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I would have more sympathy for this take if the average optometrist did anything more than prescribe whichever lens is offering the best rebate or whatever. Li

I would have more sympathy for this take if the average optometrist did anything more than prescribe whichever lens is offering the best rebate or whatever. Like, has anyone had the optometrist try multiple lenses and work to get a fit? In my experience they put you in something and then maybe if it is unpleasant they'll try something else, but it's dependent on you being proactive, much as it would be if you were in Hubble.

eragone 7y ago
I’ve had the opposite experience. I get lenses recommended, then a repeat visit in about a month to check for lens fit and adjust as needed.
falcolas 7y ago
Short answer: Yes. Absolutely yes. Long answer: I have Keratoconus, which means my cornea has uneven thickness across its surface, which causes bubbles in my cornea, creating a very uneven prescription across my eye. The contacts I use are called “scleral” lenses, which use a liquid-filled void to nullify my actual cornea shape, creating a new cornea. They are expensive, require specialized training to adjust, and nailing down a prescription involves doing adjustments with them in, and working backwards to figure out the proper prescription. My optometrist worked on my prescription for around 6 months solid, going through around 12 pairs of $250 (per lens) contacts on their dime. So, yeah. A good optometrist is fantastic, and does a ton for you.
- toomuchtodo 7y ago
  Are you a candidate for corneal reshaping with topography guided PRK combined with CXL (corneal collagen crosslinking)?
  - eugeneyev 7y ago
    Are you talking about T-PRK with CXL in Vancouver? Or one of the other protocols? My optometrist felt that doing T-PRK even combined with CXL would be a horrible idea for Keratoconus, but I haven't consulted with a surgeon directly yet.
    - Hydraulix989 7y ago
      The surgeon stands to profit, so I would be hesitant to trust them.
      - eugeneyev 7y ago
        True, although using the same logic, my optometrist stands to profit from me continuing to need scleral lenses . It's just that his logic sounds rather compelling - Keratoconus patients already have thinner corneas then normal, and PRK will disrupt the structure even further, making them even thinner in places. If CXL done at the same time is effective to strengthen the cornea, great - but if it doesn't (and CXL often needs to be repeated) you are now in a much more precarious position.
        toomuchtodo 7y ago
        This is correct, but with topography guided PRK, the surgeon can (supposedly) leave thin corneal areas intact. I am not a surgeon, nor a professional of any sort in ophthalmology. I just read a lot. Might be worth having the conversation with 2-3 surgeons based on your experience attempting to correct your vision using contacts.
        toomuchtodo 7y ago
        Edit: I thought you were OP I replied to. Apologies for the confusion (about the contact lenses comment).
  - falcolas 7y ago
    No, the degeneration has slowed enough that I'm not a candidate yet.
- hermitdev 7y ago
  Yeah, I've had 2 great ones in my lifetime. One growing up and one now as an adult. You're not likely going to find a great one if you're going to a Costco or Wal-Mart to get your prescriptions. One needs to go to a proper clinic. My current one did my ICL surgery (a corrective surgery similar to cataract surgery, but a permanent contact lens instead of a lens replacement) several years ago.
- eugeneyev 7y ago
