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The Great American Eye Exam Scam (theatlantic.com)
365 points by theothermkn 62 days ago | hide | past | web | favorite | 331 comments

Yes! It's so infuriating. I usually go to Chinatown where they will sell you contacts without an exam or prescription.

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

>I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want.

Ha!! Many woman feel this way about birth control! It's held hostage until you get a pap smear. Yearly pap smear, mind you, evidence and recommendations to the contrary be damned. This is despite the fact that cervical cancer screenings have zero to do with safety of birth control.

Just to be clear, cervical cancer screenings are very good! Especially so when done at evidence based intervals. But birth control can be safely prescribed without it, yet many health care providers require a pap test before they prescribe birth control.

I think the recommendation from USPSTF is every 3 years. If a provider is forcing yearly examinations on you without a good reason (i.e. suspicious findings on the path report) then I would consider talking to your provider or finding a new one.

edit: Here is a link to the recommendation https://www.uspreventiveservicestaskforce.org/Page/Document/...

> But I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want.

Happens to women too for birth control.

My dentist pushes a periodic "comprehensive/full panel" xray. More than the usual, and claimed the justification was in case I have jaw cancer or something serious (non tooth/gum) related problem.

I asked what about all the rest of the bones in my body?

I skipped it.

Mine does as well, once every three or five years or so? It's (also) so that they can see whether a cavity is forming underneath an existing filling, for example.

Mind you it's covered by my dental insurance so it's fine.

Roll the story where the person has an abscess and dies from it weeks later

Happened to my mother's second husband. Tho, as sibling comment points out, that came down to avoiding medical treatment for something quite painful for so long that it became life-threatening.

Seems unlikely, at least for people willing to seek medical care when they have a surprisingly pain in their jaw.

Large doses of xrays aren't without risk. Apparently the comprehensive xray uses 4-6x the exposure of a normal xray.

I was willing to seek medical care for the ongoing pain of TMJ and I didn't because what I can afford is one Dr visit & one RX for generic opioids (the only treatment that touches that pain).

But there was no point. The only Dr I could afford became terrified of prescribing opioids (thanks DEA. yes it was the DEA). No matter that I had, for years and years, taken opioids responsibly.

However it's no longer a problem. That only Dr - that countless thousands of us could afford to visit - just closed up shop.

Am I willing? Sure. Able, no. Not in any way.


So taking that xray every 3-5 years saves you from the death in a few weeks? Or should you take the xray weekly?

This is key here. As a general rule of thumb is some information has no influence on the course of action then it is useless, as interesting as it may be. In this case you have the odd chance of that 5 year exam catching the problem at just the right time, but the overwhelming probability is that it will even show nothing (in which case you do nothing) or that you are about to die (in which case you can do nothing).

5-6% of cancer comes from excess medical imaging.


It was an obvious joke.

Not all that obvious. We actually do have statistics on how X-ray scans affect your cancer odds. Full-body scans and other intense X-rays can have a 1 in 1000 chance of killing you in a couple of decades; most doctors won't consider them unless the condition they're hoping to diagnose is more dangerous than that.

Unfortunately not. Folks have some odd beliefs about medicine and with this, it isn't unlikely that a certain percentage of folks get cancer from medical treatments. I imagine that number is less in the modern world than it was before I was born. We did use Xrays to check how shoes fit, after all.


Or to get a blood test to see what kind of blood type you are, it’s not even enough to go to a primary cRe doctor and then get a lab ordered. They will try to resist telling you! Supposedly there is “no need” for you to know that information, and you can’t simply take a blood test from a lab without a PCP ordering it. Try it!

Luckily there is a loophole when you donate blood.

Or you can do your own lab, but I wouldn’t recommend it.

The "no need" is so patently false. Notwithstanding the obvious privacy implications (your data belongs to you), first thing asked for if you are in the ER bleeding? Bloodtype.

We never rely on patients telling us their blood tyoe, or even past lab results. A test must have been performed recently (in my hospital it’s within the last seven days) for the blood bank to dispense blood.

If there is a major haemorrhage the patient will receive the universal donor (O-) while the test for definitive blood type is performed.

I was told that it makes a difference what the patient or their records claim, because it can accelerate obtaining the correct result. Since, it was alleged to me, you don't do a test for "what's your blood type", but rather something more like "is your blood type A-?". Therefore, if they say "oh, I'm O+", you can just run the test "is this person O+?".

Is that not the case?

Doubtful. The risk of giving the wrong blood is so high that the hospital should only rely on a test done right then and there.

Standard procedure as far as I know in German ERs (at least a while back, my mother used to work in clinical laboratories). Even if you have your blood type tattooed on your forehead and a passport stating it they still do it. Because the test is easy and fast, relying on your own up-to-date tests is safer then anything else. If there really is not enough time they could still use 0 negative blood I think.

Nope. I've been to the ER with a head wound that would not stop bleeding, and was never asked for my blood type.

Had they asked, I would have given the wrong answer. My blood was typed when I was born. 25 years later when I started donating blood, I was typed again -- and told a different type.

My physicians and phlebotomists assure me blood type cannot change, and old blood tests were simply not very accurate. I don't know any lab or clinic that trusts what someone else claims about blood type.

There are labs online that will gladly take your money for that, where they'll have a healthcare professional order the test and make the results available online.

A quick Google search returns this, for example: https://questdirect.questdiagnostics.com/products/blood-type...

I did exactly this, went to Quest diagnostics from an online thing and in the end they don’t give you the blood type or Rh factor. It’s just a standard test for various STIs etc.

I asked my PCP what my blood type was when I was getting blood tests for other things and he told me the same thing.

