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.
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.
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.
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).
