8 ms·

There are a number of healthcare areas in the US that have been protected by regulation, but it’s increasingly unclear if this is good for patients, consumers,

by JCM9 5y ago

There are a number of healthcare areas in the US that have been protected by regulation, but it’s increasingly unclear if this is good for patients, consumers, or public health at large. The increasing sentiment seems to be probably not. Vision care is another area I’d expect to see more changes and disruption coming down the pipeline. Vision care is very important and advanced cases require special skills, but it’s also unclear why many routine checks couldn’t just be done by a family doctor. The US requires one to see a “doctor of optometry” to get a basic single vision prescription. That industry used to make its money turning around and selling you glasses from the same office but that whole industry has been turned upside down by online retailers like Warby Parker and such. Why the US can’t follow the models followed most elsewhere in the world is unclear, but it would remove a lot of extra steps and costs in getting a basic care of glasses. Ophthalmology (medical doctors) are still very much a thing but most countries don’t have this model of needed a “prescription” from an optometrist for a basic pair of single vision specs.

lisper 5y ago
> Why the US can’t follow the models followed most elsewhere in the world is unclear To the contrary, it is very clear: regulatory capture. https://en.wikipedia.org/wiki/Regulatory_capture https://en.wikipedia.org/wiki/Regulatory_capture
- JCM9 5y ago
  Yes… didn’t know what the technical term was but that’s it
- BurningFrog 5y ago
  Still unclear why Regulatory Capture only happens in the US?
  - lisper 5y ago
    It happens outside the U.S. as well, but the U.S. has a particularly weak form of democracy which makes it more prone to regulatory capture. In particular, money is a more powerful policial level in the U.S. than in most other democracies, and that creates a positive feedback loop that tends to encourage and reinforce regulatory capture (you use RC to make money, which you then turn around and use to pursue more RC in order to make more money...)
  - ddingus 5y ago
    We allow bribes.
xmprt 5y ago
One pretty big (and relatively unknown) law is that your doctor needs to give you your vision prescription so you can buy glasses elsewhere (usually for much cheaper). I think a lot of them get around this by letting you look for glasses while waiting and not telling you that this law exists.
- tyingq 5y ago
  They also get around it by first handing you a prescription that doesn't have your pupillary distance noted. It's such a passive-aggressive bullshit move.
- tristor 5y ago
  The bigger issue is that a prescription alone is not enough to order new glasses, you also need pupillary distance measurements in order to ensure the lenses are ground correctly. Many many optometrists will not provide these, only the legally obligated prescription. While for most people who have minimum prescriptions you can use a phone app or similar to get a rough PD, for anyone with serious prescriptions even minute variations in PD can prevent proper vision correction.
  - dsr_ 5y ago
    On the other hand, your PD should not change once you are an adult, outside of major traumatic events.
  - JCM9 5y ago
    If an industry’s strategy to keep itself alive is keeping the distance between your eyes a closely protected secret… the end appears near.
  - etaioinshrdlu 5y ago
    I've probably been to 5 optometrists over the years and they all provided PD.
  - FemmeAndroid 5y ago
    This happened to my wife just last month. I was very frustrated when I saw that she hadn't received a PD, but I didn't realize that this is a frequent and intentional decision at this point. Extremely frustrating.
skybrian 5y ago
Getting new glasses is different from screening for eye diseases, though it's typically done at the same time. I doubt a GP would have the special equipment they use for screening? It's pretty specialized. Apparently the need for this gets more important as you get older: https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.vision-screening-and-eye-exams-for-adults.hw121865 https://healthy.kaiserpermanente.org/health-wellness/health-...
- JCM9 5y ago
  Many optometrists don’t do much more than use a hand held scope to look into your eyes. I’d imagine most GPs either have that on hand already or could get it easily. It’s not like you need an MRI machine in the office to do an eye exam. Yes some office have fancier equipment, but here it’s unclear if that’s actually better for patients and public health or just a way to bill more. Doing a basic exam and then referring those to true specialists is generally the model followed by nearly everything else in healthcare.
  - jjeaff 5y ago
    I have been to maybe a half dozen different optometrists over the last 25 years and they have always used several expensive looking machines to screen for eye disease. Most frequently a machine that uses a puff of air to measure the pressure in your eye and more recently, a machine with a bright light that gets detailed imagery of the vascular structure on the back of your eye.
    - JCM9 5y ago
      Yes, although that test is automated and typically done by a technician not an optometrist. You can train someone to use one of these machines in a few hours. If this was a key test no reason we couldn’t just put one in every GP office and have eye pressure checked during an annual checkup.
      - InvertedRhodium 5y ago
dsizzle 5y ago