  Interesting to see someone else with this condition on YC . If you don't mind me asking, which area are you in and if you could PM the info of the optometrist. I am wearing sclerals as well, but the cost was far higher - around $5000 for the first round, and around $3500 when I went back 3 years later to see if we can improve vision and comfort even further. On the other hand, the fitting process was much more efficient - there was a new set of lenses ready daily, so although we went through 9 lenses for the right eye and 4 for the left on the first round, it took under 2 weeks. Did you end up doing CXL? Are you considering it, or any of the other procedures.
  - ajmurmann 7y ago
    About keratoconus patient here. I ended up paying around $2k for my sclerals. I'm in Oregon. Email address in profile if you want to know more.
  - falcolas 7y ago
    I have not done CXL; it's not that bad. I'm in Montana, and a vast majority of the costs were covered as medical expenses, so my health insurance covered the optometrist costs. I only end up paying the cost of the lenses themselves. The optometrist office themselves build the cost of the followup fittings into their normal billing prices; there were no costs for any of the followup meetings. Most of the iteration time was the shipping, since I'm not near any contact lens manufacturers.
- noobiemcfoob 7y ago
  Does a ton for you, if you need a ton done* I have sympathy for more complicated cases, but they're the 20% approaching 0.01%. They necessarily can't be used to justify the 80% case which is as the GP described.
  - falcolas 7y ago
    If the 80% have picked low cost optometrists (such as those attached to big chain stores or glasses retailers), then you get what you pay for. My optometrist offers the same to anyone who uses her, and has for decades. The office specializes in optometry; and their waiting list for appointments is around 11 months long.
    - noobiemcfoob 7y ago
      You miss the point. Those 80% didn't just choose low cost optometrists. They don't need high-end optometrists. A specialist with all the qualifications to help the issues with your eyes is far and above what I need to fix the relatively minor flaws in mine.
PierceJoy 7y ago
> has anyone had the optometrist try multiple lenses and work to get a fit? Yes. Most good ones do this. Just as there are good and bad doctors, there are good and bad optometrists. IMO, Hubble is straight up dangerous. Getting glasses online is relatively risk free. But when something is physically touching your eye, precautions need to be taken.
- ghaff 7y ago
  I assume by precautions you mean have periodic eye exams to verify that a particular contact lens prescription and model is still right for you. Once you have that, it really doesn’t matter what reputable source you get the lenses from. Arguably annual exams/prescriptions are overly frequent for some people. On the other hand, bypassing verification on line is fairly trivial.
zwily 7y ago
Yes. I tried several different brands till we found the ones that worked the best. Each trial I would get about two weeks worth so I could get a good feel for comfort and fit. It is a little frustrating though that now I can’t just go somewhere and buy those lenses. The prescription verification isn’t terrible but it’s an annoyance.
- asr 7y ago
  Your doctor was (is) required to give you a copy or your prescription if you ask.[1] Next time, make sure they give you one and you can use that to verify when shopping around. [1] https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-reform-proceedings/contact-lens-rule https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-...
WWLink 7y ago
Short answer: A lot of optometrists I've been to seem to only carry acuvue and can't imagine anyone wanting to use anything else. My mom used to have a favorite brand that wasn't acuvue and we'd have to argue it out with them every *(@#% time.

