Eye Opener

Miller, OD, JD

By Andrew Karp

The word diverse doesn’t begin to describe Pamela Miller’s career. In her private practice in Highland, Calif., she specializes in contact lenses, family eyecare and sports vision.

But the scope of Dr. Miller’s activities goes far beyond the exam room. She is also an attorney and draws on her legal and optometric backgrounds when she serving as a consultant and expert trial witness. It was this combination of skills that led her to play a key role in creating the “Duty to Warn” program for the Optical Laboratories Association. Designed to protect eyecare professionals from liability, the program is widely used by ECPs when presenting polycarbonate lenses to their patients.

Apart from optometry, Dr. Miller is a certified travel agent, a real estate developer and dog enthusiast, not necessarily in that order. “I don’t dabble,” she says. “I take every profession that I’m in seriously. It makes life a lot more interesting.”

How did you become involved in creating the Duty to Warn program?
The original concept should be attributed to Joe Bruneni of Vision Consultants, who was working for the OLA at the time. He realized there was a need to promote polycarbonate based on its impact resistance and other attributes, while boosting awareness of the safety issue.

In 1989, Joe organized an educational meeting for eyecare practitioners, labs and suppliers in Ontario, Calif. called the Polycarbonate Forum. It was the first venture in terms of mass education about polycarbonate. He invited several speakers to address various aspects of polycarbonate lenses such as fashion and optics. Because I’m an attorney/practitioner, I was asked to speak about the negligence arena, which includes a duty to warn and informed consent, which exists in other areas of medicine.

The Duty to Warn program comes out of tort action and cause of action for negligence. Those areas of law fall under the malpractice umbrella. We just brought it into the area of lens materials. The concept also covers contact lenses and surgery.

How did you customize Duty to Warn for the eyecare field?
Duty to Warn started out generic, but it’s court-induced. The program made it more of a legal obligation for the eyecare professional. The argument comes up ‘Would this person have been injured if not for the doctor’s negligence in lens material?’ If you can argue that the lens material worn by the patient is not what they needed, then the argument holds up. If you didn’t present a polycarbonate lens to the patient, you knowingly placed the patient in danger and didn’t give them the opportunity to select the lens material best for them.

How did Duty to Warn help promote sales of polycarbonate lenses?
When we came out with the program, we said ‘Here is a legitimate reason for considering this lens material as opposed to ‘We’re going to sell this lens and make a lot of money.’ We also pointed out that polycarbonate lenses have a much wider appeal than just safety. It’s good for athletes, children, people who are monocular and elderly people prone to falling.

How can Duty to Warn be applied to new lens materials?
From a legal standpoint, I ask ‘Does that lens material protect the patient?’ From a dispensing standpoint, I ask ‘Does it provide a better cosmetic look as well as being safer?’

The bottom line is when you’re talking about duty to warn, you’re talking about what is best for your patient.

As a sports vision specialist, do you always recommend polycarbonate lenses for athletes?
If you’re playing sports, you’d better be using polycarbonate or the equivalent. To prescribe anything other than that is wrong, especially where you know being hit in the eye is a strong possibility. I tell my patients, ‘I’d feel terrible if you lost your eye because I didn’t recommend it.’

Since you became involved with polycarbonate in the late ’80s, what changes have you noticed in the product?
You don’t see distortion or warping anymore. The product is repeatable; you order a prescription and get it the same each time. Also, we don’t have problems with AR coming off like it used to.

When I started out in practice 30 years ago, I didn’t use polycarbonate at all. Now I use it for easily 80 percent of my patients, probably higher.”