It’s most likely he doesn’t know. Order that test would be very strange for a PCP. Typically you’re only getting typed and screened if you’re about to surgery/birth/donate. This is so they can act quick to transfuse you if needed or know who to give your donated blood to. You need to ask your doctor to order this test for you and tell them your ok paying for it because it won’t get approved without reason. From a PCP perspective, he’s monitoring your cholesterol, blood counts, etc. knowing your blood type has no medical significance to him.

Thats just what the other commenter said. They won't tell you-- IE: test for-- your blood type unless they have a reason to.


And btw there is a good reason to know. Look up for example Rh sensitivity, for pregnancy reasons. A woman who had a miscarriage and was Rh negative may be sensitized and won’t be able to have children with someone that has Rh positive blood. At least - it isn’t advisable!

Ask the lab for your results. They have no problem providing it

you can get a finger prick test on amazon for something like $10

In Europe you can do it easily, no prescription needed. Costs below €10.

Any more information about how and where I'd go about this?

But it depends where exactly in Europe you live. For example if you live in Milan, you can check it here: https://www.deltamedica.net/en/laboratorio-analisi/tests-and... - this lab is on the expensive side as they ask for €14.

Where I'm from, it's done at birth, it's just a standard part of a medical registration package thing your parents get. My parents kept my bloodtype card right next to my childhood vaccination records.

It's not like your bloodtype changes over time...

It can actually change in some cases. Liver transplants and bone marrow donations can trigger a change. Apparently kids a few weeks old can flip on their own as well.

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

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

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

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

Exactly. The fact that some procedure may be a really good idea doesn’t mean it should be a prerequisite for some unrelated thing that is also important. You shouldn’t have to get a yearly physical to be able to register to vote.

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

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

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

Should we restrict toothbrushes to be only available with a prescription from a dentist to encourage regular cleaning and inspection?

The added burden may also dissuade people from getting either thing in the first place.

In Germany they usually just give you a little credit-card-sized card with your glasses that has all the information about the lenses (and thus your prescription) on it.

yes, tho the point of the article is that you need a fast expiring prescription in the US. Even if you have the information you cannot directly buy glasses.

Wow, even worse:

> Thankfully, I knew that two laws, one passed in 1997 and the other in 2003—which had, incidentally, been loudly opposed by the AOA—gave me the right to demand a copy of my prescription.

They don't even tell you the numbers, unless you insist. On they used to not tell you the numbers at all even after insisting..

Not from a brick and mortar store, but you can online from places like Zenni.

I think many people don't hear this enough. Eye exams can catch things and since a lot of the people I know get a good 4~6 years out of their glasses it makes since to get an exam when replacing them. Sure, exams might cost time/money but most people just don't hear the story of going to get a new pair of glasses and being saved from xyz eye condition story enough. I live outside the USA now and to get contacts you need a recent eye exam to purchase them. I think this works out good because the country I live in has a high number of contact users and I feel it ensures better health for the great amount of those who need vision correction.

Eye exams catch problems in the healthcare wealthy. They catch nothing in the dozens of millions of Americans who aren't (and haven't been).

Sounds like a great reason to subsidize yearly eye exams for those who can't afford them. Or even to cover the cost of an annual exam for every person, to avoid the usual problems with means testing.

I usually travel with an extra pair of glasses. My preferred frames, including lenses, are $30 from Zenni.

I’ve been using the same prescription for about 6 years, it may be about time to see an optometrist and get my eyes checked out...

It's funny how lens.com requires a scan of a valid prescription and will not fill it after it expires-- stating something about a law. They even send email recommending that you stock up before it does. So I bought 2+ years worth, got ~50% "back" as "rebates", and then emptied their spend-tracking "rebate card" into the phone bill for the number they already had.

This must be merely what "increased access to eye exams and eye doctors" means in the USA.

Zenni lets you punch in your own numbers and takes your money and gives you glasses. These are a bit strong (my eyes have to adjust) but they are satisfactory.

Someone who isn't me has forged eye prescriptions with Photoshop to get around this problem to buy contacts and glasses online. I don't know in how much legal trouble he could get, but I think many people can understand.

I have severe allergies that occasionally requires epinephrine... without an annual checkup doctors typically won’t give me a prescription. I’ve similarly been hospitalized for asthma, same deal with an inhaler.

I had to really hunt to find a doctor who would give me a prescription without an annual checkup.

Legally they can’t. If you have a steroidal inhaler, you’ll need to be evaluated every few months to ensure the steroids are hitting your lungs instead of blood stream.

> If you have a steroidal inhaler, you’ll need to be evaluated every few months... [emphasis added]

I am reasonably sure this is not true, at least for most people's definition of "few".

Came here to post this same experience. I have terrible asthma and allergies that are completely controlled by the typical prescription medications that any lay person would select after a few minutes of googling, but I can only receive access to them for up to one year without going back to a doctor.

The result is I often run out at inopportune times so I try to hoard / ration medication to avoid that situation.

Medical paternalism was the norm until surprisingly recently. See


I can see the case for it, I mean, I don't go into a car dealership and approve or deny which parts are to be replaced or which procedures are necessary. I have no basis for knowing.

Yes, but if you insist, your mechanic will probably still do what you ask them, as long a you pay up.

I’m 50/50 on this. The dealerships can be mindless flow-chart followers:

It’ll say “When A occurs, try replacing X” and they’ll do that, even though my notes stated that I switched all the Xs around and the problem didn’t move with them.

Yes. And sometimes I even want a service provider that insists they know better. (Eg I frequent some coffee shops like that.)

The crucial thing is that there are alternative providers where I can get exactly what I say I want, and get it.

As a former mechanic, at least my shop would occasionally refuse to let a vehicle leave the shop- the one example that I remember most clearly was a SUV that came in for an oil change. The owner was planning on a 800 mile trip with their family and wanted an oil change before leaving. One of the wheels had a serious suspension problem, and would likely fall off shortly & cause a rollover.

