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Why are glasses so expensive? The eyewear industry prefers to keep that blurry (latimes.com)
1158 points by prostoalex on Jan 23, 2019 | hide | past | favorite | 588 comments

Reminder, if you're in the US, the FTC says your eye doctor must give you your prescription after your exam. If a doctor refuses to do so, they can face legal action and penalties.


That said, I don't think the FTC stipulates what information must appear on the prescription. Many docs leave off your PD (pupillary distance), which is a necessary measurement if you're buying online. Fortunately, there are a variety of easy ways to take this measurement yourself after the exam, although if you're really concerned about precision, you'll want the doctor's measurement.

And by the way, it should go without saying, but I'll say it anyway. Although the quality of eyewear available online can be comparable to what you'd get in store ... please don't think an online eye exam is an acceptable substitute for visiting an ophthalmologist in person and getting a comprehensive eye exam!

It doesn't hurt to ask! The last time I got my eyes examined was at some cheap lenscrafters-type store which had a promotion for 2 pairs of glasses and an eye exam for ~$60. The PD wasn't on the prescription, but the doctor made the measurement after I asked about it.

There was a very limited selection of glasses that were available for the 2-for-$60 promotion, and they really tried to upsell me to more expensive frames and lenses. Luckily I was able to resist their sales attempts and bought a nice frame and lenses from Zenni Optical. I keep one pair of the cheap glasses at my office and the other in my car.

As an aside, being able to get inexpensive glasses online has been a huge improvement on my life. I remember growing up when I only had a single pair of glasses (and a "backup" which were with my previous prescription). I had to be very protective of my glasses, and getting a scratch on the lens meant that I was stuck with it until my prescription changed. Now I can get my favorite glasses from Zenni for $25, so I have backups if the lenses get scratched or the frame get bent. I also have prescription sunglasses for the first time! No more dorky clip-on shades!

Another satisfied Zenni customer. The lenses are not always perfect and the frames are not always the best. Sizing is hit or miss.

What I do is buy the frame with cheap lenses to check fit, then I buy it with nice lenses if I like it. They are so cheap there is no reason not to do it this way.

Even ordering multiples it ends up being inexpensive.

I want to like Zenni, and I have ordered from them, but I am frustrated every time. I have a very, very large head. I need glasses at least 155mm wide, if not 165mm wide to fit around my temples. Yet finding data on the width of their frames is next to impossible. Even their sales people I reach via chat do not have the data. Sometimes I will see frames with some measurements, but not all, and its just inconsistent. I basically gave up, and buy from 'fatheadz' that specialize in wider frames, but they are much more expensive. For an internet only company, they sure seem to limit how you can search.

I just wanted to chime in here because while I don't have a wide head, I have a long distance between my ears and my nose (i.e., narrow but long from front to back). It literally took me 40 years to figure out that if the arms of the glasses are not long enough, the glasses will tilt down, because the curve of the arm will sit on your ears. This results in really poor vision (as you can imagine). It sounds stupid that I never realised it, but hopefully I can spare someone else in a similar situation -- make sure the arms of the glasses are long enough!

Also might want to check out straight-armed glasses. Typically they'll have some roughness or rubber where they meet your ears to help stay on your head like some fancy sunglasses.

BTW - These acetate frame arms can usually be heated carefully with a torch, and bent to straighten them up. Thus making them much longer. Sometimes you can even rebend them farther back. Though straighter arms are somewhat more prone to fall from your face.

Don't your glasses shops make sure to adjust the arms to your size? Mine does, they have a special device that heats up the arms so they can bend it carefully, and pliers to adjust the nose thingies.

A bowl of hot water will usually work to bend acetate frames, but not plastic frames (which cannot be adjusted). Be sure to keep heat away from the lens/coating to avoid crazing.

This data is not difficult to find at all. It's listed in the details section for every frame. You can also use it as a filter when browsing. Their stock at this size is really limited, however.


You should look at Shuron. They don't have a fancy website but they do have great customer service and offer their frames in various measurements, and if you have a large head they have frames that will fit. You can order according to the eye size, bridge size, and TPL (temple size).

There’s nothing wrong with going slightly upscale to Warby Parker with accurate measurements and some QC, especially if you have a more “demanding” Rx.

Hinge-less frames can take any shape, so long as they are long enough they will fit you just fine.

I think the overall experience is just okay. But since getting equvilent glasses (selection, coatings) can cost several hundred dollars it is worth it.

Good hack - I think I'll try this!

> They are so cheap there is no reason not to do it this way.

Besides the environmental cost, maybe.

Relative to other things like travel, commuting, home energy usage, electronics, etc, I'm guessing the environmental cost of a pair of glasses is very, very low.

It is important to focus on effective actions. For example, a lot of people think that somehow recycling affects climate change, which (AFAIK) is not true in any meaningful sense. That isn't to say one shouldn't recycle -- there are plenty of reasons to do so in many cases.

I think the broader point was that buying something only because it's cheap is generating unnecessary waste.

I'm not saying this is the case here because the original pair of glasses can still be used, but isn't avoiding this kind of behaviour a good thing?

I believe that recycling aluminum takes significantly less energy than smelting it in the first place.

I don't have any idea about plastics/papers.

Post-consumer paper can be recycled in to some forms of low-density card that doesn't require high quality pulp. Egg cartons come to mind, and as a percentage in some packaging, newsprint and sanitary papers. Post-consumer paper cannot easily be recycled in to anything resembling printer paper due to the contaminants. Pre-consumer paper is recycled heavily as it's of known quality.

I'm not aware of any plastics that are recycled in to the same form. I know that PET (1) and HDPE (2) are recycled in to fibres.

It's a similar story to glass, certainly where I live a large amount of glass is recycled in to crushed aggregate rather than new bottles. The energy costs of cleaning don't make it worthwhile.

Glass bottles used to be reused, which is the responsible thing to do.

Consumers didn’t like it because scratches accumulate on the outside of the bottles.

I always thought it was a shame that we stopped doing that, but plastic has taken over pretty much for all the glass bottles that used to be recycled.

Aluminum is the only part of recycle that is really profitable. That's way people picking through trash take the cans and nothing else.

Everyone I've seen do this takes bottles too, and it's because they can redeem the bottles and cans to collect a state-mandated deposit.

Plus you can probably donate the glasses. There is probably some poor person out there with a prescription close to yours.

It helps the amount of garbage put into the environment, which is good regardless.

I don't throw away my old glasses. I keep them in various places as backups, such as in car gloveboxes, in the home emergency kit, in a bag while traveling and so on.

When I was younger I used to tease my Mom & Dad for essentially treating their reading glasses like pens or pencils, and letting them diffuse around the house as the acquired new pairs.

Now that I'm in my mid-40's, I take it all back. Having a pair, even if it isn't the exact right one, always with reach is a godsend.

When I wear my contacts, I need reading glasses. I buy them essentially in bulk from Amazon and leave them scattered everywhere.

Me too. I have around 10 pairs, so I never find myself in a room/place without them. I like Dr. Dean Edell’s for their combination of style/comfort/build quality/light weight. $9.99/pair

Me too. Even though my eyesight continues to deteriorate, a pair of old prescription glasses is many times better than no glasses at all in an emergency!

Around here the store has some cheap frames they use for advertizing. The problem is they look like something a crazy old aunt would wear, with wild coloring. If you want anything like normal glasses you have to pay for the expensive brands. It’s really sad seeing institutionalized and less fortunate people wearing those cheap glasses...

I actually really miss the old basic NHS frames because of this. Perfectly fine to wear every day, even if you're Michael Caine, and simply not bother with anything more expensive. They were also great for ordering a cheap second pair for manual dirty work, decorating, spare for the car, and to tide you over when the expensive pair inevitably breaks (funny that) etc. A HUGE thanks to Thatcher for removing opticians from proper NHS coverage in the mid 80s. After the demise of NHS frames, even cheap glasses were expensive.

Decades later those NHS 524 frames became all the hipster (and Morrisey) rage. For hundreds a pair. Sometimes using original repolished frames as apparently they were well enough made to last forever.

If you want a good, practical, well made modern replacement for the NHS 524, check out the Shuron Freeway. They're very sturdy and have barrel hinges. Ironically, they're much better made than designer frames but they're not as expensive!

> Around here the store has some cheap frames they use for advertizing. The problem is they look like something a crazy old aunt would wear, with wild coloring.

That would make you all the rage in a hipster circles.

I'm pretty happy with my $8-a-pair glasses at Zenni...due to my tendency to lose glasses, I was happy buying 7 sets from them and have them scattered around most of my common places in my life (e.g. my bedroom, living room, desk at work, etc)...If I lose one, I don't have to feel guilty about it.

