The Optometry Racket

Every year I curse the optometry racket when I run out of contact lenses and have to return to the optometrist to get a “new” prescription. It’s a service that I don’t want and don’t need but am forced to buy by US law which require patients to have a recent doctor’s prescription to buy eyewear. I can stretch out the time by buying months in advance, sometimes I buy when abroad, for a few years I managed to evade the law by buying from Canadian internet sellers but that route has mostly been shut down. Writing in the Atlantic Yascha Mounk notes that around the world no prescription is needed:

In every other country in which I’ve lived—Germany and Britain, France and Italy—it is far easier to buy glasses or contact lenses than it is here. In those countries, as in Peru, you can simply walk into an optician’s store and ask an employee to give you an eye test, likely free of charge. If you already know your strength, you can just tell them what you want. You can also buy contact lenses from the closest drugstore without having to talk to a single soul—no doctor’s prescription necessary.

The excuse for the law is that eye exams can discover other problems. Sure, trade offs are everywhere. Let people make their own decisions. as Mounk concludes:

Like the citizens of virtually every other country around the world, Americans should be allowed to buy any pair of glasses or set of contact lenses at a moment’s notice. While the requirement to get a medical exam from an optometrist who has spent a minimum of seven years in higher education may have good effects in some cases, it also creates unreasonable costs—and unjustifiable suffering….Put Americans in charge of their own vision care, and abolish mandatory eye exams.

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I guess when Alex goes to the optometrist, Alex only diagnoses him with Baumol's disease.

Heh.

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Don't forget, Alex, the Luxottica monopoly. The crony capitalist combination of big government mandated exams with big company monopoly is another example of yet another broken market structure in serious need of reform.

EJ, If the price of exams are high or unnecessary, then Luxottica prices are constrained. Luxoticca would be better off were there no exam requirements. Complements are worse off if the other complementary product is high. That's why it is surprising that the contact lens industry is not lobbying for the elimination of the requirement. The only reason I can think that they aren't is concern over product liability or concern that damaged eyeballs are not good advertising.

My optometrist used to say that the big contacts companies were indeed lobbying to remove the requirement, and that if they were successful he would retire.

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Why do you consider this a failure in market structure? If this is a bad thing, a simple change in the law or regulation is all that is needed. Seems like a government failure to me.

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The webmaster of this site will so agree with this.
http://www.myopia.org/
Particularly see
http://www.myopia.org/dilatingdrugs.htm

Alarmism, conveniently confirmed where the website invokes water fluoridation at the bottom of the page. Those drugs were extremely useful in diagnosing my latent hyperopia.

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'ut am forced to buy by US law which require patients to have a recent doctor’s prescription to buy eyewear'

One can be sure that someone will point out how exceptional America is, that this is just a trivial cost in the greater scheme of things, that other countries ration eye care/eye wear, etc.

' should be allowed to buy any pair of glasses or set of contact lenses at a moment’s notice'

Pretty sure that is not precisely true in Germany - 'prescription' glasses are sold by opticians, and they like to check what they are selling to someone - for free, admittedly. Obviously, if you already have a recent 'prescription,' they may not insist, particularly if you are buying a second pair as a reserve. And the 'liberalization' of being able to buy reading glasses at a normal store, not an optician's shop, is fairly recent.

The Left screamed in outrage when Thatcher liberalised the optical trade in the UK. Since it's unlikely that opticians were massive supporters of the Labour Party I suppose the outrage was just a reflex action, a hatred of the very idea of a decision-making power passing to individuals.

I see you are not familiar with the U.S. - opticians are allowed to sell glasses, but first you need to get a prescription from a (supposedly) non-optician affiliated optometrist or ophthalmologist. You can read more about another one of those crazy American health care frameworks here - https://aapos.org/glossary/difference-between-an-ophthalmologist-optometrist-and-optician And of course, the majority of Americans do not have anything resembling health insurance for eye care/wear, meaning they pay for the required prescription and the glasses.

But don't worry, someone will undoubtedly be along to explain why the American health care system is superior.