We weren't going to let that truck leave our shop w/o getting fixed, none of us wanted dead kids on our conscience. We extended credit to the customer & cut our rate so the owner could afford it. Point being, in this case we definitely knew better than the customer, somehow they didn't realize a wheel falling off at highway speed is dangerous. P

However, that was a very rare situation. If a customer insisted they wanted work done that we didn't feel was necessary, we would tell them so but still do the work if they wanted it.

Sure. And you can take steps toward dealing with ignorance that are still compatible with informed consent. For example, we should ban the advertising of prescription drugs on television. Most other respectable countries do.

Most would see that as an argument in support of paternalism, and as do I, which is why I agree with your position. Advertising drugs to consumers is akin to advertising specialty testing equipment to individuals: at best neutral and at worst harmful. You have no business self-diagnosing with a risk of stroke and running in there to demand Plavix. There should be no world in which the doctor goes, "Huh, Plavix! I've never heard of it, and if you think you're at risk of stroke, well bud, here you go, one years supply."

I do that all the time.

If you have a digestive disease your Dr may refuse to fill your prescription if your last colonoscopy was more than ~2 years ago. Even if you have a less serious condition.

(I'm providing another example, but I agree they shouldnt withhold care.)

They should care and ask you to do it, but no need for them to insist (or for there to even be a law or regulation to force them to insist).

Something that I don't understand (and I haven't lived in the USA to know): when you get tested for something, you don't walk away with the results? They are kept in some system that only the MD who asked for them have access ??? You are unable to give the results to some other doctor, asking for a second opinion?

Yes, that is accurate.

In the US, lab results are nearly always sent to the doctor who prescribed the tests, not to the patient. (And most tests cannot be requested without a doctor's order.) Some doctors are good about sharing the detailed results with their patients while others are not.

You can ask your doctor to send the results to another doctor (more often you just tell the new doctor to request them from the original doc). By law you are entitled to a copy of your medical record yourself but with many doctors it is surprisingly difficult to get them to do this. I have heard of cases where it took many weeks and the threat of a lawsuit.

Ostensibly, the reason for this state of affairs is so a patient can have a professional help explain and interpret the results.

I can go online and get all of my test results including graphs that show change. X-ray reports. The only thing not online is surgical notes, but I easier got copies of them. This is from the UCLA healthcare system. Also Quest labs has online results to patients. This is in CA. My brother-in-law, could not get results from tests in Virginia to get a second opinion. Perhaps it varies by state.

I had the option of having all test results emailed to me. I had the results of my physical before my doctor did. This is a result of modern medical information systems.

I go to a VA medical center and every word they have written about me, all my labs and scans are available online.

> But I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want.

Certain medications require regular testing (example I'm familiar with is Orkambi for Cystic Fibrosis, and regular liver screens are required due to potential side effects), and the prescribing doctor won't renew those prescriptions otherwise.

That's the opposite of unrelated. They're worried the medications are going to damage you.

True - I misread the quote

Healthcare has always been used by their practitioners as a tool to extract money from customers.

Often they will say "it's for your own good".

In reality, it's just a cartel, extremely protected by government regulation.

For some reason, people think that the rules of economics don't apply when it comes to healthcare.

That's less true now than it used to be, but it's worth remembering that the AMA killed universal healthcare in the US... in the 1950s! They were specifically worried about doctor's wages and fees going down.

Ask your optometrist why that argument fails for people who don't need vision correction.

Happens to transgender people to get HRT.

Informed consent is a thing in most of the US now.

Most of USA isn't all. I don't follow the USA anymore since moving to Canada but when I lived in USA it wasn't informed consent in my area. Nevertheless I was downvoted for giving another example to OP. I would also say the needing a prescription for the years I did.. ruined my life because all doctors for years would deny me on religious grounds.

Can't wearing "good enough" glasses and contacts cause vision quality to degrade faster?

I've been wearing my "good enough" glasses about twenty years now. I know what the perfect vision feels like (I can get 20/10 easily with "right glasses") but that is just too much for me. I just can't live with that, everything is way too sharp. Glasses that give me 20/20 but no more make me feel much better. I always order online nowadays, and never have been subjected to this American "you need prescription/license (= pay) for this" way of dumbing things down.

In general, degrading quality of vision is most likely a symptom of something. Needing reading glasses when you age is the only exception, that is just normal.

> ... prescriptions expire so quickly ...

If you mean 'come with a written expiration date,' then mine never have and I would find this practice abhorrent.

If you mean 'really is no good in six months,' then your eyes are actually changing.

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

Meanwhile everyone else is like:

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

When I was in China I wanted to get a cheap pair of prescription glasses. So I did, in an underground subway mall. Took 30 minutes. They (definitely not an eye doctor, more of a small shop owner) used a small handheld device to measure my prescription and then told me to come back in 30 minutes after I had chosen frames. I paid $40.

Ditto. In Beijing there's a multi-story building full of stores selling glasses. I walked around until someone spoke to me in English, they used a gizmo to automatically measure my prescription. I picked out a brand name pair of frames. The salesman told me to come back in an hour.

Voila a cheap (~$40US) spare pair of glasses.

A former optometrist of mine once gave me a 5 minute lecture on how I must buy my glasses from him because he makes no money from doing exams.

Cry me a river... guess ya should have gone into dentistry.

I found that the lenses quality wasn’t as good when buying in Beijing. They have (or just use?) better tech in the states for churning out lenses that aren’t overly heavy or thick. Perhaps it’s just an artifact of the glasses costing a few hundred kuai.

I’ve seen US based manufacturing. There is a mix of material type selection. But there is also a lot of machinery and automation being used. Also stringent QA. Nothing done in an hour was done well, this much I know.