Not sure why vision checks require a doctor at all. In the end, they're just relying on your responses anyway: "What's better: A or B"? In fact, I'd go further and say it doesn't even require another person. I, for one, am glad to see this bill.
- mbg721 5y ago
  Vision checks have also changed a lot in the last five years or so. I have a pretty strong prescription and always used to do rounds of reading charts and "A or B", and now there's a machine that scans my eyes and gets it very close to right, with an adjustment or two at the end.
  - dr_dshiv 5y ago
    12 years ago, I walked into a second hand eye glasses shop in India and they had one of these machines. It was amazingly effective. I felt duped by all the optometrist appointments asking me about A or B.
    - mixmastamyk 5y ago
      Duped, because they are doing it the old-fashioned way?
      - dr_dshiv 5y ago
        Because they are making theater to justify their cost.
        comeonseriously 5y ago
        Did the machine tell you if anything else was wrong with your eyes? Could it?
        dr_dshiv 5y ago
        It could determine my index accurately. It couldn’t tell if I had symptomless eye cancer, however.
dboreham 5y ago
I find Costco to be a reasonable workaround.
colordrops 5y ago
In china you can get prescription lenses at a local market without any involvement of a medical professional, at extremely cheap cost. There isn't much evidence that this is causing negative medical outcomes. On the flip side it used to be very easy to get antibiotics without a prescription there. I'd be surprised if this is still the case.
JCM9 5y ago
Vaccine administration is another area that has seen / is seeing broad deregulation. In many states one needed a medical doctor to “prescribe” a flu shot or other vaccine. Now many states have moved to allow such “prescriptions” to be written by pharmacists and issued right there on the spot in a pharmacy. Some physician groups fought that tooth and nail… not because there was any real evidence of people dropping dead from mis-prescribed vaccines but because it was a good stream of easy revenue for their office billing insurers for giving the shot. This change was much better for consumers and for public health overall by making vaccines more readily accessible.
m463 5y ago
I missed a very critical vision deficiency with my child because I only did cursory vision checks when growing up. I think this influenced the ability to see characters which greatly impacted reading ability.
diob 5y ago
There are so many cost barriers to treatments. It's definitely not for patients at this point. For instance, I am supposed to redo my sleep apnea test every so often. But it's out of pocket? Why bother, I know mine is due to my genetics (I'm not overweight). So why am I subjected to reproving my need for a prescription? For eyeglasses, if someone wants to continue the same prescription they can't. It's like healthcare in the USA is a damn subscription model with yearly fees to keep getting things just prescribed (let alone treatment on top).
- KennyBlanken 5y ago
  > For eyeglasses, if someone wants to continue the same prescription they can't. What? You don't need a medical prescription to order glasses online. You can put in whatever numbers you want and they'll happily make them. You'd be an idiot to do so, however, as your vision can change with age.
  - comeonseriously 5y ago
    > You'd be an idiot to do so, however, as your vision can change with age. Not to mention, getting an eye exam is more than just clearing up your vision. It can reveal other issues (and not just eye related! They can often see other problems, like say, cholesterol issues, for example.)
  - ViViDboarder 5y ago
    I had to submit my (very mild) prescription for glasses to Warby Parker.
  - gregw134 5y ago
    You certainly do for contacts. I have to order mine from the UK because all the US websites require prescriptions.
  - ericmcer 5y ago
    You 100% need a prescription to order prescription glasses or contact lenses online. Expired prescriptions will be rejected as well.
KennyBlanken 5y ago
Evaluating someone's eye for glasses can be done entirely by machine as can manufacturing the glasses themselves. I do not understand why we still force people to spend 5-10 minutes sitting in a chair in a dark room going "better....no...worse...better..."
- asciimov 5y ago
  The machines can't gauge for personal preference. Many people don't like their vision right at 20/20. I personally like mine closer to 20/15.
  - joe5150 5y ago
    This I think has a lot to do with individual experiences with optometrists. I went to probably half a dozen optometrists since adolescence before I happened to end up with one who actually made it clear there's a degree of subjectivity with an eyeglass prescription.
  - degrews 5y ago
    What? Doesn't 20/20, 20/15 etc. refer to visual acuity (how much detail you can see from a certain distance)? Are there people who prefer anything but the highest possible visual acuity?
- comeonseriously 5y ago
  Because an eye exam isn't just about the final prescription. It's about whole eye health (retina health, cancer, cholesterol, diabetes, etc).
  - heavyset_go 5y ago
    This is important. Eye exams are not just the part where they have you look at letters on the wall in the dark.
  - russdill 5y ago
    Right, but then the way to do that should have nothing to do with corrective lenses and requiring them shouldn't be an artificial barrier to getting corrective lenses. If it's important, then it's important for everyone.
WillPostForFood 5y ago
There are a number of healthcare areas in the US that have been protected by regulation Really, isn’t it all areas?
balls187 5y ago
