from Hacker News

The Great American Eye Exam Scam

by _bpgl on 11/28/19, 12:01 AM with 331 comments

  • by nsedlet on 11/28/19, 2:25 AM

    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.

  • by zaptheimpaler on 11/28/19, 1:12 AM

    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

  • by mncharity on 11/28/19, 3:14 AM

    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

  • by gdebel on 11/28/19, 7:50 AM

    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.

  • by notacoward on 11/28/19, 2:44 PM

    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.

  • by justinph on 11/28/19, 2:57 AM

    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.

  • by conductr on 11/28/19, 7:15 AM

    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.

  • by abstractbarista on 11/28/19, 2:58 PM

    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.

  • by lbutler on 11/28/19, 1:38 PM

    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.

  • by war1025 on 11/28/19, 1:37 AM

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

    eyebuydirect.com

    zennioptical.com

    visionpros.com

  • by yukistar on 11/28/19, 11:04 AM

    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!

  • by twic on 11/28/19, 1:25 PM

    > 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.

  • by Thorentis on 11/28/19, 3:23 AM

    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.

  • by johnnyo on 11/28/19, 1:48 AM

    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.

  • by listenallyall on 11/28/19, 3:23 PM

    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.

  • by ggm on 11/28/19, 6:10 AM

    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.

  • by victor106 on 11/28/19, 6:42 AM

    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...

  • by mattlondon on 11/28/19, 10:08 AM

    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)

  • by mirimir on 11/28/19, 1:47 AM

    The hearing aid scam is worse.

  • by threwawasy1228 on 11/28/19, 6:32 AM

    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.

  • by ryandrake on 11/28/19, 1:55 AM

    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.

  • by khazhoux on 11/28/19, 10:25 AM

    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.

  • by rishabhd on 11/28/19, 5:55 AM

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

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

    Edit: updated details

  • by ajdlinux on 11/28/19, 1:33 AM

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

  • by kaiwen1 on 11/28/19, 4:11 AM

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

  • by Jenda_ on 11/28/19, 5:52 PM

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

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

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

  • by fiatjaf on 11/28/19, 1:47 PM

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

  • by JeremyNT on 11/28/19, 1:27 PM

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

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

  • by drdeadringer on 11/28/19, 4:30 PM

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

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

  • by ilaksh on 11/29/19, 12:18 AM

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

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

  • by ilaksh on 11/29/19, 12:20 AM

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

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

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

  • by dvfjsdhgfv on 11/28/19, 5:28 AM

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

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

  • by greggman2 on 11/28/19, 2:08 AM

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

  • by christkv on 11/28/19, 9:08 AM

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

  • by tomerbd on 11/28/19, 9:44 AM

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

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

  • by fiatjaf on 11/28/19, 1:45 PM

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

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

  • by emmelaich on 11/28/19, 4:58 AM

    Similar in Australia.

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

  • by t0ddbonzalez on 11/28/19, 8:27 AM

    Reminds me of this story from a while back: https://news.ycombinator.com/item?id=21156637

  • by dade_ on 11/28/19, 1:00 PM

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

  • by chrisbennet on 11/28/19, 1:17 PM

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

  • by jonahbenton on 11/28/19, 1:00 PM

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

  • by PeterStuer on 11/28/19, 6:31 AM

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

  • by dandare on 11/28/19, 9:44 AM

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

  • by skizm on 11/28/19, 11:16 AM

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

  • by wiredone on 11/28/19, 7:02 AM

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

    Such a living contradiction

  • by diogenescynic on 11/28/19, 5:16 AM

    Simple—it’s a racket.

  • by revscat on 11/28/19, 6:20 AM

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

  • by droithomme on 11/28/19, 3:01 AM

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

  • by hardwaresofton on 11/28/19, 1:58 AM

    Title:

    > The Great American Eye-Exam Scam

    Subtitle:

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

    First line:

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

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

  • by massysett on 11/28/19, 12:54 AM

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

  • by sailfast on 11/28/19, 5:26 AM

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

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

  • by purplezooey on 11/28/19, 2:10 AM

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

  • by jelliclesfarm on 11/28/19, 1:27 AM

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

    https://www.vox.com/the-goods/2019/3/6/18253555/eyeglasses-c...

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

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