Honestly I'd be highly surprised if producing a single pair of glasses would take more than an hour end-to-end, as long as you aren't grinding them by hand. With modern plastic lenses it's basically a CNC machining operation followed by a couple of polishing steps. There's no reason you can't do a pair with basically no automation aside from the CNC in an hour easily. And that includes sticking them in a lensmeter to check if the prescription matches for QA.

Of course more complex things such as antireflective coatings add a sputtering step to the process which might be a bit much to expect a shop to do in-house.

I will say that the pair of glasses or received was not as good as one I could have bought in the States. The Chinese glasses I got were usable, and I did use them for years, but when they broke and I purchased glasses in the US going through the standard process, I was reminded of how high quality glasses here can be.

This is reminiscent of the principle that marginal improvements become exponentially more expensive as we seek ever more improvement.

Sure I could get a decent pair of glasses in China for $40, but to get a truly great pair of glasses, the increase in cost that comes with that quality will be disproportionate to the quality itself.

Neat - it looks like handheld ophthalmic auto refractometers are $4k-ish on alibaba.

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

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

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

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

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

Yeah, that expired proper prescription wasn't for toric lenses like I (supposedly) had decades ago. That first time they didn't even tell me the lenses had to be inserted at some correct orientation, and I don't remember seeing the marking on the lens, either... though they did tell me the lenses would cost a bit more. What was the point?

Oh wow

Yeah, that takes a while, even with someone explaining it to you

theoretically they should rotate to match the axis if they're slightly out of position, but if it's way out of position it won't.

Not to mention manufacturers have different ways of indicating this (with different degrees of weirdness)

> it can be surprisingly hard in many places to get lenses for rarer eye conditions.

Indeed, ZenniOptical sunglasses simply don't come in m prescription. It flat out tells me to select their regular frames and pay for the tinting. Between my astigmatism and my prism in each eye I'm fairly limited.

Or it just gets expensive. Last Friday I was curious about the new Oculus but hate how VR headsets like my friend's Vive shove my glasses into my face or just simply don't fit and looked at inserts for it, the cheapest I could find from the companies that manufacturer the lenses were 98$ per eye.

It is even worse with strong astigmatism. I have over 3 diopter according to multiple wavefront aberrometer and photokeratoscopy measurements, but the opticians always want to put a 2.5 or even 1.5 cylinder, because they do not believe it can get that high.

I'm -3.25 cylinder for each eye, plus need a prism of 0.5 down in one and 0.5 up in the other. I feel your pain.

Does it really matter much?

I have it, recently got glasses and it annoys me that in my peripheral vision and while moving things get a little distorted. Glasses without astigmatism correction seem like a valid choice.

I apparently had a very mild case of astigmatism that went undetected for years. It was so mild that it was easy to 'correct' for it by increasing the strength of the lenses. Now that I have the lenses with astigmatism correction life is much better. My eyes do not tire as quickly and I see more clearly at far distances than I used to. Granted I am sensitive to these small differences, but life quality improvement is vast.

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

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

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

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

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

You need a prescription only if you want the social security/insurances to pay for the the glasses. If you pay for them yourself, there is no need. Additionally, many opticians consider themselves and act as optometrists.

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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




I got mine on AliExpress, titanium, lightweight, lenses with coating and anti-glare. $25 shipped. Got a second pair for about $32. I already had my eye exam paperwork and just sent them an image. It took about 4 weeks each time. Considering sun glasses next. Will be expensive, maybe $45!

The prescription I got at America's Choice, got the cheapest possible (maybe $50), but for $70 got two pairs of glasses (total cost with the prescription), but the quality was nowhere near that of the glasses from China.

And note: you can get even cheaper at AliExpress (under $20 lenses and frames). I just opted for a best seller that was slightly more to play it safe.

That's crazy! What did you search for on aliexpress? Were they poly carb lenses?

See my reply to xenhim

Could you please post a link to the vendor you used?

Handoer and EOOUOOE were the two brands I used. Basically I just searched for men's glasses and then looked for some models that already had many orders. Then I chatted a little with vendor to make sure I got the right lenses, and also give them my prescription.

I really like goggles4u.com, I've been ordering from them since 2011 and it looks like $37.31 shipped was the most I ever paid for a pair of glasses. They regularly have sales and I got a pair once for $2.69.

They aren't the greatest frames in the world but they're definitely punching above their weight.

The lenses are fine, I'm nearsighted with minor correction and an astigmatism and I have no complaints.

I like that when I need new glasses, I can order two pairs and sunglasses for less than $100 shipped.

Not affiliated with the company in any way, but I'd also recommend Shuron: https://www.shuron.com/index.htm

The Ronsir Zyl, Freeway, or Sidewinder frames all appeal to me. Shuron makes quality, practical frames and allows you to choose temple length, width, and other frame dimensions, and they have stellar customer service.

There's some variation in whether online vendors will require a prescription or not. The first one I tried did, so the second one got my money. AIUI there's not a federal law requiring a prescription, but there are many state laws. Often, they make a distinction between positive and negative prescriptions, which is why you can buy reading glasses (to correct farsightedness) everywhere but have much more limited options for distance glasses (to correct nearsightedness). I guess some vendors can't be bothered figuring out which laws apply to a particular sale and just apply the strictest.

I've used coastal.com for years. Never needed a prescription. Found it by googling something like "buy glasses online". I'm reading all the comments in this thread feeling like so many here have never heard of a Google search before.

And I'm now thinking about what I'm not searching for because I think it's not available to me. Hmmm.

I bought my latest glasses from eyebuydirect.com. Read the reviews first and saw a couple of people lamenting low-quality frames, so I added a spare pair of frames to the order.

Overall, very happy. Shipped quickly, frames are pretty good, lenses are just right.

Without an official prescription, shipped to a US address?

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

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

The app is PD Meter from Glassifyme.

yes. you just need to know the correct numbers.