> The US requires one to see a “doctor of optometry” to get a basic single vision prescription. You can take virtual eye exams, which are reviewed by doctors to issue a prescription. The real issue isn't the basic care of glasses, instead it's the screening of your eye health. When you go to Urgent Care, say for a laceration, they do a quick work up, including taking your temp, blood pressure, blood o2, weight and height. Having your eyes checked out in person with a comprehensive eye exam annually is a good habit. And tying it renewing an Rx for Contacts / Glasses just makes it easier to do.
IgorPartola 5y ago
I am constantly reminded that the word “to disrupt” should be in all instances replaced with “to fuck up”.
mschuster91 5y ago
> but it’s also unclear why many routine checks couldn’t just be done by a family doctor Ordinary GPs aren't experts and the equipment for doing vision checks is expensive and consumes space. IMO, medical care should be completely re-organized. Get rid of GPs as a profession (outside of cruise ships and the military) and GP practices entirely. Instead, have community clinics for everyday medical needs spread out over the country that have a team of skilled nurses for triage with a number of subject-expert doctors at the second level, and large/university clinics for everything the community clinics can't deal with (urgent/trauma care, oncology). That would also shorten training times and effort for new doctors by a significant degree - e.g. in Germany, an ophtalmologist requires a full medical degree (over six years, not counting waiting times because medical study places are short in supply) followed by five years of specialized training. Realistically, training any expert doctor now takes at least twelve to fifteen years... and that's frankly absurd, and part of why medical costs are so sky-rocketing. Not many students make the ridiculously high entry requirements, many don't survive that time (and sometimes literally - suicide rates among medical students are way above average!), and those who have their MD are left with fifteen years worth of student debt which means they have to charge extraordinary hourly rates simply to be able to pay back the loans.
- ausername42027 5y ago
  How do the nurses know where to send the triage without a broad medical education? This has been tried and fails, and when it is fails it is not pretty. Nurses will just refer their patients to 2-3 specialists in a shotgun approach, while at the same time missing "can't miss" diagnoses that never get a referral. Medicine is not tech support with tier levels :( I would stick to talking about things you know, because medicine is not one of them.
jollybean 5y ago
"it’s also unclear why many routine checks couldn’t just be done by a family doctor." Even though it's probably not that complicated, it's probably beyond the scope of a regular doctor to do proper checks - and - it's probably more expensive than getting your eyes checked by an optometrist, which is usually pretty cheap. In fact, the optometrist model i.e. regulated specialization for something that we don't need very expensive doctors for, is probably a good model for hearing. If there's something more complicated, then they refer you to the ophthalmologist etc.. We should be trying to do this with everything i.e. get people into 3 year specialization programs which make basic health things affordable, and leave more complex cases to MDs.
softveda 5y ago
In Australia you need to go to an Optometrist who is not a doctor, they can't prescribe medicines. There are few independent Optoms most are employed by spectacles chains nowadays. They also do retinal scan, check for glaucoma etc. No one pays for Optoms. The government pays for one free eye checkup every 2 years (used to be 1 year). The glasses and frames you have to pay. Ophthalmologists are specialists for eye diseases and needs to be referred by either GP or Optom and costs an arm and a leg. My last visit was $400+
conductr 5y ago
> That industry used to make its money turning around and selling you glasses from the same office but that whole industry has been turned upside down by online retailers like Warby Parker and such This is not really the case. Online, warby Parker, etc. have built scale but the traditional retail still makes a significant portion of their profits here. And it’s a healthy business by most standards. The staff and employed OD are typically compensated heavily through variable compensation. The primary industry metric is “capture rate”, the percentage of people that buy eye wear after the exam. If I recall correctly it’s about 65-70%. From an incentive perspective, the doctors and staff are salespeople through and through. Like all segments of healthcare, it has really started to consolidate. The independents/regional brands operating now will likely sell to PE roll up play when the foundering doctor retires. PE will exit to conglomerates. Most of these are boomer’s and this form of consolidation is well under way. The already high margins can easily be improved by centralizing back office, etc. The vertical integration in the industry is insane. Luxottica for example leads retail, frame manufacturing, lens fabrication (laboratory), and owns the #2 insurance provider (of 2 main players). They have such power they can and do “force” independent retailers to use their POS software. Warby Parker has some hipness and definitely grew quickly. But, they hardly put a dent in the market. There may be some evidence that they expanded it, as happens with fashion. They would be more akin to Blue Nile in the jewelry space. Independent jewelers still dominate that market.

