
The Great American Eye Exam Scam - theothermkn
https://www.theatlantic.com/ideas/archive/2019/11/great-american-eye-exam-scam/602482/
======
nsedlet
Yes! It's so infuriating. I usually go to Chinatown where they will sell you
contacts without an exam or prescription.

I asked my optometrist once why a prescription was necessary to buy glasses or
contacts, and why prescriptions expire so quickly, and she gave me the reason
offered in the article: that it forces people to be screened early for
treatable eye diseases. But I can't think of any other area in healthcare
where your care is held hostage unless you pay them for some unrelated
diagnostics you don't want. It's hard to see it as anything other than a
cynical ploy to extract money from people.

~~~
bane
My regular eye exam caught early stage glaucoma. I go to follow-up screenings
yearly to track progress, but it's entirely correct to say that going to my
optometrist to get my updated prescription probably saved my sight.

All that being said, I always ask for a copy of my prescription so that I have
it in my wallet just in case. I've been abroad when my glasses broke and
having that on-hand made getting an emergency pair of glasses very simple.

 _edit_ I get my glasses at Costco, probably $120 all-in.

~~~
XMPPwocky
"regular eye exams are important", while probably true, seems like a really
weird reason to say "if you want to buy glasses, you need a prescription".

~~~
TeMPOraL
Honestly, I don't know. Yes, it's a hack. But it's also an effective hack.
Young people don't go to doctors unless there's something wrong with their
bodies that reminds them to go.

~~~
npongratz
I don't want to be hacked, and I don't think it's right to manipulate people
to get your desired behavior.

And in the past I did not go to the doctor because it was very often a piss
poor experience, with piss poor results.

------
zaptheimpaler
The US version reminds me of the bad kind of Java.. `GetGlasses` must
implement `AbstractMedicalProcedure` with mandatory
`waitAroundForAppointment`, `getOpaqueBillFromShittyWebsite`,
`checkIfCoveredByInsurance`. `GetGlasses.get()` takes ONLY
`AbstractOfficalPrescription` as input, which of course you CANNOT construct
directly from the left and right lens power - must go to an
'OptometristFactory`. Probably like 200 lines atleast.

Meanwhile everyone else is like:

    
    
        #pass in left_power and right_power directly if you know them.
        def get_glasses(powers=None):
           if not powers:
              powers = eye_exam()
           (left_power, right_power) = powers
           return add_frame(make_lenses(left_power,right_power)) #make_lenses takes optional args for rarer eye conditions

~~~
naniwaduni
This pseudocode reveals another truth: it can be surprisingly hard in many
places to get lenses for rarer eye conditions. If you have e.g. mild
astigmatism (actually extremely common!), you can expect to be persuaded to
leave it uncorrected.

~~~
eru
Really? I have astigmatism and got glasses made in Germany, Britain, Singapore
and Australia.

Never had anyone trying to convince me to leave it uncorrected.

~~~
twic
I'm astigmatic - -2.50 right, -3.25 left - and i have never, ever, had any
optician in the UK suggest leaving it uncorrected.

When i wanted contact lenses, i asked about leaving it uncorrected, so i
didn't need toric lenses, which come in fewer variations (i don't think there
were daily disposable torics at the time, for example). They weren't having
any of that.

------
mncharity
Oh, it's worse than that. With an app and a phone _with a high-res screen_ , a
simple device[1] (BOM of a few dollars) could give you spherical and
cylindrical numbers. Nice for the developing world and, err, other nations
with impaired health care systems.

Of course, MIT patented it, and SV made it into low-order-hundred dollar
devices, with mandatory annual per-person subscriptions, but oh well. Looks
like there's a current indiegogo, fwiw.[2] Amazon reviews are mixed. At least
it's apparently no longer necessary in the US to pretend it's not used to get
glasses - yay progress.

An optical trial lens set is another option.[3]

[1] [https://www.eyeque.com/pvt/](https://www.eyeque.com/pvt/) [2]
[https://www.indiegogo.com/projects/smartphone-vision-
tests-o...](https://www.indiegogo.com/projects/smartphone-vision-tests-order-
new-glasses#/) [3]
[https://www.amazon.com/s?k=optical+trial+lens+set](https://www.amazon.com/s?k=optical+trial+lens+set)

------
gdebel
French Ophthalmologist here. The part that describes how easy it is to obtain
glasses without a doctor's prescription is totally false. People do need a
prescription made less than 3 years ago (and optometrists do not exist here,
you have to go to the doctor). As an ophthalmologist, I may not be objective
on this subject; however I can confirm that I find everyday health problems in
people that "just want a prescription". This can be a simple cataract, as well
as a diabetic retinopathy or a glaucoma. I especially remember a 50 years old
woman who had the habit to go to an optician, have her refraction measured, go
to her family doctor and ask for the according prescription (with no eye
exam). After 10 years without seeing a doctor, I diagnosed her with an
advanced glaucoma. She was almost blind. Glaucome is the worst disease:
totally asymptomatic and irreversible. Checking your eyes at least every 3
years after 40 is usually a good idea.

