Actually, I agree with you about having the optometry shop within the ophthalmology office (seems like that should be illegal) but I am also wary of the huge discount places. If possible, I think one gets the best results in an office where the optometrist or optician sees you as a patient with an ongoing relationship, keeps a record of everything, etc, Ours regularly contacts the ophthalmologist to confer when needed, and we visit for adjustments and checks when needed, He is a wizard as far as suggesting frames, and will discuss the pros and cons of shape, lens composition type, anti-glare coating, etc- as with all things, there are good and bad aspects to most of these decisions, and we have benefitted from someone knowledgeable to help tease out the best choices for us and our specific vision problems and preferences. Also, as you have probably experienced, it is easy for kids (anyone, really) to bend or twist even the titanium frames, and a small asymmetry can really affect the vision, so having someone open to drop-in adjustments, etc, is also helpful.
I do think I would have him checked with the glasses on- for us, the optician would be comfortable (and competent) and would consider it part of the initial fitting, but you could also see the ophthalmologist, Reading a card on the table is a quickie short-cut, in my opinion- our optician uses eye charts just like the ophthalmologist. I think they should also do measurements with the glasses on, where they measure the pupil distances, temple distances, and probably some other measurements, too- it takes a bit of time but they do it every time one of us gets new glasses (sadly, several times a year between all of us!) (I don't mean to say they didn't do a thorough job, as I am not an eye doc- its just that in my expeience it is usually more involved that what you described.)
