7 ms·

The great American eye-exam scam (2019)

52 points by NavinF 3y ago

syndicatedjelly 3y ago
For glasses, sure. For contacts, maybe not. That is a medical device that is in contact with a highly sensitive organ for extended periods of time, and is often re-used by design. A yearly contact lens eye exam is annoying but seems reasonable to ensure nothing changed in the last year to suggest the wearer should stop wearing contacts, or use a different brand or type
- A_D_E_P_T 3y ago
  You can buy cosmetic contact lenses freely, without a prescription. So carving out an exception for contact lenses -- based on the notion that they are in contact with the eye -- is unprincipled. The vast majority of people who use contact lenses suffer no complications. What's more, in foreign countries eye exams are frequently done by technicians who are not doctors. It's not that complicated to press the "start" button on an autorefractor. So even if eye exams are required, they can be done far more quickly and easily than at present. In many countries in Asia and Europe, prescriptions aren't _required_ for hardly anything. You can buy drugs and glasses at will, including antibiotics. (Typical exceptions only for most stimulants and some -- but not all -- opioids.) In the US, where you can't get anything without seeing a doctor, including a box of contact lenses, one feels infantilized.
  - zen_1 3y ago
    Also worth noting is that in many countries Pharmacists can prescribe certain classes of medicines, again excluding most stimulants and opioids. But need some ciprofloxacin? Just rock up to your pharmacy and ask.
  - clarionbell 3y ago
    I can speak for some parts of Europe when I say that most antibiotics and majority of drugs definitely need prescription. There are several good reasons for it. 1. Antibiotic overuse is a serious issue. If people could just get them without prescription they would use them for flu etc. Because they wouldn't be able to tell that it's a viral infection. Over time this would lead to even more antibiotic resistant pathogens than we have now. Plus there is the whole "kills your gut biome" thing. 2. Our healthcare is heavily subsidized and practically universal. The antibiotics and many other medications are, indirectly, payed for by government, with prices negotiated and set trough complicated process involving semi-state insurance companies and government. Letting people buy drugs without prescription could lead to abuse, like exporting them to third countries. Causing shortages etc.
    - JPLeRouzic 3y ago
      Some antibiotics are authorized in Europe for veterinary use: https://www.ema.europa.eu/en/documents/report/infographic-categorisation-antibiotics-use-animals-prudent-responsible-use_en.pdf https://www.ema.europa.eu/en/documents/report/infographic-ca...
      - seszett 3y ago
        They are generally only available for professionals, and those that can easily be bought as a private person are much more expensive than the human version. I haven't heard of anyone doing that (why would anyone do that, actually?) instead of just going to a human doctor to get a prescription for human drugs.
      - samus 3y ago
        Which is indeed one of the strongest arguments against industrialized meat production.
    - A_D_E_P_T 3y ago
      I suppose it depends where in Europe. I spend most of my time in the south and east -- where, e.g., Serbia doesn't even have a prescription system. You can literally buy whatever you want, and doctors won't write you a formal prescription -- they'll give you some product names to pass along to the pharmacist. Bulgaria and other Balkan countries are similar, which is why they're so popular with steroid users and dealers. (I can confirm that you can buy testosterone and other bodybuilding drugs without a prescription, and without any fuss.) In the Czech Republic, Slovakia, and Hungary, it's mixed, but generally _much_ more relaxed than the US. In many cases, even if a prescription is "required," pharmacists won't stand on principle. I realize that one can't generalize across the entire continent, but there are certainly regions where things are more like Thailand or China than they're like the USA. And it's really no big deal.
  - Al-Khwarizmi 3y ago
    Glasses, certainly, but regarding drugs, I don't think Europe is generally less restrictive than the US, in fact I thought it was the opposite (see e.g. the phentanyl problem). In Spain not only you can't buy antibiotics at will, but you can't even buy 1 g paracetamol pills (you can buy 500 mg pills, though - I guess the government wants to protect people who can't add 500+500!). Some pharmacists will turn a blind eye with silly restrictions like paracetamol, though - but not all, because they might be fined if they get caught.
    - seszett 3y ago
      > you can buy 500 mg pills, though - I guess the government wants to protect people who can't add 500+500! I know it sounds a bit absurd at first thought, but restricting the amount that can be bought at a time actually works for preventing overdosing. People are just less likely to swallow 12 500 mg tablets in one time than 6 1g tablets.
- dr_dshiv 3y ago
  You must be in on the scam. The idea that you aren’t allowed to see unless you pay for a yearly exam is ridiculous. So much theater to it, too. In europe, you can just buy them ongoingly.
  - jtwaleson 3y ago
    Not everywhere in Europe. It varies by country. Also please drop the ad-hominem. Contact lenses are a high risk medical device. Contamination or mis-use can cause serious permanent damage. Wanting to prevent permanent damage is a good thing. Now as different countries had different policies for decades now, we can compare the health outcomes of these policies. My personal opinion is that the rules can be relaxed in the US, but I don’t have all the data and am not a policy expert.
    - dr_dshiv 3y ago
      Ad hominem attack is different from suspecting that you or a family member are in the industry. Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage. There is no evidence that expensive yearly exams are necessary. The fact is that technology almost completely replaced the need for these people and so they built themselves into the medical system.
