For contacts, maybe not. That is a medical device that is in contact with a highly sensitive organ for extended periods of time, and is often re-used by design. A yearly contact lens eye exam is annoying but seems reasonable to ensure nothing changed in the last year to suggest the wearer should stop wearing contacts, or use a different brand or type
You can buy cosmetic contact lenses freely, without a prescription. So carving out an exception for contact lenses -- based on the notion that they are in contact with the eye -- is unprincipled. The vast majority of people who use contact lenses suffer no complications.
What's more, in foreign countries eye exams are frequently done by technicians who are not doctors. It's not that complicated to press the "start" button on an autorefractor. So even if eye exams are required, they can be done far more quickly and easily than at present.
In many countries in Asia and Europe, prescriptions aren't _required_ for hardly anything. You can buy drugs and glasses at will, including antibiotics. (Typical exceptions only for most stimulants and some -- but not all -- opioids.) In the US, where you can't get anything without seeing a doctor, including a box of contact lenses, one feels infantilized.
I can speak for some parts of Europe when I say that most antibiotics and majority of drugs definitely need prescription.
There are several good reasons for it.
1. Antibiotic overuse is a serious issue. If people could just get them without prescription they would use them for flu etc. Because they wouldn't be able to tell that it's a viral infection. Over time this would lead to even more antibiotic resistant pathogens than we have now. Plus there is the whole "kills your gut biome" thing.
2. Our healthcare is heavily subsidized and practically universal. The antibiotics and many other medications are, indirectly, payed for by government, with prices negotiated and set trough complicated process involving semi-state insurance companies and government.
Letting people buy drugs without prescription could lead to abuse, like exporting them to third countries. Causing shortages etc.
I suppose it depends where in Europe. I spend most of my time in the south and east -- where, e.g., Serbia doesn't even have a prescription system. You can literally buy whatever you want, and doctors won't write you a formal prescription -- they'll give you some product names to pass along to the pharmacist. Bulgaria and other Balkan countries are similar, which is why they're so popular with steroid users and dealers. (I can confirm that you can buy testosterone and other bodybuilding drugs without a prescription, and without any fuss.)
In the Czech Republic, Slovakia, and Hungary, it's mixed, but generally _much_ more relaxed than the US. In many cases, even if a prescription is "required," pharmacists won't stand on principle.
I realize that one can't generalize across the entire continent, but there are certainly regions where things are more like Thailand or China than they're like the USA. And it's really no big deal.
They are generally only available for professionals, and those that can easily be bought as a private person are much more expensive than the human version.
I haven't heard of anyone doing that (why would anyone do that, actually?) instead of just going to a human doctor to get a prescription for human drugs.
Glasses, certainly, but regarding drugs, I don't think Europe is generally less restrictive than the US, in fact I thought it was the opposite (see e.g. the phentanyl problem).
In Spain not only you can't buy antibiotics at will, but you can't even buy 1 g paracetamol pills (you can buy 500 mg pills, though - I guess the government wants to protect people who can't add 500+500!). Some pharmacists will turn a blind eye with silly restrictions like paracetamol, though - but not all, because they might be fined if they get caught.
> you can buy 500 mg pills, though - I guess the government wants to protect people who can't add 500+500!
I know it sounds a bit absurd at first thought, but restricting the amount that can be bought at a time actually works for preventing overdosing. People are just less likely to swallow 12 500 mg tablets in one time than 6 1g tablets.
Also worth noting is that in many countries Pharmacists can prescribe certain classes of medicines, again excluding most stimulants and opioids. But need some ciprofloxacin? Just rock up to your pharmacy and ask.
In the Netherlands, you would likely get your first contacts from the same optician's that just gave you your free eye test. They famously don't let you leave with them until they've seen you put them in correctly yourself. A friend of mine had to embarrassingly come back another day and try again, after his eyes had gotten too irritated from the failed attempts.
You can still buy disposables over the counter, though.
> They famously don't let you leave with them until they've seen you put them in correctly yourself
It's the same in the US.