~~~
insickness
Are there any dangers associated with wearing the wrong lenses or no lenses at
all when they are necessary?

~~~
EForEndeavour
> Are there any dangers associated with wearing [...] no lenses at all when
> they are necessary?

The dangers associated with not being able properly come to mind.

------
notacoward
The thing I really hate is that even if you do get a prescription, most
optometrists will try to leave out the inter-pupillary distance. This area is
mostly governed by state law, not federal, and in my state they're explicitly
required to provide that information upon request. I've always had to remind
them of this fact before they'll comply. Then, the form on which they provide
the prescription - unlike the one they use themselves - usually doesn't even
have the space for that information. It ends up being written in the margin,
usually unlabeled as one last act of defiance.

It has always seemed rather scummy. That's why I've been buying glasses online
for several years, tweaking it a bit based on actual all-day wearing
experience each time because a measurement taken at any one time of day is
_sure_ to be wrong at another. So it's better as well as cheaper. Just need to
find a site that doesn't play the optometrists'game, because some do and some
don't.

------
justinph
Americans can order contact lenses from abroad without a prescription,
legally. I have purchased from the UK for about half the cost, with
international shipping, compared to what any U.S. based seller wanted. Not to
mention less hassle.

I do think it makes sense to get a checkup every few years, but the 1 or two
year prescriptions optometrists want are absurd.

~~~
darkmuck
Daysoft.com

------
conductr
I work for a PE backed roll up in this space. And have some broad healthcare
background. Margins are healthy, but the store fronts easily close without the
product margins. That’s why the hard push to buy in store. It’s called capture
rate in the industry.

In the US, much of the healthcare regulation like this has been to ensure
widespread access to care. In this case, by an optometrist not an optician.
Remember, historically and maybe even today, we’re a pretty rural and sparsely
populated country and the government is giving doctors a reason to open stores
in every tiny town. Not saying I agree, just that is what is at play. If
reverse this, access will be reduced significantly and US regulators have
track record of not liking actions that reduce access.

~~~
ilaksh
Ludicrous. People in small towns can drive 50 or 100 miles if they notice
significant vision problems. And small towns can maintain opticians.

------
abstractbarista
It's ridiculous. I've bought my contacts online from the UK for years now due
to this. I know my prescription and I know it works perfectly. Just let me buy
the damn contacts! Vision Direct is the company, and they always send candy
along with. :)

Anyways, my "vision insurance" actually covers a certain $ amount yearly
towards contacts, so I send them the receipt (in pounds) and they actually cut
me a check. Same contacts brand and model I'd get in the USA.

I calculated it and using the insurance does indeed cost me less overall than
buying the contacts straight. It's essentially just a discount program that
hopes people will forget to use it.

~~~
hansthehorse
The VA will give me eye exams and glasses but it's the only service I don't
use because the lines are so long and the waiting area is so crowded. My wife
and I go to Costco for the exam and glasses. If I remember right the last pair
came to about 110 dollars, exam included. Only drawback is it takes about a
week to get them.

------
lbutler
When my wife needed new glasses, our benefits were capped at $400, including
the eye exam. I can't remember the exact numbers, but after the exam, there
was roughly $250 left, and all the glasses started around $400 in-store. After
a few minutes getting the sales pitch and everything being framed as the gap
payment, "Oh these will only cost you $150!" my wife said "Can I get my
prescription, I'm going to go somewhere cheaper" and all of a sudden all the
prices dropped in half. She ended up getting her pair without paying anything
out of pocket.

------
war1025
Glasses are available online from many places, to name a few:

eyebuydirect.com

zennioptical.com

visionpros.com

~~~
diego
Without an official prescription, shipped to a US address?

~~~
Nasrudith
Yes - I have done them already. The "prescription" isn't actually legally
binding. Your eye doctor is legally obligated to give you the numeric
prescription on request for no additional charge.

~~~
CalChris
The only other trick is getting the pupillary distance measurement. You can
estimate this but I copied mine off the package from the opto lab the last
time I bought glasses from an optician.

~~~
wrycoder
The app is PD Meter from Glassifyme.

