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You will be happy to know that inmate #8480-11 at your local penal facility is receiving high quality vision services and materials. The Federal Bureau of Prisons has published a guide booklet of procedures and recommendations that run the gamut of requirements to insure the best care for prisoners. Inmates may also request consults with their primary care provider. Those over the age of 65 are entitled to yearly exams. If an evaluation by an ophthalmologist is required, a referral could be made by an optometrist or a physician. Certain cases qualify once an accurate ophthalmoscopy is performed during a routine exam. Annual fundus exams are recommended for the following categories: type I diabetes, type II diabetes, hypertension, and HIV infection.
Eye examiners are warned that some inmates may "peek" behind the occluder when taking the V.A. This is most evident when the inmate uses his own hands to cover his eyes. Additionally, dramatic changes in V.A. over a short period of time may be considered malingering. It is suggested that in such cases, V.A’s are taken on a different day with a different chart. If the inmate has limited English skills, the examiner may use a "tumbled E" or "illiterate" chart in those cases. Inmates with 20/40 or better in the worse eye will not be referred for refraction. Others who fall below the 20/40 line may be referred by the screening optometrist or physician for refraction. In addition, inmates with complaints of headaches or other visually related symptoms who are involved in data entry vocational or educational programs which utilize heavy amounts of close work may also be referred for refraction. This applies even if the V.A. is 20/40 or better. Eyeglasses may be ordered if refraction reveals 0.5 D or more power.
Contact lenses may not be fitted or dispensed for cosmetic reasons. One of the following criteria must be met: (1) Keratoconus with best spectacle correction at less than 2/60- 20/80. (2) Unilateral Aphakia with no implant. Contact lenses are not authorized for amblyopic cases or extensive macular damage. (3) Corneal scarring or excessive corneal astigmatism. (4) Greater than 4.0 D of difference between the two eyes. (5) Myopia exceeding 10.0 D. Exceptions are made if increased V.A. over the current spectacles
can be proven. (6) Severe Hyperopia of 10.00 or more unless proven that contacts will improve best current spectacle correction. Contacts should be fitted only if the subject will remain in prison for more than a year thereafter. If the inmate is scheduled to be released before that time, then contacts should not be fitted since adequate follow up time is not available. Furthermore, contacts may not be sent with the inmate who leaves prior to the final fitting visit. Prescriptions for contact lenses are not provided for inmates who expect to order them from the private sector.
Pending proper and complete documentation, urgent surgeries must not be delayed. All elective eye surgery requires the Regional Medical Director's approval. Criteria for cataract surgery must be met, including cases of inmates who are drivers and require
stereoscopic vision. All requests for Keratoconus therapy must supply information pertaining to attempts to improve the V.A. with single or piggy-back contact lenses. Pterygium surgery candidates must have records to show significant interference with V.A. or an astigmatism reading of over 3.0 D or a change of 30 degrees or more in the cylinder axis. For those inmates being treated with drops to control glaucoma they may receive laser surgery if they do not respond to the drops. Medication and drops are dispensed during a “pill line" so that compliance can be recorded. Retinal laser surgery can be considered upon recommendation of the ophthalmologist in charge of the patient.
There is an organization, Institutional Eye Care, which is the largest vision service in the country that is devoted solely to inmate eye care. They service over 450 separate local, county, state and federal facilities in 44 states, housing over 400,000 inmates. The owner is a bright, enterprising young optometrist, Dr. Jeffrey R. Lose of Lewisburg, PA.
I had the rare opportunity and privilege to interview Dr. Lose. He told me, "We have been supplying effective vision service, nationwide, for correctional facilities since 1983. We employ only ABOC certified opticians and we act as a professional recruiter and contract optometrists to work directly for the facilities."
I asked Dr. Lose what he considered to be the most important aspects of his eyeglass program. He replied, "One attraction is our low prices. Single vision glasses can be dispensed for only $14.75. Another attraction is that we have a turn around time that averages only three days. We also have a 100% breakage guarantee against manufacturing defects. All lenses meet or exceed ANSI.Z801 and FDA requirements for safety guidelines and tolerances.”
Scheduling is arranged so that the examiner and technician have an uninterrupted flow of inmates for testing without interference of inmate count or medications being dispensed. A full exam is performed for two inmates each hour. Total time for these clinics is four
hours. This would include down time and inmate count beginning when the provider arrives at the facility. Clinics are considered closed if no inmates are available for testing for a period greater than 15 minutes. Consecutive clinics, when required, will be scheduled for a full day’s coverage. In cases where inmates must be escorted, adequate security is assigned to assure their availability for examination.
I learned that IEC produces around 1,000 pairs of glasses in a typical week. The lab is equipped with a patternless Santinelli edger. The lenses are plastic. Bifocals are done with ST 28 segs. Dr. Lose informed me, "All eye wear received by the inmates comes with instructions regarding expectations and limitations of the new glasses. This protects the facility, the optometrist and us from the possibility of liability concerns. I make myself available to any site for technical consultation, when needed."
Dr. Lose revealed to me that prison policy meant that he could not respond to my requests for personal episodes or events regarding inmates since the accent for privacy protection is a paramount goal.
On site or off site services can be provided to any facility. IEC provides all necessary equipment to perform routine exams via a mobile unit. Routine visual fields are performed on site with an Oculus portable vision field unit. Tonometry is performed using a Tono-Pen. Retinal photography is conducted using a non Mydriatic camera by Nidek. Dr. Lose is a member of: American Correctional Association, American Correctional Health Services Assoc., American Jail Assoc., American Optometric Assoc., American Public Health Assoc., Society of Correctional Physicians and Who's Who of International Business.
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