(Well I'm sure if you insisted they'd let you, but standard practice is to try again the next day. I know people who had to go several times before buying contacts)
You must be in on the scam. The idea that you aren’t allowed to see unless you pay for a yearly exam is ridiculous. So much theater to it, too. In europe, you can just buy them ongoingly.
Contact lenses are a high risk medical device. Contamination or mis-use can cause serious permanent damage. Wanting to prevent permanent damage is a good thing.
Now as different countries had different policies for decades now, we can compare the health outcomes of these policies. My personal opinion is that the rules can be relaxed in the US, but I don’t have all the data and am not a policy expert.
Ad hominem attack is different from suspecting that you or a family member are in the industry.
Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage. There is no evidence that expensive yearly exams are necessary. The fact is that technology almost completely replaced the need for these people and so they built themselves into the medical system.
There is a risk classification system for medical devices. Most regulatory bodies have put contact lenses in the moderate to high risk category. E.g. the FDA classifies contact lenses as Class 2 out of 3.
You don’t put pencils in your eye for hours every day. The fact that most people use contacts just fine does not mean that there are no risks. If you want to know about them, talk to an eye doctor, they all have horror stories about contact lenses.
Yep I've worked in med tech. I'm more skeptical of our entire healthcare system than you are, trust me. But there is a reason regulation is in place, similar to why the airline industry is highly regulated.
> Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage.
No, it's not. That's a terrible slippery-slope argument and you know it. Contact lenses are an FDA Class II medical device. They are *designed* by the manufacturer for contact with the eyeball. A pencil is not.
> There is no evidence that expensive yearly exams are necessary.
There is a mountain of evidence suggesting that contact lenses can cause permanent blindness when used incorrectly. Feel free to search for it.
Yes, well aware of the fact that people get eye infections from contacts. What is the point of the yearly exam? Infections hurt! There is no evidence that yearly exams reduce frequency of eye damage in America relative to countries that permit contacts without yearly exams.
Also, contacts are not a high risk medical device. Only a moderate risk.
Given that scams are as pervasive and ubiquitous nowadays as they have been for thousands of years, is there any hope for a utopian future where we are free of charlatanism, quackery and general dehumanization for the sake of rigorous profit maximization of all humans not in the ruling class?
I envision the formation of such a utopia as bottom-up and community-focused, involving a lifestyle change where we deal predominately with people we know rather than strangers, strengthening social cohesion. Dream big, right? Or small, in this case; maybe something like federated villages. It’s a beautiful day in the neighborhood…
Another view of what a utopia/golden age might look like:
> "1893. When a series of suicides were vigorously discussed in United Kingdom newspapers, critic William Archer suggested that in the golden age* there would be penny-in-the-slot machines by which a man could kill himself." [1]
*"'Golden Age' denotes a period of primordial peace, harmony, stability, and prosperity." [2]
>>I think you missed some key plot points in the Star Trek lore
> Are you talking about the episodes where genetic engineering was illegal?
> Or the episodes where they completely forgot about that?
Can't you guess ?
The ones that are absolutely not key plot points in the general Star Trek lore, of course.
Congrats on spoiling it for the sake of being a smartypants. Consistency problems in Star Trek, oh noes..
edit: well, well, well:
The station was mentioned in passing in The Lost Era novel The Buried Age, where Picard called it an exception to the rule (DS9: "Doctor Bashir, I Presume") that should have never been allowed.
Quite frankly, I chalk this up to too much Roddenberry in early TNG seasons and his love for psychic mutants (and giant talking heads with god like powers).
I won't spoil it to you, so, off the top of my head I'd recommend you watch star trek tos season 01 episode 22 "space seed" then the movie "the wrath of Khan" then Star Trek Enterprise season 4 episode 6 "the augments" then DS9 episode 16 season 5 'dr bashir I presume ?' (chronological order, switch ST Enterprise with ds9 if you want release order).
There's a kind of resume of all that in Strange new world first episode (there's also another episode regarding genetic modification but considering it didn't prevent all the other episodes from happening then I suppose it can be skipped but it shows how strong is the opinion of the federation on the subject).