------
yukistar
Optometry student here. The field of optometry is trying to move towards
optometrists being like "primary care providers" for the eye. To me it makes
sense that while we are refracting (providing a glasses prescription) we also
look at the general health of the eye. It doesn't take much longer and the
signs and symptoms of pathology can be quite subtle and we are very of ten the
first people to notice eye conditions. Many people come in for check-ups to
follow up on common conditions such as glaucoma, macular degeneration, and
diabetic retinopathy. Glasses and contact lenses are only a part of what we
do. I'm only a second year student, but the nuances that you see in the field
are really quite incredible. I agree that most times a person's prescription
is fairly straight-forward, but having an understanding of the optics of the
eyes and lenses allows us to tailor glasses or contact lenses for an
individual's personal needs. This is particularly important for higher
prescriptions where the patient may experience discomfort if the glasses are
not made for their particular face due to the optical centers of the lenses
not being directly over their pupils (prismatic effect). There have been a lot
of disruptive new businesses in the area of optometry, but I personally am not
worried. I am convinced that the services that optometrists provide are far
superior to anything these new services provide. I do worry for consumers when
it comes to cheap contact lenses (such as Hubble), because the materials they
use are not as good at letting oxygen penetrate them as the well-known brands.
I just learned that HIV patients can wear contact lenses but we must tell them
to avoid these brands! Online eye exams to me seem OK but definitely a
compromise on time vs quality and would not work well for people with more
complex problems. As far as money goes, I'm fairly ignorant as of now about
how billing/insurance plays into all this. I know that some medical insurance
plans cover glasses and contact lenses. As long as your optometrist has your
insurance information they should be able to tell you how much your exam will
cost!

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

I don't think this is true of the UK. I couldn't buy contact lenses without a
contact lens prescription. That might be because i'm astigmatic and wanted
toric lenses, but i didn't think so. I can buy glasses online, and there's a
note that says i must have a current prescription to do that; i doubt they
check, but the principle is there.

Oh, and eye tests aren't usually free. They are cheap, though, around £25.
There are free eye tests for children, people over 60, diabetics, people with
various chronic eye disorders, and prisoners on parole (!). Also, if you buy
glasses from the optician who gave you the test, they will usually credit the
cost of the test towards the price of the glasses, so it sort of works out
free (except you have to buy overpriced high street glasses rather than cheap
internet ones).

This doesn't seem like a bad rule, to be honest. Glasses and contact lenses
are medical devices. They're important to their wearer, and to the safety of
people around them if they drive a car etc. Eye tests are cheap and easily
available. The article's take earns a "this ain't it, chief" from me.

~~~
platelminto
Yeah, you definitely need a prescription in the UK, though my eye test was
free so I don't know about that one. Maybe it's because I'm a student? Not
sure.

But he is right about it in Italy - no prescription required.

------
Thorentis
Solve both problems (ease of access to eyeware, and screening for eye disease)
the Australian way:

\- One free eye exam each year covered by Medicare (to obtain your latest
prescription, and check for all eye disease).

\- Ability to go into an optical store and buy contact lenses/glasses if you
tell them your prescription.

~~~
eru
About the first: why not just give poor people money, so they can spend it on
an eye exam or whatever is more urgent for them?

(And for non-poor people we can cut out the middle-men: just let them pay for
their eye check out of pocket. Instead of having them pay a levy, have some
layers of bureaucracy, and then give it back to them in the form of eye
checks.

(Note: this is not an argument against medical insurance as insurance against
unforeseeable, big events. It's only an argument against indirecting payments
for small-ish, routine and predictable items.))

~~~
ajnin
Forcing poor people to choose between their health and some other need seems
extremely cynical to me. Often the poor just can't make that choice, they need
food, shelter, clothes first. It's not a real choice when your immediate basic
needs are at stake.

~~~
eru
Hence my suggestion to give poor people money.

Giving them a specific good is equivalent to giving them money, but forcing
them to only spend it on something you approve of.

~~~
TeMPOraL
Even people with money don't go for regular medical checkups until their
health forces them to. So while I agree with what you say in most cases, in
this case I think giving poor the money would predictably result in zero of
them going for preventive tests.

Some amount of "paternalism" is good for society. Someone likened health to
car maintenance, but I can tell you that of the drivers I know, zero of them
would get their car the yearly technical check unless it was explicitly
illegal to drive that car otherwise. I'm starting to believe we should have
something similar in places with public healthcare - there should be a set of
free, mandatory, noninvasive checkups to screen for diseases that don't have
symptoms noticeable by patients, and there should be a way to compel everyone
to take those tests. It would be better for everyone's well-being, would save
public healthcare a lot of money, and the doctors could stop attaching
unrelated tests to getting prescriptions for glasses or birth control.

~~~
agent008t
The way to do it that respects freedoms would be through incentives. E.g. if
preventative checks would save public healthcare a lot of money, then give
people that do it tax credits or literally pay them money to do it!