I've personally bought from eyebuydirect several times, and vision pros once.

Vision pros was $200 for a pair of glasses. I found EyeBuyDirect later and I think the glasses I ordered were closer to $40 a pair.

Proof of prescription is not required to buy glass in the United States, however it is for contacts. You can get those too without an official prescription shipped to a US address. It’s not legal but in most of the world contacts are sold OTC so they are not exactly hard to get ahold of.

It’s easy to get glasses without a prescription.

But how do you know what to order? I just finished the article and I still feel like I'm missing something about this point.

Somebody tested you in the past and you got a pair that works fine. You still have the numbers from last time and you want another pair.

How do you know if your current pair is "working fine", though? I've been wearing glasses for 20+ years and I'm not confident/aware/knowledgeable enough to know if my current prescription is, "working fine".

So there’s some need to take a vision test periodically. You actually don’t need a professional for this, you can print an eye chart off the internet.

Even so, the need to get your vision tested is often not related to the need to replace your glasses because they broke or you lost them.

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

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

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

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

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

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

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

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

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

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

> - One free eye exam each year covered by Medicare

Only if you're over 65! Otherwise its one exam every three years for a standard exam. [1]

It's been a while since my last check, but last time I went they did try upselling to some more advanced scan that wasn't covered by medicare.

Either way, still think we're doing something right in Australia but having this base coverage for everyone.

[1] https://www.humanservices.gov.au/individuals/subjects/whats-...

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

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

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

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

Absolutely no offense intended, but it sounds to me like you want to make that decision for them.

That line of thought can be used to justify a huge amount of intrusion into people’s lives.

Hence my suggestion to give poor people money.

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

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

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

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

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

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

Poor person on disability here. Medicare in the United States gives zero dollars for eye exams and glasses, so good on Australia for actually caring about their needy. The process of losing nearly everything I owned due to my work-acquired disability and trying to navigate the confusing and mentally arduous process of getting benefits has been every bit as bad as the disability itself. Getting benefits is so confusing that I normally just don't bother. I for one would much rather receive an eye exam and prescription instead of yet another confusing bureaucratic layer between myself and my health disguised as a "choice". I would also assume that whatever stipend the government would come up with, it would pale in value to the cost of the actual procedures involved. And thank you ajnin for speaking up for us.

My suggestion was not to add a bureaucratic layer, but to just hand out the cost of the procedure in cash with no questions asked.

Of course, in practice the government would probably come up with silly layers and restrictions on how to use the money etc.

And even more cynically, many poor people will prioritize cigarettes and alcohol above food and shelter

You don't even need to be a cynic -- when you're addicted, the addiction comes first. First, before food, sleep, shelter, family and health.

The idea of giving cash is, frankly, asinine. The objective is not to increase the recipients spending power, but to reduce health problems population wide, reducing expensive medical interventions and productivity-draining disability.

Do you have a source to back up this assertion - in particular “many poor people?”

The streets of San Francisco and Seattle.

Private healthcare is almost a scam. It allows providers to charge much higher prices (thus increasing premiums) and makes affordable healthcare even more inaccessable.

A Medicare levy, while not ideal, is a fair system. You don't pay it if you don't pay tax, it is proportionate to your income, and it allows a basic level of care for those who need it. Everybody needs eye checks. Poor people get them for free. People earning an income pay for them.

> Private healthcare is almost a scam. It allows providers to charge much higher prices (thus increasing premiums) and makes affordable healthcare even more inaccessable.

Could you back that up? Are you talking about a specific country, or all manners of private healthcare?

As far as I can tell, the least regulated bits of healthcare systems that people pay out of pocket for tend to have done the best in terms of cost control.

Eg few if any insurances around the world pays for laser eye surgery. And it's one of the few common healthcare procedures whose costs have dropped massively in recent decades.

> A Medicare levy, while not ideal, is a fair system. You don't pay it if you don't pay tax, it is proportionate to your income, and it allows a basic level of care for those who need it. Everybody needs eye checks. Poor people get them for free. People earning an income pay for them.

That seems like a good argument in favour of taxing the well-to-do to give the poor money. That's a fine decision for a democracy to make.

But I don't see the argument of forcing the poor to spend that money on healthcare instead of letting them decide what's best for themselves. Do you know what they need better than them?

"Eg few if any insurances around the world pays for laser eye surgery. And it's one of the few common healthcare procedures whose costs have dropped massively in recent decades"

I don't know that an elective procedure is the best example, but it's still an example. One counter is prescription drugs. My insurance would only allow a small number of tablets for my migraine medication because the cost for them was so artificially high. When I called the insurance company to ask why they wouldn't pay for the number of tablets that I needed, I was told that my doctor should do a better job of controlling the number of migraines that I get. Where do I get this medication now that I don't have insurance? From countries that have socialized medicine, and the cost is substantially less. Unreasonably high costs for prescription meds in the US is not unusual. I recently had to take doxycycline for Lyme disease. Back in 2012, this cost 6 cents per dose. That price increased by over 6,000 in one year, just as Lyme cases were also skyrocketing.

Yes, the medical system in the US sucks. There are parts of the world where it works much better. (And not all of them have socialized health care.)

In any case, the socialized health care probably doesn't cover the drugs that get to exported to foreigners like you?

> Unreasonably high costs for prescription meds in the US is not unusual.

Yes, that's a separate problem.

Enabling (re-) imports is an important safety valve. Medical tourism is another.

Ideally, the US would fix their healthcare system. But I wouldn't hold my breath.

> In any case, the socialized health care probably doesn't cover the drugs that get to exported to foreigners like you?

Maybe I'm misunderstanding, but large markets (socialised healthcare systems) can negotiate a fair market price for medications. This is something that the US system prevents.