eragone 7y ago

I’ve had the opposite experience. I get lenses recommended, then a repeat visit in about a month to check for lens fit and adjust as needed.

falcolas 7y ago

Short answer: Yes. Absolutely yes. Long answer: I have Keratoconus, which means my cornea has uneven thickness across its surface, which causes bubbles in my cornea, creating a very uneven prescription across my eye. The contacts I use are called “scleral” lenses, which use a liquid-filled void to nullify my actual cornea shape, creating a new cornea. They are expensive, require specialized training to adjust, and nailing down a prescription involves doing adjustments with them in, and working backwards to figure out the proper prescription. My optometrist worked on my prescription for around 6 months solid, going through around 12 pairs of $250 (per lens) contacts on their dime. So, yeah. A good optometrist is fantastic, and does a ton for you.

toomuchtodo 7y ago
Are you a candidate for corneal reshaping with topography guided PRK combined with CXL (corneal collagen crosslinking)?
- eugeneyev 7y ago
  Are you talking about T-PRK with CXL in Vancouver? Or one of the other protocols? My optometrist felt that doing T-PRK even combined with CXL would be a horrible idea for Keratoconus, but I haven't consulted with a surgeon directly yet.
  - Hydraulix989 7y ago
    The surgeon stands to profit, so I would be hesitant to trust them.
    - eugeneyev 7y ago
      True, although using the same logic, my optometrist stands to profit from me continuing to need scleral lenses . It's just that his logic sounds rather compelling - Keratoconus patients already have thinner corneas then normal, and PRK will disrupt the structure even further, making them even thinner in places. If CXL done at the same time is effective to strengthen the cornea, great - but if it doesn't (and CXL often needs to be repeated) you are now in a much more precarious position.
      - toomuchtodo 7y ago
        This is correct, but with topography guided PRK, the surgeon can (supposedly) leave thin corneal areas intact. I am not a surgeon, nor a professional of any sort in ophthalmology. I just read a lot. Might be worth having the conversation with 2-3 surgeons based on your experience attempting to correct your vision using contacts.
        toomuchtodo 7y ago
        Edit: I thought you were OP I replied to. Apologies for the confusion (about the contact lenses comment).
- falcolas 7y ago
  No, the degeneration has slowed enough that I'm not a candidate yet.
hermitdev 7y ago
Yeah, I've had 2 great ones in my lifetime. One growing up and one now as an adult. You're not likely going to find a great one if you're going to a Costco or Wal-Mart to get your prescriptions. One needs to go to a proper clinic. My current one did my ICL surgery (a corrective surgery similar to cataract surgery, but a permanent contact lens instead of a lens replacement) several years ago.
eugeneyev 7y ago
Interesting to see someone else with this condition on YC . If you don't mind me asking, which area are you in and if you could PM the info of the optometrist. I am wearing sclerals as well, but the cost was far higher - around $5000 for the first round, and around $3500 when I went back 3 years later to see if we can improve vision and comfort even further. On the other hand, the fitting process was much more efficient - there was a new set of lenses ready daily, so although we went through 9 lenses for the right eye and 4 for the left on the first round, it took under 2 weeks. Did you end up doing CXL? Are you considering it, or any of the other procedures.
- ajmurmann 7y ago
  About keratoconus patient here. I ended up paying around $2k for my sclerals. I'm in Oregon. Email address in profile if you want to know more.
- falcolas 7y ago
  I have not done CXL; it's not that bad. I'm in Montana, and a vast majority of the costs were covered as medical expenses, so my health insurance covered the optometrist costs. I only end up paying the cost of the lenses themselves. The optometrist office themselves build the cost of the followup fittings into their normal billing prices; there were no costs for any of the followup meetings. Most of the iteration time was the shipping, since I'm not near any contact lens manufacturers.
noobiemcfoob 7y ago
Does a ton for you, if you need a ton done* I have sympathy for more complicated cases, but they're the 20% approaching 0.01%. They necessarily can't be used to justify the 80% case which is as the GP described.
- falcolas 7y ago
  If the 80% have picked low cost optometrists (such as those attached to big chain stores or glasses retailers), then you get what you pay for. My optometrist offers the same to anyone who uses her, and has for decades. The office specializes in optometry; and their waiting list for appointments is around 11 months long.
  - noobiemcfoob 7y ago
    You miss the point. Those 80% didn't just choose low cost optometrists. They don't need high-end optometrists. A specialist with all the qualifications to help the issues with your eyes is far and above what I need to fix the relatively minor flaws in mine.

PierceJoy 7y ago

> has anyone had the optometrist try multiple lenses and work to get a fit? Yes. Most good ones do this. Just as there are good and bad doctors, there are good and bad optometrists. IMO, Hubble is straight up dangerous. Getting glasses online is relatively risk free. But when something is physically touching your eye, precautions need to be taken.

ghaff 7y ago
I assume by precautions you mean have periodic eye exams to verify that a particular contact lens prescription and model is still right for you. Once you have that, it really doesn’t matter what reputable source you get the lenses from. Arguably annual exams/prescriptions are overly frequent for some people. On the other hand, bypassing verification on line is fairly trivial.

zwily 7y ago

Yes. I tried several different brands till we found the ones that worked the best. Each trial I would get about two weeks worth so I could get a good feel for comfort and fit. It is a little frustrating though that now I can’t just go somewhere and buy those lenses. The prescription verification isn’t terrible but it’s an annoyance.

asr 7y ago
Your doctor was (is) required to give you a copy or your prescription if you ask.[1] Next time, make sure they give you one and you can use that to verify when shopping around. [1] https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-reform-proceedings/contact-lens-rule https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-...

WWLink 7y ago

Short answer: A lot of optometrists I've been to seem to only carry acuvue and can't imagine anyone wanting to use anything else. My mom used to have a favorite brand that wasn't acuvue and we'd have to argue it out with them every *(@#% time.