      - jtwaleson 3y ago
        No need for a witch hunt. There is a risk classification system for medical devices. Most regulatory bodies have put contact lenses in the moderate to high risk category. E.g. the FDA classifies contact lenses as Class 2 out of 3. You don’t put pencils in your eye for hours every day. The fact that most people use contacts just fine does not mean that there are no risks. If you want to know about them, talk to an eye doctor, they all have horror stories about contact lenses.
      - syndicatedjelly 3y ago
        Yep I've worked in med tech. I'm more skeptical of our entire healthcare system than you are, trust me. But there is a reason regulation is in place, similar to why the airline industry is highly regulated. > Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage. No, it's not. That's a terrible slippery-slope argument and you know it. Contact lenses are an FDA Class II medical device. They are *designed* by the manufacturer for contact with the eyeball. A pencil is not. > There is no evidence that expensive yearly exams are necessary. There is a mountain of evidence suggesting that contact lenses can cause permanent blindness when used incorrectly. Feel free to search for it.
- miggol 3y ago
  In the Netherlands, you would likely get your first contacts from the same optician's that just gave you your free eye test. They famously don't let you leave with them until they've seen you put them in correctly yourself. A friend of mine had to embarrassingly come back another day and try again, after his eyes had gotten too irritated from the failed attempts. You can still buy disposables over the counter, though.
  - raverbashing 3y ago
    Yeah, I wouldn't want to buy contacts before being shown how to use them. Really It's not hard, but at the first time, the guidance is really useful
  - NavinF 3y ago
    > They famously don't let you leave with them until they've seen you put them in correctly yourself It's the same in the US. (Well I'm sure if you insisted they'd let you, but standard practice is to try again the next day. I know people who had to go several times before buying contacts)
mikhailfranco 3y ago
(2019)
- NavinF 3y ago
  There haven't been any relevant changes to US law in the last 4 years. Lack of "(2019)" in the title is intentional
  - dang 3y ago
    It's the convention on HN to append the year when an article is more than a year old. Of course the statements in the article may still be correct after N years. That's good! Edit: but the article should be the original source. Please see https://news.ycombinator.com/item?id=37505585 https://news.ycombinator.com/item?id=37505585.
  - tsimionescu 3y ago
    It's still relevant because someone who read this article 2 years ago may want to know from the title that it's the same one, not some new update on the topic.
  - dredmorbius 3y ago
    It's not about stale information. It's simply to note that it's not immediately current (within the past year), and additionally may have been previously discussed. Older content is in fact welcome. <https://news.ycombinator.com/item?id=36989353 https://news.ycombinator.com/item?id=36989353> The oldest item to make the front page was from 195 BCE: <https://news.ycombinator.com/item?id=21810145 https://news.ycombinator.com/item?id=21810145>
dang 3y ago
We changed the url from https://marginalrevolution.com/marginalrevolution/2019/11/the-optometry-racket.html https://marginalrevolution.com/marginalrevolution/2019/11/th..., which points to this. Submitters: "Please submit the original source. If a post reports on something found on another site, submit the latter." - https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
dang 3y ago
Related: The Great American Eye-Exam Scam - https://news.ycombinator.com/item?id=26479078 https://news.ycombinator.com/item?id=26479078 - March 2021 (17 comments) The Great American Eye Exam Scam - https://news.ycombinator.com/item?id=21653437 https://news.ycombinator.com/item?id=21653437 - Nov 2019 (331 comments)
unethical_ban 3y ago
I've been saying this for years. It's an industry scam. Even if I played the rhetorical game where it isn't a scam, they should give a pre test where if I read 20/20 I skip the exam and renew my prescription, sans doctor fees.
- jtwaleson 3y ago
  There’s multiple companies bringing this to the market as telemedicine (edit: yes already now in the US). Basically you do an eye test (to measure visual acuity) at home using your phone or computer and an optometrist reviews the data and approves / re-approves your Rx. Then you can order online. For limited prescription ranges it is also possible to give out a complete Rx via a remote examination but FDA has yet to approve a device on the US market for this. In the EU it is already being done. Disclaimer: I worked for one of these companies.
  - unethical_ban 3y ago
    I love this, but it seems to be a gray-area hack around protectionist state laws. For example, I believe this whole "yearly check-up" thing is at the Texas state level for me. When I order online from a site that has no physical presence in Texas, they do not care about the prescription date.
- yuppiepuppie 3y ago
  This is what happened to me last week where I live (Spain). Went in to a new optician office, the lady took my old glasses, put them in a machine which told her the prescription, she told me to put them on and then gave me the classic exam with the small letters on the far side of the room. Once she determined that everything was fine with my current prescription, she let me pick out a new set of glasses. I was in and out in 20 min with a new set already ordered. When I was in the US, getting a job done like this would be unheard of.
- khazhoux 3y ago
  Why do you need to “renew” the prescription if your glasses give you 20/20 already?
sytelus 3y ago
Personal anecdata: In span of 6 months, I did eye exams at 3 different places and got 3 different prescriptions! All 3 claimed to use latest tech and they did manual exams as well.
- jtwaleson 3y ago