Have a look at mebendazole. It's on the WHO list of essential medication. It's old so available as generic.

In the UK this costs a few pounds per tablet. https://bnf.nice.org.uk/medicinal-forms/mebendazole.html

In the US it currently costs $440 (about £340) per tablet.

There are many similar examples: Americans pay huge amounts for medications that should be cheap.

In economics, the usual prescription for high price despite low manufacturing costs is to lower barriers to entry.

There's probably a legal reason why someone can't just set up a company to buy mebendazole in bulk in the UK and ship it to the US and sell it for eg $200 per tablet?

> There are parts of the world where it works much better. (And not all of them have socialized health care.)

Almost all developed countries have socialized healthcare. What countries do you have in mind?

It depends a bit on exactly what you mean by socialized, but I have the Singaporean system in mind. (I was just quoting Cougher when using the term socialized.)

Singapore has some of the best healthcare outcomes in the world, and costs about half as much as a share of GDP per capita as the British NHS.

Where the American system seems to combine the worst of public and private healthcare, Singapore combines the best.

In the Singaporean system individuals use a health savings account to pay for small, routine health care costs. The insurance part of the system only kicks in for larger, costlier, uncertain items.

There's plenty of subsidies for poor people, too.

See eg https://www.nytimes.com/2019/04/22/upshot/singapore-health-s... for an American perspective. There's also plenty of easy to find material on the web.

I especially like that doctors usually have a list with price ranges for their most common items hanging out prominently. Very transparent.

Singapore has socialized healthcare. On the provider side, most of the hospitals are owned by the government. On the insurance side, employees are required by the government to pay into health savings accounts (with nearly matching employer contributions). There are additional public insurance schemes for the poor and elderly. On top of that, costs in the public hospitals are subsidized to a significant extent.

Seems to be an American term? https://en.wikipedia.org/wiki/Socialized_medicine But I agree with what you are stating. (Though if you call that system 'socialized', then the American systems are also 'socialized' to a large extent. So it's probably better to just talk about specific feature instead of such a loaded term.)

The aspect of the system that I wanted to highlight is that routine care is paid for out of the health savings account (Medisave), and not out of the insurance portion.

Another interesting aspect is that the bill you get for treatments always mentions the total cost and any subsidies you are getting. All very transparent.

There's also always a co-pay as a matter of principle, even if it's just a few dollars.

I agree that private healthcare can work well, but increasingly I have found that the value it offers compared to the cost is decreasing. YMMV.

In terms of letting the poor spend it on what they like, I disagree. You aren't giving them money. You're giving them healthcare. In my opinion, people are not entitled to money. But I do think they are entitled to good health if it can be at all given to them.

If someone was going to get the check-up anyway, then giving it to them for free has similar effects to giving them money. (People will use the money they save with the checkup now being free on something else.)

I'd say that if as a society we want to help (poor) people, we should do whatever provides the most bang for the buck; ie the highest quality of life improvement at the lowest burden to the rest of society and the smallest disincentive effects.

But yes, if you explicitly want to restrict what poor people can do, then your position is a consistent one.

Private health-care works wonderfully in South Africa. They're actually a very good example of a good in-between between government intervention and free-market. The government mandates all private providers have to offer free medicine for a wide array of "common" chronic conditions and emergencies. E.g. Diabetes, HIV, Hypertension.

They also quantify the degree to which private providers can "recover" costs for pre-existing conditions. E.g. mandatory wait-out periods and relatively minor penalties, and then they have to provide full cover.

But beyond some of those items, they pretty much let the private providers run it as a business. You can decent cover for as low as $60, but if you want additional benefits and ad-hoc medical spending-money, you pay more obviously. Some of them even have packages that are reduced based on they person's salary to make it more affordable for low-income families.

Why not both?

There's no good reason for healthcare that everybody needs to be locked behind a prohibitive money gate.

Doctors and nurses don't work for free. Neither do bakers.

So what's the argument that suggests poor people need to be given healthcare, but not bread?

I suggest to just give them money, and then they can buy the bread and healthcare they need.

(And that's a general principle.

However giving goods and services directly does make sense for non-excludable public goods. Eg don't give poor people money to procure national defense. Just provide national defense directly with tax payer money.)

> So what's the argument that suggests poor people need to be given healthcare, but not bread?

You (deliberately?) misread the parent's comments. It was not very long, and it centered on the word "both".

> I suggest to just give them money, and then they can buy the bread and healthcare they need.

Elsewhere you wrote that "unforeseeable, big events" should still be covered by insurance, but I don't think you understand that if people don't have enough money, even getting regular checkups and medication can be pretty "big" from the affected person's perspective. If two people are scraping by on a universal basic income that is enough for basic shelter and food, and one of those people regularly needs checkups or medication for some chronic condition, then you are screwing over one of those people.

This isn't about the freedom to choose not to be chronically ill, because there is no such freedom. Neither is it about the freedom to choose not to be treated for chronic medical conditions. There is no such freedom, the word for that "choice" is "torture".

> You (deliberately?) misread the parent's comments. It was not very long, and it centered on the word "both".

To be more clear: if society spends X dollars per year per poor person on direct financial transfers, and Y dollars per year per poor person on in-kind services, I am suggesting to move to a system of giving the poor person (X+Y) dollars in direct financial transfers.

Is that better?

About the latter part of your comment:

Yes, that is a real problem. There are (at least) two reasonable approaches that leave insurance as insurance:

First, you can just give the chronically ill or disabled person more welfare money.

Or, second, if you are a purist for equality: enter a very long running insurance contract, before you develop a chronic condition. Because then there's still uncertainty, and uncertain conditions are insurable. In the strictest form, your parents would make the arrangements before conceiving you.

BUT: I do gladly concede that for serious enough conditions just handing out medical services might be a reasonable choice. I don't know. But that doesn't say much about routine check-ups for healthy people.