Fair warning: Zenni optical sent my password to me plaintext in email after creating an account with them (this was a few years ago now).

I would expect none of my data - profile, passwords, or banking info - is safe with them.

Last time I had an eye exam (UK, Boots) they of course gave me the prescription because they are obliged to, but under no circumstances would they give me a PD. I forget their exact reason but it was something about needing to relate it to the choice of glasses. Sounded like horse-shit designed to make me buy their overpriced frames to me. I do not expect to have any better luck this year.

Another ditto -- I now have one pair of regular glasses and four pairs of computer/reading glasses, all prescription (one for each computer I sit at!). The last 3 computer glasses cost $27 for all three. At those prices, I can trivially "just get" spares for vacations and hiking.

Can confirm, can order like 8 pairs for what 1 used to cost me. The things we can do nowadays!

dittos. Another very pleased Zenni Optical customer here.

I bought three complete pairs of eyeglasses for $105 total, delivered. If you can be patient, about once a year, they'll run a buy-two-get-one-free sale. I now have prescription sunglasses, distance-only, and a set of hidden-line ("transition") bifocals. All with low-reflection coating, and high refraction index plastic. All three are holding up well after three years.

LensCrafters is very expensive.

This kind of blows my mind. A few years ago when I went to the eye doc, they refused to give me my prescription, I had to buy glasses from their store in their office. Last year when I went, they gave me my prescription at the end, without me asking. It felt really nice and at the time I figured they were doing it to create a better relationship with their customers. Now I wonder if someone knew about this rule and reported them. Kind of curious how long it's been in effect.

I just got my eye exam done this morning, and I agree it really does make a way better experience.

I think it's a state-level law thing. Here in WA State it's illegal for a optician to refuse you a plain eye exam or refuse to give you your prescription information, including pupillary distance: https://app.leg.wa.gov/rcw/default.aspx?cite=18.195&full=tru...

It's not, it's a nationwide thing enforced by the FTC. WA and some other states have stricter laws which include pupillary distance.


Good to know. But judging by the current messaging on the site that where you're supposed to send those complaints for that... I don't think there's much enforcement going on right now.


Considering the US govt has been partially closed for over a month now, it's probably a fair statement that NO enforcement of this is going on right now. :P

Did my vision exam last week at Costco. The Costco optometrist is independent from the eye glass department, which is owned by Costco and you need a member ID to buy from. The prescription had PD on there.

When I used to do target or lens crafter... I had to ask.

I went to a local business a while back, where the optometrist was about 2-3 years away from retirement. I didn't want to offend them but politely and clearly stated that I would like to get my prescription. Still, they made a big act about parading me through their small collection of frames, and even suggested a few they thought I should try on. Just to humor them for a bit, I put on a pair and they made me look like I was wearing something from the Kim Jong Il lineup. The office assistant, who reminded me of the secretary from Ferris Bueller's Day Off, gave me VERY high compliments on them. I could barely hold in my mirth after looking in the mirror and had to pretend my wife was calling so I could dodge out of there and get the laughs out in my car.

The sad thing is that it appears that (in the US) for optomtrists, the eye exam is just a loss leader for the eye glass purchase in the "store" they also own. I assume my eye dr. went to college, medical school, and then some additional training (2 more years?). He does a very comprehensive eye exam, and my VSP insurance only pays him around $70 for the exam.

Concerning the loss leader, that is correct. I should say from my Costco experience, I also got my duct glands checked. I don't remember getting that at Target/Lenscrafter the previous years. It was a few years since my last exam, so my memory could be wrong.

I believe the tear duct check is a loss leader. Most people have dry eyes (Meibomian Gland Dysfunctio) if you work in front of a computer all day. I have it and saw an actual ophthalmologist before so I knew all about it. It cost $$ so I was surprised the optometrist did it as part of the checkup. If you want to get your dry eyes fixed you have to 'melt' the clogged ducts and it cost $300 for the cheapest treatment. $900 for the one that works best (Lipiflow). The treatment isn't permanent so you gotta go back every year for the $300 treatment and every 3 for the $900.

Since the Costco optometrist can't make money from lens, I guess they make money from dry eye treatment. Also he gave me an option to dilate my pupils or he has a fancy imaging machine. The imagine machine costs $45...I opted for the imagine machine grin.

One last point - the Costco optometrist has a fancy digital goggles to check your vision. Another commenter posted that it's a waste of an education for an eye vision check. The goggles show the letters to read (it's not projected on a wall) and has lenses embedded within it. With a keystroke on the computer, it changes the lens. He really just asks "which ones looks better" and hits the keyboard. I was done in a minute.

Just to clarify, optometrists do not go to Medical School, they go to a different "Doctor of Optometry" professional program. Still, your view about the US system is likely right.

Funny enough, back in my home country, "optometrists" don't exist. Everybody goes to an actual eye doctor (Ophthalmologist) to get eye prescriptions. Of course, you pay the price, as the consultations cost as much as any other doctor visit.

Edit: somebody beat me to it below :) I'll leave it here because of my second anecdata above.

Just a clarifying point:

Optometrists are different from Ophthalmologists. Ophthalmologists are medical doctors (i.e. they have an MD), optometrists are not. Optometry also involves post-graduate training, and results in an OD (Doctorate of Optometry).

In the type of store you're talking about, it's much more likely you'll see an optometrist, not an ophthalmologist.

Such a waste of an education for a job that can be done by someone less trained. The only constraint is regulatory.

I get my eye exam checked every year for other more serious and complex diseases so I think there is a role for the more trained medical professionals but these exams need to be disentangled from the expensive professionals. That is the way to bring the costs down to a fraction of what they are...

Optometrists and Ophthalmologists both have training to check for disease in the eyes. In fact a dilated eye exam is a non-invasive way to get an actual look into your circulatory system to check for things like diabetes. So even people without glasses should be getting regular checkups.

Ophthalmologists also have specialized training for cutting the eye that they learn in medical school (eg: lasik), but for eye exams, an optometrist has the skill-set necessary to perform these kinds of screenings.

A lot of people just get auto-refracted or a checkup by an optician and assume that's enough to get new glasses, but those people can be among the tens of millions of Americans who don't realize they have pre-diabetes.

Is it, though?

My ophtalmologist wouldn't only perform measurements to see if my prescription had changed. She would do a proper eye checkup. Retina, pressure and a host of other things.

It wasn't expensive. Of course, it was also not in the US.

You are only there once a year at most, so it is an opportunity to catch things before they go wrong.

I have had the same experience in the US. An assistant rather than the ophtalmologist is the one that does the vision test (I guess it's called the refraction?). The assistant then dilutes my eyes and after that is when the ophtalmologist comes in to do the checkup for my eyes for issues.

I am not sure where did you get the amount of 70$ per exam. My OD charges approx 258$ which was reimbursed by VSP . I know this since he sent a bill to me after exam that showed what the cost of visit was and what was covered by VSP .

If you compare VSP and non-VSP houses, you might find that places that don't take VSP tend to be cheaper, and the final prices tend to look a lot like post-discount VSP prices.

I've seen the theory float around that VSP works a lot like Kohls: start from inflated prices, discount to actual market, and claim you're doing the customer a solid with that "what you saved" report you get. Once you add the premium, not even sure you break even.

Disclaimer: my wife is an optometrist (in the US).

My guess is what you're seeing is a bit of a misrepresentation. My wife would be thrilled if VSP (or any other vision insurance) reimbursed even near that amount. You might be seeing a statement that the insurance plan saved you a certain amount (the standard price of the exam), but the optometrist is not making that money.

Instead, what they do is if the doctor wants to accept their insurance (VSP, EyeMed, Superior, etc), they have to agree to a contractual amount of reimbursement for a standard comprehensive vision and eye health exam, which is often on the order of $35-45 on average. The doctor also would get the copay amount (often $10). Similarly, if you add in contact lens evaluation into your exam, they will reimburse a bit more for that portion. However, it is very rarely even close to $258 unless you have a very specific condition/situation (for example medically-necessary contact lenses, etc).

Your optometrist will have had 4 years of post-graduate education (and probably the 6-figure student loans to match), where they would have learned how to diagnose and treat a wide variety of ocular and even systemic conditions that may first present themselves in the eye. So for the $50, you're getting a steal of a deal. While it is not entirely a loss-leader (an Optometrist can make an OK living this way if they have enough patients--though still lower than what most Software Engineers make), this is why you will often see an Optical in private practices, rather than exams only.