With cars, there are greater third-party effects (i.e. your car failing and
crashing into someone else), so it makes sense to require a certificate before
one is allowed to use public roads.

~~~
eru
Agreed. And even with cars, you could internalize those externalities with big
taxes. (But I guess, if the externalities are big enough, that big tax amounts
to a fine or even jail.)

------
johnnyo
100% this.

Also, that prescription is only good for 1 year, many times I’ve wanted to get
a new pair of sunglasses, but have been prohibited since my prescription was
out of date.

~~~
adventured
You can order new glasses - sunglasses or otherwise - from numerous sites
online without needing to concern yourself with the date on a prescription.
Assuming the prescription in question still works for your eyes of course.

------
listenallyall
Thank you. The difficulty in purchasing glasses is so obvious to anyone who
has traveled extensively.

What wasn't addressed in the article is the accuracy of the typical eye exam.
A 19th century idea: a single specified distance, no movement, perfect black
vs white contrast, well-lit room, etc. Does it really measure "real-world"
scenarios like driving at night, playing sports, or staring at a computer for
10 hours? I've received (mandatory, due to the U. S. laws described)
prescriptions that were way off, that missed my astigmatism, or which switched
the eye with the stronger correction. This is why being able to diagnose one's
self, to an extent (buying glasses which vary 0.25 or 0.5 from the exact
prescription) should be allowed, at the very least.

~~~
xhkkffbf
Yes! And I've been experimenting with the EyeQue. It's a great tool that turns
your smart phone into an eye exam. All the better to take an exam regularly.

------
ggm
I have some from-birth conditions in my eyes which makes opticians invest time
in me with wierd and wonderful machines.

Separately I went to see the professor/specialist who trains them all. He used
a newer, one-click device which works with pre-literate children, pressed two
buttons and reproduced my script in 20 seconds without the flim-flam.

I did ask him, and he did smile. There's what you _can_ do and there is what
the _industry is built around_ and they aren't the same thing.

Btw the check for intra-ocular pressure, posterior vitreous detatchment,
glaucoma, signs of cateracts are all highly valuable. Don't ditch the baby
with the bath-water.

------
victor106
From the article "According to the Center for Responsive Politics, for
example, the AOA spent $1.8 million on lobbying and another $1.4 million on
campaign contributions in 2016."

I agree 100% with what the author but the combined $3.2 million does not seem
like much compared to how much Google, Amazon, Facebook, Microsoft and Apple
spent on lobbying:- $63 million.

Source:- [https://www.bloomberg.com/news/articles/2019-01-22/google-
se...](https://www.bloomberg.com/news/articles/2019-01-22/google-
set-2018-lobbying-record-as-washington-techlash-expands)

~~~
listenallyall
Perhaps you're a plant intending the minimize the impact of lobbying by
comparing to FAANG, comprised of the wealthiest companies on the planet. But
3.2 million goes a long way in U. S. politics, especially when there's nobody
lobbying against you, and you aren't really asking for anything new, just to
prevent the existing, burdensome, anti-competitive laws from being repealed.

------
mattlondon
For what it is worth in the UK in a lot of high-street opticians they will
sometimes try the hard-sell after the exam too. They also recommend that you
get it checked every 12 to 24 months as well (at least they suggest that to
me).

After the exam ends its somtimes "Let me hand you over to <person> who will
take you through the options" and the next thing you know they are trying to
make you look at £350 frames, suggesting exotic coatings to the lenses etc.

You're legally entitled to the results of your exam - you are not obliged to
buy from them. The exam itself however is usually free so I guess the
psychology of it is you feel like you _need_ to get glasses from them since
you got the free eye exam from them.

Personally I usually just say "I am in a bit of a rush - I'll come back at the
weekend with my partner to help my choose". We both know I'll never do that
:-)

There are places where you can order your glasses + lenses online though.
Enter prescription and so long as it looks "normal" (i.e. did you enter it
right) there are no questions asked. I've had pairs of glasses that have
lasted for several years of use that cost £6.99 (no typo: six ninety-nine)
including delivery. (from goggles4u if you are wondering - no connection, just
a satisfied customer)

~~~
valdiorn
I go to specsavers, and I've never had anything other than an awesome
experience there. Sure, they do lightly pressure you into buying a new pair
(definitely far from a bad experience, though), but if you do, the test is
free (otherwise it's about 20 pounds I think). Also, the coatings are actually
very good, I have coated and uncoated glasses, and the coat is definitely
worth the money.

My mom came over last christmas. In my home county, glasses are very expensive
and getting an opticians appointment can take months. She walked into
Specsavers on a Monday, and by Thursday she had two new pairs of glasses, all
for under 300 pounds. Just the appointment would have cost that much back
home. After she talked about the experience with our family, I've been getting
a steady stream of relatives coming over for a visit, just to buy glasses.

------
mirimir
The hearing aid scam is worse.

~~~
pkaye
There should be some changes coming to the hearing aid market next year. You
will be able to able to self fit hearing aids for the simple cases of mild or
moderate hearing loss.