by JCM9 5y ago

lisper 5y ago

> Why the US can’t follow the models followed most elsewhere in the world is unclear To the contrary, it is very clear: regulatory capture. https://en.wikipedia.org/wiki/Regulatory_capture https://en.wikipedia.org/wiki/Regulatory_capture

JCM9 5y ago
Yes… didn’t know what the technical term was but that’s it
BurningFrog 5y ago
Still unclear why Regulatory Capture only happens in the US?
- lisper 5y ago
  It happens outside the U.S. as well, but the U.S. has a particularly weak form of democracy which makes it more prone to regulatory capture. In particular, money is a more powerful policial level in the U.S. than in most other democracies, and that creates a positive feedback loop that tends to encourage and reinforce regulatory capture (you use RC to make money, which you then turn around and use to pursue more RC in order to make more money...)
- ddingus 5y ago
  We allow bribes.

xmprt 5y ago

One pretty big (and relatively unknown) law is that your doctor needs to give you your vision prescription so you can buy glasses elsewhere (usually for much cheaper). I think a lot of them get around this by letting you look for glasses while waiting and not telling you that this law exists.

tyingq 5y ago
They also get around it by first handing you a prescription that doesn't have your pupillary distance noted. It's such a passive-aggressive bullshit move.
tristor 5y ago
The bigger issue is that a prescription alone is not enough to order new glasses, you also need pupillary distance measurements in order to ensure the lenses are ground correctly. Many many optometrists will not provide these, only the legally obligated prescription. While for most people who have minimum prescriptions you can use a phone app or similar to get a rough PD, for anyone with serious prescriptions even minute variations in PD can prevent proper vision correction.
- dsr_ 5y ago
  On the other hand, your PD should not change once you are an adult, outside of major traumatic events.
- JCM9 5y ago
  If an industry’s strategy to keep itself alive is keeping the distance between your eyes a closely protected secret… the end appears near.
- etaioinshrdlu 5y ago
  I've probably been to 5 optometrists over the years and they all provided PD.
- FemmeAndroid 5y ago
  This happened to my wife just last month. I was very frustrated when I saw that she hadn't received a PD, but I didn't realize that this is a frequent and intentional decision at this point. Extremely frustrating.

skybrian 5y ago

Getting new glasses is different from screening for eye diseases, though it's typically done at the same time. I doubt a GP would have the special equipment they use for screening? It's pretty specialized. Apparently the need for this gets more important as you get older: https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.vision-screening-and-eye-exams-for-adults.hw121865 https://healthy.kaiserpermanente.org/health-wellness/health-...

JCM9 5y ago
Many optometrists don’t do much more than use a hand held scope to look into your eyes. I’d imagine most GPs either have that on hand already or could get it easily. It’s not like you need an MRI machine in the office to do an eye exam. Yes some office have fancier equipment, but here it’s unclear if that’s actually better for patients and public health or just a way to bill more. Doing a basic exam and then referring those to true specialists is generally the model followed by nearly everything else in healthcare.
- jjeaff 5y ago
  I have been to maybe a half dozen different optometrists over the last 25 years and they have always used several expensive looking machines to screen for eye disease. Most frequently a machine that uses a puff of air to measure the pressure in your eye and more recently, a machine with a bright light that gets detailed imagery of the vascular structure on the back of your eye.
  - JCM9 5y ago
    Yes, although that test is automated and typically done by a technician not an optometrist. You can train someone to use one of these machines in a few hours. If this was a key test no reason we couldn’t just put one in every GP office and have eye pressure checked during an annual checkup.
    - InvertedRhodium 5y ago

dsizzle 5y ago

Not sure why vision checks require a doctor at all. In the end, they're just relying on your responses anyway: "What's better: A or B"? In fact, I'd go further and say it doesn't even require another person. I, for one, am glad to see this bill.