  This is pretty normal, depending on the amount of variation of course. Basically, for each calculate the spherical equivalent (SPHEQ) = SPH + 0.5 * CYL. If SPHEQ is within 0.5 diopters of each other it’s more or less expected. This is the short version and there’s a lot more nuance (like the AX and ADD values on the Rx), if anyone is interested or has questions I can add more. Source: I was CTO for an online eye exam and have some patents related to this.
  - almostnormal 3y ago
    That limit is efficient for measuring and selling glasses. As a life-long user, glasses with an error of 0.5 are unacceptable for me. That's the amount of change over years when it is time to get new ones. Not all deviations are measurement errors. There are potential variable conditions of the eye (e.g., spasm of accommodation and sugar level). An online solution that can consider them properly is definitively worth a patent.
    - jtwaleson 3y ago
      Agreed on all points. Also the acceptability varies a lot. By your wording it sounds like you are quite picky about glasses and would A) not go to a random optician and B) return the glasses if you are not satisfied. I’m the same ;) There are many people who are not that picky.
      - qaid 3y ago
        A) How can I find a proper optician? B) how do you determine whether or not you’re satisfied? Throughout 30 years of wearing glasses, I’ve questioned many times whether the glasses are right for me. I may resist for a month or two but I always end up “adapting” to the new pair. When is this acceptable and how do I know when to speak up?
atleastoptimal 3y ago
Given that scams are as pervasive and ubiquitous nowadays as they have been for thousands of years, is there any hope for a utopian future where we are free of charlatanism, quackery and general dehumanization for the sake of rigorous profit maximization of all humans not in the ruling class?
- ddq 3y ago
  I envision the formation of such a utopia as bottom-up and community-focused, involving a lifestyle change where we deal predominately with people we know rather than strangers, strengthening social cohesion. Dream big, right? Or small, in this case; maybe something like federated villages. It’s a beautiful day in the neighborhood…
  - johnchristopher 3y ago
    Collective hallucination and peer pressure is a hell of a cocktail though. Leeches do feel good anyway and if this guy from the other village needs to wash his hands before operating it means he's not clean to begin with.
- verisimi 3y ago
  None. The whole thing is a scam. The only possible utopia, imo, is one where everyone tries to create their own whilst simultaneously allowing for other, quite different utopias. Whilst people continue to look to external authority/government for the answer (when they are the cause of the problems) we won't even start.
- deleted 3y ago
  [deleted]
- stormfather 3y ago
  Consider if you accept these three propositions: 1. In the future we will identify genes which govern sociopathy, or at least predispose to it. 2. Parents will have the ability to edit the genomes of their kids before conception. 3. Nobody wants a sociopathic kid. This is my headcannon for how humanity creates the Federation.
singingwolfboy 3y ago
https://web.archive.org/web/20230914064139/https://www.theatlantic.com/ideas/archive/2019/11/great-american-eye-exam-scam/602482/ https://web.archive.org/web/20230914064139/https://www.theat...
Ekaros 3y ago
Kinda funny I just got spam selling me free eye exam when buying glasses. Or 20€... From local mid-tier chain. USA really seems to have lot of regulation despite all of the freedom talk. Or maybe it is freedom to regulate they have...
cja 3y ago
In Poland no prescription is necessary for vision correction. At least one big chain of opticians doesn't charge for sight tests and gives full refunds on all purchases up to five years.
thecrims0nchin 3y ago
My Insurance generally pays for one visit per two years, but I haven't found an optometrist that will give me a 2y prescription despite no changes for 10+ years. I have found a way to make it 2 years on a 1y prescription. You can get "myopic glasses" on eBay for real cheap, like 7$, without a prescription. They feel cheap, but the lenses work. Contact lense websites will let you order as long as you have a valid prescription so I just buy a years worth when I get the prescription and again right before the prescription ends. Separate issue is the contact lense websites are getting predatory and just add 200$ convenience fee at the checkout. Really annoying, I found one website that doesn't but I imagine if everyone else is doing it they can't stand their ground for long.
- checkyoursudo 3y ago
  What kind of convenience do you get for this seemingly really expensive “convenience fee” they charge?
  - bongobingo1 3y ago
    Probably the same convenience ticketmaster bestows when you get to print your own tickets.
madsbuch 3y ago
maybe the solution for Americans is to just travel abroad and get your lenses / glasses? In Tokyo they tested my eyes and sold me a pair of custom fitted glasses in 30 minutes, and it was cheap. especially when a sibling comment or talks about a 200 usd convenience fee. that is basically the airfare.
- rootsudo 3y ago
  In the Philippines its the same, $20, done in an hour, pick up frames. I did it in Tokyo too, and it was a bit more but same. If it wasn't for zenni optical, I wouldn't know where I'd be personally.
- Broken_Hippo 3y ago
  That is an option now. It has been an option for decades. If you aren't poor, that is. People save just to get a passport, let alone the travel costs and trying to get time off - and even then, your choices are limited. $200 is more than half a week's pre-tax wages if you make $8/hr.
- midoridensha 3y ago
  If your test in Tokyo was like mine, the only thing they did was test your actual visual acuity, to determine your prescription. They probably didn't do any kind of eye health-check, which in my experience is normal in the US. However, they do these checks in Japan, but it's part of the annual health check-up, which everyone gets AFAIK, and is free. It's not done by optometrists, but by clinics that specialize in the annual check-up. As for USD$200, that isn't going to get an American to Tokyo. Try multiplying by 10. Even before the pandemic it certainly wasn't $200 to cross the Pacific.