[https://www.aarp.org/health/conditions-
treatments/info-2019/...](https://www.aarp.org/health/conditions-
treatments/info-2019/otc-hearing-aids.html)

~~~
mirimir
That's great news.

A few years ago, as due diligence, my GP referred me to an audiologist. She
found moderate high-frequency hearing loss in one ear. Which isn't surprising,
given my love for screaming guitars.

But no way am I spending thousands of dollars on a hearing aid. I'm the sort
of guy who'd always be turning it off.

And her office just wouldn't give up. They sent periodic reminders for at
least two years.

------
threwawasy1228
This thread is really long, so sorry if I missed it, but as someone who does
not currently know what their expired prescription was. Is there some way to
tell or measure what prescription the glasses I am currently wearing are? My
eyesight hasn't changed at all and I need another pair, but I don't know my
prescription.

~~~
dangrossman
[https://www.glassesusa.com/scan](https://www.glassesusa.com/scan) can
supposedly tell you using your cell phone and computer.

------
ryandrake
If you want to know why anything is the way it is in the USA, it’s easy: the
answer is always money. In this case, lobbying from optometrists and opticians
leads to regulatory capture and a market we are forced to use.

~~~
refurb
Ok, I’ll bite.

Why does the DMV suck so bad in the US?

In Canada it was much better because there were private retail locations.

~~~
valleyer
Money? State legislatures have limited budgets and are not well rewarded for
funding the DMV.

Private retail locations (there are some in the US too -- in California, at
least, you can go to the AAA if you pay their membership fee) can charge the
right amount needed to pay a sufficient number of skilled employees, or they
go under. The government-run DMVs have to scrape by with whatever the state
affords them.

~~~
refurb
Ahhh... I see. The DMV sucks because they don’t have enough money.

Not because they are horribly run.

------
khazhoux
This article and all the comments here are describing a Bizarro world I didn't
know existed. Myself, I got my first eye exam a couple of years ago (with all
the high-tech equipment and the blurry eyedrops, etc)... on my way out of the
office they wrote down my numbers. I went home and looked around a few
websites, and wound up ordering a great stylish set of glasses for $20 base
($60 after upgrades and tax+shipping). That was it.

Here people are talking about actual prescriptions, which expire? And hundreds
of dollars for glasses? Bizarre.

------
ajdlinux
Is it normal in the US to refer to optometrists as "doctors"?

~~~
chrisseaton
I think they have doctoral degrees, yes, like dentists do in the US.

Fun fact - most doctors in the UK do not have _any_ kind of doctoral degree!
Just bachelors degrees (they're sort of treated like masters degrees though.)

~~~
robbiep
Ophthalmologists are doctors. Optometrists [people who give eye examinations]
are almost never doctors. (edited in response to comments - seems, once again,
that things are different in the US; so i'll clarify, they are almost never
Doctors in AUS/UK/NZ)

Medical doctors in the UK and other commonwealth countries have traditionally
been MBBS.

In Australia, the adoption of the Australian Qualifications Framework and
pressure from the US, where people seem to expect 'MD's has lead to most
universities shifting to MD programs from MBBS (an AQF level 7 -> AQF level
9).

The bottom line on this is substantively nothing, except a bit less ink being
used on business cards, millions of dollars spent on website rebranding by
medical schools and endless posturing by faculty for students.

So basically, whether you are a 'Doctor' by post-nominals or a 'Doctor' by
recognition of your MBBS, your education has been effectively the same, and
the distinction is actually meaningless.

[0] [https://www.amsj.org/archives/5996](https://www.amsj.org/archives/5996)

~~~
fortran77
In the United States, an "ophthalmologist" has an M.D.

An "optometrist" has a Doctorate in Optometry, which is several years of post-
college education and internship. They can write some prescriptions, too, and
diagnose, etc.

An "optician" is a person certified to give eye exams. They do not have a
graduate degree.

~~~
dehrmann
Also worth mentioning that some physicians are ODs (Doctor of Osteopathic
Medicine), not MDs, and pharmacists are Pharm. Ds.

~~~
Scoundreller
> Doctor of Osteopathic Medicine

Those are DOs.

You may come across a lot of >40 year old pharmacists that have a Bachelors in
the US.

------
kaiwen1
My insurance covers glasses in whatever country I buy them, so I never buy
them in America. Get the same glasses cheaper and zero deductible or nonsense
on the insurance. Just submit a receipt. Done. It's not just glasses.
America's entire Healthcare system is designed to jack up prices in every
conceivable way.

~~~
vinay427
Where are the same glasses cheaper? In the country I live in, they're almost
always much more expensive than in the US, and this seems to be the case in
many other European countries as well. The newer breed of stores like Warby
Parker and JINS also doesn't exist where I live so there's no quick and
reasonably priced alternative.