I don't remember they talk much about the eugenic wars in TNG so it's most likely why it's not on your radar.
They are all on Netflix at the moment. If you want to watch only one episode I highly recommend the Star Enterprise one (and there's a nice tie-in with TNG ;).
That's a great summary of each of the relevant episodes. the TOS, the movie and DS9 episodes are really great, don't remember the enterprise episode though.
I recommend you watch the TNG Season 2 episode where Dr. Pulaski and Data visit a colony that's doing genetic engineering of children, and their engineered immune systems create some kind of virus that Pulaski has to fix on a shuttlecraft.
The Federation's opinion of the subject is very strong in some episodes, and in others they completely forget about it.
On the flipside, parents would be carrying sociopathy genes, which is why they can pass it onto their children and therefore carrying such a gene would be a sign of future success and of envy for parents that were not sociopathy gene dominant.
Personal anecdata: In span of 6 months, I did eye exams at 3 different places and got 3 different prescriptions! All 3 claimed to use latest tech and they did manual exams as well.
This is pretty normal, depending on the amount of variation of course. Basically, for each calculate the spherical equivalent (SPHEQ) = SPH + 0.5 * CYL.
If SPHEQ is within 0.5 diopters of each other it’s more or less expected.
This is the short version and there’s a lot more nuance (like the AX and ADD values on the Rx), if anyone is interested or has questions I can add more.
Source: I was CTO for an online eye exam and have some patents related to this.
That limit is efficient for measuring and selling glasses.
As a life-long user, glasses with an error of 0.5 are unacceptable for me. That's the amount of change over years when it is time to get new ones.
Not all deviations are measurement errors. There are potential variable conditions of the eye (e.g., spasm of accommodation and sugar level). An online solution that can consider them properly is definitively worth a patent.
Agreed on all points. Also the acceptability varies a lot. By your wording it sounds like you are quite picky about glasses and would A) not go to a random optician and B) return the glasses if you are not satisfied. I’m the same ;) There are many people who are not that picky.
A) How can I find a proper optician?
B) how do you determine whether or not you’re satisfied?
Throughout 30 years of wearing glasses, I’ve questioned many times whether the glasses are right for me. I may resist for a month or two but I always end up “adapting” to the new pair. When is this acceptable and how do I know when to speak up?
First of: adapting to new glasses is normal and can take a couple of weeks.
For A: I don’t really know, but use the ones that gives you B. Depending on the country, high end / non-chain stores can have better customer service and listen to your wishes, and answer your questions. There’s also smoke and mirrors and upselling so see if you trust the person.
B: for simple distance vision (if you are under 40) do a quick pin hole test and look at tree leaves or something. If your vision quality increases a lot you should not be satisfied. Same if you notice eye strain when looking at things in the distance.
Now for multifocal glasses it really depends on your use case (reading, computer work, etc), and it’s very difficult to get a really good correction. There’s no silver bullet. Find an optometrist or optician that you trust, so back to A ;)
You should try the intro to Physics lab work where students are asked to measure the length of a piece of string, and get a different result each time!
On the other hand, over the last 5 years, I’ve had my eyes examined 4 times at 2 different places (two at one, two at the other) and every time my prescription has been the exact same (modulo slight changes to my astigmatism angle, which is apparently normal).
I decided to get vision insurance. It was what, ~20 bucks a month? Free glasses, optometrists visit, why wouldn't I?
The optometrists visit wouldn't give me a prescription for contacts without extra money. Insurance didn't cover it. Even though the data they need they already have from the eye check, they wouldn't write it on the paper unless I paid.
Getting glasses, they only covered a limited selection of frames, all crappy frames. The lenses wouldn't be anything but bare lenses with one or the other add on but not both, no scratch resistance, no glare protection, and there was a copay. So I compromised on what I got.
In the end, with the insurance cost for the year, I wound up spending a little more than if I'd just walked into the optometrists office and handed them cash and bought what I wanted, and I didn't get what I wanted. Vision insurance is a rip off.