  - madsbuch 3y ago
    Well, if you want a checkup, then the American system is fine, right? The issue are those people who just want glasses / contacts – Personally I know my specs, and often just go to a pharmacy to get a box of contacts. Also, I did not propose to go to Tokyo. There are plenty other locations that are more practical for Americans.
gumby 3y ago
There is also the way in the US, when you ask for a written prescription, they leave off the IPD (inter pupillary distance) so it’s inadequate to order glasses. The standard printed form they all have conveniently doesn’t have a space to write that in. So I always ask them to add it, though fortunately it’s easy to measure at home.
- glenngillen 3y ago
  I’m based in Australia, and my son’s optometrist did the same thing when I asked for a copy of his script so we could order a rushed pair of glasses when he broke his. I’d never seen that before as my optometrist has always provided the full details after every eye exam (including IPD, but they’ve always just called it PD). Much to my delight though when I was placing the order for my son’s new glasses online the form said “don’t have or don’t know your PD? Click here to measure it now!” which asked for permission to access the web cam, asked him to follow some basic instructions, and <30 secs later put his PD into the form for us.
  - jtwaleson 3y ago
    Cool! Do you maybe have a link to that tool / the name of the shop?
- madphilosopher 3y ago
  They left me alone in the exam room before the doctor came in to do the eye exam, and I just read my PD off the computer screen that was showing my patient record. :)
glimshe 3y ago
I hacked the eye-exam scam by getting exams every few years and using cheap online glasses (those $10 glasses) to confirm/tweak prescriptions, before finally ordering a fully featured $180 pair of glasses online which tends to last for a while. My final orders are rarely exactly like what the eye exam indicated, instead they are personalized for my most common focus distance and needs.
Dowwie 3y ago
An optometrist's office, in New Jersey, presented two pricing options to me, based on vision insurance benefits, which I explain far more clearly than they did with me: pay more out of pocket for just the eye exam and contact lens fitting or pay less by ordering contacts in addition to eye exam and fitting. The agent from the insurance company (Guardian) explained to me that it sets a $150 balance that can be used towards non-exam costs (fitting and contacts, or just contacts if no fitting is done). However, the optometrist's office said that this 150 is only accessible if I order contacts as well. They wouldn't provide this policy to me in writing :). I saved money by ordering more. The incentives scheme, involving ordering contacts from the optometrist office rather than 3rd party, seems like a common convention.
notacoward 3y ago
My problem is that I need different prescriptions early and late in the day, in addition to different distances. A few years ago I bought a set of test lenses and a frame so I could measure my own prescription, and ordered a couple of pairs that were better than I'd had from an optometrist for a while. I've had even better results using an EyeQue device, but that only measures distance vision so I still need the lens set for the "add" on my near vision. Honestly, optometrists are a waste of time and money. However, it's still a good idea to visit an ophthalmologist from time to time as they can evaluate eye health in addition to optics. Glaucoma, macular degeneration, cataracts, and retinal detachment are all worth detecting early.
friend_and_foe 3y ago
I decided to get vision insurance. It was what, ~20 bucks a month? Free glasses, optometrists visit, why wouldn't I? The optometrists visit wouldn't give me a prescription for contacts without extra money. Insurance didn't cover it. Even though the data they need they already have from the eye check, they wouldn't write it on the paper unless I paid. Getting glasses, they only covered a limited selection of frames, all crappy frames. The lenses wouldn't be anything but bare lenses with one or the other add on but not both, no scratch resistance, no glare protection, and there was a copay. So I compromised on what I got. In the end, with the insurance cost for the year, I wound up spending a little more than if I'd just walked into the optometrists office and handed them cash and bought what I wanted, and I didn't get what I wanted. Vision insurance is a rip off. A couple of years ago, I ordered 2 pairs of glasses, one for regular with anti glare and scratch resistance, and one prescription polarized sunglasses, for a grand total of 70 bucks with a 2 year expired prescription (my eyesight problems are from welding irresponsibly as a teenager and not degenerative, it hasn't changed since I got my first prescription) on a popular glasses buying site online. Still using them, but I have since ordered one additional pair with that same prescription that I don't really wear, for like 50 bucks with all those lenses add ons. I plan to go get my eyes checked next year again, just to make sure nothings changed as I've gotten older, but I will never go back to doing things the usual way with yearly checks and insurance and buying glasses at the optometrist and all that, it's a giant sham. My way isn't exactly $2 glasses like in India but for an average cost of 40 bucks per pair with the addons I like and maybe one optometrists visit every 5 or so years, I think I'm doing OK.
1letterunixname 3y ago
Go to a real ophthalmologist, not some Luxottica tourist scam. It took until age 40 for a reputable ophthalmologist to do an old-school 4 PRT to discover I had monofixation syndrome. [1] It also suggests diminished depth perception and explains why I can't see autostereograms. https://eyewiki.org/Monofixation_Syndrome https://eyewiki.org/Monofixation_Syndrome 1. This condition was mentioned by symptoms, not by name, in a B-movie nicknamed "Top Gun with helicopters". https://www.imdb.com/title/tt0099575 https://www.imdb.com/title/tt0099575