~~~
distances
Rule of thumb for the European countries I've lived in: stores expensive,
online cheap.

You can just give the numbers you want for your lenses, though if buying from
a brick and mortar store the sight examination in included for free.

------
Jenda_
Can someone explain whether it is actually illegal (e.g. the person who will
cut the lenses and fit them to frames will be charged by some kind of
practicing without a license), or they just don't do it?

For the record, in the Czech Republic, I have entered strength, cylinder, axis
and PD into a website, paid $18 and picked up the glasses a few days later,
and I haven't noticed any problems with quality despite the rather high
strength (-4D). We also have over-the-counter contact lenses widely available,
though I have never used contact lenses.

($18 is a suspiciously cheap online service with basic lenses, glasses with
lenses with higher refractive index and some oleophobic and anti-reflex
coating usually cost around $150 here, but they will also make them for you
without prescription, you just tell them the numbers)

------
fiatjaf
I thought the eye scam was going to be that every time you do an eye exam you
get _completely_ different results. I'm talking about cases of people doing 3
or 4 exams in the same month with different doctors and getting 3 or 4
different results.

------
JeremyNT
The cost and hassle of dealing with the American eye care bureaucracy was one
of the factors driving me to have corrective surgery.

Now a decade later without complication, I hope they've lost a customer for
life.

------
drdeadringer
It is news to me that I am "required to have a current prescription" to buy my
eyeglasses. Sure, optometrists want you for an annual checkup as much as your
regular doctor or dentist... but the eyeglass store? Never heard of it.

Perhaps this is because I purchase my eyeglasses online, e.g. Zenni. I could
pull out my prescription from last year or five years ago and they'd take it
at face value along with my credit card.

------
ilaksh
One of the many reasons I am saving money living in Mexico. I said I needed
new glasses and they just said "same prescription?". He figured it out by
measuring my existing glasses and had me verify with a test thing that had
swappable lenses.

The last time I needed contacts I tried to save money by going to the one in
Walmart but I think it still cost about a hundred dollars for the exam.

------
rishabhd
In India, its easy to get contacts, walk into your favorite chain/ store, get
your eye examination done for free on the spot, get contacts. Simple. I bought
high index, anti scratch, photochromatic, smudge resistant prescription lenses
with frame for my father for around 125 USD very recently. Comes

If there is a more persisting issue, you may see a doctor, but for buying
contacts, its a non issue.

Edit: updated details

------
ilaksh
Apparently they only spent a few million lobbying? Maybe if everyone gets
together with a few bucks we could hire a firm and create a $25 million
lobbying campaign to change the laws.

I mean if there are five million people who would participate then that's only
$5 each.

Seems like there should be a startup for this. Buycongress.org.com or
something. Lol.

------
dvfjsdhgfv
In Europe, I get a free medical check-up every few years, paid by my
epmployer, and it includes eye examination by an eye doctor.

But when I need a new pair of glasses, I go to an optometrist. They don't do
pachymetry or fundoscopy, their job is to match a perfect set of lens. This
kind of arrangement makes perfect sense to me.

------
christkv
In Spain you get the eye test in store (using some fancy equipment) and order
the glasses at the same time.

~~~
jeltz
Same in Sweden. But you can buy glasses without the test too.

~~~
christkv
I've never tried that here but I assume you could. The competition here is
brutal. I got two pairs of prescription glasses with the whole eye exam for
100 eur.

------
greggman2
I thought LensCrafters, and places like Costco, (Walmart?) had easy cheap
access to glasses. Did that change? Jins is a big chain in Japan and they now
have 5 locations in the USA. At least in Japan it's like the article described
Peru. Walk in, get free example, buy glasses under $99

~~~
adventured
No, nothing has changed, places like Costco still provide cheap access to
glasses. There is a lot of incorrect information floating around. I don't know
how to explain the article seemingly intentionally ignoring the various
options for getting inexpensive eye glasses.

~~~
Benjammer
Well they are writing a scathing expose of “the great American eye exam scam.”
If they acknowledged existing options their story wouldn’t be as “hard
hitting.”

------
tomerbd
It's the yearly iphone upgrade that you don't need.

The test always show I need to replace my glasses because prescription
changes, I found that after 2 months of wearing new glasses I see the same way
as before replacing glasses, so it's like a yearly upgrade that you dont need.

------
fiatjaf
Pretty much anywhere in Brazil, today, without government subsidies or health
insurance:

\- Exam: ~80 BRL = 20 USD \- Glasses without the lenses: ~100 BRL (of course
there are all sorts of prices above this, but this is a very reasonable model)
= 25 USD \- Lenses: ~100 BRL = 20 USD

------
emmelaich
Similar in Australia.

Ironically, we can just buy from USA online! Cheaper and almost as fast.