My wife's office obviously sells glasses, however it is worth mentioning that the prices that are presented are largely a result of the underlying wholesale costs of the materials, with some margin to account for labor and facilities. I cannot say that some of the materials from the manufacturers are not overpriced, but there are substantial quality differences between different frames and different lenses.

The advantage of getting your frames from the same place as your doctor is that any lens recommendations for your best quality of life can be relayed directly. Ideally the optician will then help you sort through the pros and cons of different lenses and frames, along with what your insurance may cover, to ultimately get you something that you'll love at a price you are comfortable with. This often is more important as you get older and have a need for progressive lenses. The measurements get trickier, and each lens type may have different advantages. Single-vision lenses are much less particular, and you may have more success with the online shops if you are in this life-stage.

This kind of personalization is not required by everyone, but some people really appreciate it.

Basically, some people will probably have success with the online shops. That's OK. However, they don't work well for everyone.

One more thought: very few purchases will have as much impact on your daily life as your glasses, they literally affect the way you perceive the world, as well as potentially how others perceive you (fashion). We all wish things we buy were cheaper, however the cost/value proposition on glasses is not that bad when you think of it this way. The final decision on how to spend your money is up to you, as the consumer, in the end.

> We all wish things we buy were cheaper, however the cost/value proposition on glasses is not that bad when you think of it this way. The final decision on how to spend your money is up to you, as the consumer, in the end.

I find this opinion to be abhorrent when applied to durable medical devices and medical treatment. Eyeglasses are a vision prosthetic, not an optional purchase. Many people must have at least one pair in order to function normally in society. If you're rent-seeking on that necessity, that makes you a parasite. If you're providing it at or below cost, that makes you a living saint.

~~These prosthetic legs will allow you to walk again. We have decided to charge you only slightly more than you can possibly afford for them. The difference will likely be made up by a charity of some sort, funded by people who would rather pay us to help you walk again than spend the exact same amount on independently making prosthetics and giving them away. But walking is so incredibly valuable in one's daily life, that the cost/value proposition is really not that bad for you. You're only paying us everything you have, in order to live like a normal person, and we also get to use your hard-luck story to suck some more money out of a few chumps that feel sorry for you, or maybe the government. We all wish things we buy were cheaper. You, of course, also have to option to scoot yourself around on an old furniture dolly with a junked riding-lawnmower seat strapped onto it with zip-ties. The final decision on how to spend your money is up to you.~~

Optometrists and ophthalmologists should cartelize ASAP, and erect a firewall between their eye exams and the opticians and eyeglasses manufacturers. If every supplier of eyeglasses prescriptions were to refuse to conjoin themselves to an optician business, Luxottica and VSP and their ilk could not extract money from that portion of the industry that supplies the most value. If I would pay $10 for an exam (copay, with VSP) and $120 for just one pair of glasses (from Luxottica, even after VSP allowance), I would almost certainly be willing to pay ~$200 (or $20/month) for a 30-min annual exam (direct to optometrist, without VSP), and 1-4 pairs of glasses at ~$40 apiece (from someone other than Luxottica). Pay the optometrist $50-80 per exam, and the rest on business overhead and support staff. Current US average is about 1800 patients per optometrist. So the cartel can refuse to sanction more than 1 member per 6000 in the local population, which sets a floor of about 1500 patients per optometrist, if they all distribute evenly.

So an average optometrist, in an average town, charging cartel prices, should be able to clear $100k per year personally, seeing an average of 6.5 patients a day, while still taking 4 weeks vacation, working only weekdays, and taking 9 holidays, while providing $250k to support their own business. That can probably support a $70k business manager, and a decent independent office--with no frame showroom taking up most of the usable space. Maybe also a lower-paid assistant. This is very reasonable for a profession which requires post-graduate education. There is no particular reason why an optometrist with two employees should not be able to operate as a small business, without also having to also sell overpriced eyeglasses, other than the manufacturer monopolist putting the squeeze on them, by paying some optometrists to put the rest out of business if they don't agree to join the scheme. Luxottica doesn't need to be the cartel enforcer; optometrists could create their own, and use it to benefit themselves--and maybe also the patients, just a little.

That seems high. My local Costco is $70 and I've walked by Walmart where they advertise exams and I don't believe it's $250...

I also know of instances where you get charged more if you have insurance, just because the provider knows they can get more money.

> only pays him around $70 for the exam

Is that low? Ophthalmologists get 28€ per consultation in France for something basic like that (although they can charge more but the patient will only get reimbursed for 28€, so they will try to avoid those who overcharge).

Wal-mart also has optometrists that will give you your complete prescription for (last time I checked) the same cost as an eye-exam at Costco. Been my go-to for the last few years.

Both Wal-Mart and Costco have fully independent optometrists: they lease the space and equipment and are not employees. (sometimes state laws don't allow this in which case they are employees)

I think it's the other way around. Most states don't allow optometrist clinics to be owned/controlled by non-optometrists.

When they do, Walmart/Costco may find it worthwhile to own/operate the clinic themselves.

You could be right. The information I was able to find said otherwise, but that may well have been biased.

I second this, Costco is great for eye exams. No upsells.

They also can’t require a membership to get an eye exam, so if you don’t want the pressure to buy glasses there, Costco is a safe bet.

They’ll give you your prescription and literally wouldn’t sell me glasses even if I wanted them, since I wasn’t a store member. I did have to measure my own IPD though, which I did with a ruler and a mirror.

EDIT: another reply notes that they did get their IPD at Costco, so this might vary by location. As they mentioned, the optometrists are independent.

A tip for anyone measuring their own PD, shine a bright light in your eyes so your pupils constrict. That will make finding the center a bit easier.

Fun costco fact, in Canada and in many US states you also don't need a membership to use their pharmacy. And also in many US states where they sell alcohol they legally can't require a membership to buy it.

Costco's pharmacy generally also has excellent prices and makes them available through their website (for self pay or non-insurance meds, insurance co-pays are for you to determine). https://www.costco.com/pharmacy/drug-directory-main

+1 for Costco's pharmacy. In the rare occasion I need a prescription filled, its usually considerably cheaper than CVS or Walgreens. Plus, I'm prone to sinus infections and they have generic sudafed (real pseudoephedrine, not OTC) for just under $2 a box. Every other place in town is 5-10x that for the same thing.

I think that’s the case here in Connecticut for alcohol, though I’ve not gone and checked.

I know for a fact that Indiana is a state that cannot put membership barriers on alcohol.

I first saw a sign declaration in Sams Club stating that. When I went to the front desk, it was much gnashing of teeth to get the manual override for "alcohol exception".

And then they demanded I do the mandatory member search. Members agree to. I'm not a member. I dont consent to searches. Maybe it makes me an asshole ; they're free to make it truly member only by removing alcohol.

And also as another note, any alcohol sales in Indiana must be offered to all legal-to-purchase people. You cannot say "10% off with a kroger card". That's just as illegal as requiring a membership card.

What is a "mandatory member search"?

The receipt check is the mildest version of it. They can search your cart, and potentially also your person, for store items that you haven't paid for.

If you are not a member, you have not consented to it, and the transfer of ownership already occurred at the point of sale. So you can walk past the exit line and right out the doors. Attempting to hold you in the store against your will could be considered kidnapping.

Doesn't Walmart do this without a membership? How do they get away with it?

(Disclaimer: not a lawyer) Walmart might tell you not to leave, but legally speaking they probably don’t have grounds to stop you from leaving, and it may in fact be illegal for them to try.

Some states have https://en.wikipedia.org/wiki/Shopkeeper's_privilege

But that still requires cause to believe you stole something, and as far as I understand it, declining to be searched on its own doesn’t provide cause for that.

Costco has a membership agreement where you consent to being searched, Walmart does not.

I have a friend who used to load up shopping carts with cases of beer and then slowly roll out of Walmart back when he was underage. They're not legally allowed to stop him and corporate policy is to avoid chasing down thefts. Do with this information what you will.

when they ask - you say "no, thank you".

They get away with it by training the vast majority to consent for no particular reason.

That's always my technique at stores that try that (aside from CostCo). The nice part is that they really aren't used to people saying that (especially if you say it very pleasantly, as if they had offered you something) and will often stare at you with a "deer in the headlights" look.

The worst that's ever happened was that I once had a Best Buy guard yell at me and start trying to chase me out into the parking lot, but I just ignored him and he eventually gave up and went back. Flaunting fake authority like that makes me very happy for some reason.

Where I shop (Redwood City and Mountain View) the receipt check lines are long and clog the exit. There's no way to bypass them unless you don't have a cart.

Nit: An optometrist is usually fine if all you need is a refraction.