52 points by NavinF 3y ago

For glasses, sure. For contacts, maybe not. That is a medical device that is in contact with a highly sensitive organ for extended periods of time, and is often re-used by design. A yearly contact lens eye exam is annoying but seems reasonable to ensure nothing changed in the last year to suggest the wearer should stop wearing contacts, or use a different brand or type

A_D_E_P_T 3y ago
You can buy cosmetic contact lenses freely, without a prescription. So carving out an exception for contact lenses -- based on the notion that they are in contact with the eye -- is unprincipled. The vast majority of people who use contact lenses suffer no complications. What's more, in foreign countries eye exams are frequently done by technicians who are not doctors. It's not that complicated to press the "start" button on an autorefractor. So even if eye exams are required, they can be done far more quickly and easily than at present. In many countries in Asia and Europe, prescriptions aren't _required_ for hardly anything. You can buy drugs and glasses at will, including antibiotics. (Typical exceptions only for most stimulants and some -- but not all -- opioids.) In the US, where you can't get anything without seeing a doctor, including a box of contact lenses, one feels infantilized.
- zen_1 3y ago
  Also worth noting is that in many countries Pharmacists can prescribe certain classes of medicines, again excluding most stimulants and opioids. But need some ciprofloxacin? Just rock up to your pharmacy and ask.
- clarionbell 3y ago
  I can speak for some parts of Europe when I say that most antibiotics and majority of drugs definitely need prescription. There are several good reasons for it. 1. Antibiotic overuse is a serious issue. If people could just get them without prescription they would use them for flu etc. Because they wouldn't be able to tell that it's a viral infection. Over time this would lead to even more antibiotic resistant pathogens than we have now. Plus there is the whole "kills your gut biome" thing. 2. Our healthcare is heavily subsidized and practically universal. The antibiotics and many other medications are, indirectly, payed for by government, with prices negotiated and set trough complicated process involving semi-state insurance companies and government. Letting people buy drugs without prescription could lead to abuse, like exporting them to third countries. Causing shortages etc.
  - JPLeRouzic 3y ago
    Some antibiotics are authorized in Europe for veterinary use: https://www.ema.europa.eu/en/documents/report/infographic-categorisation-antibiotics-use-animals-prudent-responsible-use_en.pdf https://www.ema.europa.eu/en/documents/report/infographic-ca...
    - seszett 3y ago
      They are generally only available for professionals, and those that can easily be bought as a private person are much more expensive than the human version. I haven't heard of anyone doing that (why would anyone do that, actually?) instead of just going to a human doctor to get a prescription for human drugs.
    - samus 3y ago
      Which is indeed one of the strongest arguments against industrialized meat production.
  - A_D_E_P_T 3y ago
    I suppose it depends where in Europe. I spend most of my time in the south and east -- where, e.g., Serbia doesn't even have a prescription system. You can literally buy whatever you want, and doctors won't write you a formal prescription -- they'll give you some product names to pass along to the pharmacist. Bulgaria and other Balkan countries are similar, which is why they're so popular with steroid users and dealers. (I can confirm that you can buy testosterone and other bodybuilding drugs without a prescription, and without any fuss.) In the Czech Republic, Slovakia, and Hungary, it's mixed, but generally _much_ more relaxed than the US. In many cases, even if a prescription is "required," pharmacists won't stand on principle. I realize that one can't generalize across the entire continent, but there are certainly regions where things are more like Thailand or China than they're like the USA. And it's really no big deal.
- Al-Khwarizmi 3y ago
  Glasses, certainly, but regarding drugs, I don't think Europe is generally less restrictive than the US, in fact I thought it was the opposite (see e.g. the phentanyl problem). In Spain not only you can't buy antibiotics at will, but you can't even buy 1 g paracetamol pills (you can buy 500 mg pills, though - I guess the government wants to protect people who can't add 500+500!). Some pharmacists will turn a blind eye with silly restrictions like paracetamol, though - but not all, because they might be fined if they get caught.
  - seszett 3y ago
    > you can buy 500 mg pills, though - I guess the government wants to protect people who can't add 500+500! I know it sounds a bit absurd at first thought, but restricting the amount that can be bought at a time actually works for preventing overdosing. People are just less likely to swallow 12 500 mg tablets in one time than 6 1g tablets.
dr_dshiv 3y ago
You must be in on the scam. The idea that you aren’t allowed to see unless you pay for a yearly exam is ridiculous. So much theater to it, too. In europe, you can just buy them ongoingly.
- jtwaleson 3y ago
  Not everywhere in Europe. It varies by country. Also please drop the ad-hominem. Contact lenses are a high risk medical device. Contamination or mis-use can cause serious permanent damage. Wanting to prevent permanent damage is a good thing. Now as different countries had different policies for decades now, we can compare the health outcomes of these policies. My personal opinion is that the rules can be relaxed in the US, but I don’t have all the data and am not a policy expert.
  - dr_dshiv 3y ago
    Ad hominem attack is different from suspecting that you or a family member are in the industry. Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage. There is no evidence that expensive yearly exams are necessary. The fact is that technology almost completely replaced the need for these people and so they built themselves into the medical system.
    - jtwaleson 3y ago
      No need for a witch hunt. There is a risk classification system for medical devices. Most regulatory bodies have put contact lenses in the moderate to high risk category. E.g. the FDA classifies contact lenses as Class 2 out of 3. You don’t put pencils in your eye for hours every day. The fact that most people use contacts just fine does not mean that there are no risks. If you want to know about them, talk to an eye doctor, they all have horror stories about contact lenses.
    - syndicatedjelly 3y ago
      Yep I've worked in med tech. I'm more skeptical of our entire healthcare system than you are, trust me. But there is a reason regulation is in place, similar to why the airline industry is highly regulated. > Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage. No, it's not. That's a terrible slippery-slope argument and you know it. Contact lenses are an FDA Class II medical device. They are *designed* by the manufacturer for contact with the eyeball. A pencil is not. > There is no evidence that expensive yearly exams are necessary. There is a mountain of evidence suggesting that contact lenses can cause permanent blindness when used incorrectly. Feel free to search for it.
miggol 3y ago
In the Netherlands, you would likely get your first contacts from the same optician's that just gave you your free eye test. They famously don't let you leave with them until they've seen you put them in correctly yourself. A friend of mine had to embarrassingly come back another day and try again, after his eyes had gotten too irritated from the failed attempts. You can still buy disposables over the counter, though.
- raverbashing 3y ago
  Yeah, I wouldn't want to buy contacts before being shown how to use them. Really It's not hard, but at the first time, the guidance is really useful
- NavinF 3y ago
  > They famously don't let you leave with them until they've seen you put them in correctly yourself It's the same in the US. (Well I'm sure if you insisted they'd let you, but standard practice is to try again the next day. I know people who had to go several times before buying contacts)