It was before my time but I understand that when the NHS was set up eye tests and glasses were universally free. Not now, of course - withdrawn by a Labour government. WKPD:

'In 1949 there were ten free styles of frame and seven which could be chosen for payment of an additional fee. There could be an 18-month waiting list before the finished spectacles arrived. Initially they were free, but a £1 charge was imposed in 1951. Free NHS lenses could be fitted into privately supplied frames.'

I love the idea of an 18 month wait - it comes, presumably, from having adopted a Stalinist model for the NHS.

It was also a Labour government that introduced charges for dentistry and prescriptions, though many sources on the internet don't seem too keen to discuss the matter. I can't think why.

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I loved this comment about the Left. They delight in herding and queuing people like cattle and controlling them making their lives as inconvenient as possible -- all for their own good of course. However they must have had a real crisis of conscience over supporting the professionals when Mrs Thatcher liberated the profession and quelled its gravy train. I recall an optician's technician living near us being really upset with companies with names like ForEyes and SpecialEyes springing up.

To read comments here, you'd think this wouldn't persist when conservatives held the presidency and both houses of congress.

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Just some research results on the internet:

"Remember that a contact lens is a foreign body placed into your eye. It lies on top of the cornea—the clear, dome-like structure on the front part of your eye. Contact lenses interact with the inner tissue lining of the eye, called the conjunctiva, underneath your eyelids. They also interact with your tears. We are lucky to live in a modern world where a device such as a soft contact lens is so easily obtained and can deliver near perfect vision. We sometimes forget that a contact lens is bio-compatible with living cells, but is still a man-made piece of plastic. A very advanced piece of plastic mind you, but still a foreign body in the eye.

Over-Wearing Contact Lenses Can Lead to Negative Consequences
While the cornea provides most of the refractive power of the eye, it is made of living, breathing cells. Metabolic processes occur every day in the cornea, just as in the rest of your body. Debris and waste material from the cells in the cornea are excreted. This material can sometimes build up unnecessarily underneath a tight-fitting contact lens, creating a toxic environment for your cornea." ...It's important that you have an eye doctor at least view your cornea once a year to make sure that your lenses are not causing problems and that your prescription is accurate for your current needs."

"-Your cornea may have changed and the contacts may not fit as well as they used to. If the cornea changes its shape, even by fractions of a millimeter in its curvature, this could affect how well the contact lens fits your eye. If it is ill-fit, the size of the contact lens must be tweaked to make sure that it does not lead to discomfort, dryness, redness and/or poor corneal health. Many environmental factors can change your cornea in subtle ways, some examples are medications you may be taking, hormonal changes and systemic diseases."

I can see clearly now.

Sounds like something written by an eye doctor trying to protect their racket with post hoc rationalization. Why then do we need a prescription to get glasses? Hmmmm?

Without doing any research of your own to counter what I found.

Lazy.

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... Because each person's eye glass prescription is different? What works for you doesn't work for someone else.

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That’s true. Incorrect use of many products which are otherwise sanitary can cause the build up of dangerous bodily waste products.

Therefore, due to the risk of toxic shock, I propose a mandatory gynecological exam every 6 months for any woman or girl who wants to use tampons. The dangers are too great for use without a prescription and advice from your doctor.

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I use Zenni Optical for this purpose; you can enter any "prescription" you like.

Their selection isn't exactly fashionable, but I started using them exclusively after getting scammed by a hard-selling optometrist and am impressed that they beat even my insurer's subsidized prices.

(I suspect in my cynical moments that vision insurers are simply taking kickbacks from the glasses dealers they cover, who seem to uniformly be the highest price ones by a margin well in excess of the insurance maximum...)

Ah heck, in my enthusiasm I misread the post as concerning glasses rather than contacts.

Well, that's my opinion on glasses anyway.

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+1

Zenni is great and no requirement for “a recent prescription.”

I’d bet two bits Tabarrok is unable to cite the “US law” that he alleges to purport to force him to get new prescriptions.

'that he alleges to purport to force him to get new prescriptions'

And you would be likely be wrong, though generally, it is not 'US law' but state law that applies .'According to Virginia State Law, a contact lens prescription is only valid for one year at which time a contact lens evaluation is required to verify and/or change the prescription.' https://www.arlingtoneyecenter.com/contact-lens-policies.htm

I am a native Virginian, and have known this for more than 4 decades - possibly you don't wear contacts?