Where I live (Austria), everybody (modulo a few exceptions and quirks that shouldn't exist) has state-mandated health insurance. If we go to the doctor, of course the doctor gets paid, but not directly out of our pockets. The system is simple, and it works. I don't understand why you discount this possibility. It's the best model.

> enter a very long running insurance contract, before you develop a chronic condition. Because then there's still uncertainty, and uncertain conditions are insurable. In the strictest form, your parents would make the arrangements before conceiving you.

I guess this is a complicated way of saying the same thing as I did, except that "your parents" are "the law"?

> I guess this is a complicated way of saying the same thing as I did, except that "your parents" are "the law"?

Your parents are your parents. They have skin in the game.

People with heritable diseases would presumably pay more for that kind of pre-insurance. (That's pretty similar to how the church in Cyprus apparently asks couples to get tested for Thalassemia genes before marrying them: if both parents have a single copy of the recessive allele, the children run the risk of sickle cell anemia.)

> Where I live (Austria), everybody (modulo a few exceptions and quirks that shouldn't exist) has state-mandated health insurance. If we go to the doctor, of course the doctor gets paid, but not directly out of our pockets. The system is simple, and it works. I don't understand why you discount this possibility. It's the best model.

I grew up in Germany with a similar model. The various European models look good compared to the American mess we hear so much about. The Singaporean system is superior, even if not perfect.

They didn't have the Praxisgebühr for fun in Germany. (https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr)

>I suggest to just give them money, and then they can buy the bread and healthcare they need.

I believe you mean "bread OR healthcare".

Inclusive-or, sure.

To quote myself: if society spends X dollars per year per poor person on direct financial transfers, and Y dollars per year per poor person on in-kind services, I am suggesting to move to a system of giving the poor person (X+Y) dollars in direct financial transfers.

Sure, but then you have to refuse to spend an other Z on in-kind services when (X+Y) were spent on other things.

And you'll find politicians lack that resolve.

Yes, political implementation is a different topic.

However, this ain't an all or nothing game:

You can move some in-kind services to money payment without moving all. Eg it should be possible for politicians to refrain from handing out annual eye exams.

I've done the second, though that was with a non-chain independent glasses shop.

100% this.

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

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

That's wild. This is the first I've heard about mandatory eye exams and I've worn glasses all my life.

I've picked up frames and new lenses, both online and in local stores, without having anyone point out that my prescription was at least a decade out of date.

The frames that I generally go for are pretty pricey anyway, and maybe that's a factor, but I've never been prohibited from buying an new pair. I've also had older lenses re-cut to fit newer frames, all without issue.

Yep had this problem except it was only for 6 months. Trying to get glasses for the first time, had an eye exam in April, and last week Costco would not fill my prescription

Which makes zero sense. Whether you buy a new pair or not, you would still be wearing an out of date prescription.

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

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

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

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

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

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

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

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

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

Source:- https://www.bloomberg.com/news/articles/2019-01-22/google-se...

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

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

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

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

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

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

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

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

In the UK: To get the free trial contact lenses, the optician (who wore a white coat!) did my eye test and kept increasing the power until my prescription qualified as legally blind, despite me saying I have astigmatism. I never came back to collect the contact lenses obviously.

Went to my usual optometrist when I was back home in Malaysia 6 months later and surprise, surprise my prescription has not changed for the past 2 years!

Around here (Finland) the exam is (almost always) complimentary if you also buy glasses or contacts. Otherwise, they charge you something around 25 € for the exam.

Its 15 quid or so and if you wear glasses a lot having the anti reflection etc does make sense - if your just using occasionally not so much.

The hearing aid scam is worse.

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


That's great news.

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

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

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

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

https://www.glassesusa.com/scan can supposedly tell you using your cell phone and computer.

I've been to opticians in the UK where they have a machine that will do that.

I remember once i'd bought cheap glasses online, then a year or so later went for an eye test; my prescription hadn't changed, but they measured the glasses, and found that they weren't quite right for the prescription, so i got a new pair. An effective sales technique, and assuming that they weren't lying to me, a useful service for me.

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

Ok, I’ll bite.

Why does the DMV suck so bad in the US?

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

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

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

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

Not because they are horribly run.

I do not live in the US, but even i know the DMV being bad is a meme.

What i don't understand is why people have to visit this DMV. There isn't even an equivalent in the UK; licensing is done by the DVLA, but they don't have local offices, it's just a civil service office block in Swansea. If you want to do licensing stuff, you do it by post, or online, or via a local post office.

What is it that people are going to the DMV for?

It's actually relatively rare in my experience these days where I live in the US that you need to go to the DMV. And the last time I did have to go to get a new license (vision test, photo), as I recall it was pretty unmemorable one way or the other. If you're a AAA (American Automobile Association) member, you can also get some DMV transactions handled in one of their offices.

Most things have moved online. I needed to get a replacement license about a year ago and the online process was easy as could be.

A-f*cking-men. Everything. Law, politics, markets, culture, everything.

Unfortunately this is what happens when companies are allowed to operate completely unabated. They'll gladly build up a monopoly and try to make it as invisible as possible while lobbying behind the scenes to reduce regulations for them and add regulations to prevent challengers.

We have multiple markets like this in the US which have occured as the result of consolidation and lobbying and we're just...not doing anything about it. While they exercise rent-seeking behaviors in order to gouge customers.

This is the opposite of completely unabated. The government created a regulatory burden against consumers, ostensibly for their own good, forcing brick and mortar stores into complying.

Unabated would imply that such regulations are not enforced or in place, and you're starting to see that with online retailers that will sell you anything eye-wear related with a little warning that you're agreeing you do have a valid prescription, which noone believes anyone will get in trouble for lying about. (I.e. zenni)

The same is starting to be true for cpap machines and other things as well.