mikhailfranco 3y ago

(2019)

NavinF 3y ago
There haven't been any relevant changes to US law in the last 4 years. Lack of "(2019)" in the title is intentional
- dang 3y ago
  It's the convention on HN to append the year when an article is more than a year old. Of course the statements in the article may still be correct after N years. That's good! Edit: but the article should be the original source. Please see https://news.ycombinator.com/item?id=37505585 https://news.ycombinator.com/item?id=37505585.
- tsimionescu 3y ago
  It's still relevant because someone who read this article 2 years ago may want to know from the title that it's the same one, not some new update on the topic.
- dredmorbius 3y ago
  It's not about stale information. It's simply to note that it's not immediately current (within the past year), and additionally may have been previously discussed. Older content is in fact welcome. <https://news.ycombinator.com/item?id=36989353 https://news.ycombinator.com/item?id=36989353> The oldest item to make the front page was from 195 BCE: <https://news.ycombinator.com/item?id=21810145 https://news.ycombinator.com/item?id=21810145>

dang 3y ago

We changed the url from https://marginalrevolution.com/marginalrevolution/2019/11/the-optometry-racket.html https://marginalrevolution.com/marginalrevolution/2019/11/th..., which points to this. Submitters: "Please submit the original source. If a post reports on something found on another site, submit the latter." - https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

dang 3y ago

Related: The Great American Eye-Exam Scam - https://news.ycombinator.com/item?id=26479078 https://news.ycombinator.com/item?id=26479078 - March 2021 (17 comments) The Great American Eye Exam Scam - https://news.ycombinator.com/item?id=21653437 https://news.ycombinator.com/item?id=21653437 - Nov 2019 (331 comments)

unethical_ban 3y ago

I've been saying this for years. It's an industry scam. Even if I played the rhetorical game where it isn't a scam, they should give a pre test where if I read 20/20 I skip the exam and renew my prescription, sans doctor fees.

jtwaleson 3y ago
There’s multiple companies bringing this to the market as telemedicine (edit: yes already now in the US). Basically you do an eye test (to measure visual acuity) at home using your phone or computer and an optometrist reviews the data and approves / re-approves your Rx. Then you can order online. For limited prescription ranges it is also possible to give out a complete Rx via a remote examination but FDA has yet to approve a device on the US market for this. In the EU it is already being done. Disclaimer: I worked for one of these companies.
- unethical_ban 3y ago
  I love this, but it seems to be a gray-area hack around protectionist state laws. For example, I believe this whole "yearly check-up" thing is at the Texas state level for me. When I order online from a site that has no physical presence in Texas, they do not care about the prescription date.
yuppiepuppie 3y ago
This is what happened to me last week where I live (Spain). Went in to a new optician office, the lady took my old glasses, put them in a machine which told her the prescription, she told me to put them on and then gave me the classic exam with the small letters on the far side of the room. Once she determined that everything was fine with my current prescription, she let me pick out a new set of glasses. I was in and out in 20 min with a new set already ordered. When I was in the US, getting a job done like this would be unheard of.
khazhoux 3y ago
Why do you need to “renew” the prescription if your glasses give you 20/20 already?

sytelus 3y ago

Personal anecdata: In span of 6 months, I did eye exams at 3 different places and got 3 different prescriptions! All 3 claimed to use latest tech and they did manual exams as well.

