fell from the spotlight, and discussing it as a matter of course decreased in many practices as well.
According to representatives of the Optical Lab Division, those materials still exist and are available to any member lab or any member of the optical community who requests them.
WHAT'S YOUR DUTY?
ECPs have a responsibility to assess the visual requirements and intended use of eyewear products by each patient, and then recommend specific lens and frame styles that are appropriate for the patient.
Simply put, ECPs have a professional and legal duty to ensure patients are in the best and safest eyewear for their needs.
Pamela Miller, OD, FAAO, JD, DPNAP, is an optometrist in Highland, Calif., with a law degree who speaks about ECPs' legal responsibilities to inform patients about lens choices. “You have a duty to investigate what your patients' needs are,” she says. “And you are under an obligation to recommend the appropriate lens or lenses for that patient.”
Not every patient will take the recommendation. But the Duty to Warn is that patients are informed.
“The reasoning is that one person, the eyecare professional, has greater knowledge [of optics, safety issues, and lens options] than the other. It's an attempt to place both on more of an equal understanding so the patient can make an informed decision,” says Miller. “While it doesn't make them equal, it puts the patient in a better position to make a decision.”
BUILDING DOCUMENTATION
As in any situation in which options are discussed and recommendations are made, the key to self protection is documenting the conversation and the outcome.
The Duty to Warn materials from the Optical Lab Division of The Vision Council include sample checklist forms that list lens materials and options to explain and recommend, and spaces to indicate the patient's choice and signature.
If the patient is someone who would benefit from a higher-impact-resistance lens, Miller recommends and notes it in the record. If the patient declines, she notes that, too.
In one court case involving broken lenses in which Miller served as an expert witness, the eye doctor lost because “there was no record of the patient's declination of a poly lens,” even though Miller suspected he did discuss it because of the way the woman was talking about a “shatter-proof ” lens.
Court cases will likely hinge on the presence of “anything in the record that indicates a recommendation,” she says.
| RECOMMENDED PROCEDURES |
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| In addition to determining their visual needs, talk to each patient about the following: ■ What they will be doing while wearing their glasses ■ Their hobbies and interests ■ Possibilities for impact situations ■ The benefits of each lens option in terms of safety ■ Documenting in the patient record your recommendations, as well as what the patient chose |
| MAKING THE CHOICE |
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| A new national study by PPG Industries reaffirms that while consumers are interested in a lens that provides a combination of desirable attributes, they are unfamiliar with their lens choices. In a survey of 500 eyeglass wearers: 84% focus more on frame selection than lenses 67% didn't know which lens material they were wearing 11% were familiar with polycarbonate (versus 21 percent glass, 18 percent plastic) and they had little to no awareness of newer lens materials Their lens expectations, however, are high: 71% want the most advanced technology 38% ranked clear vision, thinness, light weight, and impact resistance as the most important lens attributes 20% ranked price most important 90% defer to ECP recommendation |
| LIFESTYLE DISPENSING |
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| “I don't like to come at it from the perspective of ‘If you don't warn, you can be sued,'” says Nathan Troxell, global marketing manager, optical materials for PPG Industries, Inc. PPG Industries created the Trivex material, also known for its high impact resistance. “My feeling is, [ECPs] should be discussing the patient's lifestyle and making the best lens recommendation based on that information.” Troxell says the higher level of awareness among consumers of the array of lens materials, including polycarbonate and Trivex, coupled with the prevalence of “lifestyle dispensing” by ECPs, has resulted in patients being prescribed the best lens for their needs—motivated by eyecare, not fear of litigation. “It's no longer an issue of ‘I need to warn you,'” he says. “It's, ‘I've listened to your hobbies and lifestyle, and here is what you need.'” A higher-impact-resistant lens should be recommended to all children, as the nature of their active days put them at risk for falling and other impact situations. But there are other patients who should be informed about the options as well. OLDER PATIENTS. These patients may be prone to falls. DRIVERS. There have been documented cases of car air bags going off and breaking the spectacles of the person sitting in front of them. This is especially true of people of small stature or those who sit very close to the steering wheel or dashboard. ACTIVE LIFESTYLES/HOBBIES. The risk of impact is almost everywhere—and ECPs should be asking what the patient will be doing throughout the day while wearing eyewear. GOLFERS. Or players of any sport that doesn't routinely necessitate a recommendation for protective eyewear. DIMINISHED VISION. Patients with only one functioning eye should be told about materials that can offer them better protection than traditional lenses. |
Graham Holt, OD, runs Wallace Eye Clinic in Hot Springs, Ark., with Thomas Wallace, OD. As part of the pre-exam paperwork, patients read and sign a Duty to Warn form explaining that standard plastic and glass lenses may shatter in high-impact situations.
“We started with the form because of the high-profile cases a while back,” Holt says. The document is written proof that every patient has been informed about the option of poly and Trivex.
Office signage is another way of letting patients know about lens options—something as simple as “Active Lifestyle? Ask Us About High-Impact-Resistance Lenses.” An office sign alone may not satisfy your duty to warn, but it is a start. EB
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