You can blame certain companies, you can blame certain politicians and bureaucrats, but you cant blame all companies or that companies are running "unabated". It is disingenuous, facile and simply incorrect.

Rent-seeking is the opposite of companies being allowed to operate completely unabated. It's government intervention on behalf of specific companies.

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

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

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

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

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

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

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

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

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

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

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

It's been my understanding since I started getting glasses in the 8th grade in the in the United States that Optometrists have an OD (a non-medical doctorate), Ophthalmologists have an MD from a medical school (with the full rights thereof, such as prescribing medicine), and Opticians are the technicians who fit and order your prescription.

That same Optometrist who taught me that also taught me about diopters (the inverse of the focal length in meters squared) and optics of my negative prescription.

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

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

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

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

> Doctor of Osteopathic Medicine

Those are DOs.

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

Ophthalmologists are medical doctors, but also have post-graduate training in Ophthalmology.

In Australia this is a closed shop, in that the College of Ophthalmology has a very entrance hard exam and effectively regulates the number of new Fellows to maintain scarcity/standards.

I wonder if there been a study on if there is any difference in outcomes. Japan also has a lower barrier to entry to be a doctor than the USA. Medical care is much less expensive but I run into plenty of quack doctors that would not qualify as doctors in the USA

We have quack “doctors” that don’t qualify as doctors in the US, too. They’ve just managed to convince several state legislatures to allow them to practice medicine and call themselves doctors or physicians anyway.

Some of them are even allowed to prescribe medicine and perform surgical procedures. And just about all of this “naturopathic medicine” is entirely without evidence.


Right, they have a "doctoral" degree, which is a bit bizarre (compared to the BOptom or similar undergrad degree that you'd do in the Commonwealth).

But what I'm more interested in - is it common to _call_ an optometrist a doctor in the US? As opposed to an opthalmologist? Or is this just a weirdness in this article?

>But what I'm more interested in - is it common to _call_ an optometrist a doctor in the US? As opposed to an opthalmologist? Or is this just a weirdness in this article?

People, at least here in Indy, don't (generally) say "I'm going to the optometrist" we say "I'm going to the eye doctor" because they are doctors (they've obtained a Doctor of Optometry degree).

Interesting! Whereas here (Australia), at least in my region/social class/etc if I heard someone say "the eye doctor" I'd assume they're going to an ophthalmologist for surgery. Optometrists are their own category of healthcare worker.

Another English dialectical difference I wasn't aware of.

In general, people don't typically distinguish between MDs/optometrists/podiatrists (in some contexts)/etc. in the US in casual conversation. (A dentist they'll call a dentist.)

They get an Doctor of Optometry degree, so a I suppose you could, but don’t Pharmacists also?

Yes, pharmacists get a Doctors of Pharmacy degree.

Yes, and they would have a Doctor of Optometry (OD) degree.

Eye doctors, yes.

There are also ophthalmologists. That requires at least 8 years of post undergraduate training in the US. 3 years which is surgical residency.

Do you also have 'opticians' as well as ophthalmologists and optometrists?

Yes. Though they are not eye doctors in any meaningful sense of the word. It requires a pretty straightforward certification while the other two require years of post graduate training.

I believe opticians are the people that measure your PD adjust frames.


In the US, even chiropractors (who are pseudoscientific quacks) are called “doctor”.

Chiropractors may be psuedoscience quacks, but they sure as hell can make your back feel better if it's out of place.

Curious why the downvotes on this? You don't have to buy into their magical alignment aura junk to objectively know that it feels good having your back aligned.

It's just a fancier version of having a friend or family member push on your back until it pops whatever was out of place.

I think that people hate on chiropractors _because_ of the pseudo-science aspects. There also isn't much science -even empirical studies- that back up the claims of chiropractic (which doesn't have a noun form of the word for whatever reason).

A fortune-teller could probably give great advice about family relationships, but I'd recommend a counselor or therapist instead. And I'd probably treat the fortune-teller as a scam artist. In the same vein, a chiropractor might relax my back, but that doesn't make them credible.

Fun fact: the inventor of chiropractic was also big believer in the healing power of magnets, and was murdered by his son.

Just go to a massage therapist. The chiropractor is a quack that gives you unnecessary X-rays.

So very true. My licensed masseuse has training in how not to hurt me, now to positively address the issues they can actually address and doesn't participate in psuedo-science. She's part of a team that gets professional athletes back on field, and they are extremely anti-quack, because of the millions of dollars involved. And never "prescribes" an Xray, unless she's sending someone to a real doctor to get it.

Because chiropracty can be very dangerous if the person performing it is not trained on basic human physiology. There is literally nothing other than magic for a chiropractor. Everything useful is just basic massage techniques, which is a field with proven benefits.

Chiropractors do go to school for 4 years.

5 years in Australia.

Just a guess, but the feeling better part and out of alignment part are unrelated. Simply stretching muscles tends to provide short term relief of a variety of issues. The alignment bit does not seem to be related in any way.

For example, muscle cramps often feel better after a stretch. However, eating a banana is more likely to help by dealing with a common underlying cause.

Probably because you're using "objectively" when you mean "for me". Typical pseudo-science. And pointing out (correctly) that you don't need a "Doctorate" to get the same effect from pretty much anyone who isn't a sadist.

They have a four-year graduate degree. It takes as long as an MD degree.

I don't believe everything they say. But when my back feels twisted, I trust them enough to straighten it out. They even did a good job straightening out my whiplash.

Chiropractic medicine is entirely state based since there's no science behind it. Every state has their own rules about what it takes to be called a chiropractor. Some get actual training on physiology and musculature but definitely not all. It's always going to be hot or miss on whether or not they are going to leave you paralyzed or feeling better.

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