jtwaleson 3y ago
This is pretty normal, depending on the amount of variation of course. Basically, for each calculate the spherical equivalent (SPHEQ) = SPH + 0.5 * CYL. If SPHEQ is within 0.5 diopters of each other it’s more or less expected. This is the short version and there’s a lot more nuance (like the AX and ADD values on the Rx), if anyone is interested or has questions I can add more. Source: I was CTO for an online eye exam and have some patents related to this.
- almostnormal 3y ago
  That limit is efficient for measuring and selling glasses. As a life-long user, glasses with an error of 0.5 are unacceptable for me. That's the amount of change over years when it is time to get new ones. Not all deviations are measurement errors. There are potential variable conditions of the eye (e.g., spasm of accommodation and sugar level). An online solution that can consider them properly is definitively worth a patent.
  - jtwaleson 3y ago
    Agreed on all points. Also the acceptability varies a lot. By your wording it sounds like you are quite picky about glasses and would A) not go to a random optician and B) return the glasses if you are not satisfied. I’m the same ;) There are many people who are not that picky.
    - qaid 3y ago
      A) How can I find a proper optician? B) how do you determine whether or not you’re satisfied? Throughout 30 years of wearing glasses, I’ve questioned many times whether the glasses are right for me. I may resist for a month or two but I always end up “adapting” to the new pair. When is this acceptable and how do I know when to speak up?

atleastoptimal 3y ago

Given that scams are as pervasive and ubiquitous nowadays as they have been for thousands of years, is there any hope for a utopian future where we are free of charlatanism, quackery and general dehumanization for the sake of rigorous profit maximization of all humans not in the ruling class?

ddq 3y ago
I envision the formation of such a utopia as bottom-up and community-focused, involving a lifestyle change where we deal predominately with people we know rather than strangers, strengthening social cohesion. Dream big, right? Or small, in this case; maybe something like federated villages. It’s a beautiful day in the neighborhood…
- johnchristopher 3y ago
  Collective hallucination and peer pressure is a hell of a cocktail though. Leeches do feel good anyway and if this guy from the other village needs to wash his hands before operating it means he's not clean to begin with.
verisimi 3y ago
None. The whole thing is a scam. The only possible utopia, imo, is one where everyone tries to create their own whilst simultaneously allowing for other, quite different utopias. Whilst people continue to look to external authority/government for the answer (when they are the cause of the problems) we won't even start.
deleted 3y ago
[deleted]
stormfather 3y ago
Consider if you accept these three propositions: 1. In the future we will identify genes which govern sociopathy, or at least predispose to it. 2. Parents will have the ability to edit the genomes of their kids before conception. 3. Nobody wants a sociopathic kid. This is my headcannon for how humanity creates the Federation.

singingwolfboy 3y ago

https://web.archive.org/web/20230914064139/https://www.theatlantic.com/ideas/archive/2019/11/great-american-eye-exam-scam/602482/ https://web.archive.org/web/20230914064139/https://www.theat...

Ekaros 3y ago

Kinda funny I just got spam selling me free eye exam when buying glasses. Or 20€... From local mid-tier chain. USA really seems to have lot of regulation despite all of the freedom talk. Or maybe it is freedom to regulate they have...

cja 3y ago

In Poland no prescription is necessary for vision correction. At least one big chain of opticians doesn't charge for sight tests and gives full refunds on all purchases up to five years.

thecrims0nchin 3y ago

My Insurance generally pays for one visit per two years, but I haven't found an optometrist that will give me a 2y prescription despite no changes for 10+ years. I have found a way to make it 2 years on a 1y prescription. You can get "myopic glasses" on eBay for real cheap, like 7$, without a prescription. They feel cheap, but the lenses work. Contact lense websites will let you order as long as you have a valid prescription so I just buy a years worth when I get the prescription and again right before the prescription ends. Separate issue is the contact lense websites are getting predatory and just add 200$ convenience fee at the checkout. Really annoying, I found one website that doesn't but I imagine if everyone else is doing it they can't stand their ground for long.

checkyoursudo 3y ago
What kind of convenience do you get for this seemingly really expensive “convenience fee” they charge?
- bongobingo1 3y ago
  Probably the same convenience ticketmaster bestows when you get to print your own tickets.

madsbuch 3y ago

maybe the solution for Americans is to just travel abroad and get your lenses / glasses? In Tokyo they tested my eyes and sold me a pair of custom fitted glasses in 30 minutes, and it was cheap. especially when a sibling comment or talks about a 200 usd convenience fee. that is basically the airfare.

rootsudo 3y ago
In the Philippines its the same, $20, done in an hour, pick up frames. I did it in Tokyo too, and it was a bit more but same. If it wasn't for zenni optical, I wouldn't know where I'd be personally.
Broken_Hippo 3y ago
That is an option now. It has been an option for decades. If you aren't poor, that is. People save just to get a passport, let alone the travel costs and trying to get time off - and even then, your choices are limited. $200 is more than half a week's pre-tax wages if you make $8/hr.
midoridensha 3y ago
If your test in Tokyo was like mine, the only thing they did was test your actual visual acuity, to determine your prescription. They probably didn't do any kind of eye health-check, which in my experience is normal in the US. However, they do these checks in Japan, but it's part of the annual health check-up, which everyone gets AFAIK, and is free. It's not done by optometrists, but by clinics that specialize in the annual check-up. As for USD$200, that isn't going to get an American to Tokyo. Try multiplying by 10. Even before the pandemic it certainly wasn't $200 to cross the Pacific.
- madsbuch 3y ago
  Well, if you want a checkup, then the American system is fine, right? The issue are those people who just want glasses / contacts – Personally I know my specs, and often just go to a pharmacy to get a box of contacts. Also, I did not propose to go to Tokyo. There are plenty other locations that are more practical for Americans.