It's when you're dealing with something that requires medical intervention (glaucoma, pars planitis, etc.) that you need to shell out for an ophthalmologist. An optometrist can still catch that stuff, but will need to refer you for treatment.

This is a good point and also worth pointing out (in the US at least) that most ophthalmologists will be covered under your medical insurance not your eye insurance (if any) because they are medical doctors.

I was getting my contact lens exam/fitting recently and the optometrist wanted me to get something checked later by an ophthalmologist. He said it was probably nothing to worry about but made it clear that it was outside his scope of expertise to diagnose or make medical recommendations.

my wife is an optometrist.

it's amazing the stuff she finds. she's found brain tumors and literally saved people's lives by referring them early to a neuro-ophthalmologist when they came in just to update their prescription. many latent systemic problems are also clearly visible in the eye: hypertension, diabetes, etc.

> This is a good point and also worth pointing out (in the US at least) that most ophthalmologists will be covered under your medical insurance not your eye insurance (if any) because they are medical doctors.

Make sure they code it correctly! I once had a rather large bill because the ophthalmologist's office accidentally billed me under a "routine" code that my medical insurance didn't cover. It took several hours of phone calls with the insurer and the ophthalmologist to get it corrected.

Just echoing this, (Canada) my optometrist caught my glaucoma early using that machine that shoots a burst of air at your eye. He referred me to an opthalmologist who said there isn't any damage yet but gave me a prescription for some eye drops that reduce eye pressure. I'm only 27 and don't have any other medical issues, so it was a but of a surprise

A few years ago after an exam, I asked for my prescription and they handed it over with no complaints. I asked for my PD measurement and was told that is free with the purchase of glasses. I offered $20 for just that measurement and they wouldn't do it.

Your PD is not actually part of your Rx. That's why it's normally not included. Your Rx consists of a OS Rx and OD Rx.

No, but the law has a handwavy bit about "everything needed to get prescription lenses," which ostensibly would include the PD at plain reading since you can't make the lenses without it and it's based on medical information. Your stance vs. that one is the crux of the debate.


> (g) A prescription is the written specifications for lenses for eyeglasses which are derived from an eye examination, including all of the information specified by state law, if any, necessary to obtain lenses for eyeglasses.

In almost every eye exam I’ve gotten the doctor doesn’t even measure my PD, but rather the glasses sales people once I’ve found a pair of frames I like.

Yeah, this. The lack of PD on scripts is mostly about how labor has typically been divided, not a nefarious or bad-faith effort to force you into using the local optometry department.

In years past, those optical departments were a major part of the ophthalmologist's/optometrist's business model. With the rise of big-box store optical, though, that changed. (And has now changed MORE with folks like Zenni and Warby Parker, etc.)

For example, my late stepfather's business (he retired in '99) depended on that optical department, but for most of his career (and his father's before him) there WEREN'T places outside doctors' offices to get glasses, especially where I grew up.

OTOH, the eye doctors I've used in Houston, where I've lived since the mid 90s, have generally not even HAD an optical department.

Oh, and one more bit: ISTR that Warby Parker will do a PD measurement for you gratis if you visit one of their stores. You might even find glasses you like -- not as cheap as Zenni, but definitely cheaper than a traditional provider.

>That said, I don't think the FTC stipulates what information must appear on the prescription. Many docs leave off your PD (pupillary distance), which is a necessary measurement if you're buying online. Fortunately, there are a variety of easy ways to take this measurement yourself after the exam, although if you're really concerned about precision, you'll want the doctor's measurement.

at that point just visit a better eye doctor.

biggest scam is that glasses/contact prescriptions only last a year in the US

Needing a prescription for glasses is a bit absurd to begin with. The worst case of wearing the wrong prescription is that you'll get a headache. I suppose it could be a bit dangerous if some drivers were slightly disoriented, but I can't imagine glasses being more dangerous than something like Tylenol.

I... can't form a coherent response. How do you even know which prescription to get? Do you have astigmatism? How do you measure that?

It's not a scam. It's just overpriced in the US, because they can't get their stuff together in the health department.

If I need a new pair of glasses with the same prescription I have now (Say, for example, I fall and break my glasses), I shouldn't be required to go get examined to get a new pair simply because it has been more than a year. I want the same thing I've been wearing, and the worst possible outcome from me getting them is that (if my prescription has worsened, which it hasn't in 4+ years) I can't see quite as clearly at long range as I ought to.

That would be weird, good thing you are not required to get examined in order to buy glasses. I don't know why you think you are required.

You are required to get a new prescription because your original prescription expired.

It's by state.

Not for contact lenses (16 CFR 315.5):


That doesn't make much sense because adult vision doesn't change much. It should be perfectly valid to use an old prescription unless you want to re-check your vision. I've never seen this law in Asia or Europe and people are living just fine.

I just had an eye test and both of my eyes had changed enough after two years to make a very noticable difference to my prescription.

You don't technically need an Rx. You can go to Zenni and just start plugging in numbers if you want. I'm not sure what that gains you, though.

It gains you the ability to replace a broken pair of glasses for just the cost of the glasses, rather than also having to pay for another eye exam.

> The worst case of wearing the wrong prescription is that you'll get a headache.

Doesn't using the wrong prescription worsen eyesight faster?

At least, it's been my general experience that when a child is curious about people's glasses and is given the glasses so they can experience the effect, they only let them try it for a couple seconds and are explained that using them for too long can cause damage to their eyesight (because it's the wrong prescription for them who have perfect eyesight). Is that a myth?

Yes, it's a myth in the sense that you would need to wear the glasses several orders of magnitude longer and/or consistently for there to be any negative effects. Some people seem to think that even looking through the glasses will unleash demons into the healthy eye.

Modern research does point in the direction of the eye remodelling itself based on what kind of input you give it on a longer scale, though. This includes the amount of light seen during the day and whether it is able to focus rays or not. There are indications these play a role in the development of myopia.

The eyes don't care about what's in front of it. The brain does the image processing, so that's the only thing that's affected by a bad prescription. If your glasses are so wrong that it causes eye strain, it may cause damage, but you'd have to purposefully put yourself into that ordeal.


The eye very much does care what's in front of it. Look up "emmetropization".

Try a web search for neuroplasticity.

The real reason is they don't want grubby hands smudging up their glasses :)

No... It's not like I've seen it only once or never talked about it with other people. It's general common sense or a common belief, even if it turns out to be false.

Plus wearing glasses with a slightly different power than your own is infinitely safer than not wearing them at all.

Tylenol (acetaminophen) is probably a pretty good example. They both seem pretty safe in reasonable situations (a slight difference in prescription value, a couple hundred extra MG dose) but can be hugely problematic at greater levels (lethal/permanent liver damage or completely unable to see anything with a terrible prescription)

Which brings up another benefit of using an online eyewear vendor: they let you type your own prescription in. If you are personally fine with using a two-year-old prescription, do it.

When I ordered glasses a year ago, I also played around with the idea of eliminating astigmatism from my prescription by adjusting the cylinder value to 0 (it was only .25 in one eye and .50 in the other) and offsetting the sphere value by half of the difference. Because their buy-one get-one free sale, I got one pair with astigmatism and one without, and got to decide which I liked better.

That's awesome. Anything more than about a half diopter and you'll probably not get away with that in glasses. Contacts can go a little higher. I'm personally astigmatism sensitive, so I have to be spot on for degree and diopter.

To be legally above board, an online provide must attempt to confirm the Rx you enter is correct AND still valid. But few if any do because its a race to the bottom on quality and price. At Topology Eyewear, we spare no expense to ensure you get the best custom frames (like a custom suit) AND the best optics money can buy. We take 100% compensated Rx very seriously!

We're already aware you're enthusiastic about your business. Kindly leave the self-endorsement out of every comment.

It depends on the vendor. Warby Parker, for example, requires you to scan/upload the prescription given by your doctor, which obviously has a date on it. I guess it's always possible to just edit out or change the date on it though.

In many states it doesn't - you can ask for an extension to 2 years and in some states you can ask for a longer timeframe than that.

The length actually varies by state and it ranges from 1 to 10 years.

It varies by retailer and also contacts vs glasses.

If I remember correctly, thr Warby Parker storefront near me accepted a glasses prescriptions given out less than either five or ten years prior.

My insurance fully covers annual exams, so that doesn't bother me too much. If the period between covered exams was longer than the prescription period, yeah, I'd be peeved.

I wonder if that depends on state and/or who prescribes it?

I got a new prescription in 2017-07-07, and just took a look at it. It says it expires 2019-07-07.

I'm in Washington, and got it at Walmart.

I thought it was a state thing. But it's apparently an FTC rule that started with contacts and was expanded to glasses as some point.