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Actually, there is a 2004 federal law. The problem I have is that the federal law sets a minimum (uses state law or federal law, whichever is higher).

The question I have is whether laws should be re-examined when technology changes. Contact lenses in 2004 are not the same as those in 2019. If there are risks, notwithstanding changes in technology, then it is appropriate to have minimum requirements because persons without knowledge presume something is regulated and will not have their eyes examined when they should have.

My drug prescriptions are only good for a year. I have to take an eye test every few years to renew my drivers license. Also have to take continuing legal ed classes, etc.

Aside from the technological change issue mentioned above, the other overlooked issue is this: your eye exam reduces my insurance premium because you will not have an incident that I pay for through with my premium.

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I'd be open to deregulating this, but the thing that does make it seem slightly sketchy to me is the driver problem. I want other drivers to have good vision. If we don't do prescription lenses, do we need a more thorough driver's license vision exam? And without renewal by mail?

The last few times I had to go to the DMV, they administered their own vision test, allowing me to wear my glasses. They certainly don't check that your prescription is recent.

The last few times I renewed by mail, nobody asked me about my glasses prescription either.

I haven't had my vision checked by a professional in some years. I keep doggedly wearing the old glasses, or I order them from China or Zenni.com. But I did pass the last vision check by the DMV. Less than a year ago.

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By the way, everyone. We can just order "prescription" swim goggles from Amazon. It makes a day at the beach much more pleasant for those of us who leave our glasses on shore.

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I've used Zenni for years. So easy and cheap I've bought a couple "reader" pairs with a weaker prescription that I specified. I don't like bifocals, would rather switch glasses when working at the PC.

I get my contacts from visiondirect.co.uk. You enter your prescription data and optometrist name, but that dr name is optional. Delivery from the UK in a couple weeks.

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"The excuse for the law is that eye exams can discover other problems."

I hear this all the time, but what I'd like to know is why I have never in my adult life had an eye exam at my yearly physical. My vision does not require correction, so the only trips to the optometrist has been to accompany minor family members.

Because eyes and teeth are not covered by "medical" insurance. You can thank the optometrist and dentist lobbying for this.

Because you have never had a complete physical, didn't have a familial eye risk, or was never on one of many meds that can affect the eye. I was taught 45 years ago in med school to do an ocular and fundascopic exam with a complete physical physical. I can also tell you that the return on these exams is quite low without the patient having a related complaint. Many eye and teeth disorders are covered by typical medical insurance. But not routine exams, except maybe by some of the Medicare Advantage plans.

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Can I test out of Alex's Econ class so I do not have to take it?

Colleges require that you must take so many classes in your major to graduate with that major.

It's a racket.

I should be able to declare my major and be able to take a test to prove I learned all I need to know to practice economics, or medicine.

The Four year degree is a racket.

Join Alex in his protest of the course requirements at George Mason!!

Also, graduate school is a Ponzi scheme.

You go to graduate school to get a graduate degree so you can teach others who go to school to get a graduate degree so they can teach others....

Higher education has lots of problems that are bigger and more complicated. The optometry scenario is a much smaller problem, that is easier to correct. I do agree with most, not all, but most of what you wrote.

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Of course the shysters omit mention of the law school racket.

Yah, I just loved law school, and those continuing legal ed classes are the greatest.

Law school could be shorter.

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There is good evidence for periodic eye screening being effective for early detection of retinopathy in diabetic adults. I think we can take this as implying that, if periodic eye screening of healthy adults were effective for early detection of anything significant, a motivated researcher could find good evidence for that. And since this has not yet occurred....

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I've seen contact lens vending machines overseas.

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In regard to eyeglasses, I prefer actual glass lenses rather than some plastic substitute because glass doesn't scratch as easily. Now it's almost impossible to obtain glass lenses in the US or Canada apparently because of the possibility of them exploding and driving shards into your eyeballs.

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My thoughts exactly these days! To add insult to injury, my optometrician "fit" me into a new brand of contacts and refuses to let me wear an older brand which my eyes are used to!