mbg721 5y ago
Vision checks have also changed a lot in the last five years or so. I have a pretty strong prescription and always used to do rounds of reading charts and "A or B", and now there's a machine that scans my eyes and gets it very close to right, with an adjustment or two at the end.
- dr_dshiv 5y ago
  12 years ago, I walked into a second hand eye glasses shop in India and they had one of these machines. It was amazingly effective. I felt duped by all the optometrist appointments asking me about A or B.
  - mixmastamyk 5y ago
    Duped, because they are doing it the old-fashioned way?
    - dr_dshiv 5y ago
      Because they are making theater to justify their cost.
      - comeonseriously 5y ago
        Did the machine tell you if anything else was wrong with your eyes? Could it?
        dr_dshiv 5y ago
        It could determine my index accurately. It couldn’t tell if I had symptomless eye cancer, however.

dboreham 5y ago

I find Costco to be a reasonable workaround.

colordrops 5y ago

In china you can get prescription lenses at a local market without any involvement of a medical professional, at extremely cheap cost. There isn't much evidence that this is causing negative medical outcomes. On the flip side it used to be very easy to get antibiotics without a prescription there. I'd be surprised if this is still the case.

JCM9 5y ago

Vaccine administration is another area that has seen / is seeing broad deregulation. In many states one needed a medical doctor to “prescribe” a flu shot or other vaccine. Now many states have moved to allow such “prescriptions” to be written by pharmacists and issued right there on the spot in a pharmacy. Some physician groups fought that tooth and nail… not because there was any real evidence of people dropping dead from mis-prescribed vaccines but because it was a good stream of easy revenue for their office billing insurers for giving the shot. This change was much better for consumers and for public health overall by making vaccines more readily accessible.

m463 5y ago

I missed a very critical vision deficiency with my child because I only did cursory vision checks when growing up. I think this influenced the ability to see characters which greatly impacted reading ability.

diob 5y ago

There are so many cost barriers to treatments. It's definitely not for patients at this point. For instance, I am supposed to redo my sleep apnea test every so often. But it's out of pocket? Why bother, I know mine is due to my genetics (I'm not overweight). So why am I subjected to reproving my need for a prescription? For eyeglasses, if someone wants to continue the same prescription they can't. It's like healthcare in the USA is a damn subscription model with yearly fees to keep getting things just prescribed (let alone treatment on top).

KennyBlanken 5y ago
> For eyeglasses, if someone wants to continue the same prescription they can't. What? You don't need a medical prescription to order glasses online. You can put in whatever numbers you want and they'll happily make them. You'd be an idiot to do so, however, as your vision can change with age.
- comeonseriously 5y ago
  > You'd be an idiot to do so, however, as your vision can change with age. Not to mention, getting an eye exam is more than just clearing up your vision. It can reveal other issues (and not just eye related! They can often see other problems, like say, cholesterol issues, for example.)
- ViViDboarder 5y ago
  I had to submit my (very mild) prescription for glasses to Warby Parker.
- gregw134 5y ago
  You certainly do for contacts. I have to order mine from the UK because all the US websites require prescriptions.
- ericmcer 5y ago
  You 100% need a prescription to order prescription glasses or contact lenses online. Expired prescriptions will be rejected as well.

KennyBlanken 5y ago

Evaluating someone's eye for glasses can be done entirely by machine as can manufacturing the glasses themselves. I do not understand why we still force people to spend 5-10 minutes sitting in a chair in a dark room going "better....no...worse...better..."

asciimov 5y ago
The machines can't gauge for personal preference. Many people don't like their vision right at 20/20. I personally like mine closer to 20/15.
- joe5150 5y ago
  This I think has a lot to do with individual experiences with optometrists. I went to probably half a dozen optometrists since adolescence before I happened to end up with one who actually made it clear there's a degree of subjectivity with an eyeglass prescription.
- degrews 5y ago
  What? Doesn't 20/20, 20/15 etc. refer to visual acuity (how much detail you can see from a certain distance)? Are there people who prefer anything but the highest possible visual acuity?
comeonseriously 5y ago
Because an eye exam isn't just about the final prescription. It's about whole eye health (retina health, cancer, cholesterol, diabetes, etc).
- heavyset_go 5y ago
  This is important. Eye exams are not just the part where they have you look at letters on the wall in the dark.
- russdill 5y ago
  Right, but then the way to do that should have nothing to do with corrective lenses and requiring them shouldn't be an artificial barrier to getting corrective lenses. If it's important, then it's important for everyone.