Not that I would advocate anyone taking shortcuts on eye exams, but assuming online US providers insist on appropriate documentation and doctors' names, there's always ordering from Canada.

2 years in many if not all places. And I assume online places don't worry about that.

my glasses prescription doesn't have an expiration date on it. Zenni and Coastal don't care if I order new glasses using my old prescription. I haven't tried with contacts... I think my last prescription had an expiration date.

Note on contacts: because you're physically inserting a medical device into your eye, part of your annual exam is making sure that you are not causing any (potentially permanent) damage do your eye. While hopefully you are not abusing your contacts, even in normal use, sometimes the eyes can be harmed, which can cause major problems down the road for you. In my opinion, the expiration is probably a good thing if you're proponent of trying to protect people's eye health.

Yeah, I'm fine with it for contacts. It's just protectionism on glasses unless the prescribee has some degenerative condition.

That varies by state. My NJ prescription lasts for 6 years IIRC.

Depends on your doctor.

In NJ mine always dates a year, so I got fed up and found a supplier to buy from that doesn't give a shit what my prescription says.

You actually need a prescription to buy glasses in the US? 0o

That's maybe Fair given the potential rate of change.

You can go decades without a change, or a significant change (more than half a diopter).

Significant change isn't just the RX, it is other things that can go wrong in the eye as well. IF caught early it can be corrected, otherwise you may not notice until you are half blind.

That's true of everything, though. Your grocery store doesn't say, "sorry, you haven't been to the dentist in 6 months, we can't sell you food", even though there are many dental issues that can be life-threatening if not treated and eating food makes it worse. It's not their business to care.

Yeah, and others may go months, or years too.

> your eye doctor must give you your prescription after your exam

In regard to the above quote, I wonder how effective or if anyone is familiar with: https://www.indiegogo.com/projects/eyeque-visioncheck-world-...

It essentially promises to not only cut out the doctor's exam visit but actually improve the prescription (since measurements are taken throughout the day).

note: not affiliated but seems like an interesting product (if not now then certainly as the field of self-testing improves, example: https://tricorder.xprize.org/prizes/tricorder)

Not affiliated either, just an amazed customer.

Never needed glasses until I was in my late forties and had to start using reading ones.

I bought the Personal Vision Tracker (the black one) on the Indiegogo campaign. It's not very easy to use but gives fairly consistent data if handled with care. I did not yet compare the device data with the ones from a doctor's visit.

(The data for my right eye are slightly worse than for the left, and I have indeed not ideal results with standard reading glasses.)

I bought prescription glasses on a UK site (I live in Europe) based on the device data. Both the reading glasses (short distance) and the computer glasses (medium distance) are perfect: I have not seen this good in years.

Because of that excellent result I have also ordered the VisionCheck (the new, white one) on the Indiegogo campaign. It is purportedly easier to use, not gotten it yet.

Meanwhile I had also got the Insight model (larger white one). That is for visual acuity and it confirmed that I have 20/20. Interestingly, it also showed I have a light form of tritanopia, which might explain past naming disagreements around colors between green and blue.

Their product page: https://www.eyeque.com/pvt/

I'm not sure if the professional designation changes country to country, but here in Canada an ophthalmologist would not be the person to give a comprehensive eye exam. That would be an optometrist. (source: optometrist parent)

Your parent had it backwards. An ophthalmologist is an MD.

A optometrist I went to did my eye exam for $90, and then I decided I wanted the prescription to get my own contacts.

First, I asked, and they denied it. Then I literally had to pull out this law and they finally granted it. But they did everything they could to obstruct me. Literally they refused to scan it and wanted me to show up in person. Then while writing it, the doctor himself said "sad to see you don't support our business". (For people living in Boston, the place was Custom Eyes in Central Square.)

I was surprised by the divergence between the law and how pissy the doctor got when I tried to exercise my rights.

> the doctor himself said "sad to see you don't support our business".

That I would want to question him about. Does he mean that the medical service is the loss-leader and that he gets a kickback off our purchase of eyewear?

Wow, I used to go there 4 years ago and liked the place. Never had trouble getting my prescription.

So sad to see how that place changed.

Eye exams are important. I have a cordial astigmatism in my left eye, I would not have know about without it.

The eye glass seller in longwood boston will measure your pupil distance, and check that your online glasses match the prescription when you get them. He charges a small fee for this.

Would that be Longwood Optical?

yeah. I like the glasses I got there but the owner was a little overbearing. Although I like it when they help curate the frames.

However, you can easily measure your own pupillary distance exactly down to the millimeter with a ruler and a mirror.


Only problem is, if you look to close in the mirror, your pd changes because your eyes rotate to focus on the shorter distance. If you are closer then 1 meter to the mirror you should compensate. Up to 2,5 mm per eye if ur at 40 cm distance.(20cm from mirror)

There is no such problem. Each eye stares at itself in the mirror. (Not necessarily at the same time, if the procedure is done as described.) Those two lines of sight are parallel if the mirror is true, regardless of distance to the mirror.

There may be a different problem: though parallel, those two lines of sight may not be exactly perpendicular to the ruler/mirror. This is not going to make a huge difference.

Suppose the mirror/ruler is rotated five degrees off relative to the plane of your pupils, which is quite a lot. For an pupillary distance of 65 mm, this introduces only a 0.25 mm error on the low side: basically the measurement shrinks by the cosine of 5 degrees which is 0.996.

Pupillary distances are typically given to the millimeter.

> If you are closer then 1 meter to the mirror you should compensate.

If you're 1 meter away from the mirror, you won't be able to read the ruler, at least if you're doing all this because of near-sightedness. :) This technique is best if your face is right up to the mirror. If you press your forehead to the mirror so your head doesn't move, that's probably best. If you're far sighted and can't read the ruler from that close, then you have to back off. If you can't read the ruler at any distance, you may have to do this with contact lenses on.

I told my doctor up front that I don't plan to ever buy eyewear from them because I don't feel comfortable buying a prescription from the prescriber. They were very accepting about it and they've been quite respectful to my wishes.

As you mention, measuring PD yourself (with a friend) isn't hard. There's articles and videos online about it.

I've seen that left off a couple times, and I just ask one of the people up front to just measure it for me and tell me what it is. I usually buy my main glasses from them anyway, and just say I'll get sunglasses or computer glasses online (which is when I use Zenni), so that helps, but even without mentioning that, I haven't gotten any pushback when I've asked for it.

It is somewhat hard to get right. I did it with a marker and old glasses, and I still got it wrong (and couldn't return the glasses that I ordered).

Ah, but no it isn't!

See kazinator's dead accurate, no-friend-required method here: https://news.ycombinator.com/item?id=13092902

Clever. Seems obvious in retrospec though.

It reminds me of collimating a telescope with a laser or your eye. You basically look down the optics of the telescope and you should be staring into your own eye, or if you use a laser the laser should be reflected by the mirrors exactly back into the emitter.

Although some assistance may be required, I wonder if the iOS Measure app might be just as accurate in measuring PD?

it won't work if the mirror is tilted or bent, so make sure you get a flat mirror on a flat surface (e.g. use a level)

If the mirror is bent, a level will not help. A level is useful if orientation relative to gravity is important (something has to be horizontal or vertical, like a cabinet, counter, or picture). That isn't even remotely relevant here. You could do this measurement while staying at the International Space Station.

Even cheap mirrors from a dollar store are more than good enough for this, as long as they are glass. Most plate glass glass is made by floating melted glass on a bath of molten metal (which is heavier). The molten metal, if undisturbed, provides a perfectly level surface.

Just don't use a plastic mirror, or a cheap polished metal one, not to mention a magnifying mirror.

Even fairly noticeable distortion will not matter at the distances involved in this measurement. Let's say that your mirror is so horribly warped over the tiny ~65 mm pupillary distance that the pupil-to-ruler lines of sight are an entire degree away from being parallel. The measurement will then be off by about 1.7% of the distance from your pupils to the ruler. If you get your eyes within 15 mm of the ruler, the error is only about 0.25 mm; below what you can resolve with that ruler.

If the mirror is fair, but tilted, the effect is negligible because the lines of sight remain parallel. The measurement is diminished according to the cosine of the tilt angle. For a rather significant five degree tilt, it will be only around 0.25 mm short.

About 6-7 months after an exam I went back to get my prescription/PD measurement because I wanted to order something online instead from local shop because of their insane prices and they outright would not give me the measurement. Likely knowing I didn't want to buy frames from them.

They've been closed for years.

I don't think the doctors normally measure the PD, they leave that to the ones who cut the glasses. That really does cause problems for doing it online, though.