gumby 3y ago

There is also the way in the US, when you ask for a written prescription, they leave off the IPD (inter pupillary distance) so it’s inadequate to order glasses. The standard printed form they all have conveniently doesn’t have a space to write that in. So I always ask them to add it, though fortunately it’s easy to measure at home.

glenngillen 3y ago
I’m based in Australia, and my son’s optometrist did the same thing when I asked for a copy of his script so we could order a rushed pair of glasses when he broke his. I’d never seen that before as my optometrist has always provided the full details after every eye exam (including IPD, but they’ve always just called it PD). Much to my delight though when I was placing the order for my son’s new glasses online the form said “don’t have or don’t know your PD? Click here to measure it now!” which asked for permission to access the web cam, asked him to follow some basic instructions, and <30 secs later put his PD into the form for us.
- jtwaleson 3y ago
  Cool! Do you maybe have a link to that tool / the name of the shop?
madphilosopher 3y ago
They left me alone in the exam room before the doctor came in to do the eye exam, and I just read my PD off the computer screen that was showing my patient record. :)

glimshe 3y ago

I hacked the eye-exam scam by getting exams every few years and using cheap online glasses (those $10 glasses) to confirm/tweak prescriptions, before finally ordering a fully featured $180 pair of glasses online which tends to last for a while. My final orders are rarely exactly like what the eye exam indicated, instead they are personalized for my most common focus distance and needs.

Dowwie 3y ago

An optometrist's office, in New Jersey, presented two pricing options to me, based on vision insurance benefits, which I explain far more clearly than they did with me: pay more out of pocket for just the eye exam and contact lens fitting or pay less by ordering contacts in addition to eye exam and fitting. The agent from the insurance company (Guardian) explained to me that it sets a $150 balance that can be used towards non-exam costs (fitting and contacts, or just contacts if no fitting is done). However, the optometrist's office said that this 150 is only accessible if I order contacts as well. They wouldn't provide this policy to me in writing :). I saved money by ordering more. The incentives scheme, involving ordering contacts from the optometrist office rather than 3rd party, seems like a common convention.

notacoward 3y ago

My problem is that I need different prescriptions early and late in the day, in addition to different distances. A few years ago I bought a set of test lenses and a frame so I could measure my own prescription, and ordered a couple of pairs that were better than I'd had from an optometrist for a while. I've had even better results using an EyeQue device, but that only measures distance vision so I still need the lens set for the "add" on my near vision. Honestly, optometrists are a waste of time and money. However, it's still a good idea to visit an ophthalmologist from time to time as they can evaluate eye health in addition to optics. Glaucoma, macular degeneration, cataracts, and retinal detachment are all worth detecting early.

friend_and_foe 3y ago

I decided to get vision insurance. It was what, ~20 bucks a month? Free glasses, optometrists visit, why wouldn't I? The optometrists visit wouldn't give me a prescription for contacts without extra money. Insurance didn't cover it. Even though the data they need they already have from the eye check, they wouldn't write it on the paper unless I paid. Getting glasses, they only covered a limited selection of frames, all crappy frames. The lenses wouldn't be anything but bare lenses with one or the other add on but not both, no scratch resistance, no glare protection, and there was a copay. So I compromised on what I got. In the end, with the insurance cost for the year, I wound up spending a little more than if I'd just walked into the optometrists office and handed them cash and bought what I wanted, and I didn't get what I wanted. Vision insurance is a rip off. A couple of years ago, I ordered 2 pairs of glasses, one for regular with anti glare and scratch resistance, and one prescription polarized sunglasses, for a grand total of 70 bucks with a 2 year expired prescription (my eyesight problems are from welding irresponsibly as a teenager and not degenerative, it hasn't changed since I got my first prescription) on a popular glasses buying site online. Still using them, but I have since ordered one additional pair with that same prescription that I don't really wear, for like 50 bucks with all those lenses add ons. I plan to go get my eyes checked next year again, just to make sure nothings changed as I've gotten older, but I will never go back to doing things the usual way with yearly checks and insurance and buying glasses at the optometrist and all that, it's a giant sham. My way isn't exactly $2 glasses like in India but for an average cost of 40 bucks per pair with the addons I like and maybe one optometrists visit every 5 or so years, I think I'm doing OK.

1letterunixname 3y ago

Go to a real ophthalmologist, not some Luxottica tourist scam. It took until age 40 for a reputable ophthalmologist to do an old-school 4 PRT to discover I had monofixation syndrome. [1] It also suggests diminished depth perception and explains why I can't see autostereograms. https://eyewiki.org/Monofixation_Syndrome https://eyewiki.org/Monofixation_Syndrome 1. This condition was mentioned by symptoms, not by name, in a B-movie nicknamed "Top Gun with helicopters". https://www.imdb.com/title/tt0099575 https://www.imdb.com/title/tt0099575