WillPostForFood 5y ago

There are a number of healthcare areas in the US that have been protected by regulation Really, isn’t it all areas?

balls187 5y ago

> The US requires one to see a “doctor of optometry” to get a basic single vision prescription. You can take virtual eye exams, which are reviewed by doctors to issue a prescription. The real issue isn't the basic care of glasses, instead it's the screening of your eye health. When you go to Urgent Care, say for a laceration, they do a quick work up, including taking your temp, blood pressure, blood o2, weight and height. Having your eyes checked out in person with a comprehensive eye exam annually is a good habit. And tying it renewing an Rx for Contacts / Glasses just makes it easier to do.

IgorPartola 5y ago

I am constantly reminded that the word “to disrupt” should be in all instances replaced with “to fuck up”.

mschuster91 5y ago

> but it’s also unclear why many routine checks couldn’t just be done by a family doctor Ordinary GPs aren't experts and the equipment for doing vision checks is expensive and consumes space. IMO, medical care should be completely re-organized. Get rid of GPs as a profession (outside of cruise ships and the military) and GP practices entirely. Instead, have community clinics for everyday medical needs spread out over the country that have a team of skilled nurses for triage with a number of subject-expert doctors at the second level, and large/university clinics for everything the community clinics can't deal with (urgent/trauma care, oncology). That would also shorten training times and effort for new doctors by a significant degree - e.g. in Germany, an ophtalmologist requires a full medical degree (over six years, not counting waiting times because medical study places are short in supply) followed by five years of specialized training. Realistically, training any expert doctor now takes at least twelve to fifteen years... and that's frankly absurd, and part of why medical costs are so sky-rocketing. Not many students make the ridiculously high entry requirements, many don't survive that time (and sometimes literally - suicide rates among medical students are way above average!), and those who have their MD are left with fifteen years worth of student debt which means they have to charge extraordinary hourly rates simply to be able to pay back the loans.

ausername42027 5y ago
How do the nurses know where to send the triage without a broad medical education? This has been tried and fails, and when it is fails it is not pretty. Nurses will just refer their patients to 2-3 specialists in a shotgun approach, while at the same time missing "can't miss" diagnoses that never get a referral. Medicine is not tech support with tier levels :( I would stick to talking about things you know, because medicine is not one of them.

jollybean 5y ago

"it’s also unclear why many routine checks couldn’t just be done by a family doctor." Even though it's probably not that complicated, it's probably beyond the scope of a regular doctor to do proper checks - and - it's probably more expensive than getting your eyes checked by an optometrist, which is usually pretty cheap. In fact, the optometrist model i.e. regulated specialization for something that we don't need very expensive doctors for, is probably a good model for hearing. If there's something more complicated, then they refer you to the ophthalmologist etc.. We should be trying to do this with everything i.e. get people into 3 year specialization programs which make basic health things affordable, and leave more complex cases to MDs.

softveda 5y ago

In Australia you need to go to an Optometrist who is not a doctor, they can't prescribe medicines. There are few independent Optoms most are employed by spectacles chains nowadays. They also do retinal scan, check for glaucoma etc. No one pays for Optoms. The government pays for one free eye checkup every 2 years (used to be 1 year). The glasses and frames you have to pay. Ophthalmologists are specialists for eye diseases and needs to be referred by either GP or Optom and costs an arm and a leg. My last visit was $400+

conductr 5y ago

> That industry used to make its money turning around and selling you glasses from the same office but that whole industry has been turned upside down by online retailers like Warby Parker and such This is not really the case. Online, warby Parker, etc. have built scale but the traditional retail still makes a significant portion of their profits here. And it’s a healthy business by most standards. The staff and employed OD are typically compensated heavily through variable compensation. The primary industry metric is “capture rate”, the percentage of people that buy eye wear after the exam. If I recall correctly it’s about 65-70%. From an incentive perspective, the doctors and staff are salespeople through and through. Like all segments of healthcare, it has really started to consolidate. The independents/regional brands operating now will likely sell to PE roll up play when the foundering doctor retires. PE will exit to conglomerates. Most of these are boomer’s and this form of consolidation is well under way. The already high margins can easily be improved by centralizing back office, etc. The vertical integration in the industry is insane. Luxottica for example leads retail, frame manufacturing, lens fabrication (laboratory), and owns the #2 insurance provider (of 2 main players). They have such power they can and do “force” independent retailers to use their POS software. Warby Parker has some hipness and definitely grew quickly. But, they hardly put a dent in the market. There may be some evidence that they expanded it, as happens with fashion. They would be more akin to Blue Nile in the jewelry space. Independent jewelers still dominate that market.