PD is actually an automatic part of having that big mass of lenses up against your face and properly positioned for testing. If they don't have that adjusted properly you're not going to see much.

My doctor did leave the PD off the prescription, but I just called the office and asked for it. To their credit, they looked it up for me in their records.

The reason glasses cost so much is because one company owns: (1) nearly all brand name frames including Ray-Ban, Oakley, Prada eyewear, Armani eyewear and so on, (2) nearly all retail stores such as LensCrafters, Pearle Vision, Sears Optical and Target Optical and (3) EyeMed, one of the largest vision insurance companies.

See this eye-opening 60 Minutes story on Luxottica: https://www.youtube.com/watch?v=gDdq2rIqAlM

Luxottica retail brands: http://www.luxottica.com/en/retail-brands

Luxottica eyewear brands: http://www.luxottica.com/en/eyewear-brands

Luxottica vision insurance: http://www.luxottica.com/en/node/6336

In the US, only Costco and Walmart's optical departments are independent of Luxottica.

I worked at Oakley when it was acquired by Lux.

Oakley puts an INSANE amount of R&D into their products, particularly their eyewear. They have laser stations to make sure the optics of the lens doesnt change the perspective of things (the difference between catching a baseball in the glove and in the mouth), "shotgun" tests, weighted spikes, and even have a machine that opens/closes the sunglasses several million times. They test each design and material very thoroughly. Or, at least, they did when I worked there.

If the design didn't survive all of the tolerance parameters, back to the drawing board.

We also subjected our competitors glasses to the same tests. You wouldn't believe how many name brands just fell apart, or blew up into shards of plastic into our dummies' eyes, etc.

When Lux bought us, they made us take down the videos of exploding ray-bans we had on our website (And some other brands). Then they ran our entire department into the ground. Real piece of shit company. Those of us who didn't leave between 08-12 got laid off in ~16 or so.

That’s really sad! Oakley was one of the companies that I respected. They had (have?) great products.

I probably watched all those videos, you could see the amount of work dedicated to each item.

I don’t believe any sunglasses company will ever put the same effort in R&D like them.

Seems to me that since the acquisition they started to use cheaper materials. Maybe I’am right?

Seems that way to me, too. I'm not certain, though, since my contacts have long moved on.

To make matters more interesting, EssilorLuxottica is going to stop separating everything, and start "bundle pricing" things -- so, whatever clarity you might have had on a receipt or something else is going to go out the window.

EssilorLuxottica is probably about 70% Sunglass Hut, 30% Vision when it comes to retail sales (I'm not factoring in Oakley). They also sell their frames on the wholesale market for independent DO's to purchase; pre-merger Luxottica did have some "house" lenses, but, they were just as expensive as Essilor lenses.

Ironically enough, Luxottica did attempt to be Costco's Vision provider for a few years back in the early 2000's, but, they did back out of it after only two years.

There are other non-Luxottica options in the US. Warby Parker, Bailey Nelson, and Ollie Quinn to name a few. Almost everyone sells Essilor frames though but not quite everyone is owned by the eyewear conglomerate. At least with Bailey you can get some quality frames for a decent price.

Does anyone know the non-Luxottica options in Europe, where the market is much more fragmented across countries?

I know about Ace And Tate (NL), GlassesDirect (UK), and Quattrocento (IT) .

Got myself a pair of titanium ace & tate glasses, great quality and good service. Would recommend if you are looking for a pair in NL.

You don't have to be in NL - they ship them to all EU countries and have stores out of Holland too - in UK, Germany, Belgium, plus you can find them in some 3rd party stores now too.

I recommend them as well. Persol (obviously from Luxottica so no good if you don't went to support them but I just couldn't find as stylish, foldable sunglasses elsewhere) and Ace & Tate are my favorite brands but I don't need prescription lenses so that may vary.

Fielmann is a German brand available in several European countries, but I'm not sure if they make their own eyewear.

Still, I can't imagine paying 1000 USD for a pair of glasses. In Poland 100 EUR gives you a decent pair, 200 EUR is already a bit much.

I can recommend Viu. They are available in some European markets and by focusing on a essential selection of frames, they are able to satisfy most peoples needs. Paid 150€ for mine.

I got Mykita frames, but they're not exactly a cheap alternative.

Costco till the day I die.

Aren't they now EssilorLuxottica and also control a good chunk of lenses market as well?

Fun fact: Costco and Walmart surface their lenses on equipment made by Essilor (Satisloh subsidiary). Also if you're buying "transitions" branded photochromatic lenses - that's Essilor too.

If EssilorLuxottica was an American company the EU would have fined them a few billion dollars, and split them up a long time ago.

Why? Which American companies did the EU split up? There was an article in the Economist this week criticising the US for fines levied on foreign businesses for misdeeds elsewhere: https://www.economist.com/leaders/2019/01/19/the-trouble-wit...

It's a recurring theme in HN discussions about fines that all the Americans think the evil EU is unfairly fining fine American companies, and all the Europeans think the evil Americans are unfairly fining their countries' fine companies :)

I was wondering why the US hasn’t gone after Luxottica, and I’m guessing that’s the answer: US crackdown on Lux will lead to retaliatory action by EU.

The US rarely cares about antitrust action anymore. Otherwise a lot of American companies would be sweating bullets right now.

The US however slaps huge fines on foreign companies for breaching sanctions or bribery of foreign officials.

Who cares? EU is already going after American companies.

I'm sure there are very few manufacturers of quality lens-making equipment.

On the other hand my latest glasses where neither lenses nor frame come from E-L cost an arm and a leg, too.

Why does that make the glasses so expensive though? The frames from my glasses were about 100 EUR and the glasses were a lot more expensive. If I ask my parents or other people, they are paying 1000 EUR or more for the glasses by themselves (not the frames). I'm about to get new glasses next month because my current glasses are 6 years old now, I'm looking forward to some new glasses.

That's insane.

I've recently bought a pair of regular glasses as well as prescription sunglasses. Regular ones use Mont Blanc frames(considered expensive) + some pretty good lenses(best ones they offered anyway). Total cost: £400 for everything.

Sunglasses: Ray-Ban frames + their own Ray-Ban G15 prescription lens(again, pretty expensive) - total cost £320 for everything.

I just don't understand - how are those people you mention paying 1000 euro for glasses(I assume you mean lenses)????? Are they some incredibly complex custom lenses that they are getting? Mine are for nearsightedness + slight astigmatism in one eye.

These are specific types of lenses that are for both nearsightedness and farsightedness.

A lot of it just comes down to lack of competition. They own pretty much every major eyewear brand.

I got a pair of $100 Warby Parker frames w/ lenses last week that are every bit as nice as any good designer pair I've seen in an optical shop.

"They are paying 1000 EUR or more for the glasses by themselves"

Where is that?

I have strong short-sightness and astigmatism so I need special lenses, and on top of it I usually ask for the thinner model.

Together with frame it cost me about 300EUR just recently, in Madrid, Spain.

Even the luxottica brands have some cheap options. They are expensive because there is a market for people to spend $200+ on eyewear.

Yep they own the industry, they've tried buying Warby Parker numerous times because they are hurting their monopoly (so I've heard). WP, won't play ball and be bought up.

> The reason glasses cost so much is because one company owns: (1) nearly all brand name frames including Ray-Ban, Oakley, Prada eyewear, Armani eyewear and so on, (2) nearly all retail stores such as LensCrafters, Pearle Vision, Sears Optical and Target Optical and (3) EyeMed, one of the largest vision insurance companies.

The vast majority of my glasses' cost is the lenses, last time around they cost me >$200 each IIRC. I didn't even change the frames, just got the lenses replaced.

That cost too is highly inflated. My wife has a crazy bad eyes/strong prescription and she was able to get glasses including frames for under $70 from Zenni.

If you're paying $400 for just lenses, you're badly over-paying.

> That cost too is highly inflated. My wife has a crazy bad eyes/strong prescription and she was able to get glasses including frames for under $70 from Zenni.

It's a combination of prescription and comfort: I have a strong prescription, thinned lenses, and because I'm pretty sensitive to light (clear eyes) photochromic and AR. Possibly a few other bits I don't remember.

I'm not saying there's no inflation, but going on zenni with my old prescription (and trying to roughly match the options / add-ons) still yields lenses around $200, and I got my current glasses almost 5 years ago.

And Walmart is still very expensive. I commented elsewhere this but they wanted $180-240 just to replace lenses in already existing frames.

I used to do accounting for several retailers. Markups are insane. Brand name frames retailing for €100+ would be purchased from suppliers at €15 or less.