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I gave up on contacts three decades ago just as the idea of disposables was floated which might have solved my problem of new contacts feeling like sand in a week no matter what I used to clean them, but it looks like 1800contacts.com has an app to give an online eye exam that is "reviewed by a doctor" to approve refills based on scanning the barcode on the box your contacts come in. The app won't run on mmy tablet so I don't know what it involves. Questions, maybe?

They are waiving the fee which claimed to be $19.99 for the holiday, or something.

This won't be shutdown faster than the pill mill docs, which took decades of ODs and failed employee drug tests mandated by the Feds "for national security".

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Are there possibly tort / liability reasons for this in the US?

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"I see you are not familiar with the U.S. - opticians are allowed to sell glasses, but first you need to get a prescription from a (supposedly) non-optician affiliated optometrist or ophthalmologist."

The root the problem lies in pricing: the exe exam is almost always underpriced; all the profit is in the sale of contacts or eyeglasses.

Of course, that's standard business psychology: most people seem to prefer paying for things over paying for services. That's why most people are happier when a plumber charges $100. to install an $800. toilet, as compared with charging $800. to install a $100. toilet. Even if you're paying $900. and in either case and getting the same toilet and the same installation, in the former case you feel as though you received value because at least you now have an $800. toilet.

In any case, online eyeglass vendors don't seem to check the age of your prescription; it's just fill-in-the-blanks-on-the-form to order 'em. Which mostly works well enough for simple single-vision eyeglasses (but not so well for more complex ones, such as progressive bifocals).

"all the profit is in the sale of ... eyeglasses"
No. All the profit is in the frames. See https://en.wikipedia.org/wiki/EssilorLuxottica

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I agree. I buy contact lenses online. I have to buy an eye exam, that often I don't need, just to buy contacts. That's a small problem in life. The exe exam costs under $100, it's pretty quick. You only need a max of one per year, and often I do appreciate being checked for other common eye problems having my prescription verified. I agree with Alex, but this is very low on my list of complaints.

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Just because american eye exams are overpriced doesn't mean that eye exams are unnecessary. It's a stupid conclusion: you pay too much because of regulation, so all regulation about it should be abolished.

We don't mandate regular physicals or dental exams, why is eye care special? For that matter, why are simple shoe salesmen allowed to sell shoes without a podiatrist first determining what side of shoe I need? Undoubtedly, I could seriously harm my feet wearing the wrong sized shoe.

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I am 74. I had an eye exam in the Spring of 2019, for the first time in about five years. the doctor noted early signs of macular degeneration, and the specialist at a regional teaching hospital picked up as well early signs of glaucoma. I may be an outlier....perhaps an eye exam should happen even regardless of visual issues every five or so years after a certain age. My beef is mainly with hearing aids -- they cost far more than they should.

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I feel like I get pretty good value from my optometrist, but then due to ignorance and superstition I haven't seen any other sort of doctor in a dozen years. For this reason, when the technician begins by taking my blood pressure, I always ask, "Is that good? That's probably really good, right?" You may opt in or out of helping pay for the fancy machine that permits you to be examined without dilating drops. I choose the cheaper option and the visit costs $80 or so. If you're buying contacts, they will give you a trial sample, whether you purchase from them or not.

It's true that one time years ago after a long interval of not going, I "took advantage of" a promotional mailer from a new, non-chain doctor in the neighborhood. I should have been placed on my guard when upon entering her chic office, I noticed what appeared to be an actual Dale Chihuly sculpture for a light fixture, amid a general "optometrist to the stars" vibe. There was bubbly water. Three lovely sirens were receptionist, technician, and eyewear salesgirl, and the doctor herself was a ringer for Gwyneth Paltrow. She spent more time sweetly explaining eye issues and solutions than the fellow at Wal-mart ever had. An hour later I had agreed to contacts for the astigmatic [I have since concluded these seem not to quite work, or be worth the extra cost over normal contacts]; frames and lenses for prescription sunglasses and readers; as well as the new lenses for distance that I had come in for. My "coupon" availed to the extent that the total bill was maybe $1700 instead of $1800.

When I got back to the car, in a daze, I phoned my husband and announced that I had just spent a great deal of money at the eye doctor's. Okay, he said

"No, like - so much, a small fortune," I repeated. "How much?" "I cannot say," I said. Okay.