A couple of years ago, I ordered 2 pairs of glasses, one for regular with anti glare and scratch resistance, and one prescription polarized sunglasses, for a grand total of 70 bucks with a 2 year expired prescription (my eyesight problems are from welding irresponsibly as a teenager and not degenerative, it hasn't changed since I got my first prescription) on a popular glasses buying site online. Still using them, but I have since ordered one additional pair with that same prescription that I don't really wear, for like 50 bucks with all those lenses add ons.
I plan to go get my eyes checked next year again, just to make sure nothings changed as I've gotten older, but I will never go back to doing things the usual way with yearly checks and insurance and buying glasses at the optometrist and all that, it's a giant sham. My way isn't exactly $2 glasses like in India but for an average cost of 40 bucks per pair with the addons I like and maybe one optometrists visit every 5 or so years, I think I'm doing OK.
I've been saying this for years. It's an industry scam.
Even if I played the rhetorical game where it isn't a scam, they should give a pre test where if I read 20/20 I skip the exam and renew my prescription, sans doctor fees.
This is what happened to me last week where I live (Spain). Went in to a new optician office, the lady took my old glasses, put them in a machine which told her the prescription, she told me to put them on and then gave me the classic exam with the small letters on the far side of the room. Once she determined that everything was fine with my current prescription, she let me pick out a new set of glasses.
I was in and out in 20 min with a new set already ordered.
When I was in the US, getting a job done like this would be unheard of.
There’s multiple companies bringing this to the market as telemedicine (edit: yes already now in the US). Basically you do an eye test (to measure visual acuity) at home using your phone or computer and an optometrist reviews the data and approves / re-approves your Rx. Then you can order online.
For limited prescription ranges it is also possible to give out a complete Rx via a remote examination but FDA has yet to approve a device on the US market for this. In the EU it is already being done.
I love this, but it seems to be a gray-area hack around protectionist state laws. For example, I believe this whole "yearly check-up" thing is at the Texas state level for me.
When I order online from a site that has no physical presence in Texas, they do not care about the prescription date.
Your prescription can change (I had 20/20 vision & no reading glasses, until I was 54; four years after that I had trouble seeing and indeed my prescription was no longer correct).
But why each year? I assume the Opthamologist association would say (as referenced in the article) that they need to look for ocular disease, or diseases that are detectable through eye exam (e.g. diabetes). Not clear to me!
There is also the way in the US, when you ask for a written prescription, they leave off the IPD (inter pupillary distance) so it’s inadequate to order glasses. The standard printed form they all have conveniently doesn’t have a space to write that in.
So I always ask them to add it, though fortunately it’s easy to measure at home.
I’m based in Australia, and my son’s optometrist did the same thing when I asked for a copy of his script so we could order a rushed pair of glasses when he broke his. I’d never seen that before as my optometrist has always provided the full details after every eye exam (including IPD, but they’ve always just called it PD).
Much to my delight though when I was placing the order for my son’s new glasses online the form said “don’t have or don’t know your PD? Click here to measure it now!” which asked for permission to access the web cam, asked him to follow some basic instructions, and <30 secs later put his PD into the form for us.
They left me alone in the exam room before the doctor came in to do the eye exam, and I just read my PD off the computer screen that was showing my patient record. :)
My Insurance generally pays for one visit per two years, but I haven't found an optometrist that will give me a 2y prescription despite no changes for 10+ years.
I have found a way to make it 2 years on a 1y prescription.
You can get "myopic glasses" on eBay for real cheap, like 7$, without a prescription. They feel cheap, but the lenses work.
Contact lense websites will let you order as long as you have a valid prescription so I just buy a years worth when I get the prescription and again right before the prescription ends.
Separate issue is the contact lense websites are getting predatory and just add 200$ convenience fee at the checkout. Really annoying, I found one website that doesn't but I imagine if everyone else is doing it they can't stand their ground for long.
In Poland no prescription is necessary for vision correction. At least one big chain of opticians doesn't charge for sight tests and gives full refunds on all purchases up to five years.