Are they also the reason why optometrists insist that it's an inborn effect, despite all the research pointing towards an environmental cause?

eyebuydirect zenioptical

You want to know what's outrageously expensive, yet equally important for basic ability to function in the workplace and other situations? Hearing aids. Hearing aids are glasses for your ears. But compared to them, glasses are unbelievably dirt cheap, and basically fully covered by a lot of decent company insurance plans. Hearing aids? Not the case.

Imagine if glasses cost $2-3000 per lens. PER LENS. And your company insurance offered to cover some of it, but limited you to ONE PAIR IN YOUR LIFETIME. That's the policy of my Fortune 50 employer believe it or not.

My wife was an office manager at an Audiologist's office. She has some crazy stories about that. Unfortunately, lots of people who don't hear well also shout all the time. Just part of doing business. :-) (Edit: She corrected me. SHE had to shout all the time.)

Also, many people purchase hearing aids and then never wear them, because they can't stand the "new" influx of noise and most of it doesn't seem necessary or even desirable. So they effectively spend the money and then feel ripped off, in a sense. Or their spouse, who paid for the hearing aids and basically feels like they burned up thousands of dollars for nothing, is very upset.

I know if I started to lose my hearing--not all, but maybe 30-40% reduction--I'd probably be quite happy with the turning-down of all that noise I deal with daily. I'd especially like it when spending time with my Cantonese in-laws. Shouting is the default conversational mode there.

As far as turning down noise, I highly recommend Etymotic's ER-20xs[1]: they reduce noise by 20db, and do so more evenly than, say, earplugs. I use them every single day. When walking near roads (cars), on buses, on the subway, at concerts. It's automatic to the point that whenever something gets louder than my comfort level, I pop them in. 99% of people don't notice them, just friends and family.

It's also changed my perception of noise, in that the expected noise level of the roadway is what I hear with them in, for better or for worse. In truly loud environments, such as bars, I find that I actually hear better.

1: https://www.etymotic.com/consumer/hearing-protection/er20xs....

Oh cool, thanks so much for posting this. I've just ordered a pair.

I've always wanted the ability to just "turn down" the sound of everyday life. I've actually wondered if some of my social anxiety has come from hearing sounds a little more intensely than some people, since after a hearing exam I apparently have super good hearing.

At times I've done audio recording without a monitor to hear my own voice. The result is me having in earbuds while speaking, and so I can't hear myself as well.

I noticed that I spoke louder and more confidently. So I've wondered if wearing something like these could be an effective way to help with social anxiety? Guess we'll see. Cheers!

Story time!

A caucasian friend got a ride home by his Chinese friend and dad to visit them.

Once the dad was out of sight, he asked his friend what he was arguing with his dad about.

Chinese friend was confused about the question and didn't understand why he was asking. Then he said: "Oh, we were just talking about how nice the wedding was that we went to".

As I understand it, some of the newer (and likely more expensive) hearing aids support bluetooth, and you can change the levels and tuning from your phone. That would give you the best of both worlds, since you could give yourself good hearing for very important things (meetings, etc) or enjoyable things things that benefit from good hearing (some movies, listening to music, etc).

I've only tried one model, but I was disappointed in the sound quality for music. Hearing aid speakers apparently aren't intended to reproduce the full range of frequencies like headphones.

It's probably convenient for voice calls, though.

I think there are likely some that are okay, given my limited knowledge of the subject, which is really just from hearing Adam Savage talk on the Still Untitled podcast about the new ones he got, how his hearing loss it at a different frequency than most people, and how it used to be a big ordeal to get them tuned for specific frequencies (you had to schedule an appointment). His new ones allowed him to re-tune for different types of listening through his phone.

Even if that capability doesn't specifically address the range frequency required for music listening adequately, I imagine there are specialty hearing aids (likely at a hefty price increase) that do, catering to musicians that suffer hearing loss.

For live sound and for people who don't have too much hearing loss, the hearing aid doesn't have to reproduce all the sound. Instead it supplements what's already there. Some of the sound goes through a vent directly to your ear. A hearing aid doesn't have to reproduce deep bass notes, for example.

And for a lot of live music, it's plenty loud enough and protection from (further) hearing loss would be more of an issue.

The main issue I have with my hearing aid when playing music is that the feedback cancelation isn't as good as I'd like for pure, higher pitched notes. (Feedback protection is needed because sound goes out the vent as well as in and that reaches the microphone.)

This. The prices are unbelievable! And $3000 is for the "cheap" ones! I was about to post the same thing and then found your post.

I will add, that getting access to the frequency curve adjustment software for each device is difficult (everybody needs a different adjustment curve and other params tweaked), prohibited and also expensive. They are often set incorrectly in the first instance and require repeat visits to an audiologist and tweaking.

So much so that I've been considering at all sorts of dodgy routes to getting control of this myself, including reverse engineering and ordering device-coupling hardware from shady non-western web sites, so that I can program them myself.

I'm really really hoping that this market will be disrupted soon, but I'm not holding my breath.

My mother has been mostly deaf her whole life. Just the introduction of Bluetooth in the hearing aid (10 years after it was mainstream) was life changing for her (being able to talk on the phone better, watching movies on her iPad, etc.). But god is the hardware freaking expensive.

Fixing this is my dream job.

Wow. USD 3000 is a bit too much. Can you show an example of which kind of device this is (some link)? When I search on Amazon.com for 'hearing aid', the ones that show up are pretty cheap (e.g. USD 54 to 100ish)? Apologies for my ignorance.

Amazon don't sell hearing aids, and cannot legally. They can sell "hearing assistance" devices or other loophole names (or just foreign sellers that don't give a darn). In the US a hearing aid is only available from medical suppliers via a doctor's prescription.

The person above wasn't being hyperbolic when they said it can be $3K e.g.: https://www.healthyhearing.com/help/hearing-aids/prices

Hearing aides are also insanely cheap to produce, they are not complicated devices and that market is only surviving due to the medical device status of them causing a high barrier to entry.

I’d take issue with “not complicated.” They are very tiny, have to be very low power, and they run a surprising amount of real-time DSP. Then the whole electronics package has to be integrated with an acoustics package including multiple microphones and transducers. And the higher quality all of those acoustical components are, the more transparent the end product. And it all has to be durable enough for continuous wear by a human for multiple years. I wouldn’t diminish what cutting edge hearing aides do, they can be quite impressive technically.

Hearing aids are sold to hunters at a much lower price (as noise protection and low noise enhancement). The same work goes into them, but they are not medical devices so they have to be affordable.

Those hearing aids aren't even remotely close to the $3,000 hearing aids a full-time wearer uses. It's kind of like comparing a free solar-powered swag calculator to a TI-84 graphing calculator.

Although, much like the TI-84, $3,000 hearing aids probably are overpriced.

Comparing these two types of hearing aids is similar to comparing a magnifying glass with normal glasses.

A magnifying glass might do the job good enough, and I know people who decided to not buy glasses but just use a magnifying glass to read.

Or, if your eyes are roughly equivalent in prescription need, you buy a $10 pair of reading glasses at any drug store.

I doubt the size constraint is pressing (as modern electronics go) unless you're trying to hide them. My decades-old high-power analog aids fit behind the ear.

Power constraints seem pretty tight, though. Modern hearing aids have radios in them for continuously sending audio data between the left and right sides, and they run for a week on a hearing aid battery.

Everything you described would be impressive if this were 1980.

This is true - the modern devices with real-time DSP _are_ amazing. I strongly suspect that the eye-watering prices are still massively overblown, though.

I ask seriously: could this be replicated with AirPods and an iPhone, in software?

The latency between the AirPods and the iPhone is too high for the iPhone to do any of the real-time work. I have no idea if the AirPods have a DSP that would be able to do that work.

But cheap, small, low power DSPs can do an amazing amount of work these days. Even if the AirPods don't have such a DSP, they're a good example of a reasonably complex piece of electronics with speakers and a microphone that sits in your ear, but costs an order of magnitude less than hearing aids. I think they're a good datapoint to argue that a truly free market could make much cheaper hearing aids.

I vaguely recall hearing about some work on this front. I suspect however that latency may be an issue.

I wouldn't say "insanely cheap", from what I understand the production costs are something like $50-$150 per unit (not per pair!) and that's with cheap overseas labor, although cheaper devices exist. They are not complicated devices inasmuch as we don't consider circuits complicated, any more. There's a lot of R&D that has gone into making those things work the way they do.

I do think that the prices are inflated, and will drop, I just also think that they're complicated devices that aren't so easy to make.

Those are similar COGS to like, iphones, a luxury good. If they only cost $600-1000 I think that'd be significantly less egregious than $2000-3000.