An hour or so after that, I bethought myself, and called their office. I think I need to cancel one of those pairs of glasses. It is too late, the lenses are already being ground, was the siren's unexpected reply. Ordinarily a bit scrappy, I continued strangely compliant and made no further resistance. Wow, I thought, Dale Chihuly is already at work on my glasses.

But in the end I got a partial refund after all. When the eyewear arrived, the girls had got my chosen frames and strengths all mixed up.

But I remain grateful they talked me into prescription sunglasses. They're terrific, at least for the blue-eyed with cave-creature vision.

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Also if you have a very bad prescription and want to minimize lens thickness, you can go to Canada and get 1.9 high index Zeiss glass lenses. The USA won't allow them to be sold, since they are 1) glass, 2) thin, and 3) close to your precious eye. Strangely, you don't read about Canadians having problems with them.

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Don't you love it when Dem voters complain about over-regulation?

Personally, it makes my entire day!

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Ask the optometrist for the prescription and order them online (zenni optical is my favorite). You can get a pair of prescription glasses for $10-30, which amazingly manages to be cheaper than even the cheapest pair in an american store with vision insurance.

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Preach

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I get an eye exam every year or two, but I have to pay extra for them to do the refraction exam for a new prescription so I don't do that since I've been stable for a decade, unless I'm thinking of new glasses.

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Over the counter reading glasses are sold in the Commonwealth of Virginia. You need a prescription for more complicated corrective lenses. This is what you fret over in order to avoid talking about employment discrimination law, because wanker.

And to think this is the very first line of what Prof. Tabarrok wrote - 'Every year I curse the optometry racket when I run out of contact lenses.'

But who knows, maybe you use OTC reading glasses instead of contact lenses. Maybe you should consult a professional if that is the case.

Evidently, your inclination to post red-herring complaints isn't deterred by this phrase uttered by AT, "but am forced to buy by US law which require patients to have a recent doctor’s prescription to buy eyewear. "

Why not quote the full text, considering it is the second sentence after Prof. Tabarrok says he needs a prescription to buy contact lenses? 'It’s a service that I don’t want and don’t need but am forced to buy by US law which require patients to have a recent doctor’s prescription to buy eyewear.' He is clearly talking about buying new contact lenses, where as noted above, you actually do need a prescription in the Commonwealth of Virginia.

Are you sure the herrings you are seeing are red?

Seriously, maybe you need glasses that are better than those you buy over the counter.

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Do not disagree with the post. A piece of trivia: I had a friend in her 70s whose ophthalmologist referred her to her MD for a possible blood clot which was confirmed (in her leg) and required surgery. I question how many eye exams would pick this up but it's fascinated me.

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And yet you spend your limited public voice betraying your own side.
https://washingtonmonthly.com/magazine/april-may-june-2018/null-hypothesis/

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To make matters worse, the prescription is only good for contacts OR glasses and on contacts FOR a particular brand style. So if you are like me who wear both, you have to pay for both exams every year AND if you want to try a new contact style a third time as well. And your vision insurance (if you have) only covers one.

THAT is the scam

You realize contact lenses and glasses are different things? One sits out in space in front your eyes. The other sits directly on your eyes. That difference in space means your contact lens prescription is different than your glasses prescription, especially if you have a large prescription. If you just get contacts of the same strength as your glasses prescription your vision will be anywhere from a bit off to a lot off. And what happens after that? 'wah the optometrist clearly made a mistake with my prescription since my vision isn’t clear.' When, no, it's actually your ignorance as to how glasses, contacts, and eyes in general work in combination with your perpetual suspicion that people are trying to get one over on you.
Contact lens prescriptions must specify a specific brand and type of lens because all lenses are designed differently and need to have their fit evaluated in order to optimize vision and comfort. Your prescription in one contact lens may be different in a lens from a different brand. One lens fits comfortably on your eyes while another causes irritation because it doesn’t fit quite right. Some lenses are meant to be worn daily and tossed each night while others are meant to be worn for two weeks or a month while being removed and stored in solution in a case each night.
If a contact lens prescription is given and it can be used for any type of contact lens, then you see people switching from dailies to extended wear lenses, not realizing there’s any difference, that they will now need to store their lenses in solution each night, that extended wear doesn’t mean you can just sleep in the lenses. All of that leads me to the point that contact lens exams are also important in order for an optometrist to have a chance to educate you about contact lens hygiene. Doing irresponsible things like sleeping in lenses, storing lenses in water rather than solution, using lenses far past their wear schedule, etc. all greatly increase risk of suffering eye infections that are not only painful and uncomfortable but can be sight-threatening as well.
The ignorance in a lot of these comments is astounding.