------
t0ddbonzalez
Reminds me of this story from a while back:
[https://news.ycombinator.com/item?id=21156637](https://news.ycombinator.com/item?id=21156637)

------
droithomme
When I switched to the WalMart optometrist not only did glasses and exam
suddenly cost 1/5 what I was paying from a private practice, the prescription
was better too.

------
dade_
I assume Americans can buy them online in Canada. Quite a self-serving agenda
for optometrists, but good work by their professional association.

------
chrisbennet
I’d heard that they will give you the prescription (here in NH, USA) but won’t
give you the PD (Pupillary Distance) I.e. distance between eyes.

~~~
ryanmercer
In the United States they _have_ to, by law, give you your prescription if you
ask for it. Pupillary distance is _not_ part of the prescription though but
you can easily measure it yourself in a mirror with a ruler that has MM (or
use a service like ZenniOptical that has a printable ruler that you use a
credit/debit card to make sure it is printed to the correct scale).

[https://www.ftc.gov/tips-advice/business-
center/guidance/com...](https://www.ftc.gov/tips-advice/business-
center/guidance/complying-eyeglass-rule)

------
jonahbenton
Not mentioned in the piece but would expect the monopoly Luxottica to be
involved in this at the regulatory/lobbying level as well.

------
PeterStuer
In some countries _everything_ is for sale, and that includes the people that
should have your health above profit.

------
dandare
Are you not able to buy cheap (but high quality) contact lenses online in the
US?

~~~
kristofferR
Can you do that anywhere? From what I've been able to gather contact lenses
are stuck in patent hell, the only cheap ones are low quality ones using 90's
materials.

Alcon and Coopervision are the only manufacturers with high quality contact
lenses, and they charge a ton for it. 6 pairs of Biofinity's is ~26USD ($2USD
per lens), totally absurd.

------
skizm
FYI: visiondirect.co.uk will sell Americans contacts without a prescription.

------
wiredone
“We have the best healthcare in the world” \- freedom

Such a living contradiction

------
diogenescynic
Simple—it’s a racket.

------
revscat
Capitalism is great for what you want, terrible for what you need.

~~~
harry8
Capitalism is fine. Much of what big business captured politics claim is
capitalism is in fact, cronyism.

This problem under discussion is not caused by capitalism but by regulatory
capture.

~~~
revscat
Humanity is going to go extinct because of capitalism. In what world is that a
successful system?

------
hardwaresofton
Title:

> The Great American Eye-Exam Scam

Subtitle:

> Why is it so difficult to get a new pair of glasses or contacts in this
> country? It’s easier pretty much everywhere else.

First line:

> On a beautiful summer day a few months ago, I walked down to the part of the
> Connecticut River that separates Vermont from New Hampshire, and rented a
> kayak. I pushed myself off the dock—and the next thing I remember is being
> underwater. Somehow, the kayak had capsized as it entered the river.

I'd much rather read a concise, 3 paragraphs outlining what is _actually wrong
with the system_ than this author's personal life story. If this trend
continues the rise of summary generation add-ons/sites is inevitable and I for
one will gladly give them my money when they ask, super tired of click bait
titles that lead to winding narratives.

~~~
anewguy9000
the atlantic is literature, not twitter.

------
massysett
When I got to the end I couldn’t tell if the author is being serious.

------
sailfast
If eye exams were really that necessary, they wouldn’t be selling readers in
every drug store in the country.

Should you get an exam? Yes. Should you need to if your vision hasn’t changed?
Nope. This whole “gotta have a two-year current prescription” nonsense has got
to go.

~~~
angry_octet
Disclaimer: Don't take medical advice from HN/The Internet.

Especially advice not to get qualified advice.

~~~
sailfast
Fair point after re-reading my above as if it were out of context of the
article. I am not trying to say you should not get qualified advice - you
should! But if my prescription is working for me 2-3 years in and I lose my
glasses, there should not be a barrier to getting the glasses. I brought up
the readers sold without a prescription to illustrate the point.

~~~
angry_octet
I get it, it's like two bad things (out of pocket health care for preventative
medicine, and optician profit lobbying) have combined to make it worse for
everybody, to make sure rich people have regular eye exams.

But the solution should be eye exams every 12-24 months; for everyone earning
above a tax threshold, the Govt takes $50/year whether you have an exam or not
(okay, with an exception for those without eyes/sight). When you go to get
lenses you can get an exam without any extra cost. If you want to get lenses
with an old prescription you can.