There are actually some decent alternatives avaliable on alibaba and other Chinese outlets. I helped my father with getting a pair, they were 125 and have been performing well for 1.5 years now. Sure, I wouldn't trust alibaba for most medical devices, but something like hearing aids should be safe enough. His insurance wouldn't kick in anything, and while he could afford the price he would never spend it. Since he so badly needed them, I suggested he try a pair of the cheaper ones, and the difference in quality of life was staggering.

beware of cheap hearing aids, hearing loss is almost never uniform, so if they aren't adjusted properly they can be far too loud in the parts of the audio spectrum where hearing is less damaged, and can in fact cause further hearing loss.

Not that this is any excuse for them costing $20,000, but its something to keep in mind, cheap abibaba ones likely just make all frequencies louder.

It seems like this could easily be solved by selling the hearing aids with a smartphone app to test your hearing and tune the aids, and a pair of flat frequency response headphones for testing.

Read about the OTC hearing aid law signed 2 years ago. http://www.hearingreview.com/2017/08/president-trump-signs-o...

tl;dr: The gist is that, by near year I think, people with mild-to-moderate hearing loss will be able to buy hearing aids without having to see a doctor or get a prescription. (I'm always amazed when the bureaucracy makes something easier rather than more difficult.)

Retirees have lots of time to vote.

This is essentially the system sold by Blamey Saunders in Australia. My pair work reasonably well.

Wow, it's crazy that those are still $3000 for essentially a microphone, DSP chip, maybe a small microcontroller and a BLE chip, and a driver. Something like the Airpods are probably on the same level of technical complexity, but an order of magnitude cheaper.

Can you post a link to the model you got? Looking for alternatives for my dad as well. Thanks.

Decent hearing aides are quite expensive, complex devices with a substantial amount of R&D and non-trivial silicon.

For those who are interested, The Amp Hour has a great episode with Jørgen Jakobsen who talks about his experience in the industry and its quirks.


How are hearing aids priced in other countries compared to the US?

I live in the former USSR, in a very poor country. Hearing aids here are primitive, no fancy schmancy DSP bad really cheap. $10-20 or smth.

I think this is why Bose entered the market with “hearphones” to help hear people in crowded bars. So they could try to market them without spending the money to be a medical device.

> help hear people in crowded bars.

It's a tall people problem too. You can hear everyone in the bar except person in front of you, 30cm below.

It’s a short people problem too, for the same reason. At least the tall person can lean over.

What a relief to know I’m not the only one!

Bose just recently got FDA approval for their first non-prescription/self fitting hearing aids.

This applies to all medical everything.

Yes, this is true. I'm actually fortunate in that I'm completely deaf in one ear and "only" profoundly deaf in the other. That means I only have to spend $3000 instead of 2x that. It's ridiculous. My hearing aid is 6 years old and I'm sure it's about to fail, but I can't afford a new one right now. It's absolute insanity.

Do the $3000 hearing aids differ significantly than, say, this:


My $3,000 hearing aid (which has allowed me to hear better than I ever have before and is worth every dollar) has, for example, 2 microphones, 4 switchable DSP programs to match different sound environments, telecoil (essential in my work), a level of water resistance (sweat and dirt is the primary killer of my hearing aids, worn 18 hours a day), and with an external receiver I can directly receive bluetooth and external microphones.

Yes, mine does the same. It's a really nice hearing aid. It's just a shame it's so expensive and not covered by insurance. I literally cannot function at a job without one, but insurance (or disability) won't cover it. Bizarre.

That’s about $150 worth of parts.

Plus R&D, plus technical and warranty support, plus 6 audiologist fitting appointments, plus all the other standard business expenses and, yes, profit.

Parts are a minor piece of the puzzle.

I'm not sure. My hearing loss is bad enough ("profoundly deaf" --- basically, the next level down is "totally deaf") that I wouldn't try an off the shelf aid without an audiologist's support.

Go to Costco, if you are willing to pass up oticons.

I had a $6000 pair of hearing aids that were lost. I replaced them with $1600 pair from Costco. Most of the time I can’t tell the difference. When I can, I wouldn’t be able to say which is better, just that I notice they didn’t sound the same.

Yeah. I've demoed the Costco ones, but they weren't great. My hearing loss isn't just a minor loss. I'm classified as "profoundly deaf", which requires serious amplification. Unfortunately, Oticon and its ilk are the ones that allow me to be functional in the real world :/

I'd encourage HNers to try self-programming.

I have Phonak HAs so I can buy the programmer (iCube) and software (Target) off ebay for $450 and a pair of hearing aids two generations old for $500-$1000. And if they break or I lose them, buy a replacement and the total is still less than buying from an audiologist.

It's also more flexible. Hearing feedback? Run the feedback test/modeling program. Can swap hearing aids between ears. Friend lose a hearing aid? Let them borrow yours (suitably programmed) and use foam inserts for earmolds (can buy or take a soldering iron to foam earplugs).

One word: Costco. The hearing aids alone pay for decades of membership fees.

My partner used to spend $10,000AUD on each hearing aid. It was insane. Now that we're going to Costco, she's paying $3000AUD each. It's still really expensive, but it's a darn sight better.

I think the OTC hearing aid law will go into effect next year. For mild of moderate hearing loss, you will be able to buy the hearing aid directly without dealing with the hearing aid specialist.

It was signed in August 2017 and the FDA has 3 years to allow sale of hearing aids for mild to moderate hearing loss.

Yeah, hearing aids seem to be a clearly over priced pseudo-monoplistic small set of companies. There are people selling mobile phone connected hearing aid like things for drastically less money, but they run into the hearing aid cabal.

I'm using hearing aids for almost 8 years now. Without them I can't interact with people without shouting or repeatedly asking them to repeat what they have said. I always have to take them out if I want to listen to music, when it rains very heavy, have to take shower or want to wear some headphones.

Initially it was very hard, but after a while you create habits around them and they become very natural. But still, even with a hearing aid, dont' forget that it doesn't improve your hearing, it just normalizes to a level where you can hear normal. In fact, because you're now running all the sound through a filter, a lot of frequencies get lost (in addition to the ones you're not able to hear anymore).

Anyway, I agree that nobody talks about the pricing. A good pair (say Oticon OPN 1) would cost me minimum $6.5K. Looking forward to see how Bose disrupts the whole industry with their entry level "hearphones".

Hearing aid is medical device. That means lots of regulation, entire floor full of departments existing just to make sure things pass regulatory assessments. Remove those and the cost might come down significantly, but will be willing to do that?

i believe it.

bose might be poised to get in to that market. their 'hearphones' struck me as a first attempt, although it's not marketed as a medical device (AFAIR).

AirPods are being used as de facto hearing aids as well.


I'm seeing more and more of these "smart headphones" that happen to maybe increase selective noises and cancel some others out but are not "hearing aids" due to the medical device designation.

i've been using bose qc20 for a few years for the noise cancelling. I'm curious about the 'hearphones' - to know if the effect is similar to the qc20 'pass through' mode - which still muffles some background noise but opens up to allow voice frequencies through. can't get any clarification if the effect is similar or something radically new, and don't want to spend that much $ to find out. :)

I learned you can't assume anything when you buy an expensive set of noise-canceling headphones and then spend an international flight with two people behind you prattling. It just made their conversation clearer.

Also nearly jumped out of my seat in a terminal when a gate announcement was made. Guy across from me pulled out his IEM and said "you know airports increased the volumes on their announcements because people wearing headphones were missing their flights?"

IEMs - best invention ever. Can't wait for adblock glasses.

QC20 are 'in-ear' not 'over the ear', with their molded rubbery ear plug things to help block out leakage. they're not perfect, and on their own, yes, noise cancelling can just make voice somewhat clearer. I always pipe a bit of grey noise through the ears to mask that (unless I'm piping music through).

Overall they're pretty good though. Until I got a pair and watched movies in a plane wearing them I never really realized how high I had to pump the volume to overcome the engine noise.I pretty much wear them all the time in a plane now even if just to use the noise cancelling.

I have a pair of Sony MDX-1000X headphones. Very good noise canceling. Passthru is a joke though. Everything passthru is slightly usable. Vvice passthru is horrible.

Bose recently got FDA approval for their "self-fitting hearing aid"


iOS 12 Live Listen can use airpods to relay audio from the iPhone mike, a capability previously limited to hearing aids. Can be useful in a pinch.


There is a new company out there that solves the cost problem by offering advanced hearing aids with a remote care from an audiologist using video conference (vs. a doctor's office visit). A friend of a friend loves their device and said that service was really good too. http://listenlively.com

What's crazier is that cochlear implants are covered by insurance.

Free Market! Free market anyone!?

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