I hacked the eye-exam scam by getting exams every few years and using cheap online glasses (those $10 glasses) to confirm/tweak prescriptions, before finally ordering a fully featured $180 pair of glasses online which tends to last for a while. My final orders are rarely exactly like what the eye exam indicated, instead they are personalized for my most common focus distance and needs.
An optometrist's office, in New Jersey, presented two pricing options to me, based on vision insurance benefits, which I explain far more clearly than they did with me: pay more out of pocket for just the eye exam and contact lens fitting or pay less by ordering contacts in addition to eye exam and fitting. The agent from the insurance company (Guardian) explained to me that it sets a $150 balance that can be used towards non-exam costs (fitting and contacts, or just contacts if no fitting is done). However, the optometrist's office said that this 150 is only accessible if I order contacts as well. They wouldn't provide this policy to me in writing :).
I saved money by ordering more. The incentives scheme, involving ordering contacts from the optometrist office rather than 3rd party, seems like a common convention.
My problem is that I need different prescriptions early and late in the day, in addition to different distances. A few years ago I bought a set of test lenses and a frame so I could measure my own prescription, and ordered a couple of pairs that were better than I'd had from an optometrist for a while. I've had even better results using an EyeQue device, but that only measures distance vision so I still need the lens set for the "add" on my near vision.
Honestly, optometrists are a waste of time and money. However, it's still a good idea to visit an ophthalmologist from time to time as they can evaluate eye health in addition to optics. Glaucoma, macular degeneration, cataracts, and retinal detachment are all worth detecting early.
Go to a real ophthalmologist, not some Luxottica tourist scam.
It took until age 40 for a reputable ophthalmologist to do an old-school 4 PRT to discover I had monofixation syndrome. [1] It also suggests diminished depth perception and explains why I can't see autostereograms.
If your test in Tokyo was like mine, the only thing they did was test your actual visual acuity, to determine your prescription. They probably didn't do any kind of eye health-check, which in my experience is normal in the US.
However, they do these checks in Japan, but it's part of the annual health check-up, which everyone gets AFAIK, and is free. It's not done by optometrists, but by clinics that specialize in the annual check-up.
As for USD$200, that isn't going to get an American to Tokyo. Try multiplying by 10. Even before the pandemic it certainly wasn't $200 to cross the Pacific.
Well, if you want a checkup, then the American system is fine, right? The issue are those people who just want glasses / contacts – Personally I know my specs, and often just go to a pharmacy to get a box of contacts.
Also, I did not propose to go to Tokyo. There are plenty other locations that are more practical for Americans.
>Well, if you want a checkup, then the American system is fine, right?
Not in my experience. They seem to have done away with yearly checkups altogether, claiming somehow they don't work (!).
Here in Japan, you get a yearly checkup (for free!) which checks all kinds of things: eyes, ears (audiometry), chest x-ray, abdominal ultrasound, blood test, stool/urine, etc. The idea is to catch problems early instead of waiting for patients to feel like there's a problem and see a doctor on their own. The American system doesn't seem to believe in this any more, though it did decades ago.
It probably depends on where in the US you are: if you live in Buffalo, for instance, you can probably save a bunch of money just driving over the border to Canada and getting some stuff there. If you're that close, you don't need to fly.
That is an option now. It has been an option for decades.
If you aren't poor, that is. People save just to get a passport, let alone the travel costs and trying to get time off - and even then, your choices are limited. $200 is more than half a week's pre-tax wages if you make $8/hr.
It's not about stale information. It's simply to note that it's not immediately current (within the past year), and additionally may have been previously discussed. Older content is in fact welcome.
It's still relevant because someone who read this article 2 years ago may want to know from the title that it's the same one, not some new update on the topic.
For contacts, maybe not. That is a medical device that is in contact with a highly sensitive organ for extended periods of time, and is often re-used by design. A yearly contact lens eye exam is annoying but seems reasonable to ensure nothing changed in the last year to suggest the wearer should stop wearing contacts, or use a different brand or type