------
purplezooey
Note this also part of why Lasik is so expensive. You basically have to buy
out your optometrist.

~~~
philwelch
What? LASIK practitioners are opthamologists (not optometrists!) who,
typically, do nothing except LASIK procedures. LASIK is "expensive" because
there are plenty of people who are willing to pay $3000 for permanently better
eyesight, LASIK equipment is expensive (especially the best and newest
equipment), and because there's really not much of a low end to the market
(because people generally only want the best available options in the "shining
lasers into your eyes to permanently reshape them" market).

Also, LASIK isn't that expensive compared to other surgical operations. Here's
a price list from the Surgery Center of Oklahoma, which specializes in low-
cost, out-of-pocket surgical procedures with transparent pricing:
[https://surgerycenterok.com/pricing/](https://surgerycenterok.com/pricing/)

And here's the pricing from the LASIK specialist I went to: [https://sharpe-
vision.com/pricing/](https://sharpe-vision.com/pricing/)

Notice how LASIK is pretty cheap compared to other surgeries--and this is from
a cash surgical center in Oklahoma as opposed to the higher-cost locations
Sharpe Vision operates from. I mean, there are cheaper surgeries out there,
but probably because they're simpler and require less expensive equipment. For
example, a local urologist in my area, "Dr. Snip", charges $1000 for a
vasectomy: [https://www.drsnip.com/getting-
started/#billing](https://www.drsnip.com/getting-started/#billing)

~~~
Scoundreller
I think the price is LASIK can be inflated by the costs it’s saving you from:
often a couple decades of contacts and solution purchasing.

That’s my main argument against getting the procedure done: my work benefits
cover my lenses/contacts, so the $thousands doesn’t yield any out-of-pocket
savings.

If it saves me several hundred a year, it would be a good ROI.

But I also stock up when chickpeas are 20 cents off/can.

I do always think about going overseas though.

~~~
philwelch
The quality of life improvement is pretty huge. Sometimes you just get better
vision after LASIK than you can be corrected to. I tested at 20/15 and
sometimes 20/10 after my procedure.

------
jelliclesfarm
I don’t get the point of this article. Essilor Luxxotica is a monopoly and
they pretty much control the eye glass frames market. This is rather old news.

[https://www.vox.com/the-
goods/2019/3/6/18253555/eyeglasses-c...](https://www.vox.com/the-
goods/2019/3/6/18253555/eyeglasses-cost-lenscrafters-essilor-luxottica)

[..] Essilor is a French optical company that’s been around since the 1800s
but has spent the past 20 years acquiring some 250 companies. In 2017, Essilor
bought Luxottica for about $24 billion. Although it got approval by regulators
in the US and the EU, and even passed an antitrust investigation by the
Federal Trade Commission, business experts have called the merged
EssilorLuxottica a monopoly.[..]

Also: how does one be ‘in charge’ of their own exams. Walking around and
operating with impaired vision is a danger to public safety. Is this a joke
article?

~~~
Fezzik
I don’t know if an analogy would help, but I thought the point the article was
trying to make was sort of like distinguishing between a dude selling shoes at
Foot Locker and a podiatrist - most people just need someone with a basic
knowledge of shoes to get appropriate-enough footwear, while a small
percentage of people with foot issues may need a podiatrist to do so, so how
stupid would it be if we made everyone who wanted shoes go to a podiatrist to
get shoes? It would be very stupid, and an excessive and unnecessary barrier
to entry in to the wearing-shoes group. The same goes for glasses. The fact
that we make everyone see a doctor that is formally trained to diagnose actual
diseases and deformities of the eye just to get a pair of glasses is absurd.
Almost anyone could be trained in a single day to prescribe glasses -
calculating the needed power of lenses is a solved and mostly mechanical
process. Sure, it would be great if everyone saw an expert in every field
before making any purchasing decisions, but given that it is substantially
more costly, cumbersome, and clearly unnecessary, why should we force people
to do it?

~~~
AnimalMuppet
I was just going in for a routine eye exam to update my prescription. The guy
said, "The good news is that we can skip the rest of the exam." The bad news
is that I had cataracts.

The same thing happens with people with glaucoma, or macular degeneration,
or...

Being able to see is a really big deal. Catching stuff that can make you blind
rather abruptly is a big deal. On the other hand, as you say, being able to
afford to get a prescription and glasses that fit them is _also_ a big deal.

~~~
jelliclesfarm
Health and food should be accessible to all and shouldn’t be subject to
profiteering.

Labour should be compensated fairly but it should be subsidized from demand
side by boosting purchasing power rather than supply side subsidies. This is
of course more true for food/Ag than healthcare...but I feel it can be
applicable to healthcare industry too.

~~~
cannonedhamster
Demand side subsidies have never lowered prices in the US as far as I'm aware.
The latest Trump tax breaks, the Kansas tax breaks, and pretty much every time
you goose demand side they pocket the money as profit and keep charging the
same. Why should they decrease their profits if the government gives them free
money?

~~~
jelliclesfarm
While formulating a solution, it would require some enforcement. Resigning to
past fates will get us nowhere.