I guess other countries with laws not quite so beholden to the optometrist lobby must be suffering an epidemic of eye infections and blindness.

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It’s an optometry racket. A healthy person with no family history of early onset eye disease does not need an annual eye exam. Ophthalmologist (MDs) have been battling optometrists on precisely this point for decades. But the optometrists are more numerous and spend much more on lobbying so their bogus screening guidelines get passed by state legislatures.

If you are at high risk for ocular disease you should be screened by an ophthalmologist. Optometrist have limited experience with diseased eyes and often are not very bright.

“Optometrist have limited experience with diseased eyes and often are not very bright.”
Glad we are passing off anecdotal experience as fact. Based on this post I would venture to say Med-Econ is not very smart but then I would be using your faulty line of thinking.
What exactly is the case here? Are you an ophthalmologist who has worked with optometrists? I’m curious what you’ve actually based your argument on considering optometrists do thousands of hours treating and diagnosing eye disease before they can even qualify for a license.

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Easy there MS3. Plenty of optometrists are as smart as the bottom third of a medical class. How is the guy in the street supposed to know he needs an ophthalmologist until it’s too late?

Easy there PGY-1. Ophthalmologists are selected from the top 10% of their medical school classes and most have board scores above the 95th percentile. Very few optometrists could gain acceptance to even the lowest ranked medical school- go review admissions stats for optometry schools.

But, that’s besides the point. Optometrists are promoting a racket that pushes states to mandate exams that have no evidence to support them. They also have gone all in on the completely discredited vision therapy BS to fleece parents who have children with learning disabilities.

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What is the cross price elasticity for eyeglasses (for which you do not need a yearly exam, unless your eye changes noticeably) and the all in costs of contact lenses which require yearly exams.

The price of Vanity must be the upper bound constraint.

One would think that the contact lens industry would be against the yearly eye exam.

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Depends the state TBH. My state requires annual eyeglass exams as well.

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I sold glasses and ground lenses for ten years from high school to just after I started my career after college. I can’t count the number of times I had a customer pick up their galsses or contacts and be amazed by how much better their vision was. 50% of the folks I helped left feeling great that they are seeing the world better than before their eye exam. Basically, eyeballs change over time and seeing a Dr is a good investment in everyday life. The author doesn’t seem to understand that eyeballs change and that the script written 10 years ago is likely trash.

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"In every other country in which I’ve lived—Germany and Britain, France and Italy—it is far easier to buy glasses or contact lenses than it is here."

Well, the British liberation must be since I last had to suffer through it. I was in Britain for a weekend in the late 1980s and suffered one of those annoying moments where you realize you've washed your contact down the drain. Fine, I thought, I'll get a new one from the pharmacist--Boots, I believe--onto whom I was vectored by the hotel clark.

Turns out he couldn't do it because my prescription had expired a few days earlier. And because it was a weekend, he had nobody he could turn to in Britain who might have been able to administer the exam.

But that was thirty years ago.

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"The excuse for the law is that eye exams can discover other problems."

I went to an optician for an eye test and they flagged up another problem, in the UK, so don't buy this. There's still regulation in the UK. But you don't see a doctor, you see an optometrist who have their own regulation and qualifications. It's a 3 year degree course. But it still means there's plenty of capacity in the market.

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It's AT's ball, so his rules. I would have preferred a reasoned argument with solid evidence demonstrating that the Null Hypothesis: (arguably something like "Everyone should have an annual eye exam because X% will be determined to suffer from an issue which will be significantly improved with proper (medical?) care" ) is false. Another of his assumptions is that he is a good judge of the adequacy of his vision. I'd agree with that as long as he doesn't drive a vehicle, fire a weapon, or have any official power to - or need to - identify people, places or things. I suspect that most hunter-gatherers with bad vision just starved to death (unless they had sufficiently robust social skills to replace their own lack of skill). Instead, the post is just a rant (without any evidence offered to justify the opinions he holds).

