Well, I had a few advantages on my side.
#1- I am actually light sensitive. That helped.
#2- I do have chronic migraines, exasperated by bright light. This helps also.
If you're intent on doing this, be right up front with the doc. I told him flat out I had been ticketed for my tint and that was part of the reason I was there. I also told him that there was no way in hell I was dumping my tint, and that I fully acknowledged my own stupidity in not getting this taken care of earlier. I FURTHER told the gentleman that I knew a lot of people came in to the optometrist looking to get a script for tint because it made their car look rad. I did tell him I liked the look of it, but that was not the reason for my visit. I told him due to issues with my peripheral vision, that my sunglasses did not always cover the issue, and that often times, just my shades (Which I wore into the office just for a little extra effect) are not enough. I further shored up my case by explaining that while shades are ok in the daytime if need be, I cannot very well wear them at night, and that if I catch an SUV in my rear view or side mirrors (Gotta have them tints on the front after all) that I'm basically screwed. I did also add that I basically refuse to drive my wifes' car, which is NOT tinted. I believe that my honesty first and foremost is what got me what I wanted. Second of all, it helped that I was able to develop a repor with the doc in a short period of time, adding a bit of levity to the situation. ( I gave him crap about me needing glasses now because he shined a REALLY bright light in my eyes... he lol'd and told me I discovered his secret.)
All in all, honesty- or the approximation of it, is the best policy. You're going to have a harder time doing this with a doc at a private clinic (it did help that I was at Vision World on a busy day, and that I was MORE than pleasant to the doc) as well as anyone that is a bit more "mature"... read doc in their 50's. My doc was a younger guy in his 30's I'd guess, not too far out of school to have become jaded. My suggestion? Attempt this at a chain like Pearle/Vision World, make sure you do so early on that day so as to catch the doc in a good mood, and don't hold any info back. You're more likely to catch a guy/girl that's willing to work with you.