++1
I would have liked to see the evidence as well. The most persuasive argument is the one with evidence. Did some and found no contrary.

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Alex,

As you can see by clicking the Virginia link on this: https://www.1800contacts.com/connect/how-long-contact-lens-prescription-good,
your optometrist is mandated to specify a “medically appropriate” expiration date on your contact lens prescription.

IMHO as an ophthalmologist, given that you’re relatively healthy and relatively responsible, your one-year expiration is indeed not medically appropriate. If you can’t get your eye doctor to extend it indefinitely for the vast majority of patients such as yourself, you might want to try to find another optometrist or ophthalmologist who may. Good luck with that.

You may wish to try obtaining a new prescription by undergoing an online refraction available for free in 36 states (including Virginia). https://www.1800contacts.com/exam
The Institute for Justice tried suing South Carolina to repeal its ban.

My state of Delaware happens indeed to mandate optometrists dispense contact lenses in accordance with “an expiration date not to exceed one year.” And Delaware bans online refractions.

I allow my healthy and responsible patients to re-order annual supplies of their state-of-the-art brand of one-day contacts as long as they wish without the expense and time of yearly in-office eye exams (instead I perform free contact lens re-fittings by email or phone immediately prior to each re- or updated order).

IMHO one-day contact lenses in particular (put them in first thing in the morning and throw them out last thing at night) should be legally allowed to be sold over-the-counter without an eye care professional’s prescription.

And as we libertarians know, with freedom comes responsibility. Occasional medical eye exams would still be voluntarily encouraged. Imagine how contact lens prices would drop as their access increases.

As far as eyeglass prescriptions, as you can see by this link:
https://s3-us-west-2.amazonaws.com/production-public-wp-content/wp-content/uploads/2017/03/Prescription-Eyeglass-Regulations-2016-update2.pdf,
Virginia mandates an expiration date only “if medically appropriate.” As you know in your case it’s not. My state of Delaware doesn’t mandate an expiration date, but LensCrafters etc. often have uniform policies of two year expiration dates (perhaps in part related to money-back guarantees, or perhaps in part related to maintaining referral networks?).

One of the issues you face is the "reasonable standard of care" when there is a statute which sets a standard, from which, it appears, you can depart in the exercise of your professional judgment. Libertarians may have a strong belief that every regulation springs forth from the head of someone hell bent on screwing them, but, in fact, to get through a legislative process there probably is some merit for the regulation or else you wouldn't see it on the books as Consumer Reports or Ralph Nader would be at their throats.

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I am surprised that no one has thrown
https://www.eyeque.com/
into this discussion. This seems clearly targeted at this phenomenon.

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Another possibility is adaptive optics. Originally developed over 20 years ago for military pilots, it gives far better than 20:20 vision
http://www.quantium.plus.com/lr/adaptive.html
No sign of it anywhere yet, though!

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1-800Contacts has an online vision test to breaks this monopoly

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Wow thats probably the best example I have seen of corruption in the US health care system. Your system is messed up. Its supposed to be a market system, but you have laws like this? Crazy....

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What about all these jewelry studs that people stick in their nostrils, ears belly buttons etc?

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I thought the same thing to be honest. I hated going to get a "new" prescription that usually was mostly the same. Then I got something calls punctate kerititis in both eyes from improper contact lens/use. My vision went from 20 20 to 20 100. It took a month to resolve with treatment. I talked with him for a while and he told me that if contact lenses go over the counter, he'll just be seeing more medical related eye visits rather than routine Contact lens prescription exams.

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I have Grave's disease. I noticed 3 years before I was diagnosed that my left eye was larger than my right eye. I informed the optometrist during a routine eye exam for contacts and she suggested plastic surgery. So much for noticing other issues.

I didn't get diagnosed until telling a doctor during a physical that one eye was larger. He immediately told me to get blood drawn for a thyroid check.

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